22646 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

42 CFR Parts 405, 412, 413, 485, and

486

[HCFA–1158–P]

RIN 0938–AK73

Medicare Program; Changes to the

Hospital Inpatient Prospective

Payment Systems and Fiscal Year 2002

Rates

AGENCY: Health Care Financing

Administration (HCFA), HHS.

ACTION: Proposed rule.

SUMMARY: We are proposing to revise the

Medicare hospital inpatient prospective

payment systems for operating and

capital costs to: Implement applicable

statutory requirements, including a

number of provisions of the Medicare,

Medicaid, and SCHIP Benefits

Improvement and Protection Act of

2000 (Public Law 106–554); and

implement changes arising from our

continuing experience with these

systems. In addition, in the Addendum

to this proposed rule, we are describing

proposed changes to the amounts and

factors used to determine the rates for

Medicare hospital inpatient services for

operating costs and capital-related costs.

These changes would be applicable to

discharges occurring on or after October

1, 2001. We also are setting forth

proposed rate-of-increase limits as well

as proposed policy changes for hospitals

and hospital units excluded from the

prospective payment systems.

We also are proposing changes to the

policies governing payments to

hospitals for the direct costs of graduate

medical education and critical access

hospitals.

DATES: Comments will be considered if

received at the appropriate address, as

provided below, no later than 5 p.m. on

July 3, 2001.

ADDRESSES: Mail written comments (an

original and three copies) to the

following address ONLY: Health Care

Financing Administration, Department

of Health and Human Services,

Attention: HCFA–1158–P, P.O. Box

8010, Baltimore, MD 21244–1850.

If you prefer, you may deliver by

courier your written comments (an

original and three copies) to one of the

following addresses:

Room 443–G, Hubert H. Humphrey

Building, 200 Independence Avenue,

SW., Washington, DC 20201, or

Room C5–14–03, Central Building, 7500

Security Boulevard, Baltimore, MD

21244–1850.

Comments mailed to those addresses

specified as appropriate for courier

delivery may be delayed and could be

considered late.

Because of staffing and resource

limitations, we cannot accept comments

by facsimile (FAX) transmission. In

commenting, please refer to file code

HCFA–1158–P.

For information on viewing public

comments, see the beginning of the

SUPPLEMENTARY INFORMATION section.

For comments that relate to

information collection requirements,

mail a copy of comments to the

following addresses:

Health Care Financing Administration,

Office of Information Services,

Security and Standards Group,

Division of HCFA Enterprise

Standards, Room N2–14–26, 7500

Security Boulevard, Baltimore,

Maryland 21244–1850. Attn: John

Burke, HCFA–1158–P; and

Office of Information and Regulatory

Affairs, Office of Management and

Budget, Room 3001, New Executive

Office Building, Washington, DC

20503, Attn: Allison Herron Eydt,

HCFA Desk Officer.

FOR FURTHER INFORMATION CONTACT:

Steve Phillips, (410) 786–4548,

Operating Prospective Payment,

Diagnosis-Related Groups (DRGs),

Wage Index, Hospital Geographic

Reclassifications, and Sole

Community Hospital Issues

Tzvi Hefter, (410) 786–4487, Capital

Prospective Payment, Excluded

Hospitals, Graduate Medical

Education and Critical Access

Hospital Issues

SUPPLEMENTARY INFORMATION:

Inspection of Public Comments

Comments received timely will be

available for public inspection as they

are received, generally beginning

approximately 3 weeks after publication

of a document, in Room C5–12–08 of

the Health Care Financing

Administration, 7500 Security Blvd.,

Baltimore, MD, on Monday through

Friday of each week from 8:30 a.m. to

5 p.m. Please call (410) 786–7197 to

arrange to view these comments.

Availability of Copies and Electronic

Access

Copies: To order copies of the Federal

Register containing this document, send

your request to: New Orders,

Superintendent of Documents, P.O. Box

371954, Pittsburgh, PA 15250–7954.

Specify the date of the issue requested

and enclose a check or money order

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Documents, or enclose your Visa or

Master Card number and expiration

date. Credit card orders can also be

placed by calling the order desk at (202)

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As an alternative, you can view and

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document at most libraries designated

as Federal Depository Libraries and at

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receive the Federal Register.

This Federal Register document is

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online database through GPO Access, a

service of the U.S. Government Printing

Office. Free public access is available on

a Wide Area Information Server (WAIS)

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login as guest (no password required).

I. Background

A. Summary

Section 1886(d) of the Social Security

Act (the Act) sets forth a system of

payment for the operating costs of acute

care hospital inpatient stays under

Medicare Part A (Hospital Insurance)

based on prospectively set rates. Section

1886(g) of the Act requires the Secretary

to pay for the capital-related costs of

hospital inpatient stays under a

prospective payment system. Under

these prospective payment systems,

Medicare payment for hospital inpatient

operating and capital-related costs is

made at predetermined, specific rates

for each hospital discharge. Discharges

are classified according to a list of

diagnosis-related groups (DRGs).

Under section 1886(d)(1)(B) of the Act

in effect without consideration of the

amendments made by the Balanced

Budget Act of 1997 (Public Law 105–

33), the Balanced Budget Refinement

Act of 1999 (Public Law 106–113, and

the recent Medicare, Medicaid, and

SCHIP Benefits Improvement and

Protection Act of 2000 (Public Law 106–

554, enacted on December 21, 2000),

certain specialty hospitals are excluded

from the hospital inpatient prospective

payment system: Psychiatric hospitals

and units, rehabilitation hospitals and

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22647

units, children’s hospitals, long-term

care hospitals, and cancer hospitals. For

these hospitals and units, Medicare

payment for operating costs is based on

reasonable costs subject to a hospitalspecific annual limit, until the payment

provisions of Public Laws 105–33, 106–

113, and 106–554 that are applicable to

three classes of these hospitals are

implemented, as discussed below.

Various sections of Public Laws 105–

33, 106–113, and 106–554 provide for

the transition of rehabilitation hospitals

and units, psychiatric hospitals and

units, and long-term care hospitals from

being paid on an excluded hospital

basis to being paid on an individual

prospective payment system basis.

These provisions are as follows:

• Rehabilitation Hospitals and Units.

Section 1886(j) of the Act, as added by

section 4421 of Public Law 105–33 and

amended by section 125 of Public Law

106–113 and section 305 of Public Law

106–554, authorizes the implementation

of a prospective payment system for

inpatient hospital services furnished by

rehabilitation hospitals and units.

Section 4421 of Public Law 105–33

amended the Act by adding section

1886(j). Section 1886(j) of the Act

provides for a fully implemented

prospective payment system for

inpatient rehabilitation hospitals and

rehabilitation units, effective for cost

reporting periods beginning on or after

October 2002, with payment provisions

during a transitional period of October

1, 2000 to October 1, 2002 based on

target amounts specified in section

1886(b) of the Act. Section 125 of Public

Law 106–113 amended section 1886(j)

of the Act to require the Secretary to use

a discharge as the payment unit for

inpatient rehabilitation services under

the prospective payment system and to

establish classes of patient discharges by

functional-related groups. Section 305

of Public Law 106–554 further amended

section 1886(j) of the Act to allow

hospitals to elect to be paid the full

Federal prospective payment rather than

the transitional period payments

specified in the Act. A brief discussion

of the November 3, 2000 proposed rule

(65 FR 66304) that we issued to propose

implementation of the prospective

payment system for inpatient

rehabilitation hospitals and

rehabilitation units is included under

section VI.A.4. of this preamble.

• Psychiatric Hospitals and Units.

Sections 124(a) and (c) of Public Law

106–113 provide for the development of

a per diem prospective payment system

for payment for inpatient hospital

services of psychiatric hospitals and

units under the Medicare program,

effective for cost reporting periods

beginning on or after October 1, 2002.

This system must include an adequate

patient classification system that reflects

the differences in patient resource use

and costs among these hospitals and

must maintain budget neutrality. We are

in the process of developing a proposed

rule, to be followed by a final rule, to

implement the prospective payment

system for psychiatric hospitals and

units, effective for October 1, 2002.

• Long-Term Care Hospitals. Sections

123(a) and (c) of Public Law 106–113

provide for the development of a per

discharge prospective payment system

for payment for inpatient hospital

services furnished by long-term care

hospitals under the Medicare program,

effective for cost reporting periods

beginning on or after October 1, 2002.

Section 307(b)(1) of Public Law 106–554

provides that payments under the longterm care prospective payment system

will be made on a prospective payment

basis rather than a cost basis. The longterm care hospital prospective payment

system must include a patient

classification system that reflects the

differences in patient resource use and

costs, and must maintain budget

neutrality. We are planning to develop

a proposed rule, to be followed by a

final rule, to implement the prospective

payment system for long-term care

hospitals, effective for October 1, 2002.

Section 307 of Public Law 106–554

provides that if the Secretary is unable

to develop a prospective payment

system for long-term care hospitals that

can be implemented by October 1, 2002,

the Secretary must implement a

prospective payment system that bases

payment under the system using the

existing acute hospital DRGs, modified

where feasible to account for resource

use of long-term care hospital patients

using the most recently available

hospital discharge data for long-term

care services.

Under sections 1820 and 1834(g) of

the Act, payments are made to critical

access hospitals (CAHs) (that is, rural

hospitals or facilities that meet certain

statutory requirements) for inpatient

and outpatient services on a reasonable

cost basis. Reasonable cost is

determined under the provisions of

section 1861(v)(1)(A) of the Act and

existing regulations under Parts 413 and

415.

Under section 1886(a)(4) of the Act,

costs of approved educational activities

are excluded from the operating costs of

inpatient hospital services. Hospitals

with approved graduate medical

education (GME) programs are paid for

the direct costs of GME in accordance

with section 1886(h) of the Act; the

amount of payment for direct GME costs

for a cost reporting period is based on

the hospital’s number of residents in

that period and the hospital’s costs per

resident in a base year.

The regulations governing the

hospital inpatient prospective payment

system are located in 42 CFR Part 412.

The regulations governing excluded

hospitals and hospital units are located

in Parts 412 and 413. The regulations

governing GME payments and payments

to CAHs are located in Part 413.

On August 1, 2000, we published a

final rule in the Federal Register (65 FR

47054) that implemented both statutory

requirements and other changes to the

Medicare hospital inpatient prospective

payment systems for both operating

costs and capital-related costs, as well

as changes addressing payment for

excluded hospitals and payments for

GME costs. Generally, these changes

were effective for discharges occurring

on or after October 1, 2000. On March

2, 2001, we published correction notices

in the Federal Register (66 FR 13020)

relating to the calculation of certain

wage indexes and the labeling of certain

DRGs.

Public Law 106–554 made a number

of changes to the Act relating to

prospective payments to hospitals for

inpatient services and payments to

excluded hospitals. This proposed rule

would implement amendments enacted

by Public Law 106–554 relating to FY

2002 payments for hospital inpatient

services, new medical services and

technology, GME costs, the payment

adjustment for disproportionate share

hospitals (DSHs), the indirect medical

education (IME) adjustment for teaching

hospitals, sole community hospitals

(SCHs), and CAHs. It would also

implement changes affecting hospitals’

geographic reclassifications and wage

index. These changes are addressed in

sections II., III., IV., and VI. of this

preamble.

Other provisions of Public Law 106–

554 that relate to Medicare payments to

hospitals effective prior to October 1,

2001 (that is, for FY 2001 or for the

period between April 1, 2001 and

September 30, 2001), are addressed in a

separate interim final rule with

comment period (HCFA–1178–IFC).

B. Major Contents of This Proposed Rule

In this proposed rule, we are setting

forth proposed changes to the Medicare

hospital inpatient prospective payment

systems for operating costs and for

capital-related costs in FY 2002. We also

are proposing changes relating to

payments for GME costs and payments

to excluded hospitals and units and

CAHs. The proposed changes would be

22648 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

effective for discharges occurring on or

after October 1, 2001.

The following is a summary of the

major changes that we are proposing to

make:

1. Proposed Changes to the DRG

Reclassifications and Recalibrations of

Relative Weights

As required by section 1886(d)(4)(C)

of the Act, we adjust the DRG

classifications and relative weights

annually. Based on analyses of Medicare

claims data, we are proposing to

establish a number of new DRGs and

make changes to the designation of

diagnosis and procedure codes under

other existing DRGs. Our proposed

changes for FY 2002 are set forth in

section II. of this preamble.

We also address the provisions of

section 533 of Public Law 106–544

regarding development of a mechanism

for adequate payment for new medical

services and technologies and the

required report to Congress on

expeditiously introducing new medical

services and technology into the DRGs.

2. Proposed Changes to the Hospital

Wage Index

In section III. of this preamble, we

discuss proposed revisions to the wage

index and the annual update of the

wage data. Specific issues addressed in

this section include the following:

• The FY 2002 wage index update,

using FY 1998 wage data.

• The transition to excluding from the

wage index Part A physician wage costs

that are teaching-related, as well as

resident and Part A certified registered

nurse anesthetist (CRNA) costs.

• The costs of contracted pharmacy

and laboratory services.

• The collection of occupational mix

data, as required by section 304(c) of

Public Law 106–554.

• Revisions to the wage index based

on hospital redesignations and

reclassifications, including changes to

reflect the provisions of sections 304(a)

and (b) of Public Law 106–554 relating

to 3-year wage index reclassifications by

the MGCRB, the use of 3 years of wage

data for evaluating reclassification

requests for FYs 2003 and later, and the

application of a statewide wage index

for reclassifications beginning in FY

2003.

• Requests for wage data corrections

and modification of the process and

timetable for updating the wage index,

and a proposed revision of that

timetable.

3. Other Decisions and Proposed

Changes to the Prospective Payment

System for Inpatient Operating and

Graduate Medical Education Costs

In section IV. of this preamble, we

discuss several provisions of the

regulations in 42 CFR Parts 412 and 413

and set forth certain proposed changes

concerning the following:

• Sole community hospitals.

• Rural referral centers.

• Changes relating to the IME

adjustment as a result of section 302 of

Public Law 106–554.

• Changes relating to the DSH

adjustment as a result of section 303 of

Public Law 106–554.

• The establishment of policies

relating to the 3-year application of

wage index reclassifications by the

MGCRB, the use of 3 years of wage data

in evaluating reclassification requests to

the MGCRB for FYs 2003 and later, and

the use of a statewide wage index for

reclassifications beginning in FY 2003,

as required by sections 304(a) and (b) of

Public Law 106–554.

• Proposed requirements for

additional payments for new medical

services and technology, as required by

section 533(b) of Public Law 106–554.

• Changes relating to payment for the

direct costs of GME, including changes

as a result of section 511 of Public Law

106–554.

4. Prospective Payment System for

Capital-Related Costs

In section V. of this preamble, we

specify the proposed payment

requirements for capital-related costs,

including the special exceptions

payment, beginning October 1, 2002.

5. Proposed Changes for Hospitals and

Hospital Units Excluded from the

Prospective Payment Systems

In section VI. of this preamble, we

discuss the following proposals

concerning excluded hospital and

hospital units and CAHs:

• Limits on and adjustments to the

proposed target amounts for FY 2002.

• Revision of the methodology for

wage neutralizing the hospital-specific

target amounts using preclassified wage

data.

• Updated caps for new excluded

hospitals and units as well as changes

in the effective date of classifications of

excluded hospitals and units.

• The prospective payment system for

inpatient rehabilitation hospitals and

units.

• Payments to CAHs, including

exclusion from the payment window

requirements; the availability of CRNA

pass-through payments; payment for

emergency room on-call physicians;

treatment of ambulance services; the use

of certain qualified practitioners for

preanesthesia and postanesthesia

evaluations; and clarification of location

requirements for CAHs.

6. Determining Prospective Payment

Operating and Capital Rates and Rate-ofIncrease Limits

In the Addendum to this proposed

rule, we set forth proposed changes to

the amounts and factors for determining

the FY 2002 prospective payment rates

for operating costs and capital-related

costs. We also establish the proposed

threshold amounts for outlier cases. In

addition, we address update factors for

determining the rate-of-increase limits

for cost reporting periods beginning in

FY 2002 for hospitals and hospital units

excluded from the prospective payment

system.

7. Impact Analysis

In Appendix A, we set forth an

analysis of the impact that the proposed

changes described in this proposed rule

would have on affected entities.

8. Capital Acquisition Model

Appendix B contains the technical

appendix on the proposed FY 2002

capital cost model.

9. Report to Congress on the Update

Factor for Hospitals Under the

Prospective Payment System and

Hospitals and Units Excluded From the

Prospective Payment System

Section 1886(e)(3) of the Act requires

the Secretary to report to Congress on

our initial estimate of a recommended

update factor for FY 2002 for payments

to hospitals included in the prospective

payment systems, and hospitals

excluded from the prospective payment

systems. This report is included as

Appendix C to this proposed rule.

10. Proposed Recommendation of

Update Factor for Hospital Inpatient

Operating Costs

As required by sections 1886(e)(4) and

(e)(5) of the Act, Appendix D provides

our recommendation of the appropriate

percentage change for FY 2002 for the

following:

• Large urban area and other area

average standardized amounts (and

hospital-specific rates applicable to sole

community and Medicare-dependent,

small rural hospitals) for hospital

inpatient services paid for under the

prospective payment system for

operating costs.

• Target rate-of-increase limits to the

allowable operating costs of hospital

inpatient services furnished by hospitals

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22649

and hospital units excluded from the

prospective payment system.

11. Discussion of Medicare Payment

Advisory Commission

Recommendations

Under section 1805(b) of the Act, the

Medicare Payment Advisory

Commission (MedPAC) is required to

submit a report to Congress, not later

than March 1 of each year, that reviews

and makes recommendations on

Medicare payment policies. This annual

report makes recommendations

concerning hospital inpatient payment

policies. In section VII. of this preamble,

we discuss the MedPAC

recommendations and any actions we

are proposing to take with regard to

them (when an action is recommended).

For further information relating

specifically to the MedPAC March 1

report or to obtain a copy of the report,

contact MedPAC at (202) 653–7220 or

visit MedPAC’s website at:

www.medpac.gov.

II. Proposed Changes to DRG

Classifications and Relative Weights

A. Background

Under the prospective payment

system, we pay for inpatient hospital

services on a rate per discharge basis

that varies according to the DRG to

which a beneficiary’s stay is assigned.

The formula used to calculate payment

for a specific case takes an individual

hospital’s payment rate per case and

multiplies it by the weight of the DRG

to which the case is assigned. Each DRG

weight represents the average resources

required to care for cases in that

particular DRG relative to the average

resources used to treat cases in all

DRGS.

Congress recognized that it would be

necessary to recalculate the DRG

relative weights periodically to account

for changes in resource consumption.

Accordingly, section 1886(d)(4)(C) of

the Act requires that the Secretary

adjust the DRG classifications and

relative weights at least annually. These

adjustments are made to reflect changes

in treatment patterns, technology, and

any other factors that may change the

relative use of hospital resources. The

proposed changes to the DRG

classification system, and the proposed

recalibration of the DRG weights for

discharges occurring on or after October

1, 2001, are discussed below.

B. DRG Reclassification

1. General

Cases are classified into DRGs for

payment under the prospective payment

system based on the principal diagnosis,

up to eight additional diagnoses, and up

to six procedures performed during the

stay, as well as age, sex, and discharge

status of the patient. The diagnosis and

procedure information is reported by

the hospital using codes from the

International Classification of Diseases,

Ninth Revision, Clinical Modification

(ICD–9–CM). Medicare fiscal

intermediaries enter the information

into their claims processing systems and

subject it to a series of automated

screens called the Medicare Code Editor

(MCE). These screens are designed to

identify cases that require further

review before classification into a DRG.

After screening through the MCE and

any further development of the claims,

cases are classified into the appropriate

DRG by the Medicare GROUPER

software program. The GROUPER

program was developed as a means of

classifying each case into a DRG on the

basis of the diagnosis and procedure

codes and demographic information

(that is, sex, age, and discharge status).

It is used both to classify past cases in

order to measure relative hospital

resource consumption to establish the

DRG weights and to classify current

cases for purposes of determining

payment. The records for all Medicare

hospital inpatient discharges are

maintained in the Medicare Provider

Analysis and Review (MedPAR) file.

The data in this file are used to evaluate

possible DRG classification changes and

to recalibrate the DRG weights.

In the July 30, 1999 final rule (64 FR

41500), we discussed a process for

considering non-MedPAR data in the

recalibration process. In order for the

use of particular data to be feasible, we

must have sufficient time to evaluate

and test the data. The time necessary to

do so depends upon the nature and

quality of the data submitted. Generally,

however, a significant sample of the

data should be submitted by August 1,

approximately 8 months prior to the

publication of the proposed rule, so that

we can test the data and make a

preliminary assessment as to the

feasibility of using the data.

Subsequently, a complete database

should be submitted no later than

December 1 for consideration in

conjunction with the next year’s

proposed rule.

Currently, cases are assigned to one of

503 DRGs (including one DRG for a

diagnosis that is invalid as a discharge

diagnosis and one DRG for ungroupable

diagnoses) in 25 major diagnostic

categories (MDCs). Most MDCs are

based on a particular organ system of

the body (for example, MDC 6 (Diseases

and Disorders of the Digestive System)).

However, some MDCs are not

constructed on this basis because they

involve multiple organ systems (for

example, MDC 22 (Burns)).

In general, cases are assigned to an

MDC based on the principal diagnosis,

before assignment to a DRG. However,

there are five DRGs to which cases are

directly assigned on the basis of

procedure codes. These are the DRGs for

liver, bone marrow, and lung

transplants (DRGs 480, 481, and 495,

respectively) and the two DRGs for

tracheostomies (DRGs 482 and 483).

Cases are assigned to these DRGs before

classification to an MDC.

Within most MDCs, cases are then

divided into surgical DRGs (based on a

surgical hierarchy that orders individual

procedures or groups of procedures by

resource intensity) and medical DRGs.

Medical DRGs generally are

differentiated on the basis of diagnosis

and age. Some surgical and medical

DRGs are further differentiated based on

the presence or absence of

complications or comorbidities (CC).

Generally, the GROUPER does not

consider other procedures; that is,

nonsurgical procedures or minor

surgical procedures generally not

performed in an operating room are not

listed as operating room (OR)

procedures in the GROUPER decision

tables. However, there are a few non-OR

procedures that do affect DRG

assignment for certain principal

diagnoses, such as extracorporeal shock

wave lithotripsy for patients with a

principal diagnosis of urinary stones.

The major changes we are proposing

to make to the DRG classification system

for FY 2002 are summarized in Charts

1, 2, and 3 below, followed by detailed

discussions in individual sections

according to MDC assignment. Other

issues concerning DRGs are also set

forth below. Unless otherwise noted,

our DRG analysis is based on data from

100 percent of the FY 2000 MedPAR file

containing hospital bills received

through May 31, 2000 for discharges in

FY 2000.

22650 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

CHART 1.—SUMMARY OF PROPOSED CHANGES IN DRG ASSIGNMENTS

Diagnosis related groups (DRGs) Added

as new Removed

Pre-MDC:

DRG 512 (Simultaneous Pancreas/Kidney Transplant) ........................................................................................... X

DRG 513 (Pancreas Transplants) ............................................................................................................................ X

MDC 5 (Diseases and Disorders of the Circulatory System):

DRG 112 (Percutaneous Cardiovascular Procedures) ............................................................................................ X

DRG 514 (Cardiac Defibrillator Implant with Cardiac Catheterization) .................................................................... X

DRG 515 (Cardiac Defibrillator Implant without Cardiac Catheterization) ............................................................... X

DRG 516 (Percutaneous Cardiovascular Procedures with Acute Myocardial Infarction (AMI)) ............................. X

DRG 517 (Percutaneous Cardiovascular Procedures without AMI, with Coronary Artery Stent Implant ............... X

DRG 518 (Percutaneous Cardiovascular Procedures without AMI, without Coronary Artery Stent Implant .......... X

MDC 8 (Diseases and Disorders of the Musculoskeletal System and Connective Tissue):

DRG 519 (Cervical Spinal Fusion with CC) ............................................................................................................. X

DRG 520 (Cervical Spinal Fusion without CC) ........................................................................................................ X

MDC 20 (Alcohol/Drug Use and Alcohol/Drug-Induced Organic Mental Disorders):

DRG 434 Alcohol/Drug Abuse or Dependency, Detoxification or Other Symptomatic Treatment with CC) .......... X

DRG 435 (Alcohol/Drug Abuse or Dependency, Detoxification or Other Symptomatic Treatment without CC) .... X

DRG 436 (Alcohol/Drug Dependence with Rehabilitation Therapy) ........................................................................ X

DRG 437 (Alcohol/Drug Dependence, Combined Rehabilitation and Detoxification Therapy) ............................... X

DRG 521 (Alcohol/Drug Abuse or Dependence with CC) ....................................................................................... X

DRG 522 (Alcohol/Drug Abuse or Dependence without CC, with Rehabilitation Therapy) .................................... X

DRG 523 (Alcohol/Drug Abuse or Dependence without CC, without Rehabilitation Therapy) ............................... X

CHART 2.—SUMMARY OF PROPOSED ASSIGNMENT OR REASSIGNMENT OF DIAGNOSIS OR PROCEDURE CODES IN EXISTING

DRGS

Diagnosis/procedure codes Removed from DRG Reassigned to DRG

MDC 5 (Diseases and Disorders of the Circulatory System):

Principal Diagnosis Code:

410.01 Acute myocardial infarction of anterolateral wall, initial episode of

care.

116 ..................................... 516

410.11 Acute myocardial infarction of other anterior wall, initial episode of

care.

116 ..................................... 516

410.21 Acute myocardial infarction of inferolateral wall, initial episode of

care.

116 ..................................... 516

410.31 Acute myocardial infarction of inferoposterior wall, initial episode of

care.

116 ..................................... 516

410.41 Acute myocardial infarction of other inferior wall, initial episode of

care.

116 ..................................... 516

410.51 Acute myocardial infarction of other lateral wall, initial episode of

care.

116 ..................................... 516

410.61 True posterior wall infarction, initial episode of care ........................... 116 ..................................... 516

410.71 Subendocardial infarction, initial episode of care ................................ 116 ..................................... 516

410.81 Acute myocardial infarction of other specified sites, initial episode of

care.

116 ..................................... 516

410.91 Acute myocardial infarction of unspecified site, initial episode of care 116 ..................................... 516

Procedure Codes:

37.94 Implantation or replacement of automatic cardioverter/defibrillation,

total system (AICD).

104, 105 ............................. 514, 515

37.95 Implantation of automatic cardioverter/defibrillator lead(s) only ............ 104, 105 ............................. 514, 515

37.96 Implantation of automatic cardioverter/defibrillator pulse generator

only.

104, 105 ............................. 514, 515

37.97 Replacement of automatic cardioverter/ defibrillator lead(s) only .......... 104, 105 ............................. 514, 515

37.98 Replacement of automatic cardioverter/defibrillator pulse generator

only.

104, 105 ............................. 514, 515

Operating Room Procedures:

35.96 Percutaneous valvuloplasty .................................................................... 116 ..................................... 516, 517, 518

36.01 Single vessel percutaneous transluminal coronary angioplasty (PTCA)

or coronary atherectomy without mention of thrombolytic agent.

116 ..................................... 516, 517, 518

36.02 Single vessel percutaneous transluminal coronary angioplasty (PTCA)

or coronary atherectomy with mention of thrombolytic agent.

116 ..................................... 516, 517, 518

36.05 Multiple vessel percutaneous transluminal coronary angioplasty

(PTCA) or coronary atherectomy performed during the same operation, with

or without mention of thrombolytic agent.

116 ..................................... 516, 517, 518

36.09 Other removal of coronary artery obstruction ........................................ 116 ..................................... 516, 517, 518

37.34 Catheter ablation of lesion or tissues of heart ....................................... 116 ..................................... 516, 517, 518

92.27 Implantation or insertion of radioactive elements .................................. Non–OR in MDC–5 ............ 517

Nonoperating Room Procedures:

36.06 Insertion of coronary artery stent(s) ....................................................... 116 ..................................... 517

37.21 Right heart cardiac catheterization ........................................................ 104 ..................................... 514

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22651

CHART 2.—SUMMARY OF PROPOSED ASSIGNMENT OR REASSIGNMENT OF DIAGNOSIS OR PROCEDURE CODES IN EXISTING

DRGS—Continued

Diagnosis/procedure codes Removed from DRG Reassigned to DRG

37.22 Left heart cardiac catheterization ........................................................... 104 ..................................... 514

37.23 Right and left heart cardiac catheterization ........................................... 104 ..................................... 514

37.26 Cardiac electrophysiologic stimulation and recording studies ............... 104, 112 ............................. 514, 516, 517, 518

37.27 Cardiac mapping .................................................................................... 112 ..................................... 516, 517, 518

88.52 Angiocardiography of right heart structures ........................................... 104 ..................................... 514

88.53 Angiocardiography of left heart structures ............................................. 104 ..................................... 514

88.54 Combined right and left heart angiocardiography .................................. 104 ..................................... 514

88.55 Coronary arteriography using a single catheter ..................................... 104 ..................................... 514

88.56 Coronary arteriography using two catheters .......................................... 104 ..................................... 514

88.57 Other and unspecified coronary arteriography ...................................... 104 ..................................... 514

88.58 Negative-contrast cardiac roentgenography .......................................... 104 ..................................... 514

MDC 8 (Diseases and Disorders of the Musculoskeletal System and Connective Tissue):

Procedure Codes:

81.02 Other cervical fusion, anterior technique ............................................... 497, 498 ............................. 519, 520

81.03 Other cervical fusion, posterior technique ............................................. 497, 498 ............................. 519, 520

MDC 15 (Newborns and Other Neonates with Conditions Originating in the Perinatal

Period)

Diagnosis Codes:

773.0 Hemolytic disease due to RH isoimmunization ..................................... 389 ..................................... 390

773.1 Hemolytic disease due to ABO isoimmunization ................................... 389 ..................................... 390

Secondary Diagnosis Codes:

478.1 Other diseases of nasal cavity and sinuses .......................................... 390 ..................................... 391

520.6 Disturbances in tooth eruption ............................................................... 390 ..................................... 391

623.8 Other specified noninflammatory disorders of vagina ........................... 390 ..................................... 391

709.00 Dyschroma, unspecified ....................................................................... 390 ..................................... 391

709.01 Vitiglio ................................................................................................... 390 ..................................... 391

709.09 Dyschromia, Other ............................................................................... 390 ..................................... 391

744.1 Accessory Auricle ................................................................................... 390 ..................................... 391

754.61 Congenital pes planus .......................................................................... 390 ..................................... 391

757.33 Congenital pigmentary anomalies of skin ............................................ 390 ..................................... 391

757.39 Other specified anomaly of skin ........................................................... 390 ..................................... 391

764.08 ‘‘Light for dates’’ without mention of fetal malnutrition, 2,000–2,499

grams.

390 ..................................... 391

764.98 Fetal growth retardation, unspecified, 2,000–2,499 grams ................. 390 ..................................... 391

772.6 Cutaneous hemorrhage .......................................................................... 390 ..................................... 391

794.15 Abnormal and auditory function studies ............................................... 390 ..................................... 391

796.4 Other abnormal clinical findings ............................................................. 390 ..................................... 391

V20.2 Routine infant or child health check ...................................................... 390 ..................................... 391

V72.1 Examination of ears and hearing ........................................................... 390 ..................................... 391

CHART 3.—SUMMARY OF PROPOSED RETITLED DRGS

MDC DRG

No. Current name Proposed name

MDC 5 ...... DRG 116 Other Permanent Cardiac Pacemaker Implantation, or

PTCA, with Coronary Artery Stent Implant.

Other Cardiac Pacemaker Implantation.

MDC 8 ...... DRG 497 Spinal Fusion with CC ....................................................... Spinal Fusion except Cervical with CC.

MDC 8 ...... DRG 498 Spinal Fusion without CC .................................................. Spinal Fusion except Cervical without CC.

2. MDC 5 (Diseases and Disorders of the

Circulatory System)

a. Removal of Defibrillator Cases From

DRGs 104 and 105

DRGs 104 (Cardiac Valve & Other

Major Cardiothoracic Procedures with

Cardiac Catheterization) and 105

(Cardiac Valve & Other Major

Cardiothoracic Procedures without

Cardiac Catheterization) include the

replacement or open repair of one or

more of the four heart valves. These

valves may be diseased or damaged,

resulting in either leakage or restriction

of blood flow to the heart,

compromising the ability of the heart to

pump blood. This procedure requires

the use of a heart-lung bypass machine,

as the heart must be stilled and opened

to repair or replace the valve.

Cardiac defibrillators are implanted to

correct episodes of fibrillation (very fast

heart rate) caused by malfunction of the

conduction mechanism of the heart.

Through implanted cardiac leads, the

defibrillator mechanism senses changes

in heart rhythm. When very fast heart

rates occur, the defibrillator produces a

burst of electric current through the

leads to restore the normal heart rate.

An implanted defibrillator constantly

monitors heart rhythm. The

implantation of this device does not

require the use of a heart-lung bypass

machine, and would be expected to be

very different in terms of resource

usage, although both procedures

currently group to DRGs 104 and 105.

As part of our ongoing review of

DRGs, we examined Medicare claims

data on DRG 104 and DRG 105. We

reviewed 100 percent of the FY 2000

MedPAR file containing hospital bills

received through May 31, 2000, for

22652 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

discharges in FY 2000, and found that

the average charges across all cases in

DRG 104 were $84,060, while the

average charges across all cases in DRG

105 were $66,348. Carving out code

37.94 (Implantation or replacement of

automatic cardioverter/defibrillator,

total system [AICD]) from DRGs 104 and

105 increased those average charges to

$91,366 for DRG 104 and $67,323 for

DRG 105. We identified 11,021

defibrillator cases in DRG 104 (out of

25,112 total cases), with average charges

of $74,719, and 2,434 defibrillator cases

in DRG 105 (out of 20,094 total cases),

with average charges of $59,267.

We performed additional review on

cases containing code 37.95

(Implantation of automatic cardioverter/

defibrillator lead(s) only) with code

37.96 (Implantation of automatic

cardioverter/defibrillator pulse

generator only) and on cases containing

code 37.97 (Replacement of automatic

cardioverter/defibrillator lead(s) only)

with code 37.98 (Replacement of

automatic cardioverter/defibrillator

pulse generator only). This subgrouping

contained only 56 patients. The average

charges for the 18 patients in DRG 104

were $58,847. The average charges for

the 38 patients in DRG 105 were

$54,891.

Because we believe the defibrillator

cases are significantly different from

other cases in DRGs 104 and 105, we are

proposing to create two new DRGs: DRG

514 (Cardiac Defibrillator Implant with

Cardiac Catheterization) and DRG 515

(Cardiac Defibrillator Implant without

Cardiac Catheterization).

We are proposing to remove

procedure codes 37.94, 37.95 and 37.96,

and 37.97 and 37.98 from DRGs 104 and

105 to form the new DRGs 514 and 515.

The proposed new DRGs 514 and 515

would include principal diagnosis

codes and procedure codes as reflected

in Chart 4 below:

CHART 4.—COMPOSITION OF PROPOSED NEW DRGS 514 AND 515 IN MDC 5

Diagnosis and procedure codes

Included in

proposed

DRG 514

Included in

proposed

DRG 515

Principal Diagnosis Codes:

All of the principal diagnosis codes assigned to MDC–5 ........................................................................................ X X

Principal or Secondary Procedure Code:

37.94 Implantation or replacement of automatic cardioverter/defibrillation, total system (AICD) ......................... X X

Combination Operating Procedure Codes:

37.95 Implantation of automatic cardioverter/defibrillator lead(s) only; plus

37.96 Implantation of automatic cardioverter/defibrillator pulse generator only; ................................................... X X

Or

37.97 Replacement of automatic cardioverter/defibrillator lead(s) only; plus

37.98 Replacement of automatic cardioverter/defibrillator pulse generator only .................................................. X X

Plus: One of the Following Nonoperating Room Procedure Codes:

37.21 Right heart cardiac catheterization .............................................................................................................. X

37.22 Left heart cardiac catheterization ................................................................................................................ X

37.23 Combined right and left heart cardiac catheterization ................................................................................. X

37.26 Cardiac electrophysiologic stimulation and recording studies ..................................................................... X

88.52 Angiocardiography of right heart structures ................................................................................................ X

88.53 Angiocardiography of left heart structures ................................................................................................... X

88.54 Combined right and left heart angiocardiography ....................................................................................... X

88.55 Coronary arteriography using a single catheter .......................................................................................... X

88.56 Coronary arteriography using two catheters ............................................................................................... X

88.57 Other and unspecified coronary arteriography ............................................................................................ X

88.58 Negative-contrast cardiac roentgenography ................................................................................................ X

b. Percutaneous Cardiovascular

Procedures

We reviewed other DRGs within MDC

5 in order to determine if there were

also logic changes that could be made to

these DRGs. The data was arrayed in a

variety of ways displaying myriad

permutations, resulting in the following

proposed changes. A percutaneous

transluminal coronary angioplasty

(PTCA) is an acute intervention

intended to minimize cardiac damage

by restarting circulation to the heart.

Some patients with an acute myocardial

infarction (AMI) are now treated by

performing a PTCA during the

hospitalization for the AMI. Currently,

PTCAs with a coronary stent implant

are assigned to DRG 116 (Other

Permanent Cardiac Pacemaker

Implantation, or PTCA with Coronary

Artery Stent Implant), along with

pacemaker implants. The remaining

percutaneous cardiovascular procedures

are assigned to DRG 112 (Percutaneous

Cardiovascular Procedures).

The volume of percutaneous

cardiovascular procedures has grown

dramatically, with 186,669 cases

identified in the FY 2000 MedPAR file

containing hospital bills submitted

through May 31, 2000. Because of the

high volume, we decided to review the

DRG for percutaneous cardiovascular

procedures. As a first step in the

evaluation, we combined the

percutaneous cardiovascular procedures

from DRGs 112 and 116. We then

subdivided the combined percutaneous

cardiovascular procedure group into

two groups based on the principal

diagnosis (Pdx) of AMI.

Group Count Average

charge

With Pdx of AMI 50,442 $31,722

Without Pdx of

AMI ................ 136,227 23,989

Each of these groups was further

evaluated by subdividing them based on

whether a coronary stent was

implanted. The vast majority of patients

with an AMI had a coronary stent

implanted. Patients without an AMI

were subdivided into two groups based

on whether a coronary stent was

implanted.

Group Count Average

charge

Without Pdx of

AMI with stent 111,441 $24,745

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22653

Group Count Average

charge

Without Pdx of

AMI without

stent .............. 24,786 20,589

Based on this analysis, we are

proposing to remove the PTCAs with

coronary artery stent from DRG 116,

thus limiting DRG 116 to permanent

cardiac pacemaker implantation. This

removal will leave approximately

68,000 non-PTCA cases in DRG 116.

In conjunction with this evaluation,

we considered a new technology,

intravascular brachytherapy, that is

being used to treat coronary in-stent

stenosis. A gamma-radiationimpregnated tape is threaded through

the affected vessel for a specified

amount of dwell time, and then the tape

is removed. Intravascular brachytherapy

was approved by the Food and Drug

Administration in November 2000.

Intravascular brachytherapy is

assigned to procedure code 92.27

(Implantation or insert of radioactive

elements). With the use of angioplasty,

these cases are currently assigned to

DRG 112 (Percutaneous Cardiovascular

Procedures). Therefore, cases involving

this new technology will be implicated

by these proposed changes.

We are proposing to retitle DRG 116

‘‘Other Cardiac Pacemaker

Implantation,’’ remove DRG 112, and

create three new DRGs: DRG 516

(Percutaneous Cardiovascular

Procedures with Acute Myocardial

Infarction (AMI)); DRG 517

(Percutaneous Cardiovascular

Procedures without AMI, with Coronary

Artery Stent Implant; and DRG 518

(Percutaneous Cardiovascular

Procedures without AMI, without

Coronary Artery Stent Implant). The

principal diagnosis codes and operating

room and nonoperating room procedure

codes that are proposed to be included

in the new DRGs 516, 517, and 518 are

reflected in Chart 5.

In order to be assigned to new DRG

516, cases must contain one of the

principal diagnoses plus the operating

room procedures listed in Chart 5.

Because DRG 516 contains acute

myocardial infarction, which is

hierarchically ordered before DRGs 517

and 518, any AMI cases also containing

codes 92.27 or 36.06 would

automatically be assigned to DRG 516.

We are proposing to assign patients with

a percutaneous cardiovascular

procedure and intravascular radiation

treatment to new DRG 517. As more

data become available, we will reassess

the assignment of intravascular

radiation treatment to DRG 517.

Proposed new DRG 518 would contain

the same operating room and

nonoperating room procedures as new

proposed DRG 517, with the exception

of codes 92.27 and 36.06.

CHART 5.—COMPOSITION OF PROPOSED NEW DRGS 516, 517, AND 518 IN MDC 5

Diagnosis and procedure codes

Included in

Proposed

DRG 516

Included in

Proposed

DRG 517

Included in

Proposed

DRG 518

Principal Diagnosis Codes:

410.01 Acute myocardial infarction of anterolateral wall, initial episode of care .......................... X

410.11 Acute myocardial infarction of other anterior wall, initial episode of care ......................... X

410.21 Acute myocardial infarction of inferolateral wall, initial episode of care ........................... X

410.31 Acute myocardial infarction of inferoposterior wall, initial episode of care ....................... X

410.41 Acute myocardial infarction of other inferior wall, initial episode of care .......................... X

410.51 Acute myocardial infarction of other lateral wall, initial episode of care ........................... X

410.61 True posterior wall infarction, initial episode of care ......................................................... X

410.71 Subendocardial infarction, initial episode of care .............................................................. X

410.81 Acute myocardial infarction of other specified sites, initial episode of care. .................... X

410.91 Acute myocardial infarction of unspecified site, initial episode of care ............................. X

plus: Operating Room Procedures:

35.96 Percutaneous valvuloplasty .................................................................................................X X X

and

36.01 Single vessel percutaneous transluminal coronary angioplasty (PTCA) or coronary

atherectomy without mention of thromolytic agent ....................................................................... X X X

or

36.02 Single vessel percutaneous transluminal coronary angioplasty (PTCA) or coronary

atherectomy with mention of thrombolytic agent .......................................................................... X X X

or

36.05 Multiple vessel percutaneous transluminal coronary angioplasty (PTCA) or coronary

atherectomy performed during the same operation, with or without mention of thrombolytic

agent ............................................................................................................................................. X X X

and

36.09 Other removal of coronary artery obstruction ...................................................................... X X X

and

37.34 Catheter ablation of lesion or tissues of heart .................................................................... X X X

92.27 Implantation or insertion of radioactive elements ................................................................ X

OR: Nonoperating Room Procedures:

36.06 Insertion of coronary artery stent(s) .................................................................................... X

37.26 Cardiac electrophysiologic stimulation and recording studies ............................................. X X X

37.27 Cardiac mapping .................................................................................................................. X X X

DRG 121 (Circulatory Disorders with

AMI and Major Complication,

Discharged Alive), DRG 122 (Circulatory

Disorders with AMI without Major

Complication, Discharged Alive), and

DRG 123 (Circulatory Disorders with

AMI, Expired) are not affected by these

changes.

c. Removal of Heart Assist Systems

The ICD–9–CM Coordination and

Maintenance Committee considered the

nonoperative removal of heart assist

systems at its November 17, 2000

meeting. A device called the intra-aortic

balloon pump (IABP) is one of the most

common types of ventricular assist

systems. A balloon catheter is placed

22654 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

into the patient’s descending thoracic

aorta, and inflates and deflates with

each heartbeat. This device is timed

with the patient’s own heart rhythm,

and inflates and circulates blood to the

heart and other organs. This allows the

heart to rest and recover. The IABP may

be used preoperatively, intraoperatively,

or postoperatively. It supports the

patient from a few hours to several days.

Code 37.64 (Removal of heart assist

system) already exists, and it is

considered by the GROUPER to be an

operative procedure. However, the

nonoperative removal of a heart assist

system can be done at the patient’s

bedside, is noninvasive, and requires no

anesthesia. Therefore, the Committee

created code 97.44 (Nonoperative

removal of heart assist system) for use

with discharges beginning on or after

October 1, 2001.

In the past, we have assigned new

ICD–9–CM codes to the same DRG to

which the predecessor code was

assigned. If this practice were to be

followed, we would have proposed that

code 97.44 be assigned to MDC 5, DRGs

478 (Other Vascular Procedures with

CC) and 479 (Other Vascular Procedures

without CC). After hospital charge data

became available, we would have

considered moving it to other DRGs.

However, in accordance with section

533(a) of Public Law 106–554, which

requires a more expeditious technique

of recognizing new medical services or

technology for the hospital inpatient

prospective payment system, we will

reconsider this longstanding practice

when possible. Therefore, as code 97.44

was designed to capture heart assist

system removal that is clearly

nonoperative, we are not proposing to

designate 97.44 as a code which the

GROUPER recognizes as a procedure.

This assignment can be found in Table

6B, New Procedure Codes in the

addendum to this proposed rule.

Therefore, these cases will be assigned

by the GROUPER to a medical DRG

based on the principal diagnosis, or to

a surgical DRG if a surgical procedure

recognized by the GROUPER is

performed.

3. MDC 8 (Diseases and Disorders of the

Musculoskeletal System and Connective

Tissue)

a. Refusions

We have received questions from

correspondents regarding the

appropriateness of the spinal fusion

DRGs: DRG 496 (Combined Anterior/

Posterior Spinal Fusion); DRG 497

(Spinal Fusion with CC); and DRG 498

(Spinal Fusion without CC). Several

correspondents expressed concern about

the inclusion of all refusions of the

spine into one procedure code, 81.09

(Refusion of spine, any level or

technique). The correspondents pointed

out that because all refusions using any

technique or level are in this one code,

all of these cases are assigned to DRG

497 and DRG 498. They also pointed out

that fusion cases involving both an

anterior and posterior technique are

assigned to DRG 496. Although cases

with the refusion code that involve

anterior and posterior techniques would

appear to be more appropriately

assigned to DRG 496, this is not the

case.

We recognized this limitation in the

refusion codes and further

acknowledged that this limitation in the

ICD–9–CM coding system creates DRG

problems by preventing the assignment

to DRG 496 even when both anterior

and posterior techniques are used for

refusion cases. Therefore, we referred

the issue to the ICD–9–CM Coordination

and Maintenance Committee and

requested the Committee to consider

code revisions for the refusions of the

spine during its year 2000 public

meetings.

After its deliberations, the Committee

approved a series of new procedure

codes for refusion of the spine that

could lead to improvements within

DRGs 497 and 498. These new codes,

listed below, go into effect on October

1, 2001.

81.30 Refusion of spine, not otherwise

specified

81.31 Refusion of atlas-axis spine

81.32 Refusion of other cervical spine,

anterior technique

81.33 Refusion of other cervical spine,

posterior technique

81.34 Refusion of dorsal and

dorsolumbar spine, anterior technique

81.35 Refusion of dorsal and

dorsolumbar spine, posterior

technique

81.36 Refusion of lumbar and

lumbosacral spine, anterior technique

81.37 Refusion of lumbar and

lumbosacral spine, lateral transverse

process technique

81.38 Refusion of lumbar and

lumbosacral spine, posterior

technique

81.39 Refusion of spine, not elsewhere

classified

As previously stated, all refusions of

the spine and corrections of the

pseudarthrosis of the spine are assigned

to code 81.09. Code 81.09, which is

always assigned to DRG 497 or DRG

498, includes refusions at any level of

the spine using any technique. With the

creation of the new procedure codes

listed above, it will be possible to

determine the level of the spine at

which the refusion is performed, as well

as the technique used, and assign the

case to a more appropriate DRG.

These new procedure codes should

greatly improve our ability to determine

the level and technique used in the

refusion.

In the past, we have assigned new

ICD–9–CM codes to the same DRG to

which the predecessor code was

assigned. If this practice were followed,

these new codes would have been

assigned to DRG 497 and 498 as they are

currently. After data became available,

we would have considered moving them

to other DRGs. However, in accordance

with section 533(a) of Public Law 106–

554, which requires more expeditious

methods of recognizing new medical

services or technology under the

inpatient hospital prospective payment

system, we will reconsider this

longstanding practice when possible.

Since the new codes clearly allow us to

identify cases where the technique was

either anterior or posterior and these

cases are clinically similar and,

therefore, should be handled in the

same fashion, we are proposing to

immediately assign these cases on the

same basis as the fusion codes (81.00

through 81.09). We would not wait for

actual claims data before making this

change. These proposed assignments are

reflected in Chart 6 and also can be

found in Table 6B, in section V. of the

Addendum to this proposed rule.

b. Fusion of Cervical Spine

We have received an additional

inquiry concerning the spinal DRGs that

focused on fusions of the cervical spine.

The inquirer stated that there was a

significant difference between

inpatients who undergo anterior

cervical spinal fusion and other types of

spinal fusion in regard to treatment,

recovery time, costs, and risk of

complications. Anterior cervical spinal

fusions are assigned to procedure code

81.02, Other cervical fusion, anterior

technique. The inquirer pointed out that

anterior cervical fusions differ

significantly from anterior techniques at

other levels since the anatomic

approach is far less invasive. Thoracic

anterior techniques require working

around the cardiac and respiratory

systems in the chest cavity, while

lumbar anterior working around bowel

and digestive system and the abdominal

muscles. The inquirer recommended

that code 81.02 be removed from DRGs

497 and 498 and grouped separately.

We analyzed claims data from 100

percent of the FY 2000 MedPAR file

containing hospital bills received

through May 31, 2000, and confirmed

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22655

that charges are lower for fusions of the

cervical spine than fusions of the

thoracic and lumbar spine. This was

true for both anterior and posterior

cervical fusions of the spine. Our

medical consultants agree that the data

and their clinical analysis support the

creation of new DRGs for cervical

fusions of the spine. Therefore, we are

proposing to remove procedure codes

81.02 and 81.03 from the spinal fusion

DRGs (currently, DRGs 497 and 498)

and assign them to new DRGs for

cervical spinal fusion with and without

CC. We are proposing to make four

groupings for fusion DRGs. We believe

that the net effect of this proposal would

be an increase in the weights for DRGs

497 and 498, since the lower charges for

the cervical fusions would be removed.

The average standardized charge for all

spinal fusions with CCs was $26,957.

For all spinal fusions without CCs, the

average charge was $16,492. The table

below also shows average standardized

charges for these types of cases before

and after the proposed revisions.

Proposed revised spinal fusion DRGs

Average

charge before proposed revisionsAverage

charge after

revisions

DRG 497 Spinal Fusion Except Cervical with CC .......................................................................................................... $26,957 $36,821

DRG 498 Spinal Fusion Except Cervical without CC ..................................................................................................... 17,492 26,297

DRG 519 Cervical Spinal Fusion with CC ...................................................................................................................... .................... 26,957

DRG 520 Cervical Spinal Fusion without CC ................................................................................................................. .................... 16,492

Based on the proposed groupings, we

would create two new DRGs: DRG 519

(Cervical Spinal Fusion with CC); and

DRG 520 (Cervical Spinal Fusion

without CC). The procedure codes that

would be included in the proposed

DRGs 519 and 520 are reflected in Chart

6 below.

We are also proposing to add the new

ICD–9-CM procedure codes for refusion

of the cervical spine (81.32 and 81.33)

to the new cervical spine fusion DRGs

because they are clinically similar.

We are proposing to retitle DRG 497

‘‘Spinal Fusion Except Cervical with

CC’’ and DRG 498 ‘‘Spinal Fusion

Except Cervical without CC.’’ The

retitled DRGs 497 and 498 would retain

fusion codes 81.00, 81.01, and 81.04

through 81.08 and include the proposed

new refusion codes 81.30, 81.31, and

81.34 through 81.39, as reflected in

Chart 6 below.

c. Posterior Spinal Fusion

We received other correspondence

regarding the current DRG assignment

for code 81.07, Lumbar and lumbosacral

fusion, lateral transverse process

technique. The correspondent stated

that physicians consider code 81.07 to

be a posterior procedure. The patient is

placed prone on the operating table and

the spine is exposed through a vertical

midline incision. The correspondent

pointed out that code 81.07 is not

classified as a posterior procedure

within DRG 496 (Combined Anterior/

Posterior Spinal Fusion). Therefore,

when 81.07 is reported with one of the

anterior techniques fusion codes, it is

not assigned to DRG 496. The

correspondent recommended that code

81.07 be added to the list of posterior

spinal fusion codes for use in

determining assignment to DRG 496.

We have consulted with our clinical

advisors and they agree that this

addition should be made. Since we are

proposing to handle the new refusion

codes in the same manner as the fusion

codes, we also are proposing to assign

DRG 496 when 81.37 is used with one

of the anterior technique fusion or

refusion codes. This would be similar to

the manner in which code 81.07 is

classified. For assignment to DRG 496,

we would consider codes 81.01, 81.04,

81.06, 81.32, 81.34, and 81.36 to be

anterior techniques and codes 81.03,

81.05, 81.07, 81.08, 81.33, 81.35, and

81.38 to be posterior techniques.

CHART 6.—PROPOSED REVISED COMPOSITION OF DRGS 496, 497, AND 498 AND PROPOSED COMPOSITION OF

PROPOSED DRG 519 AND 520 IN MDC 8

Diagnosis and procedure codes

Existing DRG 496 Proposed to

be retained

in or added

to existing

DRG 497

Proposed to

be retained

in or added

to existing

DRG 498

Included in

proposed

DRG 519

Included in

proposed

DRG 520

Proposed to

be assigned

as anterior

techniques

Proposed to

be assigned

as posterior

techniques

Principal or Secondary Procedure Codes:

81.00 Spinal fusion, not otherwise specified ......... X X

81.01 Atlas-axis fusion ........................................... X X

81.02 Other cervical fusion, anterior technique ..... X X X

81.03 Other cervical fusion, posterior technique ... X X X

81.04 Lumbar and lumbosacral fusion, anterior

technique ............................................................... X X X

81.05 Lumbar and lumbosacral fusion, posterior

technique ............................................................... X X X

81.06 Lumbar and lumbosacral fusion, anterior

technique ............................................................... X X X

81.07 Lumbar and lumbosacral fusion, lateral

transverse process technique ............................... X X X

81.08 Lumbar and lumbosacral fusion, posterior

technique ............................................................... X X X

81.30 Refusion of spine, not otherwise specified .. X X

81.31 Refusion of atlas-axis spine ......................... X X

81.32 Refusion of other cervical spine, anterior

technique ............................................................... X X X

22656 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

CHART 6.—PROPOSED REVISED COMPOSITION OF DRGS 496, 497, AND 498 AND PROPOSED COMPOSITION OF

PROPOSED DRG 519 AND 520 IN MDC 8—Continued

Diagnosis and procedure codes

Existing DRG 496 Proposed to

be retained

in or added

to existing

DRG 497

Proposed to

be retained

in or added

to existing

DRG 498

Included in

proposed

DRG 519

Included in

proposed

DRG 520

Proposed to

be assigned

as anterior

techniques

Proposed to

be assigned

as posterior

techniques

81.33 Refusion of other cervical spine, posterior

technique ............................................................... X X X

81.34 Refusion of dorsal and dorsolumbar spine,

anterior technique ................................................. X X X

81.35 Refusion of dorsal and dorsolumbar spine,

posterior technique ................................................ X X X

81.36 Refusion of lumbar and lumbosacral spine,

anterior technique ................................................. X X X

81.37 Refusion of lumbar and lumbosacral spine,

posterior technique ................................................ X X X

81.38 Refusion of lumbar and lumbosacral spine,

posterior technique ................................................ X X X

81.39 Refusion of spine, not elsewhere classified X X

d. Spinal Surgery

The California Division of Workers’

Compensation notified us of a possible

problem with the following spinal

DRGs:

DRG 496 (Combined Anterior/

Posterior Spinal Fusion)

DRG 497 (Spinal Fusion with CC)

DRG 498 (Spinal Fusion without CC)

DRG 499 (Back & Neck Procedures

except Spinal Fusion with CC)

DRG 500 (Back & Neck Procedures

except Spinal Fusion without CC)

The Division of Workers’

Compensation uses the DRG categories

developed by HCFA to classify types of

hospital care. However, instead of using

HCFA’s weights for determining

reimbursement for inpatient services,

the Division sets a global fee for all

inpatient medical services not otherwise

exempted. This fee is established by

multiplying the product of the DRG

weight (or revised DRG weight for a

small number of categories) and the

health facility’s composite factor by 1.20

to get the maximum amount for worker

compensation admissions.

The Division of Workers’

Compensation has received reports that

the formula it uses for reimbursing cases

may be providing inadequate

reimbursement. California hospitals and

orthopedists have reported that certain

spinal surgery DRGs (DRGs 496 through

500) may involve different types of care

and/or technologies than those in use at

the time these groups were formulated.

Health care providers in California

report ‘‘recent increased use of the new

implantation devices, hardware, and

instrumentation, coupled with

requirements for intensive hospital

services accompanying use of new

procedures, has led to inadequate

reimbursement in these DRGs.’’ As a

short-term response to these concerns,

the California Division of Workers’

Compensation is exempting the costs of

hardware and instrumentation from the

global fee of the fee schedule for DRGS

496 through 500. The Division also

requested that HCFA examine these

DRGs for any potential problem under

the Medicare reimbursement system.

The ICD–9–CM coding system does

not capture specific types of

implantation devices, hardware, and

instrumentation. Therefore, we were not

able to verify the claim that these new

devices have led to increased costs in

specific cases. As discussed in section

II.D. of this preamble, we believe that

the adoption of a more detailed coding

system, such as ICD–10–PCS, would

supply greater amounts of detail on

these items. However, in the short term,

it is not possible to identify a specific

problem that involves implantation

devices, hardware, and instrumentation.

4. MDC 12 (Diseases and Disorders of

the Male Reproductive System)

At its May 11, 2000 public meeting,

the ICD–9–CM Coordination and

Maintenance Committee considered a

request from a manufacturer to create a

unique code for the procedure, Penile

plethysmography with nerve

stimulation, in DRG 334 (Major Male

Pelvic Procedures with CC). The penile

plethysmography is a test that can be

performed during a radical

prostatectomy procedure. During the

course of the procedure, the physician

places a probe within an area where the

prostatic nerves are thought to be

located and is able to detect minor

changes in penile tumescence or

detumescence. This reaction tells the

physician that the nerve bundles have

been located, which may aid the

physician in performing a nerve-sparing

radical prostatectomy procedure with

precision. The nerve bundles can also

be restimulated at the conclusion of the

procedure, providing immediate

feedback as to whether erectile function

will be restored after surgery.

After a presentation on the nerve

identifying procedure and review of

existing ICD–9–CM codes, the ICD–9–

CM Coordination and Maintenance

Committee determined that the existing

code 89.58 (Plethysmogram) adequately

describes this test.

Radical prostatectomies for patients

with cancer of the prostate are grouped

in either DRG 334 (Major Male Pelvic

Procedures with CC) or DRG 335 (Major

Male Pelvic Procedures without CC). We

have received a request from a

manufacturer of a nerve-identifying

device to assign cases containing code

89.58 into DRG 334 only, not into DRG

335, resulting in higher payments to

hospitals. During FY 2001, DRG 334 had

a relative weight of 1.5591, and DRG

335 had a relative weight of 1.1697. The

manufacturer requested that we

designate code 89.58 as an operating

room procedure code that would be

recognized by the GROUPER software,

and make that code applicable only to

DRG 334. The manufacturer believed

that this would serve to take any cases

of nerve sparing out of the lower paying

DRG 335, and would make the

technology more attractive to hospitals.

As paired DRGs 334 and 335 are

currently structured, they differ only in

whether or not a secondary diagnosis

identified as a CC is recorded.

Using 100 percent of the FY 2000

MedPAR file which contains hospital

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22657

bills for FY 2000 through May 31, 2000,

we examined those cases in DRG 334 to

which the procedure code for

prostatectomy was assigned. Of the total

7,241 cases in DRG 334 identified, 5,611

of these cases contained procedure code

60.5 (Radical prostatectomy). Only three

of the prostatectomy cases included

code 89.58. There is not a sufficient

number of cases on which to base an

assessment of the payment for this

procedure. Therefore, we are not

proposing to modify the assignment of

code 89.58.

5. MDC 15 (Newborns and Other

Neonates With Conditions Originating

in the Perinatal Period)

DRG 390 (Neonate with Other

Significant Problems) contains newborn

or neonate cases with other significant

problems, not assigned to DRGs 385

through 389, DRG 391, or DRG 469. To

be assigned to DRG 389 (Full Term

Neonate with Major Problems), the

neonate must have one of the principal

or secondary diagnosis listed under this

DRG. A neonate is assigned to DRG 390

when the neonate has a principal or

secondary diagnosis of newborn or

neonate with other significant problems

that are not assigned to DRG 385

through 389, 391, or 469.

We have received correspondence

suggesting a number of changes to be

made to DRGs 398 and 391. These

changes involve removing two codes

from DRG 389 and adding 17 codes to

DRG 391, as described below.

a. DRG 389 (Full Term Neonate With

Major Problems)

The correspondent suggested

removing the following codes from DRG

389 and assigning them to DRG 390:

773.0 Hemolytic disease due to RH

isoimmunization

773.1 Hemolytic disease due to ABO

isoimmunization

The correspondent stated that

hemolytic disease due to RH

isoimmunization or due to ABO

isoimmunization should not be

considered a major problem. The

correspondent recommended that these

two conditions be classified as

significant problems instead and thus

assigned to DRG 390.

Our medical consultants sought

additional advice from the National

Association of Children’s Hospitals and

Related Institutions (NACHRI). (HCFA

contracts with the 3M Health

Information Systems to maintain the

DRG system. The medical experts at 3M

evaluate proposed DRG changes from a

clinical perspective. These medical

consultants assist HCFA in evaluating

alternative proposals.) NACHRI and our

medical consultants agree that it is

appropriate to remove codes 773.0 and

773.1 from DRG 389. Therefore, we are

proposing to remove 773.0 and 773.1

from DRG 389 so that neonates with

these conditions are assigned to DRG

390.

b. DRG 391 (Normal Newborn)

We also have received

correspondence with recommendations

for changes to DRG 391. The

correspondent pointed out that the

following secondary codes currently

lead to the assignment of the neonate to

DRG 390 (Neonate with Other

Significant Problems). The

correspondent believed that the

conditions described by these codes

should not cause the neonate to be

classified under DRG 390 when reported

as a secondary diagnosis. The

correspondent recommended that these

conditions be listed under DRG 391

(Normal Newborn).

478.1 Other diseases of nasal cavity

and sinuses

520.6 Disturbances in tooth eruption

623.8 Other specified

noninflammatory disorders of vagina

709.00 Dyschroma, unspecified

709.01 Vitiglio

709.09 Dyschromia, Other

744.1 Accesory auricle

754.61 Congenital pes planus

757.33 Congenital pigmentary

anomalies of skin

757.39 Other specified anomaly of

skin, Other

764.08 ‘‘Light for dates’’ without

mention of fetal malnutrition, 2,000–

2,499 grams

764.98 Fetal growth retardation,

unspecified, 2,000–2,499 grams

772.6 Cutaneous hemorrhage

794.15 Abnormal and auditory

function studies

796.4 Other abnormal clinical findings

V20.2 Routine infant or child health

check

V72.1 Examination of ears and hearing

Our medical consultants also sought

the advice of NACHRI on this

recommendation. NACHRI reviewed the

list of codes and agreed that none of

these conditions should be considered

to be a significant problem for a

neonate. NACHRI concurred that

neonates with these secondary

diagnoses should be classified as normal

newborns. Therefore, we are proposing

to add the codes listed above to DRG

391 and not classify them to DRG 390

when reported as a secondary diagnosis.

c. Medicare Code Editor Changes

The Medicare Code Editor (MCE) is a

front-end software program that detects

and reports errors in the coding of

claims data. The age conflict edit detects

inconsistencies between a patient’s age

and any diagnosis on the patient’s

record. A subset of diagnoses is

considered valid only for patients over

the age of 14 years. These diagnoses are

identified as ‘‘adult’’ diagnoses and

range in age from 15 through 124 years.

Therefore, any codes included on the

Newborn Diagnoses edit are valid only

for patients under age 14.

It has come to our attention that cases

including the ICD–9–CM code 770.7,

Chronic respiratory disease arising in

the perinatal period, are being rejected.

However, a condition such as

bronchopulmonary dysplasia always

originates in the perinatal period, so

regardless of the patient’s age, this

condition is always coded as 770.7. The

age at which the diagnosis was

established or the age at continuing

treatment does not affect the assignment

of code 770.7.

Because correct coding is causing

these claims to be rejected, we are

proposing to remove code 770.7 from

the Newborn Diagnoses edit in the MCE,

as well as remove it from DRG 387

(Prematurity with Major Problems) and

DRG 389 (Full Term Neonate with Major

Problems). Clinical conditions in code

770.7, such as pulmonary fibrosis,

would group to DRG 92 (Interstitial

Lung Disease with CC) and DRG 93

(Interstitial Lung Disease without CC).

Therefore, we are proposing the

addition of code 770.7 to DRGs 92 and

93, as they are most similar clinically.

We will monitor these cases in

upcoming MedPAR data to ascertain

that the cases consume similar

resources.

6. MDC 20 (Alcohol/Drug Use and

Alcohol/Drug-Induced Organic Mental

Disorders)

DRG 434 (Alcohol/Drug Abuse or

Dependency, Detoxification or Other

Symptomatic Treatment with CC is

assigned when the patient has a

principal diagnosis of alcohol or drug

abuse or dependence along with a

secondary diagnosis classified as a CC.

If these patients do not have a CC, they

are assigned to DRG 435 (Alcohol/Drug

Abuse or Dependency, detoxification or

Other Symptomatic Treatment without

CC). When the patients receive

rehabilitation and detoxification therapy

during the stay, they are assigned to

DRG 437 (Alcohol/Drug Dependence,

Combined Rehabilitation and

Detoxification Therapy). If the patients

receive only rehabilitation therapy, they

are assigned to DRG 436 (Alcohol/Drug

Dependence with Rehabilitation

Therapy).

22658 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

We have received inquiries as to why

the relative weight for DRG 437, which

includes both rehabilitation and

detoxification (for FY 2001, the relative

weight is .6606, with a geometric mean

length of stay of 7.5) is lower than the

FY 2001 relative weight for DRG 434,

which includes only detoxification

(.7256, with a geometric mean length of

stay of 3.9). Likewise, the FY 2001

relative weight for DRG 436, which

includes only rehabilitation (.7433), is

higher than the FY 2001 relative weight

for DRG 437, which includes combined

rehabilitation and detoxification therapy

(.6606). The inquirers indicated that

those patients receiving the combination

therapy would be expected to have a

longer length of stay, require more

services, and, therefore, be more costly

to treat.

We analyzed data from 100 percent of

the FY 2000 MedPAR file which

contains hospital bills received through

May 31, 2000, and did not find support

for the inquirers’ assertion that

combination therapy is more costly to

treat. The relative weights indicate that

the presence of a CC in DRG 434 leads

to a significantly higher weight than is

found in DRG 435, which does not have

a CC. Therefore, we analyzed the

alcohol/drug DRGs and focused on

eliminating the distinction between

rehabilitation and rehabilitation with

detoxification and assessing the impact

of CCs. We combined data on DRGs 436

and 437 and then subdivided the data

based on the presence or absence of a

CC. The following table contains the

results of the analysis.

AVERAGE CHARGES FOR CASES—WITH AND WITHOUT CCS

DRGs

With CC Without CC

Count Charge Length of

stay Count Charge Length ofstay

Detoxification Cases—DRG 434 and DRG 435 .............. 3,298 $8,548 5.0 9,689 $5,111 4.1

All Rehabilitation Cases—DRG 436 and DRG 437 ........ 3,298 8,117 10.1 4,473 7,407 9.6

We found that, for both the

detoxification and rehabilitation DRGs,

the with-CC group has higher charges

than the without-CC group. However,

the with-CC groups still contain the

anomaly that the detoxification DRG

434 has a slightly higher average charge

than the combined rehabilitation DRGs

436 and 437. It appears that any

significant medical problems as

indicated by the presence of a CC

dominate the cost incurred by hospitals

for treating alcohol and drug abuse

patients. For the without-CC groups, the

detoxification DRG 435 has

substantially lower average charges than

the combined rehabilitation DRGs 436

and 437. Because the average charges of

the with-CC for both the detoxification

DRG 434 and combined rehabilitation

DRGs 436 and 437 have similar average

charges, we are proposing to combine

these two groups.

Based on the results of our analysis,

we are proposing to restructure MDC 20

as follows. We first identified those

cases with a principal diagnosis within

MDC 20 where the patient left against

medical advice. These cases are found

in DRG 433 (Alcohol/Drug Abuse or

Dependence, Left Against Medical

Advice (AMA)). We next identified all

remaining cases with a principal

diagnosis within MDC 20 where there

was a CC. We assigned these cases to a

proposed new DRG, Alcohol/Drug

Abuse or Dependence with CC). The

remaining cases (without CC and did

not leave against medical advice) were

then divided into two proposed new

DRGs based on whether or not the

patient received rehabilitation (Alcohol/

Drug Abuse or Dependence without CC,

with Rehabilitation Therapy; and

Alcohol/Drug Abuse or Dependence

without CC, without Rehabilitation

Therapy).

The following table illustrates the

number of patients and average charges

for each of the four proposed DRGs.

FREQUENCIES AND AVERAGE CHARGES FOR NEW DRGS

DRG Group title Number of

cases

Average

charges

433 .............. Alcohol/Drug Abuse or Dependence, Left Against Medical Advice ...................................................... 3,509 $3,855

521 .............. Alcohol/Drug Abuse or Dependence with CC ....................................................................................... 18,235 8,470

522 .............. Alcohol/Drug Abuse or Dependence without CC, with Rehabilitation Therapy .................................... 4,473 7,407

523 .............. Alcohol/Drug Abuse or Dependence without CC, without Rehabilitation Therapy ............................... 9,689 5,111

This table illustrates that groups

based first on the presence of CC and

then on whether or not the patient

receives rehabilitation therapy provide a

much better explanation of differences

in charges. Therefore, we are proposing

to retain DRG 433, make DRGs 434

through 437 invalid, and create new

DRGs 521, 522, and 523 to include the

diagnosis and procedure codes reflected

in Chart 7 below.

CHART 7.—PROPOSED RESTRUCTURE OF MDC 20

[Alcohol/drug use and alcohol/drug-induced organic mental disorders]

Diagnosis and procedure code

Included in

existing

DRG 433

Included in

proposed

DRG 521

Included in

proposed

DRG 522

Included in

proposed

DRG 523

Principal diagnosis:

All principal diagnosis within existing MDC 20 involving cases in which patients

left against medical advice (AMA) ........................................................................ X

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22659

CHART 7.—PROPOSED RESTRUCTURE OF MDC 20—Continued

[Alcohol/drug use and alcohol/drug-induced organic mental disorders]

Diagnosis and procedure code

Included in

existing

DRG 433

Included in

proposed

DRG 521

Included in

proposed

DRG 522

Included in

proposed

DRG 523

All principal diagnoses within existing MDC 20 where there is a CC and where

patient did not leave against medical advice (AMA) ............................................ X

All principal diagnoses within existing MDC 20 without CC and where patient did

not leave against medical advice (AMA) .............................................................. X

All principal diagnoses in existing MDC 20 involving cases where patients did not

leave against medical advice (AMA) .................................................................... X

Procedure Codes:

94.61 Alcohol rehabilitation .................................................................................... X

94.63 Alcohol rehabilitation and detoxification ...................................................... X

94.64 Drug rehabilitation ........................................................................................ X

94.66 Drug rehabilitation and detoxification .......................................................... X

94.67 Combined alcohol and drug rehabilitation ................................................... X

94.69 Combined alcohol and drug rehabilitation and detoxification ...................... X

7. MDC 25 (Human Immunodeficiency

Virus Infections)

Effective October 1, 2000, ICD–9–CM

diagnosis codes 783.2 (Abnormal loss of

weight) and 783.4 (Lack of expected

normal physiological development)

were made invalid (65 FR 47171). These

two old diagnosis codes were expanded

to five digits and the following new

diagnosis codes were created:

783.21 Loss of weight

783.22 Underweight

783.40 Unspecified lack of normal

physiological development

783.41 Failure to thrive

783.42 Delayed milestones

783.43 Short stature

These six revised codes were created

in response to an industry request.

Specifically, code 783.2 did not

differentiate between whether the

patient had lost weight recently or

whether the patient was underweight.

Code 783.4 was expanded to capture

concepts such as failure to thrive,

delayed milestones, and short stature.

None of these concepts were captured in

the old codes.

We listed these new codes in the

August 1, 2000 final rule on the hospital

inpatient prospective payment system

in Table 6A—New Diagnosis Codes (65

FR 47169). At the time the final rule was

published, all of these codes were

assigned to DRGs 296 through 298. After

the final rule was published, we

received an inquiry as to why these new

diagnosis codes were not included in

MDC 25 as human immunodeficiency

virus (HIV)-related conditions. The

inquirer pointed out that the

predecessor codes (783.2 and 783.4)

were included in MDC 25 as HIV-related

conditions and suggested that the new

codes be added to MDC 25. These cases

will be assigned to other MDCs if the

patient does not have HIV.

We agree that the expanded codes

should have been placed in the MDC 25

as HIV-related conditions. The omission

was an oversight. Therefore, we are

proposing to add diagnosis codes

783.21, 783.22, 783.40, 783.41, 783.42,

and 783.43 as HIV-related conditions

within MDC 25. When these six revised

codes are reported with code 042 HIV,

the patient will be classified within

MDC 25.

8. Surgical Hierarchies

Some inpatient stays entail multiple

surgical procedures, each one of which,

occurring by itself, could result in

assignment of the case to a different

DRG within the MDC to which the

principal diagnosis is assigned.

Therefore, it is necessary to have a

decision rule by which these cases are

assigned to a single DRG. The surgical

hierarchy, an ordering of surgical

classes from resource intensive most

least, performs that function. Its

application ensures that cases involving

multiple surgical procedures are

assigned to the DRG associated with the

most resource-intensive surgical class.

Because the relative resource intensity

of surgical classes can shift as a function

of DRG reclassification and

recalibration, we reviewed the surgical

hierarchy of each MDC, as we have for

previous reclassifications, to determine

if the ordering of classes coincided with

the intensity of resource utilization, as

measured by the same billing data used

to compute the DRG relative weights.

A surgical class can be composed of

one or more DRGs. For example, in

MDC 11, the surgical class ‘‘kidney

transplant’’ consists of a single DRG

(DRG 302) and the class ‘‘kidney, ureter

and major bladder procedures’’ consists

of three DRGs (DRGs 303, 304, and 305).

Consequently, in many cases, the

surgical hierarchy has an impact on

more than one DRG. The methodology

for determining the most resourceintensive surgical class involves

weighting each DRG for frequency to

determine the average resources for each

surgical class. For example, assume

surgical class A includes DRGs 1 and 2

and surgical class B includes DRGs 3, 4,

and 5. Assume also that the average

charge of DRG 1 is higher than that of

DRG 3, but the average charges of DRGs

4 and 5 are higher than the average

charge of DRG 2. To determine whether

surgical class A should be higher or

lower than surgical class B in the

surgical hierarchy, we would weight the

average charge of each DRG by

frequency (that is, by the number of

cases in the DRG) to determine average

resource consumption for the surgical

class. The surgical classes would then

be ordered from the class with the

highest average resource utilization to

that with the lowest, with the exception

of ‘‘other OR procedures’’ as discussed

below.

This methodology may occasionally

result in a case involving multiple

procedures being assigned to the lowerweighted DRG (in the highest, most

resource-intensive surgical class) of the

available alternatives. However, given

that the logic underlying the surgical

hierarchy provides that the GROUPER

searches for the procedure in the most

resource-intensive surgical class, this

result is unavoidable.

We note that, notwithstanding the

foregoing discussion, there are a few

instances when a surgical class with a

lower average relative weight is ordered

above a surgical class with a higher

average relative weight. For example,

the ‘‘other OR procedures’’ surgical

class is uniformly ordered last in the

surgical hierarchy of each MDC in

which it occurs, regardless of the fact

that the relative weight for the DRG or

22660 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

DRGs in that surgical class may be

higher than that for other surgical

classes in the MDC. The ‘‘other OR

procedures’’ class is a group of

procedures that are least likely to be

related to the diagnoses in the MDC but

are occasionally performed on patients

with these diagnoses. Therefore, these

procedures should only be considered if

no other procedure more closely related

to the diagnoses in the MDC has been

performed.

A second example occurs when the

difference between the average weights

for two surgical classes is very small.

We have found that small differences

generally do not warrant reordering of

the hierarchy since, by virtue of the

hierarchy change, the relative weights

are likely to shift such that the higherordered surgical class has a lower

average weight than the class ordered

below it.

Based on the preliminary

recalibration of the DRGs, we are

proposing to modify the surgical

hierarchy as set forth below. As we

stated in the September 1, 1989 final

rule (54 FR 36457), we are unable to test

the effects of proposed revisions to the

surgical hierarchy and to reflect these

changes in the proposed relative

weights due to the unavailability of the

revised GROUPER software at the time

the proposed rule is prepared. Rather,

we simulate most major classification

changes to approximate the placement

of cases under the proposed

reclassification and then determine the

average charge for each DRG. These

average charges then serve as our best

estimate of relative resource use for each

surgical class. We test the proposed

surgical hierarchy changes after the

revised GROUPER is received and

reflect the final changes in the DRG

relative weights in the final rule.

Further, as discussed in section II.C. of

this preamble, we anticipate that the

final recalibrated weights will be

somewhat different from those

proposed, because they will be based on

more complete data. Consequently,

further revision of the hierarchy, using

the above principles, may be necessary

in the final rule.

At this time, we are proposing to

revise the surgical hierarchy for the preMDC DRGs, MDC 5 (Diseases and

Disorders of the Circulatory System),

MDC 8 (Diseases and Disorders of the

Musculoskeletal System & Connective

Tissue) and MDC 20 (Alcohol/Drug Use

& Alcohol/Drug Induced Organic Mental

Disorders), as these are proposed to be

revised under sections II.B.2., II.B.3.,

and II.B.6. of this preamble, as follows:

• In the pre-MDC DRGs, we are

proposing to reorder Lung Transplant

(DRG 495) above Bone Marrow

Transplant (DRG 481). We are also

proposing to reorder Simultaneous

Pancreas/Kidney Transplant (DRG 512)

and Pancreas Transplant (DRG 513)

above Lung Transplant (DRG 495).

• In MDC 5, we are proposing to

reorder Cardiac Defibrillator Implants

(DRGs 514 and 515) above Other

Cardiothoracic Procedures (DRG 108).

We are also proposing to reorder

Percutaneous Cardiovascular

Procedures (DRGs 516, 517, and 518)

above Other Vascular Procedures (DRGs

478 and 479).

• In MDC 8, we are proposing to

reorder Cervical Spinal Fusion (DRGs

519 and 520) above Back & Neck

Procedures Except Spinal Fusion (DRGs

499 and 500).

• In MDC 20, we are proposing to

order as follows: Alcohol/Drug Abuse or

Dependence, Left AMA (DRG 433)

above Alcohol/Drug Abuse or

Dependence With CC (DRG 521);

Alcohol/Drug Abuse or Dependence

With CC (DRG 521) above Alcohol/Drug

Abuse or Dependence With

Rehabilitation Therapy Without CC

(DRG 522); and Alcohol/Drug Abuse or

Dependence With Rehabilitation

Therapy Without CC (DRG 522) above

Alcohol/Drug Abuse or Dependence

Without Rehabilitation Therapy

Without CC (DRG 523).

9. Refinement of Complications and

Comorbidities (CC) List

In the September 1, 1987 final notice

(52 FR 33143) concerning changes to the

DRG classification system, we modified

the GROUPER logic so that certain

diagnoses included on the standard list

of CCs would not be considered a valid

CC in combination with a particular

principal diagnosis. Thus, we created

the CC Exclusions List. We made these

changes for the following reasons: (1) To

preclude coding of CCs for closely

related conditions; (2) to preclude

duplicative coding or inconsistent

coding from being treated as CCs; and

(3) to ensure that cases are appropriately

classified between the complicated and

uncomplicated DRGs in a pair. We

developed this standard list of

diagnoses using physician panels to

include those diagnoses that, when

present as a secondary condition, would

be considered a substantial

complication or comorbidity. In

previous years, we have made changes

to the standard list of CCs, either by

adding new CCs or deleting CCs already

on the list. At this time, we do not

propose to delete any of the diagnosis

codes on the CC list.

In the May 19, 1987 proposed notice

(52 FR 18877) concerning changes to the

DRG classification system, we explained

that the excluded secondary diagnoses

were established using the following

five principles:

• Chronic and acute manifestations

of the same condition should not be

considered CCs for one another (as

subsequently corrected in the

September 1, 1987 final notice (52 FR

33154)).

• Specific and nonspecific (that is,

not otherwise specified (NOS))

diagnosis codes for a condition should

not be considered CCs for one another.

• Conditions that may not coexist,

such as partial/total, unilateral/bilateral,

obstructed/unobstructed, and benign/

malignant, should not be considered

CCs for one another.

• The same condition in anatomically

proximal sites should not be considered

CCs for one another.

• Closely related conditions should

not be considered CCs for one another.

The creation of the CC Exclusions List

was a major project involving hundreds

of codes. The FY 1988 revisions were

intended only as a first step toward

refinement of the CC list in that the

criteria used for eliminating certain

diagnoses from consideration as CCs

were intended to identify only the most

obvious diagnoses that should not be

considered complications or

comorbidities of another diagnosis. For

that reason, and in light of comments

and questions on the CC list, we have

continued to review the remaining CCs

to identify additional exclusions and to

remove diagnoses from the master list

that have been shown not to meet the

definition of a CC. (See the September

30, 1988 final rule (53 FR 38485) for the

revision made for the discharges

occurring in FY 1989; the September 1,

1989 final rule (54 FR 36552) for the FY

1990 revision; the September 4, 1990

final rule (55 FR 36126) for the FY 1991

revision; the August 30, 1991 final rule

(56 FR 43209) for the FY 1992 revision;

the September 1, 1992 final rule (57 FR

39753) for the FY 1993 revision; the

September 1, 1993 final rule (58 FR

46278) for the FY 1994 revisions; the

September 1, 1994 final rule (59 FR

45334) for the FY 1995 revisions; the

September 1, 1995 final rule (60 FR

45782) for the FY 1996 revisions; the

August 30, 1996 final rule (61 FR 46171)

for the FY 1997 revisions; the August

29, 1997 final rule (62 FR 45966) for the

FY 1998 revisions; the July 31, 1998

final rule (63 FR 40954) for the FY 1999

revisions, and the August 1, 2000 final

rule (65 FR 47064) for the FY 2001

revisions. In the July 30, 1999 final rule

(64 FR 41490) we did not modify the CC

Exclusions List for FY 2000 because we

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22661

did not make any changes to the ICD–

9–CM codes for FY 2000.

We are proposing a limited revision of

the CC Exclusions List to take into

account the changes that will be made

in the ICD–9–CM diagnosis coding

system effective October 1, 2001. (See

section II.B.11. below, for a discussion

of ICD–9–CM changes.) These proposed

changes are being made in accordance

with the principles established when we

created the CC Exclusions List in 1987.

Tables 6F and 6G in section V. of the

Addendum to this proposed rule

contain the proposed revisions to the CC

Exclusions List that would be effective

for discharges occurring on or after

October 1, 2001. Each table shows the

principal diagnoses with proposed

changes to the excluded CCs. Each of

these principal diagnoses is shown with

an asterisk, and the additions or

deletions to the CC Exclusions List are

provided in an indented column

immediately following the affected

principal diagnosis.

CCs that are added to the list are in

Table 6G—Additions to the CC

Exclusions List. Beginning with

discharges on or after October 1, 2001,

the indented diagnoses will not be

recognized by the GROUPER as valid

CCs for the asterisked principal

diagnosis.

CCs that are deleted from the list are

in Table 6H—Deletions from the CC

Exclusions List. Beginning with

discharges on or after October 1, 2001,

the indented diagnoses will be

recognized by the GROUPER as valid

CCs for the asterisked principal

diagnosis.

Copies of the original CC Exclusions

List applicable to FY 1988 can be

obtained from the National Technical

Information Service (NTIS) of the

Department of Commerce. It is available

in hard copy for $133.00 plus shipping

and handling. A request for the FY 1988

CC Exclusions List (which should

include the identification accession

number (PB) 88–133970) should be

made to the following address: National

Technical Information Service, United

States Department of Commerce, 5285

Port Royal Road, Springfield, VA 22161;

or by calling (800) 553–6847.

Users should be aware of the fact that

all revisions to the CC Exclusions List

(FYs 1989, 1990, 1991, 1992, 1993,

1994, 1995, 1996, 1997, 1998, and 1999)

and those in Tables 6F and 6G of this

document must be incorporated into the

list purchased from NTIS in order to

obtain the CC Exclusions List applicable

for discharges occurring on or after

October 1, 2001. (Note: There was no CC

Exclusions List in FY 2000 because we

did not make changes to the ICD–9–CM

codes for FY 2000.)

Alternatively, the complete

documentation of the GROUPER logic,

including the current CC Exclusions

List, is available from 3M/Health

Information Systems (HIS), which,

under contract with HCFA, is

responsible for updating and

maintaining the GROUPER program.

The current DRG Definitions Manual,

Version 18.0, is available for $225.00,

which includes $15.00 for shipping and

handling. Version 19.0 of this manual,

which includes the final FY 2002 DRG

changes, will be available in October

2001 for $225.00. These manuals may be

obtained by writing 3M/HIS at the

following address: 100 Barnes Road,

Wallingford, CT 06492; or by calling

(203) 949–0303. Please specify the

revision or revisions requested.

10. Review of Procedure Codes in DRGs

468, 476, and 477

Each year, we review cases assigned

to DRG 468 (Extensive OR Procedure

Unrelated to Principal Diagnosis), DRG

476 (Prostatic OR Procedure Unrelated

to Principal Diagnosis), and DRG 477

(Nonextensive OR Procedure Unrelated

to Principal Diagnosis) to determine

whether it would be appropriate to

change the procedures assigned among

these DRGs.

DRGs 468, 476, and 477 are reserved

for those cases in which none of the OR

procedures performed is related to the

principal diagnosis. These DRGs are

intended to capture atypical cases, that

is, those cases not occurring with

sufficient frequency to represent a

distinct, recognizable clinical group.

DRG 476 is assigned to those discharges

in which one or more of the following

prostatic procedures are performed and

are unrelated to the principal diagnosis:

60.0 Incision of prostate

60.12 Open biopsy of prostate

60.15 Biopsy of periprostatic tissue

60.18 Other diagnostic procedures on

prostate and periprostatic tissue

60.21 Transurethral prostatectomy

60.29 Other transurethral

prostatectomy

60.61 Local excision of lesion of

prostate

60.69 Prostatectomy NEC

60.81 Incision of periprostatic tissue

60.82 Excision of periprostatic tissue

60.93 Repair of prostate

60.94 Control of (postoperative)

hemorrhage of prostate

60.95 Transurethral balloon dilation of

the prostatic urethra

60.99 Other operations on prostate

All remaining OR procedures are

assigned to DRGs 468 and 477, with

DRG 477 assigned to those discharges in

which the only procedures performed

are nonextensive procedures that are

unrelated to the principal diagnosis.

The original list of the ICD–9–CM

procedure codes for the procedures we

consider nonextensive procedures, if

performed with an unrelated principal

diagnosis, was published in Table 6C in

section IV. of the Addendum to the

September 30, 1988 final rule (53 FR

38591). As part of the final rules

published on September 4, 1990 (55 FR

36135), August 30, 1991 (56 FR 43212),

September 1, 1992 (57 FR 23625),

September 1, 1993 (58 FR 46279),

September 1, 1994 (59 FR 45336),

September 1, 1995 (60 FR 45783),

August 30, 1996 (61 FR 46173), and

August 29, 1997 (62 FR 45981), we

moved several other procedures from

DRG 468 to 477, and some procedures

from DRG 477 to 468. No procedures

were moved in FY 1999, as noted in the

July 31, 1998 final rule (63 FR 40962);

in FY 2000, as noted in the July 30, 1999

final rule (64 FR 41496); or in FY 2001,

as noted in the August 1, 2000 final rule

(65 FR 47064).

a. Moving Procedure Codes From DRGs

468 or 477 to MDCs

We annually conduct a review of

procedures producing assignment to

DRG 468 or DRG 477 on the basis of

volume, by procedure, to see if it would

be appropriate to move procedure codes

out of these DRGs into one of the

surgical DRGs for the MDC into which

the principal diagnosis falls. The data

are arrayed two ways for comparison

purposes. We look at a frequency count

of each major operative procedure code.

We also compare procedures across

MDCs by volume of procedure codes

within each MDC.

Using 100 percent of the FY 2000

MedPAR file containing bills submitted

through May 31, 2000 for discharges in

FY 2000, we determined that the

quantity of cases in DRG 477 totaled

17,153. There were 106 instances where

the major operative procedure appeared

only once (6.4 percent of the time),

resulting in assignment to DRG 477.

Using the same 100 percent sample of

the FY 2000 MedPAR file, we reviewed

DRG 468. There were a total of 40,429

cases, with one major operative code

causing the DRG assignment 311 times

(or 8 percent) and 230 instances where

the major operative procedure appeared

only once (or 6 percent of the time).

Our medical consultants then

identified those procedures occurring in

conjunction with certain principal

diagnoses with sufficient frequency to

justify adding them to one of the

surgical DRGs for the MDC in which the

22662 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

diagnosis falls. Based on this year’s

review, we did not identify any

necessary changes in procedures under

DRG 477 and, therefore, are not

proposing to move any procedures from

DRG 477 to one of the surgical DRGs.

However, our medical consultants have

identified a number of procedure codes

that should be removed from DRG 468

and put into more clinically coherent

DRGs. The movement of these codes are

specified in the charts below:

MOVEMENT OF PROCEDURE CODES FROM DRG 468

Procedure code Description Included in

DRG Description

MDC 1—Diseases and Disorders of the Nervous System

5495 .................. Peritoneal Incision ........................... 7 Peripheral and Cranial Nerve and Other Nervous System Procedures

with CC

5495 .................. Peritoneal Incision ........................... 8 Peripheral and Cranial Nerve and Other Incision Nervous System Procedures without CC

MDC 3—Diseases and Disorders of the Ear

3821 .................. Blood Vessel Biopsy ........................ 63 Other Ear, Nose, Mouth and Throat OR Procedure

MDC 4—Diseases and Disorders of the Respiratory System

3821 .................. Blood Vessel Biopsy ........................ 76 Other Respiratory System OR Procedures with CC

3821 .................. Blood Vessel Biopsy ........................ 77 Other Respiratory System OR Procedures without CC

3929 .................. Vascular Shunt & Bypass NEC ....... 76 Other Respiratory System OR Procedures with CC

3929 .................. Vascular Shunt & Bypass NEC ....... 77 Other Respiratory System OR Procedures without CC

3931 .................. Suture of Artery ............................... 76 Other Respiratory System OR Procedures with CC

3931 .................. Suture of Artery ............................... 77 Other Respiratory System OR Procedures without CC

5411 .................. Exploratory Laparotomy ................... 76 Other Respiratory System OR Procedures with CC

5411 .................. Exploratory Laparotomy ................... 77 Other Respiratory System OR Procedures without CC

7749 .................. Bone Biopsy NEC ............................ 76 Other Respiratory System OR Procedures with CC

7749 .................. Bone Biopsy NEC ............................ 77 Other Respiratory System OR Procedures without CC

8669 .................. Free Skin Graft NEC ....................... 76 Other Respiratory System OR Procedures with CC

8669 .................. Free Skin Graft NEC ....................... 77 Other Respiratory System OR Procedures without CC

MDC 5—Diseases and Disorders of the Circulatory System

3402 .................. Exploratory Thoracotomy ................. 120 Other Circulatory System OR Procedures

3403 .................. Reopen Thoracotomy Site ............... 120 Other Circulatory System OR Procedures

3421 .................. Transpleura Thoracoscopy .............. 120 Other Circulatory System OR Procedures

3422 .................. Mediastinoscoy Circulatory .............. 120 Other Circulatory System OR Procedures

3426 .................. Open Mediastinal Biopsy ................. 120 Other Circulatory System OR Procedures

436 .................... Distal Gastrectomy .......................... 120 Other Circulatory System OR Procedures

437 .................... Partial Gastrectomy with Jejunal

Anastamosis.

120 Other Circulatory System OR Procedures

4389 .................. Partial Gastrectomy ......................... 120 Other Circulatory System OR Procedures

4399 .................. Total Gastrectomy ........................... 120 Other Circulatory System OR Procedures

14561 ................ Multiple Segment Small Bowel Excision.120 Other Circulatory System OR Procedures

4562 .................. Partial Small Bowel Resectomy

NEC.

120 Other Circulatory System OR Procedures

4572 .................. Cecectomy ....................................... 120 Other Circulatory System OR Procedures

4573 .................. Right Hemicolectomy ....................... 120 Other Circulatory System OR Procedures

4574 .................. Transverse Colon Resectomy ......... 120 Other Circulatory System OR Procedures

4575 .................. Left Hemicolectomy ......................... 120 Other Circulatory System OR Procedures

4579 .................. Partial Large Bowel Excision NEC .. 120 Other Circulatory System OR Procedures

458 .................... Total Intra-Abdominal Colectomy .... 120 Other Circulatory System OR Procedures

4593 .................. Small-to-Large Bowel NEC .............. 120 Other Circulatory System OR Procedures

4603 .................. Large Bowel Exteriorization ............. 120 Other Circulatory System OR Procedures

4613 .................. Permanent Colostomy ..................... 120 Other Circulatory System OR Procedures

4709 .................. Other Appendectomy ....................... 120 Other Circulatory System OR Procedures

4862 .................. Anterior Rectal Resction With Colostomy.120 Other Circulatory System OR Procedures

4863 .................. Anterior Rectal Resection NEC ....... 120 Other Circulatory System OR Procedures

4869 .................. Rectal Resection .............................. 120 Other Circulatory System OR Procedures

5012 .................. Open Liver Biopsy ........................... 120 Other Circulatory System OR Procedures

540 .................... Abdominal Wall Incision .................. 120 Other Circulatory System OR Procedures

MDC 6—Diseases and Disorders of the Digestive System

5122 .................. Cholecystectomy .............................. 170 Other Digestive System OR Procedures with CC

5122 .................. Cholecystectomy .............................. 171 Other Digestive System OR Procedures without CC

5123 .................. Laparoscopic Cholecystectomy ....... 170 Other Digestive System OR Procedures with CC

5132 .................. GB-To-Intestine Anastomy .............. 170 Other Digestive System OR Procedures with CC

5136 .................. Choledochoenterostomy .................. 170 Other Digestive System OR Procedures with CC

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22663

MOVEMENT OF PROCEDURE CODES FROM DRG 468

Procedure code Description Included in

DRG Description

5136 .................. Choledochoenterostomy .................. 171 Other Digestive System OR Procedures without CC

5137 .................. Hepatic Duct-GI Anastomy .............. 170 Other Digestive System OR Procedures with Anastomy CC

5137 .................. Hepatic Duct-GI Anastomy .............. 171 Other Digestive System OR Procedures without CC

5159 .................. Bile Duct Incision NEC .................... 170 Other Digestive System OR Procedures with CC

5159 .................. Bile Duct Incision NEC .................... 171 Other Digestive System OR Procedures without CC

MDC 7—Diseases and Disorders of the Hepatobiliary System and Pancreas

540 .................... Abdominal Wall Incision .................. 201 Other Hepatobiliary and Pancreas Procedure

MDC 8—Diseases and Disorders of the Musculoskeletal System and Connective Tissue

3479 .................. Other Chest Wall Repair ................. 233 Other Musculoskeletal System & Connective Tissue OR Procedure with

CC

3479 .................. Other Chest Wall Repair ................. 234 Other Musculoskeletal System & Connective Tissue OR Procedure without CC

MDC 11—Diseases and Disorders of the Kidney and Urinary Tract

540 .................... Abdominal Wall Incision .................. 315 Other Kidney & Urinary Tract OR Procedure

5451 .................. Laparoscopic Periton Adhesiolysis .. 315 Other Kidney & Urinary Tract OR Procedure

5459 .................. Other Periton Adhesiolysis .............. 315 Other Kidney & Urinary Tract OR Procedure

b. Reassignment of Procedures Among

DRGs 468, 476, and 477

We also annually review the list of

ICD–9–CM procedures that, when in

combination with their principal

diagnosis code, result in assignment to

DRGs 468, 476, and 477, to ascertain if

any of those procedures should be

moved from one of these DRGs to

another of these DRGs based on average

charges and length of stay. We look at

the data for trends such as shifts in

treatment practice or reporting practice

that would make the resulting DRG

assignment illogical. If our medical

consultants were to find these shifts, we

would propose moving cases to keep the

DRGs clinically similar or to provide

payment for the cases in a similar

manner. Generally, we move only those

procedures for which we have an

adequate number of discharges to

analyze the data. Based on our review

this year, we are not proposing to move

any procedures from DRG 468 to DRGs

476 or 477, from DRG 476 to DRGs 468

or 477, or from DRG 477 to DRGs 468

or 476.

c. Adding Diagnosis Codes to MDCs

Based on our review this year, we are

not proposing to add any diagnosis

codes to MDCs.

11. Changes to the ICD–9–CM Coding

System

As described in section II.B.1. of this

preamble, the ICD–9–CM is a coding

system that is used for the reporting of

diagnoses and procedures performed on

a patient. In September 1985, the ICD–

9–CM Coordination and Maintenance

Committee was formed. This is a

Federal interdepartmental committee,

co-chaired by the National Center for

Health Statistics (NCHS) and HCFA,

charged with maintaining and updating

the ICD–9–CM system. The Committee

is jointly responsible for approving

coding changes, and developing errata,

addenda, and other modifications to the

ICD–9–CM to reflect newly developed

procedures and technologies and newly

identified diseases. The Committee is

also responsible for promoting the use

of Federal and non-Federal educational

programs and other communication

techniques with a view toward

standardizing coding applications and

upgrading the quality of the

classification system.

The NCHS has lead responsibility for

the ICD–9–CM diagnosis codes included

in the Tabular List and Alphabetic

Index for Diseases, while HCFA has lead

responsibility for the ICD–9–CM

procedure codes included in the

Tabular List and Alphabetic Index for

Procedures.

The Committee encourages

participation in the above process by

health-related organizations. In this

regard, the Committee holds public

meetings for discussion of educational

issues and proposed coding changes.

These meetings provide an opportunity

for representatives of recognized

organizations in the coding field, such

as the American Health Information

Management Association (AHIMA)

(formerly American Medical Record

Association (AMRA)), the American

Hospital Association (AHA), and

various physician specialty groups as

well as physicians, medical record

administrators, health information

management professionals, and other

members of the public to contribute

ideas on coding matters. After

considering the opinions expressed at

the public meetings and in writing, the

Committee formulates

recommendations, which then must be

approved by the agencies.

The Committee presented proposals

for coding changes for implementation

in FY 2002 at public meetings held on

May 11, 2000 and November 17, 2000,

and finalized the coding changes after

consideration of comments received at

the meetings and in writing by January

8, 2001.

Copies of the Coordination and

Maintenance Committee minutes of the

2000 meetings can be obtained from the

HCFA home page at: http://

www.hcfa.gov/medicare/icd9cm.htm.

Paper copies of these minutes are no

longer available and the mailing list has

been discontinued. We encourage

commenters to address suggestions on

coding issues involving diagnosis codes

to: Donna Pickett, Co-Chairperson; ICD–

9–CM Coordination and Maintenance

Committee; NCHS; Room 1100; 6525

Belcrest Road; Hyattsville, MD 20782.

Comments may be sent by E-mail to:

dfp4@cdc.gov.

Questions and comments concerning

the procedure codes should be

addressed to: Patricia E. Brooks, CoChairperson; ICD–9–CM Coordination

and Maintenance Committee; HCFA,

Center for Health Plans and Providers,

Purchasing Policy Group, Division of

Acute Care; C4–07–07; 7500 Security

22664 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

Boulevard; Baltimore, MD 21244–1850.

Comments may be sent by E-mail to:

pbrooks@hcfa.gov.

The ICD–9–CM code changes that

have been approved will become

effective October 1, 2001. The new ICD–

9–CM codes are listed, along with their

proposed DRG classifications, in Tables

6A and 6B (New Diagnosis Codes and

New Procedure Codes, respectively) in

section V. of the Addendum to this

proposed rule. As we stated above, the

code numbers and their titles were

presented for public comment at the

ICD–9–CM Coordination and

Maintenance Committee meetings. Both

oral and written comments were

considered before the codes were

approved. Therefore, we are soliciting

comments only on the proposed DRG

classification of these new codes.

Further, the Committee has approved

the expansion of certain ICD–9–CM

codes to require an additional digit for

valid code assignment. Diagnosis codes

that have been replaced by expanded

codes or other codes or have been

deleted are in Table 6C (Invalid

Diagnosis Codes). These invalid

diagnosis codes will not be recognized

by the GROUPER beginning with

discharges occurring on or after October

1, 2001. For codes that have been

replaced by new or expanded codes, the

corresponding new or expanded

diagnosis codes are included in Table

6A (New Diagnosis Codes). There were

no procedure codes that were replaced

by expanded codes or other codes, or

were deleted. Revisions to diagnosis

code titles are in Table 6E (Revised

Diagnosis Code Titles), which also

include the proposed DRG assignments

for these revised codes. Revisions to

procedure code titles are in Table 6F

(Revised Procedure Codes Titles).

In September 2000, the Department

implemented a policy of paying for

inpatient hospital stays for Medicare

beneficiaries participating in clinical

trials (HCFA Program Memorandum AB

00–89, September 19, 2000). Hospitals

were encouraged to identify the patients

involved by reporting an ICD–9–CM

code. This would allow the examination

of data on the patients involved in

clinical trials. However, there was no

clear ICD–9–CM diagnosis code for

patients who took part in a clinical trial.

There was a code for patients receiving

an examination as part of the control

group for clinical trials. This control

group code was V70.7 (Examination for

normal comparison or control in clinical

research). Hospitals were instructed to

use V70.5 (Health examination of

defined subpopulations), for patients

participating in a clinical trial.

This coding directive has created

some confusion because of the title and

description of the two codes. Hospitals

also have requested that all clinical

patients be captured under one code.

They indicated that the use of one code

would be especially useful because

patients frequently do not know if they

are part of the control group or are

receiving new therapy.

To help alleviate the confusion, the

ICD–9–CM Coordination and

Maintenance Committee revised code

V70.7. Effective October 1, 2001, the

new title of code V70.7 is ‘‘Examination

of patient in clinical trial.’’ This revision

will make it easier to capture data on

Medicare beneficiaries who are

participating in a clinical trial.

12. Other Issues

a. Pancreas Transplant

Effective July 1, 1999, Medicare

covers whole organ pancreas

transplantation if the transplantation is

performed simultaneously with or after

a kidney transplant (procedure codes

55.69 (Other kidney transplantation), or

diagnosis code V42.0 (Organ or tissue

replaced by transplant, Kidney), along

with 52.80 (Pancreatic transplant, not

otherwise specified), or 52.82

(Homotransplant of pancreas)). A

discussion of the history of these

coverage decisions and codes can be

found in the August 1, 2000 final rule

on the prospective payment system for

FY 2001 (65 FR 47067).

We discussed the appropriate DRG

classification for these cases in both the

July 30, 1999 final rule (64 FR 41497)

and the August 1, 2000 final rule (65 FR

47067). Currently, cases can be assigned

to one of two major DRGs depending on

principal diagnosis. If a kidney

transplant and a pancreas transplant are

performed simultaneously on a patient

with chronic renal failure secondary to

diabetes with renal manifestations

(diagnosis codes 250.40 through

250.43), the cases will be assigned to

DRG 302 (Kidney Transplant). If a

pancreas transplant is performed

following a kidney transplant (during a

different hospital admission) on a

patient with chronic renal failure

secondary to diabetes with renal

manifestations, the case is assigned to

DRG 468 (Extensive OR Procedure

Unrelated to Principal Diagnosis). This

is because pancreas transplant is not

assigned to MDC 11 (Diseases and

Disorders of the Kidney and Urinary

Tract), the MDC to which a principal

diagnosis of chronic renal failure

secondary to diabetes is assigned.

In the August 1, 2000 final rule, we

noted that we would continue to

monitor these transplant cases to

determine the appropriateness of

establishing a new DRG. For this

proposed rule, using 100 percent of the

data in the FY 2000 MedPAR file (which

contains hospital bills received for FY

2000 through May 31, 2000), we

analyzed the cases for which procedure

codes 52.80 and 52.82 were reported.

(Our data showed that 15 of the cases

were coded using 52.83

(Heterotransplant of pancreas), which is

not a covered procedure under any

circumstances.) We identified a total of

221 cases for this time period. The

United Network for Organ Sharing

(UNOS) reported it had identified 270

cases through September 2000.

These 221 MedPAR cases were

distributed over 6 DRGs, with the

majority (158 cases or 72 percent)

assigned to DRG 302, and 23 cases (10

percent) assigned to DRG 468. The

remaining 40 cases were distributed

between 4 other DRGs, with the majority

(25 cases) being assigned to DRG 292

(Other Endocrine, Nutritional and

Metabolic OR Procedures with CC).

Four cases were assigned to DRG 483

(Tracheostomy with Principal Diagnosis

except Face, Mouth and Neck

Diagnoses) in the Pre-MDC grouping,

which took precedence over any other

DRG assignment.

We arrayed the data based on the

presence or absence of kidney

transplant; that is, pancreas transplant

codes with or without 55.69. The

majority of cases (166 or 75 percent) had

the combined kidney-pancreas

transplant in one operative episode,

with 55 (25 percent) of the cases having

pancreas transplant subsequent to the

kidney transplant. Differences in

hospital charges were significantly

higher for a pancreas transplant plus a

kidney transplant ($138,809) than a

pancreas transplant alone ($85,972), and

both were higher than average

standardized charges in DRG 302

($64,760) or DRG 468 ($39,707),

although it must be noted that these

figures do reflect the resource intensive

patients assigned to DRG 483. Those

patients in DRG 483 had average

standardized charges of $377,934.

Because these categories of patients

do not fit into existing DRGs from either

a clinical or resource perspective, we

are proposing to create two new DRGs

that would reflect these patients’ unique

clinical profiles: DRG 512

(Simultaneous Pancreas/Kidney

Transplant) and DRG 513 (Pancreas

Transplants). Cases grouped to either

proposed DRGs 512 or 513 must have a

principal or secondary diagnosis code

and procedure code or combination of

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22665

procedure codes as indicated in the

chart below:

COMPOSITION OF PROPOSED DRGS 512 AND 513

Diagnosis and procedure codes

Included in

proposed

DRG 512

Included in

proposed

DRG 513

Principal or Secondary ICD–9–CM Diabetes Mellitus Code:

250.00 Diabetes mellitus without mention of complication, Type II or unspecified type, not stated as uncontrolled .................................................................................................................................................................... X X

250.01 Diabetes mellitus without mention of complication, Type I, not stated as uncontrolled ........................... X X

250.02 Diabetes mellitus without mention of complication, Type I, ...................................................................... X X

250.03 Diabetes mellitus without mention of complication, Type I, uncontrolled ................................................. X X

250.10 Diabetes with ketoacidosis, Type II or Unspecified type, not stated as uncontrolled ............................... X X

250.11 Diabetes with ketoacidosis, Type I, not stated as uncontrolled ................................................................ X X

250.12 Diabetes with ketoacidosis, Type II or unspecified type, uncontrolled .....................................................X X

250.13 Diabetes with ketoacidosis, Type I, controlled .......................................................................................... X X

250.20 Diabetes with hyperosmolarity, Type II or unspecified type, not stated as uncontrolled .......................... X X

250.21 Diabetes with hyperosmolarity, Type I, not stated as uncontrolled .......................................................... X X

250.22 Diabetes with hyperosmolarity, Type II or unspecified type, uncontrolled ................................................ X X

250.23 Diabetes with hyperosmolarity, Type I, uncontrolled ................................................................................. X X

250.30 Diabetes with other coma, Type II or unspecified type, not stated as uncontrolled.

250.31 Diabetes with other coma, Type I, not stated as uncontrolled .................................................................. X X

250.32 Diabetes with other coma, Type II or unspecified type, uncontrolled .......................................................X X

250.33 Diabetes with other coma, Type I, uncontrolled ........................................................................................ X X

250.40 Diabetes with renal manifestations, Type II or unspecified type, not stated as uncontrolled ................... X X

250.41 Diabetes with renal manifestations, Type I, not stated as uncontrolled ................................................... X X

250.42 Diabetes with renal manifestations, Type II unspecified type, uncontrolled ............................................. X X

250.43 Diabetes with renal manifestations, Type I, uncontrolled .......................................................................... X X

250.50 Diabetes with ophthalmic manifestations, Type II or unspecified type, not stated as uncontrolled ......... X X

250.51 Diabetes with ophthalmic manifestations, Type I, not stated as uncontrolled .......................................... X X

250.52 Diabetes with ophthalmic manifestations, Type II or unspecified type, uncontrolled ............................... X X

250.53 Diabetes with ophthalmic manifestations, Type I, uncontrolled ................................................................ X X

250.60 Diabetes with neurological manifestations, Type II or unspecified type, not stated as uncontrolled ....... X X

250.61 Diabetes with neurological manifestations, Type I, not stated as uncontrolled ........................................ X X

250.62 Diabetes with neurological manifestations, Type II or unspecified type, uncontrolled ............................. X X

250.63 Diabetes with neurological manifestations, Type I uncontrolled ............................................................... X X

250.70 Diabetes with peripheral circulatory disorders, Type II or unspecified type, not stated as uncontrolled X X

250.71 Diabetes with peripheral circulatory disorders, Type I, not stated as uncontrolled .................................. X X

250.72 Diabetes with peripheral circulatory disorders, Type II or unspecified type, uncontrolled ........................ X X

250.73 Diabetes with peripheral circulatory disorders, Type I, uncontrolled ........................................................ X X

250.80 Diabetes with other specified manifestations, Type II or unspecified type, not stated as uncontrolled ... X X

250.81 Diabetes with other specified manifestations, Type I, not stated as uncontrolled .................................... X X

250.82 Diabetes with other specified manifestations, Type II or unspecified type, uncontrolled ......................... X X

250.83 Diabetes with other specified manifestations, Type I, uncontrolled .......................................................... X X

250.90 Diabetes with unspecified complication, Type II or unspecified type, not stated as uncontrolled ............ X X

250.91 Diabetes with unspecified complication, Type I, not stated as uncontrolled ............................................ X X

250.92 Diabetes with unspecified complication, Type II or unspecified type, uncontrolled .................................. X X

250.93 Diabetes with unspecified complication, Type I, uncontrolled ................................................................... X X

Principal or Secondary Diagnosis Code:

585 Chronic renal failure ........................................................................................................................................ X X

403.01 Hypertensive renal disease, malignant, with renal failure ......................................................................... X X

403.11 Hypertensive renal disease, benign, with renal failure .............................................................................. X X

403.91 Hypertensive renal disease, unspecified, with renal failure ...................................................................... X X

404.02 Hypertensive heart & renal disease, malignant, with renal failure ............................................................ X X

404.03 Hypertensive heart & renal disease, malignant, with congestive heart failure and renal disease ........... X X

404.12 Hypertensive heart & renal disease, benign, with renal failure ................................................................. X X

404.13 Hypertensive heart & renal disease, benign, with congestive heart failure and renal disease ................ X X

404.92 Hypertensive heart & renal disease, unspecified, with renal failure ......................................................... X X

404.93 Hypertensive heart & renal disease, unspecified, with congestive heart failure and renal failure ........... X X

V42.0 Organ or tissue replaced by transplant, kidney .......................................................................................... X X

V43.89 Organ or tissue replaced by other means, other (Kidney) ....................................................................... X X

Procedure Code:

52.80 Pancreatic transplant, not otherwise specified ............................................................................................ X

52.82 Homotransplant of pancreas ........................................................................................................................ X

Combination Procedure Codes:

52.80 Pancreatic transplant, not otherwise specified, plus

55.69 Other kidney transplantation ........................................................................................................................ X

or

52.82 Homotransplant of pancreas plus

55.69 Other kidney transplantation ........................................................................................................................ X

22666 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

The logic for the proposed DRG 512

accepts the pair of diagnosis codes in

any position (principal/secondary or

secondary/secondary). The pair of

procedure codes must be present along

with the two diagnosis codes. This DRG

would be placed in the Pre-MDC

GROUPER logic immediately following

DRG 480 (Liver Transplant).

The logic for DRG 513 accepts the pair

of diagnosis codes in any position

(principal/secondary or secondary/

secondary). Only one procedure code

must be used along with the two

diagnosis codes. This DRG would be

placed in the Pre-MDC GROUPER logic

immediately following proposed new

DRG 512 (Simultaneous Pancreas/

Kidney Transplant).

b. Intestinal Transplantation

Effective April 1, 2001, Medicare

covers intestinal transplantation for the

purpose of restoring intestinal function

in patients with irreversible intestinal

failure (Medicare Program

Memorandum Transmittal No. AB–00–

130, December 22, 2000). This

procedure is covered only when

performed for patients who have failed

total parenteral nutrition (TPN) and

only when performed in centers that

meet approval criteria.

Intestinal failure is defined as the loss

of absorptive capacity of the small

bowel secondary to severe primary

gastrointestinal disease or surgically

induced short bowel syndrome.

Intestinal failure prevents oral nutrition

and may be associated with both

mortality and profound morbidity.

If an intestinal transplantation alone

is performed on a patient with an

intestinal principal diagnosis, the case

would be assigned to either DRG 148

(Major Small & Large Bowel Procedures

With CC) or DRG 149 (Major Small &

Large Bowel Procedures Without CC). If

an intestinal transplantation and a liver

transplantation are performed

simultaneously, the case would be

assigned to DRG 480 (Liver Transplant).

If an intestinal transplantation and a

pancreas transplantation are performed

simultaneously, currently the case

would be assigned to either DRG 148 or

DRG 149. As we have proposed in

section II.B.12.A. of this proposed rule,

effective October 1, 2001, the case

would be assigned to DRG 513 (Pancreas

Transplant). We are proposing to make

a conforming change to the regulations

at § 412.2(e)(4) and § 486.302 to include

intestines (and multivisceral organs) in

the list of organs for which Medicare

pays for the acquisition costs on a

reasonable cost basis.

Effective October 1, 2000, procedure

code 46.97 (Transplant of intestine) was

created. We have examined our

Medicare claims data to determine

whether it is appropriate to propose a

new intestinal transplant DRG. We

examined 100 percent of the data in the

FY 2000 MedPAR file containing bills

submitted through May 31, 2000.

Therefore, we focused our examination

on the previous code assignment for

intestinal transplant, code 46.99 (Other

operations on intestines), and facilities

that are currently performing intestinal

transplantation. We were able to

identify only one case, with an average

charge of approximately $10,738 as

compared to the average standardized

charges for DRGs 148 and 149, which

are approximately $37,961, and $16,965,

respectively. We will continue to

monitor these cases to determine

whether it may be appropriate in the

future to establish a new DRG.

C. Recalibration of DRG Weights

We are proposing to use the same

basic methodology for the FY 2002

recalibration as we did for FY 2001

(August 1, 2000 final rule (65 FR

47069)). That is, we would recalibrate

the weights based on charge data for

Medicare discharges. However, we

propose to use the most current charge

information available, the FY 2000

MedPAR file. (For the FY 2001

recalibration, we used the FY 1999

MedPAR file.) The MedPAR file is based

on fully coded diagnostic and procedure

data for all Medicare inpatient hospital

bills.

The proposed recalibrate DRG relative

weights are constructed from FY 2000

MedPAR data (discharges occurring

between October 1, 1999 and September

30, 2000), based on bills received by

HCFA through December 31, 2000, from

all hospitals subject to the prospective

payment system and short-term acute

care hospitals in waiver States. The FY

2000 MedPAR file includes data for

approximately 11,008,302 Medicare

discharges.

The methodology used to calculate

the proposed DRG relative weights from

the FY 2000 MedPAR file is as follows:

• To the extent possible, all the

claims were regrouped using the

proposed DRG classification revisions

discussed in section II.B. of this

preamble. As noted in section II.B.8.,

due to the unavailability of the revised

GROUPER software, we simulated most

major classification changes to

approximate the placement of cases

under the proposed reclassification.

However, there are some changes that

cannot be modeled.

• Charges were standardized to

remove the effects of differences in area

wage levels, indirect medical education

and disproportionate share payments,

and, for hospitals in Alaska and Hawaii,

the applicable cost-of-living adjustment.

• The average standardized charge

per DRG was calculated by summing the

standardized charges for all cases in the

DRG and dividing that amount by the

number of cases classified in the DRG.

• We then eliminated statistical

outliers, using the same criteria used in

computing the current weights. That is,

all cases that are outside of 3.0 standard

deviations from the mean of the log

distribution of both the charges per case

and the charges per day for each DRG

are eliminated.

• The average charge for each DRG

was then recomputed (excluding the

statistical outliers) and divided by the

national average standardized charge

per case to determine the relative

weight. A transfer case is counted as a

fraction of a case based on the ratio of

its transfer payment under the per diem

payment methodology to the full DRG

payment for nontransfer cases. That is,

transfer cases paid under the transfer

methodology equal to half of what the

case would receive as a nontransfer

would be counted as 0.5 of a total case.

• We established the relative weight

for heart and heart-lung, liver, and lung

transplants (DRGs 103, 480, and 495) in

a manner consistent with the

methodology for all other DRGs except

that the transplant cases that were used

to establish the weights were limited to

those Medicare-approved heart, heartlung, liver, and lung transplant centers

that have cases in the FY 1999 MedPAR

file. (Medicare coverage for heart, heartlung, liver, and lung transplants is

limited to those facilities that have

received approval from HCFA as

transplant centers.)

• Acquisition costs for kidney, heart,

heart-lung, liver, lung, and pancreas

transplants continue to be paid on a

reasonable cost basis. Unlike other

excluded costs, the acquisition costs are

concentrated in specific DRGs (DRG 302

(Kidney Transplant); DRG 103 (Heart

Transplant); DRG 480 (Liver

Transplant); DRG 495 (Lung

Transplant); and proposed new DRGs

512 (Simultaneous Pancreas/Kidney

Transplant) and 513 (Pancreas

Transplant). Because these costs are

paid separately from the prospective

payment rate, it is necessary to make an

adjustment to prevent the relative

weights for these DRGs from including

the acquisition costs. Therefore, we

subtracted the acquisition charges from

the total charges on each transplant bill

that showed acquisition charges before

computing the average charge for the

DRG and before eliminating statistical

outliers.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22667

When we recalibrated the DRG

weights for previous years, we set a

threshold of 10 cases as the minimum

number of cases required to compute a

reasonable weight. We propose to use

that same case threshold in recalibrating

the DRG weights for FY 2002. Using the

FY 2000 MedPAR data set, there are 39

DRGs that contain fewer than 10 cases.

We computed the weights for these 39

low-volume DRGs by adjusting the FY

2001 weights of these DRGs by the

percentage change in the average weight

of the cases in the other DRGs.

The new weights are normalized by

an adjustment factor (1.44813) so that

the average case weight after

recalibration is equal to the average case

weight before recalibration. This

adjustment is intended to ensure that

recalibration by itself neither increases

nor decreases total payments under the

prospective payment system, and

accounts for the gradual shift in cases

toward higher-weighted DRGs over

time.

Section 1886(d)(4)(C)(iii) of the Act

requires that, beginning with FY 1991,

reclassification and recalibration

changes be made in a manner that

assures that the aggregate payments are

neither greater than nor less than the

aggregate payments that would have

been made without the changes.

Although normalization is intended to

achieve this effect, equating the average

case weight after recalibration to the

average case weight before recalibration

does not necessarily achieve budget

neutrality with respect to aggregate

payments to hospitals because payment

to hospitals is affected by factors other

than average case weight. Therefore, as

we have done in past years and as

discussed in section II.A.4.b. of the

Addendum to this proposed rule, we are

proposing to make a budget neutrality

adjustment to ensure that the

requirement of section 1886(d)(4)(C)(iii)

of the Act is met.

D. Incorporating New Medical Services

and Technologies in the Inpatient

Hospital Prospective Payment System

Much attention recently has focused

on how well Medicare incorporates the

cost of new medical services and

technologies into its payment systems.

Of particular concern is the adequacy of

Medicare’s payment systems in

facilitating access to new technologies

for Medicare beneficiaries. Section 533

of Public Law 106–554 directs the

Secretary to develop a mechanism for

ensuring adequate payment under the

hospital inpatient prospective payment

system for new medical services and

technologies, and to report to Congress

on ways to more expeditiously

incorporate new services and

technologies into that system. This

discussion addresses the requirements

of section 533 of Public Law 106–554.

1. Overview

Medicare payment for an inpatient

hospital discharge under the inpatient

prospective payment system is

determined by multiplying the relative

weight associated with a particular DRG

by the national average standardized

amount (adjusted for other hospital

characteristics such as a geographic

wage index, teaching status, and treating

a high percentage of low-income

patients). Cases are classified into DRGs

for payment under the prospective

payment system based on the principal

diagnosis, up to eight additional

diagnoses, and up to six procedures

performed during the stay, as well as

age, sex, and discharge status of the

patient. The diagnosis and procedure

information is reported by the hospital

using codes from the International

Classification of Diseases, Ninth

Revision, Clinical Modification (ICD–9–

CM). The DRG relative weights are

recalculated each year to reflect the

average resources expended across all

hospitals to treat patients within a

particular DRG.

In general, the inpatient prospective

payment system makes payments for

new medical services and technologies

as soon as these items are payable. New

items or services generally fit within

existing DRGs, and hospitals using these

items and services will be paid at

established payment rates for the

applicable DRGs. Payment rates may

subsequently be adjusted through the

annual process of evaluating the

assignment of cases within DRGs and

recalculating the relative weights

associated with each DRG based on

average charges. These annual changes

are made to reflect changes in treatment

patterns, technology, and any other

factors that may change the relative use

of hospital resources.

Since the prospective payment system

was first implemented in October 1983,

the pace of innovation in medical

technology has been rapid. Generally

speaking, the system appears to have

accommodated these innovations

without occasioning significant

concerns regarding access to new

technologies. In its March 2001 report to

the Congress, the Medicare Payment

Advisory Commission stated ‘‘the

design of the inpatient PPS (prospective

payment system) makes it easier to

ensure an appropriate distribution of

payments while accommodating

technological advances’’ (page 44).

2. Current Practice—Coding and

Payment

A number of issues arise relating to

present methods of incorporation of

new technologies in the inpatient

hospital prospective payment system.

One issue is the appropriate ICD–9–CM

code to be assigned to the new

technology. This issue is discussed in

detail below. Assuming the new

technology is or can be covered by

Medicare, a determination must be

made concerning to which DRG should

the new technology be assigned. The

DRG (and the value of the relative

weight associated with that DRG) to

which the new technology is assigned

determines the payment rate for the new

technology. Under the DRG system, the

condition of the patient is the primary

consideration in the decision to assign

a new technology to a DRG. Therefore,

a new technology generally will be

assigned to the same DRG as the DRG’s

predecessor technologies and treatment

modalities. In this way, hospitals can

receive payment for new technology

under the inpatient hospital prospective

payment system quickly. As use of the

new technology diffuses among

hospitals, HCFA will gradually and

largely automatically recalibrate DRG

payment rates based on hospital claims

data to reflect increasing or decreasing

costs of cases assigned to the DRG.

Generally, it takes 2 years for claims

data to be reflected in recalibrated DRG

weights. Considering the actual costs as

reflected in the claims data, HCFA may

also reassign new technologies to

different DRGs. However, because a new

technology is often more costly initially

than the predecessor technologies, the

adequacy of the initial payment rate

occasionally becomes an issue.

At present, if payment is to be made

other than by routine assignment of the

new technology to an existing DRG, it is

necessary to establish a new ICD–9–CM

code. The lag between application for a

new code and its being made effective

for payment is at least a year. Because

we use actual charge data from

hospitals, additional costs or savings

from the new technology are not

reflected in the DRG weight for 2 years

after a new code is effective. For

example, the costs or savings

attributable to any new technologies

that were assigned new ICD–9–CM

codes effective October 1, 1999, will be

reflected in the DRG relative weights

effective for discharges on or after

October 1, 2001.

The lag before new technology

affected payment has been viewed by

some observers as a useful check on

payment changes, helping to ensure that

22668 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

these changes reflect the benefit of a

new technology. Hospitals would adopt

and utilize the new technology, it was

reasoned, with a speed and to a degree

commensurate with its medical

advantages. Any differences in the

resource requirements between the new

and existing technologies would then be

reflected over time in claims data and in

changes in the DRG weights. To the

extent particular new technologies may

have been initially given relatively low

payment, the design of the system

provided incentives to compensate by

achieving efficiencies elsewhere.

Conversely, if a particular new

technology reduced costs compared to

existing technologies, hospitals would

reap the payment benefits until such

time as the DRG weights began to reflect

the lower costs.

3. Current Practice—Data

Recently, HCFA provided an explicit

avenue to permit more rapid payment

adjustment through use of additional

data. The Conference Report that

accompanied the Balanced Budget Act

of 1997 (Public Law 105–33) stated that

‘‘in order to ensure that Medicare

beneficiaries have access to innovative

new drug therapies, the conferees

believe that HCFA should consider, to

the extent feasible, reliable, validated

data other than Medicare Provider

Analysis and Review (MedPAR) data in

annually recalibrating and reclassifying

the DRGs’’ (H.R. Conf. Rep. No. 105–

217, 105th Cong., 1st Sess., at 734

(1997)). The MedPAR contains records

for all Medicare hospital discharges and

is the source data used for DRG

recalibration. Although we had never

precluded the use of non-MedPAR data,

we established an explicit process for

the submission of such data in a manner

consistent with the annual recalibration

of the DRG weights. We stated in the

July 30, 1999 Federal Register that, in

the case of external data, a significant

sample of the data should be submitted

by August 1, approximately 8 months

prior to the publication of the proposed

rule. This would allow us to verify and

test the data and make a preliminary

assessment as to the feasibility of the

data’s use (64 FR 41499). Subsequently,

a complete database must be submitted

no later than December 1,

approximately 4 months prior to the

publication of the proposed rule. On the

issue of the use of sample data, we

stated in the Federal Register that we

were not establishing specific criteria

regarding sample sizes or data collection

methodologies prior to gaining

experience that would enable us to

realistically reflect the availability of

external data based on actual

experience. We also encouraged anyone

interested in submitting such data in the

future to contact us to discuss the

specific data they wish to submit and

whether the data may be adequate.

4. New Legislation

Section 533 of Public Law 106–554

addresses the issue of how new

technologies are introduced into the

DRGs, and how DRG payment rates

must be adapted to accommodate them.

Specifically, the provision requires that

the Secretary:

• Not later than April 1, 2001, submit

a report to Congress on methods of

expeditiously incorporating new

medical services and technologies into

the clinical coding system.

• Not later than October 1, 2001,

implement the preferred methods

described in the report.

• Effective October 1, 2001, establish

a mechanism to recognize the costs of

new medical services and technologies

after notice and opportunity for public

comment.

• Establish criteria to identify new

medical services or technologies after

notice and an opportunity for public

comment.

5. DRG Assignment Issues

As background for discussion of how

the DRGs should be changed to better

accommodate new technology, this

section will discuss the rationale for

basing the initial DRG assignment on

patient condition. The underlying

assumption of the prospective payment

system is that because hospitals are

responsible for the delivery of care they

can respond to the incentives to control

costs inherent in the system. The

success of any payment system that is

predicated on providing incentives for

cost control is almost totally dependent

on the effectiveness with which the

incentives are communicated. The DRGs

were designed to be a management tool

that is used also as the basis for

prospective payments. The key

distinction between a management tool

and payment method is the ability of the

hospital to use the information to take

action in response to the incentives in

the system. Thus, a management tool

communicates information in a form

and at a level of detail that can lead to

specific actions. The effectiveness of

any incentive-based payment system is

enhanced if the payment method is

simultaneously a management tool.

Because the DRGs were developed to

group clinically similar patients, an

extremely important means of

communication between the clinical

and financial aspects of care was

created. DRGs provided administrators

and physicians with a meaningful basis

for evaluating both the process of

providing care and the associated

financial impacts. Development of care

pathways by DRG and profit-and-loss

reports by DRG product lines became

commonplace. With the adoption of

these new management methods, length

of stay and the use of ancillary services

dropped dramatically.

The DRGs not only provided a

communications tool for hospital

management, but they also provided an

effective means for hospitals and

Medicare to communicate. Instead of

accountants and lawyers arguing the

fine points of cost accounting, the focus

of payment deliberations became the

determination of a fair payment rate for

patients with specific clinical problems.

The vast majority of modifications to the

DRGs since the inception of the

Medicare inpatient hospital prospective

payment system have resulted from

recommendations from hospitals. The

recommendations have almost always

been the result of clinicians identifying

specific types of patients with unique

needs. A recent example of such a

clinical dialogue relates to the DRGs for

burns. The FY 1999 update to the DRGs

included a major restructuring of the

burn DRGs. This restructuring was the

direct result of detailed and specific

clinical recommendations provided to

HCFA by burn specialists.

Central to the success of the Medicare

inpatient hospital prospective payment

system is that DRGs have remained a

clinical description of why the patient

required hospitalization. We believe it

would be undesirable to transform DRGs

into detailed descriptions of the

technology and processes used by the

hospital to treat the patient. If such a

transformation were to happen, the

DRGs would become largely a

repackaging of fee-for-service without

the management and communication

benefits. A fundamental assumption

underlying DRGs is that the hospital has

the responsibility for deciding what

technology and process to employ in

treating a particular type of patient. As

hospitals in the aggregate make

treatment decisions, these decisions are

reflected in the DRG payment weights.

The separation of the clinical and

payment weight methodologies allows a

stable clinical methodology to be

maintained while the payment weights

evolve in response to changing practice

patterns. The packaging of all services

associated with the care of a particular

type of patient into a single payment

amount provides the incentive for

efficiency inherent in a DRG-based

prospective payment system.

Substantial disaggregation of the DRGs

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22669

into smaller units of payment, or a

substantial number of cases receiving

extra payments, would undermine the

incentives and communication value in

the DRG system.

6. Coding Issues

To permit us to identify use of a new

technology on hospital claims and

hence to make different payments than

would otherwise be applicable, we

would require a code that can be used

to specify when that technology is used.

a. Process for Establishing New Codes

The ICD–9–CM Coordination and

Maintenance Committee is responsible

for discussing potential changes to ICD–

9–CM. This is a Federal

interdepartmental committee, cochaired by the National Center for

Health Statistics (NCHS) and HCFA.

The NCHS has lead responsibility for

the ICD–9–CM diagnosis codes, while

HCFA has lead responsibility for the

ICD–9–CM procedure codes. The

committee holds meetings twice a year,

usually in May and November. Agendas

for the discussions about procedure

codes are published on HCFA’s Internet

website a month before the meeting. A

Federal Register notice is also

published listing topics to be discussed.

The meetings are open to the public and

are held usually in Baltimore, Maryland.

Shortly afterwards, an extensive

summary of the meeting is published on

HCFA’s website and the public is given

an additional opportunity to comment.

Final comments are due by early

January. A complete, current timeline is

included in the Summary Report of the

Committee at: www.hcfa.gov/medicare/

icd9cm.htm.

For a topic to be discussed at one of

the two yearly meetings of the

committee, the committee must receive

a request 2 months prior to the meeting.

This timeframe allows HCFA to publish

the agendas in the Federal Register

notices and allows individuals and

organizations to review the agenda and

to determine if they wish to attend the

public meetings. The timeframe is also

necessary to allow the committee to

research the topic and prepare a draft

solution in time for the meeting. During

the meetings, the committee provides a

brief description of the topic (such as a

new technology that may not be

adequately identified by the current

code) and then describes the technology

or procedure through a formal

presentation. Frequently, medical

experts who perform the procedure

make a presentation to describe the

procedure and how it might be different

from other procedures in the current

code. Proposals are made to either

continue capturing the procedure in the

existing code, revise existing codes, or

create a new code. The public then

discusses the merits of the proposals

and offers any alternate suggestions.

The ICD–9–CM is updated once a

year, effective October 1. This date

coincides with the annual updates to

the DRGs within the inpatient hospital

prospective payment system. Each

spring HCFA publishes a proposed rule

that includes proposed changes to the

inpatient hospital prospective payment

system. This notice also includes final

decisions on changes to ICD–9–CM

codes. By August 1, HCFA publishes the

new codes in the Addendum to the final

rule, which is a technical presentation

of actual changes to be made in both the

index and tabular sections of the ICD–

9–CM coding books. The Addendum is

available on HCFA’s website and is also

sent to organizations such as the

American Hospital Association (AHA)

and the American Health Information

Management Association (AHIMA) to

distribute to their members. By October

1 of each year, the Department of Health

and Human Services also produces a

CD–ROM version of the ICD–9–CM,

which may be purchased at the

Government Printing Office. Since the

ICD–9–CM is not a copyrighted system,

many publishers and organizations

distribute and sell books or other

publications that include the changes to

ICD–9–CM.

Although the committee’s process for

discussing proposed changes to the

ICD–9–CM fully involves and informs

the public, the deliberative nature of the

process does require some time. Topics

discussed at the May and November

2000 meetings of the Committee are for

changes to ICD–9–CM in October 2001.

Therefore, depending on whether a

request is considered at the May or

November meeting, resulting changes

may not be effective for approximately

a year to a year-and-a-half later.

b. Options To Expedite the

Implementation of Coding Changes

Several constraints upon the system

would complicate implementing

extensive changes. One significant

complication is the interaction between

the DRG system and the ICD–9–CM

diagnosis and procedure codes (in the

case of new services and technologies,

the discussion focuses on procedure

rather than diagnosis codes). When a

new procedure code is created, a

decision must be made as to whether

the new code affects DRG assignment

(for example, resulting in a case being

assigned to a surgical rather than a

medical DRG). Currently, new

technology is generally assigned to the

same DRG as its predecessor codes.

Even if new codes do not affect DRG

assignment, the GROUPER software

(used to assign cases to DRGs) must be

reprogrammed to recognize and classify

all the new codes. This is necessary to

allow Medicare’s claims processing

systems to process the claim.

In addition to the changes to the

GROUPER software, implementing

changes to ICD–9–CM codes is a

detailed and far-reaching process

involving modifications to code books

and software coding systems, as well as

changes to hospitals’ claims processing

systems. As described above, the current

process is organized around the annual

publication of coding changes in the

Federal Register as part of the updates

and changes to the inpatient hospital

prospective payment system. The

changes are made available during the

summer, and communicated via

multiple channels to hospitals. This

process allows for the necessary

processing changes to be thoroughly

tested prior to implementation, both by

HCFA and by the hospitals. This testing

procedure is essential given the volume

(generally 11 million claims annually)

and dollar impact (approximately $75

billion during FY 2001) of Medicare

inpatient discharges.

Another important issue when

considering expediting the process of

making coding changes is that the

annual DRG reclassification and

recalibration of the relative weights

must be made in a manner that ensures

that aggregate payments to hospitals are

not affected (section 1886(d)(4)(C)(iii) of

the Act). If ICD–9–CM changes were

made at multiple times during the year,

the budget neutrality requirement

would mean the standardized amounts,

and potentially the cost outlier

thresholds, would change as well. These

changes would compromise the

prospective nature of the payment

system, whereby hospitals are able to

project their revenues for the year and

plan accordingly. Because we do not

believe the requirement in section 533

of Public Law 106–554 to explore ways

to expedite coding changes was

intended to disrupt the prospective

nature of the payment system, we did

not consider options that would require

revising the DRG weights and the

standardized amounts more than once a

year.

With these considerations in mind,

we explored the potential for shortening

the current process.

First, we are proposing to move the

November meeting of the Coordination

and Maintenance Committee to

December without significant

disruption. To move it further would

22670 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

disrupt the process for production of the

annual inpatient prospective payment

system regulation. This step would

shorten the code assignment process by

a month and permit coding changes

resulting in payment changes to be

implemented in a year.

Second, we are proposing to expedite

the process by issuing new coding

decisions resulting from the spring

meeting of the Committee (currently in

May) that would be effective the

following October 1. It may be necessary

to move the May meeting to April to

accommodate this procedure. Because

the timing of this process would not

allow the coding changes to be

incorporated into the proposed rule

published in the spring, cases with the

new codes would have to be assigned to

the same DRG to which they would

have been assigned without the new

code and no other payment adjustments

would be possible. These coding

changes would thus not affect the DRG

weights or the budget neutrality

calculations. However, more rapid

introduction of new codes would permit

reflection of the codes in claims data

more quickly, and thus would permit

eventual adjustment of payment rates

sooner than otherwise possible. This

capability could be of particular use

where otherwise available data were not

sufficient to support an immediate

payment change, because hospital

claims data permitting identification of

use of the new technology would be

available more quickly.

This change would reduce the time

between discussion of a proposed code

and its implementation from a

minimum of 11 months to 6 months. It

would allow for the collection of

MedPAR data a full year earlier than

under the current process, providing the

possibility that DRG revisions based on

new codes could be expedited by up to

1 year.

There would be significant challenges

to making this proposed process work.

Because the changes would not be

published in the proposed rule, the

public would be given less opportunity

to consider the merits of the proposals,

and it would have to either attend the

spring meeting of the Committee or

respond to the summary report within a

few weeks. The decisions from the

spring meeting must be finalized by the

middle of June in order for us to include

the changes in the Addendum of the

final rule and in order to make changes

in the GROUPER software to be effective

October 1; it may be necessary to

schedule the spring meeting earlier to

meet this deadline. The opportunity to

solicit additional input from industry

groups and experts would be curtailed

because of the short time lines. There

would be an increased risk of errors

related to revisions in the procedure

code index (a manual process performed

by HCFA), as there would be less time

available to review and revise the

procedure index to ensure that all

changes are accurately reflected.

For example, we are creating a new

procedure code to capture percutaneous

gastrojejunostomy (code 44.32). All

coding instructions (indexing, inclusion

terms, and exclusion terms) must be

verified so that the procedure is

appropriately indexed. If one of the

many index entries for

gastrojejunostomy is not correctly

updated, percutaneous

gastrojejunostomy would be assigned to

another gastroenterostomy (code 44.39),

which is an operating room procedure.

This can have a significant impact on

national health care data. Coders at

different hospitals may follow different

entries and arrive at different codes. To

limit the potential for confusion in the

hospital and coding communities

resulting from two separate schedules

for implementing code changes, we

would limit these changes to those that

meet our definition of new technology

eligible for special treatment as

proposed below. It would not be

necessary, however, to demonstrate that

the cases involving the new technology

would be inadequately paid, since there

would be no payment impacts of these

changes.

The changes would be included in the

Addendum of the proposed rule for the

inpatient hospital prospective payment

system, and placed on the website for

use by the industry in updating books

and software systems. They also would

be published in the final rule, and

included in the CD–ROM version of

ICD–9–CM that is distributed by the

Government Printing Office. We are

requesting public comments on this

proposal.

c. Limitations of ICD–9–CM

While the updating process currently

in use may not lend itself to

expeditiously incorporating new

medical services and technologies into

the ICD–9–CM coding system, another

important factor is the dated and limited

structure of the ICD–9–CM system. The

ICD–9–CM system was developed in the

1970s and implemented in 1979.

Dramatic advances have occurred in

medicine since that time. Although the

ICD–9–CM Coordination and

Maintenance Committee has attempted

to make coding modifications to capture

new technology, it has sometimes been

difficult to achieve a reasonable result.

The ICD–9–CM procedure codes are

made up of four digits: two numerical

characters followed by a decimal, and

then two additional numerical

characters. The first two digits indicate

a category, such as 36—Operations on

the vessels of the heart. The third digit

provides additional breakdown, such as

36.0—Removal of coronary artery

obstruction and insertion of stents.

When the fourth digit is added, the code

is fully described. There are only 10

codes available within each category

(fourth digits 0–9). Once a category is

full, we must either combine types of

similar procedures under one code, or

find a place in another section of the

codebook for a new code. The benefit of

such a system is that we can collapse

the codes into categories when

analyzing claims data to capture a wide

range of similar procedures. However, if

similar codes are placed in separate

sections of the code book, coders may

not easily find them. Errors may occur

when trying to identify particular types

of cases when codes are not carefully

placed within a system such as the

current ICD–9–CM.

ICD–9–CM is 22 years old and the

premises on which the coding system

was established are dated. A number of

approaches and techniques used for

procedures such as lasers and the use of

scopes were not anticipated when the

structure of ICD–9–CM was developed.

Consequently, the basic categories were

established on technology that is now

outdated. Making needed coding

changes each year has been quite

difficult and involves making

compromises that effect the precision of

the coding.

d. Short-Term Solutions Within the

ICD–9–CM Structure

To consider how we might better

respond to requests for new codes in the

short term, we examined ICD–9–CM to

attempt to identify an open series of

codes that could be used for new

procedures and technologies. There are

currently 16 chapters of procedure

codes. However, codes 17.00 through

17.99 are not in use. These codes are

found between Chapter 3, ‘‘Operations

on the Eye,’’ and Chapter 4, ‘‘Operations

on the Ear.’’ This series of 100 codes

could be used to provide codes for new

procedures and technology. To fully

utilize this new series of codes, we

would assign new procedures to the

next available code.

A limitation of this approach would

be that this new chapter would capture

a diverse group of procedures

potentially affecting all body systems.

Assigning procedure codes to this new

chapter would undoubtedly create

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22671

considerable confusion for coders.

Currently, procedures are grouped by

body system, and similar procedures are

placed in categories. This arrangement

assists the coder in choosing the most

appropriate code because he or she can

quickly review closely related codes

that are together. Using Chapter 17 for

new technology codes, on the other

hand, would mean that closely related

codes would be widely separated.

Use of Chapter 17 would also require

a major revision of coding rules since

coders are taught to identify codes

within a group of similar procedures.

They are not accustomed to looking for

a list of unrelated procedures in a

separate section of the coding book.

To supplement the Chapter 17 codes,

the Coordination and Maintenance

Committee may be able to assign vacant

codes in other chapters. However, large

numbers of sequences are already fully

or nearly fully occupied, and this

strategy would only provide limited

availability of new codes.

e. Alternative Short-Term Approaches

Some observers have expressed

concern that the additional codes

available within the ICD–9–CM code set

may not be adequate to accommodate

both routine changes in coding and the

new technologies under consideration

here, particularly if a long-term change,

such as adoption of ICD–10–PCS, is

significantly delayed. We have

examined several alternative short-term

options in the event the additional

available codes are used before a longterm solution is reached. In evaluating

these alternatives, one must consider

the changes each entails to hospitals’

and HCFA’s coding and claims

processing systems, and the time

necessary to implement such changes

(balanced against the timeframe for

adopting a long-term coding solution).

Expanding ICD–9–CM procedure

codes by making them alphanumeric or

adding a fifth digit would make

available a substantial number of new

codes for new technology but would

require substantial system changes and

create standards issues. This approach

was extensively discussed in meetings

of the ICD–9–CM Coordination and

Maintenance Committee prior to the

development of ICD–10–PCS. Input

from the public indicated that such a

significant modification to a limited and

dated system would only make the

system worse. The time it would take to

make this system work well would be

longer than that required to build a new

system and the resources needed for

system changes would be significant.

Such a modification of the ICD–9–CM

standard code set would require the

formal standards setting process

prescribed by the regulations

implementing the Health Insurance

Portability and Accountability Act of

1996 (Public Law 104–191). We solicit

comments from the public about the

desirability of pursuing expansion and

modification of the ICD–9–CM

standards for this purpose.

Using the V-code section of ICD–9–

CM diagnosis codes to report new

technology would not require any

systems changes or create any standards

issues and would create a moderate

number of codes for new technology.

We have discussed this

recommendation with NCHS. NCHS

opposed this option as an inappropriate

use of diagnosis codes. While ‘‘V’’ codes

are used for the classification of factors

influencing health status and contact

with health services, they are not a

substitute for procedure coding. By

adding procedure coding concepts to

the diagnosis coding system, confusion

could easily lead to increased errors.

Furthermore, the V-code section has

only a limited number of available

spots.

We also considered using HCFA

Common Procedure Coding System

(HCPCS) codes to report use of new

technology for inpatient cases. However,

using HCPCS would require a moderate

amount of systems change and may

require the formal standards setting

process prescribed by Public Law 104–

191, since the HCPCS code set is not the

standard for inpatient services.

However, it would make a substantial

number of codes available for new

technology. Alphanumeric HCPCS

codes are currently used in outpatient

departments and physician offices for

reporting services, and they are used on

a limited basis by hospitals in reporting

specific inpatient services. For instance,

alphanumeric HCPCS codes are used for

reporting the use of hemophilia clotting

factors used during an inpatient stay.

Use of HCPCS codes would require

that a new service or technology either

be assigned a code through otherwise

applicable processes for HCPCS coding

or that HCFA assign a specific,

temporary code for use in connection

with new technology payments for

inpatient hospital services. Specifically

assigned codes could be assigned

relatively quickly. However, use of such

codes would run the risk of confusion

if other codes were assigned to the same

service or items when used in other

settings. More generally, HCPCS coding

would duplicate information found in

the ICD–9–CM procedure codes. Careful

attention to integration of coding across

the two systems would be necessary,

and dissemination of information about

correct coding to hospital coders would

present challenges. Even with excellent

integration and dissemination, the risk

of confusion by hospital coders would

be high.

The use of HCPCS codes would also

raise questions on how the accuracy of

claims data will be assessed. HCFA

contracts with Peer Review

Organizations (PROs) to validate the

accuracy of coded data. Consideration

would need to be given to how the

accuracy of these data could be verified.

If two separate coding systems with

overlapping information are used,

considerable variations in reporting

practices might arise.

Similar to the option of using

alphanumeric ICD–9–CM procedure

codes, changes in systems and in

hospital coding procedures that would

be associated with this approach would

take time and resources to implement

for hospitals, HCFA, and potentially

other payers such as Medicare

secondary insurers.

In recognition of these considerations,

we do not propose to proceed with use

of HCPCS codes for this purpose at the

present. We believe this possibility

should be revisited later if the ICD–9–

CM codes in fact prove inadequate and

if a longer term solution is not yet

available. However, we are encouraging

public comments on the concept of

using HCPCS codes to identify specific

new technologies on inpatient hospital

claims.

f. Development of ICD–10–PCS; A

Possible Long-Term Solution

While acknowledging the limitations

of the ICD–9–CM system, the Secretary

designated the ICD–9–CM system as the

national standard in a final rule in the

Federal Register on August 17, 2000 (65

FR 50311) following notice and

comment rulemaking in accordance

with Public Law 104–191. In that same

final rule, the public was advised that

there would be a need in the near future

to replace this dated coding system with

a system that could better capture

today’s health care information. At that

time, work was proceeding on an

updated variant of the ICD system, ICD–

10, that could replace ICD–9–CM, but

this system was not yet completed. The

World Health Organization developed

ICD–10 as an international diagnosis

coding system. NCHS has been

modifying ICD–10 to replace the

diagnosis section of ICD–9–CM. This

system is being referred to as ICD–10–

CM. At the same time, HCFA has been

developing the ICD–10–Procedure

Coding System (ICD–10–PCS) as a

possible replacement for the ICD–9–CM

procedure codes.

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Criteria for the development of a new

procedure coding system were

established by the National Committee

on Vital and Health Statistics (NCVHS).

The criteria included the following:

• Completeness—all substantially

different procedures have a unique

code.

• Expandability—the structure of the

system allows incorporation of new

procedures and technologies as unique

codes.

• Standardized terminology—the

coding system includes definitions of

the terminology used. While the

meaning of the specific words can vary

in common usage, the coding scheme

does not include multiple meanings for

the same term. Each term is assigned a

specific meaning.

• Multiaxial—the system has a

multiaxial structure with each code

character having the same meaning

within the specific procedure section

and across procedure sections to the

extent possible.

• Diagnostic information is not

included in the procedure description.

The ICD–10–PCS was developed

using these criteria by HCFA through a

contract with 3M Health Information

Systems. The ICD–10–PCS system

provides much greater code capacity

because all substantially different

procedures have a unique code. While

the ICD–9–CM procedure coding system

is limited to a maximum of 10,000

codes, the current draft of ICD–10–PCS

contains 197,769 codes and the number

could be expanded further.

g. Public Meeting on Implementing

ICD–10–PCS

The Department of Health and Human

Services is starting the process of

soliciting public comments on whether

it should proceed to adopt ICD–10–PCS

as the national standard for coding

inpatient hospital services to replace

ICD–9–CM procedures. A public

meeting on this issue has been

scheduled for May 17, 2001, in the

HCFA Auditorium in Baltimore,

Maryland. Information on this meeting

can be found in the Summary Report of

the November 2000 meeting of the ICD–

9–CM Coordination and Maintenance

Committee at: www.hcfa.gov/medicare/

icd9cm.htm. The public is encouraged

to attend and participate in the

discussion on whether ICD–10–PCS

should become a national standard.

Organizations and groups will be given

the opportunity to make a brief

presentation on their members’ behalf.

Groups wishing to be scheduled to

present should contact Pat Brooks,

HCFA, at (410) 786–5318. This meeting

will begin the process of evaluating

ICD–10–PCS as a future national

standard.

h. Proposed Methods of Expeditiously

Incorporating New Medical Services

and Technologies Into the Coding

System

In summary, we are proposing a twopart strategy for expeditiously

incorporating new medical services and

technologies into the clinical coding

system used with respect to payment for

inpatient hospital services. First, we are

proposing to shorten the timeframe for

implementing new codes by processing

changes that do not have payment

implications without first publishing

them in the proposed rule in the spring.

This means new codes approved at the

spring meeting of the ICD–9–CM

Coordination and Maintenance

Committee could be implemented by

October of the same year. We also are

proposing to move the November

meeting to December. These proposed

changes would reduce the time it

currently takes to implement new codes,

as well as reduce the time required to

collect data through the MedPAR by up

to a year in many cases.

Second, to make more codes available

to identify new technology, we will

immediately begin to work with the

public to use Chapter 17 of ICD–9–CM

procedures. This will provide room for

100 additional procedure codes. We also

will continue the current process of

adding and revising codes within the

current chapters as room and structure

allow. Our long-range strategy is to

consider the implementation of ICD–10–

PCS as a replacement system for ICD–

9–CM. However, because of the need to

address any such change through notice

and public rulemaking procedures (a

proposed and final rule), in addition to

the need to revise both our payment

systems and those of hospitals, this

could occur no earlier than October

2003.

7. New Requirements Relative to New

Services and Technologies

Section 533 of Public Law 106–554

addresses the process by which new

technologies and services are

introduced into the DRGs and how DRG

payment rates are to be adapted to

accommodate them. Section 533(b)

added new section 1886(d)(5)(K) to the

Act, which specifies that the Secretary

must establish criteria to use to identify

a new technology after notice and an

opportunity for public comment. Under

new section 1886(d)(5)(K)(ii)(I) of the

Act, effective for discharges occurring

on or after October 1, 2001, the

Secretary is required to apply a

mechanism to recognize the costs of

new technologies if, ‘‘based on the

estimated costs incurred with respect to

discharges involving such service or

technology, the DRG prospective

payment rate otherwise applicable to

such discharges under this subsection is

inadequate.’’ Further, new section

1886(d)(5)(K)(v) stipulates that the

requirement for an additional payment

for a new medical service or technology

may be satisfied by means of ‘‘an addon payment, a payment adjustment, or

any other similar mechanism for

increasing the amount otherwise

payable with respect to a discharge

under this subsection.’’ Section 533(b)

also added a new section 1886(d)(5)(L)

to the Act which states that the

requirement for an additional payment

for a new medical service or technology

may also be met through establishing

‘‘new-technology groups into which a

new medical service or technology will

be classified.’’

In section IV.F. of this preamble, we

are setting forth, for public comment,

our policy proposals to implement

section 1886(d)(5)(K) of the Act, as

added by section 533(b) of Public Law

106–554. In summary, the proposed

policies include—

• Proposed criteria for identifying

new medical services and technologies

for additional payments beyond the

DRG prospective payment system

payment.

• The proposed methodology for

determining the adequacy of current

payments for new services and

technology.

• The proposed methodology for

determining the amount of the

additional payment and for payment

mechanism for new medical services

and technologies.

III. Proposed Changes to the Hospital

Wage Index

A. Background

Section 1886(d)(3)(E) of the Act

requires that, as part of the methodology

for determining prospective payments to

hospitals, the Secretary must adjust the

standardized amounts ‘‘for area

differences in hospital wage levels by a

factor (established by the Secretary)

reflecting the relative hospital wage

level in the geographic area of the

hospital compared to the national

average hospital wage level.’’ In

accordance with the broad discretion

conferred under 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

the Office of Management and Budget

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22673

(OMB). The OMB also designates

Consolidated MSAs (CMSAs). A CMSA

is a metropolitan area with a population

of one million or more, comprising two

or more PMSAs (identified by their

separate economic and social character).

For purposes of the hospital wage index,

we use the PMSAs rather than CMSAs

since they allow a more precise

breakdown of labor costs. If a

metropolitan area is not designated as

part of a PMSA, we use the applicable

MSA. Rural areas are areas outside a

designated MSA, PMSA, or NECMA.

For purposes of the wage index, we

combine all of the rural counties in a

State to calculate a rural wage index for

that State.

We note that, effective April 1, 1990,

the term Metropolitan Area (MA)

replaced the term MSA (which had been

used since June 30, 1983) to describe the

set of metropolitan areas consisting of

MSAs, PMSAs, and CMSAs. The

terminology was changed by OMB in

the March 30, 1990 Federal Register to

distinguish between the individual

metropolitan areas known as MSAs and

the set of all metropolitan areas (MSAs,

PMSAs, and CMSAs) (55 FR 12154). For

purposes of the prospective payment

system, we will continue to refer to

these areas as MSAs.

Beginning October 1, 1993, section

1886(d)(3)(E) of the Act requires that we

update the wage index annually.

Furthermore, this section provides that

the Secretary base the update on a

survey of wages and wage-related costs

of short-term, acute care hospitals. The

survey should measure, to the extent

feasible, the earnings and paid hours of

employment by occupational category,

and must exclude the wages and wagerelated costs incurred in furnishing

skilled nursing services. As discussed

below in section III.F. of this preamble,

we also take into account the geographic

reclassification of hospitals in

accordance with sections 1886(d)(8)(B)

and 1886(d)(10) of the Act when

calculating the wage index.

B. FY 2002 Wage Index Update

The proposed FY 2002 wage index

values in section V of the Addendum to

this proposed rule (effective for hospital

discharges occurring on or after October

1, 2001 and before October 1, 2002) are

based on the data collected from the

Medicare cost reports submitted by

hospitals for cost reporting periods

beginning in FY 1998 (the FY 2001 wage

index was based on FY 1997 wage data).

The proposed FY 2002 wage index

includes the following categories of data

associated with costs paid under the

hospital inpatient prospective payment

system (as well as outpatient costs),

which were also included in the FY

2001 wage index:

• Salaries and hours from short-term,

acute care hospitals.

• Home office costs and hours.

• Certain contract labor costs and

hours.

• Wage-related costs.

Consistent with the wage index

methodology for FY 2001, the proposed

wage index for FY 2002 also continues

to exclude the direct and overhead

salaries and hours for services not paid

through the inpatient prospective

payment system such as skilled nursing

facility (SNF) services, home health

services, or other subprovider

components that are not subject to the

prospective payment system.

We calculate a separate Puerto Ricospecific wage index and apply it to the

Puerto Rico standardized amount. (See

62 FR 45984 and 46041.) This wage

index is based solely on Puerto Rico’s

data. Finally, section 4410 of Public

Law 105–33 provides that, for

discharges on or after October 1, 1997,

the area wage index applicable to any

hospital that is not located in a rural

area may not be less than the area wage

index applicable to hospitals located in

rural areas in that State.

C. FY 2002 Wage Index Proposal

Because it is used to adjust payments

to hospitals under the prospective

payment system, the hospital wage

index should, to the extent possible,

reflect the wage costs associated with

the areas of the hospital included under

the hospital inpatient prospective

payment system. In response to

concerns within the hospital

community related to the removal, from

the wage index calculation, of costs

related to graduate medical education

(GME) (teaching physicians and

residents) and certified registered nurse

anesthetists (CRNAs), which are paid by

Medicare separately from the

prospective payment system, the

American Hospital Association (AHA)

convened a workgroup to develop a

consensus recommendation on this

issue. The workgroup recommended

that costs related to GME and CRNAs be

phased out of the wage index

calculation over a 5-year period. Based

upon our analysis of hospitals’ FY 1996

wage data, and consistent with the AHA

workgroup’s recommendation, we

specified in the July 30, 1999 final rule

(64 FR 41505) that we would phase-out

these costs from the calculation of the

wage index over a 5-year period,

beginning in FY 2000. In keeping with

the decision to phase-out costs related

to GME and CRNAs, the proposed FY

2002 wage index is based on a blend of

40 percent of an average hourly wage

including these costs, and 60 percent of

an average hourly wage excluding these

costs.

Beginning with the FY 1998 cost

reports, we revised the Worksheet S–3,

Part II so that hospitals can separately

report teaching physician Part A costs

on lines 4.01, 10.01, 12.01, and 18.01.

Therefore, it is no longer necessary for

us to conduct the special survey we

used for the FY 2000 and FY 2001 wage

indexes (64 FR 41505 and 65 FR 47071).

1. Health Insurance and Health-Related

Costs

In the August 1, 2000 final rule, we

clarified our definition of ‘‘purchased

health insurance costs’’ and ‘‘selfinsurance’’ for hospitals that provide

health insurance to employees (65 FR

47073). For purposes of the wage index,

purchased or self-funded health

insurance plan costs include the

hospitals’ insurance premium costs,

external administration costs, and the

share of costs for services delivered to

employees.

In response to a comment received

concerning this issue, we stated that, for

self-funded health insurance costs,

personnel costs associated with hospital

staff that deliver the services to the

employees must continue to be

excluded from wage-related costs if the

costs are already included in the wage

data as salaries on Worksheet S–3, Part

II, Line 1. However, after further

consideration of this policy, particularly

with respect to concerns expressed by

our fiscal intermediaries about the level

of effort required during the wage index

desk review process to ensure hospitals

are appropriately identifying and

excluding these costs, we are proposing

a revision. Effective with the calculation

of the FY 2003 wage index, for either

purchased or self-funded health

insurance, we would allow health

insurance personnel costs, associated

with hospital staff that deliver services

to employees, to be included as part of

the wage-related costs. We believe this

proposed revised policy will ensure that

health insurance costs are consistently

reported by hospitals. Health insurance

costs would continue to be developed

using generally accepted accounting

principles.

In the August 1, 2000 final rule (65 FR

47073), we further clarified that healthrelated costs (including employee

physical examinations, flu shots, and

clinic visits, and other services that are

not covered by employees’ health

insurance plans but are provided at no

cost or at discounted rates to employees

of the hospital) may be included as

‘‘other’’ wage-related costs if, among

22674 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

other criteria, the combined cost of all

such health-related costs is greater than

one percent of the hospital’s total

salaries (less excluded area salaries).

For purposes of calculating the FY

2003 wage index (which will be based

on data for cost reporting periods

beginning in FY 1999), we are proposing

to revise this policy to allow hospitals

to include health-related costs as

allowable core wage-related costs.

2. Costs of Contracted Pharmacy and

Laboratory Services

Our policy concerning inclusion of

contract labor costs for purposes of

calculating the wage index has evolved

over the years. We recognize the role of

contract labor in meeting special

personnel needs of many hospitals. In

addition, improvements in the wage

data have allowed us to more accurately

identify contract labor costs and hours.

As a result, effective with the FY 1994

wage index, we included the costs of

direct patient care contract services in

the wage index calculation. The FY

1999 wage index included the costs and

hours of certain management contract

services, and the FY 2000 wage index

included the costs for contract

physician Part A services. (The 1996

proposed rule (61 FR 27456) provided

an in-depth background to the issues

related to the inclusion of contract labor

costs in the wage index calculation.)

We revised the 1998 cost report to

collect the data associated with contract

pharmacy, Worksheet S–3, Part II, Line

9.01, and contract laboratory, Worksheet

S–3, Part II, Line 9.02. The cost

reporting instructions for these line

numbers followed that for all contract

labor lines; that is, to include the

amount paid for services furnished

under contract for direct patient care,

and not include cost for equipment,

supplies, travel expenses, and other

miscellaneous or overhead items

(Medicare Provider Reimbursement

Manual, Part 2, Cost Reporting Forms

and Instructions, Chapter 36,

Transmittal 6, page 36–32). Effective

with the FY 2002 wage index, which

uses FY 1998 wage data, we are

proposing to include the costs and

hours of contract pharmacy and

laboratory.

3. Collection of Occupational Mix Data

Section 304(c) of Public Law 106–554

amended section 1886(d)(3)(E) of the

Act to require that the Secretary must

provide for the collection of data every

3 years on the occupational mix of

employees for each short-term, acute

care hospital participating in the

Medicare program, in order to construct

an occupational mix adjustment to the

wage index. The initial collection of

these data must be completed by

September 30, 2003, for application

beginning October 1, 2004.

Currently, the wage data collected by

HCFA on the cost report reflect the sum

of wages, hours, and wage-related costs

for all hospital employees. There is no

separate collection by occupational

categories of employees, such as

registered nurses or physical therapists.

Total salaries and hours reflect

management decisions made by

hospitals in terms of how many

employees within a certain occupation

to employ to treat different types of

patients. For example, a large academic

medical center may tend to hire more

high-cost specialized employees to treat

its more acutely ill patient population.

The argument is that the higher labor

costs incurred to treat this patient

population are reflected in the higher

case mix of these hospitals, and

therefore, reflecting these costs in the

wage index is essentially counting them

twice.

An occupational mix adjustment can

be used to account for hospital

management decisions about how many

employees to hire in each occupational

category. Occupational mix data

measure the price the hospital must pay

for employees within each category. A

wage index that reflected only these

market prices would remove the impact

of management decisions about the mix

of employees needed and, therefore,

better capture geographic variations in

the labor market.

We have examined this issue

previously. In the May 27, 1994 Federal

Register (59 FR 27724), we discussed

the outcome of consideration of this

issue by a hospital workgroup. At that

time, the workgroup’s consensus was

that the data required to implement an

occupational mix adjustment were not

available and the likelihood of obtaining

such data would be minimal. There

seemed to be little support among

hospital industry representatives for

developing a system that would create

additional reporting burdens with an

unproven or minimal impact on the

distribution of payments. Also, in the

August 30, 1991 Federal Register (56 FR

43219), we stated our belief that the

collection of these data would be costly

and difficult.

In considering the format to collect

occupational mix data, we looked to

data currently being collected by the

Bureau of Labor Statistics (BLS), which

conducts an annual mail survey to

produce estimates of employment and

wages for specific occupations. This

program, Occupational Employment

Statistics (OES), collects data on wage

and salary workers in nonfarm

establishments in order to produce

employment and wage estimates for

over 700 occupations.

The OES survey collects wage data in

12 hourly rate intervals. Employers

report the number of employees in an

occupation per each wage range. To

illustrate, the wage intervals used for

the 1999 survey are as follows:

Interval Hourly wages Annual wages

Range A .................................................................................................................................... Under $6.75 .................. Under $14,040

Range B .................................................................................................................................... 6.75 to 8.49 ................... 14,040 to 17,659

Range C ................................................................................................................................... 8.50 to 10.74 ................. 17,660 to 22,359

Range D ................................................................................................................................... 10.75 to 13.49 ............... 22,360 to 28,079

Range E .................................................................................................................................... 13.50 to 16.99 ............... 28,080 to 35,359

Range F .................................................................................................................................... 17.00 to 21.49 ............... 35,360 to 44,719

Range G ................................................................................................................................... 21.50 to 27.24 ............... 44,720 to 56,679

Range H ................................................................................................................................... 27.25 to 34.49 ............... 56,680 to 71,759

Range I ..................................................................................................................................... 34.50 to 43.74 ............... 71,760 to 90,999

Range J .................................................................................................................................... 43.75 to 55.49 ............... 91,000 to 115,439

Range K .................................................................................................................................... 55.50 to 69.99 ............... 115,440 to 145,599

Range L .................................................................................................................................... 70,000 and over ............ 145,600 and over

It should be noted that this table is for

illustrative purposes, and we may

update the data ranges in our actual

collection instrument.

Although we initially considered

using the OES data, section 304(c) of

Public Law 106–554 requires us to

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22675

collect data from every short-term, acute

care hospital. The OES data are a

sample survey and, therefore, as

currently conducted, are not consistent

with the statutory requirement to

include data from every hospital.

Another issue with using OES data is

that, for purposes of the Medicare wage

index, the hospitals’ data must be

reviewed and verified by the fiscal

intermediaries. The OES survey is a

voluntary survey.

Although we decided to pursue a

separate data collection effort than OES,

we propose to model our format after

the one used by OES. In this way,

hospitals participating in the OES

survey, should have no additional

recordkeeping and reporting

requirements beyond those of the OES

survey.

The OES survey of the hospital

industry is designed to capture all

occupational categories within the

industry. For purposes of adjusting the

wage index for occupational mix, we do

not believe it is necessary to collect data

from such a comprehensive scope of

categories. Furthermore, because the

data must be audited, a comprehensive

list of categories would be excessively

burdensome.

In deciding which job categories to

include, we reviewed the occupational

categories collected by OES and

identified those with at least 35,000

hospital employees. Our goal is to

collect data from a sample of job

categories that provides a valid measure

of wage rates within a geographical area.

Using this threshold of at least 35,000

employees within a category nationally,

we are proposing to collect the number

of employees by wage range as

illustrated in the above table, for the

occupational categories listed below.

The following data are based on the

1999 OES survey:

OES code Category Employees

Percent of total

hospital

employees

Mean hourly

wage

15008 ............................................................. Medicine and Health Services Managers ..... 93,680 1.9 $27.38

27302 ............................................................. Social Workers, Medial and Psychiatric ........ 53,360 1.1 16.33

32102 ............................................................. Physicians and Surgeons ............................. 125,640 2.6 43.76

32308 ............................................................. Physical Therapists ....................................... 39,840 0.8 26.14

32502 ............................................................. Registered Nurses ........................................ 1,231,980 25.0 21.12

32505 ............................................................. Licensed Practical Nurses ............................ 206,360 4.2 13.39

32517 ............................................................. Pharmacists ................................................... 46,860 1.0 28.62

32911, 32928, 32931 ..................................... Clinical Technologists and Technicians ........ 122,380 2.50 11.69

51002, 55105, 55108, 55305 ......................... First-Line Supervisors and Clerical Workers 445,730 9.5 11.39

55332, 55347

65038, 67002, 67005 ..................................... Food Preparation Workers and Housekeeping.218,440 4.5 8.17

66008 ............................................................. Nursing Aides, Orderlies, and Attendants .... 301,240 6.2 8.67

We believe this list of occupational

categories provides a good

representation of the employee mix at

most hospitals. Definitions for each

occupational category are available on

the BLS website at http://stats.bls.gov/

oes/1999/oes_alph.htm.

We have yet to settle on the

methodology on how to use the

occupational mix index. One option

would be to weight each hospital’s wage

index by its occupational mix index.

This requires calculating a national

occupational mix index and then

breaking it down by MSA and by

hospital, similar to how the wage index

is broken down. In this way, the wage

index would capture geographic

differences in wage rates. The decision

about how to apply the occupational

mix index to the wage index depends on

the quality of the data collected, since

this effort will be the first time wage and

hour data by occupation are collected in

this audited manner.

Section 304(c) directs the Secretary to

provide for the collection of these data

by September 30, 2003, and to apply

them in the wage index by October 1,

2004. Therefore, the data are to be

incorporated in the FY 2005 wage

index. Under our current timetable, the

FY 2005 wage index will be based on

wage data collected from hospitals’ cost

reporting periods beginning during FY

2001. In order to facilitate the fiscal

intermediaries’ review of these data, we

believe the occupational mix data

should coincide with the data otherwise

used to calculate the cost report.

Therefore, we will conduct a special

survey of all short-term acute-care

hospitals that are required to report

wage data to collect these data

coinciding with hospitals’ FY 2001 cost

reports. More specific procedural

information regarding this survey will

be included in the FY 2002 final rule

scheduled to be published by August 1,

2001.

D. Verification of Wage Data From the

Medicare Cost Report

The data for the proposed FY 2002

wage index were obtained from

Worksheet S–3, Parts II and III of the FY

1998 Medicare cost reports. The data

file used to construct the proposed wage

index includes FY 1998 data submitted

to HCFA as of mid-February 2001. As in

past years, we performed an intensive

review of the wage data, mostly through

the use of edits designed to identify

aberrant data.

We asked our fiscal intermediaries to

revise or verify data elements that

resulted in specific edit failures. Some

unresolved data elements are included

in the calculation of the proposed FY

2002 wage index pending their

resolution before calculation of the final

FY 2002 wage index. We have

instructed the intermediaries to

complete their verification of

questionable data elements and to

transmit any changes to the wage data

no later than April 9, 2001. We expect

that all unresolved data elements will be

resolved by that date. The revised data

will be reflected in the final rule.

Also, as part of our editing process,

we removed data for 47 hospitals that

failed edits. For 23 of these hospitals,

we were unable to obtain sufficient

documentation to verify or revise the

data because the hospitals are no longer

participating in the Medicare program

or are in bankruptcy status. Twenty-four

hospitals had incomplete or inaccurate

data resulting in zero or negative

average hourly wages. Therefore, they

were removed from the calculation. The

data for these hospitals will be included

in the final wage index if we receive

corrected data that pass our edits. As a

result, the proposed FY 2002 wage

index is calculated based on FY 1998

wage data for 4,868 hospitals.

22676 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

E. Computation of the Proposed FY

2002 Wage Index

We note a proposed technical change

to the FY 2002 calculation. For the FY

2001 wage index calculation, we

initially proposed to subtract Line 13 of

Worksheet S–3, Part III from total hours

when determining the excluded hours

ratio used to estimate the amount of

overhead attributed to excluded areas

(65 FR 26299). However, the formula

resulted in large and inappropriate

increases in the average hourly wages

for some hospitals (65 FR 47074),

particularly hospitals that have large

overhead and excluded area costs.

Therefore, for the final FY 2001 wage

index calculation, we reverted to the FY

2000 excluded hours ratio formula,

which did not subtract Line 13.

We, and others in the hospital

community, continued to believe that

subtracting Part III, Line 13 from total

hours is the correct formula for

determining the excluded hours ratio.

We analyzed how the application of this

formula resulted in overstated average

hourly wages for some hospitals and

how we could improve the overall

accuracy of the overhead allocation

methodology. We became aware that the

problem was not in the excluded hours

ratio formula. Rather, our wage index

calculation did not also remove the

overhead wage-related costs associated

with excluded areas, an amount that

must be estimated before it can be

subtracted from the calculation. The

combined effect of applying the

excluded hours ratio formula, which

appropriately removes salaries of lowerwage, overhead employees, and not

subtracting overhead wage-related costs

associated with excluded areas, resulted

in overstated salary costs and average

hourly wages.

For the FY 2002 wage index

calculation, we are proposing to apply

the excluded hours ratio formula that

subtracts Part III, Line 13 from total

hours. Additionally, for the first time in

the wage index calculation, we

estimated and subtracted overhead

wage-related costs allocated to excluded

areas.

After we applied this new calculation,

there were still a few hospitals that

experienced large increases in their

average hourly wages. The

intermediaries verified that the

hospitals’ wage data were accurate, so

we kept the data in the wage index

calculation. These hospitals primarily

function as SNFs, psychiatric hospitals,

or rehabilitation hospitals that have few

acute care beds. The hospitals’ higher

average hourly wages reflect the costs of

the higher salaried employees that

remain in the wage index calculation

after we subtract the costs of excluded

area and associated overhead

employees.

The method used to compute the

proposed FY 2002 wage index follows.

Step 1—As noted above, we are

proposing to base the FY 2002 wage

index on wage data reported on the FY

1998 Medicare cost reports. We gathered

data from each of the non-Federal,

short-term, acute care hospitals for

which data were reported on the

Worksheet S–3, Parts II and III of the

Medicare cost report for the hospital’s

cost reporting period beginning on or

after October 1, 1997 and before October

1, 1998. In addition, we included data

from any hospital that had cost

reporting periods beginning before

October 1997 and reported a cost

reporting period covering all of FY

1998. These data were included because

no other data from these hospitals

would be available for the cost reporting

period described above, and because

particular labor market areas might be

affected due to the omission of these

hospitals. However, we generally

describe these wage data as FY 1998

data. We note that, if a hospital had

more than one cost reporting period

beginning during FY 1998 (for example,

a hospital had two short cost reporting

periods beginning on or after October 1,

1997 and before October 1, 1998), we

included wage data from only one of the

cost reporting periods, the longest, in

the wage index calculation. If there was

more than one cost reporting period and

the periods were equal in length, we

included the wage data from the latest

period in the wage index calculation.

Step 2—Salaries—The method used to

compute a hospital’s average hourly

wage is a blend of 40 percent of the

hospital’s average hourly wage

including all GME and CRNA costs, and

60 percent of the hospital’s average

hourly wage after eliminating all GME

and CRNA costs.

In calculating a hospital’s average

salaries plus wage-related costs,

including all GME and CRNA costs, we

subtracted from Line 1 (total salaries)

the Part B salaries reported on Lines 3

and 5, home office salaries reported on

Line 7, and excluded salaries reported

on Lines 8 and 8.01 (that is, direct

salaries attributable to skilled nursing

facility services, home health services,

and other subprovider components not

subject to the prospective payment

system). We also subtracted from Line 1

the salaries for which no hours were

reported on Lines 2, 4, and 6. To

determine total salaries plus wagerelated costs, we added to the net

hospital salaries the costs of contract

labor for direct patient care, certain top

management, pharmacy, laboratory, and

physician Part A services (Lines 9, 9.01,

9.02, 10, and 10.01), home office salaries

and wage-related costs reported by the

hospital on Lines 11, 12, and 12.01, and

nonexcluded area wage-related costs

(Lines 13, 14, 16, 18, 18.01, and 20).

We note that contract labor and home

office salaries for which no

corresponding hours are reported were

not included. In addition, wage-related

costs for specific categories of

employees (Lines 16, 18, 18.01, and 20)

are excluded if no corresponding

salaries are reported for those

employees (Lines 2, 4, 4.01, and 6,

respectively).

We then calculated a hospital’s

salaries plus wage-related costs by

subtracting from total salaries the

salaries plus wage-related costs for

teaching physicians, Lines (4.01, 10.01,

12.01, and 18.01), Part A CRNAs (Lines

2 and 16), and residents (Lines 6 and

20).

Step 3—Hours—With the exception of

wage-related costs, for which there are

no associated hours, we computed total

hours using the same methods as

described for salaries in Step 2.

Step 4—For each hospital reporting

both total overhead salaries and total

overhead hours greater than zero, we

then allocated overhead costs to areas of

the hospital excluded from the wage

index calculation. First, we determined

the ratio of excluded area hours (sum of

Lines 8 and 8.01 of Worksheet S–3, Part

II) to revised total hours (Line 1 minus

the sum of Part II, Lines 3, 5, 7, and Part

III, Line 13 of Worksheet S–3). We then

computed the amounts of overhead

salaries and hours to be allocated to

excluded areas by multiplying the above

ratio by the total overhead salaries and

hours reported on Line 13 of Worksheet

S–3, Part III. Next, we computed the

amounts of overhead wage-related costs

to be allocated to excluded areas using

three steps: (1) We determined the ratio

of overhead hours (Part III, Line 13) to

revised hours (Line 1 minus the sum of

Lines 3, 5, and 7); (2) we computed

overhead wage-related costs by

multiplying the overhead hours ratio by

wage-related costs reported on Part II,

Lines 13, 14, 16, 18, 18.01, and 20; and

(3) we multiplied the computed

overhead wage-related costs by the

above excluded area hours ratio.

Finally, we subtracted the computed

overhead salaries, wage-related costs,

and hours associated with excluded

areas from the total salaries (plus wagerelated costs) and hours derived in

Steps 2 and 3. Using the above method

for computing overhead salaries, wagerelated costs, and hours to allocate to

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22677

excluded areas, we also computed these

costs excluding all costs associated with

GME and CRNAs (Lines 2, 4.01, 6,

10.01, 12.01, and 18.01).

Step 5—For each hospital, we

adjusted the total salaries plus wagerelated costs to a common period to

determine total adjusted salaries plus

wage-related costs. To make the wage

adjustment, we estimated the percentage

change in the employment cost index

(ECI) for compensation for each 30-day

increment from October 14, 1997

through April 15, 1999 for private

industry hospital workers from the

Bureau of Labor Statistics’

Compensation and Working Conditions.

We use the ECI because it reflects the

price increase associated with total

compensation (salaries plus fringes)

rather than just the increase in salaries.

In addition, the ECI includes managers

as well as other hospital workers. This

methodology to compute the monthly

update factors uses actual quarterly ECI

data and assures that the update factors

match the actual quarterly and annual

percent changes. The factors used to

adjust the hospital’s data were based on

the midpoint of the cost reporting

period, as indicated below.

MIDPOINT OF COST REPORTING

PERIOD

After Before Adjustment

factor

12/14/97 ............ 01/15/98 1.03292

01/14/98 ............ 02/15/98 1.03048

02/14/98 ............ 03/15/98 1.02828

03/14/98 ............ 04/15/98 1.02621

04/14/98 ............ 05/15/98 1.02411

05/14/98 ............ 06/15/98 1.02200

06/14/98 ............ 07/15/98 1.01973

07/14/98 ............ 08/15/98 1.01714

08/14/98 ............ 09/15/98 1.01424

09/14/98 ............ 10/15/98 1.01137

10/14/98 ............ 11/15/98 1.00885

11/14/98 ............ 12/15/98 1.00669

12/14/98 ............ 01/15/99 1.00462

01/14/99 ............ 02/15/99 1.00239

02/14/99 ............ 03/15/99 1.00000

03/14/99 ............ 04/15/99 0.99746

For example, the midpoint of a cost

reporting period beginning January 1,

1998 and ending December 31, 1998 is

June 30, 1998. An adjustment factor of

1.01973 would be applied to the wages

of a hospital with such a cost reporting

period. In addition, for the data for any

cost reporting period that began in FY

1998 and covered a period of less than

360 days or more than 370 days, we

annualized the data to reflect a 1-year

cost report. Annualization is

accomplished by dividing the data by

the number of days in the cost report

and then multiplying the results by 365.

Step 6—Each hospital was assigned to

its appropriate urban or rural labor

market area before any reclassifications

under section 1886(d)(8)(B) or section

1886(d)(10) of the Act. Within each

urban or rural labor market area, we

added the total adjusted salaries plus

wage-related costs obtained in Step 5

(with and without GME and CRNA

costs) for all hospitals in that area to

determine the total adjusted salaries

plus wage-related costs for the labor

market area.

Step 7—We divided the total adjusted

salaries plus wage-related costs obtained

under both methods in Step 6 by the

sum of the corresponding total hours

(from Step 4) for all hospitals in each

labor market area to determine an

average hourly wage for the area.

Because the proposed FY 2002 wage

index is based on a blend of average

hourly wages, we then added 40 percent

of the average hourly wage calculated

without removing GME and CRNA

costs, and 60 percent of the average

hourly wage calculated with these costs

excluded.

Step 8—We added the total adjusted

salaries plus wage-related costs obtained

in Step 5 for all hospitals in the nation

and then divided the sum by the

national sum of total hours from Step 4

to arrive at a national average hourly

wage (using the same blending

methodology described in Step 7). Using

the data as described above, the national

average hourly wage is $22.0545.

Step 9—For each urban or rural labor

market area, we calculated the hospital

wage index value by dividing the area

average hourly wage obtained in Step 7

by the national average hourly wage

computed in Step 8.

Step 10—Following the process set

forth above, we developed a separate

Puerto Rico-specific wage index for

purposes of adjusting the Puerto Rico

standardized amounts. (The national

Puerto Rico standardized amount is

adjusted by a wage index calculated for

all Puerto Rico labor market areas based

on the national average hourly wage as

described above.) We added the total

adjusted salaries plus wage-related costs

(as calculated in Step 5) for all hospitals

in Puerto Rico and divided the sum by

the total hours for Puerto Rico (as

calculated in Step 4) to arrive at an

overall average hourly wage of $10.8100

for Puerto Rico. For each labor market

area in Puerto Rico, we calculated the

Puerto Rico-specific wage index value

by dividing the area average hourly

wage (as calculated in Step 7) by the

overall Puerto Rico average hourly

wage.

Step 11—Section 4410 of Public Law

105–33 provides that, for discharges on

or after October 1, 1997, the area wage

index applicable to any hospital that is

located in an urban area may not be less

than the area wage index applicable to

hospitals located in rural areas in that

State. Furthermore, this wage index

floor is to be implemented in such a

manner as to ensure that aggregate

prospective payment system payments

are not greater or less than those that

would have been made in the year if

this section did not apply. For FY 2002,

this change affects 240 hospitals in 41

MSAs. The MSAs affected by this

provision are identified in Table 4A by

a footnote.

F. Revisions to the Wage Index Based on

Hospital Redesignation

Under section 1886(d)(8)(B) of the

Act, hospitals in certain rural counties

adjacent to one or more MSAs are

considered to be located in one of the

adjacent MSAs if certain standards are

met. Under section 1886(d)(10) of the

Act, the MGCRB considers applications

by hospitals for geographic

reclassification for purposes of payment

under the prospective payment system.

1. Provisions of Public Law 106–554

Section 304 of Public Law 106–554

made changes to several provisions of

section 1886(d)(10) of the Act relating to

hospital reclassifications and the wage

index:

• Section 304(a) amended section

1886(d)(10)(D) of the Act by adding a

clause (v) to provide that, beginning

with FY 2001, an MGCRB decision on

a hospital reclassification for purposes

of the wage index is effective for 3 years,

unless the hospital elects to terminate

the reclassification. Section 304(a) also

provides that the MGCRB must use the

3 most recent years’ average hourly

wage data in evaluating a hospital’s

reclassification application for FY 2003

and any succeeding fiscal year (section

1886(d)(10)(D)(vi) of the Act).

• Section 304(b) provides that, by

October 1, 2001, the Secretary must

establish a mechanism under which a

statewide entity may apply to have all

of the geographic areas in the State

treated as a single geographic area for

purposes of computing and applying a

single wage index, for reclassifications

beginning in FY 2003. Section 304(b)

further requires that, if the Secretary

applies a statewide wage index to an

area, an application by an individual

hospital in that area would not be

considered.

We address our policy proposals

relating to implementation of these

three provisions of sections 304(a) and

(b) of Public Law 106–554 in section IV.

of this proposed rule. The following

22678 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

discussion of the proposed revisions to

the wage index based on hospital

redesignations reflects these proposed

policies.

2. Effects of Reclassification

The methodology for determining the

wage index values for redesignated

hospitals is applied jointly to the

hospitals located in those rural counties

that were deemed urban under section

1886(d)(8)(B) of the Act and those

hospitals that were reclassified as a

result of the MGCRB decisions under

section 1886(d)(10) of the Act. Section

1886(d)(8)(C) of the Act provides that

the application of the wage index to

redesignated hospitals is dependent on

the hypothetical impact that the wage

data from these hospitals would have on

the wage index value for the area to

which they have been redesignated.

Therefore, as provided in section

1886(d)(8)(C) of the Act, the wage index

values were determined by considering

the following:

• If including the wage data for the

redesignated hospitals would reduce the

wage index value for the area to which

the hospitals are redesignated by 1

percentage point or less, the area wage

index value determined exclusive of the

wage data for the redesignated hospitals

applies to the redesignated hospitals.

• If including the wage data for the

redesignated hospitals reduces the wage

index value for the area to which the

hospitals are redesignated by more than

1 percentage point, the area wage index

determined inclusive of the wage data

for the redesignated hospitals (the

combined wage index value) applies to

the redesignated hospitals.

• If including the wage data for the

redesignated hospitals increases the

wage index value for the area to which

the hospitals are redesignated, both the

area and the redesignated hospitals

receive the combined wage index value.

• The wage index value for a

redesignated urban or rural hospital

cannot be reduced below the wage

index value for the rural areas of the

State in which the hospital is located.

• Rural areas whose wage index

values would be reduced by excluding

the wage data for hospitals that have

been redesignated to another area

continue to have their wage index

values calculated as if no redesignation

had occurred.

• Rural areas whose wage index

values increase as a result of excluding

the wage data for the hospitals that have

been redesignated to another area have

their wage index values calculated

exclusive of the wage data of the

redesignated hospitals.

• Currently, the wage index value for

an urban area is calculated exclusive of

the wage data for hospitals that have

been reclassified to another area.

For the FY 2002 wage index, we are

proposing to include the wage data for

a reclassified urban hospital in both the

area to which it is reclassified and the

MSA where the hospital is physically

located. We believe this will improve

consistency and predictability in

hospital reclassification and wage

indices, as well as alleviate the

fluctuations in the wage indexes due to

reclassifications. For example, hospitals

applying to reclassify into another area

will know which hospitals’ data will be

included in calculating the wage index,

because even if some hospitals in the

area are reclassified, their data will be

included in the calculation of the wage

index of the area where they are

geographically located. Also, in some

cases, excluding the data of hospitals

reclassified to another MSA could have

a large downward impact on the wage

index of the MSA in which the hospital

is physically located. The negative

impact of removing the data of the

reclassified hospitals from the wage

index calculation could lead to large

wage disparities between the

reclassified hospitals and other

hospitals in the MSA, as the remaining

hospitals would receive reduced

payments due to a lower wage index.

Our proposed approach would promote

consistency, and simplify our rules,

with respect to how we construct the

wage indexes of rural and urban areas.

As noted above, in the case of rural

hospitals redesignated to another area,

the wage index of the rural area where

the hospitals are geographically located

is calculated by including the wage data

of the redesignated hospitals (unless

doing so would result in a lower wage

index).

Finally, we note that the Medicare

Payment Advisory Commission

(MedPAC), in its March 2001 ‘‘Report to

the Congress: Medicare Payment

Policy,’’ recommended this policy (p.

82). (Section VII. of this preamble

includes a discussion of MedPAC’s

recommendations and our responses.)

To illustrate the potential negative

impact on hospitals in an area where

reclassifications of some hospitals to

another area results in a decline in the

wage index after the reclassified

hospitals are excluded from the wage

index calculation, MedPAC points out

that hospitals in several MSAs have

organized to pay qualifying hospitals

not to reclassify. Our proposed policy

change would remove this distorted

incentive.

The proposed wage index values for

FY 2002 are shown in Tables 4A, 4B,

4C, and 4F in the Addendum to this

proposed rule. Hospitals that are

redesignated should use the wage index

values shown in Table 4C. Areas in

Table 4C may have more than one wage

index value because the wage index

value for a redesignated urban or rural

hospital cannot be reduced below the

wage index value for the rural areas of

the State in which the hospital is

located. When the wage index value of

the area to which a hospital is

redesignated is lower than the wage

index value for the rural areas of the

State in which the hospital is located,

the redesignated hospital receives the

higher wage index value; that is, the

wage index value for the rural areas of

the State in which it is located, rather

than the wage index value otherwise

applicable to the redesignated hospitals.

As mentioned earlier, section 304(a)

of Public Law 106–554 amended section

1886(d)(10)(D) of the Act by adding a

new clause (v) to provide that a

reclassification of a hospital by the

MGCRB for purposes of the wage index

is effective for 3 years (instead of 1 year)

unless, under procedures established by

the Secretary, the hospital elects to

terminate the reclassification before the

end of the 3-year period. Section 304(a)

of Public Law 106–554 also amended

section 1886(d)(10)(D) of the Act to

specify that, for applications for

reclassification for the wage index for

FYs 2003 and later, the MGCRB must

base any comparison of the average

hourly wage of the hospital with the

average hourly wage for hospitals in the

area in which it is located and the area

to which it seeks reclassification, using

data from the most recently published

hospital wage survey (as of the date of

the hospital’s application), as well as

data from each of the two immediately

preceding surveys. (Our policy

proposals to incorporate the provisions

of section 304(a) of Public Law 106–554

in the regulations are addressed in

section IV.E. of this proposed rule).

Consistent with the section 304(a)

amendment, Tables 3A and 3B list the

3-year average hourly wage for each

labor market area before the

redesignation of hospitals, based on FY

1996, 1997, and 1998 wage data. In

addition, Table 2 in the Addendum to

this proposed rule includes the adjusted

average hourly wage for each hospital

from the FY 1996 and FY 1997 cost

reporting periods, as well as the FY

1998 period. Table 2 also shows the 3-

year average (as well as hospitals’

average hourly wages for each of the 3

years) that the MGCRB will use (as

published in the final rule following

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22679

this proposed rule) to evaluate a

hospital’s application for

reclassification for FY 2003 (unless that

average hourly wage is later revised in

accordance with § 412.63(w)(2)). The 3-

year averages are calculated by dividing

the sum of the dollars (adjusted to a

common reporting period using the

method described previously in this

section) across all 3 years, by the sum

of the hours. If a hospital is missing data

for any of the previous years, its average

hourly wage for the 3-year period is

calculated based on the data available

during that period.

Applications for FY 2003

reclassifications are due to the MGCRB

by September 1, 2001. (We note that the

new location and mailing address of the

MGCRB and the Provider

Reimbursement Review Board (PRRB)

is: 2520 Lord Baltimore Drive, Suite L,

Baltimore, MD 21244–2670. The

MGCRB and PRRB will be functioning

at this new location as of May 21, 2001.

Also, please specify whether the mail is

intended for the MGCRB or the PRRB.)

At the time this proposed wage index

was constructed, the MGCRB had

completed its review of FY 2002

reclassification requests. The proposed

FY 2002 wage index values incorporate

all 643 hospitals redesignated for

purposes of the wage index (hospitals

redesignated under section

1886(d)(8)(B) or section 1886(d)(10) of

the Act for FY 2002. The final number

of reclassifications may vary because

some MGCRB decisions are still under

review by the Administrator and

because some hospitals may withdraw

their requests for reclassification.

Any changes to the wage index that

result from withdrawals of requests for

reclassification, wage index corrections,

appeals, and the Administrator’s review

process will be incorporated into the

wage index values published in the final

rule following this proposed rule. The

changes may affect not only the wage

index value for specific geographic

areas, but also the wage index value

redesignated hospitals receive; that is,

whether they receive the wage index

value for the area to which they are

redesignated, or a wage index value that

includes the data for both the hospitals

already in the area and the redesignated

hospitals. Further, the wage index value

for the area from which the hospitals are

redesignated may be affected.

Under § 412.273, hospitals that have

been reclassified by the MGCRB are

permitted to withdraw their

applications within 45 days of the

publication of this proposed rule in the

Federal Register. The request for

withdrawal of an application for

reclassification that would be effective

in FY 2002 must be received by the

MGCRB by June 18, 2001. A hospital

that requests to withdraw its application

may not later request that the MGCRB

decision be reinstated.

In addition, because the 3-year effect

of the amendment made by section

304(a) of Public Law 106–554 is

applicable to reclassifications for FY

2001 (which had already taken place

prior to the date of enactment of Public

Law 106–554) and because the

application process for reclassification

for FY 2002 had already been completed

by the date of enactment, we are

deeming hospitals that are reclassified

for purposes of the wage index to one

area for FY 2001 and are reclassified for

purposes of the wage index or the

standardized amount to another area for

FY 2002 to be reclassified to the area for

which they applied for FY 2002, unless

they elect to receive the wage index

reclassification they were granted for FY

2001. Consistent with our application

withdrawal procedures under § 412.273,

we are allowing hospitals that wish to

receive, for FY 2002, the reclassification

they were granted for FY 2001, to

withdraw their applications within 45

days of the publication of this proposed

rule (that is, by June 18, 2001. (These

procedures are discussed in detail under

section IV.E.1. of this preamble.)

3. Statewide Wage Index

As stated earlier, section 304(b) of

Public Law 106–554 requires the

Secretary to establish, by October 1,

2001, a process (based on the voluntary

process utilized by the Secretary under

section 1848 of the Act) under which an

appropriate statewide entity may apply

to have all the geographic areas in the

State treated as a single geographic area

for purposes of computing and applying

a single wage index, for reclassification

beginning in FY 2003. Section 304(b)

further requires that, if the Secretary

applies a statewide wage index to an

area, an application by an individual

hospital in that area would not be

considered. We believe the reference to

the voluntary process utilized by the

Secretary under section 1848 of the Act

refers to the process whereby we allow

a State containing multiple physician

fee schedule payment areas (and thus

multiple geographic adjustment factors)

to voluntarily convert to a single

statewide payment area with a single

geographic adjustment factor (see

§ 414.4(b), as discussed in the June 24,

1994 Federal Register (59 FR 32759).

Section IV.E. of this proposed rule

contains our policy proposal for

implementing the provisions of section

304(b) in regulations. We are proposing

that hospitals that seek a statewide

geographic reclassification under the

amendments made by section 304(b) of

Public Law 106–554 apply to the

MGCRB with the same deadlines as

other hospitals. An approved

application by the MGCRB would mean

that the data of all the hospitals in the

State would be used in computing and

applying the wage index for that State.

We are proposing that the statewide

wage index would be applicable for 3

years from the date of approval or until

all of the participating hospitals

terminate their approved statewide

wage index reclassification (effective

with the next full fiscal year after their

termination request), whichever occurs

first.

4. Section 402 of Public Law 106–113

Beginning October 1, 1988, section

1886(d)(8)(B) of the Act required us to

treat a hospital located in a rural county

adjacent to one or more urban areas as

being located in the MSA to which the

greatest number of workers in the

county commute, if the rural county

would otherwise be considered part of

an urban area under the standards

published in the Federal Register on

January 3, 1980 (45 FR 956) for

designating MSAs (and for designating

NECMAs), and if the commuting rates

used in determining outlying counties

(or, for New England, similar recognized

areas) were determined on the basis of

the aggregate number of resident

workers who commute to (and, if

applicable under the standards, from)

the central county or counties of all

contiguous MSAs (or NECMAs).

Hospitals that met the criteria using the

January 3, 1980 version of these OMB

standards were deemed urban for

purposes of the standardized amounts

and for purposes of assigning the wage

data index.

During FY 1994, we incorporated the

revised MSA definitions based on 1990

census population data. As a result,

some counties that previously were

treated as an adjacent county under

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

officially became part of certain MSAs.

However, as specified in the Act, we

continued to utilize the January 3, 1980

standards. For FY 2000, there were 27

hospitals in 22 counties affected by this

provision.

On March 30, 1990, OMB issued

revised 1990 standards (55 FR 12154).

There has been an increasing amount of

interest by the hospital industry in

using the 1990 standards as opposed to

the 1980 standards to determine which

hospitals qualify under the provisions

set forth in section 1886(d)(8)(B) of the

Act. Section 402 of Public Law 106–113

provides that, with respect to FYs 2001

22680 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

and 2002, a hospital may elect to have

the 1990 standards applied to it for

purposes of section 1886(d)(8)(B) and

that, beginning with FY 2003, hospitals

will be required to use the standards

published in the Federal Register by the

Director of OMB based on the most

recent decennial census.

We worked with staff of the

Population Distribution Branch within

the Population Division of the United

States Census Bureau to compile a list

of hospitals that meet the March 30,

1990 standards using 1990 census

population data and information

prepared for the Metropolitan Area

Standards Review Project. The

conditions that must be met for a

hospital located in a rural county

adjacent to one or more urban areas to

be treated as being located in the urban

area to which the greatest number of

workers in the rural county commute

are as follows: • The rural county would otherwise

be considered part of an MSA but for

the fact that the rural county does not

meet the standard established by OMB

relating to the commuting rate of

workers between the county and the

central county or counties of any

adjacent MSA. • The county would meet the

commuting standard if commuting to

(and where applicable, from) the central

county or central counties of all

adjacent MSAs or NECMAs (rather than

to just one) were considered. A county meeting the above

commuting standards must also meet

the other standards established by OMB

for inclusion in an MSA as an outlying

county. In order to meet these

requirements, the rural county must

have a degree of ‘‘metropolitan

character.’’ ‘‘Metropolitan character’’ is

established by meeting one of the

following OMB standards, which were

published in the Federal Register on

March 30, 1990:

a. At least 50 percent of the employed

workers residing in the county commute

to the central county/counties, and

either— • The population density of the

county is at least 25 persons per square

mile; or • At least 10 percent of the

population, or at least 5,000 persons,

lives in the qualifier urbanized area(s). b. From 40 to 50 percent of the

employed workers commute to the

central county/counties, and either— • The population density is at least

35 persons per square mile; or • At least 10 percent of the

population, or at least 5,000 persons,

lives in the qualifier urbanized area(s). c. From 25 to 40 percent of the

employed workers commute to the

central county/counties and either the

population density of the county is at

least 50 persons per square mile, or any

two of the following conditions exist: • Population density is at least 35

persons per square mile. • At least 35 percent of the

population is urban. • At least 10 percent of the

population, or at least 5,000 persons,

lives in the qualifier urbanized area(s). d. From 15 to 25 percent of the

employed workers commute to the

central county/counties, the population

density of the county is at least 50

persons per square mile, and any two of

the following conditions also exist: • Population density is at least 60

persons per square mile. • At least 35 percent of the

population is urban. • Population growth between the last

two decennial censuses is at least 20

percent. • At least 10 percent of the

population, or at least 5,000 persons,

lives in the qualifier urbanized area(s). Also accepted as meeting this

commuting requirement under item d.

are:• The number of persons working in

the county who live in the central

county/counties is equal to at least 15

percent of the number of employed

workers living in the county; or • The sum of the number of workers

commuting to and from the central

county/counties is equal to at least 20

percent of the number of employed

workers living in the county. e. From 15 to 25 percent of the

employed workers commute to the

central county/counties, the population

density of the county is less than 50

persons per square mile, and any two of

the following conditions also exist: • At least 35 percent of the

population is urban. • Population growth between the last

two decennial censuses is at least 20

percent. • At least 10 percent of the

population, or at least 5,000 persons,

lives in the qualifier urbanized area(s). f. At least 2,500 of the population

lives in a central city of the MSA

located in the qualifier urbanized

area(s).

When we apply the 1990 standards as

opposed to 1980 standards, the number

of qualifying counties increases from 22

to 31. On the basis of the evaluation of

these data, effective for discharges

occurring on or after October 1, 2001,

hospitals located in the first column of

the following table are proposed to be

considered, for purposes of assigning

the inpatient standardized amount and

the wage index, to be located in the

corresponding urban area in the second

column:

Rural County MSA

Chilton, AL ................ Birmingham, AL.

Marshall, AL .............. Huntsville, AL.

Talladega, AL ............ Anniston, AL.

Bradford, FL .............. Jacksonville, FL.

Hendry, FL ................ West Palm BeachBoca Raton, FL.

Putnam, FL ............... Gainesville, FL.

Jackson, GA .............. Athens, GA.

Christian, IL ............... Springfield, IL.

Macoupin, IL ............. St. Louis, MO–IL.

Piatt, IL ...................... Champaign-Urbana,

IL.

Brown, IN .................. Indianapolis, IN.

Carroll, IN .................. Lafayette, IN.

Henry, IN ................... Indianapolis, IN.

Jefferson, KS ............ Topeka, KS.

Barry, MI ................... Kalamazoo-Battle

Creek, MI.

Cass, MI .................... Benton Harbor, MI.

Ionia, MI .................... Grand Rapids-Muskegon-Holland, MI.

Shiawassee, MI ......... Flint, MI.

Tuscola, MI ............... Saginaw-Bay CityMidland, MI

Caswell, NC .............. Greensboro-Winston

Salem-High Point,

NC.

Greene, NC ............... Greenville, NC.

Harnett, NC ............... Raleigh-DurhamChapel Hill, NC.

Wilson, NC ................ Rocky Mount, NC.

Preble, OH ................ Dayton-Springfield,

OH.

Van Wert, OH ........... Lima, OH.

Adams, PA ................ York, PA.

Lawrence, PA ............ Pittsburgh, PA.

Monroe, PA ............... Newark, NJ.

Schuylkill, PA ............ Reading, PA.

Jefferson, WI ............. MilwaukeeWaukesha, WI.

Walworth, WI ............. MilwaukeeWaukesha, WI.

There are 14 counties that meet the

qualifying criteria using 1990 standards

that did not meet the criteria using the

1980 standards. These 14 counties are:

Chilton, AL

Talladega, AL

Bradford, FL

Hendry, FL

Putnam, FL

Jackson, GA

Piatt, IL

Brown, IN

Carroll, IN

Greene, NC

Wilson, NC

Adams, PA

Monroe, PA

Schuylkill, PA

In addition, when we apply the 1980

standards for three of the counties, the

MSA assigned is different from the MSA

that would be assigned using the 1990

standards. These counties are as

follows:

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22681

Rural county 1980 MSA designation 1990 MSA designation

Ionia, MI .................................... Lansing-East Lansing, MI ................................ Grand Rapids-Muskegon-Hollan, MI.

Caswell, NC .............................. Danville, VA ...................................................... Greensboro-Winston Salem-High Point, NC.

Harnett, NC ............................... Fayetteville, NC ................................................ Raleigh-Durham-Chapel Hill, NC.

Section 402 of Public Law 106–113

states that hospitals may elect to use

either the January 3, 1980 standards or

the March 30, 1990 standards for

payments during FY 2001 and FY 2002.

We are assuming hospitals will elect to

go to the MSA resulting in the highest

payment amount accounting for the

applicable wage indexes and

standardized amounts. Based on our

analysis, we believe all hospitals in the

designated rural counties would benefit

by being included in the respective

MSAs shown above. Therefore, we are

proposing to assign the FY 2002

standardized amount and wage index of

each respective MSA to the affected

hospitals. Hospitals electing not to use

the 1990 standards would be required to

notify their fiscal intermediary in

writing of such election prior to

September 1, 2001, in order to allow

sufficient time to reflect this change in

our payment systems. (For FY 2001, we

are providing further information

related to this election, including

recalculated wage indexes, through

separate instruction.)

We note that five rural counties no

longer meet the qualifying criteria when

we apply the revised OMB standards.

These rural counties are as follows:

Indian River, FL; Mason, IL; Owen, IN;

Morrow, OH; and Lincoln, WV. For FY

2002, we propose to continue to treat

these hospitals as attached to an MSA

on the basis of the 1980 standards.

Beginning FY 2003, they must meet the

1990 standards to continue to be treated

as such.

We stated in the August 1, 2000 final

rule that implemented changes to the

prospective payment system for FY

2001 that we were in the process of

working with OMB to identify the

hospitals that would be affected by

section 402 of Public Law 106–113 (65

FR 47076). We further indicated we

would revise payments to hospitals in

the affected counties as soon as data

were available. Now that the affected

counties have been identified, hospitals

in the 14 counties identified above will

be offered the opportunity to elect this

designation, as previously described.

(For FY 2001, we are providing further

information related to this election,

including recalculated wage indexes,

through separate instructions.)

Finally, three hospitals located in

counties affected by the revised OMB

standards also have been reclassified by

the MGCRB. The affected hospitals are

listed below. If the hospitals do not

wish to be reclassified for FY 2002

based on their new designation as

described above, they must follow the

procedures described above for

requesting that their reclassification be

withdrawn.

Provider Number 1990 MSA designation FY 2002 reclassification, MSA

34–0071 ............................... Raleigh-Durham-Chapel Hill, NC .................................... Fayetteville, NC.

34–0124 ............................... Raleigh-Durham-Chapel Hill, NC .................................... Fayetteville, NC.

34–0126 ............................... Rocky Mount, NC ............................................................ Raleigh-Durham-Chapel Hill, NC (wage index only.)

G. Requests for Wage Data Corrections

As stated in section II.D. of this

preamble, the data file used to construct

the proposed wage index includes FY

1998 data submitted to HCFA as of midFebruary 2001. In a memorandum dated

February 5, 2001, we instructed all

Medicare intermediaries to inform the

prospective payment hospitals they

service of the availability of the wage

data file and the process and timeframe

for requesting revisions. The wage data

file was made available on February 13,

2001 through the Internet at HCFA’s

home page (http://www.hcfa.gov). We

also instructed the intermediaries to

advise hospitals of the availability of

these data either through their

representative hospital organizations or

directly from HCFA. Additional details

on ordering this data file are discussed

in section IX.A of this preamble,

‘‘Requests for Data from the Public.’’

In addition, Table 2 in the Addendum

to this proposed rule contains each

hospital’s adjusted average hourly wage

used to construct the proposed wage

index values for the past 3 years,

including the FY 1998 data used to

construct the proposed FY 2002 wage

index. It should be noted that the

hospital average hourly wages shown in

Table 2 do not reflect any changes made

to a hospital’s data after mid-February

2001. Changes approved by a hospital’s

fiscal intermediary and forwarded to

HCFA by April 9, 2001, will be reflected

on the final public use wage data file

scheduled to be made available on or

about May 4, 2001.

We believe hospitals have sufficient

time to ensure the accuracy of their FY

1998 wage data. Moreover, the ultimate

responsibility for accurately completing

the cost report rests with the hospital,

which must attest to the accuracy of the

data at the time the cost report is filed.

Hospitals should know what wage data

were submitted on their cost reports.

Additionally, they are notified of any

changes to their data as a result of their

intermediary’s review. However, if a

hospital believed that its FY 1998 wage

data were incorrectly reported, the

hospital was to submit corrections along

with complete, detailed supporting

documentation to its intermediary by

March 9, 2001. Hospitals were notified

of this deadline, and of all other

possible deadlines and requirements,

through written communications from

their fiscal intermediaries in early

February 2001.

After reviewing requested changes

submitted by hospitals, intermediaries

transmitted any revised cost reports to

HCFA and forwarded a copy of the

revised Worksheet S–3, Parts II and III

to the hospitals. In addition, fiscal

intermediaries were to notify hospitals

of the changes or the reasons that

changes were not accepted. This

procedure ensures that hospitals have

every opportunity to verify the data that

will be used to construct their wage

index values. We believe that fiscal

intermediaries are generally in the best

position to make evaluations regarding

the appropriateness of a particular cost

and whether it should be included in

the wage index data. However, if a

hospital disagrees with the

intermediary’s resolution of a requested

change, the hospital may contact HCFA

in an effort to resolve policy disputes.

We note that the April 9, 2001 deadline

also applies to these requested changes.

We will not consider factual

determinations at this time, as these

22682 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

should have been resolved earlier in the

process.

Any wage data corrections to be

reflected in the final wage index must

have been reviewed and verified by the

intermediary and transmitted to HCFA

on or before April 9, 2001. (The

deadline for hospitals to request

changes from their fiscal intermediaries

was March 9, 2001.) These deadlines are

necessary to allow sufficient time to

review and process the data so that the

final wage index calculation can be

completed for development of the final

prospective payment rates to be

published by August 1, 2001.

We have created the process

described above to resolve all

substantive wage data correction

disputes before we finalize the wage

data for the FY 2002 payment rates.

Accordingly, hospitals that do not meet

the procedural deadlines set forth above

will not be afforded a later opportunity

to submit wage data corrections or to

dispute the intermediary’s decision with

respect to requested changes.

Specifically, our policy is that hospitals

that do not meet the procedural

deadlines set forth above will not be

permitted to later challenge, before the

Provider Reimbursement Review Board,

HCFA’s failure to make a requested data

revision (See W. A. Foote Memorial

Hospital v. Shalala, No. 99–CV–75202–

DT (E.D. Mich. 2001)).

The final wage data public use file

will be released by May 4, 2001.

Hospitals should examine both Table 2

of this proposed rule and the May 4

final public use wage data file (which

reflects revisions to the data used to

calculate the values in Table 2) to verify

the data HCFA is using to calculate the

wage index. Hospitals will have until

June 4, 2001, to submit requests to

correct errors in the final wage data due

to data entry or tabulation errors by the

intermediary or HCFA. The correction

requests that will be considered at that

time will be limited to errors in the

entry or tabulation of the final wage data

that the hospital could not have known

about before the release of the final

wage data public use file.

As with the file made available in

February 2001, HCFA will make the

final wage data file released in May

2001 available to hospital associations

and the public on the Internet. However,

the May 2001 file will be made available

solely for the limited purpose of

identifying any potential errors made by

HCFA or the intermediary in the entry

of the final wage data that result from

the correction process described above

(with the March 9 deadline). Hospitals

are encouraged to review their hospital

wage data promptly after the release of

the final file. Data presented at this time

cannot be used by hospitals to initiate

new wage data correction requests.

If, after reviewing the final file, a

hospital believes that its wage data are

incorrect due to a fiscal intermediary or

HCFA error in the entry or tabulation of

the final wage data, it should send a

letter to both its fiscal intermediary and

HCFA. The letters should outline why

the hospital believes an error exists and

provide all supporting information,

including dates. These requests must be

received by HCFA and the

intermediaries no later than June 4,

2001. Requests mailed to HCFA should

be sent to: Health Care Financing

Administration; Center for Health Plans

and Providers; Attention: Wage Index

Team, Division of Acute Care; C4–07–

07; 7500 Security Boulevard; Baltimore,

MD 21244–1850. Each request must also

be sent to the hospital’s fiscal

intermediary. The intermediary will

review requests upon receipt and

contact HCFA immediately to discuss

its findings.

At this point in the process, that is,

between release of the May 2001 wage

index file and June 4, 2001, changes to

the hospital wage data will only be

made in those very limited situations

involving an error by the intermediary

or HCFA that the hospital could not

have known about before its review of

the final wage data file. Specifically,

neither the intermediary nor HCFA will

accept the following types of requests at

this stage of the process:

• Requests for wage data corrections

that were submitted too late to be

included in the data transmitted to

HCFA on or before April 9, 2001.

• Requests for correction of errors

that were not, but could have been,

identified during the hospital’s review

of the February 2001 wage data file.

• Requests to revisit factual

determinations or policy interpretations

made by the intermediary or HCFA

during the wage data correction process.

Verified corrections to the wage index

received timely (that is, by June 4, 2001)

will be incorporated into the final wage

index to be published by August 1, 2001

and effective October 1, 2001.

Again, we believe the wage data

correction process described above

provides hospitals with sufficient

opportunity to bring errors in their wage

data to the intermediary’s attention.

Moreover, because hospitals will have

access to the final wage data by early

May 2001, they will have the

opportunity to detect any data entry or

tabulation errors made by the

intermediary or HCFA before the

development and publication of the FY

2002 wage index by August 1, 2001 and

the implementation of the FY 2002 wage

index on October 1, 2001. If hospitals

avail themselves of this opportunity, the

wage index implemented on October 1

should be accurate. Nevertheless, in the

event that errors are identified after that

date, we retain the right to make

midyear changes to the wage index

under very limited circumstances.

Specifically, in accordance with

§ 412.63(w)(2), we may make midyear

corrections to the wage index only in

those limited circumstances in which a

hospital can show (1) That the

intermediary or HCFA made an error in

tabulating its data; and (2) that the

hospital could not have known about

the error, or did not have an opportunity

to correct the error, before the beginning

of FY 2002 (that is, by the June 4, 2001

deadline). As indicated earlier, since a

hospital will have the opportunity to

verify its data, and the intermediary will

notify the hospital of any changes, we

do not foresee any specific

circumstances under which midyear

corrections would be necessary.

However, should a midyear correction

be necessary, the wage index-change for

the affected area will be effective

prospectively from the date the

correction is made.

H. Modification of the Process and

Timetable for Updating the Wage Index

Although the wage data correction

process described above has proven

successful in the past for ensuring that

the wage data used each year to

calculate the wage indexes are generally

reliable and accurate, we are concerned

about the growing volume of wage data

revisions initiated by hospitals during

February and the first week of March.

We first discussed this issue in the FY

1998 proposed rule (62 FR 29918). At

that time, we noted that, in developing

the FY 1997 wage index, the wage data

were revised between the proposed and

final rules for more than 13 percent of

the hospitals (approximately 700 of

5,200). Last year, in developing the FY

2001 wage index, the wage data were

revised between the proposed and final

rules for more than 32 percent of the

hospitals (1,605 of 4,950).

Since hospitals are expected to submit

complete and accurate cost report data,

and intermediaries review and request

hospitals to correct problematic wage

data before the data are submitted to

HCFA in mid-November, we believe

there should be limited revisions at this

stage of the process. We remind the

hospital community that the primary

purpose of this file is to allow hospitals

to verify that we have their correct data

on file. However, according to

information received from the

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22683

intermediaries, these late revisions are

frequently due to hospitals’ lack of

responsiveness in providing sufficient

information to the intermediaries during

the desk reviews (that is, during the

intermediary’s review of the hospital’s

cost report).

We are proposing two changes to the

wage index development process and

timetable beginning with the FY 2003

wage index. We believe these changes

will encourage earlier submissions of

wage data revisions by hospitals and

will allow intermediaries more time to

address the heavy volume of revisions

requested after the intermediaries have

completed their desk reviews of these

data. First, we are proposing to release

the preliminary wage data file by early

January rather than early February. As

with the current preliminary file, the

January file would include desk

reviewed wage data that intermediaries

submitted to HCFA by November of the

previous year and any timely revisions

HCFA received from intermediaries

prior to release of the January file.

Hospitals would be allowed until early

February to submit requests for wage

data revisions to their intermediaries.

Second, intermediaries would be

allowed approximately 8 weeks from

the hospitals’ deadline for submitting

revision requests (that is, until early

March) to review and transmit revised

wage data to HCFA.

We believe this proposed revised

schedule will improve the quality of the

wage index by allowing intermediaries

more time to sufficiently review wage

data revisions before the data are

submitted to HCFA. Further, we believe

the proposed revised process will

encourage hospitals to submit revisions

earlier, so the proposed wage index,

from which hospitals base geographic

reclassification decisions, is more

accurate.

IV. Other Decisions and Proposed

Changes to the Prospective Payment

System for Inpatient Operating Costs

and Graduate Medical Education Costs

A. Sole Community Hospitals (SCHs)

(§§ 412.63, 412.71, 412.72, 412.73,

412.75, 412.77, and 412.92)

For the benefit of the reader, in this

proposed rule, we are discussing and

seeking to clarify many of the rules and

policies governing SCHs because of the

legislative changes that have occurred in

recent years. It has been several years

since the SCH criteria have been

published in one location. Rather than

continue to refer to various Federal

Register documents and sections of the

Code of Federal Regulations, we are

publishing a detailed discussion of

these policies, proposing to make

further changes to incorporate the

provisions of sections 213, 302, 303,

304, and 311 of Public Law 106–554,

and proposing to clarify other related

policies.

Under the hospital inpatient

prospective payment system, special

payment protections are provided to an

SCH. Section 1886(d)(5)(D)(iii) of the

Act defines an SCH as a hospital that,

by reason of factors such as isolated

location, weather conditions, travel

conditions, absence of other like

hospitals (as determined by the

Secretary), or historical designation by

the Secretary as an Essential Access

Community Hospital (EACH), is the sole

source of inpatient hospital services

reasonably available to Medicare

beneficiaries. The regulations that set

forth the criteria that a hospital must

meet to be classified as an SCH are at

§ 412.92. To be classified as an SCH, a

hospital must either have been

designated as an SCH prior to the

beginning of the prospective payment

system on October 1, 1983, and must be

located more than 35 miles from other

like hospitals, or the hospital must be

located in a rural area and meet one of

the following requirements:

• It is located more than 35 miles

from other like hospitals.

• It is located between 25 and 35

miles from other like hospitals, and it—

—Serves at least 75 percent of all

inpatients, or 75 percent of Medicare

beneficiary inpatients, within a 35-

mile radius or, if larger, within its

service area; or

—Has fewer than 50 beds and would

qualify on the basis of serving 75

percent of its area’s inpatients except

that some patients seek specialized

care unavailable at the hospital.

• It is located between 15 and 25

miles from other like hospitals, and

because of local topography or extreme

weather conditions, the other like

hospitals are inaccessible for at least 30

days in each of 2 out of 3 years.

• The travel time between the

hospital and the nearest like hospital is

at least 45 minutes because of distance,

posted speed limits, and predictable

weather conditions.

• Effective with hospital cost

reporting periods beginning on or after

April 1, 1990, section 1886(d)(5)(D)(i) of

the Act, as amended by section 6003(e)

of Public Law 101–239, provides that

SCHs are paid based on whichever of

the following rates yields the greatest

aggregate payment:

• The Federal rate applicable to the

hospital.

• The updated hospital-specific rate

based on FY 1982 costs per discharge.

• The updated hospital-specific rate

based on FY 1987 costs per discharge.

Effective with hospital cost reporting

periods beginning on or after October 1,

2000, section 1886(b)(3)(I)(i) of the Act,

as added by section 405 of Public Law

106–113 and amended by section 213 of

Public Law 106–554, provides for other

options, in addition to the three bulleted

options in the above paragraph, for

determining which rate would yield the

greatest aggregate payment. For

discharges for FY 2001 through FY

2003, these additional optional rates

are—

• A phase-in blended rate of the

updated hospital-specific rate based on

FY 1982 costs per discharge and an FY

1996 hospital-specific rate; or

• A phase-in blended rate of the

updated hospital-specific rate based on

FY 1987 costs per discharge and an FY

1996 hospital-specific rate.

For discharges beginning in FY 2004,

the additional optional rate would be

100 percent of the FY 1996 hospitalspecific rate.

For each cost reporting period, the

fiscal intermediary determines which of

the payment options will yield the

highest rate of payment. Payments are

automatically made at the highest rate

using the best data available at the time

the fiscal intermediary makes the

determination. However, it may not be

possible for the fiscal intermediary to

determine in advance precisely which

of the rates will yield the highest

payment by year’s end. In many

instances, it is not possible to forecast

the update factor for the Federal rates,

outlier payments, the amount of the

DSH adjustment, or the IME adjustment,

all of which are applicable only to

payments based on the Federal rate. The

fiscal intermediary makes a final

adjustment at the close of the cost

reporting period to determine precisely

which of the payment rates would yield

the highest payment to the hospital.

If a hospital disagrees with the fiscal

intermediary’s determination regarding

the final amount of program payment to

which it is entitled, it has the right to

appeal the fiscal intermediary’s decision

in accordance with the procedures set

forth in Subpart R of Part 405, which

concern provider payment

determinations and appeals.

In calculating a hospital-specific rate

for an SCH based on its FY 1996 cost

reporting period, we will, to the extent

possible, use the same methodology that

we used to calculate the hospitalspecific rate based on either the FY 1982

or FY 1987 cost reporting period. That

22684 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

methodology is set forth in §§ 412.71,

412.72, 412.73, 412.75 and 412.77.

• If a hospital has a cost reporting

period ending in FY 1982, it will be

paid a hospital-specific rate based on its

FY 1982 costs; or a hospital-specific rate

based on its FY 1987 costs; or a

hospital-specific rate based on its FY

1996 costs (which, until FY 2004, would

be a blend of the greater of the FY 1982

or FY 1987 costs and the FY 1996 costs);

or it will be paid based on the Federal

rate.

• If a hospital has no cost reporting

period ending in FY 1982, it will be

paid a hospital-specific rate based on its

FY 1987 costs; or a hospital-specific rate

based on its FY 1996 costs (which, until

FY 2004, would be a blend of its FY

1987 costs and FY 1996 costs); or it will

be paid based on the Federal rate.

• If a hospital has no cost reporting

period ending in either FY 1982 or FY

1987, it will be paid based on its FY

1996 costs; or it will be paid based on

the Federal rate.

• If a hospital has no cost reporting

period ending in FY 1982, FY 1987, or

FY 1996, it cannot be paid based on a

hospital-specific rate; it will be paid

based on the Federal rate.

• If a hospital was operating during

any or all of FY 1982, FY 1987, or FY

1996, but, for some reason, the cost

report records are no longer available,

the hospital will be treated as if it had

no cost report for the applicable period.

The hospital will not be allowed to

substitute any other base period for the

FY 1982, FY 1987, or FY 1996 base

period.

For each SCH, the fiscal intermediary

will calculate a hospital-specific rate

based on the hospital’s FY 1982, FY

1987, or FY 1996 cost report as follows:

• Determine the hospital’s total

allowable Medicare inpatient operating

cost, as stated on the cost report.

• Divide the total Medicare operating

cost by the number of Medicare

discharges (without adjusting for

transfers) in the cost reporting period to

determine the base period cost per case.

• In order to take into consideration

the hospital’s individual case-mix, the

base year cost per case is divided by the

hospital’s case-mix index applicable to

the cost reporting period. This step is

necessary to adjust the hospital’s base

period cost for case mix. This is done

to remove the effects of case mix from

the base period costs per case. Payments

using these base period costs are then

adjusted to reflect the actual case mix

during the payment year. A hospital’s

case mix is computed based on its

Medicare patient discharges subject to

DRG-based payment.

The fiscal intermediary will inform

each SCH of its hospital-specific rate

based on its applicable cost reporting

period within 180 days after the start of

its cost reporting period.

An SCH is also eligible for a payment

adjustment if, for reasons beyond its

control, it experiences a decline in

volume of greater than 5 percent

compared to its preceding cost reporting

period. This adjustment is also available

to hospitals that could qualify as SCHs

but choose not to be paid as SCHs; that

is, hospitals that qualify and

successfully apply to be designated as

SCHs but continue to receive payments

based on the Federal rate. In addition,

section 6003(c)(1) of Public Law 101–

239 deleted the sunset date on the 5-

percent volume decline adjustment,

thus allowing SCHs to receive the

adjustment indefinitely. The sunset

provision was included under section

1886(d)(5)(C)(ii) of the Act. (Section

6003(c)(1) of Public Law 101–239

amended that provision and

redesignated it as section 1886(d)(5)(D)

of the Act.)

In the September 1, 1983, issue of the

Federal Register (48 FR 39781), we

stated that any hospital designated as an

SCH would retain that status until it

experienced a change in circumstances.

Section 6003(e)(3) of Public Law 101–

239 specifically stated that any hospital

classified as an SCH as of the date of

enactment of Public Law 101–239

(December 19, 1989), will retain its SCH

status even if the hospital did not meet

the criteria established under section

6003(e)(1) of that law. These hospitals

are the ‘‘grandfathered’’ SCH hospitals.

Therefore, we have continued to allow

hospitals designated as SCHs prior to

December 19, 1989, to be

‘‘grandfathered’’ under current criteria.

In the June 4, 1991, Federal Register,

we stated that a hospital’s special status

as an SCH would not be retained in light

of the hospital’s geographic

reclassification for purposes of the

standardized amount. In the event the

hospital’s reclassification ceases, it must

reapply for special status and must meet

all of the applicable qualifying criteria

in effect at the time it seeks

requalification (56 FR 25482). However,

in the event a ‘‘grandfathered’’ SCH was

successfully reclassified, it would be

reinstated as an SCH if its

reclassification ceased.

Section 401(a) of Public Law 106–113

established that any subsection (d)

hospital (section 1886(d) of the Act)

located in an urban area may be

redesignated as being located in a rural

area if the hospital meets one of several

criteria established by the legislation.

One of these criteria is that the hospital

could qualify as an SCH if the hospital

were located in a rural area. Under this

provision, an urban hospital that may

have been ‘‘grandfathered’’ as an SCH

could now qualify and receive payment

as an SCH if it met the criteria of a rural

SCH. Given this extension of SCH

eligibility, we no longer believe it is

necessary to extend special protection to

‘‘grandfathered’’ SCHs that successfully

apply for geographic reclassification

through the MGCRB for the

standardized amount after their MGCRB

reclassification ends. This circumstance

falls under the provisions of

§§ 412.92(b)(3) and (b)(5), which state

that an approved classification as an

SCH remains in effect without need for

reapproval unless there is a change in

the circumstances under which the

classification was approved. We believe

that a successful reclassification by the

MGCRB fits the definition of a change

in circumstances.

Because some hospitals may not have

understood the effect reclassification

would have on their special status,

under existing § 412.273(a) we are

permitting affected hospitals the option

to withdraw their applications for

reclassification for FY 2002, even if the

MGCRB has issued a decision, by

submitting a withdrawal request to the

MGCRB within 45 days of publication of

this proposed rule. Finally, just as a

competing hospital that closes leaves an

opportunity for an existing hospital to

qualify as an SCH, a new hospital that

opens in an area with an existing

hospital designated as an SCH

endangers the SCH status of the existing

hospital.

As of October 1, 1997, no designations

of hospitals as EACHs can be made. The

EACHs designated by HCFA before

October 1, 1997, will continue to be

paid as SCHs for as long as they comply

with the terms, conditions, and

limitations under which they were

designated as EACHs.

Under § 412.92(b)(2), we define the

effective dates for several situations in

which a hospital gains or gives up SCH

status. First, SCH status and the

associated payment adjustment is

effective 30 days after HCFA’s written

notification to the SCH. Thus, 30 days

after the issuance of HCFA’s notice of

approval, the hospital is considered to

be an SCH and the payment adjustment

is applied to discharges occurring on or

after that date.

Second, § 412.92(b)(4)(ii) defines the

effective date when a hospital chooses

to give up its SCH status. Our policy has

always been that an SCH can elect to

give up its SCH status at any time by

submitting a written request to the

appropriate HCFA regional office

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22685

through its fiscal intermediary. The

change to fully national rates becomes

effective no later than 30 days after the

hospital submits its request. We believe

that the ‘‘no later than 30 days’’ policy

for the effective date for cancelling SCH

status is in keeping with the prospective

nature of the prospective payment

system. In addition, the 30-day

timeframe to give up SCH status

provides the fiscal intermediaries with

enough time to alter their automated

payment systems prospectively, thus

avoiding expensive and time-consuming

reprocessing of claims. The variable

timeframe of ‘‘no later than 30 days

from the date of the hospital’s request’’

also permits the regional office, the

fiscal intermediary, and the hospital to

select a mutually agreeable date, for

example, at the end of a month, to

facilitate the change in SCH status. We

expect that hospitals will anticipate

when they wish to give up SCH status

and to submit their requests in sufficient

time to permit the 30-day period for

making the change.

In addition, § 412.92(b)(2)(ii) defines

the effective date of SCH status in the

situation where a final and

nonappealable administrative or judicial

decision reverses HCFA’s denial of SCH

status to a hospital. In this situation, if

the hospital’s application was submitted

on or after October 1, 1983, the effective

date will be 30 days after the date of

HCFA’s original written notification of

denial.

Under § 412.92(b)(2)(iii), we define

retroactive approval of SCH status. If a

hospital is granted retroactive approval

of SCH status by a final and

nonappealable court order or an

administrative decision under subpart R

of Part 405 of the regulations, and it

wishes its SCH status terminated prior

to the current date (that is, it wishes to

be paid as an SCH for a time-limited

period, all of which is in the past), it

must submit written notice to the HCFA

regional office through its fiscal

intermediary within 90 days of the court

order or the administrative decision.

This written notice must clearly state

that, although SCH status was granted

retroactively by the court order or by the

administrative decision, the hospital

wants this status terminated as of a

specific date. If written notice is not

received within 90 days of the court

order or the administrative decision,

SCH status will continue. Written

requests to terminate SCH status that are

received subsequent to the 90-day

period will be effective no later than 30

days after the request is submitted, as

discussed above.

Under § 412.92(c)(1), we define

mileage. We believe that mileage should

continue to be measured by the shortest

route over improved roads maintained

by any local, State, or Federal

Government entity for public use. We

consider improved roads to include the

paved surface up to the front entrance

of the hospital because this portion of

the distance is utilized by the public to

access the hospital. This definition

provides consistency with the

interpretation of the MGCRB when

considering hospital reclassification

applications. The MGCRB measures the

distance between the hospital and the

county line of the area to which it seeks

reclassification beginning with the

paved area outside the front entrance of

the hospital. This provides a consistent,

national definition that is easily

recognizable for each hospital. Finally,

rounding of mileage is not permissible.

this is also consistent with the MGCRB

definition of mileage (56 FR 25483). We

are proposing to revise the definition of

‘‘miles’’ under § 412.92(c)(1) to state that

an improved road includes the paved

surface up to the front entrance of the

hospital.

Under § 412.92(c)(2), we define ‘‘like’’

hospital. We consider like hospitals to

be those hospitals furnishing short-term

acute care. That is, a hospital may not

qualify for an SCH classification on the

grounds that neighboring hospitals offer

specialty services, thereby seeking to

exclude close-by competitors as like

hospitals, in order to meet the mileage

criteria by measuring to a like hospital

that is located further away. For

example, we believe that competing

hospitals within a given area may each

have their own specialty services, while

all the facilities continue to be

considered short-term acute care

hospitals. We note that under

§ 412.92(a)(1)(ii), a hospital with fewer

than 50 beds may qualify for SCH status

under a special provision if patients that

it would normally serve are seeking care

elsewhere due to the unavailability of

specialty services. This means that, if a

hospital can prove that the patients from

its service area are seeking specialty

services elsewhere (such as, among

others, heart surgery, transplants, and

burn care), rather than routine care, and,

because of that fact, that it otherwise

would have met the criteria of section

§ 412.92(a)(1)(i), it can qualify as an

SCH.

We note that § 412.92(b)(1)(iii)(A)

retains an outdated reference to

‘‘hospitals located within a 50 mile

radius of the hospital.’’ With the

issuance of the September 1, 1989

Federal Register (54 FR 36481, 36482),

the 50 mile radius was determined to be

unreasonable and all references should

have been changed to 35 miles in

accordance with § 412.92(a)(1)(i). We

are proposing to revise the reference to

‘‘a 50 mile radius’’ in

§ 412.92(b)(1)(iii)(A) to read ‘‘a 35 mile

radius’’.

We note that the travel time and

weather conditions criteria set forth in

§ 412.92(a)(3) were discussed in detail

in the September 4, 1990 Federal

Register (55 FR 36050 through 36055

and 36162 through 36163).

Under § 412.92(a)(1)(i) and (b)(1)(ii),

we define the market area analysis

criteria used to determine SCH status.

There are several points concerning

these requests for SCH status that we

would like to clarify in this proposed

rule. First, a hospital seeking an SCH

designation based on these criteria must

make its initial request to the fiscal

intermediary with all the appropriate

documents as will be discussed below

(§ 412.92(b)(1)(i)). The fiscal

intermediary will make a

recommendation on the request, based

on receipt of all the appropriate

documentation and its own

investigation and analysis, and that

recommendation will be forwarded to

the HCFA regional office for another

level of review and final approval or

disapproval. The fiscal intermediary

would forward its recommendation to

the HCFA regional office located in the

hospital’s area as opposed to the fiscal

intermediary’s area, if there is a

difference in these areas. As discussed

above, an approval of the request for

SCH status will be effective 30 days

after HCFA issues the approval letter. If

a determination on the request requires

the use of data that are available at

HCFA central office only, upon receipt

of the fiscal intermediary’s

recommendation, the HCFA regional

office will forward the request and the

fiscal intermediary’s recommendation to

the appropriate contact at HCFA central

office where the determination will be

made.

Second, a hospital must provide

patient origin data (the number of

patients from each zip code from which

the hospital draws inpatients) for all

inpatient discharges to document the

boundaries of its service area

(§ 412.92(b)(1)(ii)(A)). Or, the hospital

can request that HCFA develop patient

origin data to define its service area

based on the number of patients from

each zip code from which the hospital

draws Medicare Part A inpatients

(§ 412.92(b)(1)(iii)). Then, the lowest

number of zip codes in descending

percentage order of Medicare inpatients

that meets the 75-percent threshold will

be used to represent the hospital’s

service area. We note that hospitals

cannot substitute zip codes elsewhere

22686 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

on the list in order to manipulate the

service area. See (Howard Young

Medical Center, Inc. v. Shalala, 207

F.3d 437 (7th Cir. 2000).)

Third, the hospital must provide

patient origin data from all other

hospitals located within a 35-mile

radius of it or, if larger, within its

service area, to document that no more

than 25 percent of either all of the

population or the Medicare beneficiaries

residing in the hospital’s service area

and hospitalized for inpatient care were

admitted to other like hospitals for care

(§ 412.92(b)(1)(ii)(B)). Again, HCFA

central office can develop patient origin

data for other hospitals within the

requesting hospital’s service area if the

hospital is requesting SCH status based

on an examination of Medicare Part A

inpatient utilization. In either case, the

requesting hospital is required to submit

a comprehensive list of hospitals

located within a 35-mile radius or, if

larger, within its service area. This list

will be checked by both the fiscal

intermediary and HCFA. Again, a

requesting hospital cannot argue that a

competing hospital should be excluded

from the service area based on the

existence of specialty services at that

hospital if both hospitals are short-term

acute care facilities. Distances between

all reported hospitals will be checked by

both the fiscal intermediary and HCFA,

through electronic geographic mapping

services (such as Yahoo or Mapquest) or

by physically driving the distance

involved.

In addition, data will be analyzed

based on the year for which the hospital

requests SCH status. Subsequent

hospital mergers or terminations will

not be taken into consideration in

processing the request. For example, if

a hospital requests SCH status using

data for FY 1999, and that data show

that there is a competing hospital in

existence that subsequently closed its

doors in FY 2000, the data will be

analyzed with the terminated hospital

in existence, unless the hospital seeking

SCH status applies using later data, such

as FY 2001. This principle is consistent

with how we analyze wage index data.

If a terminated hospital has a viable cost

report for the year of wage data that is

being analyzed to produce the wage

index, its data are included as part of

the computation.

B. Rural Referral Centers (§ 412.96)

Under the authority of section

1886(d)(5)(C)(i) of the Act, the

regulations at § 412.96 set forth the

criteria a hospital must meet in order to

receive special treatment under the

prospective payment system as a rural

referral center. For discharges occurring

before October 1, 1994, rural referral

centers received the benefit of payment

based on the other urban amount rather

than the rural standardized amount.

Although the other urban and rural

standardized amounts were the same for

discharges beginning with that date,

rural referral centers would continue to

receive special treatment under both the

disproportionate share hospital (DSH)

payment adjustment and the criteria for

geographic reclassification.

Section 401 of Public Law 106–113

amended section 1886(d)(8) of the Act

by adding subparagraph (E), which

creates a mechanism, separate and apart

from the MGCRB, permitting an urban

hospital to apply to the Secretary to be

treated as being located in the rural area

of the State in which the hospital is

located. The statute directs the Secretary

to treat a qualifying hospital as being

located in the rural area for purposes of

provisions under section 1886(d) of the

Act. Congress clearly intended hospitals

that become rural under section

1886(d)(8)(E) of the Act to receive some

benefit as a result. In addition, one of

the criteria under section 1886(d)(8)(E)

of the Act is that the hospital would

qualify as an SCH or a rural referral

center if it were located in a rural area.

An SCH would be eligible to be paid on

the basis of the higher of its hospitalspecific rate or the Federal rate. On the

other hand, the only benefit under

section 1886(d) of the Act for an urban

hospital to become a rural referral center

would be waiver of the proximity

requirements that are otherwise

applicable under the MGCRB process, as

set forth in § 412.230(a)(3)(i).

When we implemented section 401 of

Public Law 106–113 in the August 1,

2000 final rule (65 FR 47089), we stated

that we believed Congress contemplated

that hospitals might seek to be

reclassified as rural under section

1886(d)(8)(E) of the Act in order to

become rural referral centers so that the

hospitals would be exempt from the

MGCRB proximity requirement and

could be reclassified by the MGCRB to

another urban area. Therefore, in that

final rule we sought a policy approach

that would appropriately address our

concern that these urban to rural

redesignations not be utilized

inappropriately, and that would benefit

hospitals seeking to reclassify under the

MGCRB process by achieving rural

referral center status. (We became aware

of several specific hospitals that were

rural referral centers for FY 1991, but

subsequently lost their status when the

county in which they were located

became urban, and had expressed their

wish to be redesignated as a rural

referral center in order to be eligible to

reclassify.) Accordingly, in light of

section 1886(d)(8)(E) of the Act and the

language in the accompanying

Conference Report, effective as of

October 1, 2000, hospitals located in

what is now an urban area, if they were

ever a rural referral center, were

reinstated to rural referral center status.

In addition, as discussed in 62 FR

45999 and 63 FR 26317, under section

4202 of Public Law 105–33, a hospital

that was classified as a rural referral

center for FY 1991 is to be classified as

a rural referral center for FY 1998 and

later years so long as that hospital

continued to be located in a rural area

and did not voluntarily terminate its

rural referral center status. Otherwise, a

hospital seeking rural referral center

status must satisfy applicable criteria.

One of the criteria under which a

hospital may qualify as a rural referral

center is to have 275 or more beds

available for use. A rural hospital that

does not meet the bed size requirement

can qualify as a rural referral center if

the hospital meets two mandatory

prerequisites (specifying a minimum

case-mix index and a minimum number

of discharges) and at least one of three

optional criteria (relating to specialty

composition of medical staff, source of

inpatients, or referral volume). With

respect to the two mandatory

prerequisites, a hospital may be

classified as a rural referral center if

its—

• Case-mix index is at least equal to

the lower of the median case-mix index

for urban hospitals in its census region,

excluding hospitals with approved

teaching programs, or the median casemix index for all urban hospitals

nationally; and

• Number of discharges is at least

5,000 per year, or if fewer, the median

number of discharges for urban

hospitals in the census region in which

the hospital is located. (The number of

discharges criterion for an osteopathic

hospital is at least 3,000 discharges per

year.)

1. Case-Mix Index

Section 412.96(c)(1) provides that

HCFA will establish updated national

and regional case-mix index values in

each year’s annual notice of prospective

payment rates for purposes of

determining rural referral center status.

The methodology we use to determine

the proposed national and regional casemix index values is set forth in

regulations at § 412.96(c)(1)(ii). The

proposed national case-mix index value

includes all urban hospitals nationwide,

and the proposed regional values are the

median values of urban hospitals within

each census region, excluding those

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22687

with approved teaching programs (that

is, those hospitals receiving indirect

medical education payments as

provided in § 412.105). These values are

based on discharges occurring during

FY 1999 (October 1, 1998 through

September 30, 1999) and include bills

posted to HCFA’s records through

December 1999.

We are proposing that, in addition to

meeting other criteria, hospitals with

fewer than 275 beds, if they are to

qualify for initial rural referral center

status for cost reporting periods

beginning on or after October 1, 2001,

must have a case-mix index value for FY

2000 that is at least—

• 1.3286; or

• The median case-mix index value

for urban hospitals (excluding hospitals

with approved teaching programs as

identified in § 412.105) calculated by

HCFA for the census region in which

the hospital is located.

The median case-mix values by region

are set forth in the following table:

Region Case-mix

index value

1. New England (CT, ME, MA, NH, RI, VT) ........................................................................................................................................ 1.2377

2. Middle Atlantic (PA, NJ, NY) ........................................................................................................................................................... 1.2305

3. South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV) ............................................................................................................... 1.3055

4. East North Central (IL, IN, MI, OH, WI) .......................................................................................................................................... 1.2613

5. East South Central (AL, KY, MS, TN) ............................................................................................................................................. 1.2537

6. West North Central (IA, KS, MN, MO, NE, ND, SD) ...................................................................................................................... 1.1653

7. West South Central (AR, LA, OK, TX) ............................................................................................................................................ 1.2484

8. Mountain (AZ, CO, ID, MT, NV, NM, UT, WY) ............................................................................................................................... 1.3286

9. Pacific (AK, CA, HI, OR, WA) ......................................................................................................................................................... 1.2693

The preceding numbers will be

revised in the final rule to the extent

required to reflect the updated FY 2000

MedPAR file, which will contain data

from additional bills received through

March 31, 2001.

Hospitals seeking to qualify as rural

referral centers or those wishing to

know how their case-mix index value

compares to the criteria should obtain

hospital-specific case-mix values from

their fiscal intermediaries. Data are

available on the Provider Statistical and

Reimbursement (PS&R) System. In

keeping with our policy on discharges,

these case-mix index values are

computed based on all Medicare patient

discharges subject to DRG-based

payment.

2. Discharges

Section 412.96(c)(2)(i) provides that

HCFA will set forth the national and

regional numbers of discharges in each

year’s annual notice of prospective

payment rates for purposes of

determining rural referral center status.

As specified in section 1886(d)(5)(C)(ii)

of the Act, the national standard is set

at 5,000 discharges. We are proposing to

update the regional standards based on

discharges for urban hospitals’ cost

reporting periods that began during FY

1999 (that is, October 1, 1998 through

September 30, 1999). That is the latest

year for which we have complete

discharge data available.

Therefore, we are proposing that, in

addition to meeting other criteria, a

hospital, if it is to qualify for initial

rural referral center status for cost

reporting periods beginning on or after

October 1, 2001, must have as the

number of discharges for its cost

reporting period that began during FY

1999 a figure that is at least—

• 5,000; or

• The median number of discharges

for urban hospitals in the census region

in which the hospital is located, as

indicated in the following table:

Region Number of

discharges

1. New England (CT, ME, MA, NH, RI, VT) ........................................................................................................................................ 7083

2. Middle Atlantic (PA, NJ, NY) ........................................................................................................................................................... 8371

3. South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV) ............................................................................................................... 8202

4. East North Central (IL, IN, MI, OH, WI) .......................................................................................................................................... 7430

5. East South Central (AL, KY, MS, TN) ............................................................................................................................................. 6505

6. West North Central (IA, KS, MN, MO, NE, ND, SD) ...................................................................................................................... 4708

7. West South Central (AR, LA, OK, TX) ............................................................................................................................................ 4911

8. Mountain (AZ, CO, ID, MT, NV, NM, UT, WY) ............................................................................................................................... 8287

9. Pacific (AK, CA, HI, OR, WA) ......................................................................................................................................................... 7001

These numbers will be revised in the

final rule based on the latest FY 1999

cost report data.

We reiterate that an osteopathic

hospital, if it is to qualify for rural

referral center status for cost reporting

periods beginning on or after October 1,

2001, must have at least 3,000

discharges for its cost reporting period

that began during FY 2000.

C. Indirect Medical Education (IME)

Adjustment (§ 412.105)

1. IME Adjustment Factor Formula

Multiplier (Section 302 of Public Law

106–554 and § 412.105(d)(3))

Section 1886(d)(5)(B) of the Act

provides that prospective payment

hospitals that have residents in an

approved graduate medical education

(GME) program receive an additional

payment to reflect the higher indirect

operating costs associated with GME.

The regulations regarding the

calculation of this additional payment,

known as the indirect medical

education (IME) adjustment, are located

at § 412.105. The additional payment is

based in part on the applicable IME

adjustment factor. The IME adjustment

factor is calculated using a hospital’s

ratio of residents to beds, which is

represented as r, and a multiplier,

which is represented as c, in the

following equation: c × [(1 + r).405 ¥ 1].

The formula is traditionally described in

terms of a certain percentage increase in

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payment for every 10-percent increase

in the resident-to-bed ratio.

Section 302 of Public Law 106–554

amended section 1886(d)(5)(B) of the

Act to modify the transition for the IME

formula multiplier, or c, that was first

established by Public Law 105–33 and

revised by Public Law 106–113.

Section 302(a) of Public Law 106–554

provides that, for discharges occurring

during FY 2002, the formula multiplier

is 1.6. For discharges occurring during

FY 2003 and thereafter, the formula

multiplier is 1.35. (Section 302(b) of

Public Law 106–554 provides for a

special payment rule which states that,

for discharges occurring on or after

April 1, 2001 and before October 1,

2001, IME payments are to be made if

‘‘c’’ equalled 1.66 rather than 1.54. We

are issuing a separate interim final rule

with comment period (HCFA–1178–IFC)

to include this change for payments in

FY 2001.) The multiplier of 1.6 for FY

2002 represents a 6.5-percent increase

for every 10-percent increase in the

resident-to-bed ratio. The multiplier for

FY 2003 and thereafter (1.35) represents

a 5.5-percent increase for every 10-

percent increase in the resident-to-bed

ratio.

We are proposing to revise

§ 412.105(d)(3)(vi) to reflect the change

in the formula multiplier for FY 2002 to

1.6 as made by section 302(a) of Public

Law 106–554 for discharges occurring

during FY 2002. We also are proposing

to add § 412.105(d)(3)(vii) to incorporate

the formula multiplier of 1.35 for

discharges occurring on or after October

1, 2002.

2. Resident-to-Bed Ratio Cap

(§ 412.105(a)(1))

It has come to our attention that there

is some misunderstanding about

§ 412.105(a)(1) regarding the

determination of the resident-to-bed

ratio that is used in calculating the IME

adjustment. Section 4621(b)(1) of Public

Law 105–33 amended section

1886(d)(5)(B) of the Act by adding a new

clause (vi) to provide that, effective for

cost reporting periods beginning on or

after October 1, 1997, the resident-tobed ratio may not exceed the ratio

calculated during the prior cost

reporting period (after accounting for

the cap on the hospital’s number of fulltime equivalent (FTE) residents). We

implemented this policy in the August

29, 1997 final rule (62 FR 46003) and

the May 12, 1998 final rule (63 FR

26323) under regulations at

§ 412.105(a)(1). Existing § 412.105(a)(1)

specifies that ‘‘[e]xcept for the special

circumstances for affiliated groups and

new programs described in paragraphs

(f)(1)(vi) and (f)(1)(vii) of this section,

for a hospital’s cost reporting periods

beginning on or after October 1, 1997,

this ratio may not exceed the ratio for

the hospital’s most recent prior cost

reporting period.’’ We are proposing to

clarify § 412.105(a)(1) to add a provision

that this ratio may not exceed the ratio

for the hospital’s most recent prior cost

reporting period after accounting for the

cap on the number of FTE residents.

In general, the resident-to-bed ratio

from the prior cost reporting period,

which is to be used as the cap on the

resident-to-bed ratio for the current

payment cost reporting period, should

only include an FTE count that is

subject to the FTE cap on the number

of allopathic and osteopathic residents,

but is not subject to the rolling average.

(An explanation of rolling average

appears in section IV.G.3. of this

preamble.)

The following illustrates the steps for

determining the resident-to-bed ratio for

the current payment year cost reporting

period and the cap on the resident-tobed ratio:

Current payment year cost reporting

period resident-to-bed ratio:

Step 1. Determine the hospital’s

number of FTE residents in the current

payment year cost reporting period.

Step 2. Compare the number of FTEs

from step 1 to the hospital’s FTE cap

(§ 412.105(f)(1)(iv)). If the number of

FTEs from step 1 exceeds the FTE cap,

replace it with the number of FTEs in

the FTE cap.

Step 3. Determine the 3-year rolling

average of the FTE residents using the

FTEs from the current payment year

cost reporting period and the prior two

cost reporting periods (subject to the

FTE cap in each cost reporting period).

(Include podiatry and dental residents,

and exclude residents in new programs

in accordance with § 412.105(f)(1)(iv)

and proposed revised (f)(1)(v). Residents

in new programs are added to the

quotient of the rolling average.)

Step 4. Determine the hospital’s

number of beds (see § 412.105(b)) in the

current payment year cost reporting

period.

Step 5. Determine the ratio of the

number of FTEs from step 3 to the

number of beds from step 4. The lower

of this resident-to-bed ratio or the

resident-to-bed ratio cap (calculated

below) from the immediately preceding

cost reporting period is used to calculate

the hospital’s IME adjustment factor for

the current payment year cost reporting

period.

Resident-to-bed ratio cap:

Step 1. Determine the hospital’s

number of FTE residents in its cost

reporting period that immediately

precedes the current payment year cost

reporting period.

Step 2. Compare the number of FTEs

from step 1 to the hospital’s FTE cap. If

the number of FTEs from step 1 exceeds

the FTE cap, replace it with the number

of FTEs in the FTE cap. (If there is an

increase in the number of FTEs in the

current payment year cost reporting

period due to a new program or an

affiliation agreement, these FTEs are

added to FTEs in the preceding cost

reporting period after comparison to the

FTE cap.)

Step 3. Determine the hospital’s

number of beds (§ 412.105(b)) in its cost

reporting period that immediately

precedes the current payment year cost

reporting period.

Step 4. Determine the ratio of the

number of FTEs in step 2 to the number

of beds in step 3. This ratio is the

resident-to-bed ratio cap for the current

payment year cost reporting period.

Step 5. Compare the resident-to-bed

ratio cap in step 4 to the resident-to-bed

ratio in the current payment year cost

reporting period. The lower of the

resident-to-bed ratio from the current

payment year cost reporting period or

the resident-to-bed ratio cap from the

immediately preceding cost reporting

period is used to calculate the hospital’s

IME adjustment factor for the current

payment year cost reporting period.

We note that the resident-to-bed ratio

cap is a cap on the resident-to-bed ratio

calculated for all residents, including

allopathic, osteopathic, dental, and

podiatry residents (63 FR 26324, May

12, 1998). However, as described in

existing § 412.105(a)(1), the resident-tobed ratio cap may be adjusted to reflect

an increase in the current cost reporting

period’s resident-to-bed ratio due to

residents in a new GME program or an

affiliation agreement. While this

exception does not apply if the residentto-bed ratio increases because of an

increase in the number of podiatry or

dentistry residents or because of a

change in the number of beds, the ratio

could increase after a one-year delay.

An increase in the current cost reporting

period’s ratio (while subject to the cap

on the overall number of allopathic and

osteopathic residents) thereby

establishes a higher cap for the

following cost reporting period.

The following is an example of the

application of the cap on the residentto-bed ratio:

Example—Part 1:

• Assume Hospital A has 50 FTEs in

its cost reporting period ending

September 30, 1996, thereby

establishing an IME FTE resident cap of

50 FTEs.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22689

• In its cost reporting period of

October 1, 1996 to September 30, 1997

(the prior year), it has 50 FTEs and 200

beds, so that its resident-to-bed ratio for

this period is 50/200 = .25.

• In the (current year) cost reporting

period of October 1, 1997 to September

30, 1998 (the first cost reporting period

in which the FTE resident cap, the

resident-to-bed ratio cap, and the rolling

average apply), Hospital A has 50 FTEs

and 200 beds.

• Hospital A s FTEs do not exceed its

FTE cap, so its current number of FTEs

(50) is used to calculate the 2-year

rolling average: (50 + 50)/2 = 50.

• The result of the rolling average is

used as the numerator of the residentto-bed ratio. Thus, the resident-to-bed

ratio is 50/200 = .25.

• .25 is compared to the resident-tobed ratio from the prior period of

October 1, 1996 to September 30, 1997.

Because the FTE resident cap and the

rolling average were not yet effective in

the period of October 1, 1996 to

September 30, 1997, that period’s

resident-to-bed ratio does not have to be

recalculated to account for the FTE

resident cap. Accordingly, the residentto-bed ratio cap for October 1, 1997 to

September 30, 1998 is .25.

• Because the resident-to-bed ratio

does not exceed the prior year ratio,

Hospital A would use the resident-tobed ratio of .25 to determine the IME

adjustment in its cost reporting period

of October 1, 1997 to September 30,

1998.

Example—Part 2:

• In the (current year) cost reporting

period of October 1, 1998 to September

30, 1999, Hospital A adds 1 podiatric

and 1 dental resident, so that it has a

total of 52 FTEs and 200 beds. Since the

FTE resident cap only includes

allopathic and osteopathic residents,

Hospital A has not exceeded its FTE

resident cap with the addition of a

podiatric and a dental resident.

• Accordingly, the (now) 3-year

rolling average would be (52 + 50 + 50)/

3 = 50.67.

• 50.67 is used in the numerator of

the current payment year’s resident-tobed ratio, so that the resident-to-bed

ratio is 50.67/200 = .253.

• .253 is compared to the resident-tobed ratio from the prior year’s cost

reporting period of October 1, 1997 to

September 30, 1998 that is recalculated

to account for the FTE resident cap.

Because Hospital A did not exceed its

FTE resident cap of 50 FTEs in this

period of October 1, 1997 to September

30, 1998, the recalculated resident-tobed ratio would be 50/200 = .25.

• Compare the current year residentto-bed ratio (.253) to the resident-to-bed

ratio cap (.25); .253 does exceed .25.

• Therefore, the resident-to-bed ratio

in the period of October 1, 1998 to

September 30, 1999 is capped at .25,

which is to be used in calculating

Hospital A’s IME adjustment for October

1, 1998 to September 30, 1999.

Example—Part 3:

• In the cost reporting period of

October 1, 1999 to September 30, 2000,

Hospital A adds 2 internal medicine

residents so that it has a total of 54 FTEs

and 200 beds. While podiatric and

dental residents are not included in the

FTE resident cap, internal medicine

residents are included. Hospital A has

exceeded its IME FTE resident cap of 50

by 2 FTEs. Thus, 2 FTEs are excluded

from the FTE count.

• Accordingly, the rolling average

would be (52 + 52 + 50)/3 = 51.33.

• 51.33 is used in the numerator of

the resident-to-bed ratio, so that the

resident-to-bed ratio is 51.33/200 = .257.

• .257 is compared to the resident-tobed ratio from October 1, 1998 to

September 30, 1999 that is recalculated

to only account for the FTE resident

cap. The recalculated resident-to-bed

ratio would be 50 allopathic or

osteopathic FTEs plus 1 podiatric and 1

dental resident, which is 52/200 = .26.

• .26 is the resident-to-bed ratio cap

for October 1, 1999 to September 30,

2000. .257 does not exceed .26.

• Therefore, the resident-to-bed ratio

in the period of October 1, 1998 to

September 30, 1999 is .257, which is to

be used in calculating this period s IME

adjustment.

If a hospital starts a new GME

program, the adjustment to the residentto-bed ratio cap applies for the period of

years equal to the minimum accredited

length for that type of program. (For

example, for a new internal medicine

program, the period of years equals 3;

for a new surgery program, the period of

years equals 5.) Within these program

years, the number of new FTE residents

in the current cost reporting period is

added to the FTE resident count used in

the numerator of the resident-to-bed

ratio from the previous cost reporting

period. The lower of the resident-to-bed

ratio from the current cost reporting

period or the adjusted resident-to-bed

ratio from the preceding cost reporting

period is used to calculate the hospital’s

IME adjustment for the current cost

reporting period. If a hospital continues

to expand its program after the period

of years, the numerator of the residentto-bed ratio from the preceding cost

reporting period would not be adjusted

to reflect these additional residents.

However, an increase in the ratio of the

current cost reporting period would

establish a higher cap for the following

cost reporting period. We also are

proposing to add a provision that the

exception for new programs described

in § 412.105(f)(1)(vii) applies for the

period of years equal to the minimum

accredited length for that type of

program.

Similarly, if a hospital increases the

number of FTE residents in the current

cost reporting period because of an

affiliation agreement, the number of

additional FTEs is added to the FTE

resident count used in the numerator of

the resident-to-bed ratio from the

previous cost reporting period. The

lower of the resident-to-bed ratio from

the current cost reporting period or the

adjusted resident-to-bed ratio from the

preceding cost reporting period is used

to calculate the hospital’s IME

adjustment for the current cost reporting

period.

3. Conforming Changes

(§ 412.105(f)(1)(ii)(C) and (f)(1)(v))

In the August 29, 1997 final rule with

comment period (62 FR 46003), the May

12, 1998 final rule (63 FR 26323), and

the July 31, 1998 final rule (63 FR

40986), to implement the provisions of

Public Law 105–33, we set forth certain

policies that affected payment for both

direct and indirect GME. Some of these

policies related to the FTE cap on

allopathic and osteopathic residents, the

rolling average, and payment for

residents training in nonhospital

settings. When we amended the

regulations under § 413.86 for direct

GME, we inadvertently did not make

certain conforming changes in § 412.105

for IME. We are proposing to make the

following conforming changes:

• To revise § 412.105(f)(1)(ii)(C) to

specify that, effective for discharges

occurring on or after October 1, 1997,

the time residents spend training in a

nonhospital setting in patient care

activities under an approved medical

residency training program may be

counted towards the determination of

full-time equivalency if the criteria set

forth at § 413.86(f)(3) or § 413.86(f)(4), as

applicable, are met.

• To revise § 412.105(f)(1)(v) to

specify that residents in new residency

programs are not included in the rolling

average for a period of years equal to the

minimum accredited length for the type

of program.

In addition, we are proposing to

revise § 412.105(f)(1)(ix) to specify, for

IME purposes, a temporary adjustment

to a hospital’s FTE cap to reflect

residents added because of another

hospital’s closure of its medical

residency program (to conform to the

22690 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

proposed change for GME discussed in

section IV.G.5. of this preamble).

D. Payments to Disproportionate Share

Hospitals (§ 412.106)

Effective for discharges beginning on

or after May 1, 1986, hospitals that serve

a significantly disproportionate number

of low-income patients (as defined in

section 1886(d)(5)(F) of the Act) receive

additional payments through the DSH

adjustment.

Section 1886(d)(5)(F)(ix) of the Act, as

amended by section 112 of Public Law

106–113, specifies a percentage

reduction in the payments a hospital

would otherwise receive under the

disproportionate share formula. Prior to

enactment of section 303 of Public Law

106–554, the reduction percentages

were as follows: 3 percent for FY 2001,

4 percent for FY 2002, and 0 percent for

FY 2003 and each subsequent fiscal

year.

Section 303 of Public Law 106–554

revised the amount of the percent

reductions to 2 percent for discharges

occurring in FY 2001, and to 3 percent

for discharges occurring in FY 2002.

The reduction continues to be 0 percent

for FY 2003 and each subsequent fiscal

year. Section 303 of Public Law 106–554

contains a special rule for FY 2001: For

discharges occurring on or after October

1, 2000 and before April 1, 2001, the

reduction is to be 3 percent, and for

discharges occurring on or after April 1,

2001 and before October 1, 2001, the

reduction is to be 1 percent. Changes

made by section 303 with respect to FY

2001 discharges are being implemented

in a separate interim final rule with

comment period (HCFA–1178–IFC).

We are proposing to revise

§ 412.106(e) to reflect the change in the

percentage for FY 2002 made by section

303 of Public Law 106–554. We also are

proposing to make a technical change in

the heading of paragraph (e).

E. Medicare Geographic Classification

Review Board (Proposed New § 412.235

and Existing §§ 412.256, 412.273,

412.274(b), and 412.276)

With the creation of the Medicare

Geographic Classification Review Board

(MGCRB), beginning in FY 1991, under

section 1886(d)(10) of the Act, hospitals

could request reclassification from one

geographic location to another for the

purpose of using the other area’s

standardized amount for inpatient

operating costs or the wage index value,

or both (September 6, 1990 interim final

rule with comment period (55 FR

36754), June 4, 1991 final rule with

comment period (56 FR 25458), and

June 4, 1992 proposed rule (57 FR

23631)). Implementing regulations in

Subpart L of Part 412 (§§ 412.230 et

seq.) set forth criteria and conditions for

redesignations from rural to urban, rural

to rural, or from an urban area to

another urban area with special rules for

SCHs and RRCs.

Section 304 of Public Law 106–554

contained several provisions related to

the wage index and reclassification

decisions made by the MGCRB. In

summary, section 304 first establishes

that hospital reclassification decisions

by the MGCRB for wage index purposes

are effective for 3 years, beginning with

reclassifications for FY 2001. Second, it

provides that the MGCRB must use the

3 most recent years of average hourly

wage data in evaluating a hospital’s

reclassification application for FY 2003

and subsequent years. Third, it provides

that an appropriate statewide entity may

apply to have all of the geographic areas

in a State treated as a single geographic

area for purposes of computing and

applying the wage index, for

reclassifications beginning in FY 2003.

A discussion of how we are proposing

to implement these three provisions

follows. (Section III.F. of this preamble

discusses the application of these

proposed policy changes to the

development of the proposed FY 2002

and later wage indexes based on

hospital reclassification under the

provisions of section 304 of Public Law

106–554.)

1. Three-Year Reclassifications for Wage

Index Purposes

Section 304(a) of Public Law 106–554

amended section 1886(d)(10)(D) of the

Act by adding clause (v), which

provides that, if a hospital is approved

for reclassification by the MGCRB for

purposes of the wage index, the

reclassification is effective for 3 years.

The amendment made by section 304(a)

is effective for reclassifications for FY

2001 and subsequent years. In addition,

the legislation specifies that the

Secretary must establish a mechanism

under which a hospital may elect to

terminate such reclassification during

the 3-year period.

Consistent with new section

1886(d)(10)(D)(v) of the Act, we are

proposing to revise § 412.274(b) to

provide under new paragraph (b)(2) that

any hospital that is reclassified for a

particular fiscal year for purposes of

receiving the wage index value of

another area would receive that

reclassification for 3 years beginning

with discharges occurring on the first

day (October 1) of the second Federal

fiscal year in which a hospital files a

complete application. This 3-year

reclassification would remain in effect

unless the hospital terminates the

reclassification under proposed revised

procedures that we are establishing

under new proposed § 412.273(b). The

proposed provision would apply to

hospitals that are reclassified for

purposes of the wage index only, as well

as those that are reclassified for both the

wage index and the standardized

amount. However, in the latter case,

only the wage index reclassification

would be extended for 2 additional

years beyond the 1 year provided for in

the existing regulations (3 years total).

Hospitals seeking reclassification for

purposes of the standardized amount

must continue to reapply to the MGCRB

on an annual basis.

a. Special Rule for a Hospital That Was

Reclassified for FY 2001 and FY 2002 to

Different Areas

Because the 3-year effect of the

amendment made by section 304(a) of

Public Law 106–554 is applicable to

reclassifications for FY 2001 (which had

already taken place prior to the date of

enactment of section 304(a) (December

21, 2000), and because the application

process for reclassifications for FY 2002

had already been completed by the date

of enactment, we are establishing

special procedures for hospitals that are

reclassified for purposes of the wage

index to one area for FY 2001, and are

reclassified for purposes of the wage

index or the standardized amount to

another area for FY 2002. We are

deeming such a hospital to be

reclassified to the area for which it

applied for FY 2002, unless the hospital

elects to receive the wage index

reclassification it was granted for FY

2001. Consistent with our procedures

for withdrawing an application for

reclassification (§ 412.273), we are

allowing a hospital that wishes to

receive the reclassification it was

granted for FY 2001 to withdraw its FY

2002 application by making a written

request to the MGCRB within 45 days of

the publication date of this proposed

rule (that is, by June 18, 2001). Again,

only the wage index reclassification is

extended for 2 additional years (3 years

total). Hospitals seeking reclassification

for purposes of the standardized amount

must continue to reapply to the MGCRB

on an annual basis.

(We note that the new location and

mailing address of the MGCRB and the

Provider Reimbursement Review Board

(PRRB) is: 2520 Lord Baltimore Drive,

Suite L, Baltimore, MD 21244–2670.

The MGCRB and PRRB will be

functioning at this new location as of

May 21, 2001. Also, please specify

whether the mail is intended for the

MGCRB or the PRRB.)

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22691

b. Overlapping Reclassifications Are Not

Permitted

Under the broad authority delegated

to the Secretary by section 1886(d)(10)

of the Act, we are proposing that a

hospital that is reclassified to an area for

purposes of the wage index may not

extend the 3-year effect of the

reclassification under section 304(a) of

Public Law 106–554 by subsequently

applying for reclassification to the same

area for purposes of the wage index for

a fiscal year that would be within the 3-

year period. For example, if a hospital

is reclassified for purposes of the wage

index to Area A for FY 2002, is

approved to receive Area A’s wage

index for 3 years (FYs 2002, 2003, and

2004), and reapplies to be reclassified to

Area A for FYs 2003, 2004, and 2005 (3

years) for purposes of the wage index,

the hospital would not be permitted to

receive Area A’s wage index for FY 2005

as a result of the reapplication. Instead,

we are proposing that if the hospital

wishes to extend the FY 2002 3-year

reclassification for fiscal years beyond

FY 2004, it would have to apply for

reclassification for FY 2005.

We believe new section

1886(d)(10)(D)(v) of the Act replaces the

current annual reclassification cycle

with a 3-year reclassification cycle. We

believe this policy was intended to

provide consistency and predictability

in hospital reclassification and wage

index data, as well as to alleviate the

year-to-year fluctuations in the ability of

some hospitals to qualify for

reclassification. We do not believe it

was intended to be used to extend

reclassifications for which hospitals

otherwise would not be eligible (by

reapplying during the second year of a

3-year reclassification because a

hospital fears it may not be eligible for

reclassification after its current 3-year

reclassification expires).

c. Withdrawals of Applications and

Terminations of Approved

Reclassifications

(1) General

Under § 412.273(a), a hospital, or

group of hospitals, may withdraw its

application for reclassification at any

time before the MGCRB issues its

decision or, if after the MGCRB issues

its decision, within 45 days of

publication of our annual notice of

proposed rulemaking concerning

changes to the inpatient hospital

prospective payment system and

proposed payment rates for the fiscal

year for which the application was filed.

We are proposing that the withdrawal

procedures and the applicable

timeframes in the existing regulations

would apply to hospitals that would

receive 3-year reclassification for wage

index purposes. For example, if a

hospital applied for reclassification to

Area A for purposes of the wage index

for FY 2002, but wished or wishes to

withdraw its application, it must have

done so prior to the MGCRB issuing a

decision on its application or, if the

MGCRB issued such a decision, within

45 days of the publication date of this

proposed rule. Such a withdrawal, if

effective, means that the hospital would

not be reclassified to Area A for

purposes of the wage index for FY 2002

(and would not receive continued

reclassification for FYs 2003 and 2004).

In other words, a withdrawal, if

accepted, prevents a reclassification

from ever becoming effective.

On the other hand, a reclassification

decision that is terminated upon the

request of the hospital has partial effect.

Section 1886(d)(10)(D)(v) of the Act, as

added by section 304(a) of Public Law

106–554, provides that a reclassification

for purposes of the wage index is

effective for 3 years ‘‘except that the

Secretary shall establish procedures

under which a * * * hospital may elect

to terminate such reclassification before

the end of such period.’’ Consistent with

section 1886(d)(10)(D)(v) of the Act, we

are proposing to allow a hospital to

terminate its approved 3-year

reclassification for 1 or 2 years of the 3-

year effective period (proposed

§ 412.273(b)). For example, a hospital

that has been reclassified for purposes

of the wage index for FY 2001 is also

reclassified for FYs 2002 and 2003 (3

years). Such a hospital could terminate

its approved reclassification so that the

reclassification is effective only for FY

2001, or only for FYs 2001 and 2002.

Consistent with the prospective nature

of reclassifications, we would not

permit a hospital to terminate its

approved 3-year reclassification for part

of a fiscal year. A termination would be

effective for the next fiscal year. In order

to terminate an approved 3-year

reclassification, we would require the

hospital to notify the MGCRB in writing

within 45 days of the publication date

of the annual proposed rule for changes

to the inpatient hospital prospective

payment system. A termination request,

once accepted, is effective for the

balance of the 3-year period (as

discussed below under reapplying

within original 3-year period, following

a termination).

We are establishing a special

procedural rule for handling FY 2001

reclassifications. As noted above, the

amendments made by section 304(a) of

Public Law 106–554 are effective for

reclassifications for FYs 2001 and

beyond, and reclassification

applications for FY 2001 had already

been submitted prior to the date of

enactment of section 304(a). We are

deeming those hospitals that were

reclassified for FY 2001 to be

reclassified for FYs 2002 and 2003.

Therefore, if a deemed hospital that was

reclassified for purposes of the wage

index for FY 2001 does not wish to

continue its reclassification for FY 2002

and FY 2003, the hospital must notify

the MGCRB in writing within 45 days

after the publication of this proposed

rule (that is, by June 18, 2001).

(2) Reinstatement After a Withdrawal of

Application or a Termination of an

Approved Reclassification

We are proposing that if a hospital

elects to withdraw its 3-year

reclassification application after the

MGCRB has issued its decision, it may

cancel its withdrawal in a subsequent

fiscal year and request the MGCRB to

reinstate its reclassification for the

remaining fiscal years of the 3-year

reclassification period. (This proposal is

consistent with our proposal that 3-year

reclassification periods may not overlap,

as discussed in section IV.E.1.b. of this

preamble.) Alternatively, a hospital may

apply for reclassification to a different

area (that is, an area different from the

one to which it was originally

reclassified), and if successful, the

reclassification effect would be for 3

years.

Example 1: Hospital A files an application

and the MGCRB issues a decision to

reclassify it to Area A for purposes of wage

index for FY 2002 through FY 2004 (3 years).

Within 45 days after the publication of this

proposed rule, Hospital A withdraws its

application. Within the time for applying for

a FY 2003 reclassification, Hospital A cancels

its withdrawal for classification to Area A. Its

reclassification to Area A is reinstated, but

only for FYs 2003 and 2004.

Example 2: Hospital B files an application

for reclassification for wage index purposes

for FY 2002 through FY 2004 and the

MGCRB issues a decision for reclassification

to Area B. Within 45 days after publication

of this proposed rule, Hospital B withdraws

its application. Hospital B does not cancel its

withdrawal of the application. Hospital B

timely applies and is reclassified to Area B

for 3 years, beginning with FY 2003. In this

case, the reclassification to Area B would be

for FYs 2003 through 2005.

Similarly, and for the same reasons, we are

proposing that if a hospital elects to

terminate its accepted 3-year reclassification,

it may cancel that termination and have its

original reclassification reinstated for the

duration of the original 3-year period.

Alternatively, a hospital could apply for

reclassification to a different area and receive

a new 3-year period of reclassification.

Example 3: Hospital C is reclassified to

Area A for purposes of the wage index for FY

22692 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

2002, and terminates its 3-year

reclassification effective for FYs 2003 and

2004. Within the timeframe for applying for

FY 2004 reclassification, Hospital C cancels

its termination. Its reclassification to Area A

would be reinstated for FY 2004 only.

Example 4: Hospital D has the same

circumstances as Hospital C in Example 3,

except that instead of canceling its

termination, Hospital D applies and is

reclassified to Area B for FY 2004. In this

case, the reclassification would be for FYs

2004 through 2006.

d. Special Rules for Group

Reclassifications

Section 412.232 discusses situations

where all hospitals in a rural county are

seeking urban redesignation, and

§ 412.234 discusses criteria where all

hospitals in an urban county are seeking

redesignation to another urban county.

In these cases, hospitals submit an

application as a group, and all hospitals

in the county must be a party to the

application. The reclassification is

effective both for purposes of the wage

index and the standardized amount of

the area to which the hospitals are

reclassified.

Section 304(a) of Public Law 106–554

does not specifically address the group

reclassification situations under

§§ 412.232 and 412.234. However, we

believe that, in the case of hospitals

reclassified under these group

reclassification procedures, it would be

appropriate to extend the 3-year

reclassification provision to these

situations for the wage index only. In

order to be reclassified for the

standardized amount during the second

and third years of a 3-year

reclassification for the wage index, the

hospitals located in these counties

would have to reapply on an annual

basis to the MGCRB either as a group or

as individual hospitals and meet the

criteria outlined in §§ 412.232(a) and

412.234(a).

Hospitals that are part of a group

reclassification would be able to

withdraw or terminate their 3-year wage

index reclassifications in the same

manner as described above. If one

hospital within the group elects to

withdraw or terminate its

reclassification, the reclassification of

other hospitals in the group would be

unaffected.

Under section 152(b) of Public Law

106–113, hospitals in certain counties

were deemed to be located in specified

areas for purposes of payment under the

hospital inpatient prospective payment

system, for discharges occurring on or

after October 1, 2000. For payment

purposes, these hospitals are to be

treated as though they were reclassified

for purposes of both the standardized

amount and the wage index. Section

152(b) also requires that these

reclassifications be treated for FY 2001

as though they are reclassification

decisions by the MGCRB. For purposes

of applying the 3-year extension of wage

index reclassifications, we are

proposing to extend section

1886(d)(10)(D)(v) to hospitals

reclassified under section 152(b) of

Public Law 106–113. These hospitals

also would have to apply for the

standardized amount on an annual basis

to the MGCRB.

e. Administrator Authority To Cancel

Inappropriate Reclassification Decisions

Under the provisions of § 412.278(g),

the Administrator has the authority to

review an inappropriate reclassification

decision made by the MGCRB, as

discovered by either the hospital or

HCFA, including 3-year reclassifications

in the second and third year, and to

determine whether or not to cancel that

decision as a result of the review of the

facts. Hospitals that are concerned that

they have been inappropriately

reclassified should follow the

procedures outlined in § 412.278.

2. Three-Year Average Hourly Wages

Section 304(a) of Public Law 106–554

amended section 1886(d)(10)(D) of the

Act by adding clause (vi) which

provides that the MGCRB must use the

average of the 3 most recent years of

hourly wage data for the hospital when

evaluating a hospital’s request for

reclassification. Specifically, the

MGCRB must base its evaluation on an

average of the average hourly wage for

the most recent years for the hospital

seeking reclassification and the area to

which the hospital seeks to reclassify.

This provision is effective for

reclassifications for FY 2003 and

subsequent years. (Section III.F. of this

preamble discusses the development

and application of the proposed 3-year

average hourly wage data (Table 2 in the

Addendum to this proposed rule) that

the MGCRB would use to evaluate

hospitals’ applications for

reclassifications for FY 2003; and the 3-

year average hourly wage data (Tables

3A and 3B in the Addendum to this

proposed rule) for hospital

reclassification applications for FY

2001.)

We are proposing to revise

§§ 412.230(e)(2) and 412.232(d)(2) to

incorporate the provisions of section

1886(d)(10)(D)(vi) of the Act as added

by section 304(a) of Public Law 106–

554. Specifically, we are providing that,

for redesignations effective beginning

FY 2003, for hospital-specific data, the

hospital must provide a 3-year average

of its average hourly wages using data

from the HCFA hospital wage survey

used to construct the wage index in

effect for prospective payment purposes.

For data for other hospitals, we are

proposing to require hospitals to

provide a 3-year average of the average

hourly wage in the area in which the

hospital is located and a 3-year average

of the average hourly wage in the area

to which the hospital seeks

reclassification. The wage data would be

taken from the HCFA hospital wage

survey used to construct the wage index

for prospective payment purposes. The

3-year averages are calculated by

dividing the sum of the dollars (adjusted

to a common reporting period using the

method described in section III. of the

proposed rule) across all 3 years, by the

sum of the hours.

3. Statewide Wage Index

As stated earlier, section 304(b) of

Public Law 106–554 provides for a

process under which an appropriate

statewide entity may apply to have all

the geographic areas in the State treated

as a single geographic area for purposes

of computing and applying the area

wage index for reclassifications

beginning in FY 2003.

Section 304 does not indicate the

duration of the application of these

statewide wage indexes. However, it

should be noted that the statutory

language does refer to these applications

as reclassifications. We are proposing

that these statewide wage index

applications be processed similar to

MGCRB applications, with the same

effective dates of the decisions and the

withdrawal process. Therefore, similar

to wage index reclassification decisions

under section 1886(d)(10)(D)(v) of the

Act as added by section 304(a) of Public

Law 106–554, the statewide wage index

reclassification would be effective for a

total of 3 years. The same deadlines and

timetable applicable to MGCRB

reclassification applications would

apply for statewide wage index

applications.

We are proposing to establish a new

§ 412.235 to include the requirements

for statewide wage indexes. We are

proposing to apply the following criteria

to determine whether hospitals would

be approved for a statewide geographic

wage index reclassification (proposed

§ 412.235(a)):

• There must be unanimous support

for a statewide wage index among

hospitals in the State in which the

statewide wage index would be applied.

We would require a signed affidavit on

behalf of all the hospitals in the State of

this support as part of the application

for reclassification.

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• All hospitals in the State must

apply through a signed single

application for the statewide wage index

in order for the application to be

considered by the MGCRB. We believe

this is necessary to ensure that every

hospital in the State is included in the

application, since the payment of every

hospital would be affected by the

statewide wage index.

• There must be unanimous support

for the termination or withdrawal of a

statewide wage index among hospitals

in the State in which the statewide

index would be applied. We would

require a signed affidavit for this

agreement.

• All hospitals in the State waive

their rights to any wage index that they

would otherwise receive absent the

statewide wage index, including a wage

index that any of the hospitals might

have received through individual or

group geographic reclassification under

§ 412.273(a).

An individual hospital within the

State may receive a wage index that

could be higher or lower under the

statewide wage index reclassification in

comparison to its wage index otherwise

(proposed § 412.235(b)). Specifically,

hospitals must be aware that there may

be a reduction in the wage index as a

result of participation on a statewide

basis.

We are proposing to consider

statewide wage index applications

under the same process we use for

hospital reclassification applications,

including the effective dates of the

MGCRB decision and the withdrawal

process (proposed § 412.235(c)). We are

proposing that applications for the

statewide wage index would be effective

for 3 years beginning with discharges

occurring on the first day (October 1) of

the second Federal fiscal year following

the Federal fiscal year in which the

hospitals file a complete application

unless all of the participating hospitals

terminate their approved statewide

wage index classification earlier, as

discussed below. Once approved by the

MGCRB, an application for a statewide

wage index can only be withdrawn or

terminated as a result of a signed

affidavit on behalf of all the hospitals in

the State indicating their request that

the statewide reclassification be

withdrawn or terminated. A request for

withdrawal or termination must be

submitted within 45 days of the

publication of the annual proposed rule

for the inpatient hospital prospective

payment system announcing the

reclassification. New hospitals that open

prior to the deadline for submitting an

application for a statewide wage index,

but after a group application has been

submitted, would be required to agree to

the statewide wage index in order for

the group application to remain viable.

New hospitals that open after the

deadline for submitting an application

would receive the statewide wage index.

The agreement of new hospitals would

also be required in order to withdraw or

terminate a statewide wage index

reclassification. The proposed rules

discussed under section IV.E.1.c. of this

preamble for withdrawals of

applications and terminations of

approved 3-year wage index

reclassification decisions would apply

to decisions regarding statewide wage

index reclassifications.

We also are proposing to allow

hospitals outside a State in which

hospitals have received approval of a

statewide wage index classification to

seek reclassification for the statewide

wage index into that State. In that case,

an outside hospital(s) that is reclassified

into the statewide wage index area

would receive a wage index calculated

based on the statewide wage index

reclassification. However, the support of

such an outside hospital(s) would not be

needed in the case of withdrawal or

termination of a statewide wage index

reclassification.

F. New Medical Services and

Technology: Additional Payments

Under the Inpatient Hospital

Prospective Payment System (Proposed

New §§ 412.87 and 412.88)

Section 533(b) of Public Law 106–554

amended section 1886(d)(5) of the Act

to add new subparagraphs (K) and (L) to

address a process of identifying and

ensuring adequate payment for new

medical services and technologies under

Medicare. Under new section

1886(d)(5)(K)(i) of the Act, effective for

discharges beginning on or after October

1, 2001, the Secretary is required to

establish (after notice and opportunity

for public comment) a mechanism to

recognize the costs of new services and

technologies under the inpatient

hospital prospective payment system.

New section 1886(d)(5)(K)(ii)(I) of the

Act specifies that the mechanism must

apply to a new medical service or

technology if, ‘‘based on the estimated

costs incurred with respect to

discharges involving such service or

technology, the DRG prospective

payment rate otherwise applicable to

such discharges * * * is inadequate.’’

New section 1886(d)(5)(K)(vi) of the Act

specifies that a medical service or

technology will be considered ‘‘new’’ if

it meets criteria established by the

Secretary (after notice and opportunity

for public comment).

New sections 1886(d)(5)(K)(ii)

through (vi) of the Act further provide—

• For an additional payment for new

medical services and technology in an

amount beyond the DRG prospective

payment system payment rate that

adequately reflects the estimated

average cost of the service or

technology.

• That the requirement for an

additional payment for a new service or

technology may be satisfied by means of

a new-technology group (described in

new section 1886(d)(5)(L) of the Act), an

add-on payment, a payment adjustment,

or any other similar mechanism for

increasing the amount otherwise

payable with respect to a discharge.

• For the collection of data relating to

the cost of new medical service, or

technology for not less than 2 years and

no more than 3 years after an

appropriate inpatient hospital services

code is issued. The statute further

provides that discharges involving new

services or technology that occur after

the collection of these data will be

classified within a new or existing DRG

group with a weighting factor derived

from cost data collected for discharges

occurring during such period.

A discussion of how we are proposing

to implement the provisions of section

533(b) of Public Law 106–554 follows.

Section II.D. of this preamble discusses

the Report to Congress required by

section 533(a) of Public Law 106–553

relating to methods of expeditiously

incorporating new medical services and

technologies into the clinical coding

system used for payments for inpatient

hospital services and our preferred

method of achieving this purpose.

1. Criteria for Identifying New Medical

Services and Technology

New section 1886(d)(5)(K)(vi) of the

Act specifies that a medical service or

technology will be considered ‘‘new’’ if

it meets criteria established by the

Secretary (after notice and opportunity

for public comment). (For convenience,

hereafter we refer to ‘‘new medical

services and technology’’ as ‘‘new

technology.’’) We are proposing that a

new technology would be an

appropriate candidate for an additional

payment when, in the judgment of the

Secretary, it represents an advance in

medical technology that substantially

improves, relative to technologies

previously available, the diagnosis or

treatment of Medicare beneficiaries

(proposed § 412.87(b)(1)). This criterion

is to ensure that new technology can be

demonstrated to provide a substantial

clinical improvement based on

verifiable evidence. Because any

additional payments made under this

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provision will be financed by reducing

the payments made for all other services

(in order to maintain budget neutrality

as discussed under section IV.F.4. of

this preamble), we believe that these

payments should be focused on those

technologies that afford clear

improvements over use of previously

available technologies. As explained

below, we are proposing that new

technologies meeting this clinical

definition also must be demonstrated to

be inadequately paid otherwise under

the DRG system to receive special

payment treatment (proposed

§ 412.87(b)(3)). Hospitals adopting other

new technologies that do not meet these

standards would be paid for these

technologies through other applicable

DRG payments. These payments would

be recalibrated over time to reflect

actual use of the new technology.

We expect to implement this criterion

by considering the clinical benefits for

beneficiaries. We are aware that some

technologies may offer substantial

clinical improvements for small subsets

of beneficiaries, such as those who have

not responded to other treatments, and

we expect to recognize such substantial

advantages in these instances.

In addition to the clinical and cost

criteria, we are proposing that, in order

to qualify for the special payment

treatment provided under new section

1886(d)(5)(K)(ii)(I) of the Act, a specific

technology must be new (proposed

§ 412.87(b)(2)). We believe the new

provision contemplates the special

payment treatment for new technologies

until such time as data are available to

reflect the cost of the technology in the

DRG weights through recalibration

(generally 2 years). Specifically, new

section 1886(d)(5)(K)(ii)(II) of the Act

states that the Secretary must ‘‘provide

for the collection of data with respect to

the costs of a new medical service or

technology * * * for a period of not less

than two years and not more than three

years beginning on the date on which an

inpatient hospital code is issued with

respect to the service or technology.’’ In

addition, new section

1886(d)(5)(K)(ii)(III) states that the

Secretary must ‘‘provide for additional

payment to be made * * * with respect

to discharges involving a new medical

service or technology described in

subclause (I) that occur during the

period described in subclause (II) in an

amount that adequately reflects the

estimated average costs of such service

or technology.’’

We are proposing to make

determinations regarding which

technologies meet this criterion using a

panel of Federal clinical and other

experts, supplemented as appropriate

with outside expertise. The results of all

such determinations would be

announced in the Federal Register as

part of the annual updates and changes

to the inpatient hospital prospective

payment system (proposed

§ 412.87(b)(1)). We note that this

determination is separate and distinct

from the coverage decision process. In

the case of new technologies that have

gone through the national coverage

determination process, we would expect

that the evidence reviewed in that

process would, in general, be sufficient

for making these determinations as well.

Requests to recognize new technology

for special payment treatment under

new section 1886(d)(5)(K)(ii)(I) of the

Act would be evaluated against this

proposed criterion based on evidence

submitted by the requestor. These

requests should be submitted in

conjunction with the initial submission

of data on the costs of the new

technology. In general, we encourage

interested parties to initiate this process

by August of the year preceding the year

in which a new code identifying the

new technology would become

effective. This will allow maximum

time to review the requestor’s data and

clinical material. In particular, it affords

an opportunity to work with the

requestor to resolve any problems or

questions that may arise. At a minimum,

requests should be submitted by early

October of that year. It should be noted

that submitting requests as late as

October may not afford the opportunity

for HCFA to work with the requestor to

resolve problems or questions. Requests

must be submitted by early October to

allow adequate time to consider all

aspects of a request prior to making a

determination to be included in the

proposed rule. Work begins on

preparing the DRG changes for the

following fiscal year by the middle of

December, and any decisions to

recognize particular new technologies

should be taken into account at that

time.

We are soliciting comments on these

proposals. In particular, given that this

process is the result of new legislation

with possibly major implications for the

hospital inpatient prospective payment

system, we invite public comment on:

our definition of new medical services

and technologies; the use of Federal

clinical and other experts to make

determinations regarding which criteria

meet our definition of a new service or

technology; the information necessary to

determine whether payment would be

inadequate; and our payment

mechanism (see following discussions

for these latter two issues).

2. Determining Adequacy of Current

Payments for New Services and

Technology

Because the inpatient hospital

prospective payment system includes

costs associated with all aspects of a

patient’s stay in the hospital, it is not

enough to simply identify a technology

as ‘‘new’’ and pay an additional amount.

A single DRG may encompass many

different treatment approaches for a

particular illness, with an array of costs

associated with those approaches.

Clinicians are expected to select the

appropriate approach based on the

needs of the patient, with the payments

averaging out over time to approximate

the level of resources needed to treat the

average patient in the DRG.

Section 1886(d)(b)(K)(ii) of the Act, as

added by section 533(b) of Public Law

106–554, requires that the Secretary

make a determination whether the

payment otherwise applicable under the

existing DRG is inadequate compared to

the estimated costs incurred with

respect to new technology (as defined

previously). We believe that, in order to

evaluate whether the DRG payment

inadequately reflects the costs of new

technology, we must be able to assess

the costs of cases involving the new

technology against other cases in the

DRG. In other words, the criteria for

identifying new technology that will

receive special payment treatment

should reflect whether the new

technology is so expensive that

hospitals are unlikely to offset the

higher costs with other less costly cases

within the DRG. We are proposing that

this threshold be set at one standard

deviation beyond the mean

standardized charge for all cases in the

DRG to which the new technology is

assigned (or the case-weighted average

of all relevant DRGs, if the new

technology occurs in many different

DRGs) (proposed § 412.87(b)(3)).

(Standardization adjusts the actual

charges of a case by the payment factors

such as the wage index, the indirect

medical education adjustment factor,

and the disproportionate share

adjustment factor.)

This comparison would preferably be

done using Medicare cases identifiable

in our MedPAR database, although data

from a clinical trial (including Food and

Drug Administration clinical trials)

where no bills were submitted for

payment may be considered. To the

extent possible, HCFA intends to rely on

existing information in making these

determinations. In most instances, the

information would include the

Medicare provider number of the

hospital where each case was treated,

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22695

the beneficiary identification numbers

of the Medicare patients, the dates of

admission and discharge, the charges

associated with each case, and all

relevant ICD–9–CM codes associated

with each case. We would then assess

the charges of identified cases involving

the new technology, accounting for the

additional costs of the new technology

that might not be included in the

charges if the new technology is being

provided by the manufacturer as part of

the clinical trial. If the costs of the new

technology are not included in the total

charges, the requestor must submit

adequate documentation upon which to

formulate an estimate of the likely costs

to hospitals of the new technology.

A significant sample of the data

should be submitted no later than early

October, approximately 6 months prior

to the publication of the proposed rule.

Subsequently, a complete database must

be submitted no later than midDecember. This timetable is necessary to

allow adequate time to assess and verify

the data, as well as to work with the

submitters to deal with any unique

situations with respect to data

availability. It is also necessary to allow

us to accurately incorporate the data

into the proposed rule, which we begin

preparing in January. We are soliciting

public comments on this process.

To illustrate the proposed use of the

standard deviation thresholds, consider

DRG 8 (Peripheral and Cranial Nerve

and Other Nervous System Procedures

Without CC). The average standardized

charge of cases assigned to this DRG

based on discharges during FY 2000 was

$13,212, and the standard deviation was

$8,978. Therefore, if a requestor were to

seek assignment of a new technology

that would otherwise be assigned to

DRG 8 to a different DRG, the requestor

would be expected to provide data

indicating that the average standardized

charge of cases receiving this new

technology will exceed $22,190. These

data must be of a sufficient sample size

to demonstrate a significant likelihood

that the true mean across all cases likely

to receive the new technology will

exceed the mean for the cases in DRG

8 by one standard deviation.

Using standard deviation as the

threshold takes into account the

distribution of charges associated with

different treatment modalities around

the mean charge for a particular DRG,

and the extent to which lower cost cases

in the DRG should be expected to offset

higher cost cases. Using this method,

new technology in a DRG with very

little variation in charges would be more

likely to meet the criteria. This would

be appropriate because there are fewer

opportunities within such a DRG to

recover the costs of very high cost cases

from excess payments for very low cost

cases.

We note that, although we anticipate

a limited number of new technologies

will qualify under this proposed

threshold, we will continue to evaluate

the appropriateness of all DRG

assignments. This applies not only to

new technology but existing

technologies as well.

3. Developing a Payment Mechanism

Section 1886(d)(5)(K)(v) of the Act, as

added by section 533(b) of Public Law

106–554, provides flexibility to the

Secretary in terms of deciding exactly

how the requirement for an additional

payment will be satisfied: a newtechnology group, an add-on payment, a

payment adjustment, or any other

similar mechanism for increasing the

amount otherwise payable. We believe

the approach most consistent with the

design and incentives of the inpatient

hospital prospective payment system

would be to assign new technology to

the most appropriate DRG based on the

condition of the patient as described

above, and adjust payments for

individual cases that involve the new

technology when the costs of those

cases exceed a threshold amount. That

is, we would not pay an additional

amount for every case involving the new

technology, but only where the costs of

the entire case exceed the DRG payment

amount. We are concerned that the

establishment of new DRGs specifically

for the purpose of recognizing costly

new technology could potentially

severely disrupt the DRG classification

structure. In particular, we are

concerned that some new technologies

may involve large numbers of cases

across multiple DRGs. Creating new

DRGs specifically for new technology

would pull cases out of existing DRGs,

possibly leading to severe distortions in

the relative weights and inadequate

payments for cases remaining in the

existing DRGs.

We are proposing that Medicare

provide higher payments for cases with

higher costs involving identified new

technologies, while preserving some of

the incentives under the average-based

payments for all treatment modalities

for a particular patient category. The

payment mechanism we are proposing

would be based on the cost to hospitals

for the new technology. We are

proposing under § 412.88 that Medicare

would pay a marginal cost factor of 50

percent for the costs of the new

technology in excess of the full DRG

payment. This would be calculated

before any outlier payments under

section 1886(d)(5)(A) of the Act, if

applicable. Similarly, cases involving

new technology would be eligible for

outlier payments, with the additional

amounts paid for the new technology

included in the base payment amount.

Costs would be determined by applying

the cost-to-charge ratio in a manner

identical to that currently used for

outlier payments. If the costs of a new

technology case exceed the DRG

payment by more than the estimated

costs of the new technology, Medicare

payment would be limited to the DRG

payment plus 50 percent of the

estimated costs of the new technology,

except if the case qualified for outlier

payments. (We are proposing a

conforming change to § 412.80 by

adding a new paragraph (a)(3) to

provide that outlier qualifying

thresholds and payments would be in

addition to standard DRG payments and

additional payments for new medical

services and technology (effective

October 1, 2001).)

For example, consider a new

technology estimated to cost $3,000, in

a DRG that pays $20,000. A hospital

submits three claims for cases involving

this new technology. After applying the

hospital’s cost-to-charge ratio, it is

determined the costs of these three cases

are $19,000, $22,000, and $25,000.

Under our proposal, Medicare would

pay $20,000 (the DRG payment) for the

first claim. For the second claim,

Medicare would pay one half of the

amount by which the costs of the case

exceed the DRG payment, up to the

estimated cost of the new technology, or

$21,000 ($20,000 plus one half of

$2,000). For the third claim, Medicare

would pay $21,500 ($20,000 plus one

half of the total estimated costs of the

new technology).

We believe it is appropriate to limit

the additional payment to 50 percent of

the additional cost to appropriately

balance the incentives. This limit would

provide hospitals an incentive for

continued cost-effective behavior in

relation to the overall costs of the case.

In addition, hospitals would face an

incentive to balance the desirability of

using the new technology versus the

old; otherwise, there would be a large

and perhaps inappropriate incentive to

use the new technology. For example, in

the late 1980s, we considered whether

to establish a special payment

adjustment for tissue plasminogen

activator (TPA), a thrombolytic agent

used in treating blockages of coronary

arteries, reflecting the high costs of the

drug. We did not establish such an

adjustment because we believed that the

updates to the standardized amounts,

combined with the potential for

continuing improvements in hospital

22696 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

productivity, would be adequate to

finance appropriate care of Medicare

patients. In fact, the costs of the drug

were offset by shorter hospital stays and

an overall reduction in costs per case.

As clinical experience with TPA

accumulated, furthermore, it appeared

that the drug was not as widely

beneficial as its original proponents

expected. Establishing an add-on

payment for this drug might have

actually led to more extensive use of

this drug for patients who would not

have benefited, and might have even

been harmed, by its blood-thinning

characteristics.

4. Budget Neutrality

The report language accompanying

section 533 of Public Law 106–554

directs that the Secretary implement the

new mechanism on a budget neutral

basis (H.R. Conf. Rep. No. 106–1033,

106th Cong., 2d Sess. at 897 (2000)).

Section 1886(d)(4)(C)(iii) of the Act

requires that the adjustments to annual

DRG classifications and relative weights

must be made in a manner that ensures

that aggregate payments to hospitals are

not affected. Therefore, we would

simulate projected payments under this

provision for new technology during the

upcoming fiscal year at the same time

we estimate the payment effect of

changes to the DRG classifications and

recalibration. The impact of those

additional payments would then be

factored into the budget neutrality

factor, which is applied to the

standardized amounts.

Because any additional payments

directed toward new technology under

this provision would be offset to ensure

budget neutrality, it is important to

carefully consider the extent of this

provision and ensure that only

technologies representing substantial

advances are recognized for additional

payments. In that regard, we would

discuss in the annual proposed and

final regulations implementing changes

to the inpatient hospital prospective

payment system those technologies that

were considered under this provision;

our determination as to whether a

particular new technology meets our

criteria for a new technology; whether it

is determined further that cases

involving the new technology would be

inadequately paid under the existing

DRG payment; and any assumptions

that went into the budget neutrality

calculations related to additional

payments for that new technology,

including the expected number,

distribution, and costs of these cases.

The payments made under this

provision would be redistributed from

all other payments made under the

inpatient prospective payment system;

DRG payments would be reduced by

amounts we estimate to be necessary to

pay for the estimated aggregate new

technology payments. Our projections of

the aggregate payments for new

technology would involve not only

estimates of the effect of the new

technology on the entire cost per case

but also estimates of the volume of cases

expected to involve the new technology

during the upcoming year. Given the

uncertainty in both of these aspects of

the projections, we believe it is

important to expose our estimates to

public comment before implementing

them.

G. Payment for Direct Costs of Graduate

Medical Education (§ 413.86)

1. Background

Under section 1886(h) of the Act,

Medicare pays hospitals for the direct

costs of graduate medical education

(GME). The payments are based in part

on the number of residents trained by

the hospital. Section 1886(h) of the Act,

as amended by section 4623 of Public

Law 105–33, caps the number of

residents that hospitals may count for

direct GME.

Section 1886(h)(2) of the Act, as

amended by section 9202 of the

Consolidated Omnibus Reconciliation

Act (COBRA) of 1985 (Public Law 99–

272), and implemented in regulations at

§ 413.86(e), establishes a methodology

for determining payments to hospitals

for the costs of approved GME

programs. Section 1886(h)(2) of the Act,

as amended by COBRA, sets forth a

payment methodology for the

determination of a hospital-specific,

base-period per resident amount (PRA)

that is calculated by dividing a

hospital’s allowable costs of GME for a

base period by its number of residents

in the base period. The base period is,

for most hospitals, the hospital’s cost

reporting period beginning in FY 1984

(that is, the period of October 1, 1983

through September 30, 1984). The PRA

is multiplied by the number of FTE

residents working in all areas of the

hospital complex (or nonhospital sites,

when applicable), and the hospital’s

Medicare share of total inpatient days to

determine Medicare’s direct GME

payments. In addition, as specified in

section 1886(h)(2)(D)(ii) of the Act, for

cost reporting periods beginning on or

after October 1, 1993, through

September 30, 1995, each hospital’s

PRA for the previous cost reporting

period is not updated for inflation for

any FTE residents who are not either a

primary care or an obstetrics and

gynecology resident. As a result,

hospitals with both primary care and

obstetrics and gynecology residents and

nonprimary care residents have two

separate PRAs beginning in FY 1994:

one for primary care and one for

nonprimary care.

Section 1886(h)(2) of the Act was

further amended by section 311 of

Public Law 106–113 to establish a

methodology for the use of a national

average PRA in computing direct GME

payments for cost reporting periods

beginning on or after October 1, 2000,

and on or before September 30, 2005.

Generally, section 1886(h)(2) of the Act

establishes a ‘‘floor’’ and a ‘‘ceiling’’

based on a locality-adjusted, updated,

weighted average PRA. Each hospital’s

PRA is compared to the floor and ceiling

to determine whether its PRA should be

revised. PRAs that are below the floor,

that is, 70 percent of the localityadjusted, updated, weighted average

PRA, would be revised to equal 70

percent of the locality-adjusted,

updated, weighted average PRA. PRAs

that exceed the ceiling, that is, 140

percent of the locality-adjusted,

updated, weighted average PRA, would,

depending on the fiscal year, either be

frozen and not increased for inflation, or

increased by a reduced inflation factor.

We implemented section 311 of Public

Law 106–113 in the hospital inpatient

prospective payment system final rule

published on August 1, 2000 (65 FR

47090). In that final rule, we set forth

the methodology for calculating the

weighted average PRA and outlined the

steps for determining whether a

hospital’s PRA would be revised.

2. Amendments Made by Section 511 of

Public Law 106–554

(§ 413.86(e)(4)(ii)(C) and (e)(5)(iv))

Section 511 of Public Law 106–554

amended section 1886(h)(2)(D)(iii) of

the Act by increasing the floor to 85

percent of the locality-adjusted national

average PRA. In general, section 511

provides that, effective for cost reporting

periods beginning on or after October 1,

2001, and before October 1, 2002, PRAs

that are below 85 percent of the

respective locality-adjusted national

average PRA would be increased to

equal 85 percent of that localityadjusted national average PRA.

Accordingly, we are proposing to

implement section 511 by revising

§ 413.86(e)(4)(ii)(C)(1) to incorporate

this change and by outlining the

methodology for determining whether a

hospital’s PRA(s) will be adjusted in FY

2002 relative to the increased floor of

the locality-adjusted national average

PRA.

In the August 1, 2000 final rule (65 FR

47091 and 47092), as implemented at

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22697

§ 413.86(e)(4), we determined, in

accordance with section 311 of Public

Law 106–113, that the weighted average

PRA for cost reporting periods ending

during FY 1997 is $68,464. We

described the procedures for updating

the weighted average PRA of $68,464 for

inflation to FY 2001 and for adjusting

this average for the locality of each

individual hospital. We then outlined

the steps for comparing each hospital’s

PRA(s) to the locality-adjusted national

average PRA to determine if, for cost

reporting periods beginning on or after

October 1, 2000, and before October 1,

2001, the PRAs should be revised to

equal the 70-percent floor.

In accordance with section 511 of

Public Law 106–554, in this proposed

rule, we are proposing that, for cost

reporting periods beginning during FY

2002, the FY 2002 PRAs of hospitals

that are below 85 percent of the

respective locality-adjusted national

average PRA for FY 2002 be increased

to equal 85 percent of that localityadjusted national average PRA.

Specifically, to determine which PRAs

(primary care and nonprimary care

separately) for each hospital are below

the 85-percent floor, each hospital’s

locality-adjusted national average PRA

for FY 2002 is multiplied by 85 percent.

This resulting number is then compared

to each hospital’s PRA that is updated

for inflation to FY 2002. If the hospital’s

PRA would be less than 85 percent of

the locality-adjusted national average

PRA, the individual PRA is replaced

with 85 percent of the locality-adjusted

national average PRA for that cost

reporting period, and in future years the

new PRA would be updated for inflation

by the Consumer Price Index for All

Urban Consumers (CPI–U) as compiled

by the Bureau of Labor Statistics.

There may be some hospitals with

both primary care and nonprimary care

PRAs that are below the floor, and both

PRAs are, therefore, replaced with 85

percent of the locality-adjusted national

average PRA. In these situations, the

hospitals would receive a single PRA; a

distinction between PRAs would no

longer be made for differences in

inflation (under § 413.86(e)(3)(ii)). On

the other hand, hospitals may have

primary care PRAs that are above the

floor, and nonprimary care PRAs that

are below the floor. In these situations,

only the nonprimary care PRAs would

be revised to equal 85 percent of the

locality adjusted national average PRA,

and the prior year primary care PRAs

would be updated for inflation by the

CPI–U.

For example, if the FY 2002 localityadjusted national average PRA for Area

X is $100,000, then 85 percent of that

amount is $85,000. If, in Area X,

Hospital A has a primary care FY 2002

PRA of $84,000 and a nonprimary care

FY 2002 PRA of $82,000, both of

Hospital A’s FY 2002 PRAs are replaced

by the $85,000 floor. Thus, $85,000 is

the amount that would be used to

determine Hospital A’s direct GME

payments for both primary care and

nonprimary care FTEs in its cost

reporting period beginning in FY 2002,

and the $85,000 PRA would be updated

for inflation by the CPI-U in subsequent

years. However, Hospital B, also located

in Area X, has a primary care FY 2002

PRA of $86,000 and a nonprimary care

FY 2002 PRA of $84,000. Thus, for

Hospital B, only the nonprimary care

PRA of $84,000 is replaced by the

$85,000 floor. This new PRA of $85,000

would be updated for inflation by the

CPI-U in subsequent years. Hospital B’s

primary care PRA of $86,000 and its

nonprimary care PRA of $85,000 would

be used to determine its direct GME

payments in its cost reporting period

beginning in FY 2002.

We note that section 511 of Public

Law 106–554 only affects hospitals with

PRAs below the 85-percent floor, and

does not affect hospitals with PRAs that

are either between the floor and ceiling

or exceed the ceiling. Thus, with the

exception of the change in the floor as

provided by section 511, the policy

regarding the use of a national average

PRA for making direct GME payments

remains as implemented in the

regulations at § 413.86(e)(4).

We are proposing to amend

§ 413.86(e)(4)(ii)(C)(1) to add the rules

implementing section 1886(h)(2)(D)(iii)

of the Act as amended by section 511 of

Public Law 106–554.

We also are proposing to amend

§ 413.86(e)(5) regarding the

determination of base year PRAs for

new teaching hospitals for cost

reporting periods beginning during FYs

2001 through 2005. In the August 1,

2000 final rule, we made a conforming

change to § 413.86(e)(5) to account for

situations in which hospitals do not

have a 1984 base year PRA and establish

a PRA in a cost reporting period

beginning on or after October 1, 2000.

Existing § 413.86(e)(5)(iv) specifies that

the new base year PRAs of such

hospitals are subject to the regulations

regarding the floor and the ceiling of the

locality-adjusted national average PRA.

Although the determination of new base

year PRAs is subject to the national

average methodology, it is not necessary

to include this provision in the

regulations. Therefore, we are proposing

to remove § 413.86(e)(5)(iv).

We would like to clarify that, for

purposes of calculating a base year PRA

for a new teaching hospital, when

calculating the weighted mean value of

PRAs of hospitals located in the same

geographic area or the weighted mean

value of the PRAs in the hospital’s

census region (as defined in

§ 412.62(f)(1)(i)), the PRAs used in the

weighted average calculation must not

be less than the floors for cost reporting

periods beginning during FY 2001 or FY

2002, or if they exceed the ceiling, they

must either be frozen for FYs 2001 and

2002 or updated with the CPI-U minus

2 percent for FYs 2003 through 2005. In

addition, existing § 413.86(e)(5)

provides that the PRA for a new

teaching hospital is based on the lower

of the hospital’s actual costs incurred in

connection with the GME program or

the weighted mean value of PRAs. For

cost reporting periods beginning during

FYs 2001 and 2005, the PRA for a new

teaching hospital also would be subject

to the floor and the ceiling of the

national average PRA methodology. If a

hospital’s actual costs of the GME

program during its cost reporting period

beginning during FY 2001 or FY 2002

are less than the floors, the hospital’s

PRA would not be based on the actual

costs. Instead, it would be equal to 70

percent in FY 2001, or 85 percent

during FY 2002, of the locality-adjusted

national average PRA. The floor applies

to hospitals with existing PRAs in FYs

2001 and 2002, or to hospitals that are

establishing new base year PRAs in FYs

2001 and 2002. We are proposing to

clarify that if a hospital establishes a

new base year PRA in a cost reporting

period beginning after FY 2002, its PRA

would not be increased to equal the

floor if it is less than the floor.

Similarly, the ceiling applies to

hospitals with existing PRAS in FYs

2001 through 2005, or to hospitals that

are establishing new base year PRAs in

FYs 2001 through 2005.

3. Determining the 3-Year Rolling

Average for Direct GME Payments

(§ 413.86(g)(4) and (g)(5))

Section 1886(h)(4)(G)(iii) of the Act,

as added by section 4623 of Public Law

106–33, provides that for the hospital’s

first cost reporting period beginning on

or after October 1, 1997, the hospital’s

weighted FTE count for direct GME

payment purposes equals the average of

the weighted FTE count for that cost

reporting period and the preceding cost

reporting period. For cost reporting

periods beginning on or after October 1,

1998, section 1886(h)(4)(G) of the Act

requires that hospitals’ direct medical

education weighted FTE count for

payment purposes equal the average of

the actual weighted FTE count for the

payment year cost reporting period and

22698 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

the preceding two cost reporting periods

(rolling average). This provision phases

in the associated reduction in payment

over a 3-year period for hospitals that

are reducing their number of residents.

In the August 29, 1997 final rule with

comment period (62 FR 46004), we

revised § 413.86(g)(5) accordingly, and

outlined the methodology for

determining a hospital’s direct GME

payment. Based on what we explained

in the 1997 final rule, for cost reporting

periods beginning on or after October 1,

1997, we would determine a hospital’s

direct GME payment as follows:

Step 1. Determine the average of the

weighted FTE counts for the payment

year cost reporting period and the prior

two immediately preceding cost

reporting periods (with exception of the

hospital’s first cost reporting period

beginning on or after October 1, 1997,

which will be based on the average of

the weighted average for that cost

reporting period and the immediately

preceding cost reporting period).

Step 2. Determine the hospital’s direct

GME amount without regard to the FTE

cap (before determining Medicare’s

share). That is, take the sum of (a) the

product of the primary care PRA and the

primary care weighted FTE count in the

current payment year, and (b) the

product of the nonprimary care PRA

and the nonprimary care weighted FTE

count in the current payment year.

Step 3. Divide the hospital’s direct

GME amount by the total number of FTE

residents (including the effect of

weighting factors) for the cost reporting

period to determine the weighted

average PRA (this amount reflects the

FTE weighted average of the primary

and nonprimary care PRAs) for the cost

reporting period.

Step 4. Multiply the weighted average

PRA for the cost reporting period by the

3-year average weighted count to

determine the hospital’s allowable

direct GME costs. This product is then

multiplied by the hospital’s Medicare

patient load for the cost reporting period

to determine Medicare’s direct GME

payment to the hospital.

Steps 2 and 3 above describe the

methodology for combining a hospital’s

primary care PRA and nonprimary care

PRA to determine the hospital’s single

weighted average PRA for the payment

year cost reporting period. (This step

accounts for hospitals that were training

residents in both primary care and

nonprimary care residency programs in

FYs 1994 and 1995, when, as described

in § 413.86(e)(3)(ii), each hospital’s PRA

for the previous cost reporting period

was not adjusted for any resident FTEs

who were not either a primary care

resident or an obstetrics or a gynecology

resident. As a result, such hospitals

have two PRAs for direct GME payment;

one for primary care and obstetrics and

gynecology residents, and one for all

other, or nonprimary care, residents.

Hospitals that train either only primary

care (including obstetrics and

gynecology) residents or only

nonprimary care residents follow the

methodology described above, with the

exception of combining two PRAs). Step

4 then dictates that the resulting average

PRA is multiplied by the 3-year rolling

average, which, in turn, is multiplied by

the hospital’s Medicare patient load in

the current year to determine Medicare’s

direct GME payment to the hospital for

that cost reporting period.

In implementing this provision in the

August 29, 1997 final rule with

comment period, we believed that the

methodology described above was

appropriate because it was consistent

with the methodology described under

section 1886(h)(3)(B) of the Act. This

section specifies that, in order to arrive

at the average PRA, or ‘‘aggregate

approved amount,’’ HCFA must

multiply a hospital’s PRA by the

‘‘weighted average number of [FTE]

residents * * * in the hospital’s

approved medical residency training

programs in that period’’ (emphasis

added).

We also believed the methodology

outlined above and in the August 29,

1997 rule was appropriate because it

was consistent with the intent of the

statute that, after October 1, 1997, direct

GME payments should be based on a

rolling average. Specifically, section

4623 of Public Law 106–33 provides

that, ‘‘For cost reporting periods

beginning on or after October 1, 1997

* * * the total number of full-time

equivalent residents for determining a

hospital’s graduate medical education

payment shall equal the average of the

actual full-time equivalent resident

counts for the cost reporting period and

the preceding two cost reporting

periods’’ (emphasis added). Thus, while

the statute does not include a specific

methodology for computing the direct

GME payments, it clearly indicates that

the payment should be based on a 3-

year average of the weighted number of

residents, not the weighted number of

residents in the current payment year

cost reporting period.

As stated above, Congress provided

that the direct GME payments should be

made based on a 3-year average of the

weighted number of residents in order

to phase in the associated reduction in

payment over a 3-year period for

hospitals that are reducing the number

of residents they are training. However,

in steps 2 and 3 above, when combining

a hospital’s primary care PRA and

nonprimary care PRA, we weight the

respective PRAs by current year

residents. This introduces the number of

residents that a hospital is training in

the current cost reporting period into

the payment formula. A payment

formula that incorporates the number of

current year residents ‘‘dilutes’’ the

effect of the rolling average as related to

direct GME payments. After further

consideration, we believe that,

consistent with the statute, the formula

should be based on rolling average

counts of residents. We are proposing an

alternative methodology in which the

direct GME payment would be the sum

of (a) the product of the primary care

PRA and the primary care and obstetrics

and gynecology rolling average, and (b)

the product of the nonprimary care PRA

and the nonprimary care rolling average.

(This sum would then be multiplied by

the Medicare patient load.) We note that

IME payments would not be affected

because, although they also are based on

a 3-year rolling average, there is no

distinction between primary care and

nonprimary care residents.

The new methodology would be

effective for cost reporting periods

beginning on or after October 1, 2001.

The proposed methodology for

determining a hospital’s direct GME

payment is as follows:

Step 1. Determine that the hospital’s

total unweighted FTE counts in the

payment year cost reporting period and

the prior two immediately preceding

cost reporting periods for all residents

in allopathic and osteopathic medicine

do not exceed the hospital’s FTE cap for

these residents in accordance with

§ 413.86(g)(4). If the hospital’s total

unweighted FTE count in a cost

reporting period exceeds its cap, the

hospital’s weighted FTE count, for

primary care and obstetrics and

gynecology residents and nonprimary

care residents, respectively, will be

reduced in the same proportion that the

number of these FTE residents for that

cost reporting period exceeds the

unweighted FTE count in the cap. The

proportional reduction is calculated for

primary care and obstetrics and

gynecology residents and nonprimary

care residents separately in the

following manner:

(FTE cap/unweighted total FTEs in the

cost reporting period) × (weighted

primary care and obstetrics and

gynecology FTEs in the cost reporting

period)

plus

(FTE cap/unweighted total FTEs in the

cost reporting period) × (weighted

nonprimary care FTEs in the cost

reporting period).

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Add the two products to determine

the hospital’s reduced cap.

Step 2. Determine the 3-year average

of the weighted FTE count for primary

care and obstetrics and gynecology

residents in the payment year cost

reporting period and the two

immediately preceding cost reporting

periods. Determine the 3-year average of

the weighted FTE count for nonprimary

care residents in the payment year cost

reporting period and the two

immediately preceding cost reporting

periods.

Step 3. Determine the product of the

primary care PRA and the primary care

and obstetrics and gynecology 3-year

average from step 2. Determine the

product of the nonprimary care PRA

and the nonprimary care 3-year average

from step 2.

Step 4. Sum the products of step 3.

Step 5. Multiply the sum from step 4

by the hospital’s Medicare patient load

for the cost reporting period to

determine Medicare’s direct GME

payment to the hospital.

Existing § 413.86(g)(5) specifies that

residents in new programs are excluded

from the rolling average calculation for

a period of years equal to the minimum

accredited length for the type of

program, and are added to the payment

formula after applying the averaging

rules. Accordingly, for hospitals that

qualify for an adjustment to their FTE

caps for residents training in new

programs under § 413.86(g)(6), primary

care and obstetrics and gynecology

residents in new programs would be

added to the quotient of the primary

care and obstetrics and gynecology 3-

year average, and nonprimary care

residents in new programs would be

added to the quotient of the nonprimary

care 3-year average. The sums of the

respective 3-year averages and new

residents would then be multiplied by

the respective PRAs.

The following example illustrates the

determination of direct GME payment

under the proposed rolling average

methodology for an existing teaching

hospital with no new programs:

Example: Assume a hospital with a

cost reporting period ending September

30, 1996 (beginning October 1, 1995)

had 100 unweighted FTE residents and

90 weighted FTE residents. The

hospital’s FTE cap is 100 unweighted

residents.

Step 1. In its cost reporting period

beginning in FY 2000, it had 100

unweighted residents and 90 weighted

residents (50 primary care and 40

nonprimary care).

• The hospital had 90 unweighted

residents and 85 weighted residents (50

primary care and 35 nonprimary care)

for its cost reporting period beginning in

FY 2001.

• In its cost reporting period

beginning in FY 2002, the hospital had

80 unweighted residents and 80

weighted residents (50 primary care and

30 nonprimary care).

Step 2. The 3-year average of

weighted primary care and obstetrics

and gynecology residents is (50 + 50 +

50)/3 = 50. The 3-year average of

weighted nonprimary care residents is

(40 + 35 + 30)/3 = 35.

Step 3. Primary care: $80,000 PRA ×

50 weighted primary care and obstetrics

and gynecology FTEs = $4,000,000.

Nonprimary care: $78,000 × 35 weighted

nonprimary care FTEs = $2,730,000.

Step 4. $4,000,000 + $2,730,000 =

$6,730,000.

Step 5. If the hospital’s Medicare

patient load for the payment cost

reporting period is .20, Medicare’s

direct GME payment would be

$6,730,000 × .20 = $1,346,000.

Whether the proposed methodology

results in a payment difference for a

hospital is dependent upon whether or

not the number and mix (primary care

and nonprimary care) of FTEs changes

in a 3-year period. If the number and

mix of FTEs does not change in a 3-year

period, there would be no difference in

a direct GME payment amount derived

using the proposed methodology versus

the existing methodology. For example,

if a hospital has 90 weighted FTEs (50

primary care and 40 nonprimary care) in

the current year and the 2 previous

years (using the PRAs and the Medicare

patient load from the example above),

the payment amounts derived from the

existing methodology and the proposed

methodology would be equal.

If the number and mix of FTEs varies

from year to year, there will be a

difference in the results of the two

methodologies. In some instances the

existing methodology would result in a

higher payment, and in other instances

the proposed methodology would result

in a higher payment. In the example

above, the hospital has reduced its

number of weighted residents by 5 FTEs

in FYs 2001 and 2002. Calculating this

hospital’s direct GME payment amount

using the existing methodology (using

the PRAs and the Medicare patient load

from the example) would result in a

payment of $1,347,250, which is $1,250

more than $1,346,000, the amount

calculated in the example using the

proposed methodology.

In a scenario where a hospital makes

larger reductions to the number of FTEs,

the proposed methodology may be more

beneficial. For example, using the PRAs

and the Medicare patient load from the

example above, assume a hospital has

90 weighted FTEs (50 primary care and

40 nonprimary care) in FY 2000, 85

weighted FTEs (50 primary care and 35

nonprimary care) in FY 2001, and 70

weighted FTEs (35 primary care and 35

nonprimary care) in FY 2002. If the

proposed methodology is used, the

payment amount of $1,292,050 would

be calculated, which is $1,666 more

than $1,290,386, the amount calculated

if the existing methodology is used.

We are proposing to revise

§ 413.86(g)(4) to specify that, effective

for cost reporting periods beginning on

or after October 1, 2001, if the hospital’s

total unweighted FTE count in a cost

reporting period exceeds its cap, the

hospital’s weighted FTE count, for

primary care and obstetrics and

gynecology residents and nonprimary

care residents, respectively, will be

reduced in the same proportion that the

number of these FTE residents for that

cost reporting period exceeds the

unweighted FTE count in the cap. We

also are proposing to revise

§ 413.86(g)(5) to specify that, effective

for cost reporting periods beginning on

or after October 1, 2001, the direct GME

payment will be calculated using two

separate rolling averages, one for

primary care and obstetrics and

gynecology residents and one for

nonprimary care residents.

4. Counting Research Time as Direct and

Indirect GME Costs (§§ 412.105 and

413.86)

It has come to our attention that there

appears to be some confusion in the

provider community as to whether the

time that residents spend performing

research is countable for the purposes of

direct and indirect GME reimbursement.

Although we are not proposing to make

any policy changes in this proposed

rule, we would like to reiterate our

longstanding policy regarding time that

residents spend in research and propose

to incorporate this policy in the IME

regulations.

Section 413.86(f) specifies that, for the

purposes of determining the total

number of FTE residents for the direct

GME payment, residents in an approved

program working in all areas of the

hospital complex may be counted.

Accordingly, the time the residents

spend performing research as part of an

approved program anywhere in the

hospital complex may be counted for

direct GME payment purposes. If the

requirements listed at §§ 413.86(f)(3)

and (f)(4) are met, a hospital may also

count the time residents spend doing

research in non-hospital settings for

direct GME payment.

For purposes of determining the IME

payment, § 412.105(f)(ii) specifies that

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the time residents spend training in

parts of the hospital that are subject to

the inpatient prospective payment

system, in the outpatient departments,

or (effective on or after October 1, 1997,

in accordance with §§ 413.86(f)(3) and

(f)(4)) in nonhospital settings, may be

counted. Section 2405.3.F.2. of the

Provider Reimbursement Manual (PRM)

further states that a resident must not be

counted for the IME adjustment if the

resident is engaged exclusively in

research. Resident time spent

‘‘exclusively’’ in research means that the

research is not associated with the

treatment or diagnosis of a particular

patient of the hospital. Therefore,

although the research component may

be part of an approved program, the

time that residents devote specifically to

performing research that is not related

to delivering patient care, whether it

occurs in the hospital complex or in

non-hospital settings, may not be

counted for IME payment purposes.

‘‘Exclusively research’’ time is not

allowable for IME purposes irrespective

of whether the resident is engaged only

in research or spends only part of his or

her time on research. Accordingly, time

spent exclusively in research over the

course of a program year should be

subtracted from the total FTE for that

year. For example, if a resident is

required to spend 3 months in a

particular program year engaged in

research activities unrelated to

delivering patient care, that amount of

time should be subtracted from the total

FTE, whether or not the research time

is fulfilled in one block of time, or is

distributed throughout the training year.

We note that in order to count

residents for both direct GME and IME

payment purposes, the residents’

training must be part of an approved

program. This applies whether or not

the residents are doing work that is

clinical in nature. There are situations

where residents have completed their

residency program requirements but

remain for an additional period of time

to continue their training (that is, to

conduct research or other activities)

outside the context of a formally

organized approved program. As we

explained in the September 29, 1989

final rule (54 FR 40306), these residents

are not countable for direct GME or IME

reimbursement. Rather, patient care

services provided by these residents

should be paid as Part B services.

We are proposing to amend

§ 412.105(f)(1)(iii) to add a paragraph (B)

to incorporate language that reflects this

policy.

5. Temporary Adjustments to FTE Cap

To Reflect Residents Affected by

Residency Program Closure

In the July 30, 1999 hospital inpatient

prospective payment system final rule

(64 FR 41522), we indicated that we

would allow a temporary adjustment to

a hospital’s FTE resident cap under

limited circumstances and if certain

criteria are met when a hospital assumes

the training of additional residents

because of another hospital’s closure.

We made this change because hospitals

had indicated a reluctance to accept

additional residents from a closed

hospital without a temporary

adjustment to their caps. When we

proposed this change 2 years ago, we

received several comments suggesting

that we include lost accreditation of a

program (that is, a program’s closure) in

the temporary adjustment policy. We

explained in our response to these

comments (64 FR 41522) that we did not

believe it was appropriate to expand our

policy to cover any acts other than a

hospital’s closure. We made this

decision because, unless the hospital

terminates its Medicare agreement, the

hospital would retain its statutory FTE

cap and could affiliate with other

hospitals to enable the residents to

finish their training.

It has come to our attention that,

despite a hospital’s ability to affiliate

with other hospitals when it shuts down

a residency program, some hospitals for

various reasons do not affiliate before

their programs close, particularly when

the program closes abruptly towards the

end of the program year (the deadline to

submit Medicare affiliation agreements

is July 1 of the upcoming program year).

Therefore, we are proposing that if a

hospital that closes its residency

training program agrees to temporarily

reduce its FTE cap, another hospital(s)

may receive a temporary adjustment to

its FTE cap to reflect residents added

because of the closure of the former

hospital’s residency training program.

For purposes of this proposed policy on

closed programs, we are proposing to

define ‘‘closure of a hospital residency

training program’’ as when the hospital

ceases to offer training for residents in

a particular approved medical residency

training program (proposed

§ 413.86(g)(8)(i)(B)). The methodology

for adjusting the caps for the ‘‘receiving

hospital’’ and the ‘‘hospital that closed

its program’’ is described below.

a. Receiving hospital. We are

proposing that a hospital(s) may receive

a temporary adjustment to its (or their)

FTE cap to reflect residents added

because of the closure of another

hospital’s residency training program

if—

• The hospital is training additional

residents from the residency training

program of a hospital that closed its

program; and

• No later that 60 days after the

hospital begins to train the residents,

the hospital submits to its fiscal

intermediary a request for a temporary

adjustment to its FTE cap, documents

that the hospital is eligible for this

temporary adjustment by identifying the

residents who have come from another

hospital’s closed program and have

caused the hospital to exceed its cap,

specifies the length of time the

adjustment is needed, and submits to its

fiscal intermediary a copy of the FTE

cap reduction statement by the hospital

closing the program, as specified in

paragraph (g)(8)(iii)(B)(2).

In general, the above criteria we are

proposing for the temporary adjustment

are reflective of the criteria for the

temporary adjustment for taking on the

training of displaced residents from

closed hospitals. We note that we are

proposing that more than one hospital

would be eligible to apply for the

temporary adjustment, because

residents from one closed program may

go to different hospitals, or they may

finish their training at more than one

hospital. We also note that only to the

extent a hospital would exceed its FTE

cap by training displaced residents

would it be eligible for the temporary

adjustment.

Finally, we note that we are proposing

that hospitals that meet the above

proposed criteria would be eligible to

receive temporary adjustments (for cost

reporting periods beginning on or after

October 1, 2001, for direct GME and

with discharges beginning on or after

October 1, 2001 for IME) for training the

displaced residents from programs that

closed even before the effective date of

this policy. We mention this because

hospitals may have closed programs in

the recent past and the residents from

the closed programs may not have

completed their training as of the

effective date of this policy. For

instance, if a 5-year residency program,

such as surgery, closed on July 1, 1997,

the 5th program year residents may still

be training during this residency year

(2001). We are proposing that if both the

receiving hospital(s) and the hospital

that closed the program in this example

follow the criteria described in this

preamble, the receiving hospital may

receive a temporary adjustment to its

FTE cap for 9 months (October 1, 2001

through June 30, 2002) to accommodate

the 5th year surgery residents. However,

we note that hospitals would not be

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22701

eligible to receive a temporary

adjustment for training the residents

until the effective date of this rule.

b. Hospital that closed its program(s).

We are proposing that a hospital that

agrees to train residents who have been

displaced by the closure of another

hospital’s program may receive a

temporary FTE cap adjustment only if

the hospital with the closed

program(s)—

• Temporarily reduces its FTE cap by

the number of FTE residents in each

program year training in the program at

the time of the program’s closure. The

yearly reduction would be determined

by deducting the number of those

residents who would have been training

in the program year during each year

had the program not closed; and

• No later than 60 days after the

residents who were in the closed

program begin training at another

hospital, submits to its fiscal

intermediary a statement signed and

dated by its representative that specifies

that it agrees to the temporary reduction

in its FTE cap to allow the hospital

training the displaced residents to

obtain a temporary adjustment to its

cap; identifies the residents who were

training at the time of the program’s

closure; identifies the hospitals to

which the residents are transferring

once the program closes; and specifies

the reduction for the applicable program

years.

Unlike the closed hospital policy at

§ 413.86(g)(8), we are proposing under

this closed program policy (which we

are proposing to amend § 413.86(g)(8) to

include), that in order for the receiving

hospital(s) to qualify for a temporary

adjustment to its FTE cap, the hospitals

that are closing their programs would

need to reduce their FTE cap for the

duration of time the displaced residents

would need to finish their training. We

are proposing this change because, as

explained below, the hospital that

closes the program still has the FTE

slots in its cap, even if the hospital

chooses not to fill the slots with

residents. We believe it is inappropriate

to allow an increase to the receiving

hospital’s cap without an attendant

decrease to the cap of the hospital with

the closed program, even if the increase

is only temporary. We note that even

under this proposed closed program

policy, the hospital that closes its

program may choose instead to affiliate

with another hospital by July 1 of the

next residency year so that the residents

can more easily finish their training.

We are proposing that the cap

reduction for the hospital with the

closed program would be based on the

number of FTE residents in each

program year who were in the program

at the program’s closure, and who began

training at another hospital, rather than

the count of residents each year at the

hospital(s) receiving the temporary

adjustment(s). We believe it would be

too burdensome administratively to

require the hospital closing the program

to keep track of the status of the

residents when they are training at other

hospitals. For instance, Joe Smith, a

resident who is a PGY 1 when Hospital

X closes its pathology residency

program, may then finish his training at

Hospital Y. The resident trains for one

year at Hospital Y as a PGY 2, but

decides to drop out of the program

before finishing. It would be

burdensome to require Hospital X to

keep track of Joe Smith’s status while he

is training at Hospital Y for purposes of

the reduction in Hospital X’s cap.

Therefore, we are proposing to ‘‘freeze’’

the basis for the reduction of the FTE

cap of the hospital that closed the

program based on the count and status

of the residents when the hospital closes

the program.

Example: Hospital A, which has a

direct GME FTE cap of 20 FTEs and an

IME FTE cap of 18 FTEs, is experiencing

financial difficulties and decides to

close down its internal medicine

residency training program effective

June 30, 2002. As of June 30, 2002,

Hospital A is training 2 PGY 1s, 4 PGY

2s, and 6 PGY 3s in its internal

medicine program. Hospitals B, C, and

D take on the training of the displaced

residents. These hospitals are eligible to

receive temporary adjustments to their

FTE caps if they follow the proposed

criteria stated above. In order for

Hospitals B, C, and D to receive the

temporary adjustments, however,

Hospital A must agree to reduce its FTE

cap. According to the proposed criteria

stated above, Hospital A’s reduction

would be:

July 1, 2002 through June 30, 2003

Direct GME FTE cap: 14 FTEs, (20 FTEs

cap—2 PGY 2s—4 PGY 3s)

IME FTE cap: 12 FTEs (18 FTEs—2 PGY

2s—4 PGY 3s)

We note that no downward

adjustment for the 6 PGY 3s for either

cap is necessary since these residents

will have completed their training in

that program by the July 1, 2000 through

June 30, 2003 program year.

July 1, 2003 through June 30, 2004

Direct GME FTE cap: 18 FTEs (20 FTEs

cap—2 PGY 3s)

IME FTE cap: 16 FTEs (18 FTEs cap—

2 PGY 3s)

July 1, 2004 through June 30, 2005

Direct GME FTE cap: 20 FTEs

IME FTE cap: 18 FTEs

We also are proposing to revise

§ 412.105(f)(1)(ix) to make the provision

relating to the adjustment to FTE caps

to reflect residents affected by closure of

hospitals’ medical residency training

programs applicable to determining the

IME payment.

6. Conforming Change to Regulations

Governing Payment to Federally

Qualified Health Centers (§ 405.2468(f))

We have discovered a technical error

in the regulations at § 405.2468(f)

regarding payment to federally qualified

health centers (FQHCs) and rural health

centers (RHCs) for the costs of graduate

medical education. Specifically,

§ 405.2468(f)(6)(ii)(D) provides that

‘‘The costs associated with activities

described in § 413.85(d) of this chapter’’

are not allowable graduate medical

education costs. We recently amended

§ 413.85 in a final rule (66 FR 3358,

January 12, 2001) regarding Medicare

pass-through payment for approved

nursing and allied health education

programs. However, we inadvertently

did not make a conforming change to

§ 405.2468(f)(6)(ii)(D). Section

405.2468(f)(6)(ii)(D) should read ‘‘The

costs associated with activities

described in § 413.85(h) of this

chapter.’’ We are proposing to revise

§ 405.2468(f)(6)(ii)(D) to reflect this

change.

V. Proposed Changes to the Prospective

Payment System for Capital-Related

Costs

A. End of the Transition Period

Federal fiscal year (FY) 2001 is the

last year of the 10-year transition period

established to phase in the prospective

payment system for hospital capitalrelated costs. For the readers’ benefit in

this proposed rule, we are providing a

summary of the statutory basis for the

system, the development and evolution

of the system, the methodology used to

determine capital-related payments to

hospitals, and the policy for providing

exceptions payments during the

transition period.

Section 1886(g) of the Act requires the

Secretary to pay for the capital-related

costs of inpatient hospital services ‘‘in

accordance with a prospective payment

system established by the Secretary.’’

Under the statute, the Secretary has

broad authority in establishing and

implementing the capital prospective

payment system. We initially

implemented the capital prospective

payment system in the August 30, 1991

final rule (56 FR 43409), in which we

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established a 10-year transition period

to change the payment methodology for

Medicare inpatient capital-related costs

from a reasonable cost-based

methodology to a prospective

methodology (based fully on the Federal

rate).

The 10-year transition period

established to phase in the prospective

payment system for capital-related costs

is effective for cost reporting periods

beginning on or after October 1, 1991

(FY 1992) and before October 1, 2001

(FY 2002). Beginning in FY 2001, the

last year of the 10-year transition period

for the prospective payment system for

hospital capital-related costs, capital

prospective payment system payments

are based solely on the Federal rate for

the vast majority of hospitals. Since FY

2001 is the final year of the capital

transition period, we will no longer

determine a hospital-specific rate for FY

2002 in section IV. of the Addendum of

this proposed rule. For cost reporting

periods beginning on or after October 1,

2001, payment for capital-related costs

for all hospitals, except those defined as

new hospitals under § 412.30(b), will be

determined based solely on the capital

standard Federal rate.

Generally, during the transition

period, inpatient capital-related costs

are paid on a per discharge basis, and

the amount of payment depended on the

relationship between the hospitalspecific rate and the Federal rate during

the hospital’s base year. A hospital with

a base year hospital-specific rate lower

than the Federal rate is paid under the

fully prospective payment methodology

during the transition period. This

method is based on a dynamic blend

percentage of the hospital’s hospitalspecific rate and the applicable Federal

rate for each year during the transition

period. A hospital with a base period

hospital-specific rate greater than the

Federal rate is paid under the holdharmless payment methodology during

the transition period.

During the transition period, a

hospital paid under the hold-harmless

payment methodology receives the

higher of (1) a blended payment of 85

percent of reasonable cost for old capital

plus an amount for new capital based on

a portion of the Federal rate; or (2) a

payment based on 100 percent of the

adjusted Federal rate. The amount

recognized as old capital is generally

limited to the allowable Medicare

capital-related costs that were in use for

patient care as of December 31, 1990.

Under limited circumstances, capitalrelated costs for assets obligated as of

December 31, 1990, but put in use for

patient care after December 31, 1990,

also may be recognized as old capital if

certain conditions were met. These costs

are known as obligated capital costs.

New capital costs are generally defined

as allowable Medicare capital-related

costs for assets put in use for patient

care after December 31, 1990.

Hospitals that are defined as ‘‘new’’

for the purposes of capital payments

during the transition period (see

§ 412.300(b)) will continue to be paid

according to the applicable payment

methodology outlined in § 412.324.

During the transition period, new

hospitals are exempt from the

prospective payment system for capitalrelated costs for their first 2 years of

operation and are paid 85 percent of

their reasonable capital-related costs

during that period. The hospital’s first

12-month cost reporting period (or

combination of cost reporting periods

covering at least 12 months), beginning

at least 1 year after the hospital accepts

its first patient, serves as the hospital’s

base period. Those base year costs

qualify as old capital and are used to

establish its hospital-specific rate used

to determine its payment methodology

under the capital prospective payment

system. Effective with the third year of

operation, the hospital will be paid

under either the fully prospective

methodology or the hold-harmless

methodology. If the fully prospective

methodology is applicable, the hospital

is paid using the appropriate transition

blend of its hospital-specific rate and

the Federal rate for that fiscal year until

the conclusion of the transition period,

at which time the hospital will be paid

based on 100 percent of the Federal rate.

If the hold-harmless methodology is

applicable, the hospital will receive

hold-harmless payment for assets in use

during the base period for 8 years,

which may extend beyond the transition

period.

The basic methodology for

determining capital prospective

payments based on the Federal rate is

set forth in § 412.312. For the purpose

of calculating payments for each

discharge, the standard Federal rate is

adjusted as follows:

(Standard Federal Rate) × (DRG Weight)

× (GAF) × (Large Urban Add-on, if

applicable) × (COLA Adjustment for

Hospitals Located in Alaska and

Hawaii) × (1 + DSH Adjustment

Factor + IME Adjustment Factor)

Hospitals may also receive outlier

payments for those cases that qualify

under the thresholds established for

each fiscal year. Section 412.312(c)

provides for a single set of thresholds to

identify outlier cases for both inpatient

operating and inpatient capital-related

payments.

In accordance with section

1886(d)(9)(A) of the Act, under the

prospective payment system for

inpatient operating costs, hospitals

located in Puerto Rico are paid for

operating costs under a special payment

formula. Prior to FY 1998, hospitals in

Puerto Rico were paid a blended rate

that consisted of 75 percent of the

applicable standardized amount specific

to Puerto Rico hospitals and 25 percent

of the applicable national average

standardized amount. However,

effective October 1, 1997, under

amendments to the Act enacted by

section 4406 of Public Law 105–33,

operating payments to hospitals in

Puerto Rico are based on a blend of 50

percent of the applicable standardized

amount specific to Puerto Rico hospitals

and 50 percent of the applicable

national average standardized amount.

In conjunction with this change to the

operating blend percentage, effective

with discharges on or after October 1,

1997, we compute capital payments to

hospitals in Puerto Rico based on a

blend of 50 percent of the Puerto Rico

rate and 50 percent of the Federal rate

as specified in the regulations at

§ 412.374. For capital-related costs, we

compute a separate payment rate

specific to Puerto Rico hospitals using

the same methodology used to compute

the national Federal rate for capitalrelated costs.

In the August 30, 1991 final rule (56

FR 43409), we established a capital

exceptions policy, which provided for

exceptions payments during the

transition period (§ 412.348). Section

412.348 provides that, during the

transition period, a hospital may receive

additional payment under the

exceptions process when its regular

payments are less than a minimum

percentage, established by class of

hospital, of the hospital’s reasonable

capital-related costs. The amount of the

exceptions payment is the difference

between the hospital’s minimum

payment level and the payments the

hospital would have received under the

capital prospective payment system in

the absence of an exceptions payment.

The comparison is made on a

cumulative basis for all cost reporting

periods during which the hospital has

been subject to the capital prospective

payment transition rules. The minimum

payment percentages throughout the

transition period for regular capital

exceptions payments by class of

hospitals are:

• For sole community hospitals, 90

percent;

• For urban hospitals with at least

100 beds that have a disproportionate

share patient percentage of at least 20.2

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22703

percent or that received more than 30

percent of their net inpatient care

revenues from State or local

governments for indigent care, 80

percent;

• For all other hospitals, 70 percent of

the hospital’s reasonable inpatient

capital-related costs.

The provision for regular exceptions

payments expires at the end of the

transition period, that is, on September

30, 2001. Capital prospective payment

system payments are no longer adjusted

to reflect regular exceptions payments at

§ 412.348 after that date. Accordingly,

for cost reporting periods beginning on

or after October 1, 2001, all hospitals

other than those defined as ‘‘new’’

under § 412.300(b) will receive only the

per discharge payment based on the

Federal rate for capital costs (plus any

applicable DSH or IME and outlier

adjustments) unless a hospital qualifies

for a special exceptions payment under

§ 412.348(g).

B. Special Exceptions Process

In the August 30, 1991 final rule (56

FR 43409), we established a capital

exceptions policy at § 412.348, which

provided for regular exception

payments during the transition period.

In the September 1, 1994 final rule (59

FR 45385), we added the special

exceptions process, describing it as

‘‘* * * narrowly defined, focusing on a

small group of hospitals who found

themselves in a disadvantaged position.

The target hospitals were those who had

an immediate and imperative need to

begin major renovations or replacements

just after the beginning of the capital

prospective payment system. These

hospitals would not be eligible for

protection under the old capital and

obligated capital provisions, and would

not have been allowed any time to

accrue excess capital prospective

payments to fund these projects.’’

Under the special exceptions

provisions at § 412.348(g), an additional

payment may be made through the 10th

year beyond the end of the capital

prospective payment system transition

period for eligible hospitals that meet

(1) a project need requirement as

described at § 412.348(g)(2), which, in

the case of certain urban hospitals,

includes an excess capacity test; and (2)

a project size requirement as described

at § 412.348(g)(5). Eligible hospitals

include sole community hospitals,

urban hospitals with at least 100 beds

that have a disproportionate share

percentage of at least 20.2 percent, and

hospitals with a combined Medicare

and Medicaid inpatient utilization of at

least 70 percent.

When we established the special

exceptions process, we selected the

hospital’s cost reporting period

beginning before October 1, 2001, as the

project completion date in order to limit

cost-based exceptions payments to a

period of not more than 10 years beyond

the end of the transition to the fully

Federal capital prospective payment

system. Therefore, hospitals are eligible

to receive special exceptions payments

for the 10 years after the cost reporting

year in which they complete their

project. Generally, if a project is

completed in the hospital cost reporting

period ending September 29, 2002,

exceptions payments would continue

through September 29, 2012. In

addition, we believe that, for projects

completed after the deadline, hospitals

would have had the opportunity to

reserve their prior years’ capital

prospective payment system payments

for financing projects. We note that the

August 1, 2000 final rule (65 FR 47095)

incorrectly stated that special

exceptions payments could extend

through September 30, 2011; the date

should have been September 29, 2012.

For each cost reporting period, the

amount of the special exceptions

payment is determined by comparing

the cumulative payments made to the

hospital under the capital payment

system to the cumulative minimum

payment levels applicable to the

hospital for each cost reporting period

subject to the prospective payment

system. This comparison is offset or

reduced by (1) any amount by which the

hospital’s cumulative payments exceed

its cumulative minimum payments

under the regular exceptions process for

all cost reporting periods during which

the hospital has been subject to the

capital prospective payment system;

and (2) any amount by which the

hospital’s current year Medicare

inpatient operating and capital

prospective payment system payments

(excluding 75 percent of its operating

DSH payments) exceed its Medicare

inpatient operating and capital costs (or

its Medicare inpatient margin). During

the capital prospective payment system

transition period, the minimum

payment level under the regular

exceptions process varied by class of

hospital as set forth in § 412.348(c) and

described in section V.A. of this

preamble. After the transition period

and for the duration of the special

exceptions provision, the minimum

payment level is 70 percent as set forth

in § 412.348(g)(6).

In the July 31, 1998 final rule (63 FR

40999), we stated that a few hospitals

had expressed concern with the

required completion date of October 1,

2001, and other qualifying criteria for

the special exceptions payment.

Therefore, we solicited certain

information from hospitals on major

capital construction projects that might

qualify for the capital special exceptions

payments so we could determine if any

changes in the special exceptions

criteria or process were necessary. In the

May 7, 1999 proposed rule (64 FR

24736), we reported that four hospitals

had responded timely to our solicitation

with information on their major capital

construction projects. The hospitals

submitted information about their

location, the cost of the project, the date

that the certificate of need approval was

received, the start date of the project,

and the anticipated completion date.

Some hospitals also suggested changing

a number of the requirements of the

special exception provision.

When we issued the May 7, 1999

proposed rule, we had no specific

proposal to revise the special exceptions

process. However, we invited comments

and suggestions from hospitals and

other interested parties on the revision

to the special exceptions process (64 FR

24738). We noted that, because the

capital special exceptions process is

budget neutral, any liberalization of the

policy would require a commensurate

reduction in the capital rate paid to all

hospitals. That is, we will continue to

make an adjustment to the capital

Federal rate in a budget neutral manner

to pay for exceptions as long as an

exceptions policy is in force, just as we

have for regular exceptions during the

transition period. We also stated that,

based on the comments we received, we

may make changes to the special

exceptions criteria in the final

regulation or propose changes in the FY

2001 proposed rule.

In the July 30, 1999 final rule (64 FR

41526), we responded to the six

comments we received on potential

changes to the special exceptions

process. In that same final rule, we also

described our attempt to obtain

information on hospital projects that

might qualify for special exceptions

payments in order to assess the impact

of the recommended changes to the

existing policy. In conjunction with the

most recent cost report data readily

available at that time (FY 1996), we

attempted to estimate which of the

hospital construction projects might

qualify for special exception payments

under the existing policy and how that

universe of hospitals might change as a

result of the recommended revisions to

the special exceptions criteria.

Because exception payments to a

hospital for a given cost reporting

period are based on a percentage of the

22704 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

capital costs incurred during the cost

reporting period, we were unable to

determine a precise estimate of the

amount of payments to hospitals that

might be eligible for special exceptions.

In addition, hospitals are not eligible for

special exception payments until the

assets are put into use for patient care.

Once eligibility for special exceptions

payment has been demonstrated, it is

some time before completed and settled

cost reports are available to determine

these payments.

Based on our research, we determined

that it is difficult to predict whether

particular hospitals will be able to meet

all of the special exceptions eligibility

criteria (DSH percentage, completion

date, project size, and project need

requirements) as well as qualify to

receive special exception payments after

taking into account the appropriate

offsets, such as inpatient operating and

capital margins. However, we believe

that any changes to the special

exceptions policy may affect a

significant number of hospitals.

Based on our belief that these changes

may have an impact on a significant

number of hospitals, our evaluation of

the comments, and careful

consideration of all the issues, we stated

in the July 30, 1999 final rule that the

more appropriate forum for addressing

changes to the capital special exceptions

policy is the legislative process in

Congress rather than the regulation

process (64 FR 41528).

As we also indicated in the July 30,

1999 final rule (64 FR 41526), we have

little information about the number of

hospitals that may qualify for special

exceptions payments or the projected

dollar amount of special exception

payments, because no hospitals are

currently being paid under the special

exceptions process. Until FY 2002, the

special exceptions provision pays either

the same as the regular exceptions

process or less for high DSH and sole

community hospitals. In accordance

with § 412.348(g)(7), a qualifying

hospital may receive additional

payments for up to 10 years from the

year in which it completes a project that

meets the project need and project size

requirements of the special exception

provision in §§ 412.348(g)(2) through

(g)(5). Because a qualifying project

under the special exceptions provision

at § 412.348(g) must be completed (put

into use for patient care) by the end of

the hospital’s last cost reporting period

beginning before the end of the

transition period (September 30, 2001),

a hospital may receive special exception

payments for 10 years through

September 30, 2012. For example, an

eligible hospital that completes a

qualifying project in October 1993 (FY

1994) will be eligible to receive special

exception payments up through FY

2003 (September 30, 2003).

In order to assist our fiscal

intermediaries in determining the end of

the 10-year period in which an eligible

hospital will no longer be entitled to

receive special exception payments, we

are proposing to add a new

§ 412.348(g)(9) to require that hospitals

eligible for special exception payments

under § 412.348(g) submit

documentation to the intermediary

indicating the completion date of their

project (the date the project was put in

use for patient care) that meets the

project need and project size

requirements outlined in

§§ 412.348(g)(2) through (g)(5). We are

proposing that, in order for an eligible

hospital to receive special exception

payments, this documentation would

have to be submitted in writing to the

intermediary by the later of October 1,

2001, or within 3 months of the end of

the hospital’s last cost reporting period

beginning before October 1, 2001,

during which a qualifying project was

completed. For example, if a hospital

completed a qualifying project in March

1995, it would be required to submit

documentation to the intermediary by

October 1, 2001. If a hospital with a 12-

month cost reporting period beginning

on July 1 completed a qualifying project

in November 2001, it would be required

to submit documentation to the

intermediary no later than September

30, 2002, which is 3 months after the

end of its 12-month cost reporting

period that began on July 1, 2001.

C. Exceptions Minimum Payment Level

Section 412.348(h) limits the

estimated aggregate amount of

exceptions payments under both the

regular exceptions and special

exceptions process to no more than 10

percent of the total estimated capital

prospective payment system payments

in a given fiscal year. Consistent with

the requirements for regular exceptions

at § 412.348(c), we are proposing that if

we estimate that special exception

payments would exceed 10 percent of

total capital prospective payment

system payments for a given fiscal year,

we will adjust the minimum payment

level of 70 percent by one percentage

point increments until the estimated

payments are within the 10-percent

limit. For example, we could set the

minimum payment level at 69 percent

to ensure that estimated aggregate

special exceptions payments do not

exceed 10 percent of estimated total

capital prospective payment system

payments. If the estimate of aggregate

special exceptions payments were still

projected to exceed 10 percent of total

capital prospective payment system

payments, we would continue reducing

the minimum payment level by one

percentage point increments until the

requirements in § 412.348(h) were

satisfied. We are proposing to revise

§ 412.348(g)(6) accordingly to reflect

this policy.

D. Exceptions Adjustment Factor

Section 412.308(c)(3) requires that the

standard capital Federal rate be reduced

by an adjustment factor equal to the

estimated proportion of additional

payments for both regular exceptions

and special exceptions under § 412.348

relative to total capital prospective

payment system payments. In

estimating the proportion of regular

exceptions payments to total capital

prospective payment system payments

during the transition period, we used

the model originally developed for

determining budget neutrality

(described in Appendix B of this

proposed rule) to determine the

exception adjustment factor, which was

applied to both the Federal and

hospital-specific rates. Below we

describe our proposed methodology for

determining the special exceptions

adjustment used in establishing the

Federal capital rate.

Under the special exceptions

provision specified at § 412.348(g)(1),

eligible hospitals include SCHs, urban

hospitals with at least 100 beds that

have a disproportionate share

percentage of at least 20.2 percent or

qualify for DSH payments under

§ 412.106(c)(2), and hospitals with a

combined Medicare and Medicaid

inpatient utilization of at least 70

percent. An eligible hospital may

receive special exception payments if it

meets (1) a project need requirement as

described at § 412.348(g)(2), which, in

the case of certain urban hospitals,

includes an excess capacity test; (2) an

age of assets test as described at

§ 412.348(g)(3); and (3) a project size

requirement as described at

§ 412.348(g)(5).

In order to determine the estimated

proportion of special exceptions

payments to total capital payments, we

attempted to identify the universe of

eligible hospitals that may potentially

qualify for special exception payments.

First, we identified hospitals that met

the eligibility requirements at

§ 412.348(g)(1). Then we determined

each hospital’s average fixed asset age in

the earliest available cost report starting

in FY 1992 and later. For each of those

hospitals, we calculated the average

fixed asset age by dividing the

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22705

accumulated depreciation by the current

year’s depreciation. In accordance with

§ 412.348(g)(3), a hospital must have an

average age of buildings and fixed assets

above the 75th percentile of all hospitals

in the first year of capital prospective

payment system. In the September 1,

1994 final rule (59 FR 45385), we stated

that, based on the June 1994 update of

the cost report files in HCRIS, the 75th

percentile for buildings and fixed assets

for FY 1992 was 16.4 years. However,

we noted that we would make a final

determination of that value on the basis

of more complete cost report

information at a later date. In the August

29, 1997 final rule (62 FR 46012), based

on the December 1996 update of HCRIS

and the removal of outliers, we finalized

the 75th percentile for buildings and

fixed assets for FY 1992 as 15.4 years.

Thus, we eliminated any hospitals from

the potential universe of hospitals that

may qualify for special exception

payments if its average age of fixed

assets did not exceed 15.4 years.

For the hospitals remaining in the

potential universe, we estimated

project-size by using the fixed capital

acquisitions shown on Worksheet A7

from the following HCRIS cost reports

updated through December 2000.

PPS year

Cost reports periods beginning in

IX ................................................ FY 1992

X ................................................. FY 1993

XI ................................................ FY 1994

XII ............................................... FY 1995

XIII .............................................. FY 1996

XIV .............................................. FY 1997

PPS year

Cost reports periods beginning in

XV ............................................... FY 1998

XVI .............................................. FY 1999

Because the project phase-in may

overlap 2 cost reporting years, we added

together the fixed acquisitions from

sequential pairs of cost reports to

determine project size. Under

§ 412.348(g)(5), the project-size must

meet the following requirements: (1)

$200 million; or (2) 100 percent of its

operating cost during the first 12-month

cost reporting period beginning on or

after October 1, 1991. We calculated the

operating costs from the earliest

available cost report starting in FY 1992

and later by subtracting inpatient capital

costs from inpatient costs (for all

payers). We did not subtract the direct

medical education costs as those costs

are not available on every update of the

HCRIS minimum data set. If the hospital

met the project size requirement, we

assumed that it also met the project

need requirements at § 412.348(g)(2) and

the excess capacity test for urban

hospitals at § 412.348(g)(4).

Because we estimate that so few

hospitals will qualify for special

exceptions, projecting costs, payments,

and margins would result in high

statistical variance. Consequently, we

decided to model the effects of special

exceptions using historical data based

on hospitals’ actual cost experiences. If

we determined that a hospital may

qualify for special exceptions, we

modeled special exceptions payments

from the project start date through the

last available cost report (FY 1999). For

purposes of modeling we used the cost

and payment data on the cost reports

from HCRIS assuming that special

exceptions would begin at the start of

the qualifying project. In other words,

when modeling costs and payment data,

we ignored any regular exception

payments that these hospitals may

otherwise have received as if there had

not been regular exceptions during the

transition period. In projecting an

eligible hospital’s special exception

payments, we applied the 70-percent

minimum payment level, the

cumulative comparison of current year

capital prospective payment system

payments and costs, and the cumulative

operating margin offset (excluding 75

percent of operating DSH payments).

Because hospitals may receive regular

exception payments up through the end

of their last cost reporting period

beginning before October 1, 2001,

hospitals with cost reporting periods

beginning on a day other than October

1 will continue to receive regular

exception payments until the end of

their FY 2002 cost reporting period.

Therefore, these hospitals will only

receive special exception payments for

the remainder of Federal FY year 2002.

Consequently, the special exceptions

payments made in FY 2002 will be less

than for subsequent years since they are

only being paid a special exception

payment for a portion of FY 2002.

Our modeling of special exception

payments produced the following

results:

Cost report

Number of

hospitals eligible for special

exceptions

Special exceptions as a fraction of capital

payments to

all hospitals

Special exceptions as a fraction of capital

payments to

all hospitals

weighted by

portion of FY

2002 for which

special exceptions are paid

PPS IX ......................................................................................................................................... ........................ ........................ ........................

PPS X .......................................................................................................................................... ........................ ........................ ........................

PPS XI ......................................................................................................................................... 3 ........................ ........................

PPS XII ........................................................................................................................................ 6 0.0002 0.0001

PPS XIII ....................................................................................................................................... 8 0.0001 0.0000

PPS XIV ....................................................................................................................................... 14 0.0002 0.0001

PPS XV ........................................................................................................................................ 18 0.0016 0.0002

PPS XVI ....................................................................................................................................... 22 0.0011 0.0008

Currently, the PPS XVI cost reports in

HCRIS are incomplete because there is

a 2-year lag time between the end of a

hospital’s cost reporting period and the

submission and processing of the cost

reports for HCRIS. In particular,

hospitals whose cost reporting periods

begin July 1 are missing. We expect

more hospitals to qualify for special

exceptions once data from later HCRIS

updates are available. In addition,

hospitals still have two more cost

reporting periods (PPS XVII and PPS

XVIII) to complete their projects in

order to be eligible for special

exceptions. We estimate that about 30

additional hospitals could qualify for

special exceptions. Thus, we project

22706 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

that special exception payments as a

fraction of capital payments to all

hospitals could be approximately

0.0025. However, after weighting this

amount to account for the FY 2002

phase-in of special exception payments,

we project that this factor would be

approximately 0.0012. Because special

exceptions are budget neutral, we

propose to offset the Federal capital rate

by 0.12 percent for special exceptions

for FY 2002. Therefore, the proposed

exceptions adjustment factor would

equal 0.9988 (1 minus 0.0012) to

account for special exception payments

in FY 2002. We will revise this

projection of the special exception

adjustment factor in the final rule based

on the latest available data.

VI. Proposed Changes for Hospitals and

Hospital Units Excluded From the

Prospective Payment System

A. Limits on and Adjustments to the

Target Amounts for Excluded Hospitals

and Units (§§ 413.40(b)(4) and (g))

1. Updated Caps for Existing Hospitals

and Units

Section 1886(b)(3) of the Act (as

amended by section 4414 of Public Law

105–33) established caps on the target

amounts for certain existing hospitals

and units excluded from the prospective

payment system for cost reporting

periods beginning on or after October 1,

1997 through September 30, 2002. The

caps on the target amounts apply to the

following three classes of excluded

hospitals: psychiatric hospitals and

units, rehabilitation hospitals and units,

and long-term care hospitals.

In addition, section 4416 of Public

Law 105–33 limited payments for

psychiatric hospitals and units,

rehabilitation hospitals and units, and

long-term care hospitals that first

received payments on or after October 1,

1997. Payment for these hospitals and

units is limited to the lesser of the

hospital’s operating costs per case or

110 percent of the national median of

target amounts for the same class of

hospitals for cost reporting periods

ending during FY 1996, updated and

adjusted for differences in area wage

levels.

A discussion of how the caps on the

target amounts and the payment

limitation were calculated can be found

in the August 29, 1997 final rule with

comment period (62 FR 46018); the May

12, 1998 final rule (63 FR 26344); the

July 31, 1998 final rule (63 FR 41000),

and the July 30, 1999 final rule (64 FR

41529). For purposes of calculating the

caps for existing facilities, the statute

required the Secretary to estimate the

national 75th percentile of the target

amounts for each class of hospital

(psychiatric, rehabilitation, or long-term

care) for cost reporting periods ending

during FY 1996 without adjusting for

differences in area wage levels. Under

section 1886(b)(3)(H)(iii) of the Act, the

resulting amounts are updated by the

market basket percentage to the

applicable fiscal year.

Section 121 of Public Law 106–113

amended section 1886(b)(3)(H) of the

Act to also provide for an appropriate

wage adjustment to the caps on the

target amounts for existing psychiatric

hospitals and units, rehabilitation

hospitals and units, and long-term care

hospitals, effective for cost reporting

periods beginning on or after October 1,

1999, through September 30, 2002. On

August 1, 2000, we published an

interim final rule with comment period

that implemented this provision for cost

reporting periods beginning on or after

October 1, 1999 and before October 1,

2000 (65 FR 47026) and a final rule that

implemented this provision for cost

reporting periods beginning on or after

October 1, 2000 (65 FR 47054). This

proposed rule addresses the wage

adjustment to the caps and payment

limitations for cost reporting periods

beginning on or after October 1, 2001.

For purposes of calculating the caps,

section 1886(b)(3)(H)(ii) of the Act

requires the Secretary to first ‘‘estimate

the 75th percentile of the target amounts

for such hospitals within such class for

cost reporting periods ending during

fiscal year 1996.’’ Furthermore, section

1886(b)(3)(H)(iii), as added by Public

Law 106–113, requires the Secretary to

also provide for existing hospitals ‘‘an

appropriate adjustment to the laborrelated portion of the amount

determined under such subparagraph to

take into account the differences

between average wage-related costs in

the area of the hospital and the national

average of such costs within the same

class of hospital.’’

Consistent with the broad authority

conferred on the Secretary by section

1886(b)(3)(H)(iii) of the Act to determine

the appropriate wage adjustment, we

account for differences in wage-related

costs by adjusting the caps to account

for the following:

First, we adjust each hospital’s target

amount to account for area differences

in wage-related costs. For each class of

hospitals (psychiatric, rehabilitation,

and long-term care), we determine the

labor-related portion of each hospital’s

FY 1996 target amount by multiplying

its target amount by the actuarial

estimate of the labor-related portion of

costs (or 0.71553). Similarly, we

determine the nonlabor-related portion

of each hospital’s FY 1996 target

amount by multiplying its target amount

by the actuarial estimate of the

nonlabor-related portion of costs (or

0.28447).

Next, we account for wage differences

among hospitals within each class by

dividing the labor-related portion of

each hospital’s target amount by the

hospital’s wage index under the hospital

inpatient prospective payment system.

Within each class, each hospital’s wageneutralized target amount was

calculated by adding the wageneutralized labor-related portion of its

target amount and the nonlabor-related

portion of its target amount. Then, the

wage-neutralized target amounts for

hospitals within each class were arrayed

in order to determine the national 75th

percentile caps on the target amounts

for each class.

Taking into account the national 75th

percentile of the target amounts for cost

reporting periods ending during FY

1996 (wage-neutralized using the FY

2000 acute care wage index), the wage

adjustment provided for under Public

Law 106–113, and the applicable update

factor based on the market basket

percentage increase for FY 2001, in the

August 1, 2000 final rule (65 FR 47096),

we established the FY 2001 caps on the

target amounts as follows:

Class of excluded hospital

or unit

FY 2001

labor-related

share

FY 2001

nonlabor-related share

Psychiatric ........ $8,131 $3,233

Rehabilitation .... 15,164 6,029

Long Term Care 29,284 11,642

In reviewing our methodology for

wage neutralizing the hospital specific

target amounts, it appears that we

incorrectly used the FY 2000 hospital

inpatient prospective payment system

wage index published in Tables 4A and

4B of the July 30, 1999 final rule (64 FR

41585 through 41593), which is based

on wage data after taking into account

geographic reclassification under

section 1886(d)(8) of the Act. We are

proposing to revise the methodology of

wage neutralizing the hospital-specific

target amounts using pre-reclassified

wage data. We propose to recalculate

the limit for new excluded hospitals and

units, as well as calculate the cap for

existing excluded hospitals and units,

using the pre-reclassification wage

index. The pre-reclassification wage

index is the same wage index used

under the prospective payment system

for skilled nursing facilities (SNFs) and

was included in Table 7 of the July 30,

1999 SNF final rule (64 FR 41690). (We

note that both SNFs and ambulatory

surgical centers use the prospective

payment system inpatient wage index

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22707

without regard to the prospective

payment system reclassification as a

proxy for variations in local costs.)

As we stated in the August 1, 2000

final rule, long-term care hospitals,

rehabilitation hospitals and units, and

psychiatric hospitals and units that are

exempt from the prospective payment

system are not subject to the prospective

payment system hospital reclassification

system under section 1886(d)(10)(A) of

the Act. This section establishes the

MGCRB for the purpose of evaluating

applications from short-term, acute care

providers. There is no equivalent

statutory mandate for HCFA to develop

an alternative board for long-term care

hospitals, psychiatric hospitals and

units, and rehabilitation hospitals and

units. In addition, while it would be

feasible to allow units physically

located in prospective payment system

hospitals that have been reclassified by

the MGCRB to use the wage index for

the area to which that hospital has been

reclassified, at the present time there is

no process in place to make

reclassification determinations for

freestanding excluded providers. There

are approximately 1,000 freestanding

excluded providers. Therefore, in the

interest of equity, we believe that, in

determining a hospital’s wage-adjusted

cap on its target amount, it is

appropriate for excluded hospitals and

units to use the wage index associated

with the area in which they are

physically located (MSA or rural area)

and the prospective payment system

reclassification under section

1886(d)(10) of the Act is not applicable.

This policy is also consistent with the

policy for SNFs and ambulatory surgical

centers that use the acute care, inpatient

hospital prospective payment system

wage index and that does not allow for

reclassifications since there is no

analogous determinations process to the

MGCRB. The MGCRB only has authority

over the prospective payment system for

acute care hospitals.

Therefore, based on the broad

authority conferred on the Secretary by

section 1886(b)(3)(H)(iii) of the Act to

determine the appropriate wage

adjustment to the caps, we have

determined the labor-related and

nonlabor-related portions of the

proposed caps on the target amounts for

FY 2002 using the methodology

outlined above.

Class of excluded hospital

or unit

FY 2002

proposed

labor-related

share

FY 2002

proposed

nonlabor-related share

Psychiatric ........ $8,404 $3,341

Rehabilitation .... 15,689 6,237

Class of excluded hospital

or unit

FY 2002

proposed

labor-related

share

FY 2002

proposed

nonlabor-related share

Long-Term Care 31,399 12,483

These labor-related and nonlaborrelated portions of the proposed caps on

the target amounts for FY 2002 are

based on the current estimate of the

market basket increase for excluded

hospitals and units for FY 2002 of 3.0

percent and reflect the change in

applying the pre-reclassified hospital

inpatient prospective payment system

wage index as discussed above.

Furthermore, in accordance with section

307(a) of Public Law 106–554, which

amended section 1886(b)(3) of the Act,

the labor-related and nonlabor-related

portions of the proposed cap for longterm care hospitals for FY 2002 are

increased by 2 percent. We are

providing a further discussion of this

provision in an interim final rule with

comment period that will implement

provisions of Public Law 106–554 for

FY 2001 and for periods in FY 2001

from April 1, 2001 through September

30, 2001 (HCFA–1178–IFC).

Finally, to determine payments

described in § 413.40(c), the cap on the

hospital’s target amount per discharge is

determined by adding the hospital’s

nonlabor-related portion of the national

75th percentile cap to its wage-adjusted,

labor-related portion of the national

75th percentile cap. A hospital’s wageadjusted, labor-related portion of the

target amount is calculated by

multiplying the labor-related portion of

the national 75th percentile cap for the

hospital’s class by the hospital’s

applicable wage index. For FY 2002, a

hospital’s applicable wage index is the

pre-reclassified wage index under the

hospital inpatient prospective payment

system (see § 412.63). The proposed

wage index values are computed based

on the same data used to compute the

proposed FY 2002 wage index values for

the hospital inpatient prospective

payment system without taking into

account changes in geographic

reclassification under section

1886(d)(8)(B) of the Act for certain rural

hospitals or reclassifications based on

MGCRB decisions or the Secretary’s

decisions under sections 1886(d)(8)

through (d)(10) of the Act. For cost

reporting periods beginning on or after

October 1, 2001 and before October 1,

2002, the pre-reclassified wage index is

in Tables 4G and 4H of this proposed

rule. A hospital’s applicable wage index

corresponds to the area in which the

hospital or unit is physically located

(MSA or rural area).

2. New Excluded Hospitals and Units

a. Updated Caps (§ 413.40(f))

Section 1886(b)(7) of the Act

establishes a payment methodology for

new psychiatric hospitals and units,

new rehabilitation hospitals and units,

and new long-term care hospitals.

Under the statutory methodology, for a

hospital that is within a class of

hospitals specified in the statute and

first receives payments as a hospital or

unit excluded from the prospective

payment system on or after October 1,

1997, the amount of payment will be

determined as follows: For the first two

12-month cost reporting periods, the

amount of payment is the lesser of (1)

the operating costs per case; or (2) 110

percent of the national median of target

amounts for the same class of hospitals

for cost reporting periods ending during

FY 1996, updated to the first cost

reporting period in which the hospital

receives payments as adjusted for

differences in area wage levels.

As discussed earlier, in reviewing our

methodology for wage neutralizing the

hospital-specific target amounts, it

appears we incorrectly used the FY

2000 hospital inpatient prospective

payment system wage index published

in Tables 4A and 4B of the July 30, 1999

final rule, which is based on wage data

after taking into account geographic

reclassifications under section

1886(d)(8) of the Act. Therefore, we also

are proposing to revise the methodology

of wage neutralizing the hospitalspecific target amounts using prereclassified wage data in our calculation

of the limit for new excluded hospitals

and units.

The proposed amounts included in

the following table reflect the updated

and recalculated 110 percent of the

wage neutralized national median target

amounts for each class of excluded

hospitals and units for cost reporting

periods beginning during FY 2002.

These figures are updated to reflect the

projected market basket increase of 3.0

percent. For a new provider, the laborrelated share of the target amount is

multiplied by the appropriate

geographic area wage index, without

regard to prospective payment system

reclassifications, and added to the

nonlabor-related share in order to

determine the per case limit on payment

under the statutory payment

methodology for new providers.

Class of excluded hospital

or unit

FY 2002

proposed

labor-related

share

FY 2002

proposed

nonlabor-related share

Psychiatric ........ $6,795 $2,701

Rehabilitation .... 13,425 5,337

22708 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

Class of excluded hospital

or unit

FY 2002

proposed

labor-related

share

FY 2002

proposed

nonlabor-related share

Long-Term Care 16,651 6,620

b. Changes in Type of Hospital

Classification (§§ 412.23 and 412.25)

Section 1886(b)(3) of the Act (as

amended by section 4414 of Public Law

105–33) establishes caps on the target

amounts for existing psychiatric

hospitals and units, rehabilitation

hospitals and units, and long-term care

hospitals for cost reporting periods

beginning on or after October 1, 1997

through September 30, 2002. Section

4416 of Public Law 105–33 amended

section 1886(b)(7) of the Act to provide

for a limitation on payment for new

excluded psychiatric hospitals and

units, new rehabilitation hospitals and

units, and new long-term care hospitals.

Since the establishment of the caps on

target amounts and the payment

limitations, there has been an increase

in the number of hospitals requesting a

change from one classification type to

another (for example, from

rehabilitation to long-term care).

Regulations at § 412.22(d) state that ‘‘For

purposes of exclusion from the

prospective payment systems under this

subpart, the status of each currently

participating hospital (excluded or not

excluded) is determined at the

beginning of each cost reporting period

and is effective for the entire cost

reporting period. Any changes in the

status of the hospital are made only at

the start of a cost reporting period.’’

Even though the existing regulations

directly address only a hospital that

changes from a prospective payment

system hospital to an excluded hospital,

our longstanding policy has been that a

change of any classification type can be

effective only at the beginning of the

provider’s cost reporting period.

Although the existing regulations do not

directly address changes in a

classification type of excluded hospital,

we believe that a change from one

classification type of excluded hospital

to another type of excluded hospital is

analogous to a change from a

prospective payment system hospital to

an excluded hospital. Therefore, we

believe it would be consistent with our

longstanding policy to amend our

regulations to specify that a change from

one excluded hospital classification

type to another type is allowed only at

the beginning of the hospital’s cost

reporting period.

The rationale underlying our present

policy of requiring that these types of

changes should only be effective at the

beginning of the cost reporting period is

the need to avoid any undue (and

possibly significant) administrative

burden that could result from doing

otherwise (for example, cost allocation,

cost reporting requirements,

certification issues). If we were to accept

changes in an excluded hospital’s

classification type from one type of

classification to another, other than at

the beginning of the cost reporting

period, the hospital would need to file

a terminating cost report with respect to

its original classification as well as file

a separate cost report for the remainder

of the cost reporting period with respect

to its new classification. Filing these

cost reports would involve gathering the

appropriate cost data, allocating the

data, and apportioning the data between

the two hospital classes. Additionally,

we would have to validate the cost

reports. To allow these types of changes

in the middle of a cost reporting period

would result in a significant

administrative burden. We would point

out that this burden is applicable

equally for either a change from a

prospective payment system hospital to

an excluded hospital, or a change from

one excluded hospital classification

type to another classification type.

Therefore, we are proposing to amend

the regulations to provide that the

effective date of any of these

classification changes is only at the

beginning of a provider’s cost reporting

period (proposed § 412.23(i), for

excluded hospitals, and proposed

§ 412.25(f), for excluded units).

3. Effective Date of Exclusion of LongTerm Care Hospitals

Existing regulations at § 412.23(e)

require a newly established long-term

care hospital to operate for at least 6

months with an average length of stay

in excess of 25 days in order to qualify

for exclusion from the inpatient hospital

prospective payment system as a longterm care hospital. Other regulations at

§ 412.22(d) allow changes in a hospital’s

status from not excluded to excluded to

occur only at the start of a cost reporting

period. These two regulations, taken

together, typically require a hospital to

operate for at least 6 months under the

prospective payment system before

becoming eligible for payment at the

more favorable rate under section

1886(b)(3) of the Act.

These regulations were challenged in

litigation by a chain organization that

operates a large number of long-term

care hospitals (Transitional Hospital

Corporation of Louisiana, Inc. v.

Shalala, 222 F.3d 1019 (D.C. Cir. 2000)

(THC)). Although the court of appeals in

this case found that the Secretary has

ample authority to adopt current

regulatory provisions, it also concluded

that the Secretary has not adequately

considered other policy options.

Consequently, it remanded the case to

the agency for the agency to consider

whether it wanted to continue its

existing policy or adopt a policy of

either ‘‘self-certification’’ or ‘‘retroactive

adjustment.’’ Generally, under a selfcertification approach, hospitals that

have not yet demonstrated the required

average length of stay would be

excluded from the prospective payment

system based on a commitment to

maintain such a length of stay. Under a

retroactive adjustment approach, a

hospital’s long-term care classification

would be made effective with the

beginning of the 6-month period in

which it demonstrated the required

average length of stay. Payments for that

period initially would be made under

the prospective payment system and

then adjusted retroactively to amounts

payable for an excluded long-term care

hospital once length of stay was

successfully established.

As directed by the court of appeals,

we are reviewing the issues raised in

this case in light of the court’s decision,

and are specifically considering the

options of self-certification and

retroactive adjustment. Our current

proposals and the alternatives we

considered before arriving at them are

set forth below. To assist us in

completing the review process, we are

requesting public comment on our

proposals, taking into account the

following considerations.

a. Demonstrating Required Average

Length of Stay

Although we understand that we have

discretion to select other policy options,

we are proposing to continue our policy

of requiring hospitals seeking long-term

care hospital classification to

demonstrate the required average length

of stay based on 6 months of data,

instead of permitting these hospitals to

‘‘self-certify’’ the required average

length of stay.

We note that the statute provides the

agency with broad authority to

determine the methodology by which

facilities can qualify for exclusion as

long-term care hospitals (section

1886(d)(1)(B)(iv)(I) of the Act specifies

that ‘‘a hospital which has an average

inpatient length of stay (as determined

by the Secretary) of greater than 25

days’’ qualifies for exclusion as a longterm care hospital). As the court of

appeals decided, the parenthetical

phrase as determined by the Secretary

‘‘gives the Secretary considerable

leeway to determine whether to require

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22709

prospective, contemporaneous, or

retrospective evaluation and payment.’’

(THC at 1026.)

Although we have considered the selfcertification option, we do not believe

that it is appropriate to permit long-term

care hospitals to self-certify. Long-term

care hospitals ‘‘are licensed as acute

care hospitals in the States in which

they operate [and] their only

distinguishing characteristic is their

long average length of stay’’ (ProPAC

March 1, 1997 Report and

Recommendations to the Congress,

Recommendation 30). For this reason,

and because average length of stay can

be difficult, if not impossible, to forecast

when a new hospital first opens its

doors for service, it would not be

appropriate to allow new hospitals to

self-certify that they will have an

average length of stay exceeding 25

days.

Requiring newly participating

hospitals to collect at least 6 months of

length of stay data before permitting

them to qualify as long-term care

hospitals is consistent with treatment of

other types of excluded hospitals in the

regulations. Like long-term care

hospitals, children’s hospitals, which by

statute are also excluded from the

prospective payment system, also have

just one distinguishing characteristic

from acute care hospitals; namely,

having inpatients who are

predominantly individuals under 18

years of age (section 1886(d)(1)(B)(iii) of

the Act). As with long-term care

hospitals, we do not permit children’s

hospitals to self-certify that they will

meet this requirement as to a future cost

reporting period (§ 412.23(d)).

Although we permit rehabilitation

hospitals to self-certify that they meet

certain elements of the definition for

such a hospital, important differences

between rehabilitation hospitals and

long-term care hospitals render such a

scheme inappropriate for the latter. The

differences in the two types of excluded

hospitals begin with the statute, which

excludes from the prospective payment

system ‘‘a rehabilitation hospital (as

defined by the Secretary)’’ and ‘‘a

hospital which has an average inpatient

length of stay (as defined by the

Secretary) of greater than 25 days’’; that

is, a long-term care hospital (sections

1886(d)(1)(B)(ii) and 1886(d)(1)(B)(iv)(I)

of the Act). Thus, Congress delegated

broad authority to the Secretary to

define rehabilitation hospitals, but

provided the definition of long-term

care hospitals in the statute itself (and

then, as discussed above, gave the

agency broad authority to determine

how to apply that definition).

In exercising our authority to define a

rehabilitation hospital, we promulgated

regulations that contain several defining

features that a facility must possess to

be considered such a hospital, as

opposed to the one statutorily mandated

feature (average length of stay) that

defines long-term care hospitals

(§ 412.23(b)). The requirements that a

rehabilitation hospital must meet

include a showing that 75 percent of its

patients are of a certain type, the

existence of a preadmission screening

process, assurance that patients will

receive close medical supervision and

that the hospital will furnish certain

types of therapy through the use of

qualified personnel, the presence of a

director of rehabilitation with certain

qualifications, evidence of a plan of

treatment for each inpatient that is

established and monitored by a

physician, and the use of a coordinated

interdisciplinary team approach in the

rehabilitation of each patient

(§ 412.23(b)(1) through (b)(7)). With the

exception of the ‘‘75 percent rule,’’ all

of these requirements are

‘‘characteristics of the patients and

types of services that the facility

furnishes’’ that ‘‘can be assessed at a

given point in time’’ (ProPAC March 1,

1997 Report and Recommendations to

the Congress, Recommendation 30).

Thus, rehabilitation hospitals are

defined primarily by static and

observable features, most of which can

be accurately assessed when a new

rehabilitation hospital is first certified

under the Medicare program. As a

result, the regulations permit a new

rehabilitation hospital to provide

written certification that it will meet the

75 percent rule, provided we find that

it also meets the six other elements of

the definition of a rehabilitation facility

(§ 412.23(b)(8)). The hospital’s

demonstrated ability to meet the six

remaining requirements provides an

adequate level of assurance that the

hospital will also meet the 75-percent

requirement if it so certifies. No such

assurance is available, however,

regarding whether a hospital might,

during a future period, meet the sole

requirement for qualification as a longterm care hospital—the average length

of stay of its patients.

b. Effective Date of Exclusion From the

Prospective Payment System

Because we propose to continue our

policy of not allowing a hospital to selfcertify the required average length of

stay in order to be paid as an excluded

long-term care hospital, it is necessary

to consider the effective date of

excluded status for a hospital that has

demonstrated the required average

length of stay. We considered making

long-term care classification effective

retroactively with the beginning of the

6-month period in which the hospital

demonstrated the required average

length of stay. Doing so would mean, for

example, that a hospital that admitted

its first patient on January 1, 2001, and

demonstrated that its average length of

stay exceeded 25 days for the period

January 1 through June 30, and that was

approved for long-term care

classification on July 15, would be paid

for its discharges from January 1, 2001

forward as an excluded long-term care

hospital rather than under the

prospective payment system, as long as

it continued to demonstrate the

requisite average length of stay.

However, we believe that such

retroactive application of excluded

status is inappropriate.

For the reasons below, we are

proposing to continue our policy that a

hospital’s payment as a long-term care

hospital would be effective with the

beginning of the hospital’s cost

reporting period that follows the

determination to classify the hospital as

a long-term care hospital. From the first

rulemaking implementing the inpatient

acute hospital prospective payment

system payment methodology, the

agency has generally applied decisions

regarding various elements of the

prospective payment system payment

methodology prospectively only, and

the courts have upheld that action.

(THC at 1022 (‘‘status’’ decisions

regarding whether a hospital is subject

to or excluded from the prospective

payment system); County of Los Angeles

v. Shalala 192 F.3d 1005 (D.C. Cir.

1999) (decisions regarding criteria for

receipt of ‘‘outlier’’ payments);

Methodist Hospital of Sacramento v.

Shalala, 38 F.3d 1225 (D.C. Cir. 1994)

(decisions to revise ‘‘wage index’’

component of the prospective payment

system payment rate); Hennepin County

v. Sullivan, 883 F.2d 85, 91 (D.C. Cir.

1989) (‘‘there is nothing inherently

arbitrary or capricious about an agency’s

decision to apply new data

prospectively only’’); 57 FR 39746 and

39798 (1992).)

For the same reasons that existed in

the cases cited above, we believe that

prospective implementation of the

statutory exclusion for long-term care

hospitals is fully consistent with

Congress’ goals in enacting the

prospective payment system. It allows

both the hospital and us to know with

certainty at the beginning of each cost

reporting period of the hospital whether

the hospital is subject to or excluded

from the prospective payment system

for that cost reporting period and thus

22710 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

promotes certainty and predictability of

payment for both providers and the

agency. County of Los Angeles at 1019;

Methodist Hospital of Sacramento at

1232 (‘‘because the Secretary’s

prospectivity policy permits hospitals to

rely with certainty on one additional

element in the PPS calculation rate

* * * the Secretary could reasonably

conclude that it will promote efficient

and realistic cost saving targets’’).

Moreover, retroactive application of a

prospective payment system excluded

status decision would entail a

significant administrative burden as it

would require reprocessing of large

numbers of a hospital’s claims for

hospital inpatient services. See 49 FR

234 and 271 (1984) (making retroactive

changes in decisions regarding

providers’ status as ‘‘sole community

hospitals’’ would require us ‘‘to

reprocess every inpatient hospital claim

submitted for the hospital and make

adjustment payments at the new rate). It

is reasonable to conclude that such a

burden outweighs any ‘‘increase in

accuracy that would result’’ from

retroactive application of decisions

regarding long-term care hospital

exclusions (Methodist Hospital of

Sacramento at 1233).

Finally, we apply our prospectiveonly policy evenhandedly, regardless of

whether it results in a hospital’s being

subject to, or excluded from, the

prospective payment system. Thus,

retroactive adjustments in hospitals’

status are as likely to hurt providers that

slip below the required average length

of stay during a cost reporting period as

they are to help them by furnishing

reimbursement for a past period in

which they met that requirement

(Methodist Hospital of Sacramento at

1232, 1233). Any adverse effect of the

prospective only policy that might be

perceived by new long-term care

facilities is also lessened by the

availability of a short initial cost

reporting period and outlier payments

for extraordinarily lengthy cases during

the initial period when the hospital is

subject to the prospective payment

system.

In addition to believing that it is

appropriate to make payment as a longterm care hospital effective

prospectively rather than retroactively,

we believe it is also appropriate to

continue our policy of making payment

effective with the beginning of the

hospital’s next cost reporting period

rather than as of the date of approval of

long-term care status. This policy is

consistent with how we treat changes in

status (that is, from excluded to

nonexcluded or from nonexcluded to

excluded) for all types of hospitals. As

we explain in more detail in section

VI.A.2.b of this proposed rule, the

rationale for requiring changes in a

hospital’s status, or changes in a

hospital’s classification (that is, from

one type of excluded hospital to

another), only at the start of the

hospital’s cost reporting period is to

alleviate the administrative burden and

potential confusion that would result

from doing otherwise.

As noted earlier, we request public

comments on the proposals described

above.

4. Development of Prospective Payment

System for Inpatient Rehabilitation

Hospitals and Units

Section 1886(j) of the Act, as added by

section 4421 of Public Law 105–33,

provided the phase-in of a case-mix

adjusted prospective payment system

for inpatient rehabilitation services

(freestanding hospitals and units) for

cost reporting periods beginning on or

after October 1, 2000 and before October

1, 2002, with a fully implemented

system for cost reporting periods

beginning on or after October 1, 2002.

Section 1886(j) of the Act was amended

by section 125 of Public Law 106–113

to require the Secretary to use the

discharge as the payment unit under the

prospective payment system for

inpatient rehabilitation services and to

establish classes of patient discharges by

functional-related groups. Section 305

of Public Law 106–554 further amended

section 1886(j) of the Act to allow

hospitals to elect to be paid the full

Federal prospective payment rather than

the transitional period payments

specified in the Act.

On November 3, 2000, we issued a

notice of proposed rulemaking in the

Federal Register (65 FR 66303) on the

proposed establishment of the

prospective payment system for

inpatient rehabilitation facilities, to be

effective on April 1, 2001. Due to the

scope and complexity of the proposed

system and requests from the public for

more time to comment on the proposed

rule, we extended the public comment

period for an additional 30 days, from

January 3, 2001 to February 1, 2001. As

a result of the extension of the comment

period, it would have been technically

impossible to publish a final rule 60

days prior to implementing the

prospective payment system for

rehabilitation facilities by April l. We

anticipate publication of a final rule in

May 2001 and intend to announce our

plans for implementation at that time.

B. Critical Access Hospitals (CAHs)

1. Exclusion of CAHs From Payment

Window Requirements

Section 1886 of the Act specifies the

requirements governing payment to fullservice hospitals for the operating costs

of inpatient hospital services under both

the inpatient hospital prospective

payment system and the limits on the

target amounts for hospitals excluded

from the prospective payment system.

‘‘Operating costs of inpatient hospital

services’’ are defined in section

1886(a)(3) of the Act, which provides in

part that costs of certain services

provided to a beneficiary during the 3

days (or in the case of an excluded

hospital or unit, during the 1 day)

immediately preceding the patient’s

admission are to be included in the

payments for costs under the inpatient

hospital prospective payment system, or

the target amount for excluded hospitals

and units. This part of the definition is

sometimes referred to as the ‘‘payment

window’’ requirement. Regulations

implementing the payment window

requirement are found at § 412.2(c)(5)

for hospitals subject to the prospective

payment system, and § 413.40(c)(2) for

hospitals excluded from the prospective

payment system.

Payment to CAHs for inpatient

services is not made under section 1886

of the Act, nor are CAHs considered to

be hospitals excluded from the inpatient

hospital Prospective Payment System.

Instead, payment is made on a

reasonable cost basis, as mandated by

section 1814(l) of the Act. Neither

section 1814(l) nor section 1861(v) of

the Act (which defines ‘‘reasonable

cost’’) requires application of the

payment window to services furnished

on an outpatient basis immediately

before admission to a CAH. Therefore,

we have determined that the payment

window provision does not apply to

CAHs. To clarify this point and avoid

possible misapplication of the payment

window, we are proposing to amend

§ 413.70(a)(l) to provide that the

requirements of §§ 412.2(c)(5) and

413.40(c)(2) do not apply to CAHs.

2. Availability of CRNA Pass-Through

for CAHs

Generally, anesthesia services

furnished to a hospital patient by a

certified registered nurse anesthetist

(CRNA) must be billed to the Part B

carrier and payment is made under the

applicable fee schedule provisions of

§ 414.60. However, certain rural

hospitals that furnish no more than 500

surgical procedures requiring anesthesia

per year and meet other specified

requirements are exempted from the fee

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22711

schedule. These hospitals are paid on a

reasonable cost basis for their costs of

anesthesia services furnished by

qualified nonphysician anesthetists. The

exemption is provided in accordance

with section 9320(k) of the Omnibus

Budget Reconciliation Act of 1986

(Public Law 99–509) (as added by

section 608(c)(2) of the Family Support

Act of 1988 (Public Law 100–185), as

amended by section 6132 of the

Omnibus Budget Reconciliation Act of

1989 (Public Law 101–239)). HCFA has

codified this exemption at § 412.113(c).

Although § 412.113(c) does not

specifically extend eligibility for the

pass-through payment for CRNAs to

CAHs, some CAHs have pointed out that

they are similar to the rural hospitals

that are eligible for this payment, in that

they also furnish low volumes of

surgical procedures requiring anesthesia

and could face the same problem of

potentially inadequate payment for

CRNA services if they are not allowed

to qualify for the pass-through payment.

We share this concern.

We recognize that the legislation cited

above, which provides the legal basis for

the pass-through payments, refers only

to ‘‘hospitals,’’ not to CAHs. Moreover,

section 1861(e) of the Act states that

‘‘the term ‘‘hospital’’ does not include,

unless the context otherwise requires, a

critical access hospital * * *.’’ It is

clear from section 1861(e) of the Act

that CAHs are not to be considered

hospitals under the Medicare law for

most purposes. However, the reference

to ‘‘context’’ in the provision indicates

that CAHs may be classified as hospitals

where, in specific contexts, it would be

consistent with the purpose of the

legislation to do so.

We believe this is the case with the

statutory provisions authorizing passthrough payments for CRNA costs. The

purpose of the pass-through legislation

is to provide small rural hospitals with

low surgical volumes with relief from

the difficulties they might otherwise

have in furnishing CRNA services for

their patients. CAHs are by definition

limited’service facilities located in rural

areas and, as such, they serve a

population much like those served by

hospitals eligible for the pass-through

payments. In some cases, an institution

that now participates as a CAH may

even have been eligible for the passthrough payments when it participated

as a hospital. Such an institution would

clearly be disadvantaged if it were to

lose this status. Thus, in accordance

with section 1861(e) of the Act and in

light of the context of the pass-through

legislation cited above, we consider

CAHs to be ‘‘hospitals’’ for purposes of

extending eligibility for the CRNA passthrough payments to them.

Therefore, we are proposing to add a

new § 413.70(a)(3) and revise

§§ 413.70(a)(2), (b)(1), and (b)(6) to

permit CAHs that meet the criteria for

the pass-through payments in

§ 412.113(c) to qualify for pass-through

payments for the costs of anesthesia

services for both inpatient and

outpatient surgeries, on the same basis

as full service rural hospitals. As an

unrelated technical correction, we are

proposing to revise § 413.70(b)(2)(i)(C)

to delete the incorrect reference to

§ 413.130(j)(2) and replace it with a

reference to reduction in capital costs

under § 413.130(j). We also are

proposing to revise § 412.113(c) by

changing the term ‘‘hospital’’ to

‘‘hospital or CAH’’.

3. Payment to CAHs for Emergency

Room On-Call Physicians (Proposed

§ 413.70(b)(4))

Under section 1834(g) of the Act,

Medicare payment to a CAH for facility

services to Medicare outpatients is the

reasonable costs of the CAH in

providing such services. The term

‘‘reasonable cost’’ is defined in section

1861(v) of the Act and in regulations at

42 CFR Part 413, including, with

specific reference to CAHs, § 413.70.

Consistent with the general policies

stated in section 2109 of the Medicare

Provider Reimbursement Manual (PRM),

Part I (HCFA Publication 15–1), the

reasonable cost of CAH services to

outpatients may include reasonable

costs of compensating physicians who

are on standby status in the emergency

room (that is, physicians who are

present and ready to treat patients if

necessary). However, under existing

policy, the reasonable cost of CAH

services to outpatients may not include

any costs of compensating physicians

who are not present in the facility but

are on call.

Section 204 of Public Law 106–554

further amended section 1834(g) of the

Act (as amended by section 201 of

Public Law 106–554) by adding a new

paragraph (5). New section 1834(g)(5) of

the Act provides that, in determining

the reasonable costs of outpatient CAH

services under sections 1834(g)(1) and

1834(g)(2)(A) of the Act, the Secretary

shall recognize as allowable costs

amounts (as defined by the Secretary)

for reasonable compensation and related

costs for emergency room physicians

who are on call (as defined by the

Secretary) but who are not present on

the premises of the CAH involved, are

not otherwise furnishing physicians’

services, and are not on call at any other

provider or facility. The provisions of

section 204 of Public Law 106–554 are

effective for cost reporting periods

beginning on or after October 1, 2001.

To implement the provisions of

section 1834(g)(5) of the Act, we are

proposing to add a new paragraph (4) to

§ 413.70(b). The proposed § 413.70(b)(4)

would permit the reasonable costs of

CAH outpatient services to include the

reasonable compensation and related

costs of emergency room on-call

physicians under the terms and

conditions specified in the statute. As

directed in the statute, under

§ 413.70(b)(4)(ii)(A) of this proposed

rule, we are defining ‘‘amounts for

reasonable compensation and related

costs’’ as those allowable costs of

compensating emergency room

physicians for being on call, to the

extent these costs are found to be

reasonable under the rules in

§ 413.70(b)(2).

In addition, as specified under

§ 413.70(b)(4)(ii)(A) of this proposed

rule, we are defining an ‘‘emergency

room physician who is on call’’ as a

doctor of medicine or osteopathy with

training or experience in emergency

care who is immediately available by

telephone or radio contact, and who is

available on site within the timeframes

specified in our existing regulations

under § 485.618(d). Existing

§ 485.618(d) specifies that the physician

must be available on site (1) within 30

minutes, on a 24-hour a day basis, if the

CAH is located in an area other than an

area described in item (2); or (2) within

60 minutes, on a 24-hour a day basis, if

all of the following requirements are

met:

• The CAH is located in an area

designated as a frontier area (that is, an

area with fewer than six residents per

square mile based on the latest

population data published by the

Bureau of the Census) or in an area that

meets criteria for a remote location

adopted by the State in its rural health

care plan, and approved by HCFA,

under section 1820(b) of the Act.

• The State has determined under

criteria in its rural health care plan that

allowing an emergency response time

longer than 30 minutes is the only

feasible method of providing emergency

care to residents of the area served by

the CAH.

• The State maintains documentation

showing that the response time of up to

60 minutes at a particular CAH it

designates is justified because other

available alternatives would increase

the time needed to stabilize a patient in

an emergency.

We also believe that it is essential that

physicians who are paid to be in on-call

status in fact come to the facility when

22712 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

summoned. Therefore, we are proposing

to specify that costs of on-call

emergency room physicians are

allowable only if the costs are incurred

under written contracts that require

them to come to the CAH when their

presence is medically required.

4. Treatment of Ambulance Services

Furnished by Certain Critical Access

Hospitals (Proposed § 413.70(b)(5))

Under section 1861(s)(7) of the Act,

Medicare Part B covers and pays for

ambulance services, to the extent

prescribed in regulations, when the use

of other methods of transportation

would be contraindicated. Various

Congressional reports indicate that

Congress intended that (1) the

ambulance benefit cover transportation

services only if other means of

transportation are contraindicated by

the beneficiary’s medical condition; and

(2) only ambulance services to local

facilities be covered unless necessary

services are not available locally, in

which case, transportation to the nearest

facility furnishing those services is

covered. (H.R. Rept. No. 89–213, 89th

Cong., 1st Sess. at 37 (1995) and S. Rept.

No. 89–404, 89th Cong., 1st Sess., Pt. I,

at 43 (1995).)

The Medicare program currently pays

for ambulance services on a reasonable

cost basis when furnished by a provider

and on a reasonable charge basis when

furnished by a supplier. (The term

‘‘provider’’ includes all Medicareparticipating institutional providers that

submit claims for Medicare ambulance

services (hospitals, CAHs, SNFs, and

home health agencies). The term

‘‘supplier’’ means an entity that is

independent of any provider. The

reasonable charge methodology that is

the basis of payment for ambulance

services is determined by the lowest of

the customary, prevailing, actual, or

inflation indexed charge.

Section 4531(a)(1) of Public Law 105–

33 amended section 1861(v)(1) of the

Act and imposed an additional per trip

limitation on reasonable cost payment

to hospitals and CAHs for ambulance

service. As amended, the statute

provides that, in determining the

reasonable cost of ambulance services

furnished by a provider of services, the

Secretary shall not recognize the cost

per trip in excess of the prior year’s

reasonable cost per trip updated by an

inflation factor. This trip limit provision

was first effective for services furnished

during Federal fiscal year 1998 (October

1, 1997 through September 30, 1998).

Section 205 of Public Law 106–554

amended section 1834(l) of the Act by

adding a new paragraph (8) to that

section. New section 1834(l)(8) provides

that the Secretary is to pay the

reasonable costs incurred in furnishing

ambulance services if such services are

furnished by a CAH (as defined in

section 1861(mm)(1) of the Act), or by

an entity owned or operated by the

CAH. This provision in effect eliminates

any trip limit that CAHs had been

subject to as a result of section

1861(v)(1) of the Act, as amended by

Public Law 105–33. However, section

205 further states that in order to receive

reasonable cost reimbursement for the

furnishing of ambulance services, the

CAH or entity must be the only provider

or supplier of ambulance services

located within a 35-mile drive of the

CAH. Section 205 is effective for

services furnished on or after December

21, 2000, the date of enactment of

Public Law 106–554.

To implement the provisions of

section 1834(l)(8) of the Act, we are

proposing to add a new paragraph (5) to

§ 413.70(b). Proposed § 413.70(b)(5)

would permit a CAH, or an entity

owned or operated by a CAH, to be paid

for furnishing ambulance services on a

reasonable cost basis if the CAH or

entity is the only provider or supplier of

ambulance services within a 35-mile

drive of the CAH. In determining

whether there is any other provider or

supplier of ambulance services within a

35-mile drive of a CAH or entity, we

would first identify the site where the

nearest other ambulance provider or

supplier garages its vehicles, and then

determine whether that site is within 35

miles, calculated as the shortest

distance in miles measured over

improved roads. An improved road for

this purpose would be defined as any

road that is maintained by a local, State,

or Federal government entity, and is

available for use by the general public.

Consistent with the change we are

proposing in § 412.92(c)(1) relating to

SCH determinations (as explained in

section IV. of this preamble), we would

consider improved roads to include the

paved surface up to the front entrance

of the hospital and, for purposes of

§ 413.70(b)(5), the front entrance of the

garage.

5. Qualified Practitioners for

Preanesthesia and Postanesthesia

Evaluation in CAHs

Section 1820 of the Act sets forth the

conditions for designating certain

hospitals as CAHs. Implementing

regulations for section 1820 of the Act

are located in 42 CFR part 485, Subpart

F. Among the conditions of

participation regulations for CAHs in

subpart F is the condition for surgical

services (§ 485.639). Existing § 485.639

specifies that preanesthesia and

postanesthesia services in a CAH can

only be performed by a doctor of

medicine or an osteopathic practitioner;

a doctor of dental surgery or dental

medicine; or a doctor of podiatric

medicine. This Medicare condition of

participation requirement regarding

preanesthesia and postanesthesia

evaluations for CAHs differs from, and

is more restrictive than, the current

requirement for acute care hospitals in

general. In an acute care hospital, the

CRNA is listed among the practitioners

who may perform the preanesthesia and

postanesthesia evaluations.

Our principal consideration in

regulating providers is to ensure patient

safety and high quality patient

outcomes. As circumstances and health

care environments change, we reassess

regulations and propose changes

accordingly.

When the regulations for the initial

Rural Primary Care Hospital (RPCH)

program (which later became the CAH

program) were adopted, RPCHs were

limited to patient stays of no more than

72 hours and to bed counts of no more

than 6 acute care beds. We initially

viewed RPCHs as very limited-service

facilities that would be unlikely to

perform any surgery beyond what might

be done in a physician’s office;

therefore, we did not have a condition

of participation for surgery. Section

102(a)(1) of the Social Security

Amendments of 1994, Public Law 103–

432, specifically authorized surgical

care in RPCHs. In June 1995, we

proposed a surgical condition of

participation that incorporated the

ambulatory surgery center (ASC)

standards. We expected that the types of

procedures done in a RPCH would most

likely be those that could be done in

ASCs. At the time, we received no

comments in response to the proposed

standards and therefore adopted them in

the final RPCH conditions of

participation that were published on

September 1, 1995 (60 FR 45851).

In 1997, the RPCH (now CAH)

program was expanded through a

statutory change to include all States

and to allow for an increase in bed size

and length of stay (August 29, 1997 final

rule, 62 FR 46035). Since that time, the

program’s original conditions of

participation have been revised to

remove possible barriers to access to

care. One example of this effort is the

final rule to eliminate the Federal

requirement for physician supervision

of CRNAs in CAHs as well as acute care

hospitals and ASCs that was published

in the Federal Register on January 18,

2001 (66 FR 96570).

Recently, provider and medical

groups have suggested that CAHs may

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22713

be at risk of losing the ability to provide

access to appropriate surgical services

without the full support of available

CRNAs. They indicated that the existing

regulations place the responsibility of

the preanesthesia and postanesthesia

evaluations on the operating

practitioner, thereby creating a higher

standard for CAHs than for other

hospitals.

In an effort to eliminate or minimize

potential access issues in rural areas and

to recognize the CAH’s program

expansion, we are proposing to revise

§ 485.639(b) to allow CRNAs to perform

preanesthesia and postanesthesia

evaluations in a CAH. As with any

licensed independent health care

provider, the proposed change would

not permit CRNAs to practice beyond

his or her licensed scope of practice or

the approved policies and procedures of

the CAH.

6. Clarification of Location

Requirements for CAHs

Under section 1820(c)(2)(B)(i) of the

Act, a facility seeking designation by the

State as a CAH must meet two distinct

types of location requirements. First, the

facility must either be actually located

in a county or equivalent unit of local

government in a rural area, as defined

in section 1886(d)(2)(D) of the Act, or it

must be located in an urban area as

defined in section 1886(d)(2)(D) of the

Act, but be treated as being located in

a rural area under section 1886(d)(8)(E)

of the Act. Second, the facility must also

be located more than a 35-mile drive (or,

in the case of mountainous terrain or in

areas with only secondary roads

available, a 15-mile drive) from a

hospital or similar facility described in

section 1820(c) of the Act, or it must be

certified by the State as being a

necessary provider of health care

services to residents in the area.

Implementing regulations for these

provisions were published in an interim

final rule with comment period in the

Federal Register on August 1, 2000 (65

FR 47026) and are set forth at

§ 485.610(b).

Recently, concern has been expressed

that § 485.610(b) does not accurately

reflect the fact that a facility may satisfy

the ‘‘rural location’’ requirement either

by actually being located in a rural area

or by being located in an urban area but

qualifying for treatment as rural under

section 1886(d)(8)(E) of the Act. In

addition, we have received questions as

to whether a potential CAH must meet

both the rural location requirement and

the requirement for location relative to

other facilities (or certification by the

State as a ‘‘necessary provider’’).

To avoid any further confusion, and

ensure that our regulations reflect the

provisions of the law accurately, we are

proposing to revise § 485.610(b) to

clarify that a potential CAH must either

be actually located in a rural area, or be

treated as being rural under section

1886(d)(8)(E) of the Act. In addition, we

are proposing to place the provisions of

the existing § 485.610(b)(5) in a newly

created paragraph (c) entitled, ‘‘Location

relative to other facilities or necessary

provider certification’’. We are

proposing to relocate this provision in

order to clarify that these criteria are

separate from the rural location criteria.

These proposed changes do not reflect

any change in policy; they are merely an

attempt to improve the clarity of the

regulations.

VII. MedPAC Recommendations

We have reviewed the March 1, 2001

report submitted by MedPAC to

Congress and have given it careful

consideration in conjunction with the

proposals set forth in this document.

Recommendation 5A concerning the

update factor for inpatient hospital

operating costs and for hospitals and

hospital distinct-part units excluded

from the prospective payment system

are discussed in Appendix D to this

proposed rule. Other MedPAC

recommendations and our responses are

set forth below.

A. Accounting for New Technology in

Hospital Prospective Payment Systems

(Recommendations 3D and 3E)

Recommendation 3D: For the

inpatient payment system, the Secretary

should develop formalized procedures

for expeditiously assigning codes,

updating relative weights, and

investigating the need for patient

classification changes to recognize the

costs of new and substantially improved

technologies.

Response: Section 533 of Public Law

106–554 directs the Secretary to develop

a mechanism for ensuring adequate

payment under the hospital inpatient

prospective payment system for new

medical services and technologies, and

to report to Congress on ways to more

expeditiously incorporate new services

and technologies into that system. The

discussion relating to new medical

services and technologies is found in

section II.D. of this proposed rule and

addresses MedPAC’s concern regarding

the process of assigning new codes. In

addition, MedPAC acknowledges, and

we agree, that the process of updating

the relative weights has an established

track record.

MedPAC states that a more formal

system for assigning codes and

investigating the need for DRG changes

would have enabled the current system

to more adequately respond to new

technology. Although we believe the

current process for assigning new codes

has the advantage of being wellunderstood, the proposed new process

we described in section II. of this

proposed rule should improve the

ability of the system to respond to the

introduction of new technology.

Recommendation 3E: Additional

payments in the inpatient payment

system should be limited to new or

substantially improved technologies

that add significantly to the cost of care

in a diagnosis related group and should

be made on a budget-neutral basis.

Response: Section 533 of Public Law

106–554 directed the Secretary to

establish a mechanism to make these

payments beginning with discharges on

or after October 1, 2001, and we are

proposing implementation of this

provision under section IV.F. of this

proposed rule.

B. Occupational-Mix Adjusted Wage

Index for FY 2005 (Recommendation 4)

Recommendation: To implement an

occupation-mix adjusted wage index in

FY 2005, the Secretary should collect

data on wage rates by occupation in the

fiscal year 2002 Medicare cost reports.

Hospital-specific wage rates for each

occupation should be supplemented by

data on the mix of occupations for each

provider type. The Secretary also should

continue to improve the accuracy of the

wage index by investigating differences

in wages across areas for each type of

provider and in the substitution of one

occupation for another.

Response: We are proposing to collect

occupational mix data from hospitals

through a supplemental survey to the

cost report for cost reporting periods

beginning during FY 2001. A more

complete discussion of our proposed

methodology can be found in section III.

of this proposed rule.

C. Financial Performance and Inpatient

Payment Issues (Recommendations 5B,

5C, and 5D)

Recommendation 5B: In collecting

sample patient-level data, HCFA should

seek to balance the goals of minimizing

payment errors and furthering

understanding of the effects of coding

on case-mix change.

Response: The sample data referred to

by MedPAC is the Payment Error

Prevention Program (PEPP) Surveillance

Sample. These data are collected to

monitor the payment error rate for

Medicare inpatient prospective payment

system services and provide outcome

data to measure PROs’ performance in

22714 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

reducing payment errors in their

respective States. This information can

be appropriately weighted to reflect the

true distribution of DRGs nationally.

The sample data supplant the DRG

validation sample that MedPAC used in

its original 1996 through 1998 estimates.

The current PEPP Surveillance Sample

doubles the size of the earlier DRG

validation sample. It is comprised of

approximately 60,000 cases per year.

We believe this is a sufficient number of

cases to both monitor case-mix index

changes and PRO performance on

payment error reduction.

Recommendation 5C: Although the

Benefits Improvement and Protection

Act of 2000 improved the equity of the

hospital disproportionate share

adjustment, Congress still needs to

reform this adjustment by:

• Including the costs of all poor

patients in calculating low-income

shares used to distribute

disproportionate share payments; and

• Using the same formula to

distribute payments to all hospitals

covered by prospective payment.

Response: HCFA is participating a

Medicare Technical Advisory Group

workgroup concerning technical issues

related to the collection of

uncompensated care data relative to the

Medicare disproportionate share

formula. A worksheet and instructions

to collect these data will be sent out for

prior consultation this summer for

revisions to the cost reports applicable

for cost reporting periods beginning on

or after October 1, 2001.

Recommendation 5E: The Congress

should protect urban hospitals from the

adverse effect of nearby hospitals being

reclassified to areas with higher wage

indexes by computing each area’s wage

index as if none of the hospitals located

in the area had been reassigned.

Response: With this rule, HCFA has

proposed to include the wage data for a

reclassified hospital in both the area to

which it is reclassified and the area

where the hospital is physically located.

We agree with MedPAC and believe that

this will provide consistency and

predictability in hospital reclassification

and wage indices.

D. Specialties With Training Beyond the

Initial Residency Period

(Recommendation 10)

Recommendation: The Congress

should eliminate the weighting factors

that currently determine Medicare’s

direct graduate medical education

payments and count all residencies

equally through completion of residents’

first specialty or combined program and

subspecialty if one is pursued.

Residents training longer than the

minimum number of years required for

board eligibility in a specialty,

combined program, or subspecialty

should not be included in hospitals’

direct graduate medical education

resident counts. These policy changes

should be implemented in a budgetneutral manner through adjustments to

the per resident payment amounts.

Response: Currently, Medicare

payments to hospitals for direct GME is

dependent, in part, on the initial

residency period of the residents.

Generally, the initial residency period is

defined at § 413.86(g)(1) as the

minimum number of years required for

board eligibility, not to exceed 5 years.

For purposes of determining the direct

GME payment, residents are weighted at

1.0 FTE within the initial residency

period, and at .5 FTE beyond the initial

residency period. The limitation on the

initial residency period was designed by

Congress to limit full Medicare direct

GME payment to the time required to

train in a single specialty.

MedPAC states that Medicare’s

current direct GME payment policy of

limiting full funding to the first

specialty in which a resident trains

provides a disincentive for hospitals to

offer training in subspecialties or

combined programs, and therefore, may

influence hospitals’ decisions on the

types of residents that they train.

MedPAC believes that Medicare should

not influence workforce policy and

recommends that the disincentive be

removed to make Medicare payments

policies neutral with regard to programs

with prerequisites, subspecialties, and

combined programs. Accordingly,

MedPAC recommends that Congress

eliminate the weighting factors

associated with direct GME payment so

that all residents would be counted for

full direct GME payment through the

completion of their first specialty,

combined program, or subspecialty.

Residents training beyond the minimum

number of years required for board

eligibility in a specialty, combined

program, or subspecialty should not be

counted for purposes of the direct GME

payment.

MedPAC also believes that

eliminating the weighting factors could

potentially increase Medicare’s direct

GME payments by approximately 5 to 8

percent. Therefore, MedPAC

recommends that hospitals’ per resident

amounts (PRAs), which are used to

calculate the direct GME payment, be

reduced so that this change can be

implemented, to the extent possible, in

a budget-neutral manner. MedPAC

explains that, although further research

is needed, it appears that hospitals with

substantial subspecialty training (that is,

at least 15 percent of the resident mix)

would likely see a small net increase in

payments, despite the reduction to the

PRAs, while hospitals that do not have

subspecialty training would likely see a

small decrease in payments.

In response to MedPAC’s

recommendation, we question

MedPAC’s estimate that eliminating the

weighting factors could increase

Medicare direct GME payments by only

5 to 8 percent. We believe that

subspecialty training constitutes a

significant portion of all GME programs,

and, consequently, the elimination of

the weighting factors could potentially

increase payments by far more than 8

percent. If budget neutrality is to be

maintained, this could mean that the

attendant reductions to the PRAs could

be much greater than MedPAC might

assume. For those teaching hospitals

that have substantial subspecialty

training, there is no guarantee that the

decreases in the PRAs will be offset by

the increases in the direct GME

payments due to the elimination of the

weighting factors.

While the recommendation would

remove the existing disincentive for

training in subspecialties, we believe

the reductions to the PRAs, whether

they are minimal or more significant,

will be far more detrimental to the

smaller teaching hospitals that have

little or no subspecialty training. Many

of these hospitals provide care to

beneficiaries in rural, underserved areas

and in nonhospital settings. We believe

these conditions may discourage the

expansion of residency training in these

areas. It may be inappropriate to limit

the direct GME funding to such

hospitals, considering Congress’

initiatives to encourage residency

training in rural, underserved areas and

in nonhospital settings. We also are

unclear as to how MedPAC would

implement the proposed reduction to

the PRAs. MedPAC did not explain in

its recommendation how it would

propose to do this.

VIII. Other Required Information

A. Requests for Data From the Public

In order to respond promptly to

public requests for data related to the

prospective payment system, we have

established a process under which

commenters can gain access to raw data

on an expedited basis. Generally, the

data are available in computer tape or

cartridge format; however, some files are

available on diskette as well as on the

Internet at http://www.hcfa.gov/stats/

pubfiles.html. Data files, and the cost for

each, are listed below. Anyone wishing

to purchase data tapes, cartridges, or

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22715

diskettes should submit a written

request along with a company check or

money order (payable to HCFA–PUF) to

cover the cost to the following address:

Health Care Financing Administration,

Public Use Files, Accounting Division,

P.O. Box 7520, Baltimore, Maryland

21207–0520, (410) 786–3691. Files on

the Internet may be downloaded

without charge.

1. Expanded Modified MedPAR–

Hospital (National)

The Medicare Provider Analysis and

Review (MedPAR) file contains records

for 100 percent of Medicare

beneficiaries using hospital inpatient

services in the United States. (The file

is a Federal fiscal year file, that is,

discharges occurring October 1 through

September 30 of the requested year.)

The records are stripped of most data

elements that would permit

identification of beneficiaries. The

hospital is identified by the 6-position

Medicare billing number. The file is

available to persons qualifying under

the terms of the Notice of Proposed New

Routine Uses for an Existing System of

Records published in the Federal

Register on December 24, 1984 (49 FR

49941), and amended by the July 2,

1985 notice (50 FR 27361). The national

file consists of approximately 11 million

records. Under the requirements of

these notices, an agreement for use of

HCFA Beneficiary Encrypted Files must

be signed by the purchaser before

release of these data. For all files

requiring a signed agreement, please

write or call to obtain a blank agreement

form before placing an order. Two

versions of this file are created each

year. They support the following:

• Notice of Proposed Rulemaking

(NPRM) published in the Federal

Register. This file, scheduled to be

available by the end of April, is derived

from the MedPAR file with a cutoff of

3 months after the end of the fiscal year

(December file).

• Final Rule published in the Federal

Register. The FY 2000 MedPAR file

used for the FY 2002 final rule will be

cut off 6 months after the end of the

fiscal year (March file) and is scheduled

to be available by the end of April.

Media: Tape/Cartridge

File Cost: $3,655.00 per fiscal year

Periods Available: FY 1988 through FY

2000

2. Expanded Modified MedPARHospital (State)

The State MedPAR file contains

records for 100 percent of Medicare

beneficiaries using hospital inpatient

services in a particular State. The

records are stripped of most data

elements that will permit identification

of beneficiaries. The hospital is

identified by the 6-position Medicare

billing number. The file is available to

persons qualifying under the terms of

the Notice of Proposed New Routine

Uses for an Existing System of Records

published in the December 24, 1984

Federal Register notice, and amended

by the July 2, 1985 notice. This file is

a subset of the Expanded Modified

MedPAR-Hospital (National) as

described above. Under the

requirements of these notices, an

agreement for use of HCFA Beneficiary

Encrypted Files must be signed by the

purchaser before release of these data.

Two versions of this file are created

each year. They support the following:

• NPRM published in the Federal

Register. This file, scheduled to be

available by the end of April, is derived

from the MedPAR file with a cutoff of

3 months after the end of the fiscal year

(December file).

• Final Rule published in the Federal

Register. The FY 2000 MedPAR file

used for the FY 2002 final rule will be

cut off 6 months after the end of the

fiscal year (March file) and is scheduled

to be available by the end of April.

Media: Tape/Cartridge

File Cost: $1,130.00 per State per year

Periods Available: FY 1988 through FY

2000

3. HCFA Wage Data

This file contains the hospital hours

and salaries for FY 1998 used to create

the proposed FY 2002 prospective

payment system wage index. The file

will be available by the beginning of

February for the NPRM and the

beginning of May for the final rule.

Processing year Wage data

year

PPS fiscal

year

2001 .................. 1998 2002

2000 .................. 1997 2001

1999 .................. 1996 2000

1998 .................. 1995 1999

1997 .................. 1994 1998

1996 .................. 1993 1997

1995 .................. 1992 1996

1994 .................. 1991 1995

1993 .................. 1990 1994

1992 .................. 1989 1993

1991 .................. 1988 1992

These files support the following:

• NPRM published in the Federal

Register.

• Final Rule published in the Federal

Register.

Media: Diskette/most recent year on the

Internet

File Cost: $165.00 per year

Periods Available: FY 2002 PPS Update

4. HCFA Hospital Wages Indices

(Formerly: Urban and Rural Wage Index

Values Only)

This file contains a history of all wage

indices since October 1, 1983.

Media: Diskette/most recent year on the

Internet

File Cost: $165.00 per year

Periods Available: FY 2002 PPS Update

5. PPS SSA/FIPS MSA State and County

Crosswalk

This file contains a crosswalk of State

and county codes used by the Social

Security Administration (SSA) and the

Federal Information Processing

Standards (FIPS), county name, and a

historical list of Metropolitan Statistical

Area (MSA).

Media: Diskette/Internet

File Cost: $165.00 per year

Periods Available: FY 2002 PPS Update

6. Reclassified Hospitals New Wage

Index (Formerly: Reclassified Hospitals

by Provider Only)

This file contains a list of hospitals

that were reclassified for the purpose of

assigning a new wage index. Two

versions of these files are created each

year. They support the following:

• NPRM published in the Federal

Register.

• Final Rule published in the Federal

Register.

Media: Diskette/Internet

File Cost: $165.00 per year

Periods Available: FY 2002 PPS Update

7. PPS–IV to PPS–XII Minimum Data

Set

The Minimum Data Set contains cost,

statistical, financial, and other

information from Medicare hospital cost

reports. The data set includes only the

most current cost report (as submitted,

final settled, or reopened) submitted for

a Medicare participating hospital by the

Medicare fiscal intermediary to HCFA.

This data set is updated at the end of

each calendar quarter and is available

on the last day of the following month.

Media: Tape/Cartridge

File Cost: $770.00 per year

Periods beginning

on or after

And before

PPS–IV ............. 10/01/86 10/01/87

PPS–V .............. 10/01/87 10/01/88

PPS–VI ............. 10/01/88 10/01/89

PPS–VII ............ 10/01/89 10/01/90

PPS–VIII ........... 10/01/90 10/01/91

PPS–IX ............. 10/01/91 10/01/92

PPS–X .............. 10/01/92 10/01/93

PPS–XI ............. 10/01/93 10/01/94

PPS–XII ............ 10/01/94 10/01/95

22716 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

Note: The PPS–XIII, PPS–XIV, PPS–XV,

and PPS–XVI Minimum Data Sets are part of

the PPS–XIII, PPS–XIV, PPS–XV, and PPS

XVI Hospital Data Set Files.

8. PPS–IX to PPS–XII Capital Data Set

The Capital Data Set contains selected

data for capital-related costs, interest

expense and related information and

complete balance sheet data from the

Medicare hospital cost report. The data

set includes only the most current cost

report (as submitted, final settled or

reopened) submitted for a Medicare

certified hospital by the Medicare fiscal

intermediary to HCFA. This data set is

updated at the end of each calendar

quarter and is available on the last day

of the following month.

Media: Tape/Cartridge

File Cost: $770.00 per year

Periods beginning on

or after

And before

PPS–IX ............. 10/01/91 10/01/92

PPS–X .............. 10/01/92 10/01/93

PPS–XI ............. 10/01/93 10/01/94

PPS–XII ............ 10/01/94 10/01/95

Note: The PPS–XIII, PPS–XIV, PPS–XV,

and PPS–XVI Capital Data Sets are part of the

PPS–XIII, PPS–XIV, PPS–XV, and PPS–XVI

Hospital Data Set Files.

9. PPS–XIII to PPS–XVI Hospital Data

Set

The file contains cost, statistical,

financial, and other data from the

Medicare Hospital Cost Report. The data

set includes only the most current cost

report (as submitted, final settled, or

reopened) submitted for a Medicarecertified hospital by the Medicare fiscal

intermediary to HCFA. The data set are

updated at the end of each calendar

quarter and is available on the last day

of the following month.

Media: Diskette/Internet

File Cost: $2,500.00

Periods beginning on

or after

And before

PPS–XIII ........... 10/01/95 10/01/96

PPS–XIV ........... 10/01/96 10/01/97

PPS–XV ............ 10/01/97 10/01/98

PPS–XVI ........... 10/01/98 10/01/99

10. Provider-Specific File

This file is a component of the

PRICER program used in the fiscal

intermediary’s system to compute DRG

payments for individual bills. The file

contains records for all prospective

payment system eligible hospitals,

including hospitals in waiver States,

and data elements used in the

prospective payment system

recalibration processes and related

activities. Beginning with December

1988, the individual records were

enlarged to include pass-through per

diems and other elements.

Media: Diskette/Internet

File Cost: $265.00

Periods Available: FY 2002 PPS Update

11. HCFA Medicare Case-Mix Index File

This file contains the Medicare casemix index by provider number as

published in each year’s update of the

Medicare hospital inpatient prospective

payment system. The case-mix index is

a measure of the costliness of cases

treated by a hospital relative to the cost

of the national average of all Medicare

hospital cases, using DRG weights as a

measure of relative costliness of cases.

Two versions of this file are created

each year. They support the following:

• NPRM published in the Federal

Register.

• Final rule published in the Federal

Register.

Media: Diskette/most recent year on

Internet

Price: $165.00 per year/per file

Periods Available: FY 1985 through FY

2000

12. DRG Relative Weights (Formerly

Table 5 DRG)

This file contains a listing of DRGs,

DRG narrative description, relative

weights, and geometric and arithmetic

mean lengths of stay as published in the

Federal Register. The hard copy image

has been copied to diskette. There are

two versions of this file as published in

the Federal Register:

• NPRM.

• Final rule.

Media: Diskette/Internet

File Cost: $165.00

Periods Available: FY 2002 PPS Update

13. PPS Payment Impact File

This file contains data used to

estimate payments under Medicare’s

hospital inpatient prospective payment

systems for operating and capital-related

costs. The data are taken from various

sources, including the Provider-Specific

File, Minimum Data Sets, and prior

impact files. The data set is abstracted

from an internal file used for the impact

analysis of the changes to the

prospective payment systems published

in the Federal Register. This file is

available for release 1 month after the

proposed and final rules are published

in the Federal Register.

Media: Diskette/Internet

File Cost: $165.00

Periods Available: FY 2002 PPS Update

14. AOR/BOR Tables

This file contains data used to

develop the DRG relative weights. It

contains mean, maximum, minimum,

standard deviation, and coefficient of

variation statistics by DRG for length of

stay and standardized charges. The BOR

tables are ‘‘Before Outliers Removed’’

and the AOR is ‘‘After Outliers

Removed.’’ (Outliers refers to statistical

outliers, not payment outliers.) Two

versions of this file are created each

year. They support the following:

• NPRM published in the Federal

Register.

• Final rule published in the Federal

Register.

Media: Diskette/Internet

File Cost: $165.00

Periods Available: FY 2002 PPS Update

For further information concerning

these data tapes, contact the HCFA

Public Use Files Hotline at (410) 786–

3691.

Commenters interested in obtaining or

discussing any other data used in

constructing this rule should contact

Stephen Phillips at (410) 786–4531.

B. Information Collection Requirements

Under the Paperwork Reduction Act

of 1995, we are required to provide 60-

day notice in the Federal Register and

solicit public comment before a

collection of information requirement is

submitted to the Office of Management

and Budget (OMB) for review and

approval. In order to fairly evaluate

whether an information collection

should be approved by OMB, section

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

Reduction Act of 1995 requires that we

solicit comment on the following issues:

• The need for the information

collection and its usefulness in carrying

out the proper functions of our agency.

• The accuracy of our estimate of the

information collection burden.

• The quality, utility, and clarity of

the information to be collected.

• Recommendations to minimize the

information collection burden on the

affected public, including automated

collection techniques.

We are soliciting public comments on

each of these issues for the sections that

contain information collection

requirements.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22717

Proposed New § 412.230(e)(2)(ii)

Criteria for an Individual Hospital

Seeking Redesignation to Another Rural

Area or an Urban Area; Proposed New

§ 412.232(d)(2)(ii) Criteria for All

Hospitals in a Rural County Seeking

Urban Redesignation; Proposed New

§ 412.235 Criteria for All Hospitals in

a State Seeking a Statewide Wage Index;

and Proposed Revised § 412.273

Withdrawing an Application or

Terminating an Approved 3-Year

Reclassification

Proposed §§ 412.230(e)(2)(ii) and

412.232(d)(2)(ii) specify that, for

hospital-specific data for wage index

changes for redesignations effective

beginning FY 2003, the hospital must

provide a 3-year average of its average

hourly wages using data from the HCFA

hospital wage survey used to construct

the wage index in effect for prospective

payment purposes. For other data, the

hospital must provide a weighted 3-year

average of the average hourly wage in

the area in which the hospital is located

and a weighted 3-year average of the

average hourly wage in the area to

which the hospital seeks

reclassification. Proposed new § 412.235

specifies that in order for all prospective

payment system hospitals in a State to

use a statewide wage index, the

hospitals as a group must submit an

application to the MGCRB for a decision

for reclassifications for wage index

purposes. The proposed changes to

§ 412.273 would incorporate proposed

revised procedures for hospitals that

request withdraw of their wage index

application or termination of their wage

index reclassification. These proposed

changes, discussed in detail in section

IV.E. of this proposed rule, implement

sections 304(a) and (b) of Public Law

106–554.

The information collection

requirements associated with a

hospital’s application to the MGCRB for

geographic reclassifications, including

reclassifications for wage index

purposes and the required submittal of

wage data, that are codified in Part 412

are currently approved by OMB under

OMB Approval Number 0938–0573,

with an expiration date of September

30, 2002.

Proposed § 412.348(g)(9) Exception

Payments

As discussed in section V. of this

proposed rule, Medicare makes special

exceptions payments for capital-related

costs through the 10th year beyond the

end of the capital prospective payment

system transition period for eligible

hospitals that complete a project that

meets certain requirements specified in

§ 412.348. In order to assist our fiscal

intermediaries in determining the end of

the 10-year period in which an eligible

hospital will no longer be entitled to

receive special exception payments, we

are proposing to add a new

§ 412.348(g)(9) to require that hospitals

eligible for special exception payments

under § 412.348(g) submit

documentation to the intermediary

indicating the completion date of their

project (the date the project was put in

use for patient care) that meets the

project need and project size

requirements outlined in

§§ 412.348(g)(2) through (g)(5). We are

proposing that, in order for an eligible

hospital to receive special exception

payments, this documentation would

have to be submitted in writing to the

intermediary by the later of October 1,

2001, or within 3 months of the end of

the hospital’s last cost reporting period

beginning before October 1, 2001,

during which a qualifying project was

completed.

We estimate that the information

collection requirement of preparing and

submitting the documentation on a

hospital’s capital project would impose

a burden of approximately 1 hour for

approximately 30 hospitals.

If you comment on these information

collection and recordkeeping

requirements, please mail copies

directly to the following addresses:

Health Care Financing Administration,

Office of Information Services,

Security and Standards Group,

Division of HCFA Enterprise

Standards Room N2–14–26, 7500

Security Boulevard, Baltimore,

Maryland 21244–1850, Attn: John

Burke HCFA–1158–P; and

Office of Information and Regulatory

Affairs, Office of Management and

Budget, Room 3001, New Executive

Office Building, Washington, DC

20503, Attn: Allison Herron Eydt,

HCFA Desk Officer.

These new information collection and

recordkeeping requirements have been

submitted to the Office of Management

and Budget (OMB) for review under the

authority of PRA. We have submitted a

copy of the proposed rule to OMB for

its review of the information collection

requirements. These requirements will

not be effective until they have been

approved by OMB.

C. Public Comments

Because of the large number of items

of correspondence we normally receive

on a proposed rule, we are not able to

acknowledge or respond to them

individually. However, in preparing the

final rule, we will consider all

comments concerning the provisions of

this proposed rule that we receive by

the date and time specified in the DATES

section of this preamble and respond to

those comments in the preamble to that

rule. We emphasize that section

1886(e)(5) of the Act requires the final

rule for FY 2002 to be published by

August 1, 2001, and we will consider

only those comments that deal

specifically with the matters discussed

in this proposed rule.

List of Subjects

42 CFR Part 405

Administrative practice and

procedure, Health facilities, Health

professions, Kidney diseases, Medicare,

Reporting and recordkeeping

requirements, Rural areas, X-rays.

42 CFR Part 412

Administrative practice and

procedure, Health facilities, Medicare,

Puerto Rico, Reporting and

recordkeeping requirements.

42 CFR Part 413

Health facilities, Kidney diseases,

Medicare, Puerto Rico, Reporting and

recordkeeping requirements.

42 CFR Part 485

Grant programs-health, Health

facilities, Medicaid, Medicare,

Reporting and recordkeeping

requirements.

42 CFR Part 486

Health professions, Medicare, Organ

procurement, X-rays.

42 CFR Chapter IV is proposed to be

amended as set forth below:

PART 405—FEDERAL HEALTH

INSURANCE FOR THE AGED AND

DISABLED

A. Part 405 is amended as set forth

below:

1. The authority citation for Part 405

continues to read as follows:

Authority: Secs. 1102, 1861, 1862(a), 1871,

1874, 1881, and 1886(k) of the Social

Security Act (42 U.S.C. 1302, 1395x,

1395y(a), 1395hh, 1395kk, 1395rr, and

1395ww(k), and sec. 353 of the Public Health

Service Act (42 U.S.C. 263a).

2. In § 405.2468, paragraph (f)(6)(ii) is

republished and paragraph (f)(6)(ii)(D) is

revised to read as follows.

§ 405.2468 Allowable costs.

* * * * *

(f) Graduate medical education.

***

(6) * * *

22718 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

(ii) The following costs are not

allowable graduate medical education

costs:

* * * * *

(D) The costs associated with

activities described in § 413.85(h) of this

chapter.

* * * * *

PART 412—PROSPECTIVE PAYMENT

SYSTEMS FOR INPATIENT HOSPITAL

SERVICES

B. Part 412 is amended as follows:

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).

2. Section 412.2 is amended as

follows:

a. The introductory text of paragraph

(e) is republished.

b. Paragraph (e)(4) is revised.

c. The introductory text of paragraph

(f) is republished.

d. A new paragraph (f)(9) is added.

§ 412.2 Basis of payment.

* * * * *

(e) Excluded costs. The following

inpatient hospital costs are excluded

from the prospective payment amounts

and are paid on a reasonable cost basis:

* * * * *

(4) The acquisition costs of hearts,

kidneys, livers, lungs, pancreas, and

intestines (or multivisceral organs)

incurred by approved transplantation

centers.

* * * * *

(f) Additional payments to hospitals.

In addition to payments based on the

prospective payment system rates for

inpatient operating and inpatient

capital-related costs, hospitals receive

payments for the following:

* * * * *

(9) Special additional payment for

certain new technology as specified in

§ 412.87 and 412.88 of Subpart F.

3. Section 412.23 is amended by

adding a new paragraph (i) to read as

follows:

§ 412.23 Excluded hospitals:

Classifications.

* * * * *

(i) Changes in classification of

hospitals. For purposes of exclusions

from the prospective payment system,

the classification of a hospital is

effective for the hospital’s entire cost

reporting period. Any changes in the

classification of a hospital are made

only at the start of a cost reporting

period.

4. Section 412.25 is amended by

adding a new paragraph (f) to read as

follows:

§ 412.25 Excluded hospital units: Common

requirements.

* * * * *

(f) Changes in classification of

hospital units. For purposes of

exclusions from the prospective

payment system under this section, the

classification of a hospital unit is

effective for the unit’s entire cost

reporting period. Any changes in the

classification of a hospital unit is made

only at the start of a cost reporting

period.

5. Section 412.63 is amended by

revising paragraphs (t) and (u) to read as

follows:

§ 412.63 Federal rates for inpatient

operating costs for fiscal years after

Federal fiscal year 1984.

* * * * *

(t) Applicable percentage change for

fiscal years 2002 and 2003. The

applicable percentage change for fiscal

years 2002 and 2003 is the percentage

increase in the market basket index for

prospective payment hospitals (as

defined in § 413.40(a) of this

subchapter) minus 0.55 percentage

points for hospitals in all areas.

(u) Applicable percentage change for

fiscal year 2004 and for subsequent

fiscal years. The applicable percentage

change for fiscal year 2004 and for

subsequent years is the percentage

increase in the market basket index for

prospective payment hospitals (as

defined in § 413.40(a) of this

subchapter) for hospitals in all areas.

* * * * *

6. The title of Subpart F is revised to

read as follows:

Subpart F—Payment for Outlier Cases

and Special Treatment Payment for

New Technology

7. A new undesignated center heading

is added after the Subpart F heading and

before § 412.80; the section heading of

§ 412.80 is revised; and a new paragraph

(a)(3) is added to read as follows:

Payment for Outlier Cases

§ 412.80 Outlier cases: General provisions.

(a) Basic rule.

* * * * *

(3) Discharges occurring on or after

October 1, 2001. For discharges

occurring on or after October 1, 2001,

except as provided in paragraph (b) of

this section concerning transfers, HCFA

provides for additional payment,

beyond standard DRG payments and

beyond additional payments for new

medical services or technology specified

in §§ 412.87 and 412.88, to a hospital for

covered inpatient hospital services

furnished to a Medicare beneficiary if

the hospital’s charges for covered

services, adjusted to operating costs and

capital costs by applying cost-to-charge

ratios as described in § 412.84(h),

exceed the DRG payment for the case

(plus payments for indirect costs of

graduate medical education (§ 412.105),

payments for serving a disproportionate

share of low-income patients

(§ 412.106), and additional payments for

new medical services or technologies)

plus a fixed dollar amount (adjusted for

geographic variation in costs) as

specified by HCFA.

* * * * *

8. A new undesignated center heading

and §§ 412.87 and 412.88 are added

immediately following § 412.86, to read

as follows:

Additional Special Payment for Certain

New Technology

§ 412.87 Additional payment for new

medical services and technologies: General

provisions.

(a) Basis. Sections 412.87 and 412.88

implement sections 1886(d)(5)(K) and

1886(d)(5)(L) of the Act, which

authorizes the Secretary to establish a

mechanism to recognize the costs of

new medical services and technologies

under the hospital inpatient prospective

payment system.

(b) Eligibility criteria. For discharges

occurring on or after October 1, 2001,

HCFA provides for additional payments

(as specified in § 412.88) beyond the

standard DRG payments and outlier

payments to a hospital for discharges

involving covered inpatient hospital

services that are new medical services

and technologies, if the following

conditions are met:

(1) A new medical service or

technology represents an advance that

substantially improves, relative to

technologies previously available, the

diagnosis or treatment of Medicare

beneficiaries. HCFA will determine

whether a new medical service or

technology meets this criterion and

announce the results of its

determinations in the Federal Register

as a part of its annual updates and

changes to the hospital inpatient

prospective payment system.

(2) A medical service or technology

may be considered new within 2 or 3

years after it becomes available on the

market (depending on when a new code

is assigned and data on the new service

or technology become available for DRG

recalibration). After HCFA has

recalibrated the DRGs, based on

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22719

available data, to reflect the costs of an

otherwise new medical service or

technology, the medical service or

technology will no longer be considered

‘‘new’’ under the criterion of this

section.

(3) The DRG prospective payment rate

otherwise applicable to discharges

involving the medical service or

technology is determined to be

inadequate, based on application of a

threshold amount to estimated costs

incurred with respect to such

discharges. To determine whether the

payment would be adequate, HCFA will

determine whether the costs of the cases

involving a new medical service or

technology will exceed a threshold

amount set at one standard deviation

beyond the mean standardized charge

for all cases in the DRG to which the

new medical service or technology is

assigned (or the case-weighted average

of all relevant DRGs if the new medical

service or technology occurs in many

different DRGs). Standardized charges

reflect the actual charges of a case

adjusted by the prospective payment

system payment factors applicable to an

individual hospital, such as the wage

index, the indirect medical education

adjustment factor, and the

disproportionate share adjustment

factor.

§ 412.88 Additional payment for new

medical service or technology.

(a) For discharges involving new

medical services or technologies that

meet the criteria specified in § 412.87,

Medicare payment will be:

(1) The standard DRG payment; plus

(2) If the costs of the discharge

(determined by applying cost-to-charge

ratios as described in § 412.84(h))

exceed the standard DRG payment, an

additional amount equal to the lesser

of—

(i) 50 percent of the costs of the new

medical service or technology; or

(ii) 50 percent of the amount by which

the costs of the case exceed the standard

DRG payment.

(b) Unless a discharge case qualifies

for outlier payment under § 412.84,

Medicare will not pay any additional

amount beyond the DRG payment plus

50 percent of the estimated costs of the

new medical service or technology.

9. Section 412.92 is amended as

follows:

a. Paragraph (b)(1)(iii)(A) is amended

by revising the phrase ‘‘50 mile radius’’

to read ‘‘35 mile radius.’’

b. Paragraph (c)(1) is revised.

§ 412.92 Special treatment: Sole

community hospitals.

* * * * *

(c) Terminology. ***

(1) The term miles means the shortest

distance in miles measured over

improved roads. An improved road for

this purpose is any road that is

maintained by a local, State, or Federal

government entity and is available for

use by the general public. An improved

road includes the paved surface up to

the front entrance of the hospital.

* * * * *

10. Section 412.105 is amended as

follows:

a. The introductory text of paragraph

(a) is republished.

b. Paragraph (a)(1) is revised.

c. Paragraph (d)(3)(vi) is revised.

d. A new paragraph (d)(3)(vii) is

added.

e. Paragraph (f)(1)(ii)(C) is revised.

f. Paragraph (f)(1)(iii) is revised.

g. Paragraph (f)(1)(v) is amended by

adding four sentences at the end.

h. Paragraph (f)(1)(ix) is revised.

§ 412.105 Special treatment: Hospitals that

incur indirect costs for graduate medical

education programs.

* * * * *

(a) Basic data. HCFA determines the

following for each hospital:

(1) The hospital’s ratio of full-time

equivalent residents, except as limited

under paragraph (f) of this section, to

the number of beds (as determined

under paragraph (b) of this section).

Except for the special circumstances for

affiliated groups and new programs

described in paragraphs (f)(1)(vi) and

(f)(1)(vii) of this section, for a hospital’s

cost reporting periods beginning on or

after October 1, 1997, this ratio may not

exceed the ratio for the hospital’s most

recent prior cost reporting period after

accounting for the cap on the number of

full-time equivalent residents as

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

section. The exception for new

programs described in paragraph

(f)(1)(vii) of this section applies for the

period of years equal to the minimum

accredited length for that type of

program.

* * * * *

(d) Determination of education

adjustment factor.

* * * * *

(3) * * *

(vi) For discharges occurring during

fiscal year 2002, 1.6.

(vii) For discharges occurring on or

after October 1, 2002, 1.35.

* * * * *

(f) Determining the total number of

full-time equivalent residents for cost

reporting periods beginning on or after

July 1, 1991.

(1) * * *

(ii) * * *

(C) Effective for discharges occurring

on or after October 1, 1997, the time

spent by a resident in a non-hospital

setting in patient care activities under

an approved medical residency training

program is counted towards the

determination of full-time equivalency

if the criteria set forth in § 413.86(f)(3)

or § 413.86 (f)(4), as applicable, are met.

(iii) (A) Full-time equivalent status is

based on the total time necessary to fill

a residency slot. No individual may be

counted as more than one full-time

equivalent. If a resident is assigned to

more than one hospital, the resident

counts as a partial full-time equivalent

based on the proportion of time worked

in any of the areas of the hospital listed

in paragraph (f)(1)(ii) of this section, to

the total time worked by the resident. A

part-time resident or one working in an

area of the hospital other than those

listed under paragraph (f)(1)(ii) of this

section (such as a freestanding family

practice center or an excluded hospital

unit) would be counted as a partial fulltime equivalent based on the proportion

of time assigned to an area of the

hospital listed in paragraph (f)(1)(ii) of

this section, compared to the total time

necessary to fill a full-time residency

slot.

(B) The time spent by a resident in

research that is not associated with the

treatment or diagnosis of a particular

patient of the hospital is not countable.

* * * * *

(v) * * * If a hospital qualified for an

adjustment to the limit established

under paragraph (f)(1)(iv) of this section

for new medical residency programs

created under paragraph (f)(1)(vii) of

this section, the count of residents

participating in new medical residency

training programs above the number

included in the hospital’s FTE count for

the cost reporting period ending during

calendar year 1996 is added after

applying the averaging rules in this

paragraph for a period of years.

Residents participating in new medical

residency training programs are

included in the hospital’s FTE count

before applying the averaging rules after

the period of years has expired. For

purposes of this paragraph, the period of

years equals the minimum accredited

length for the type of program. The

period of years begins when the first

resident begins training.

* * * * *

(ix) A hospital may receive a

temporary adjustment to its full-time

equivalent cap to reflect residents added

because of another hospital’s closure if

the hospital meets the criteria specified

in §§ 413.86(g)(8)(i) and (g)(8)(ii) of this

22720 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

subchapter. If a hospital that closes its

residency training program agrees to

temporarily reduce its FTE cap

according to the criteria specified in

§§ 413.86(g)(8)(i) and (g)(8)(iii)(B) of this

subchapter, another hospital(s) may

receive a temporary adjustment to its

FTE cap to reflect residents added

because of the closure of the residency

training program if the criteria specified

in §§ 413.86(g)(8)(i) and (g)(8)(iii)(A) of

this subchapter are met.

* * * * *

11. Section 412.106 is amended by

revising the heading of paragraph (e)

and paragraph (e)(5) to read as follows:

§ 412.106 Special treatment: Hospitals that

serve a disproportionate share of lowincome patients.

* * * * *

(e) Reduction in payments beginning

FY 1998. * * *

(5) For FY 2002, 3 percent.

* * * * *

§ 412.113 [Amended]

12. In § 412.113(c), including the

heading for paragraph (c), the term

‘‘hospital’’, wherever it appears, is

revised to read ‘‘hospital or CAH’’ (16

times).

13. Section 412.230 is amended by

revising paragraph (e)(2) to read as

follows:

§ 412.230 Criteria for an individual hospital

seeking redesignation to another rural area

or an urban area.

* * * * *

(e) Use of urban or other rural area’s

wage index.

* * * * *

(2) Appropriate wage data. For a wage

index change, the hospital must submit

appropriate wage data as follows:

(i) For redesignations effective

through FY 2002:

(A) For hospital-specific data, the

hospital must provide data from the

HCFA hospital wage survey used to

construct the wage index in effect for

prospective payment purposes during

the fiscal year prior to the fiscal year for

which the hospital requests

reclassification.

(B) For data for other hospitals, the

hospital must provide data concerning

the average hourly wage in the area in

which the hospital is located and the

average hourly wage in the area to

which the hospital seeks

reclassification. The wage data are taken

from the HCFA hospital wage survey

used to construct the wage index in

effect for prospective payment purposes

during the fiscal year prior to the fiscal

year for which the hospital requests

reclassification.

(C) If the hospital is requesting

reclassification under paragraph

(e)(1)(iv)(B) of this section, the hospital

must provide occupational-mix data to

demonstrate the average occupational

mix for each employment category in

the area to which it seeks

reclassification. Occupational-mix data

can be obtained from surveys conducted

by the American Hospital Association.

(ii) For redesignations effective

beginning FY 2003:

(A) For hospital-specific data, the

hospital must provide a weighted 3-year

average of its average hourly wages

using data from the HCFA hospital wage

survey used to construct the wage index

in effect for prospective payment

purposes.

(B) For data for other hospitals, the

hospital must provide a weighted 3-year

average of the average hourly wage in

the area in which the hospital is located

and a weighted 3-year average of the

average hourly wage in the area to

which the hospital seeks

reclassification. The wage data are taken

from the HCFA hospital wage survey

used to construct the wage index in

effect for prospective payment purposes.

* * * * *

14. Section 412.232 is amended by

revising paragraph (d)(2) to read as

follows:

§ 412.232 Criteria for all hospitals in a rural

county seeking urban redesignation.

* * * * *

(d) Appropriate data.

* * * * *

(2) Appropriate wage data. The

hospitals must submit appropriate data

as follows:

(i) For redesignations effective

through FY 2002:

(A) For hospital-specific data, the

hospitals must provide data from the

HCFA wage survey used to construct the

wage index in effect for prospective

payment purposes during the fiscal year

prior to the fiscal year for which the

hospitals request reclassification.

(B) For data for other hospitals, the

hospitals must provide the following:

(1) The average hourly wage in the

adjacent area, which is taken from the

HCFA hospital wage survey used to

construct the wage index in effect for

prospective payment purposes during

the fiscal year prior to the fiscal year for

which the hospitals request

reclassification.

(2) Occupational-mix data to

demonstrate the average occupational

mix for each employment category in

the adjacent area. Occupational-mix

data can be obtained from surveys

conducted by the American Hospital

Association.

(ii) For redesignations effective

beginning FY 2003:

(A) For hospital-specific data, the

hospital must provide a weighted 3-year

average of its average hourly wages

using data from the HCFA hospital wage

survey used to construct the wage index

in effect for prospective payment

purposes.

(B) For data for other hospitals, the

hospital must provide a weighted 3-year

average of the average hourly wage in

the area in which the hospital is located

and a weighted 3-year average of the

average hourly wage in the area to

which the hospital seeks

reclassification. The wage data are taken

from the HCFA hospital wage survey

used to construct the wage index in

effect for prospective payment purposes.

15. Section 412.235 is added to read

as follows:

§ 412.235 Criteria for all hospitals in a

State seeking a statewide wage index

redesignation.

(a) General criteria. For all

prospective payment system hospitals

in a State to be redesignated to a

statewide wage index, the following

conditions must be met:

(1) All prospective payment system

hospitals in the State must apply as a

group for reclassification to a statewide

wage index through a signed single

application.

(2) All prospective payment system

hospitals in the State must agree to the

reclassification to a statewide wage

index through a signed affidavit on the

application.

(3) All prospective payment system

hospitals in the State must agree,

through an affidavit, to withdrawal of an

application or to termination of an

approved statewide wage index

reclassification.

(4) All hospitals in the State must

waive their rights to any wage index

classification that they would otherwise

receive absent the statewide wage index

classification, including a wage index

that any of the hospitals might have

received through individual geographic

reclassification.

(5) New hospitals that open within

the State prior to the deadline for

submitting an application for a

statewide wage index reclassification

(September 1), regardless of whether a

group application has already been

filed, must agree to the use of the

statewide wage index as part of the

group application. New hospitals that

open within the State after the deadline

for submitting a statewide wage index

reclassification application or during

the approved reclassification period will

be considered a party to the statewide

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22721

wage index application and

reclassification.

(b) Effect on payments. (1) An

individual hospital within the State may

receive a wage index that could be

higher or lower under the statewide

wage index reclassification in

comparison to its otherwise

redesignated wage index.

(2) Any new prospective payment

system hospital that opens in the State

during the effective period of an

approved statewide wage index

reclassification will be designated to

receive the statewide wage index for the

duration of that period.

(3) A hospital located in an area

outside a State in which all

participating hospitals have received an

approved statewide wage index

reclassification may apply to be

reclassified into the statewide wage

index area. In that case, such a hospital

that is reclassified into a statewide wage

index area will receive a wage index

calculated based on the statewide wage

index reclassification.

(c) Terms of the decision. (1) A

decision by the MGCRB on an

application for a statewide wage index

reclassification will be effective for 3

years beginning with discharges

occurring on the first day (October 1) of

the second Federal fiscal year following

the Federal fiscal year in which the

hospitals filed a complete application.

(2) The procedures and timeframes

specified in § 412.273 apply to

withdrawals of applications for

redesignation to a statewide wage index

and terminations of approved statewide

wage index reclassifications, including

the requirement that, to withdraw an

application or terminate an approved

reclassification, the request must be

made in writing by all hospitals that are

party to the application, except

hospitals reclassified into the State for

purposes of receiving the statewide

wage index.

16. Section 412.273 is amended as

follows:

a. The title of the section is revised.

b. Paragraphs (b) and (c) are

redesignated as paragraphs (c) and (d),

respectively.

c. A new paragraph (b) is added.

d. Redesignated paragraph (c) is

revised.

§ 412.273 Withdrawing an application or

terminating an approved 3-year

reclassification.

* * * * *

(b) Request for termination of

approved 3-year wage index

reclassifications.

(1) A hospital, or a group of hospitals,

that has been issued a decision on its

application for a 3-year reclassification

for wage index purposes only or for

redesignation to a statewide wage index

and has not withdrawn that application

under the procedures specified in

paragraph (a) of this section may request

termination of its approved 3-year wage

index reclassification under the

following conditions:

(i) The request to terminate must be

received by the MGCRB within 45 days

of the publication of the annual notice

of proposed rulemaking concerning

changes to the inpatient hospital

prospective payment system and

proposed payment rates for the fiscal

year for which the termination is to

apply.

(ii) A request to terminate a 3-year

reclassification will be effective only for

the full fiscal year(s) remaining in the 3-

year period at the time the request is

received. Requests for terminations for

part of a fiscal year will not be

considered.

(2) Reapplication within the approved

3-year period.

(i) If a hospital elects to withdraw its

wage index application after the

MGCRB has issued its decision, it may

terminate its withdrawal in a

subsequent fiscal year and request the

MGCRB to reinstate its wage index

reclassification for the remaining fiscal

year(s) of the 3-year period.

(ii) A hospital may apply for

reclassification for purposes of the wage

index to a different area (that is, an area

different from the one to which it was

originally reclassified for the 3-year

period). If the application is approved,

the reclassification will be effective for

3 years.

(c) Written request only. A request to

withdraw an application or terminate an

approved reclassification must be made

in writing to the MGCRB by all hospitals

that are party to the application or

reclassification.

* * * * *

17. Section 412.274 is amended by

revising paragraph (b) to read as follows:

§ 412.274 Scope and effect of an MGCRB

decision.

* * * * *

(b) Effective date and term of the

decision. (1) A standardized amount

classification change is effective for one

year beginning with discharges

occurring on the first day (October 1) of

the second Federal fiscal year following

the Federal fiscal year in which the

complete application is filed and ending

effective at the end of that Federal fiscal

year (the end of the next September 30).

(2) A wage index classification change

is effective for 3 years beginning with

discharges occurring on the first day

(October 1) of the second Federal fiscal

year in which the complete application

is filed.

* * * * *

18. Section 412.348 is amended by

revising paragraph (g)(6) and adding a

new paragraph (g)(9) to read as follows:

§ 412.348 Exception payments.

* * * * *

(g) Special exceptions process. ***

(6) Minimum payment level.

(i) The minimum payment level for

qualifying hospitals will be 70 percent.

(ii) HCFA will adjust the minimum

payment level in one percentage point

increments as necessary to satisfy the

requirement specified in paragraph (h)

of this section that total estimated

payments under the exceptions process

not exceed 10 percent of the total

estimated capital prospective payment

system payments for the same fiscal

year.

* * * * *

(9) Notification requirement. Eligible

hospitals must submit documentation to

the intermediary indicating the

completion date of a project that meets

the project need requirement under

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

project size requirement under

paragraph (g)(5) of this section, and, in

the case of certain urban hospitals, an

excess capacity test under paragraph

(g)(4) of this section, by the later of

October 1, 2001 or within 3 months of

the end of the hospital’s last cost

reporting period beginning before

October 1, 2001, during which a

qualifying project was completed.

* * * * *

PART 413—PRINCIPLES OF

REASONABLE COST

REIMBURSEMENT; PAYMENT FOR

END-STAGE RENAL DISEASE

SERVICES; OPTIONAL

PROSPECTIVELY DETERMINED

PAYMENT RATES FOR SKILLED

NURSING FACILITIES

C. Part 413 is amended as follows:

1. The authority citation for Part 413

is revised to read as follows:

Authority: Secs. 1102, 1812(d), 1814(b),

1815, 1833(a), (i), and (n), 1871, 1881, 1883,

and 1886 of the Social Security Act (42

U.S.C. 1302, 1395d(d), 1395f(b), 1395g,

1395l(a), (i), and (n), 1395hh, 1395rr, 1395tt,

and 1395ww).

2. Section 413.70 is amended as

follows:

a. Paragraph (a)(1) introductory text is

republished.

b. A new paragraph (a)(1)(iv) is added.

c. Paragraph (a)(2) is revised.

d. A new paragraph (a)(3) is added.

e. Paragraph (b)(1) is revised.

22722 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

f. Paragraph (b)(2)(i)(C) is revised.

g. New paragraphs (b)(4), (b)(5) and

(b)(6) are added.

§ 413.70 Payment for services of a CAH.

(a) Payment for inpatient services

furnished by a CAH.

(1) Payment for inpatient services of

a CAH is the reasonable costs of the

CAH in providing CAH services to its

inpatients, as determined in accordance

with section 1861(v)(1)(A) of the Act

and the applicable principles of cost

reimbursement in this part and in Part

415 of this chapter, except that the

following payment principles are

excluded when determining payment

for CAH inpatient services:

* * * * *

(iv) The payment window provisions

for preadmission services, specified in

§ 412.2(c)(5) of this subchapter and

§ 413.40(c)(2).

(2) Except as specified in paragraph

(a)(3) of this section, payment to a CAH

for inpatient services does not include

any costs of physician services or other

professional services to CAH inpatients,

and is subject to the Part A hospital

deductible and coinsurance, as

determined under subpart G of part 409

of this chapter.

(3) If a CAH meets the criteria in

§ 412.113(c) of this subchapter for passthrough of costs of anesthesia services

furnished by qualified nonphysician

anesthetists employed by the CAH or

obtained under arrangements, payment

to the CAH for the costs of those

services is made in accordance with

§ 412.113(c).

(b) Payment for outpatient services

furnished by CAH.—(1) General. (i)

Unless the CAH elects to be paid for

services to its outpatients under the

method specified in paragraph (b)(3) of

this section, the amount of payment for

outpatient services of a CAH is the

amount determined under paragraph

(b)(2) of this section.

(ii) Except as specified in paragraph

(b)(6) of this section, payment to a CAH

for outpatient services does not include

any costs of physician services or other

professional services to CAH

outpatients.

* * * * *

(2) Reasonable costs for facility

services.

(i) * * *

(C) Any type of reduction to operating

or capital costs under § 413.124 or

§ 413.130(j).

* * * * *

(4) Costs of emergency room on-call

physicians. (i) Effective for cost

reporting periods beginning on or after

October 1, 2001, the reasonable costs of

outpatient CAH services under

paragraph (b) of this section may

include amounts for reasonable

compensation and related costs for an

emergency room physician who is on

call but who is not present on the

premises of the CAH involved, is not

otherwise furnishing physicians’

services, and is not on call at any other

provider or facility.

(ii) For purposes of this paragraph

(b)(4)—

(A) ‘‘Amounts for reasonable

compensation and related costs’’ means

all allowable costs of compensating

emergency room physicians who are on

call to the extent the costs are found to

be reasonable under the rules specified

in paragraph (b)(2) of this section and

the applicable sections of Part 413.

Costs of compensating emergency room

physicians are allowable only if the

costs are incurred under written

contracts that require the physician to

come to the CAH when the physician’s

presence is medically required.

(B) An ‘‘emergency room physician

who is on call’ means a doctor of

medicine or osteopathy with training or

experience in emergency care who is

immediately available by telephone or

radio contact, and is available on site

within the timeframes specified in

§ 485.618(d) of this chapter.

(5) Costs of ambulance services. (i)

Effective for services furnished on or

after December 21, 2000, payment for

ambulance services furnished by a CAH

or an entity that is owned and operated

by a CAH is the reasonable costs of the

CAH or the entity in furnishing those

services, but only if the CAH or the

entity is the only provider or supplier of

ambulance services located within a 35-

mile drive of the CAH or the entity.

(ii) For purposes of paragraph (b)(5) of

this section, the distance between the

CAH or the entity and the other

provider or supplier of ambulance

services will be determined as the

shortest distance in miles measured

over improved roads between the CAH

or the entity and the site at which the

vehicles of the closest provider or

supplier of ambulance services are

garaged. An improved road for this

purpose is any road that is maintained

by a local, State, or Federal government

entity and is available for use by the

general public. An improved road will

be considered to include the paved

surface up to the front entrance of the

hospital and the front entrance of the

garage.

(6) If a CAH meets the criteria in

§ 412.113(c) of this subchapter for passthrough of costs of anesthesia services

furnished by nonphysician anesthetists

employed by the CAH or obtained under

arrangement, payment to the CAH for

the costs of those services is made in

accordance with § 412.113(c).

* * * * *

3. Section 413.86 is amended as

follows:

a. Paragraph (e)(4)(ii)(C)(1) is revised.

b. Paragraph (e)(5)(iv) is removed.

c. Paragraph (g)(4) is revised.

d. Paragraph (g)(5) is revised.

e. Paragraph (g)(8) is revised.

§ 413.86 Direct graduate medical

education payments.

* * * * *

(e) Determining per residents amounts

for the base period. ***

(4) * * *

(ii) * * *

(C) Determining necessary revisions to

the per resident amount. ***

(1) Floor. (i) For cost reporting periods

beginning on or after October 1, 2000,

and before October 1, 2001, if the

hospital’s per resident amount would

otherwise be less than 70 percent of the

locality-adjusted national average per

resident amount for FY 2001 (as

determined under paragraph (e)(4)(ii)(B)

of this section), the per resident amount

is equal to 70 percent of the localityadjusted national average per resident

amount for FY 2001.

(ii) For cost reporting periods

beginning on or after October 1, 2001,

and before October 1, 2002, if the

hospital’s per resident amount would

otherwise be less than 85 percent of the

locality-adjusted national average per

resident amount for FY 2002 (as

determined under paragraph (e)(4)(ii)(B)

of this section), the per resident amount

is equal to 85 percent of the localityadjusted national average per resident

amount for FY 2002.

(iii) For subsequent cost reporting

periods beginning on or after October 1,

2002, the hospital’s per resident amount

is updated using the methodology

specified under paragraph (e)(3)(i) of

this section.

* * * * *

(g) Determining the weighted number

of FTE residents. ***

(4) For purposes of determining direct

graduate medical education payments—

(i) For cost reporting periods

beginning on or after October 1, 1997, a

hospital’s unweighted FTE count for

residents in allopathic and osteopathic

medicine may not exceed the hospital’s

unweighted FTE count (or, effective for

cost reporting periods beginning on or

after April 1, 2000, 130 percent of the

unweighted FTE count for a hospital

located in a rural area) for these

residents for the most recent cost

reporting period ending on or before

December 31, 1996.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22723

(ii) If a hospital’s number of FTE

residents in a cost reporting period

beginning on or after October 1, 1997,

and before October 1, 2001, exceeds the

limit described in this paragraph (g), the

hospital’s total weighted FTE count

(before application of the limit) will be

reduced in the same proportion that the

number of FTE residents for that cost

reporting period exceeds the number of

FTE residents for the most recent cost

reporting period ending on or before

December 31, 1996.

(iii) If the hospital’s number of FTE

residents in a cost reporting period

beginning on or after October 1, 2001

exceeds the limit described in this

paragraph (g), the hospital’s weighted

FTE count (before application of the

limit), for primary care and obstetrics

and gynecology residents and

nonprimary care residents, respectively,

will be reduced in the same proportion

that the number of FTE residents for

that cost reporting period exceeds the

number of FTE residents for the most

recent cost reporting period ending on

or before December 31, 1996.

(iv) Hospitals that are part of the same

affiliated group may elect to apply the

limit on an aggregate basis.

(v) The fiscal intermediary may make

appropriate modifications to apply the

provisions of this paragraph (g)(4) based

on the equivalent of a 12-month cost

reporting period.

(5) For purposes of determining direct

graduate medical education payment—

(i) For the hospital’s first cost

reporting period beginning on or after

October 1, 1997, the hospital’s weighted

FTE count is equal to the average of the

weighted FTE count for the payment

year cost reporting period and the

preceding cost reporting period.

(ii) For cost reporting periods

beginning on or after October 1, 1998,

and before October 1, 2001, the

hospital’s weighted FTE count is equal

to the average of the weighted FTE

count for the payment year cost

reporting period and the preceding two

cost reporting periods.

(iii) For cost reporting periods

beginning on or after October 1, 2001,

the hospital’s weighted FTE count for

primary care and obstetrics and

gynecology residents is equal to the

average of the weighted primary care

and obstetrics and gynecology counts

for the payment year cost reporting

period and the preceding two cost

reporting periods, and the hospital’s

weighted FTE count for nonprimary

care residents is equal to the average of

the weighted nonprimary care FTE

counts for the payment year cost

reporting period and the preceding two

cost reporting periods.

(iv) The fiscal intermediary may make

appropriate modifications to apply the

provisions of this paragraph (g)(5) based

on the equivalent of 12-month cost

reporting periods.

(v) If a hospital qualifies for an

adjustment to the limit established

under paragraph (g)(4) of this section for

new medical residency programs

created under paragraph (g)(6) of this

section, the count of the residents

participating in new medical residency

training programs above the number

included in the hospital’s FTE count for

the cost reporting period ending during

calendar year 1996 is added after

applying the averaging rules in this

paragraph (g)(5) for a period of years.

Residents participating in new medical

residency training programs are

included in the hospital’s FTE count

before applying the averaging rules after

the period of years has expired. For

purposes of this paragraph (g)(5), the

period of years equals the minimum

accredited length for the type of

program. The period of years begins

when the first resident begins training.

* * * * *

(8) Closure of hospital or hospital

residency program. 

(i) Definitions. For purposes of this

paragraph (g)(8)—

(A) ‘‘Closure of a hospital’’ means the

hospital terminates its Medicare

agreement under the provisions of

§ 489.52 of this chapter.

(B) ‘‘Closure of a hospital residency

training program’’ means the hospital

ceases to offer training for residents in

a particular approved medical residency

training program.

(ii) Closure of a hospital. A hospital

may receive a temporary adjustment to

its FTE cap to reflect residents added

because of another hospital’s closure if

the hospital meets the following criteria:

(A) The hospital is training additional

residents from a hospital that closed on

or after July 1, 1996.

(B) No later than 60 days after the

hospital begins to train the residents,

the hospital submits a request to its

fiscal intermediary for a temporary

adjustment to its FTE cap, documents

that the hospital is eligible for this

temporary adjustment by identifying the

residents who have come from the

closed hospital and have caused the

hospital to exceed its cap, and specifies

the length of time the adjustment is

needed.

(iii) Closure of a hospital’s residency

training program. If a hospital that

closes its residency training program

voluntarily agrees to temporarily reduce

its FTE cap according to the criteria

specified in paragraph (g)(8)(iii)(B) of

this section, another hospital(s) may

receive a temporary adjustment to its

FTE cap to reflect residents added

because of the closure of the residency

training program if the criteria specified

in paragraph (g)(8)(iii)(A) of this section

are met.

(A) Receiving hospital(s). A hospital

may receive a temporary adjustment to

its FTE cap to reflect residents added

because of the closure of another

hospital’s residency training program

if—

(1) The hospital is training additional

residents from the residency training

program of a hospital that closed a

program; and

(2) No later than 60 days after the

hospital begins to train the residents,

the hospital submits to its fiscal

intermediary a request for a temporary

adjustment to its FTE cap, documents

that it is eligible for this temporary

adjustment by identifying the residents

who have come from another hospital’s

closed program and have caused the

hospital to exceed its cap, specifies the

length of time the adjustment is needed,

and submits to its fiscal intermediary a

copy of the FTE reduction statement by

the hospital that closed its program, as

specified in paragraph (g)(8)(iii)(B)(2) of

this section.

(B) Hospital that closed its

program(s). A hospital that agrees to

train residents who have been displaced

by the closure of another hospital’s

program may receive a temporary FTE

cap adjustment only if the hospital with

the closed program—

(1) Temporarily reduces its FTE cap

based on the FTE residents in each

program year training in the program at

the time of the program’s closure. This

yearly reduction in the FTE cap will be

determined based on the number of

those residents who would have been

training in the program during that year

had the program not closed; and

(2) No later than 60 days after the

residents who were in the closed

program begin training at another

hospital, submit to its fiscal

intermediary a statement signed and

dated by its representative that specifies

that it agrees to the temporary reduction

in its FTE cap to allow the hospital

training the displaced residents to

obtain a temporary adjustment to its

cap; identifies the residents who were in

training at the time of the program’s

closure; identifies the hospitals to

which the residents are transferring

once the program closes; and specifies

the reduction for the applicable program

years.

* * * * *

22724 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

PART 485—CONDITIONS OF

PARTICIPATION: SPECIALIZED

PROVIDERS

D. Part 485 is amended as follows:

1. The authority citation for part 485

continues to read as follows:

Authority: Secs. 1102 and 1871 of the Act

(42 U.S.C. 1302 and 1395hh).

2. Section 485.610 is amended by

revising paragraph (b) and adding a new

paragraph (c) to read as follows:

§ 485.610 Condition of participation:

Status and location.

* * * * *

(b) Standard: Location in a rural area

or treatment as rural. The CAH meets

the requirements of either paragraph

(b)(1) or (b)(2) of this section.

(1) The CAH meets the following

requirements:

(i) The CAH is located outside any

area that is a Metropolitan Statistical

Area, as defined by the Office of

Management and Budget, or that has

been recognized as urban under

§ 412.62(f) of this chapter;

(ii) The CAH is not deemed to be

located in an urban area under

§ 412.63(b) of this chapter; and

(iii) The CAH has not been classified

as an urban hospital for purposes of the

standardized payment amount by HCFA

or the Medicare Geographic

Classification Review Board under

§ 412.230(e) of this chapter, and is not

among a group of hospitals that have

been redesignated to an adjacent urban

area under § 412.232 of this chapter.

(2) The CAH is located within a

Metropolitan Statistical Area, as defined

by the Office of Management and

Budget, but is being treated as being

located in a rural area in accordance

with § 412.103 of this chapter.

(c) Standard: Location relative to

other facilities or necessary provider

certification. The CAH is located more

than a 35-mile drive (or, in the case of

mountainous terrain or in areas with

only secondary roads available, a 15-

mile drive) from a hospital or another

CAH, or the CAH is certified by the

State as being a necessary provider of

health care services to residents in the

area.

3. Section 485.639 is amended by

revising paragraph (b) to read as follows:

§ 485.639 Condition of participation:

Surgical services.

* * * * *

(b) Anesthetic risk and evaluation. (1)

A qualified practitioner, as specified in

paragraph (a) of this section, must

examine the patient immediately before

surgery to evaluate the risk of the

procedure to be performed.

(2) A qualified practitioner, as

specified in paragraph (c) of this

section, must examine each patient

before surgery to evaluate the risk of

anesthesia.

(3) Before discharge from the CAH,

each patient must be evaluated for

proper anesthesia recovery by a

qualified practitioner, as specified in

paragraph (c) of this section.

* * * * *

4. Section 485.643 is amended by

revising paragraph (f) to read as follows:

§ 485.643 Condition of participation:

Organ, tissue, and eye procurement.

* * * * *

(f) For purposes of these standards,

the term ‘‘organ’’ means a human

kidney, liver, heart, lung, pancreas, or

intestines (or multivisceral organs).

PART 486—CONDITIONS FOR

COVERAGE OF SPECIALIZED

SERVICES FURNISHED BY

SUPPLIERS

F. Part 486 is amended as follows:

1. The authority citation for Part 486

continues to read as follows:

Authority: Sections 1102 and 1871 of the

Social Security Act (42 U.S.C. 1302 and

1395hh).

2. Section 486.302 is amended by

revising the definition of ‘‘organ’’ to

read as follows:

§ 486.302 Definitions.

* * * * *

‘‘Organ’’ means a human kidney,

liver, heart, lung, pancreas, or intestines

(or multivisceral organs).

* * * * *

(Catalog of Federal Domestic Assistance

Program No. 93.773, Medicare—Hospital

Insurance; and Program No. 93.774,

Medicare—Supplementary Medical

Insurance Program)

Dated: March 15, 2001.

Michael McMullan,

Acting Deputy Administrator, Health Care

Financing Administration.

Dated: April 3, 2001.

Tommy G. Thompson,

Secretary.

Editorial Note: The following Addendum

and appendixes will not appear in the Code

of Federal Regulations.

Addendum—Proposed Schedule of

Standardized Amounts Effective With

Discharges Occurring On or After

October 1, 2001 and Update Factors

and Rate-of-Increase Percentages

Effective With Cost Reporting Periods

Beginning On or After October 1, 2001

I. Summary and Background

In this Addendum, we are setting

forth the proposed amounts and factors

for determining prospective payment

rates for Medicare inpatient operating

costs and Medicare inpatient capitalrelated costs. We are also setting forth

proposed rate-of-increase percentages

for updating the target amounts for

hospitals and hospital units excluded

from the prospective payment system.

For discharges occurring on or after

October 1, 2001, except for SCHs,

MDHs, and hospitals located in Puerto

Rico, each hospital’s payment per

discharge under the prospective

payment system will be based on 100

percent of the Federal national rate.

SCHs are paid based on whichever of

the following rates yields the greatest

aggregate payment: the Federal national

rate, the updated hospital-specific rate

based on FY 1982 cost per discharge,

the updated hospital-specific rate based

on FY 1987 cost per discharge, or, if

qualified, 50 percent of the updated

hospital-specific rate based on FY 1996

cost per discharge, plus the greater of 50

percent of the updated FY 1982 or FY

1987 hospital-specific rate or 50 percent

of the Federal DRG payment rate.

Section 213 of Public Law 106–554

amended section 1886(b)(3) of the Act to

allow all SCHs to rebase their hospitalspecific rate based on their FY 1996 cost

per discharge.

Under section 1886(d)(5)(G) of the

Act, MDHs are paid based on the

Federal national rate or, if higher, the

Federal national rate plus 50 percent of

the difference between the Federal

national rate and the updated hospitalspecific rate based on FY 1982 or FY

1987 cost per discharge, whichever is

higher.

For hospitals in Puerto Rico, the

payment per discharge is based on the

sum of 50 percent of a Puerto Rico rate

and 50 percent of a Federal national

rate. (See section II.D.3. of this

Addendum for a complete description.)

As discussed below in section II. of

this Addendum, we are proposing to

make changes in the determination of

the prospective payment rates for

Medicare inpatient operating costs for

FY 2002. The changes, to be applied

prospectively, would affect the

calculation of the Federal rates. In

section III. of this Addendum, we

discuss our proposed changes for

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22725

determining the prospective payment

rates for Medicare inpatient capitalrelated costs for FY 2002. Section IV. of

this Addendum sets forth our proposed

changes for determining the rate-ofincrease limits for hospitals excluded

from the prospective payment system

for FY 2002. The tables to which we

refer in the preamble to this proposed

rule are presented at the end of this

Addendum in section V.

II. Proposed Changes to Prospective

Payment Rates for Inpatient Operating

Costs for FY 2002

The basic methodology for

determining prospective payment rates

for inpatient operating costs is set forth

at § 412.63. The basic methodology for

determining the prospective payment

rates for inpatient operating costs for

hospitals located in Puerto Rico is set

forth at §§ 412.210 and 412.212. Below,

we discuss the proposed factors used for

determining the prospective payment

rates. The Federal and Puerto Rico rate

changes, once issued as final, will be

effective with discharges occurring on

or after October 1, 2001.

In summary, the proposed

standardized amounts set forth in

Tables 1A and 1C of section V. of this

Addendum reflect—

• Updates of 2.55 percent for all areas

(that is, the market basket percentage

increase of 3.1 percent minus 0.55

percentage points);

• An adjustment to ensure budget

neutrality of hospital geographic

reclassification, as provided for under

sections 1886(d)(4)(C)(iii) and (d)(3)(E)

of the Act, by applying new budget

neutrality adjustment factors to the large

urban and other standardized amounts;

• An adjustment to ensure budget

neutrality as provided for in section

1886(d)(8)(D) of the Act by removing the

FY 2001 budget neutrality factor and

applying a revised factor;

• An adjustment to apply the revised

outlier offset by removing the FY 2001

outlier offsets and applying a new offset;

and

• An adjustment in the Puerto Rico

standardized amounts to reflect the

application of a Puerto Rico-specific

wage index.

A. Calculation of Adjusted

Standardized Amounts

1. Standardization of Base-Year Costs or

Target Amounts

Section 1886(d)(2)(A) of the Act

required the establishment of base-year

cost data containing allowable operating

costs per discharge of inpatient hospital

services for each hospital. The preamble

to the September 1, 1983 interim final

rule (48 FR 39763) contains a detailed

explanation of how base-year cost data

were established in the initial

development of standardized amounts

for the prospective payment system and

how they are used in computing the

Federal rates.

Section 1886(d)(9)(B)(i) of the Act

required us to determine the Medicare

target amounts for each hospital located

in Puerto Rico for its cost reporting

period beginning in FY 1987. The

September 1, 1987 final rule (52 FR

33043, 33066) contains a detailed

explanation of how the target amounts

were determined and how they are used

in computing the Puerto Rico rates.

The standardized amounts are based

on per discharge averages of adjusted

hospital costs from a base period or, for

Puerto Rico, adjusted target amounts

from a base period, updated and

otherwise adjusted in accordance with

the provisions of section 1886(d) of the

Act. Sections 1886(d)(2)(B) and (d)(2)(C)

of the Act required us to update baseyear per discharge costs for FY 1984 and

then standardize the cost data in order

to remove the effects of certain sources

of cost variations among hospitals.

These effects include case-mix,

differences in area wage levels, cost-ofliving adjustments for Alaska and

Hawaii, indirect medical education

costs, and payments to hospitals serving

a disproportionate share of low-income

patients.

Under sections 1886(d)(2)(H) and

(d)(3)(E) of the Act, in making payments

under the prospective payment system,

the Secretary estimates from time to

time the proportion of costs that are

wages and wage-related costs. Since

October 1, 1997, when the market basket

was last revised, we have considered

71.1 percent of costs to be labor-related

for purposes of the prospective payment

system. The average labor share in

Puerto Rico is 71.3 percent. We are

proposing to revise the dischargeweighted national standardized amount

for Puerto Rico to reflect the proportion

of discharges in large urban and other

areas from the FY 2000 MedPAR file.

2. Computing Large Urban and Other

Area Averages

Sections 1886(d)(2)(D) and (d)(3) of

the Act require the Secretary to compute

two average standardized amounts for

discharges occurring in a fiscal year: one

for hospitals located in large urban areas

and one for hospitals located in other

areas. In addition, under sections

1886(d)(9)(B)(iii) and (d)(9)(C)(i) of the

Act, the average standardized amount

per discharge must be determined for

hospitals located in large urban and

other areas in Puerto Rico. Hospitals in

Puerto Rico are paid a blend of 50

percent of the applicable Puerto Rico

standardized amount and 50 percent of

a national standardized payment

amount.

Section 1886(d)(2)(D) of the Act

defines ‘‘urban area’’ as those areas

within a Metropolitan Statistical Area

(MSA). A ‘‘large urban area’’ is defined

as an urban area with a population of

more than 1 million. In addition, section

4009(i) of Public Law 100–203 provides

that a New England County

Metropolitan Area (NECMA) with a

population of more than 970,000 is

classified as a large urban area. As

required by section 1886(d)(2)(D) of the

Act, population size is determined by

the Secretary based on the latest

population data published by the

Bureau of the Census. Urban areas that

do not meet the definition of a ‘‘large

urban area’’ are referred to as ‘‘other

urban areas.’’ Areas that are not

included in MSAs are considered ‘‘rural

areas’’ under section 1886(d)(2)(D) of

the Act. Payment for discharges from

hospitals located in large urban areas

will be based on the large urban

standardized amount. Payment for

discharges from hospitals located in

other urban and rural areas will be

based on the other standardized

amount.

Based on 1999 population estimates

published by the Bureau of the Census,

63 areas meet the criteria to be defined

as large urban areas for FY 2002. These

areas are identified in Table 4A.

3. Updating the Average Standardized

Amounts

Under section 1886(d)(3)(A) of the

Act, we update the average standardized

amounts each year. In accordance with

section 1886(d)(3)(A)(iv) of the Act, we

are proposing to update the large urban

areas’ and the other areas’ average

standardized amounts for FY 2002 using

the applicable percentage increases

specified in section 1886(b)(3)(B)(i) of

the Act. Section 1886(b)(3)(B)(i)(XVII) of

the Act as amended by section 301 of

Public Law 106–554 specifies that the

update factor for the standardized

amounts for FY 2002 is equal to the

market basket percentage increase

minus 0.55 percentage points for

hospitals in all areas. Section 301 also

established that the update factor for FY

2003 is equal to the market basket

percentage increase minus 0.55

percentage points. We are proposing to

revise § 412.63 to reflect these changes.

The percentage change in the market

basket reflects the average change in the

price of goods and services purchased

by hospitals to furnish inpatient care.

The most recent forecast of the hospital

22726 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

market basket increase for FY 2002 is

3.1 percent. Thus, for FY 2002, the

proposed update to the average

standardized amounts equals 2.55

percent for hospitals in all areas.

As in the past, we are adjusting the

FY 2001 standardized amounts to

remove the effects of the FY 2001

geographic reclassifications and outlier

payments before applying the FY 2002

updates. That is, we are increasing the

standardized amounts to restore the

reductions that were made for the

effects of geographic reclassification and

outliers. We then apply the new offsets

to the standardized amounts for outliers

and geographic reclassifications for FY

2002.

Although the update factors for FY

2002 are set by law, we are required by

section 1886(e)(3) of the Act to report to

the Congress our initial

recommendation of update factors for

FY 2002 for both prospective payment

hospitals and hospitals excluded from

the prospective payment system. For

general information purposes, we have

included the report to Congress as

Appendix C to this proposed rule. Our

proposed recommendation on the

update factors (which is required by

sections 1886(e)(4)(A) and (e)(5)(A) of

the Act) is set forth as Appendix D to

this proposed rule.

4. Other Adjustments to the Average

Standardized Amounts

a. Recalibration of DRG Weights and

Updated Wage Index—Budget

Neutrality Adjustment. Section

1886(d)(4)(C)(iii) of the Act specifies

that, beginning in FY 1991, the annual

DRG reclassification and recalibration of

the relative weights must be made in a

manner that ensures that aggregate

payments to hospitals are not affected.

As discussed in section II. of the

preamble, we normalized the

recalibrated DRG weights by an

adjustment factor, so that the average

case weight after recalibration is equal

to the average case weight prior to

recalibration.

Section 1886(d)(3)(E) of the Act

requires us to update the hospital wage

index on an annual basis beginning

October 1, 1993. This provision also

requires us to make any updates or

adjustments to the wage index in a

manner that ensures that aggregate

payments to hospitals are not affected

by the change in the wage index.

To comply with the requirement of

section 1886(d)(4)(C)(iii) of the Act that

DRG reclassification and recalibration of

the relative weights be budget neutral,

and the requirement in section

1886(d)(3)(E) of the Act that the updated

wage index be budget neutral, we used

FY 2000 discharge data to simulate

payments and compared aggregate

payments using the FY 2001 relative

weights and wage index to aggregate

payments using the proposed FY 2002

relative weights and wage index. The

same methodology was used for the FY

2001 budget neutrality adjustment. (See

the discussion in the September 1, 1992

final rule (57 FR 39832).) Based on this

comparison, we computed a budget

neutrality adjustment factor equal to

0.992493. We also adjust the Puerto

Rico-specific standardized amounts for

the effect of DRG reclassification and

recalibration. We computed a budget

neutrality adjustment factor for Puerto

Rico-specific standardized amounts

equal to 0.994677. These budget

neutrality adjustment factors are applied

to the standardized amounts without

removing the effects of the FY 2001

budget neutrality adjustments. We do

not remove the prior budget neutrality

adjustment because estimated aggregate

payments after the changes in the DRG

relative weights and wage index should

equal estimated aggregate payments

prior to the changes. If we removed the

prior year adjustment, we would not

satisfy this condition.

In addition, we are proposing to apply

these same adjustment factors to the

hospital-specific rates that are effective

for cost reporting periods beginning on

or after October 1, 2001. (See the

discussion in the September 4, 1990

final rule (55 FR 36073).)

b. Reclassified Hospitals—Budget

Neutrality Adjustment. Section

1886(d)(8)(B) of the Act provides that,

effective with discharges occurring on

or after October 1, 1988, certain rural

hospitals are deemed urban. In addition,

section 1886(d)(10) of the Act provides

for the reclassification of hospitals

based on determinations by the

Medicare Geographic Classification

Review Board (MGCRB). Under section

1886(d)(10) of the Act, a hospital may be

reclassified for purposes of the

standardized amount or the wage index,

or both.

Under section 1886(d)(8)(D) of the

Act, the Secretary is required to adjust

the standardized amounts so as to

ensure that aggregate payments under

the prospective payment system after

implementation of the provisions of

sections 1886(d)(8)(B) and (C) and

1886(d)(10) of the Act are equal to the

aggregate prospective payments that

would have been made absent these

provisions. To calculate this budget

neutrality factor, we used FY 2000

discharge data to simulate payments,

and compared total prospective

payments (including indirect medical

education and disproportionate share

hospital payments) prior to any

reclassifications to total prospective

payments after reclassifications. Based

on these simulations, we are applying

an adjustment factor of 0.991054 to

ensure that the effects of reclassification

are budget neutral.

The adjustment factor is applied to

the standardized amounts after

removing the effects of the FY 2001

budget neutrality adjustment factor. We

note that the proposed FY 2002

adjustment reflects wage index and

standardized amount reclassifications

approved by the MGCRB or the

Administrator as of February 28, 2001,

and the effects of section 304 of Public

Law 106–554 to extend wage index

reclassifications for 3 years. The effects

of any additional reclassification

changes resulting from appeals and

reviews of the MGCRB decisions for FY

2002 or from a hospital’s request for the

withdrawal of a reclassification request

will be reflected in the final budget

neutrality adjustment published in the

final rule for FY 2002.

c. Outliers. Section 1886(d)(5)(A) of

the Act provides for payments in

addition to the basic prospective

payments for ‘‘outlier’’ cases, cases

involving extraordinarily high costs

(cost outliers). Section 1886(d)(3)(B) of

the Act requires the Secretary to adjust

both the large urban and other area

national standardized amounts by the

same factor to account for the estimated

proportion of total DRG payments made

to outlier cases. Similarly, section

1886(d)(9)(B)(iv) of the Act requires the

Secretary to adjust the large urban and

other standardized amounts applicable

to hospitals in Puerto Rico to account

for the estimated proportion of total

DRG payments made to outlier cases.

Furthermore, under section

1886(d)(5)(A)(iv) of the Act, outlier

payments for any year must be projected

to be not less than 5 percent nor more

than 6 percent of total payments based

on DRG prospective payment rates.

i. FY 2002 outlier thresholds. For FY

2001, the fixed loss cost outlier

threshold was equal to the prospective

payment rate for the DRG plus the IME

and DSH payments plus $17,550 (16,036

for hospitals that have not yet entered

the prospective payment system for

capital-related costs). The marginal cost

factor for cost outliers (the percent of

costs paid after costs for the case exceed

the threshold) was 80 percent. We

applied an outlier adjustment to the FY

2001 standardized amounts of 0.948908

for the large urban and other areas rates

and 0.9409 for the capital Federal rate.

For FY 2002, we propose to establish

a fixed loss cost outlier threshold equal

to the prospective payment rate for the

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22727

DRG plus the IME and DSH payments

plus $21,000. The capital prospective

payment system is fully phased in,

effective FY 2002. Therefore, we no

longer are establishing a separate

threshold for hospitals that have not yet

entered the prospective payment system

for capital-related costs. We propose to

maintain the marginal cost factor for

cost outliers at 80 percent.

To calculate FY 2002 outlier

thresholds, we simulated payments by

applying FY 2002 rates and policies to

the December 2000 update of the FY

2000 MedPAR file and the December

2000 update of the provider-specific

file. As we have explained in the past,

to calculate outlier thresholds, we apply

a cost inflation factor to update costs for

the cases used to simulate payments.

For FY 2000, we used a cost inflation

factor of zero percent. For FY 2001, we

used a cost inflation factor (or cost

adjustment factor) of 1.8 percent. To set

the proposed FY 2002 outlier

thresholds, we are using a 2-year cost

inflation factor of 5.5 percent (to inflate

FY 2000 charges to FY 2002). This factor

reflects our analysis of the best available

cost report data as well as calculations

(using the best available data) indicating

that the percentage of actual outlier

payments for FY 2000 is higher than we

projected before the beginning of FY

2000, and that the percentage of actual

outlier payments for FY 2001 will likely

be higher than we projected before the

beginning of FY 2001. The calculations

of ‘‘actual’’ outlier payments are

discussed further below.

ii. Other changes concerning outliers.

In accordance with section

1886(d)(5)(A)(iv) of the Act, we

calculated proposed outlier thresholds

so that outlier payments are projected to

equal 5.1 percent of total payments

based on DRG prospective payment

rates. In accordance with section

1886(d)(3)(E), we reduced the proposed

FY 2002 standardized amounts by the

same percentage to account for the

projected proportion of payments paid

to outliers.

As stated in the September 1, 1993

final rule (58 FR 46348), we establish

outlier thresholds that are applicable to

both inpatient operating costs and

inpatient capital-related costs. When we

modeled the combined operating and

capital outlier payments, we found that

using a common set of thresholds

resulted in a higher percentage of outlier

payments for capital-related costs than

for operating costs. We project that the

proposed thresholds for FY 2002 will

result in outlier payments equal to 5.1

percent of operating DRG payments and

5.7 percent of capital payments based

on the Federal rate.

The proposed outlier adjustment

factors to be applied to the standardized

amounts for FY 2002 are as follows:

Operating

standardized

amounts

Capital federal rate

National ............. 0.948910 0.974711

Puerto Rico ....... 0.942593 0.970336

We apply the proposed outlier

adjustment factors after removing the

effects of the FY 2001 outlier adjustment

factors on the standardized amounts.

Table 8A in section V. of this

Addendum contains the updated

Statewide average operating cost-tocharge ratios for urban hospitals and for

rural hospitals to be used in calculating

cost outlier payments for those hospitals

for which the fiscal intermediary is

unable to compute a reasonable

hospital-specific cost-to-charge ratio.

These Statewide average ratios would

replace the ratios published in the

August 1, 2000 final rule (65 FR 47054).

Table 8B contains comparable statewide

average capital cost-to-charge ratios.

These average ratios would be used to

calculate cost outlier payments for those

hospitals for which the fiscal

intermediary computes operating costto-charge ratios lower than 0.1908357 or

greater than 1.3133937 and capital costto-charge ratios lower than 0.0120498 or

greater than 0.1668928. This range

represents 3.0 standard deviations (plus

or minus) from the mean of the log

distribution of cost-to-charge ratios for

all hospitals. We note that the cost-tocharge ratios in Tables 8A and 8B would

be used during FY 2002 when hospitalspecific cost-to-charge ratios based on

the latest settled cost report are either

not available or outside the three

standard deviations range.

iii. FY 2000 and FY 2001 outlier

payments. In the August 1, 2000 final

rule (65 FR 47054), we stated that, based

on available data, we estimated that

actual FY 2000 outlier payments would

be approximately 6.2 percent of actual

total DRG payments. This was

computed by simulating payments using

the March 2000 update of the FY 1999

bill data available at the time. That is,

the estimate of actual outlier payments

did not reflect actual FY 2000 bills but

instead reflected the application of FY

2000 rates and policies to available FY

1999 bills. Our current estimate, using

available FY 2000 bills, is that actual

outlier payments for FY 2000 were

approximately 7.4 percent of actual total

DRG payments. We note that the

MedPAR file for FY 2000 discharges

continues to be updated. Thus, the data

indicate that, for FY 2000, the

percentage of actual outlier payments

relative to actual total payments is

higher than we projected before FY 2000

(and thus exceeds the percentage by

which we reduced the standardized

amounts for FY 2000). In fact, the data

indicate that the proportion of actual

outlier payments for FY 2000 exceeds

6.0 percent. Nevertheless, consistent

with the policy and statutory

interpretation we have maintained since

the inception of the prospective

payment system, we do not plan to

recoup money and make retroactive

adjustments to outlier payments for FY

2000.

We currently estimate that actual

outlier payments for FY 2001 will be

approximately 5.9 percent of actual total

DRG payments, 0.8 percent higher than

the 5.1 percent we projected in setting

outlier policies for FY 2001. This

estimate is based on simulations using

the December 2000 update of the

provider-specific file and the December

2000 update of the FY 2000 MedPAR

file (discharge data for FY 2000 bills).

We used these data to calculate an

estimate of the actual outlier percentage

for FY 2001 by applying FY 2001 rates

and policies to available FY 2000 bills.

5. FY 2002 Standardized Amounts

The adjusted standardized amounts

are divided into labor and nonlabor

portions. Table 1A contains the two

national standardized amounts that we

are proposing to be applicable to all

hospitals, except hospitals in Puerto

Rico. Under section 1886(d)(9)(A)(ii) of

the Act, the Federal portion of the

Puerto Rico payment rate is based on

the discharge-weighted average of the

national large urban standardized

amount and the national other

standardized amount (as set forth in

Table 1A). The labor and nonlabor

portions of the national average

standardized amounts for Puerto Rico

hospitals are set forth in Table 1C. This

table also includes the Puerto Rico

standardized amounts.

B. Adjustments for Area Wage Levels

and Cost of Living

Tables 1A and 1C, as set forth in this

Addendum, contain the proposed laborrelated and nonlabor-related shares that

would be used to calculate the

prospective payment rates for hospitals

located in the 50 States, the District of

Columbia, and Puerto Rico. This section

addresses two types of adjustments to

the standardized amounts that are made

in determining the prospective payment

rates as described in this Addendum.

22728 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

1. Adjustment for Area Wage Levels

Sections 1886(d)(3)(E) and

1886(d)(9)(C)(iv) of the Act require that

we make an adjustment to the laborrelated portion of the prospective

payment rates to account for area

differences in hospital wage levels. This

adjustment is made by multiplying the

labor-related portion of the adjusted

standardized amounts by the

appropriate wage index for the area in

which the hospital is located. In section

III. of this preamble, we discuss the data

and methodology for the proposed FY

2002 wage index. The proposed wage

index is set forth in Tables 4A, 4B, 4C,

and 4F of this Addendum.

2. Adjustment for Cost-of-Living in

Alaska and Hawaii

Section 1886(d)(5)(H) of the Act

authorizes an adjustment to take into

account the unique circumstances of

hospitals in Alaska and Hawaii. Higher

labor-related costs for these two States

are taken into account in the adjustment

for area wages described above. For FY

2002, we propose to adjust the

payments for hospitals in Alaska and

Hawaii by multiplying the nonlabor

portion of the standardized amounts by

the appropriate adjustment factor

contained in the table below. If the

Office of Personnel Management

releases revised cost-of-living

adjustment factors before July 1, 2001,

we will publish them in the final rule

and use them in determining FY 2002

payments.

TABLE OF COST-OF-LIVING ADJUSTMENT FACTORS, ALASKA AND HAWAII

HOSPITALS

Alaska—All areas ..................... 1.25

Hawaii:

County of Honolulu ............... 1.1650

County of Hawaii ................... 1.2325

County of Kauai .................... 1.2325

County of Maui ...................... 1.2375

County of Kalawao ................ 1.2375

(The above factors are based on data obtained from the U.S. Office of Personnel

Management.)

C. DRG Relative Weights

As discussed in section II. of the

preamble, we have developed a

classification system for all hospital

discharges, assigning them into DRGs,

and have developed relative weights for

each DRG that reflect the resource

utilization of cases in each DRG relative

to Medicare cases in other DRGs. Table

5 of section V. of this Addendum

contains the relative weights that we are

proposing to use for discharges

occurring in FY 2002. These factors

have been recalibrated as explained in

section II. of the preamble.

D. Calculation of Prospective Payment

Rates for FY 2002

General Formula for Calculation of

Prospective Payment Rates for FY 2002

The prospective payment rate for all

hospitals located outside of Puerto Rico,

except SCHs and MDHs, equals the

Federal rate.

The prospective payment rate for

SCHs equals whichever of the following

rates yields the greatest aggregate

payment: the Federal national rate, the

updated hospital-specific rate based on

FY 1982 cost per discharge, the updated

hospital-specific rate based on FY 1987

cost per discharge, or, if qualified, 50

percent of the updated hospital-specific

rate based on FY 1996 cost per

discharge, plus the greater of 50 percent

of the updated FY 1982 or FY 1987

hospital-specific rate or 50 percent of

the Federal DRG payment rate. Section

213 of Public Law 106–554 amended

section 1886(b)(3) of the Act to allow all

SCHs to rebase their hospital-specific

rate based on their FY 1996 cost per

discharge.

The prospective payment rate for

MDHs equals 100 percent of the Federal

rate, or, if the greater of the updated FY

1982 hospital-specific rate or the

updated FY 1987 hospital-specific rate

is higher than the Federal rate, 100

percent of the Federal rate plus 50

percent of the difference between the

applicable hospital-specific rate and the

Federal rate.

The prospective payment rate for

Puerto Rico equals 50 percent of the

Puerto Rico rate plus 50 percent of a

discharge-weighted average of the

national large urban standardized

amount and the Federal national other

standardized amount.

1. Federal Rate

For discharges occurring on or after

October 1, 2001 and before October 1,

2002, except for SCHs, MDHs, and

hospitals in Puerto Rico, the hospital’s

payment is based exclusively on the

Federal national rate.

The payment amount is determined as

follows:

Step 1—Select the appropriate

national standardized amount

considering the type of hospital and

designation of the hospital as large

urban or other (see Table 1A in section

V. of this Addendum).

Step 2—Multiply the labor-related

portion of the standardized amount by

the applicable wage index for the

geographic area in which the hospital is

located (see Tables 4A, 4B, and 4C of

section V. of this Addendum).

Step 3—For hospitals in Alaska and

Hawaii, multiply the nonlabor-related

portion of the standardized amount by

the appropriate cost-of-living

adjustment factor.

Step 4—Add the amount from Step 2

and the nonlabor-related portion of the

standardized amount (adjusted, if

appropriate, under Step 3).

Step 5—Multiply the final amount

from Step 4 by the relative weight

corresponding to the appropriate DRG

(see Table 5 of section V. of this

Addendum).

2. Hospital-Specific Rate (Applicable

Only to SCHs and MDHs)

Section 1886(b)(3)(C) of the Act

provides that SCHs are paid based on

whichever of the following rates yields

the greatest aggregate payment: the

Federal national rate, the updated

hospital-specific rate based on FY 1982

cost per discharge, the updated hospitalspecific rate based on FY 1987 cost per

discharge, or, if qualified, 50 percent of

the updated hospital-specific rate based

on FY 1996 cost per discharge, plus the

greater of 50 percent of the updated FY

1982 or FY 1987 hospital-specific rate or

50 percent of the Federal DRG payment

rate.

Section 1886(d)(5)(G) of the Act

provides that MDHs are paid based on

whichever of the following rates yields

the greatest aggregate payment: the

Federal rate or the Federal rate plus 50

percent of the difference between the

Federal rate and the greater of the

updated hospital-specific rate based on

FY 1982 and FY 1987 cost per

discharge.

Hospital-specific rates have been

determined for each of these hospitals

based on either the FY 1982 cost per

discharge, the FY 1987 cost per

discharge or, for qualifying SCHs, the

FY 1996 cost per discharge. For a more

detailed discussion of the calculation of

the hospital-specific rates, we refer the

reader to the September 1, 1983 interim

final rule (48 FR 39772); the April 20,

1990 final rule with comment (55 FR

15150); the September 4, 1990 final rule

(55 FR 35994); and the August 1, 2000

final rule (65 FR 47082).

a. Updating the FY 1982, FY 1987,

and FY 1996 Hospital-Specific Rates for

FY 2002. We are proposing to increase

the hospital-specific rates by 2.55

percent (the hospital market basket

percentage increase minus 0.55

percentage points) for SCHs and MDHs

for FY 2002. Section 1886(b)(3)(C)(iv) of

the Act provides that the update factor

applicable to the hospital-specific rates

for SCHs equal the update factor

provided under section 1886(b)(3)(B)(iv)

of the Act, which, for SCHs in FY 2002,

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22729

is the market basket rate of increase

minus 0.55 percentage points. Section

1886(b)(3)(D) of the Act provides that

the update factor applicable to the

hospital-specific rates for MDHs equals

the update factor provided under

section 1886(b)(3)(B)(iv) of the Act,

which, for FY 2002, is the market basket

rate of increase minus 0.55 percentage

points.

b. Calculation of Hospital-Specific

Rate. For SCHs, the applicable FY 2002

hospital-specific rate would be based on

the following: the hospital-specific rate

calculated using the greater of the FY

1982 or FY 1987 costs, increased by the

applicable update factor of 2.55 percent;

or, if the hospital-specific rate based on

cost per case in FY 1996 is greater than

the hospital-specific rate using either

the FY 1982 or the FY 1987 costs, the

greater of 50 percent of the hospitalspecific rate based on the FY 1982 or FY

1987 costs, increased by the applicable

update factor, or 50 percent of the

Federal rate plus 50 percent of its

rebased FY 1996 hospital-specific rate

updated through FY 2002. For MDHs,

the applicable FY 2002 hospital-specific

rate would be calculated by increasing

the hospital’s hospital-specific rate for

the preceding fiscal year by the

applicable update factor of 2.55 percent,

which is the same as the update for all

prospective payment hospitals. In

addition, for both SCHs and MDHs, the

hospital-specific rate would be adjusted

by the budget neutrality adjustment

factor (that is, by 0.992493) as discussed

in section II.A.4.a. of this Addendum.

The resulting rate is used in

determining the payment under which

rate an SCH or a MDH is paid for its

discharges beginning on or after October

1, 2001.

3. General Formula for Calculation of

Prospective Payment Rates for Hospitals

Located in Puerto Rico Beginning On or

After October 1, 2001 and Before

October 1, 2002

a. Puerto Rico Rate. The Puerto Rico

prospective payment rate is determined

as follows:

Step 1—Select the appropriate

adjusted average standardized amount

considering the large urban or other

designation of the hospital (see Table 1C

of section V. of the Addendum).

Step 2—Multiply the labor-related

portion of the standardized amount by

the appropriate Puerto Rico-specific

wage index (see Table 4F of section V.

of the Addendum).

Step 3—Add the amount from Step 2

and the nonlabor-related portion of the

standardized amount.

Step 4—Multiply the result in Step 3

by 50 percent.

Step 5—Multiply the amount from

Step 4 by the appropriate DRG relative

weight (see Table 5 of section V. of the

Addendum).

b. National Rate. The national

prospective payment rate is determined

as follows:

Step 1—Multiply the labor-related

portion of the national average

standardized amount (see Table 1C of

section V. of the Addendum) by the

appropriate national wage index (see

Tables 4A and 4B of section V. of the

Addendum).

Step 2—Add the amount from Step 1

and the nonlabor-related portion of the

national average standardized amount.

Step 3—Multiply the result in Step 2

by 50 percent.

Step 4—Multiply the amount from

Step 3 by the appropriate DRG relative

weight (see Table 5 of section V. of the

Addendum).

The sum of the Puerto Rico rate and

the national rate computed above equals

the prospective payment for a given

discharge for a hospital located in

Puerto Rico.

III. Proposed Changes to Payment Rates

for Inpatient Capital-Related Costs for

FY 2002

The prospective payment system for

hospital inpatient capital-related costs

was implemented for cost reporting

periods beginning on or after October 1,

1991. Effective with that cost reporting

period and during a 10-year transition

period extending through FY 2001,

hospital inpatient capital-related costs

are paid on the basis of an increasing

proportion of the capital prospective

payment system Federal rate and a

decreasing proportion of a hospital’s

historical costs for capital.

The basic methodology for

determining Federal capital prospective

rates is set forth at §§ 412.308 through

412.352. Below we discuss the factors

that we used to determine the proposed

Federal for FY 2002. The rates, which

will be effective for discharges occurring

on or after October 1, 2001. As we stated

in section V of the preamble of this

proposed rule, we are no longer

determining an update to the capital

hospital-specific rate, since FY 2001 is

the last year of the 10-year transition

period, and beginning in FY 2002 all

hospitals (except those defined as

‘‘new’’ under § 412.300) will be paid

based on 100 percent of the capital

Federal rate.

For FY 1992, we computed the

standard Federal payment rate for

capital-related costs under the

prospective payment system by

updating the FY 1989 Medicare

inpatient capital cost per case by an

actuarial estimate of the increase in

Medicare inpatient capital costs per

case. Each year after FY 1992, we

update the standard Federal rate, as

provided in § 412.308(c)(1), to account

for capital input price increases and

other factors. Also, § 412.308(c)(2)

provides that the Federal rate is

adjusted annually by a factor equal to

the estimated proportion of outlier

payments under the Federal rate to total

capital payments under the Federal rate.

In addition, § 412.308(c)(3) requires that

the Federal rate be reduced by an

adjustment factor equal to the estimated

proportion of payments for (regular and

special) exceptions under § 412.348.

Furthermore, § 412.308(c)(4)(ii) requires

that the Federal rate be adjusted so that

the annual DRG reclassification and the

recalibration of DRG weights and

changes in the geographic adjustment

factor are budget neutral. For FYs 1992

through 1995, § 412.352 required that

the Federal rate also be adjusted by a

budget neutrality factor so that aggregate

payments for inpatient hospital capital

costs were projected to equal 90 percent

of the payments that would have been

made for capital-related costs on a

reasonable cost basis during the fiscal

year. That provision expired in FY 1996.

Section 412.308(b)(2) describes the 7.4

percent reduction to the rate that was

made in FY 1994, and § 412.308(b)(3)

describes the 0.28 percent reduction to

the rate made in FY 1996 as a result of

the revised policy of paying for

transfers. In the FY 1998 final rule with

comment period (62 FR 45966), we

implemented section 4402 of Public

Law 105–33, which requires that for

discharges occurring on or after October

1, 1997, and before October 1, 2002, the

unadjusted standard Federal rate is

reduced by 17.78 percent. A small part

of that reduction will be restored

effective October 1, 2002.

To determine the appropriate budget

neutrality adjustment factor and the

regular exceptions payment adjustment,

we developed a dynamic model of

Medicare inpatient capital-related costs,

that is, a model that projects changes in

Medicare inpatient capital-related costs

over time. With the expiration of the

budget neutrality provision, the model

is still used to estimate the regular

exceptions payment adjustment and

other factors. The model and its

application are described in greater

detail in Appendix B of this proposed

rule.

In accordance with section

1886(d)(9)(A) of the Act, under the

prospective payment system for

inpatient operating costs, hospitals

located in Puerto Rico are paid for

operating costs under a special payment

22730 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

formula. Prior to FY 1998, hospitals in

Puerto Rico were paid a blended rate

that consisted of 75 percent of the

applicable standardized amount specific

to Puerto Rico hospitals and 25 percent

of the applicable national average

standardized amount. However,

effective October 1, 1997, as a result of

section 4406 of Public Law 105–33,

operating payments to hospitals in

Puerto Rico are based on a blend of 50

percent of the applicable standardized

amount specific to Puerto Rico hospitals

and 50 percent of the applicable

national average standardized amount.

In conjunction with this change to the

operating blend percentage, effective

with discharges on or after October 1,

1997, we compute capital payments to

hospitals in Puerto Rico based on a

blend of 50 percent of the Puerto Rico

rate and 50 percent of the Federal rate.

Section 412.374 provides for the use

of this blended payment system for

payments to Puerto Rico hospitals under

the prospective payment system for

inpatient capital-related costs.

Accordingly, for capital-related costs,

we compute a separate payment rate

specific to Puerto Rico hospitals using

the same methodology used to compute

the national Federal rate for capital.

A. Determination of Federal Inpatient

Capital-Related Prospective Payment

Rate Update

In the August 1, 2000 final rule (65 FR

47122), we established a Federal rate of

$382.03 for FY 2001. In a separate

interim final rule with comment, as a

result of implementing section 301(a) of

Public Law 106–554 we are establishing

a Federal rate of $380.85 for discharges

occurring on or after April 1, 2001 and

before October 1, 2001. In accordance

with section 547 of Public Law 106–554,

the special increases and adjustments

provided by Public Law 106–554

effective between April and October

2001 do not apply for discharges

occurring after FY 2001 and should not

be included in determining the payment

rates in subsequent years. Thus, the

adjustments and rates published in the

August 1, 2000 final rule were used in

determining the proposed FY 2002

rates. As a result of the changes we are

proposing to the factors used to

establish the Federal rate in this

addendum, the proposed FY 20021

Federal rate is $389.09.

In the discussion that follows, we

explain the factors that were used to

determine the proposed FY 2002

Federal rate. In particular, we explain

why the proposed FY 2002 Federal rate

has increased 1.85 percent compared to

the FY 2001 Federal rate (published in

the August 1, 2000 final rule (65 FR

47122)). We also estimate aggregate

capital payments will increase by 3.80

percent during this same period. This

increase is primarily due to the increase

in the number of hospital admissions

and the increase in case-mix. This

increase in capital payments is less than

last year (5.48 percent) because with the

end of the transition period the

remaining hold harmless hospitals

receiving ‘‘cost-based’’ payments will

begin being paid based on 100 percent

of the Federal rate.

Total payments to hospitals under the

prospective payment system are

relatively unaffected by changes in the

capital prospective payments. Since

capital payments constitute about 10

percent of hospital payments, a 1

percent change in the capital Federal

rate yields only about 0.1 percent

change in actual payments to hospitals.

Aggregate payments under the capital

prospective payment transition system

are estimated to increase in FY 2002

compared to FY 2001.

1. Standard Federal Rate Update

a. Description of the Update

Framework. Under § 412.308(c)(1), the

standard Federal rate is updated on the

basis of an analytical framework that

takes into account changes in a capital

input price index and other factors. The

update framework consists of a capital

input price index (CIPI) and several

policy adjustment factors. Specifically,

we have adjusted the projected CIPI rate

of increase as appropriate each year for

case-mix index-related changes, for

intensity, and for errors in previous CIPI

forecasts. The proposed update factor

for FY 2002 under that framework is 1.1

percent. This proposal is based on a

projected 0.5 percent increase in the

CIPI, a 0.3 percent adjustment for

intensity, a 0.0 percent adjustment for

case-mix, a 0.0 percent adjustment for

the FY 2000 DRG reclassification and

recalibration, and a forecast error

correction of 0.3 percent. We explain

the basis for the FY 2002 CIPI projection

in section II.D. of this Addendum.

Below we describe the policy

adjustments that have been applied.

The case-mix index is the measure of

the average DRG weight for cases paid

under the prospective payment system.

Because the DRG weight determines the

prospective payment for each case, any

percentage increase in the case-mix

index corresponds to an equal

percentage increase in hospital

payments.

The case-mix index can change for

any of several reasons:

• The average resource use of

Medicare patients changes (‘‘real’’ casemix change);

• Changes in hospital coding of

patient records result in higher weight

DRG assignments (‘‘coding effects’’); and

• The annual DRG reclassification

and recalibration changes may not be

budget neutral (‘‘reclassification

effect’’).

We define real case-mix change as

actual changes in the mix (and resource

requirements) of Medicare patients as

opposed to changes in coding behavior

that result in assignment of cases to

higher weighted DRGs but do not reflect

higher resource requirements. In the

update framework for the prospective

payment system for operating costs, we

adjust the update upwards to allow for

real case-mix change, but remove the

effects of coding changes on the casemix index. We also remove the effect on

total payments of prior changes to the

DRG classifications and relative

weights, in order to retain budget

neutrality for all case-mix index-related

changes other than patient severity. (For

example, we are adjustinged for the

effects of the FY 2000 DRG

reclassification and recalibration as part

of our FY 2002 update

recommendation.) We have adopted this

case-mix index adjustment in the capital

update framework as well.

For FY 2002, we are projecting a 1.0

percent increase in the case-mix index.

We estimate that real case-mix increase

will equal 1.0 percent in FY 2002.

Therefore, the proposed net adjustment

for case-mix change in FY 2002 is 0.0

percentage points.

We estimate that FY 2000 DRG

reclassification and recalibration will

result in a 0.0 percent change in the

case-mix when compared with the casemix index that would have resulted if

we had not made the reclassification

and recalibration changes to the DRGs.

Therefore, we are making a 0.0 percent

adjustment for DRG reclassification and

recalibration in the update

recommendation for FY 2002.

The capital update framework

contains an adjustment for forecast

error. The input price index forecast is

based on historical trends and

relationships ascertainable at the time

the update factor is established for the

upcoming year. In any given year there

may be unanticipated price fluctuations

that may result in differences between

the actual increase in prices and the

forecast used in calculating the update

factors. In setting a prospective payment

rate under the framework, we make an

adjustment for forecast error only if our

estimate of the change in the capital

input price index for any year is off by

0.25 percentage points or more. There is

a 2-year lag between the forecast and the

measurement of the forecast error. A

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22731

forecast error of 0.3 percentage points

was calculated for the FY 2000 update.

That is, current historical data indicate

that the FY 2000 CIPI used in

calculating the forecasted FY 2000

update factor (0.6 percent) understated

the actual realized price increases (0.9

percent) by 0.3 percent. This underprediction was due to prices from

municipal bond yields declining slower

than expected. Therefore, we are making

a 0.3 percent adjustment for forecast

error in the update for FY 2002.

Under the capital prospective

payment system framework, we also

make an adjustment for changes in

intensity. We calculate this adjustment

using the same methodology and data as

in the framework for the operating

prospective payment system. The

intensity factor for the operating update

framework reflects how hospital

services are utilized to produce the final

product, that is, the discharge. This

component accounts for changes in the

use of quality-enhancing services,

changes in within-DRG severity, and

expected modification of practice

patterns to remove cost-ineffective

services.

We calculate case-mix constant

intensity as the change in total charges

per admission, adjusted for price level

changes (the CPI for hospital and related

services), and changes in real case-mix.

The use of total charges in the

calculation of the proposed intensity

factor makes it a total intensity factor,

that is, charges for capital services are

already built into the calculation of the

factor. Therefore, we have incorporated

the intensity adjustment from the

operating update framework into the

capital update framework. Without

reliable estimates of the proportions of

the overall annual intensity increases

that are due, respectively, to ineffective

practice patterns and to the combination

of quality-enhancing new technologies

and within-DRG complexity, we

assume, as in the revised operating

update framework, that one-half of the

annual increase is due to each of these

factors. The capital update framework

thus provides an add-on to the input

price index rate of increase of one-half

of the estimated annual increase in

intensity to allow for within-DRG

severity increases and the adoption of

quality-enhancing technology.

For FY 2002, we have developed a

Medicare-specific intensity measure

based on a 5-year average using FY 1996

through 2000 data. In determining casemix constant intensity, we found that

observed case-mix increase was 1.6

percent in FY 1996, 0.3 percent in FY

1997, ¥0.4 percent in FY 1998, and

¥0.3 in FY 1999, and ¥0.7 percent in

FY 2000. Since we found an increase in

case-mix of 1.6 for FY 1996, which was

outside of the range of 1.0 to 1.4

percent, we estimate that real case-mix

increase was 1.0 to 1.4 percent for that

year. The estimate of 1.0 to 1.4 percent

is supported by past studies of case-mix

change by the RAND Corporation. The

most recent study was ‘‘Has DRG Creep

Crept Up? Decomposing the Case Mix

Index Change Between 1987 and 1988’’

by G. M. Carter, J. P. Newhouse, and D.

A. Relles, R–4098–HCFA/ProPAC

(1991). The study suggested that real

case-mix change was not dependent on

total change, but was usually a fairly

steady 1.0 to 1.4 percent per year. We

use 1.4 percent as the upper bound

because the RAND study did not take

into account that hospitals may have

induced doctors to document medical

records more completely in order to

improve payment. Following that study,

we consider up to 1.4 percent of

observed case-mix change as real for FY

1996 through FY 2000. Based on this

analysis, we believe that all of the

observed case-mix increase for FY 1997,

FY 1998, and FY 1999, and FY 2000 is

real. The increases for FY 1996 was in

excess of our estimate of real case-mix

increase.

We calculate case-mix constant

intensity as the change in total charges

per admission, adjusted for price level

changes (the CPI for hospital and related

services), and changes in real case-mix.

Based upon an upper limit of 1.0

percent real case-mix increase, we

estimate that case-mix constant

intensity increased by an average 0.3

percent during FYs 1996 through 2000,

for a cumulative increase of 1.4 percent

given estimates of real case-mix of 1.0

percent for FY 1996, 0.3 percent for FY

1997, ¥0.4 for FY 1998, and ¥0.3 for

FY 1999, and ¥0.7 percent for FY 2000.

Based upon an upper limit of 1.4

percent real case-mix increase, we

estimate that case-mix constant

intensity increase by an average 0.2

percent during FYs 1996 through 2000,

for a cumulative increase of 1.2 percent,

given that real case-mix increase was 1.4

percent for FY 1996, 0.3 percent for FY

1997, ¥0.4 for FY 1998, ¥0.3 for FY

1999, and ¥0.7 percent for FY 2000.

Since we estimate that intensity has

increased during that period, we are

recommending a 0.3 percent intensity

adjustment for FY 2002.

b. Comparison of HCFA and MedPAC

Update Recommendations. In its March

2001 Report to Congress, MedPAC

presented a combined operating and

capital update for hospital inpatient

prospective payment system payments

for FY 2002. Currently, section

1886(b)(3)(B)(i)(XVII) of the Act sets

forth the FY 2002 percentage increase in

the prospective payment system

operating cost standardized amounts.

The prospective payment system capital

update is set at the discretion of the

Secretary under the framework outlined

in § 412.308(c)(1).

For FY 2002, MedPAC’s update

framework supports a combined

operating and capital update for

hospital inpatient prospective payment

system payments of 1.5 percent to 3.0

percent (or between the increase in the

combined operating and capital market

basket minus 1.3 percentage points and

the increase in the combined operating

and capital market basket plus 0.2

percentage points). MedPAC also notes

that while the number of hospitals with

negative inpatient hospital margins have

increased in FY 1999 (from 33.7 percent

in FY 1998 to 36.7 percent in FY 1999

(page 71)), overall high inpatient

Medicare margins generally offset

hospital losses on other lines of

Medicare services. MedPAC continues

to project substantially improved

hospital total margins for FY 2000 based

on performance in the first half of the

fiscal year (page 72).

MedPAC’s FY 2002 combined

operating and capital update framework

uses a weighted average of HCFA’s

forecasts of the operating (PPS Input

Price Index) and capital (CIPI) market

baskets. This combined market basket is

used to develop an estimate of the

change in overall operating and capital

prices. MedPAC calculated a combined

market basket forecast by weighting the

operating market basket forecast by 0.92

and the capital market basket forecast by

0.08, since operating costs are estimated

to represent 92 percent of total hospital

costs (capital costs are estimated to

represent the remaining 8 percent of

total hospital costs). MedPAC’s

combined market basket for FY 2002 is

estimated to increase by 2.8 percent,

based on HCFA’s December 2000

forecasted operating market basket

increase of 3.0 percent and HCFA’s

December 2000 forecasted capital

market basket increase of 0.8 percent.

Response: As we stated in the August

1, 2000 final rule (65 FR 47119), our

long-term goal is to develop a single

update framework for operating and

capital prospective payments and that

we would begin development of a

unified framework. However, we have

not yet developed such a single

framework as the actual operating

system update has been determined by

Congress through FY 2003 (as amended

by Public Law 106–554). In the

meantime, we intend to maintain as

much consistency as possible with the

current operating framework in order to

22732 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

facilitate the eventual development of a

unified framework.

Our recommendation for updating the

prospective payment system capital

Federal rate is supported by the

following analyses that measure changes

in scientific and technological advances,

practice pattern changes, changes in

case-mix, the effect of reclassification

and recalibration, and forecast error

correction. MedPAC recommends a 1.5

to 3.0 percent combined operating and

capital update for hospital inpatient

prospective payments. Under our

existing capital update framework, we

are recommending a 1.1 percent update

to the capital Federal rate. For purposes

of comparing HCFA’s capital update

recommendation and MedPAC’s update

recommendation for FY 2002, we have

isolated the capital component of

MedPAC’s combined market basket

forecast, which was based on HCFA’s

December 2000 CIPI forecast of 0.8

percent. As a result, MedPAC’s update

recommendation for FY 2002 for capital

payments is between ¥0.9 percent and

0.6 percent (see Table 1).

There are some differences between

HCFA’s and MedPAC’s update

frameworks, which account for the

difference in the respective update

recommendations. In its combined FY

2002 update recommendation, MedPAC

uses HCFA’s capital input price index

(the CIPI) as the starting point for

estimating the change in prices since the

previous year. HCFA’s CIPI includes

price measures for interest expense,

which are an indicator of the interest

rates facing hospitals during their

capital purchasing decisions.

Previously, MedPAC’s capital market

basket did not include interest expense;

instead it included a financing policy

adjustment when necessary to account

for the prolonged changes in interest

rates. HCFA’s CIPI is vintage-weighted,

meaning that it takes into account price

changes from past purchases of capital

when determining the current period

update. In the past, MedPAC’s capital

market basket was not vintage-weighted,

and only accounted for the current year

price changes. Beginning last year, both

HCFA’s and MedPAC’s FY 2002 update

frameworks use HCFA’s CIPI. MedPAC

used HCFA’s December 2000 CIPI in

preparing its FY 2002 recommendation,

which was forecast at 0.8 percent.

Currently, the CIPI is forecast at 0.5

percent (March 2001).

MedPAC and HCFA also differ in the

adjustments they make to their price

indices. (See Table 1 for a comparison

of HCFA and MedPAC’s update

recommendations.) MedPAC makes an

adjustment for scientific and

technological advances, which is offset

by a fixed standard for productivity

growth and one-time factors. HCFA has

not adopted a separate adjustment for

capital science and technology or

productivity and efficiency.

In addition, MedPAC includes, when

appropriate, an adjustment for one-time

factors expected to affect costs in FY

2002 and the removal of the adjustment

for FY 2002 one-time factors in its

science and technology adjustment.

MedPAC concluded that a one-time

adjustment of 0.5 percent for the Health

Insurance Portability and

Accountability Act of 1996 (HIPAA)

regulatory requirements be reflected in

its FY 2002 payment update.

Additionally, since MedPAC believes

that the costs associated with one-time

factors should not be built permanently

into the rates, it recommended that the

FY 2002 payment rates be reduced by

0.5 percent to offset the increase it

recommended in the FY 2000 update for

the costs associated with year 2000

(Y2K) computer improvements. Thus,

MedPAC’s combined FY 2002

adjustment for science and

technological advances is 0.0 percent to

0.5 percent.

Instead, we have identified a total

intensity factor, which reflects scientific

and technological advances, but we

have not identified an adequate total

productivity measure. MedPAC also

includes a site-of-care substitution

adjustment (unbundling of the payment

unit) to account for the decline in the

average length of Medicare acute

inpatient stays. This adjustment is

designed to shift funding along with

associated costs when Medicare patients

are discharged to postacute settings that

replace acute impatient days. Other

factors, such as technological advances

that allow for a decreased need in

follow-up care and BBA mandated

policy on payment for transfer cases that

limits payments within certain DRGs,

are reflected in the site-of-care

substitution adjustment as well. We

agree with MedPAC that the site-of-care

substitution effect is real and believe

that it is factored into our intensity

recommendation.

For FY 2002, MedPAC recommends a

¥2.0 to ¥1.0 percent combined

adjustment for site-of-care substitutions.

MedPAC recommends a 0.0 to a 0.5

percent combined adjustment for

scientific and technological advances,

which was offset by a fixed productivity

standard of 0.5 percent and a 0.0

percent adjustment for one-time factors

for FY 2002. We recommend a 0.3

intensity adjustment.

Additionally, MedPAC includes an

adjustment for Medicare policy changes

affecting financial status in its section of

factors affecting current level of

payments in its FY 2002 update

recommendation. While MedPAC’s

update framework has not considered

such costs in the past, MedPAC believes

that it is appropriate to account for

significant costs incurred as a result of

new Medicare policy. For FY 2002,

MedPAC believes that legislated

updates will match cost growth and that

the overall net affects of legislative

changes (from Public Law 105–33,

Public Law 106–113, and Public Law

106–554) will be small. Thus, it did not

recommend any additional allowance

for these costs for FY 2002. Accordingly,

MedPAC recommended a 0.0 percent

adjustment for Medicare policy changes.

MedPAC makes a two-part adjustment

for case-mix changes, which takes into

account changes in case-mix in the past

year. It recommends a 0.0 percent

combined adjustment for DRG coding

change and a 0.0 percent combined

adjustment for within-DRG complexity

change. This results in a combined total

case-mix adjustment of 0.0 percent. We

recommend a 0.0 adjustment for casemix, since we are projecting a 1.0

percent increase in case-mix index and

we estimate that real case-mix increase

will equal 1.0 percent in FY 2002.

We recommend a 0.3 percent

adjustment for forecast error correction.

MedPAC’s combined FY 2002 update

recommendation includes a 0.7 percent

adjustment for forecast error correction.

However, it noted that this forecast error

adjustment is a result of the difference

between the forecasted FY 2000

operating market basket of 2.9 percent

and the actual FY 2000 operating market

basket increase of 3.6 percent. The FY

2000 capital market basket was forecast

at 0.6 percent, while the actual observed

increase equaled 0.9 percent for capital

costs. Therefore, we have included 0.3

percent adjustment for FY 2000 forecast

error correction in the comparison of

MedPAC’s and HCFA’s update

recommendations for FY 2002 shown

below in Table 1.

We applied MedPAC’s ratio of

hospital capital costs to total hospital

costs (8 percent) to the adjustment

factors in its update framework for

comparison with HCFA’s capital update

framework. The net result of these

adjustments is that MedPAC has

recommended a ¥0.9 to 0.6 percent

update to the capital Federal rate for FY

2002. MedPAC believes that the annual

updates to the capital and operating

payments under the prospective

payment system should not differ

substantially, even though they are

determined separately, since they

correspond to costs generated by

providing the same inpatient hospital

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22733

services to the same Medicare patients.

We describe the basis for our 1.1 percent

total capital update for FY 2002 in the

preceding section. Our recommendation

of 1.1 percent is 0.5 percent higher than

the upper limit of the range

recommended by MedPAC due to

MedPAC’s ¥2.0 to ¥1.0 percent

combined (operating and capital)

adjustment for unbundling of the

payment unit for FY 2002. If we had

applied only the portion of that

adjustment attributable to capitalrelated services, our proposed update

recommendation would most likely

have fallen with in the range of

MedPAC’s update recommendation for

capital for FY 2002. While in previous

years, our update recommendation has

fallen within the range recommended by

MedPAC, since MedPAC has developed

its combined operating and capital

update recommendation beginning in

FY 2001, we have only been outside of

that range by 0.5 percent. For FY 2001,

our update recommendation of 0.9

percent was only 0.5 percentage points

below MedPAC’s lower limit of its FY

2002 recommendation.

TABLE 1.—HCFA’S FY 2002 UPDATE FACTOR AND MEDPAC’S RECOMMENDATION

HCFA’s update factorMedPAC’s recommendation

Capital Input Price Index ...................................................................................................................................... 0.5 0.81

Policy Adjustment Factors:

Intensity ......................................................................................................................................................... 0.3 (2)

Science and Technology ........................................................................................................................ ........................ 0.0 to 0.5.

Real within DRG Change ....................................................................................................................... ........................ (3)

Site-of-Care Substitution ........................................................................................................................ ........................ ¥2.0 to ¥1.0.

One-Time Factors .................................................................................................................................. (4) 0.0

Subtotal .................................................................................................................................................. 0.3 ¥2.0 to ¥0.5.

Medicare Policy Change; .............................................................................................................................. ........................ 0.0

Case-Mix Adjustment Factors:

Projected Case-Mix Change ......................................................................................................................... ¥1.0

Real Across DRG Change ............................................................................................................................ 1.0

Coding Change .............................................................................................................................................. ........................ 0.0

Real within DRG Change .............................................................................................................................. (4) 0.0

Subtotal .................................................................................................................................................. 0.0 0.0

Effect of FY 2000 Reclassification and Recalibration .......................................................................................... 0.0

Forecast Error Correction ..................................................................................................................................... 0.3 0.3

Total Update ........................................................................................................................................... 1.1 ¥0.9 to 0.6.

1 Used HCFA’s December 2000 capital marker basket forecast in its combined update recommendation. 2 Included in MedPAC’s productivity offset in its science and technology adjustment. 3 Included in MedPAC’s case-mix adjustment. 4 Included in HCFA’s intensity factor.

2. Outlier Payment Adjustment Factor

Section 412.312(c) establishes a

unified outlier methodology for

inpatient operating and inpatient

capital-related costs. A single set of

thresholds is used to identify outlier

cases for both inpatient operating and

inpatient capital-related payments.

Section 412.308(c)(2) provides that the

standard Federal rate for inpatient

capital-related costs be reduced by an

adjustment factor equal to the estimated

proportion of capital-related outlier

payments to total inpatient capitalrelated PPS payments. The outlier

thresholds are set so that operating

outlier payments are projected to be 5.1

percent of total operating DRG

payments.

In the August 1, 2000 final rule, we

estimated that outlier payments for

capital in FY 2001 would equal 5.91

percent of inpatient capital-related

payments based on the Federal rate (65

FR 47121). Accordingly, we applied an

outlier adjustment factor of 0.9409 to

the Federal rate. Based on the

thresholds as set forth in section

II.A.4.d. of this Addendum, we estimate

that outlier payments for capital will

equal 5.74 percent of inpatient capitalrelated payments based on the Federal

rate in FY 2002. Therefore, we are

proposing an outlier adjustment factor

of 0.9426 to the Federal rate. Thus, the

projected percentage of capital outlier

payments to total capital standard

payments for FY 2002 is lower than the

percentage for FY 2001.

The outlier reduction factors are not

built permanently into the rates; that is,

they are not applied cumulatively in

determining the Federal rate. As

explained previously, in accordance

with section 547 of Public Law 106–554,

the proposed FY 2002 rates are based on

the FY 2001 adjustments and rates

published in the August 1, 2000 final

rule (65 FR 47122). Therefore, the

proposed net change in the outlier

adjustment to the Federal rate for FY

2002 is 1.0018 (0.9426/0.9409). The

outlier adjustment increases the FY

2002 Federal rate by 0.18 percent

compared with the FY 2001 outlier

adjustment.

3. Budget Neutrality Adjustment Factor

for Changes in DRG Classifications and

Weights and the Geographic Adjustment

Factor

Section 412.308(c)(4)(ii) requires that

the Federal rate be adjusted so that

aggregate payments for the fiscal year

based on the Federal rate after any

changes resulting from the annual DRG

reclassification and recalibration and

changes in the geographic adjustment

factor (GAF) are projected to equal

aggregate payments that would have

been made on the basis of the Federal

rate without such changes. We use the

actuarial model, described in Appendix

B of this proposed rule, to estimate the

aggregate payments that would have

been made on the basis of the Federal

rate without changes in the DRG

classifications and weights and in the

GAF. We also use the model to estimate

aggregate payments that would be made

on the basis of the Federal rate as a

result of those changes. We then use

22734 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

these figures to compute the adjustment

required to maintain budget neutrality

for changes in DRG weights and in the

GAF.

For FY 2001, we calculated a GAF/

DRG budget neutrality factor of 0.9979.

For FY 2002, we are proposing a GAF/

DRG budget neutrality factor of 0.9913.

The GAF/DRG budget neutrality factors

are built permanently into the rates; that

is, they are applied cumulatively in

determining the Federal rate. This

follows from the requirement that

estimated aggregate payments each year

be no more than they would have been

in the absence of the annual DRG

reclassification and recalibration and

changes in the GAF. As explained

previously, in accordance with section

547 of Public Law 106–554, the

proposed FY 2002 adjustments and rates

are based on the FY 2001 adjustment

and rates published in the August 1,

2000 final rule (65 FR 47122). The

proposed incremental change in the

adjustment from FY 2001 to FY 2002 is

0.9913. The proposed cumulative

change in the rate due to this

adjustment is 0.9906 (the product of the

incremental factors for FY 1993, FY

1994, FY 1995, FY 1996, FY 1997, FY

1998, FY 1999, FY 2000, FY 2001 and

the proposed incremental factor for FY

2002: 0.9980 × 1.0053 × 0.9998 × 0.9994

× 0.9987 × 0.9989 × 1.0028 × 0.9985 ×

0.9979 × 0.9913 = 0.9906).

This proposed factor accounts for

DRG reclassifications and recalibration

and for changes in the GAF. It also

incorporates the effects on the GAF of

FY 2002 geographic reclassification

decisions made by the MGCRB

compared to FY 2001 decisions.

However, it does not account for

changes in payments due to changes in

the DSH and IME adjustment factors or

in the large urban add-on.

4. Exceptions Payment Adjustment

Factor

Section 412.308(c)(3) requires that the

standard Federal rate for inpatient

capital-related costs be reduced by an

adjustment factor equal to the estimated

proportion of additional payments for

exceptions under § 412.348 relative to

total capital payments payments under

the hospital-specific rate and Federal

rate. We use the model originally

developed for determining the budget

neutrality adjustment factor to

determine the regular exceptions

payment adjustment factor. We describe

that model in Appendix B to this

proposed rule. An adjustment for

regular exceptions is necessary for

determining the FY 2002 rates because

we will continue to pay regular

exceptions for cost reporting periods

beginning before October 1, 2001 but

ending in FY 2002 in accordance with

§ 412.312(c)(3). In FY 2003 and later, no

payments will be made under the

regular exceptions provision, hence we

will only compute a budget neutrality

adjustment under § 412.348(d) for

special exceptions. We describe the

proposed methodology to determine to

special exceptions adjustment in section

V.D. of this proposed rule. For FY 2002,

the exceptions adjustment is a

combination of the adjustment that

would be made under the regular

exceptions provision and under the

special exceptions provision under

§ 412.348(g).

For FY 2001, we estimated that

exceptions payments would equal 2.15

percent of aggregate payments based on

the Federal rate and the hospitalspecific rate. Therefore, we applied an

exceptions reduction factor of 0.9785

(1¥0.0215) in determining the Federal

rate. For this proposed rule, we estimate

that regular exceptions payments for FY

2002 will equal 0.63 percent of

aggregate payments based on the

Federal rate we estimate that special

exceptions payments for FY 2002 will

equal 0.12 percent of aggregate

payments based on the Federal rate.

Therefore, we estimate that total

exceptions payments for FY 2002 will

equal 0.75 percent (0.63 + 0.12 = 0.75)

of aggregate payments based on the

Federal rate and we are proposing an

exceptions payment reduction factor of

0.9925 (1 ¥ 0.0075) to the Federal rate

for FY 2002. The proposed exceptions

reduction factor for FY 2002 is 1.43

percent higher than the factor for FY

2001 published in the August 1, 2000

final rule. This increase is primarily due

to the expiration of the regular

exceptions provision and the narrowly

defined nature of the special exceptions

policy.

The exceptions reduction factors are

not built permanently into the rates; that

is, the factors are not applied

cumulatively in determining the Federal

rate. As explained previously, in

accordance with section 547 of Public

Law 106–554, the proposed FY 2002

adjustments and rates are based on the

FY 2001 adjustments and rates

published in the August 1, 2000 final

rule (65 FR 47122). Therefore, the

proposed net adjustment to the FY 2002

Federal rate is 0.9925/0.9785, or 1.0143.

5. Standard Capital Federal Rate for FY

2002

For FY 2001, the capital Federal rate

was $383.06 for discharges occurring

between October 1, 2000 and April 1,

2001. As a result of implementing

section 301(a) of Public Law 106–554,

for discharges occurring from April to

October 2001, the capital Federal rate

was $380.85. However, as explained

previously, in accordance with section

547 of Public Law 106–554, the

proposed FY 2002 adjustments and rates

are based on the FY 2001 adjustments

and rates published in the August 1,

2000 final rule (65 FR 47122). As a

result of changes we are proposing to

the factors used to establish the Federal

rate, the proposed FY 2002 Federal rate

is $389.09. The proposed Federal rate

for FY 2002 was calculated as follows:

• The proposed FY 2002 update

factor is 1.0110; that is, the proposed

update is 1.10 percent.

• The proposed FY 2002 budget

neutrality adjustment factor that is

applied to the standard Federal payment

rate for changes in the DRG relative

weights and in the GAF is 0.9913.

• The proposed FY 2002 outlier

adjustment factor is 0.9426.

• The proposed FY 2002 (regular and

special) exceptions payments

adjustment factor is 0.9925.

Since the Federal rate has already

been adjusted for differences in casemix, wages, cost-of-living, indirect

medical education costs, and payments

to hospitals serving a disproportionate

share of low-income patients, we

propose to make no additional

adjustments in the standard Federal rate

for these factors other than the budget

neutrality factor for changes in the DRG

relative weights and the GAF.

We are providing a chart that shows

how each of the factors and adjustments

for FY 2002 affected the computation of

the proposed FY 2002 Federal rate in

comparison to the FY 2001 Federal rate.

The proposed FY 2002 update factor has

the effect of increasing the Federal rate

by 1.10 percent compared to the FY

2001 rate published in the August 1,

2000 final rule, while the proposed

geographic and DRG budget neutrality

factor has the effect of decreasing the

Federal rate by 0.87 percent. The

proposed FY 2002 outlier adjustment

factor has the effect of increasing the

Federal rate by 0.18 percent compared

to the FY 2001 rate published in the

August 1, 2000 final rule. The proposed

FY 2002 (regular and special)

exceptions reduction factor has the

effect of increasing the Federal rate by

1.43 percent compared to the exceptions

reduction for FY 2001. The combined

effect of all the proposed changes is to

increase the proposed Federal rate by

1.85 percent compared to the Federal

rate for FY 2001.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22735

COMPARISON OF FACTORS AND ADJUSTMENTS: FY 2001 FEDERAL RATE AND PROPOSED FY 2002 FEDERAL RATE

FY 2001 Proposed FY

2002 Change Percentchange

Update factor 1 ............................................................................................. 1.0090 1.0110 1.0110 1.10

GAF/DRG Adjustment Factor 1 .................................................................... 0.9979 0.9913 0.9913 ¥0.87

Outlier Adjustment Factor 2 .......................................................................... 0.9409 0.9426 1.0018 0.18

Exceptions Adjustment Factor 2 ................................................................... 0.9785 0.9925 1.0143 1.43

Federal Rate ................................................................................................ $382.03 $38.09 1.018 1.85

1The update factor and the GAF/DRG budget neutrality factors are built permanently into the rates. Thus, for example, the incremental change

from FY 2000 to FY 2001 resulting from the application of the 0.9913 GAF/DRG budget neutrality factor for FY 2001 is 0.9913. 2The outlier reduction factor and the exceptions reduction factor are not built permanently into the rates; that is, these factors are not applied

cumulatively in determining the rates. Thus, for example, the net change resulting from the application of the FY 2001 outlier reduction factor is

0.9426/0.9409, or 1.0018.

6. Special Rate for Puerto Rico Hospitals

As explained at the beginning of

section IV of this Addendum, hospitals

in Puerto Rico are paid based on 50

percent of the Puerto Rico rate and 50

percent of the Federal rate. The Puerto

Rico rate is derived from the costs of

Puerto Rico hospitals only, while the

Federal rate is derived from the costs of

all acute care hospitals participating in

the prospective payment system

(including Puerto Rico). To adjust

hospitals’ capital payments for

geographic variations in capital costs,

we apply a GAF to both portions of the

blended rate. The GAF is calculated

using the operating prospective

payment system wage index and varies

depending on the MSA or rural area in

which the hospital is located. We use

the Puerto Rico wage index to determine

the GAF for the Puerto Rico part of the

capital-blended rate and the national

wage index to determine the GAF for

the national part of the blended rate.

Because we implemented a separate

GAF for Puerto Rico in FY 1998, we also

apply separate budget neutrality

adjustments for the national GAF and

for the Puerto Rico GAF. However, we

apply the same budget neutrality factor

for DRG reclassifications and

recalibration nationally and for Puerto

Rico. The Puerto Rico GAF budget

neutrality factor is 0.99941, while the

DRG adjustment is 0.9943, for a

combined cumulative adjustment of

0.9937.

In computing the payment for a

particular Puerto Rico hospital, the

Puerto Rico portion of the rate (50

percent) is multiplied by the Puerto

Rico-specific GAF for the MSA in which

the hospital is located, and the national

portion of the rate (50 percent) is

multiplied by the national GAF for the

MSA in which the hospital is located

(which is computed from national data

for all hospitals in the United States and

Puerto Rico). In FY 1998, we

implemented a 17.78 percent reduction

to the Puerto Rico rate as a result of

Public Law 105–33.

For FY 2001, before application of the

GAF, the special rate for Puerto Rico

hospitals was $185.06. As explained

previously, in accordance with section

547 of Public Law 106–554, the

proposed FY 2002 adjustments and rates

are based on the FY 2001 rates

published in the August 1, 2000 final

rule. With the changes we are proposing

to the factors used to determine the rate,

the proposed FY 2002 special rate for

Puerto Rico is $188.67.

B. Calculation of Inpatient CapitalRelated Prospective Payments for FY

2002

With the end of the capital

prospective payment system transition

period, all hospitals (except those

defined as ‘‘new’’ under § 412.300(b))

will be paid based on 100 percent of the

Federal rate in FY 2002. The applicable

Federal rate was determined by making

adjustments as follows:

• For outliers, by dividing the

standard Federal rate by the outlier

reduction factor for that fiscal year; and

• For the payment adjustments

applicable to the hospital, by

multiplying the hospital’s GAF,

disproportionate share adjustment

factor, and IME adjustment factor, when

appropriate.

For purposes of calculating payments

for each discharge during FY 2002, the

standard Federal rate is adjusted as

follows:

(Standard Federal Rate) × (DRG weight) ×

(GAF) × (Large Urban Add-on, if

applicable) × (COLA adjustment for

hospitals located in Alaska and Hawaii) ×

(1 + Disproportionate Share Adjustment

Factor + IME Adjustment Factor, if

applicable).

The result is the adjusted Federal rate.

Hospitals also may receive outlier

payments for those cases that qualify

under the thresholds established for

each fiscal year. Section 412.312(c)

provides for a single set of thresholds to

identify outlier cases for both inpatient

operating and inpatient capital-related

payments. The proposed outlier

thresholds for FY 2002 are in section

II.A.4.c. of this Addendum. For FY

2002, a case qualifies as a cost outlier if

the cost for the case (after

standardization for the indirect teaching

adjustment and disproportionate share

adjustment) is greater than the

prospective payment rate for the DRG

plus $20,900.

During the capital prospective

payment system transition period, a

hospital also may receive an additional

payment under the regular an

exceptions process through its cost

reporting period beginning before

October 1, 2001 but ending in FY 2002

if its total inpatient capital-related

payments are less than a minimum

percentage of its allowable Medicare

inpatient capital-related costs. The

minimum payment level is established

by class of hospital under § 412.348(c).

Under § 412.348(d), the amount of a

regular exceptions payment is

determined by comparing the

cumulative payments made to the

hospital under the capital prospective

payment system to the cumulative

minimum payment levels applicable to

the hospital for each cost reporting

period subject to that system. Any

amount by which the hospital’s

cumulative payments exceed its

cumulative minimum payment is

deducted from the additional payment

that would otherwise be payable for a

cost reporting period.

An eligible hospital may qualify for a

special exception payment under

§ 412.348(g) through the 10th year

beyond the end of the capital transition

period if meets (1) a project need

requirement described at

§ 412.348(g)(2), which in the case of

certain urban hospitals includes an

excess capacity test; and (2) a project

size requirement as described at

§ 412.348(g)(5). Eligible hospitals

include sole community hospitals,

urban hospitals with at lest 100 beds

that have a DSH percentage of at least

22736 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

20.2 percent, and hospitals that have a

combined Medicare and Medicaid

inpatient utilization of at least 70

percent. Under § 412.348(g)(8), the

amount of a special exceptions payment

is determined by comparing the

cumulative payments made to the

hospital under the capital prospective

payment system to the cumulative

minimum payment level. This amount

is offset by (1) any amount by which a

hospital’s cumulative capital payments

exceed its cumulative minimum

payment levels applicable under the

regular exceptions process for cost

reporting periods beginning during

which the hospital has been subject to

capital PPS; and (2) any amount by

which a hospital’s current year

operating and capital payments

(excluding 75 percent of operating DSH

payments) exceed its operating and

capital costs. The minimum payment

level is 70 percent for all eligible

hospitals under § 412.348(g).

New hospitals as defined under

§ 412.300 are exempted from the capital

prospective payment system for their

first 2 years of operation and are paid

85 percent of their reasonable costs

during that period. A new hospital’s old

capital costs are its allowable costs for

capital assets that were put in use for

patient care on or before the later of

December 31, 1990, or the last day of the

hospital’s base year cost reporting

period, and are subject to the rules

pertaining to old capital and obligated

capital as of the applicable date.

Effective with the third year of

operation, we will pay the hospital

under either the fully prospective

methodology, using the appropriate

transition blend in that Federal fiscal

year, or the hold-harmless methodology.

If the hold-harmless methodology is

applicable, the hold-harmless payment

for assets in use during the base period

would extend for 8 years, even if the

hold-harmless payments extend beyond

the normal transition period.

C. Capital Input Price Index

1. Background

Like the operating input price index,

the capital input price index (CIPI) is a

fixed-weight price index that measures

the price changes associated with costs

during a given year. The CIPI differs

from the operating input price index in

one important aspect—the CIPI reflects

the vintage nature of capital, which is

the acquisition and use of capital over

time. Capital expenses in any given year

are determined by the stock of capital in

that year (that is, capital that remains on

hand from all current and prior capital

acquisitions). An index measuring

capital price changes needs to reflect

this vintage nature of capital. Therefore,

the CIPI was developed to capture the

vintage nature of capital by using a

weighted-average of past capital

purchase prices up to and including the

current year.

Using Medicare cost reports,

American Hospital Association (AHA)

data, and Securities Data Company data,

a vintage-weighted price index was

developed to measure price increases

associated with capital expenses. We

periodically update the base year for the

operating and capital input prices to

reflect the changing composition of

inputs for operating and capital

expenses. Currently, the CIPI is based to

FY 1992 and was last rebased in 1997.

The most recent discussion of the cost

category weights in the CIPI was in the

final rule with comment period for FY

1998 published on August 29, 1997 (62

FR 46050).

2. Forecast of the CIPI for Federal Fiscal

Year 2001

We are forecasting the CIPI to increase

0.9 percent for FY 2002. This reflects a

projected 1.5 percent increase in

vintage-weighted depreciation prices

(building and fixed equipment, and

movable equipment) and a 3.5 percent

increase in other capital expense prices

in FY 2002, partially offset by a 1.3

percent decline in vintage-weighted

interest rates in FY 2002. The weighted

average of these three factors produces

the 0.9 percent increase for the CIPI as

a whole.

IV. Proposed Changes to Payment Rates

for Excluded Hospitals and Hospital

Units: Rate-of-Increase Percentages

The inpatient operating costs of

hospitals and hospital units excluded

from the prospective payment system

are subject to rate-of-increase limits

established under the authority of

section 1886(b) of the Act, which is

implemented in regulations at § 413.40.

Under these limits, a hospital-specific

target amount (expressed in terms of the

inpatient operating cost per discharge)

is set for each hospital, based on the

hospital’s own historical cost

experience trended forward by the

applicable rate-of-increase percentages

(update factors). In the case of a

psychiatric hospital or hospital unit, a

rehabilitation hospital or hospital unit,

or a long-term care hospital, the target

amount may not exceed the updated

figure for the 75th percentile of target

amounts adjusted to take into account

differences between average wagerelated costs in the area of the hospital

and the national average of such costs

within the same class of hospital for

hospitals and units in the same class

(psychiatric, rehabilitation, and longterm care) for cost reporting periods

ending during FY 1996. The target

amount is multiplied by the number of

Medicare discharges in a hospital’s cost

reporting period, yielding the ceiling on

aggregate Medicare inpatient operating

costs for the cost reporting period.

Each hospital-specific target amount

is adjusted annually, at the beginning of

each hospital’s cost reporting period, by

an applicable update factor.

Section 1886(b)(3)(B) of the Act,

which is implemented in regulations at

§ 413.40(c)(3)(vii), provides that for cost

reporting periods beginning on or after

October 1, 1998 and before October 1,

2002, the update factor for a hospital or

unit depends on the hospital’s or

hospital unit’s costs in relation to the

ceiling for the most recent cost reporting

period for which information is

available. For hospitals with costs

exceeding the ceiling by 10 percent or

more, the update factor is the market

basket increase. For hospitals with costs

exceeding the ceiling by less than 10

percent, the update factor is the market

basket minus .25 percent for each

percentage point by which costs are less

than 10 percent over the ceiling. For

hospitals with costs equal to or less than

the ceiling but greater than 66.7 percent

of the ceiling, the update factor is the

greater of 0 percent or the market basket

minus 2.5 percent. For hospitals with

costs that do not exceed 66.7 percent of

the ceiling, the update factor is 0.

The most recent forecast of the market

basket increase for FY 2002 for hospitals

and hospital units excluded from the

prospective payment system is 3.0

percent. Therefore, the update to a

hospital’s target amount for its cost

reporting period beginning in FY 2002

would be between 0.5 and 3.0 percent,

or 0 percent, depending on the

hospital’s or unit’s costs in relation to

its rate-of-increase limit.

In addition, § 413.40(c)(4)(iii) requires

that for cost reporting periods beginning

on or after October 1, 1998 and before

October 1, 2002, the target amount for

each psychiatric hospital or hospital

unit, rehabilitation hospital or hospital

unit, and long-term care hospital cannot

exceed a cap on the target amounts for

hospitals in the same class.

Section 1886(b)(3)(H) of the Act, as

amended by section 121 of Public Law

106–113, provides for an appropriate

wage adjustment to the caps on the

target amounts for psychiatric hospitals

and units, rehabilitation hospitals and

units, and long-term care hospitals,

effective for cost reporting periods

beginning on or after October 1, 1999,

through September 30, 2002. On August

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22737

1, 2000, we published an interim final

rule with comment period that

implemented this provision for cost

reporting periods beginning on or after

October 1, 1999 and before October 1,

2000 (65 FR 47026) and a final rule that

implemented the provision for cost

reporting periods beginning on or after

October 1, 2000 and before October 1,

2001 (65 FR 47054). This proposed rule

addresses the wage adjustment to the

caps for cost reporting periods

beginning on or after October 1, 2001.

As discussed in section VI. of the

preamble of this proposed rule, the cap

on the target amount per discharge is

determined by adding the hospital’s

nonlabor-related portion of the national

75th percentile cap to its wage-adjusted,

labor-related portion of the national

75th percentile cap (the labor-related

portion of costs equals 0.71553 and the

nonlabor-related portion of costs equals

0.28447). A hospital’s wage-adjusted,

labor-related portion of the target

amount is calculated by multiplying the

labor-related portion of the national

75th percentile cap for the hospital’s

class by the wage index under the

hospital inpatient prospective payment

system (see § 412.63), without taking

into account reclassifications under

sections 1886(d)(8)(B) and (d)(10) of the

Act.

As discussed in section VI. of the

preamble of this proposed rule, we are

proposing to make an adjustment to the

caps on target amounts for new and

existing excluded hospitals and units. In

calculating the wage-adjusted caps on

target amounts for new and existing

excluded and units for FY 2001, we

inadvertently made an error. In wage

neutralizing FY 1996 target amounts, we

used the FY 2000 hospital inpatient

prospective payment system wage index

published in Tables 4A and 4B of the

July 30, 1999 final rule (64 FR 41585

through 41593), which is based on wage

data after taking into account geographic

reclassifications under section

1886(d)(8) of the Act. We are proposing

to use pre-reclassified wage data in our

recalculation of the caps for FY 2002.

We propose to recalculate the limits for

new excluded hospitals and units, as

well as calculate the cap for existing

excluded hospitals and units using the

same wage index used under the

prospective payment system for skilled

nursing facilities (SNF) as shown in

Table 7 of the July 30, 1999 SNF final

rule (64 FR 41690). We do not anticipate

a significant impact on overall payments

to these hospitals and units.

Section 307(a) of Public Law 106–554

amended section 1886(b)(3) of the Act to

provide for a 2-percent increase to the

wage-adjusted 75th percentile cap on

the target amount for long-term care

hospitals, effective for cost reporting

periods beginning during FY 2001. This

provision is applicable to long-term care

hospitals that were subject to the cap for

existing excluded hospitals and units, as

specified in § 413.40(c).

In addition to the increase to the cap

on target amounts for long-term care

hospitals, section 307(a) of Public Law

106–554 amended section 1886(b)(3)(A)

of the Act to make the section

applicable to all long-term care

hospitals, effective for cost reporting

periods beginning during FY 2001. This

provision requires a revision to the

determination of each long-term care

hospital’s FY 2001 target amount as

specified in § 413.40(c)(4). For cost

reporting periods beginning during FY

2001, the hospital-specific target

amount otherwise determined for a

long-term care hospital as specified

under § 413.40(c)(4)(ii) is multiplied by

1.25 (that is, increased by 25 percent).

However, the revised FY 2001 target

amount for a long-term care hospital

cannot exceed its wage-adjusted

national cap as required by section

1886(b)(3) of the Act, as amended by

section 307(a) of Public Law 106–554.

For cost reporting periods beginning

in FY 2002, the proposed caps are as

follows:

Class of excluded hospital

or unit

Labor-related shareNonlabor-related share

Psychiatric ........ $8,404 $3,341

Rehabilitation .... 15,689 6,237

Long-Term Care 31,399 12,483

Regulations at § 413.40(d) specify the

formulas for determining bonus and

relief payments for excluded hospitals

and specify established criteria for an

additional bonus payment for

continuous improvement. Regulations at

§ 413.40(f)(2)(ii) specify the payment

methodology for new hospitals and

hospital units (psychiatric,

rehabilitation, and long-term care)

effective October 1, 1997.

V. Tables

This section contains the tables

referred to throughout the preamble to

this proposed rule and in this

Addendum. For purposes of this

proposed rule, and to avoid confusion,

we have retained the designations of

Tables 1 through 5 that were first used

in the September 1, 1983 initial

prospective payment final rule (48 FR

39844). Tables 1A, 1C, 1D, 2, 3A, 3B,

4A, 4B, 4C, 4F, 4G, 4H, 5, 6A, 6B, 6C,

6D, 6E, 6F, 6G, 6H, 7A, 7B, 8A, and 8B

are presented below. The tables

presented below are as follows:

Table 1A—National Adjusted Operating

Standardized Amounts, Labor/

Nonlabor

Table 1C—Adjusted Operating

Standardized Amounts for Puerto

Rico, Labor/Nonlabor

Table 1D—Capital Standard Federal

Payment Rate

Table 2—Hospital Average Hourly Wage

for Federal Fiscal Years 2000 (1996

Wage Data), 2001 (1997 Wage Data)

and 2002 (1998 Wage Data) Wage

Indexes and 3-Year Average of

Hospital Average Hourly Wages

Table 3A—3-Year Average Hourly Wage

for Urban Areas

Table 3B—3-Year Average Hourly Wage

for Rural Areas

Table 4A—Wage Index and Capital

Geographic Adjustment Factor

(GAF) for Urban Areas

Table 4B—Wage Index and Capital

Geographic Adjustment Factor

(GAF) for Rural Areas

Table 4C—Wage Index and Capital

Geographic Adjustment Factor

(GAF) for Hospitals That Are

Reclassified

Table 4F—Puerto Rico Wage Index and

Capital Geographic –Adjustment

Factor (GAF)

Table 4G—Pre-Reclassified Wage Index

for Urban Areas

Table 4H—Pre-Reclassified Wage Index

for Rural Areas

Table 5—List of Diagnosis Related

Groups (DRGs), Relative Weighting

Factors, Geometric and Arithmetic

Mean Length of Stay

Table 6A—New Diagnosis Codes

Table 6B—New Procedure Codes

Table 6C—Invalid Diagnosis Codes

Table 6D—Invalid Procedure Codes

Table 6E—Revised Diagnosis Code

Titles

Table 6F—Revised Procedure Code

Titles

Table 6G—Additions to the CC

Exclusions List

Table 6H—Deletions to the CC

Exclusions List

Table 7A—Medicare Prospective

Payment System Selected

–Percentile Lengths of Stay FY 2000

MedPAR Update 12/00 –GROUPER

V18.0

Table 7B—Medicare Prospective

Payment System Selected Percentile

Lengths of Stay FY 2000 MedPAR

Update 12/00 GROUPER V20.0

Table 8A—Statewide Average Operating

Cost-to-Charge Ratios for Urban and

Rural Hospitals (Case Weighted)

March 2001

Table 8B—Statewide Average Capital

Cost-to-Charge Ratios (Case

Weighted) March 2001

22738

TABLE 1A.—NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR

Large urban areas Other areas

Labor-related Nonlabor-related Labor-related Nonlabor-related

$2,940.89 $1,195.38 $2,894.33 $1,176.46

TABLE 1C.—ADJUSTED OPERATING STANDARDIZED AMOUNTS FOR PUERTO RICO, LABOR/NONLABOR

Large urban areas Other areas

Labor Nonlabor Labor Nonlabor

National ............................................................................................................ $2,915.45 $1,185.04 $2,915.45 $1,185.04

Puerto Rico ...................................................................................................... 1,414.18 569.25 1,391.79 560.23

TABLE 1D.—CAPITAL STANDARD FEDERAL PAYMENT RATE

Rate

National ................................................................................................................................................................................................ $389.09

Puerto Rico .......................................................................................................................................................................................... 188.67

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

010001 ............................................................................................................. 15.8484 16.4088 17.1352 16.4665

010004 ............................................................................................................. 15.0194 17.9732 19.0010 17.1863

010005 ............................................................................................................. 16.2615 17.5985 18.6554 17.4986

010006 ............................................................................................................. 17.3081 16.7480 17.3537 17.1306

010007 ............................................................................................................. 14.8048 15.4798 15.6788 15.3288

010008 ............................................................................................................. 17.6549 14.7443 17.4728 16.6080

010009 ............................................................................................................. 17.5328 18.7731 18.4390 18.2439

010010 ............................................................................................................. 15.9090 16.4468 16.4664 16.2848

010011 ............................................................................................................. 20.6261 20.7972 21.9311 21.1001

010012 ............................................................................................................. 19.2992 17.7171 15.8686 17.5430

010015 ............................................................................................................. 18.3461 15.4510 18.7062 17.3913

010016 ............................................................................................................. 16.1311 17.2473 18.6772 17.4112

010018 ............................................................................................................. 18.9617 17.6449 18.9388 18.5180

010019 ............................................................................................................. 15.4910 16.3493 17.0672 16.3245

010021 ............................................................................................................. 14.6297 16.2919 15.1241 15.3000

010022 ............................................................................................................. 20.5050 18.5879 17.6435 18.8422

010023 ............................................................................................................. 16.2581 16.1025 16.3209 16.2283

010024 ............................................................................................................. 16.0263 16.2900 16.2974 16.2091

010025 ............................................................................................................. 14.5311 15.1356 15.1548 14.9441

010027 ............................................................................................................. 14.9278 11.7900 16.8595 14.1053

010029 ............................................................................................................. 16.4103 17.6461 18.3605 17.4403

010031 ............................................................................................................. 18.0194 18.7835 18.5180 18.4445

010032 ............................................................................................................. 12.6540 12.5995 15.3590 13.6017

010033 ............................................................................................................. 19.6797 20.3923 21.1818 20.4188

010034 ............................................................................................................. 14.7342 15.0959 15.3639 15.0606

010035 ............................................................................................................. 17.4788 20.1853 16.0377 17.7343

010036 ............................................................................................................. 17.2880 17.8140 17.0366 17.3872

010038 ............................................................................................................. 18.3309 18.2671 19.6098 18.7632

010039 ............................................................................................................. 18.8080 20.1045 20.3406 19.7778

010040 ............................................................................................................. 19.1030 18.9376 19.9152 19.2851

010043 ............................................................................................................. 16.2022 30.7489 18.6640 19.9982

010044 ............................................................................................................. 17.0229 22.0091 24.0265 20.8906

010045 ............................................................................................................. 15.0065 15.2200 17.0417 15.7248

010046 ............................................................................................................. 17.1822 17.3970 18.9737 17.8750

010047 ............................................................................................................. 16.3803 13.3521 15.4332 15.2044

010049 ............................................................................................................. 14.4823 14.7590 15.5246 14.9487

010050 ............................................................................................................. 15.4159 18.5163 17.3895 17.0820

22739

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

010051 ............................................................................................................. 9.9390 11.9275 11.8108 11.1940

010052 ............................................................................................................. 13.8649 16.5486 18.0653 16.1248

010053 ............................................................................................................. 13.1778 14.6267 15.5649 14.5406

010054 ............................................................................................................. 17.1246 18.5103 19.5148 18.4901

010055 ............................................................................................................. 18.1930 18.9526 18.8590 18.6711

010058 ............................................................................................................. 12.7809 16.1702 16.9715 15.1274

010059 ............................................................................................................. 18.1886 19.1286 18.8020 18.7124

010061 ............................................................................................................. 15.9215 14.9547 14.5003 15.1112

010062 ............................................................................................................. 13.5690 14.7732 12.3259 13.5151

010064 ............................................................................................................. 20.8966 20.4139 19.5256 20.2712

010065 ............................................................................................................. 15.6357 16.4049 16.8752 16.3279

010066 ............................................................................................................. 12.0681 15.4317 13.1559 13.4757

010068 ............................................................................................................. 18.7367 12.0525 12.9616 14.2644

010069 ............................................................................................................. 13.5684 13.8636 14.7211 14.0429

010072 ............................................................................................................. 14.3481 14.9526 16.2339 15.1957

010073 ............................................................................................................. 12.8328 13.8601 14.1273 13.6015

010078 ............................................................................................................. 17.7110 17.9202 18.1028 17.9134

010079 ............................................................................................................. 16.8701 16.4421 14.5611 15.8427

010080 ............................................................................................................. 13.8473 * * 13.8473

010081 ............................................................................................................. 16.9823 18.9474 17.2996 17.7081

010083 ............................................................................................................. 16.2146 16.8933 18.0312 17.0916

010084 ............................................................................................................. 18.7794 18.4965 18.7769 18.6812

010085 ............................................................................................................. 18.8696 18.4744 19.6888 19.0044

010086 ............................................................................................................. 14.9255 16.6694 16.5711 16.0968

010087 ............................................................................................................. 18.3889 19.0033 17.3321 18.3237

010089 ............................................................................................................. 16.6090 16.8042 17.7800 17.0521

010090 ............................................................................................................. 18.1121 18.3866 18.9445 18.4882

010091 ............................................................................................................. 16.3620 13.9405 17.0799 15.6820

010092 ............................................................................................................. 16.4980 16.9900 17.8144 17.1322

010094 ............................................................................................................. 18.5603 * * 18.5603

010095 ............................................................................................................. 11.8993 12.4525 12.2597 12.2090

010097 ............................................................................................................. 12.8955 13.0413 12.7286 12.8889

010098 ............................................................................................................. 14.2787 15.9165 14.0300 14.6833

010099 ............................................................................................................. 15.9309 15.9874 15.5619 15.8073

010100 ............................................................................................................. 15.4826 17.2011 17.7237 16.8503

010101 ............................................................................................................. 15.4173 15.3859 14.4460 15.0721

010102 ............................................................................................................. 12.7251 13.7933 13.8136 13.4259

010103 ............................................................................................................. 19.3115 17.9358 16.6514 17.9628

010104 ............................................................................................................. 18.0997 17.7126 15.9964 17.2534

010108 ............................................................................................................. 20.7914 17.9017 19.4617 19.3047

010109 ............................................................................................................. 14.0870 15.3107 14.6834 14.6934

010110 ............................................................................................................. 15.9066 15.6317 15.8283 15.7917

010112 ............................................................................................................. 15.1056 15.1401 16.8271 15.6716

010113 ............................................................................................................. 17.2440 16.9683 13.9413 15.9844

010114 ............................................................................................................. 17.2612 15.2454 17.0136 16.4485

010115 ............................................................................................................. 13.7524 14.6268 14.9632 14.4787

010118 ............................................................................................................. 16.6889 18.8477 17.0834 17.5145

010119 ............................................................................................................. 18.1707 18.8024 20.7741 19.7059

010120 ............................................................................................................. 17.0332 17.2336 18.2567 17.5146

010121 ............................................................................................................. 15.1806 14.6444 14.5262 14.8160

010123 ............................................................................................................. 18.1604 16.7344 19.2140 17.9949

010124 ............................................................................................................. 16.2666 16.2846 16.7465 16.4273

010125 ............................................................................................................. 14.4153 15.5304 16.0136 15.3557

010126 ............................................................................................................. 17.6405 19.5710 19.1065 18.7347

010127 ............................................................................................................. 19.6095 19.5190 18.2786 19.1726

010128 ............................................................................................................. 12.5747 14.5056 14.4322 13.6385

010129 ............................................................................................................. 14.4267 14.7286 16.1733 15.1385

010130 ............................................................................................................. 16.3465 16.6809 18.1314 16.9797

010131 ............................................................................................................. 17.9076 17.8260 20.1883 18.6602

010134 ............................................................................................................. 10.7817 18.8835 19.9856 15.8677

010137 ............................................................................................................. 15.9348 12.1217 20.4561 15.8609

010138 ............................................................................................................. 12.1295 12.8675 14.5254 13.1763

010139 ............................................................................................................. 19.9487 19.0001 20.6815 19.8355

22740

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

010143 ............................................................................................................. 15.7144 16.7911 17.6212 16.7651

010144 ............................................................................................................. 17.1211 17.1320 17.7580 17.3377

010145 ............................................................................................................. 20.7460 20.8434 20.5895 20.7209

010146 ............................................................................................................. 18.8561 18.5198 19.1415 18.8309

010148 ............................................................................................................. 14.6443 12.2214 15.8349 13.9784

010149 ............................................................................................................. 17.0836 18.6333 18.0156 17.9216

010150 ............................................................................................................. 16.9749 17.8951 18.8977 17.9203

010152 ............................................................................................................. 17.3835 17.8306 18.2173 17.8172

010155 ............................................................................................................. 16.7028 9.0300 15.0689 12.5183

010158 ............................................................................................................. * 17.3227 18.3957 17.8637

020001 ............................................................................................................. 27.9690 28.1747 27.4110 27.8426

020002 ............................................................................................................. 26.9145 24.5815 25.1987 25.5092

020004 ............................................................................................................. 26.3979 30.5667 25.4679 27.5927

020005 ............................................................................................................. 29.0068 30.2920 29.2378 29.5337

020006 ............................................................................................................. 26.7706 31.2404 28.1417 28.8630

020007 ............................................................................................................. 24.9555 27.8319 32.3852 28.0097

020008 ............................................................................................................. 30.4712 29.4146 30.8691 30.2487

020009 ............................................................................................................. 23.1801 20.1930 18.4660 20.3801

020010 ............................................................................................................. 18.6417 23.6727 22.7559 21.4818

020011 ............................................................................................................. 29.4697 30.4727 28.0658 29.3006

020012 ............................................................................................................. 23.9259 24.8543 25.5320 24.7635

020013 ............................................................................................................. 26.8172 23.8847 28.1557 26.0576

020014 ............................................................................................................. 24.0932 27.3823 24.9201 25.4246

020017 ............................................................................................................. 24.9714 26.8319 27.6501 26.5037

020024 ............................................................................................................. 22.7263 24.0872 25.3205 24.0621

020025 ............................................................................................................. 27.1529 21.7557 20.2583 22.6334

030001 ............................................................................................................. 19.8695 20.3673 21.7869 20.6506

030002 ............................................................................................................. 21.6263 21.5977 21.8375 21.6886

030003 ............................................................................................................. 23.6722 23.4833 22.6804 23.3063

030004 ............................................................................................................. 17.7333 14.0711 15.5478 15.4308

030006 ............................................................................................................. 17.6409 18.2668 19.7289 18.5307

030007 ............................................................................................................. 18.5602 19.6708 21.5169 19.9379

030008 ............................................................................................................. * 22.2758 22.2190 22.2524

030009 ............................................................................................................. 17.9343 18.1794 18.7557 18.2786

030010 ............................................................................................................. 18.7997 19.0907 19.5123 19.1422

030011 ............................................................................................................. 20.0784 19.2973 19.4310 19.5785

030012 ............................................................................................................. 19.4245 18.9918 20.6585 19.6997

030013 ............................................................................................................. 21.0182 20.7458 19.6369 20.4298

030014 ............................................................................................................. 19.4697 19.9315 19.7966 19.7342

030016 ............................................................................................................. 20.5606 19.3967 19.4785 19.8559

030017 ............................................................................................................. 20.4185 22.8765 21.7938 21.6805

030018 ............................................................................................................. 18.9115 20.2032 20.8980 20.0193

030019 ............................................................................................................. 19.9211 21.7005 21.2540 20.9846

030022 ............................................................................................................. 15.7886 19.2966 17.3485 17.0947

030023 ............................................................................................................. 22.4365 23.6697 24.1678 23.4686

030024 ............................................................................................................. 21.6692 22.2541 22.6199 22.1974

030025 ............................................................................................................. 17.6759 12.7254 11.9894 13.7385

030027 ............................................................................................................. 17.5796 15.7554 17.6555 16.9563

030030 ............................................................................................................. 21.6249 20.8303 21.6932 21.3795

030033 ............................................................................................................. 16.8396 20.0044 20.2820 18.9069

030034 ............................................................................................................. 19.0868 16.8241 20.8689 18.8279

030035 ............................................................................................................. 19.7153 19.2781 20.0226 19.6580

030036 ............................................................................................................. 18.9449 20.7567 21.6371 20.4743

030037 ............................................................................................................. 21.4376 22.8266 23.7615 22.6712

030038 ............................................................................................................. 22.0777 22.6776 22.9822 22.5885

030040 ............................................................................................................. 17.9722 18.5456 19.7636 18.7537

030041 ............................................................................................................. 17.4389 15.8921 18.8717 17.2718

030043 ............................................................................................................. 20.7721 20.9341 20.5598 20.7468

030044 ............................................................................................................. 16.4654 16.8649 17.6575 17.0214

030047 ............................................................................................................. 19.6916 22.6401 21.4412 21.2271

030049 ............................................................................................................. 19.0896 19.0881 19.3580 19.1639

030054 ............................................................................................................. 14.4861 15.3338 15.0657 14.9801

030055 ............................................................................................................. 18.2751 16.3613 20.2991 18.2684

22741

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

030059 ............................................................................................................. 21.7100 24.0465 22.6279 22.7570

030060 ............................................................................................................. 16.7661 19.2461 18.6313 18.2043

030061 ............................................................................................................. 17.3470 18.9063 19.9047 18.7238

030062 ............................................................................................................. 17.4825 17.6738 18.0603 17.7568

030064 ............................................................................................................. 18.5391 19.5673 19.9437 19.3687

030065 ............................................................................................................. 19.9277 20.5130 20.7838 20.4254

030067 ............................................................................................................. 15.6207 14.4446 17.2778 15.7364

030068 ............................................................................................................. 17.3482 17.3614 17.7208 17.4823

030069 ............................................................................................................. 19.0013 19.0961 21.0936 19.7255

030080 ............................................................................................................. 19.9865 20.5144 20.6581 20.3684

030083 ............................................................................................................. 23.6433 23.3355 23.5229 23.4991

030085 ............................................................................................................. 17.8402 21.0954 20.8611 19.9420

030086 ............................................................................................................. 18.5030 19.5436 * 19.0352

030087 ............................................................................................................. 20.0469 21.4084 21.9465 21.1838

030088 ............................................................................................................. 19.5772 19.8682 20.4978 20.0029

030089 ............................................................................................................. 19.9018 20.4019 20.9516 20.4404

030092 ............................................................................................................. 21.5628 20.6986 21.8308 21.3646

030093 ............................................................................................................. 19.4688 19.7262 20.4314 19.9052

030094 ............................................................................................................. 19.4773 21.6218 22.8123 21.4086

030095 ............................................................................................................. 14.2499 13.7293 13.7664 13.9087

030099 ............................................................................................................. 18.0747 16.1541 18.2263 17.4781

030100 ............................................................................................................. * * 23.7609 23.7609

030101 ............................................................................................................. * * 19.2547 19.2547

030102 ............................................................................................................. * * 18.2413 18.2413

040001 ............................................................................................................. 15.5735 15.1624 16.9178 15.8741

040002 ............................................................................................................. 14.0865 13.0592 15.1107 14.0333

040003 ............................................................................................................. 14.0027 14.2089 15.5740 14.5731

040004 ............................................................................................................. 17.2926 17.8476 17.9034 17.6718

040005 ............................................................................................................. 12.8825 13.2597 11.1318 12.3937

040007 ............................................................................................................. 19.5299 21.9583 18.6998 19.9568

040008 ............................................................................................................. 12.6974 15.3040 14.7985 14.3087

040010 ............................................................................................................. 17.6231 18.6023 19.4913 18.6031

040011 ............................................................................................................. 12.2654 14.5319 16.0995 14.1756

040014 ............................................................................................................. 15.3853 17.6340 18.1434 17.0051

040015 ............................................................................................................. 14.6045 16.5891 15.5207 15.5649

040016 ............................................................................................................. 17.5431 19.0295 20.2321 18.9152

040017 ............................................................................................................. 14.9533 13.5098 15.4686 14.6576

040018 ............................................................................................................. 17.5602 17.6027 18.7463 17.9749

040019 ............................................................................................................. 25.7080 22.6769 23.4163 23.8479

040020 ............................................................................................................. 14.8059 16.4827 18.9844 16.6335

040021 ............................................................................................................. 16.4628 17.6398 19.6835 17.8176

040022 ............................................................................................................. 16.0006 17.0397 14.8398 15.8797

040024 ............................................................................................................. 15.7282 14.4541 17.6523 15.9585

040025 ............................................................................................................. 10.9496 11.5079 13.4705 11.8847

040026 ............................................................................................................. 18.2398 19.5563 19.7924 19.1863

040027 ............................................................................................................. 14.5406 16.0975 17.4431 16.0716

040028 ............................................................................................................. 12.8409 14.6584 13.9946 13.7921

040029 ............................................................................................................. 17.7777 17.8787 21.1370 18.9480

040030 ............................................................................................................. 14.1541 13.5428 11.2402 12.7784

040032 ............................................................................................................. 13.3280 13.7030 13.2872 13.4471

040035 ............................................................................................................. 11.2123 12.8300 10.9569 11.6408

040036 ............................................................................................................. 17.9080 18.9757 20.0835 18.9954

040037 ............................................................................................................. 13.4815 14.6559 14.0941 14.0704

040039 ............................................................................................................. 13.8386 14.3576 14.7177 14.3115

040040 ............................................................................................................. 17.4283 18.0895 19.1984 18.2668

040041 ............................................................................................................. 13.3613 15.9896 16.4624 15.2103

040042 ............................................................................................................. 14.6641 15.2142 15.2057 15.0333

040044 ............................................................................................................. 11.4422 12.6275 13.3501 12.5381

040045 ............................................................................................................. 18.7724 14.9429 16.2469 16.4870

040047 ............................................................................................................. 16.3948 16.8654 17.5336 16.9538

040048 ............................................................................................................. 15.8203 * * 15.8203

040050 ............................................................................................................. 11.7934 13.3818 14.0036 13.0341

040051 ............................................................................................................. 16.2803 15.8627 16.6039 16.2390

22742

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

040053 ............................................................................................................. 15.8193 16.3610 15.0219 15.7502

040054 ............................................................................................................. 15.0412 15.3219 14.2577 14.8844

040055 ............................................................................................................. 16.1029 17.1269 17.7214 16.9813

040058 ............................................................................................................. 15.6706 17.6766 16.4278 16.6344

040060 ............................................................................................................. 11.4686 12.8148 17.9805 13.6105

040062 ............................................................................................................. 17.2757 18.2048 17.8902 17.8204

040064 ............................................................................................................. 12.4007 10.7255 11.5029 11.4801

040066 ............................................................................................................. 17.6429 18.3377 17.8338 17.9377

040067 ............................................................................................................. 13.4930 14.6014 14.4741 14.1956

040069 ............................................................................................................. 16.1147 17.5052 17.0026 16.8681

040070 ............................................................................................................. 15.4757 16.9027 16.9700 16.4358

040071 ............................................................................................................. 16.3022 16.9610 17.2834 16.8497

040072 ............................................................................................................. 15.8425 16.0895 17.4822 16.4893

040074 ............................................................................................................. 17.3819 18.3224 18.7542 18.1968

040075 ............................................................................................................. 12.7496 13.3623 14.0975 13.3977

040076 ............................................................................................................. 18.5512 19.0732 20.5840 19.3801

040077 ............................................................................................................. 12.4625 12.9211 13.9114 13.0965

040078 ............................................................................................................. 17.8573 18.7600 18.5821 18.4100

040080 ............................................................................................................. 15.7397 19.2461 19.3707 18.0636

040081 ............................................................................................................. 10.6791 11.3169 11.1332 11.0311

040082 ............................................................................................................. 16.5127 16.2152 15.1331 15.9302

040084 ............................................................................................................. 17.2469 17.2613 17.7295 17.4070

040085 ............................................................................................................. 15.7765 16.8957 16.5216 16.3838

040088 ............................................................................................................. 15.6710 17.9636 17.1624 16.9372

040090 ............................................................................................................. 17.5503 17.8282 19.0824 18.0989

040091 ............................................................................................................. 17.0444 19.8700 20.1378 18.8893

040093 ............................................................................................................. 12.9010 12.3537 13.9741 13.0114

040100 ............................................................................................................. 14.9688 14.7587 15.6833 15.1704

040105 ............................................................................................................. 14.2409 15.3319 14.3896 14.6616

040106 ............................................................................................................. 15.4000 15.6545 18.1341 16.4515

040107 ............................................................................................................. 19.6184 18.8120 17.8628 18.6841

040109 ............................................................................................................. 13.9807 14.6266 16.6278 15.0815

040114 ............................................................................................................. 18.3133 18.8743 21.1110 19.3778

040116 ............................................................................................................. 19.5695 20.2716 * 19.9151

040118 ............................................................................................................. 17.4300 19.3720 18.2123 18.3407

040119 ............................................................................................................. 15.3847 15.5338 16.7730 15.9002

040124 ............................................................................................................. 17.2547 19.1349 19.2889 18.5723

040126 ............................................................................................................. 11.6845 12.5368 11.6517 11.9404

040132 ............................................................................................................. 13.1760 17.5179 10.3875 13.4483

040134 ............................................................................................................. * 18.0787 19.0185 18.5701

040135 ............................................................................................................. * 22.6761 23.0084 22.8797

050002 ............................................................................................................. 27.6006 37.8295 36.9630 33.5586

050006 ............................................................................................................. 19.5272 19.5594 18.2061 19.0382

050007 ............................................................................................................. 29.5398 30.7126 30.8676 30.4910

050008 ............................................................................................................. 25.8570 26.2458 26.3682 26.1654

050009 ............................................................................................................. 26.2506 26.8159 28.0701 27.0878

050013 ............................................................................................................. 24.8541 23.2201 28.0569 25.1985

050014 ............................................................................................................. 24.5302 22.8478 23.6745 23.6450

050015 ............................................................................................................. 25.3838 26.2481 27.7731 26.4938

050016 ............................................................................................................. 20.1542 20.5566 21.2045 20.6377

050017 ............................................................................................................. 23.6639 23.9625 24.4598 24.0349

050018 ............................................................................................................. 14.6622 15.4721 15.2903 15.1444

050021 ............................................................................................................. 28.5003 25.8966 * 27.2682

050022 ............................................................................................................. 22.9583 24.0318 24.5254 23.8802

050024 ............................................................................................................. 20.3427 21.3989 22.4274 21.4070

050025 ............................................................................................................. 21.9952 23.3896 23.9879 23.0936

050026 ............................................................................................................. 28.6850 27.8736 27.0130 27.8531

050028 ............................................................................................................. 16.4531 16.4671 17.6138 16.8496

050029 ............................................................................................................. 23.2911 25.1259 24.6839 24.3441

050030 ............................................................................................................. 21.0096 20.9812 21.5621 21.1955

050032 ............................................................................................................. 22.5868 25.2010 24.3598 24.0616

050033 ............................................................................................................. 24.5609 24.9328 31.7747 27.1293

050036 ............................................................................................................. 20.4703 21.2420 20.1678 20.6131

22743

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

050038 ............................................................................................................. 27.8274 28.6528 29.9698 28.8293

050039 ............................................................................................................. 22.2524 22.7117 22.5974 22.5195

050040 ............................................................................................................. 30.6664 32.1287 30.4110 31.0613

050042 ............................................................................................................. 22.2343 24.8067 24.5260 23.8317

050043 ............................................................................................................. 33.2286 32.9958 33.8255 33.3456

050045 ............................................................................................................. 20.7307 19.8831 21.1474 20.5973

050046 ............................................................................................................. 31.3831 25.3185 25.2005 27.4555

050047 ............................................................................................................. 29.4412 29.9255 29.9580 29.7840

050051 ............................................................................................................. 17.8401 17.8945 18.7809 18.1179

050054 ............................................................................................................. 19.3686 20.7212 22.0982 20.7075

050055 ............................................................................................................. 29.0872 29.3984 29.2730 29.2593

050056 ............................................................................................................. 23.8507 27.4321 23.8058 24.9609

050057 ............................................................................................................. 21.7581 21.1554 20.7050 21.1842

050058 ............................................................................................................. 25.7261 23.1641 23.3009 23.9601

050060 ............................................................................................................. 20.9219 20.7747 20.5450 20.7207

050061 ............................................................................................................. 23.7443 23.5454 24.5488 23.9503

050063 ............................................................................................................. 23.0724 24.8851 25.7593 24.5061

050065 ............................................................................................................. 21.1848 24.0420 24.3835 23.0762

050066 ............................................................................................................. 21.4187 16.5725 16.1649 17.6784

050067 ............................................................................................................. 21.3029 23.1966 25.8857 23.3989

050068 ............................................................................................................. 28.4804 20.6851 19.3615 22.4409

050069 ............................................................................................................. 29.2980 25.9420 24.6153 26.4351

050070 ............................................................................................................. 32.5964 32.5166 33.0195 32.7172

050071 ............................................................................................................. 33.1379 33.1850 33.3740 33.2367

050072 ............................................................................................................. 32.9660 33.2858 38.5136 34.8941

050073 ............................................................................................................. 34.6111 33.3922 31.4874 33.0669

050075 ............................................................................................................. 33.5246 33.9095 32.6142 33.3899

050076 ............................................................................................................. 33.8835 27.7797 32.7847 31.3195

050077 ............................................................................................................. 23.2986 24.1019 24.2083 23.8775

050078 ............................................................................................................. 22.8023 23.0736 24.3150 23.3638

050079 ............................................................................................................. 34.4253 33.2432 30.0167 32.3461

050082 ............................................................................................................. 21.7004 22.1009 23.7617 22.5498

050084 ............................................................................................................. 23.0966 23.5866 25.4517 24.0054

050088 ............................................................................................................. 24.0634 20.8406 24.9641 23.1779

050089 ............................................................................................................. 20.0194 20.9117 21.9331 20.9434

050090 ............................................................................................................. 23.8969 23.4097 23.9183 23.7390

050091 ............................................................................................................. 22.2220 25.2792 23.7713 23.6457

050092 ............................................................................................................. 15.3841 16.7969 17.1211 16.4241

050093 ............................................................................................................. 24.0837 25.2130 25.6647 24.9860

050095 ............................................................................................................. 33.3761 33.6718 32.5552 33.2492

050096 ............................................................................................................. 21.6752 20.0487 22.7394 21.3870

050097 ............................................................................................................. 22.6147 16.7054 22.5991 20.1968

050099 ............................................................................................................. 24.2921 24.8091 23.5693 24.1958

050100 ............................................................................................................. 30.0552 29.8758 25.0335 28.0584

050101 ............................................................................................................. 30.0132 31.0264 31.8957 30.9871

050102 ............................................................................................................. 21.2947 22.2937 24.0014 22.4745

050103 ............................................................................................................. 25.3384 24.7932 25.4133 25.1832

050104 ............................................................................................................. 25.4407 25.5797 26.8367 25.9399

050107 ............................................................................................................. 21.7649 21.2690 22.2019 21.7497

050108 ............................................................................................................. 25.2116 23.5564 25.1307 24.5504

050109 ............................................................................................................. 26.4768 * * 26.4768

050110 ............................................................................................................. 20.1769 20.1870 19.9589 20.1175

050111 ............................................................................................................. 21.7397 21.5487 20.7897 21.3840

050112 ............................................................................................................. 26.2922 25.3015 26.8182 26.1335

050113 ............................................................................................................. 27.7805 28.8420 28.5224 28.4025

050114 ............................................................................................................. 25.9073 24.7286 26.6757 25.7599

050115 ............................................................................................................. 21.0499 21.3291 23.0182 21.8124

050116 ............................................................................................................. 25.5919 25.2130 24.9196 25.2412

050117 ............................................................................................................. 20.4379 23.3612 22.2123 21.9903

050118 ............................................................................................................. 23.9976 23.7698 23.7129 23.8243

050121 ............................................................................................................. 18.8818 19.5252 18.4827 18.9563

050122 ............................................................................................................. * 26.3172 26.9546 26.6358

050124 ............................................................................................................. 23.0193 22.7736 24.5069 23.3667

22744

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

050125 ............................................................................................................. 24.0434 29.6147 32.0230 28.3742

050126 ............................................................................................................. 23.8424 23.9247 24.6752 24.1448

050127 ............................................................................................................. 19.7654 22.1937 20.9157 20.9577

050128 ............................................................................................................. 24.1801 25.7240 26.6132 25.5185

050129 ............................................................................................................. 27.1586 26.5030 23.0719 25.3795

050131 ............................................................................................................. 29.0570 31.0732 32.5462 30.8106

050132 ............................................................................................................. 22.9139 24.0834 24.0173 23.6527

050133 ............................................................................................................. 24.4011 24.9746 23.2093 24.1354

050135 ............................................................................................................. 27.0341 23.2361 24.7157 24.9796

050136 ............................................................................................................. 24.4336 24.7921 24.4162 24.5396

050137 ............................................................................................................. 30.0725 32.6507 31.5620 31.4326

050138 ............................................................................................................. 37.4088 37.3286 40.3920 38.3945

050139 ............................................................................................................. 31.3785 32.9351 30.3774 31.5037

050140 ............................................................................................................. 33.6644 34.1499 31.6524 33.0748

050144 ............................................................................................................. 25.7483 27.8751 27.4069 26.9409

050145 ............................................................................................................. 33.0620 32.3857 34.5185 33.3152

050148 ............................................................................................................. 21.0584 21.9211 20.0971 20.9748

050149 ............................................................................................................. 23.3754 24.6078 26.8674 24.8666

050150 ............................................................................................................. 23.4777 24.9073 24.6596 24.3771

050152 ............................................................................................................. 27.7504 34.0766 33.3305 31.5833

050153 ............................................................................................................. 29.5915 30.5714 32.3389 30.8441

050155 ............................................................................................................. 22.9420 21.0257 25.3354 22.9852

050158 ............................................................................................................. 27.9789 27.5623 28.6071 28.0313

050159 ............................................................................................................. 25.2105 23.2912 22.5313 23.6099

050167 ............................................................................................................. 21.6778 21.9128 21.8796 21.8226

050168 ............................................................................................................. 25.2504 23.3511 25.1937 24.5830

050169 ............................................................................................................. 24.6361 22.3888 24.8407 23.8796

050170 ............................................................................................................. 22.1989 23.9574 24.3654 23.4164

050172 ............................................................................................................. 17.6976 20.1841 19.6120 19.1630

050173 ............................................................................................................. 23.3255 24.5545 24.8694 24.1923

050174 ............................................................................................................. 31.2136 30.2140 30.1320 30.4943

050175 ............................................................................................................. 27.7875 27.2806 24.7548 26.2477

050177 ............................................................................................................. 20.2485 21.7943 21.1396 21.0728

050179 ............................................................................................................. 19.2861 21.7175 23.8868 21.4573

050180 ............................................................................................................. 32.1883 31.8947 33.3257 32.5107

050183 ............................................................................................................. 19.9765 20.3638 * 20.1665

050186 ............................................................................................................. 21.9062 22.4155 23.6288 22.6119

050188 ............................................................................................................. 27.4364 28.0918 28.2364 27.9460

050189 ............................................................................................................. 23.2415 22.8687 27.4071 24.6245

050191 ............................................................................................................. 26.7297 20.8321 25.2399 24.1511

050192 ............................................................................................................. 17.8095 18.6701 14.0828 16.5416

050193 ............................................................................................................. 23.7260 22.6316 24.9444 23.7567

050194 ............................................................................................................. 28.2701 29.7371 29.3310 29.0932

050195 ............................................................................................................. 34.7789 35.5621 36.9068 35.7823

050196 ............................................................................................................. 16.6866 18.5180 18.2411 17.8430

050197 ............................................................................................................. 31.4513 35.7449 32.0779 32.9661

050204 ............................................................................................................. 24.3944 23.6105 22.7099 23.5849

050205 ............................................................................................................. 21.1545 23.6831 24.1691 23.0778

050207 ............................................................................................................. 20.8576 21.6214 22.9941 21.8243

050211 ............................................................................................................. 31.2175 31.6084 31.7280 31.5153

050213 ............................................................................................................. 20.7338 21.4806 21.4438 21.1694

050214 ............................................................................................................. 20.8704 21.7335 24.0276 22.1888

050215 ............................................................................................................. 28.4058 29.8563 32.4402 30.1364

050217 ............................................................................................................. 19.8913 19.6010 20.2042 19.9076

050219 ............................................................................................................. 25.4730 21.7444 21.2458 22.6404

050222 ............................................................................................................. 27.0713 27.4809 26.9958 27.1794

050224 ............................................................................................................. 23.7942 23.5316 23.5101 23.6043

050225 ............................................................................................................. 20.7978 23.3480 21.6206 21.8948

050226 ............................................................................................................. 26.9297 27.7315 24.4443 26.2380

050228 ............................................................................................................. 30.3772 34.0711 34.2596 32.7722

050230 ............................................................................................................. 25.3640 27.7357 26.6291 26.5638

050231 ............................................................................................................. 25.5798 26.1508 26.7319 26.1758

050232 ............................................................................................................. 23.3849 24.3072 24.5245 24.0793

22745

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

050233 ............................................................................................................. 31.3954 * * 31.3954

050234 ............................................................................................................. * * 28.5188 25.7035

050235 ............................................................................................................. 25.8595 25.2527 27.0922 26.0726

050236 ............................................................................................................. 26.2723 26.9803 25.9458 26.4027

050238 ............................................................................................................. 24.0043 24.2922 24.5823 24.2994

050239 ............................................................................................................. 20.4071 22.6625 21.9889 21.6674

050240 ............................................................................................................. 25.2540 26.3657 26.7736 26.0561

050241 ............................................................................................................. 27.2198 26.3740 29.8345 27.7426

050242 ............................................................................................................. 30.1432 31.1576 31.9079 31.0590

050243 ............................................................................................................. 22.9123 28.9635 26.4627 26.1049

050245 ............................................................................................................. 24.3969 23.8124 23.2716 23.7873

050248 ............................................................................................................. 27.4214 26.2015 27.6457 27.0910

050251 ............................................................................................................. 18.4990 21.6574 23.6360 21.1907

050253 ............................................................................................................. 20.0658 16.0701 16.7540 17.4281

050254 ............................................................................................................. 19.6899 19.3126 20.1176 19.7146

050256 ............................................................................................................. 23.5302 23.6887 23.4835 23.5723

050257 ............................................................................................................. 19.5923 15.2306 15.0481 16.3402

050260 ............................................................................................................. 23.5201 23.2421 27.4234 24.5032

050261 ............................................................................................................. 20.4496 20.0552 20.1040 20.2029

050262 ............................................................................................................. 29.0054 28.8785 29.5550 29.1532

050264 ............................................................................................................. 29.4542 32.1312 36.0219 32.4654

050267 ............................................................................................................. 24.7464 26.2264 26.0401 25.6690

050270 ............................................................................................................. 23.7260 24.0439 25.3757 24.3521

050272 ............................................................................................................. 21.4374 22.4247 23.1111 22.3118

050274 ............................................................................................................. 21.1943 20.0422 * 20.6204

050276 ............................................................................................................. 28.5051 29.8624 33.3302 30.5715

050277 ............................................................................................................. 22.3125 20.0520 26.0822 22.5131

050278 ............................................................................................................. 23.8434 24.7787 23.9289 24.1853

050279 ............................................................................................................. 21.0570 20.8444 21.8949 21.2309

050280 ............................................................................................................. 24.4267 25.2149 25.4011 25.0356

050281 ............................................................................................................. 18.5907 19.6888 24.2251 20.7934

050282 ............................................................................................................. 24.4593 28.8261 25.4428 26.2214

050283 ............................................................................................................. 27.8763 29.7734 31.7669 30.1598

050286 ............................................................................................................. 17.8045 16.5708 18.5915 17.4822

050289 ............................................................................................................. 26.7185 34.1393 30.4750 30.2632

050290 ............................................................................................................. 26.3745 28.6231 29.6796 28.2631

050291 ............................................................................................................. 26.4908 30.2748 28.3483 28.3026

050292 ............................................................................................................. 22.4878 21.6243 20.8410 21.6183

050293 ............................................................................................................. 19.1761 22.2963 24.1875 21.4642

050295 ............................................................................................................. 20.7393 21.2892 21.5335 21.1814

050296 ............................................................................................................. 25.3166 27.2948 28.3906 27.0098

050298 ............................................................................................................. 20.5181 24.4477 23.2006 22.6781

050299 ............................................................................................................. 25.7697 26.4543 25.5035 25.9187

050300 ............................................................................................................. 22.7423 23.5116 25.9228 24.1102

050301 ............................................................................................................. 26.0355 22.5201 21.1403 23.0323

050302 ............................................................................................................. 29.2007 * * 29.2007

050305 ............................................................................................................. 32.7082 34.5185 36.7908 34.7340

050307 ............................................................................................................. 27.9830 17.2147 * 21.7503

050308 ............................................................................................................. 28.4019 29.3803 28.9284 28.9113

050309 ............................................................................................................. 24.4034 23.7884 25.3515 24.5133

050310 ............................................................................................................. 20.6181 * * 20.6181

050312 ............................................................................................................. 23.7936 26.7617 26.0015 25.5439

050313 ............................................................................................................. 23.1009 21.7577 25.6827 23.5594

050315 ............................................................................................................. 21.9227 24.7086 22.7359 23.0264

050317 ............................................................................................................. 19.4479 21.6937 * 20.5789

050320 ............................................................................................................. 30.6054 30.4101 32.4809 31.1252

050324 ............................................................................................................. 26.2735 26.6049 25.3694 26.0738

050325 ............................................................................................................. 23.2355 24.4862 23.6327 23.7872

050327 ............................................................................................................. 22.8511 23.9484 25.6450 24.1469

050328 ............................................................................................................. 23.1889 * * 23.1889

050329 ............................................................................................................. 21.4125 19.7455 15.1669 18.2146

050331 ............................................................................................................. 25.5252 22.2536 25.0230 24.1261

050333 ............................................................................................................. 20.1468 19.4589 19.1449 19.5671

22746

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

050334 ............................................................................................................. 32.0169 34.2330 34.2557 33.5307

050335 ............................................................................................................. 20.2013 23.0258 22.9926 22.0827

050336 ............................................................................................................. 20.0980 20.7979 21.3402 20.7523

050342 ............................................................................................................. 19.3524 20.1841 20.8255 20.1210

050343 ............................................................................................................. 17.3394 17.2085 * 17.2799

050348 ............................................................................................................. 20.7505 23.8779 25.1085 23.3219

050349 ............................................................................................................. 15.0515 14.9754 15.0667 15.0310

050350 ............................................................................................................. 25.0676 24.8340 26.4161 25.4163

050351 ............................................................................................................. 24.6936 25.4791 24.8121 24.9948

050352 ............................................................................................................. 23.5927 26.1380 26.0974 25.3078

050353 ............................................................................................................. 23.2468 23.0564 23.2699 23.1944

050355 ............................................................................................................. 17.1597 17.2778 21.0969 18.0157

050357 ............................................................................................................. 23.6411 22.6545 24.5345 23.6386

050359 ............................................................................................................. 20.4005 17.7907 21.7548 19.8316

050360 ............................................................................................................. 31.7608 31.3526 31.7583 31.6236

050366 ............................................................................................................. 21.3442 23.7528 19.6823 21.4770

050367 ............................................................................................................. 29.4763 28.2805 30.7328 29.5063

050369 ............................................................................................................. 24.2604 27.0548 26.2234 25.8174

050373 ............................................................................................................. 26.6548 26.9776 28.0655 27.2088

050376 ............................................................................................................. 25.3036 26.5840 28.5679 26.7332

050377 ............................................................................................................. 25.6401 17.1764 17.0012 20.1035

050378 ............................................................................................................. 22.2363 25.9810 26.9101 24.8709

050379 ............................................................................................................. 15.4994 15.2022 17.8958 16.1098

050380 ............................................................................................................. 30.5790 31.4343 31.9578 31.3600

050382 ............................................................................................................. 26.1465 26.1398 25.9244 26.0725

050385 ............................................................................................................. 25.9188 24.6083 20.1687 23.1378

050388 ............................................................................................................. 13.7863 19.1512 22.0122 17.5709

050390 ............................................................................................................. 22.5668 25.0426 24.2700 23.9349

050391 ............................................................................................................. 22.4881 18.9266 20.0615 20.3952

050392 ............................................................................................................. 21.9324 21.6729 22.9430 22.1487

050393 ............................................................................................................. 23.1387 25.6964 24.1981 24.3082

050394 ............................................................................................................. 22.2424 23.0604 23.1526 22.8333

050396 ............................................................................................................. 23.6322 24.0636 25.3729 24.3512

050397 ............................................................................................................. 20.7698 20.2601 20.6397 20.5453

050401 ............................................................................................................. 17.7807 20.7473 18.4593 18.9557

050404 ............................................................................................................. 19.2754 17.3396 15.9839 17.4356

050406 ............................................................................................................. 16.8931 17.3016 17.8596 17.3407

050407 ............................................................................................................. 30.1222 29.9642 30.8346 30.2996

050410 ............................................................................................................. 16.4735 17.6769 19.8508 17.8663

050411 ............................................................................................................. 32.2364 34.8899 32.2157 33.0639

050414 ............................................................................................................. 24.4243 24.2060 23.9069 24.1441

050417 ............................................................................................................. 21.8884 21.5739 23.3005 22.2456

050419 ............................................................................................................. 23.1162 23.7584 23.4936 23.4646

050420 ............................................................................................................. 22.6819 22.3166 23.1651 22.7188

050423 ............................................................................................................. 23.3296 17.3771 21.3552 20.6272

050424 ............................................................................................................. 23.7788 22.8350 24.0727 23.5641

050425 ............................................................................................................. 33.6911 32.8364 33.8624 33.4842

050426 ............................................................................................................. 23.7082 25.2453 29.2475 25.9886

050427 ............................................................................................................. 20.0698 20.1674 16.4330 18.6499

050430 ............................................................................................................. 21.3428 23.8788 21.2275 22.2136

050432 ............................................................................................................. 21.4984 24.4133 24.5630 23.4427

050433 ............................................................................................................. 16.8035 17.4643 18.9021 17.7004

050434 ............................................................................................................. 15.6348 19.7591 * 17.6624

050435 ............................................................................................................. 32.9865 25.6676 23.3426 26.8858

050436 ............................................................................................................. 16.3594 14.8121 * 15.5729

050438 ............................................................................................................. 24.0828 25.0138 22.5006 23.8790

050440 ............................................................................................................. 21.1100 23.5167 22.6946 22.4056

050441 ............................................................................................................. 28.7067 28.9804 31.8774 29.8169

050443 ............................................................................................................. 16.4308 19.9020 17.2875 17.7906

050444 ............................................................................................................. 24.6741 21.4533 22.4530 22.8550

050446 ............................................................................................................. 20.5383 20.4908 22.3422 21.1378

050447 ............................................................................................................. 18.4183 17.9751 18.9851 18.4558

050448 ............................................................................................................. 20.0757 19.7046 21.7718 20.5035

22747

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

050449 ............................................................................................................. 22.1784 23.8001 23.4614 23.1469

050454 ............................................................................................................. 28.6857 28.7432 30.9487 29.5840

050455 ............................................................................................................. 19.9209 20.1643 20.2611 20.1204

050456 ............................................................................................................. 17.6229 20.1254 18.1585 18.5890

050457 ............................................................................................................. 31.2489 34.4949 32.1910 32.6376

050459 ............................................................................................................. 37.0914 * * 37.0914

050464 ............................................................................................................. 22.3142 25.3292 25.7710 24.4665

050468 ............................................................................................................. 23.1701 23.3050 22.2926 22.8998

050469 ............................................................................................................. 23.4404 23.8759 24.5205 23.8915

050470 ............................................................................................................. 17.0353 16.0292 15.7832 16.2133

050471 ............................................................................................................. 24.2887 25.6172 26.2221 25.3560

050476 ............................................................................................................. 23.1428 22.4754 24.0253 23.2552

050477 ............................................................................................................. 27.7855 27.9595 27.5819 27.7866

050478 ............................................................................................................. 23.0530 24.5401 26.3306 24.6133

050481 ............................................................................................................. 26.8293 28.9722 27.7973 27.8692

050482 ............................................................................................................. 16.9268 18.1217 16.0114 17.0134

050483 ............................................................................................................. 21.6038 22.7182 * 22.1632

050485 ............................................................................................................. 23.1933 24.1983 24.6906 24.0174

050486 ............................................................................................................. 24.4967 * * 24.4967

050488 ............................................................................................................. 32.8620 34.6939 31.7481 33.0979

050491 ............................................................................................................. 25.1011 26.8703 27.4600 26.4606

050492 ............................................................................................................. 21.4156 19.5457 20.5030 20.4277

050494 ............................................................................................................. 25.4078 29.2621 29.1296 27.9125

050496 ............................................................................................................. 33.0168 32.5168 34.9704 33.4862

050497 ............................................................................................................. * 13.8110 15.4115 14.5264

050498 ............................................................................................................. 24.8445 24.9677 26.1716 25.3085

050502 ............................................................................................................. 22.6253 22.3788 24.3517 23.0821

050503 ............................................................................................................. 23.5911 24.4069 23.3745 23.7879

050506 ............................................................................................................. 21.2165 25.0845 25.0333 23.8164

050510 ............................................................................................................. 33.4617 33.3774 32.6940 33.1728

050512 ............................................................................................................. 34.3138 35.3581 33.4465 34.3098

050515 ............................................................................................................. 35.0412 35.3419 32.6021 34.2147

050516 ............................................................................................................. 25.1850 24.7992 26.1969 25.4171

050517 ............................................................................................................. 20.3733 20.9550 22.0985 21.1081

050522 ............................................................................................................. 31.7326 35.3784 35.2780 33.9529

050523 ............................................................................................................. 28.4235 27.0544 31.2522 28.8864

050526 ............................................................................................................. 26.9206 23.8099 26.4014 25.6096

050528 ............................................................................................................. 18.6898 19.0611 18.9155 18.8867

050531 ............................................................................................................. 20.7332 22.7308 21.3948 21.6689

050534 ............................................................................................................. 23.3026 24.0700 24.0001 23.7954

050535 ............................................................................................................. 24.2257 25.4215 26.8511 25.4120

050537 ............................................................................................................. 22.2073 22.2256 23.8790 22.8084

050539 ............................................................................................................. 23.2501 20.7129 21.2318 21.6610

050541 ............................................................................................................. 34.6195 34.4573 35.5912 34.9089

050542 ............................................................................................................. 17.8537 16.0892 17.7737 17.2018

050543 ............................................................................................................. 23.0437 22.3994 21.6795 22.3610

050545 ............................................................................................................. 27.5713 26.3304 31.7280 27.9472

050546 ............................................................................................................. 27.7557 26.1949 38.8087 28.7303

050547 ............................................................................................................. 27.0845 26.8305 37.7681 28.7499

050548 ............................................................................................................. 26.5922 28.8083 29.8516 28.2370

050549 ............................................................................................................. 27.9098 27.2765 28.5457 27.9239

050550 ............................................................................................................. 25.7546 24.8048 25.6588 25.4034

050551 ............................................................................................................. 24.0488 25.4652 24.8084 24.7966

050552 ............................................................................................................. 22.8731 21.5216 20.3239 21.6775

050557 ............................................................................................................. 22.1385 21.1243 22.2562 21.8314

050559 ............................................................................................................. 24.6689 23.5759 24.7866 24.3485

050561 ............................................................................................................. 33.9268 34.5791 32.3907 33.5772

050564 ............................................................................................................. 24.5099 23.5922 24.2091 24.0891

050565 ............................................................................................................. 22.8785 23.7829 20.8349 22.3644

050566 ............................................................................................................. 18.3297 17.4423 22.3448 19.2949

050567 ............................................................................................................. 24.2349 24.6454 25.0787 24.6746

050568 ............................................................................................................. 20.5205 19.5816 20.5376 20.2025

050569 ............................................................................................................. 24.9453 26.5479 27.3429 26.2484

22748

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

050570 ............................................................................................................. 24.4961 25.2294 26.1015 25.2629

050571 ............................................................................................................. 24.3741 26.2039 23.6702 24.7124

050573 ............................................................................................................. 25.1398 24.9644 25.6589 25.2612

050575 ............................................................................................................. * 19.5611 20.7090 20.0979

050577 ............................................................................................................. 20.5177 25.1549 23.5487 22.9797

050578 ............................................................................................................. 28.9073 28.5379 28.3177 28.5843

050579 ............................................................................................................. 30.0694 30.4952 29.9348 30.1803

050580 ............................................................................................................. 23.9183 25.9004 24.6962 24.8350

050581 ............................................................................................................. 23.5660 23.8584 24.1233 23.8604

050583 ............................................................................................................. 23.3609 24.3987 25.8800 24.5448

050584 ............................................................................................................. 23.1610 21.2366 19.5805 21.2667

050585 ............................................................................................................. 26.4985 25.9426 24.2824 25.5872

050586 ............................................................................................................. 23.8402 23.4079 23.1850 23.4570

050588 ............................................................................................................. 30.3873 25.3094 24.5472 26.4705

050589 ............................................................................................................. 24.3453 24.8698 23.8109 24.3084

050590 ............................................................................................................. * 22.4480 23.9599 23.1967

050591 ............................................................................................................. 22.3224 23.9412 24.8356 23.6641

050592 ............................................................................................................. 26.0528 21.1745 22.1174 23.0414

050594 ............................................................................................................. 22.7826 27.1584 27.7002 25.6455

050597 ............................................................................................................. 23.1789 22.8523 23.3280 23.1176

050598 ............................................................................................................. 28.1062 24.3597 23.9202 25.2869

050599 ............................................................................................................. 26.3191 29.1221 26.0892 27.1846

050601 ............................................................................................................. 32.8704 31.8670 29.7417 31.4201

050603 ............................................................................................................. 22.7500 23.3390 21.7031 22.5608

050604 ............................................................................................................. 33.3239 34.0461 34.3923 33.9347

050607 ............................................................................................................. 24.1052 * * 24.1052

050608 ............................................................................................................. 16.1529 18.0947 17.6170 17.2527

050609 ............................................................................................................. 31.9340 34.9935 32.3640 33.0668

050613 ............................................................................................................. 23.4779 23.3835 30.2413 25.4419

050615 ............................................................................................................. 23.7015 23.8815 27.5682 24.9089

050616 ............................................................................................................. 22.7960 22.7437 24.9843 23.5101

050618 ............................................................................................................. 21.7032 21.6509 21.4895 21.6219

050623 ............................................................................................................. 30.3208 29.1806 33.3458 30.6877

050624 ............................................................................................................. 22.3419 22.7148 26.4659 23.7251

050625 ............................................................................................................. 24.3503 26.4849 27.5816 26.1377

050630 ............................................................................................................. 24.0961 23.9159 23.9834 23.9961

050633 ............................................................................................................. 21.9790 23.1918 25.4283 23.5401

050635 ............................................................................................................. 37.8481 * * 37.8481

050636 ............................................................................................................. 20.8349 21.2618 23.5257 21.8335

050638 ............................................................................................................. 23.6341 18.2859 18.2159 19.5807

050641 ............................................................................................................. 21.3605 21.8315 17.1258 19.7042

050644 ............................................................................................................. 23.1229 22.3456 22.1489 22.5048

050661 ............................................................................................................. 20.4769 19.6780 * 20.1699

050662 ............................................................................................................. 28.2910 26.9606 35.0989 28.9225

050663 ............................................................................................................. 23.7097 30.6591 24.9110 25.8492

050667 ............................................................................................................. 24.1064 24.9979 27.5045 25.1663

050668 ............................................................................................................. 39.9001 42.0974 61.7751 44.9671

050670 ............................................................................................................. 21.8750 20.0152 24.6101 21.9523

050674 ............................................................................................................. 36.2361 34.7380 31.4935 33.9505

050675 ............................................................................................................. 15.8423 15.6794 * 15.7602

050676 ............................................................................................................. 17.5302 18.6672 52.8683 22.3243

050677 ............................................................................................................. 33.7056 35.6503 32.6045 33.9333

050678 ............................................................................................................. 22.6591 26.8741 22.7756 23.9129

050680 ............................................................................................................. 27.3188 28.0584 31.4839 28.9200

050682 ............................................................................................................. 17.9715 26.2882 17.3566 19.6443

050684 ............................................................................................................. 21.8067 22.3398 23.3697 22.4849

050685 ............................................................................................................. 32.1330 31.1725 35.1307 32.7762

050686 ............................................................................................................. 33.2515 35.2631 32.3401 33.5425

050688 ............................................................................................................. 29.9990 30.6635 31.0648 30.5922

050689 ............................................................................................................. 34.1851 30.7295 30.9399 31.8127

050690 ............................................................................................................. 33.8277 32.8204 33.7648 33.4827

050693 ............................................................................................................. 33.2977 26.8265 25.5662 28.3155

050694 ............................................................................................................. 22.5719 23.2293 23.5572 23.1120

22749

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

050695 ............................................................................................................. 23.5215 21.1377 24.3451 23.0440

050696 ............................................................................................................. 26.4103 28.0015 28.3291 27.6235

050697 ............................................................................................................. 21.4716 21.1566 18.2338 20.1433

050699 ............................................................................................................. 28.4754 25.7843 17.5296 23.1610

050700 ............................................................................................................. 28.4522 * * 28.4522

050701 ............................................................................................................. 27.6190 22.6959 24.3055 24.7548

050702 ............................................................................................................. 12.2518 * * 12.2518

050704 ............................................................................................................. 20.7568 22.8716 22.7618 22.3025

050707 ............................................................................................................. 27.5065 26.2732 27.8958 27.2979

050708 ............................................................................................................. 21.9149 22.7821 24.8647 23.2324

050709 ............................................................................................................. 19.4255 21.9598 19.4977 20.2535

050710 ............................................................................................................. 26.8095 26.9060 26.7221 26.8057

050713 ............................................................................................................. 15.3027 17.7259 16.8538 16.6077

050714 ............................................................................................................. * 28.9314 30.1925 29.4900

050715 ............................................................................................................. 19.1151 * * 19.1151

050717 ............................................................................................................. * 25.9534 29.6608 27.7154

050718 ............................................................................................................. * 17.6062 18.0940 17.8064

050719 ............................................................................................................. * 25.5508 23.0833 23.8495

050720 ............................................................................................................. * * 25.8677 25.8677

060001 ............................................................................................................. 20.5908 21.3659 21.1819 21.0411

060003 ............................................................................................................. 19.3243 19.8023 20.4682 19.8685

060004 ............................................................................................................. 21.7899 22.8750 21.4496 22.0469

060006 ............................................................................................................. 17.8613 19.3651 20.0213 19.0568

060007 ............................................................................................................. 16.3833 17.4682 18.2977 17.3945

060008 ............................................................................................................. 17.0944 18.0333 18.4590 17.8646

060009 ............................................................................................................. 21.1795 21.4312 22.6084 21.7644

060010 ............................................................................................................. 22.7241 24.0872 23.6827 23.5135

060011 ............................................................................................................. 21.9727 23.4366 22.6254 22.6752

060012 ............................................................................................................. 19.7746 20.1442 19.4932 19.7974

060013 ............................................................................................................. 19.1369 22.7346 18.4230 20.1121

060014 ............................................................................................................. 20.5353 24.2459 23.8228 22.8253

060015 ............................................................................................................. 23.5675 20.9773 23.0206 22.5102

060016 ............................................................................................................. 15.9627 16.4707 20.2408 17.3661

060018 ............................................................................................................. 21.8607 20.3183 21.5083 21.2146

060020 ............................................................................................................. 17.7250 18.3099 18.8985 18.3187

060022 ............................................................................................................. 19.6488 21.0558 21.0830 20.6200

060023 ............................................................................................................. 19.6534 19.2373 21.2785 20.0409

060024 ............................................................................................................. 22.8347 21.9955 22.5663 22.4704

060027 ............................................................................................................. 21.6731 20.9846 21.7448 21.4691

060028 ............................................................................................................. 22.2461 23.2065 23.1792 22.8860

060029 ............................................................................................................. 21.4111 20.8585 18.2938 20.0752

060030 ............................................................................................................. 20.0345 20.5002 20.3452 20.2923

060031 ............................................................................................................. 19.3998 21.1649 22.0161 20.8402

060032 ............................................................................................................. 22.3702 23.4162 21.7060 22.5248

060033 ............................................................................................................. 13.8165 15.9085 16.0760 15.2591

060034 ............................................................................................................. 21.4110 22.4791 22.1375 22.0321

060036 ............................................................................................................. 19.2386 15.0698 18.5988 17.4095

060037 ............................................................................................................. 14.0458 15.5611 15.4513 15.0213

060038 ............................................................................................................. 14.3084 14.0791 14.3249 14.2429

060041 ............................................................................................................. 14.8299 14.8934 19.1263 15.9980

060042 ............................................................................................................. 20.0815 19.1892 20.8597 19.9134

060043 ............................................................................................................. 13.0544 13.6717 13.4443 13.3963

060044 ............................................................................................................. 22.5286 19.7039 20.8673 21.1240

060046 ............................................................................................................. 20.4359 19.4567 22.2699 20.7384

060047 ............................................................................................................. 15.1181 15.8770 17.1534 15.9786

060049 ............................................................................................................. 20.6427 21.7797 25.5038 22.5344

060050 ............................................................................................................. 16.8012 18.2238 19.0832 18.0606

060052 ............................................................................................................. 12.5517 13.4210 14.6309 13.5896

060053 ............................................................................................................. 14.9399 15.9806 18.0232 16.2596

060054 ............................................................................................................. 19.3943 22.8985 20.4160 20.8278

060056 ............................................................................................................. 17.0509 18.2831 18.1263 17.9597

060057 ............................................................................................................. 23.3804 26.4046 25.4185 25.1123

060058 ............................................................................................................. 16.9064 15.4856 13.8539 15.6088

22750

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

060060 ............................................................................................................. 14.8894 15.6469 15.6018 15.4330

060062 ............................................................................................................. 14.9354 17.2991 16.8640 16.3901

060063 ............................................................................................................. 15.0896 * * 15.0896

060064 ............................................................................................................. 20.9349 21.2207 22.6830 21.6302

060065 ............................................................................................................. 24.3032 21.6305 23.7162 23.1229

060066 ............................................................................................................. 14.0672 16.3485 17.2537 15.7129

060068 ............................................................................................................. 19.6355 * * 19.6355

060070 ............................................................................................................. 16.5821 17.3184 18.8960 17.6173

060071 ............................................................................................................. 16.9545 17.5987 17.4068 17.3254

060073 ............................................................................................................. 15.8385 15.7860 17.0846 16.2338

060075 ............................................................................................................. 22.8498 24.1550 23.8724 23.6295

060076 ............................................................................................................. 19.2861 24.8732 20.3265 21.3796

060085 ............................................................................................................. 13.4761 13.6277 14.3409 13.7955

060087 ............................................................................................................. 21.0277 * * 21.0277

060088 ............................................................................................................. 16.6753 25.2786 13.7174 17.2655

060090 ............................................................................................................. 14.5096 22.2974 16.3760 17.6196

060096 ............................................................................................................. 23.1232 21.9623 20.8937 21.9261

060100 ............................................................................................................. 21.9983 23.5986 22.9395 23.0367

060103 ............................................................................................................. 22.3414 24.8151 23.5320 23.5039

060104 ............................................................................................................. 22.3008 22.2295 21.0656 21.8025

060107 ............................................................................................................. 13.6449 14.2698 21.9221 15.1674

070001 ............................................................................................................. 26.5150 26.0878 26.1878 26.2690

070002 ............................................................................................................. 25.4570 26.2801 26.2089 25.9775

070003 ............................................................................................................. 26.0894 25.6949 27.3062 26.3527

070004 ............................................................................................................. 23.2664 22.4871 24.2567 23.3158

070005 ............................................................................................................. 25.5739 26.6483 26.7916 26.3250

070006 ............................................................................................................. 28.7139 27.5674 28.4368 28.2423

070007 ............................................................................................................. 27.1867 26.9505 26.0179 26.7076

070008 ............................................................................................................. 26.0269 23.0227 24.2971 24.3585

070009 ............................................................................................................. 23.4686 24.6201 24.1871 24.0886

070010 ............................................................................................................. 25.9375 26.2354 28.0116 26.6816

070011 ............................................................................................................. 23.9603 23.3638 23.0883 23.4486

070012 ............................................................................................................. 25.1022 23.0321 28.8067 25.3536

070015 ............................................................................................................. 25.3317 23.8240 25.4250 24.8350

070016 ............................................................................................................. 26.3005 24.9148 24.4633 25.2035

070017 ............................................................................................................. 24.8038 26.2923 26.0424 25.7039

070018 ............................................................................................................. 28.8776 28.0689 30.6864 29.1923

070019 ............................................................................................................. 24.7025 25.7283 24.9249 25.1145

070020 ............................................................................................................. 23.7227 23.9987 25.0719 24.2498

070021 ............................................................................................................. 26.5173 25.2978 27.1879 26.2849

070022 ............................................................................................................. 25.0845 26.5691 26.5225 26.0295

070024 ............................................................................................................. 25.1491 25.2983 24.8948 25.1081

070025 ............................................................................................................. 25.4055 25.1315 25.0631 25.2037

070026 ............................................................................................................. 18.7892 * * 18.7892

070027 ............................................................................................................. 23.6381 23.6412 26.8450 24.6648

070028 ............................................................................................................. 24.6913 24.6788 25.6145 24.9846

070029 ............................................................................................................. 22.7507 22.0080 23.9682 22.8885

070030 ............................................................................................................. 24.9676 28.9117 22.1578 25.5338

070031 ............................................................................................................. 21.6565 23.4419 24.1198 23.0342

070033 ............................................................................................................. 28.8099 30.4214 31.4671 30.2045

070034 ............................................................................................................. 29.1220 28.9200 29.1514 29.0628

070035 ............................................................................................................. 23.0574 23.0869 23.7003 23.2881

070036 ............................................................................................................. 28.9463 28.8400 29.9470 29.2263

070039 ............................................................................................................. 21.7791 22.9032 22.3356 22.3067

080001 ............................................................................................................. 25.2849 25.4836 24.2845 25.0307

080002 ............................................................................................................. 15.5984 19.6011 20.1965 18.4286

080003 ............................................................................................................. 22.3957 22.1856 22.6814 22.4058

080004 ............................................................................................................. 19.7725 21.9391 23.0537 21.6106

080005 ............................................................................................................. 14.4289 * * 14.4289

080006 ............................................................................................................. 22.2632 20.0792 21.1059 21.1131

080007 ............................................................................................................. 20.3833 19.6213 21.2441 20.4479

090001 ............................................................................................................. 25.8921 21.7526 19.4884 22.5234

090002 ............................................................................................................. 19.6997 19.4191 21.5726 20.1912

22751

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

090003 ............................................................................................................. 28.6092 22.1090 23.1268 24.5792

090004 ............................................................................................................. 24.4267 24.3367 25.4836 24.6979

090005 ............................................................................................................. 24.8766 23.8620 26.1199 24.9264

090006 ............................................................................................................. 20.0816 20.8675 22.0789 21.0107

090007 ............................................................................................................. 21.6551 22.1973 29.2840 24.7855

090008 ............................................................................................................. 21.5972 20.2166 25.2708 22.3042

090010 ............................................................................................................. 15.8676 24.1287 23.6616 20.2595

090011 ............................................................................................................. 27.3741 27.4781 25.5395 26.7683

100001 ............................................................................................................. 17.6948 19.5796 19.4948 18.9110

100002 ............................................................................................................. 21.3243 20.7136 20.8100 20.9384

100004 ............................................................................................................. 15.2465 14.6283 15.4149 15.0845

100006 ............................................................................................................. 20.6302 20.1133 21.0230 20.6052

100007 ............................................................................................................. 21.7217 21.7242 21.8476 21.7676

100008 ............................................................................................................. 20.7232 20.4980 20.8381 20.6876

100009 ............................................................................................................. 24.2947 22.6419 20.1263 22.1819

100010 ............................................................................................................. 21.9101 21.9078 23.0637 22.2904

100012 ............................................................................................................. 18.5169 19.6177 20.4659 19.5030

100014 ............................................................................................................. 19.8352 19.8023 19.5770 19.7276

100015 ............................................................................................................. 18.2394 18.4779 18.0654 18.2696

100017 ............................................................................................................. 17.7739 19.0608 19.8655 18.9086

100018 ............................................................................................................. 20.8392 21.0332 21.0971 20.9923

100019 ............................................................................................................. 19.8134 22.6152 22.9645 21.7772

100020 ............................................................................................................. 26.1783 21.3848 20.7816 22.5004

100022 ............................................................................................................. 25.8853 26.4094 26.5695 26.2778

100023 ............................................................................................................. 21.1068 19.9739 19.1787 20.0604

100024 ............................................................................................................. 20.7760 21.8791 22.1332 21.6047

100025 ............................................................................................................. 19.1219 18.7774 19.4159 19.1009

100026 ............................................................................................................. 20.7591 20.5641 20.9461 20.7639

100027 ............................................................................................................. 12.9410 19.1481 14.7916 15.3484

100028 ............................................................................................................. 19.7491 19.3757 19.3371 19.4791

100029 ............................................................................................................. 19.1768 20.8745 20.8950 20.2753

100030 ............................................................................................................. 18.8229 22.8204 20.6176 20.6840

100032 ............................................................................................................. 19.3165 19.8127 19.7451 19.6185

100034 ............................................................................................................. 18.2314 17.8743 19.5282 18.5138

100035 ............................................................................................................. 19.5842 20.1540 23.7366 21.2058

100038 ............................................................................................................. 24.7851 23.3578 24.5864 24.2183

100039 ............................................................................................................. 20.2529 21.5297 21.7861 21.1854

100040 ............................................................................................................. 18.6417 19.0449 18.4371 18.7010

100043 ............................................................................................................. 17.5215 18.7993 18.8206 18.3605

100044 ............................................................................................................. 21.1370 21.4764 22.3808 21.6907

100045 ............................................................................................................. 20.7688 20.9216 20.5433 20.7423

100046 ............................................................................................................. 21.2094 21.6207 22.0001 21.5991

100047 ............................................................................................................. 18.8677 20.0114 20.6068 19.8263

100048 ............................................................................................................. 13.5021 15.0584 15.7790 14.8232

100049 ............................................................................................................. 18.5598 18.8535 19.1025 18.8421

100050 ............................................................................................................. 16.6058 17.2377 17.9039 17.2452

100051 ............................................................................................................. 18.8377 23.1273 17.9453 19.6449

100052 ............................................................................................................. 16.1855 17.9537 18.1780 17.4312

100053 ............................................................................................................. 18.7103 20.1724 19.6800 19.5213

100054 ............................................................................................................. 18.1853 23.5491 21.1710 20.9429

100055 ............................................................................................................. 17.6226 18.0547 18.8760 18.1971

100056 ............................................................................................................. 23.6545 25.7863 21.8506 23.8349

100057 ............................................................................................................. 18.7489 19.9712 19.5319 19.4242

100060 ............................................................................................................. 22.3904 23.2561 23.5983 23.0794

100061 ............................................................................................................. 21.7923 22.1133 22.9176 22.2483

100062 ............................................................................................................. 17.9575 19.4370 21.4424 19.6570

100063 ............................................................................................................. 16.2324 19.2629 18.4642 17.9066

100067 ............................................................................................................. 17.3950 18.0877 18.4851 17.9682

100068 ............................................................................................................. 18.6480 19.9305 19.8148 19.4667

100069 ............................................................................................................. 16.1393 16.8271 17.3666 16.7757

100070 ............................................................................................................. 20.3358 18.7408 19.5034 19.4826

100071 ............................................................................................................. 16.4756 17.5451 17.7234 17.2640

100072 ............................................................................................................. 19.2223 21.0225 20.1930 20.2012

22752

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

100073 ............................................................................................................. 18.1554 21.1898 22.2812 20.4948

100075 ............................................................................................................. 18.0548 18.3688 19.4480 18.6211

100076 ............................................................................................................. 16.2469 17.8733 17.8612 17.3644

100077 ............................................................................................................. 19.6214 22.3438 18.0424 19.9689

100078 ............................................................................................................. 18.2791 18.4499 19.2891 18.6609

100080 ............................................................................................................. 21.1603 22.1966 21.4042 21.5955

100081 ............................................................................................................. 13.9564 14.8313 15.4253 14.7661

100082 ............................................................................................................. 19.8033 18.8998 * 19.3432

100084 ............................................................................................................. 20.4002 22.3674 22.0600 21.6577

100085 ............................................................................................................. 21.0802 22.1231 * 21.5986

100086 ............................................................................................................. 21.1625 21.6997 23.3718 22.0734

100087 ............................................................................................................. 23.1162 23.6090 23.3607 23.3648

100088 ............................................................................................................. 20.0571 20.3693 20.5566 20.3435

100090 ............................................................................................................. 17.8768 19.1479 19.7695 18.9939

100092 ............................................................................................................. 18.1953 17.9216 20.1760 18.7907

100093 ............................................................................................................. 16.6310 16.5128 16.8422 16.6633

100098 ............................................................................................................. 19.0319 19.2427 20.8315 19.7124

100099 ............................................................................................................. 15.2983 15.7823 15.7591 15.6112

100102 ............................................................................................................. 19.3330 18.9701 19.7673 19.3542

100103 ............................................................................................................. 18.1019 17.2364 18.7844 18.0201

100105 ............................................................................................................. 21.5028 21.6604 21.8268 21.6611

100106 ............................................................................................................. 19.3113 17.2527 17.4958 17.9164

100107 ............................................................................................................. 18.0142 20.1281 20.0396 19.3936

100108 ............................................................................................................. 11.4692 19.9593 20.1125 16.4375

100109 ............................................................................................................. 22.1715 20.8440 19.8488 20.8649

100110 ............................................................................................................. 19.6439 20.8995 20.1853 20.2509

100112 ............................................................................................................. 9.7706 25.2570 15.2128 15.6728

100113 ............................................................................................................. 22.2584 23.2020 28.8892 24.7828

100114 ............................................................................................................. 23.4501 21.6262 22.8178 22.5825

100117 ............................................................................................................. 18.8619 20.7624 20.6962 20.1889

100118 ............................................................................................................. 19.7608 22.8702 20.7323 21.1427

100121 ............................................................................................................. 19.3435 * 18.2789 18.7785

100122 ............................................................................................................. 18.0551 19.8783 19.2567 19.0659

100124 ............................................................................................................. 19.0527 17.0713 20.4022 18.8192

100125 ............................................................................................................. 17.3358 18.9535 19.6097 18.6719

100126 ............................................................................................................. 18.0943 19.5413 19.3103 18.9490

100127 ............................................................................................................. 19.8727 19.9860 19.2122 19.6859

100128 ............................................................................................................. 21.3653 20.1536 22.8826 21.4045

100129 ............................................................................................................. 18.5723 19.1936 * 18.8646

100130 ............................................................................................................. 19.1052 18.6751 20.0947 19.3019

100131 ............................................................................................................. 22.1680 23.4373 21.1195 22.2597

100132 ............................................................................................................. 16.8978 18.1167 18.7863 17.9218

100134 ............................................................................................................. 13.4711 15.1764 15.9733 14.8260

100135 ............................................................................................................. 17.4785 18.8253 19.0430 18.4539

100137 ............................................................................................................. 19.0464 18.6955 19.5562 19.1372

100138 ............................................................................................................. 11.0135 17.1373 14.9539 13.7935

100139 ............................................................................................................. 15.6444 15.6514 15.2532 15.5227

100140 ............................................................................................................. 17.3518 17.1389 19.0584 17.8826

100142 ............................................................................................................. 18.6812 19.6815 13.0623 16.5381

100144 ............................................................................................................. 15.0197 12.2877 * 13.4059

100145 ............................................................................................................. 19.1143 * * 19.1143

100146 ............................................................................................................. 17.8692 18.1267 21.3359 19.1001

100147 ............................................................................................................. 14.6751 14.6616 15.2348 14.8665

100150 ............................................................................................................. 21.0224 21.2807 21.5057 21.2659

100151 ............................................................................................................. 19.3990 21.6087 23.8489 21.6478

100154 ............................................................................................................. 19.8485 20.0015 20.4068 20.1020

100156 ............................................................................................................. 17.1335 19.4980 18.4779 18.3856

100157 ............................................................................................................. 21.0324 22.6744 22.6195 22.1032

100159 ............................................................................................................. 16.3778 10.2793 6.3232 9.8839

100160 ............................................................................................................. 21.6339 20.5581 23.3121 21.8278

100161 ............................................................................................................. 21.5025 22.2994 22.4181 22.0895

100162 ............................................................................................................. 19.8748 20.1411 14.1842 17.5642

100165 ............................................................................................................. 18.5739 19.0388 22.6622 20.3299

22753

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

100166 ............................................................................................................. 20.4228 20.0250 21.2309 20.5491

100167 ............................................................................................................. 21.8138 23.4075 23.2969 22.8605

100168 ............................................................................................................. 20.1260 20.1994 20.2632 20.1979

100169 ............................................................................................................. 20.7778 20.9506 20.6223 20.7811

100170 ............................................................................................................. 15.1167 18.5088 19.3005 17.5325

100172 ............................................................................................................. 15.1848 14.3446 14.8826 14.8099

100173 ............................................................................................................. 17.3416 18.5662 17.1337 17.6572

100174 ............................................................................................................. 20.5125 26.1826 21.9807 22.2819

100175 ............................................................................................................. 17.8237 18.1692 20.5477 19.0035

100176 ............................................................................................................. 24.6978 22.8604 24.3089 23.9493

100177 ............................................................................................................. 22.0034 24.4296 23.5394 23.2665

100179 ............................................................................................................. 20.9053 22.3015 18.4114 20.3782

100180 ............................................................................................................. 18.4754 20.2130 21.5180 19.9976

100181 ............................................................................................................. 24.5704 23.0800 18.9510 21.8206

100183 ............................................................................................................. 20.8579 24.6121 23.0654 22.6623

100187 ............................................................................................................. 20.6938 20.2533 18.7750 19.8300

100189 ............................................................................................................. 21.0102 21.3147 26.5962 23.0255

100191 ............................................................................................................. 18.4692 19.9879 18.8676 19.1050

100199 ............................................................................................................. 23.3713 21.7193 * 22.5030

100200 ............................................................................................................. 22.2575 22.4579 23.8729 22.8861

100203 ............................................................................................................. 18.8628 * * 18.8628

100204 ............................................................................................................. 20.2049 20.8995 19.6128 20.2366

100206 ............................................................................................................. 20.3511 19.5710 20.1171 20.0138

100207 ............................................................................................................. 15.9173 * * 15.9173

100208 ............................................................................................................. 20.8337 21.2117 20.7029 20.9220

100209 ............................................................................................................. 19.7329 22.4577 22.7340 21.6408

100210 ............................................................................................................. 19.1799 21.3575 21.8545 20.7662

100211 ............................................................................................................. 25.5277 20.6427 20.7516 21.9172

100212 ............................................................................................................. 25.3441 21.1187 20.6343 22.0357

100213 ............................................................................................................. 19.1238 20.6558 21.1818 20.2975

100217 ............................................................................................................. 19.8700 20.5909 22.7335 21.0211

100220 ............................................................................................................. 19.9121 21.2796 21.1605 20.7655

100221 ............................................................................................................. 22.2517 17.3965 21.2672 20.0933

100222 ............................................................................................................. 22.1958 * * 22.1958

100223 ............................................................................................................. 18.7580 20.6302 18.6039 19.2991

100224 ............................................................................................................. 24.7023 20.0251 21.8799 21.8886

100225 ............................................................................................................. 20.6404 20.6802 21.1013 20.8046

100226 ............................................................................................................. 24.8641 20.6858 22.0308 22.2904

100228 ............................................................................................................. 23.6986 21.3168 20.9039 21.8386

100229 ............................................................................................................. 18.2070 19.6908 18.2350 18.7682

100230 ............................................................................................................. 20.6018 20.5051 22.5650 21.2357

100231 ............................................................................................................. 17.4002 17.9226 18.3597 17.8974

100232 ............................................................................................................. 17.3171 19.3491 19.8002 18.8267

100234 ............................................................................................................. 21.5763 20.9104 21.6362 21.3290

100235 ............................................................................................................. 17.6648 17.1622 * 17.4262

100236 ............................................................................................................. 21.8111 20.3766 19.9007 20.6153

100237 ............................................................................................................. 22.9344 22.0865 23.2408 22.7368

100238 ............................................................................................................. 17.6310 19.6367 20.8252 19.4032

100239 ............................................................................................................. 19.7605 21.3193 19.4481 20.1474

100240 ............................................................................................................. 17.9339 20.4340 21.0606 19.8014

100241 ............................................................................................................. 13.8344 14.7224 17.1063 15.0865

100242 ............................................................................................................. 17.1154 17.9260 18.6938 17.9097

100243 ............................................................................................................. 20.3838 21.2644 20.8041 20.8228

100244 ............................................................................................................. 17.4124 18.6227 20.5352 18.9148

100246 ............................................................................................................. 21.2160 19.6376 20.8989 20.5473

100248 ............................................................................................................. 21.5399 20.7007 21.3017 21.1691

100249 ............................................................................................................. 19.0243 19.2808 18.1397 18.8067

100252 ............................................................................................................. 17.8726 17.7778 19.8032 18.4710

100253 ............................................................................................................. 20.6014 21.3232 21.8890 21.2952

100254 ............................................................................................................. 20.9080 19.6598 19.5489 19.9883

100255 ............................................................................................................. 21.0224 25.2119 21.0284 22.2338

100256 ............................................................................................................. 23.5640 20.9356 20.8947 21.6340

100258 ............................................................................................................. 21.8764 21.3501 20.0300 21.0257

22754

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

100259 ............................................................................................................. 19.8600 20.3815 21.1160 20.4723

100260 ............................................................................................................. 21.2224 21.0506 24.6599 22.2640

100262 ............................................................................................................. 19.5874 20.0433 21.0927 20.2558

100263 ............................................................................................................. 16.9012 * * 16.9012

100264 ............................................................................................................. 17.6085 19.1556 19.9394 18.8935

100265 ............................................................................................................. 19.8571 18.8301 18.2291 18.8491

100266 ............................................................................................................. 17.7319 18.2993 19.3623 18.4763

100267 ............................................................................................................. 17.0986 20.1141 21.7430 19.6266

100268 ............................................................................................................. 23.5863 23.9249 24.0538 23.8633

100269 ............................................................................................................. 21.2047 21.6724 22.5114 21.8200

100270 ............................................................................................................. 19.8576 15.1462 16.7148 17.2012

100271 ............................................................................................................. 19.9208 20.4824 20.8695 20.4494

100275 ............................................................................................................. 21.3273 20.9188 21.2396 21.1563

100276 ............................................................................................................. 21.9797 22.3646 24.1022 22.8308

100277 ............................................................................................................. 16.1410 16.6255 19.7241 17.0041

100279 ............................................................................................................. 23.0213 22.9095 21.5291 22.5018

100280 ............................................................................................................. 16.5851 17.3676 18.1972 17.4129

100281 ............................................................................................................. 22.0202 22.4392 23.0142 22.5262

100282 ............................................................................................................. 19.7717 19.1978 17.7837 18.9361

100284 ............................................................................................................. * * 18.9448 18.9448

110001 ............................................................................................................. 18.0571 19.1971 20.1150 19.1086

110002 ............................................................................................................. 17.3674 17.1406 19.5113 18.0107

110003 ............................................................................................................. 16.9099 18.1168 17.1450 17.3940

110004 ............................................................................................................. 18.9468 19.5591 19.7733 19.4194

110005 ............................................................................................................. 19.2639 17.7348 21.4023 19.6576

110006 ............................................................................................................. 20.1273 20.7820 21.0601 20.6571

110007 ............................................................................................................. 23.4976 21.9505 25.0143 23.4851

110008 ............................................................................................................. 18.2642 22.0081 18.5265 19.5622

110009 ............................................................................................................. 14.8218 16.3069 17.4306 16.2843

110010 ............................................................................................................. 24.5493 23.3213 23.8794 23.9073

110011 ............................................................................................................. 18.2846 18.6144 18.9823 18.6368

110013 ............................................................................................................. 16.0264 16.2811 18.9160 17.1183

110014 ............................................................................................................. 16.1168 16.0658 18.1787 16.7192

110015 ............................................................................................................. 19.4769 21.2146 20.9926 20.5614

110016 ............................................................................................................. 15.2967 22.5321 14.2398 16.6540

110017 ............................................................................................................. 10.5399 13.1960 21.4010 15.0953

110018 ............................................................................................................. 21.0415 19.6064 22.1480 20.9298

110020 ............................................................................................................. 18.5251 18.3147 19.4457 18.7684

110023 ............................................................................................................. 18.6460 21.1994 21.8081 20.5099

110024 ............................................................................................................. 19.7923 20.7297 20.7345 20.4144

110025 ............................................................................................................. 18.6463 19.5749 20.4232 19.5033

110026 ............................................................................................................. 16.1414 17.2977 16.2484 16.5517

110027 ............................................................................................................. 14.6834 16.0642 14.8266 15.2090

110028 ............................................................................................................. 19.8894 20.1547 29.1670 22.3800

110029 ............................................................................................................. 20.0507 20.2906 19.6048 19.9639

110030 ............................................................................................................. 17.6785 18.8105 19.6354 18.7183

110031 ............................................................................................................. 21.5794 19.9482 20.0553 20.4598

110032 ............................................................................................................. 16.1859 15.7349 18.2014 16.6413

110033 ............................................................................................................. 21.4143 22.1879 25.1743 22.8060

110034 ............................................................................................................. 18.1882 19.6055 19.5554 19.0987

110035 ............................................................................................................. 21.1670 19.3795 22.7950 21.1658

110036 ............................................................................................................. 24.4181 22.2498 20.7284 22.3301

110038 ............................................................................................................. 16.3750 17.7060 17.5767 17.2140

110039 ............................................................................................................. 20.7710 20.6011 20.4998 20.6248

110040 ............................................................................................................. 16.4043 17.0743 16.8083 16.7529

110041 ............................................................................................................. 16.6927 18.8035 20.2755 18.6583

110042 ............................................................................................................. 20.6503 24.0153 25.2331 23.2575

110043 ............................................................................................................. 17.2175 20.1016 20.6150 19.2219

110044 ............................................................................................................. 19.5983 16.3624 17.2087 17.5794

110045 ............................................................................................................. 19.9445 20.2498 21.3049 20.4714

110046 ............................................................................................................. 19.2327 19.7377 21.4905 20.1167

110048 ............................................................................................................. 15.6463 16.3148 15.6113 15.8483

110049 ............................................................................................................. 14.2135 16.1817 16.8639 15.7669

22755

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

110050 ............................................................................................................. 18.7516 20.7619 19.2291 19.5578

110051 ............................................................................................................. 15.7475 17.0070 17.2292 16.6496

110052 ............................................................................................................. 15.0562 * * 15.0562

110054 ............................................................................................................. 19.2712 * 20.2638 19.7639

110056 ............................................................................................................. 16.4960 15.6202 15.8122 15.9689

110059 ............................................................................................................. 17.6984 16.6678 16.7990 17.0253

110061 ............................................................................................................. 13.7196 15.0367 16.3557 15.0889

110062 ............................................................................................................. 12.2107 18.8019 17.0053 16.1264

110063 ............................................................................................................. 17.9743 16.9612 18.5071 17.7965

110064 ............................................................................................................. 18.3368 18.9515 19.1203 18.8163

110065 ............................................................................................................. 13.3245 15.6771 16.3546 15.1604

110066 ............................................................................................................. 20.6502 21.0207 22.4189 21.3274

110069 ............................................................................................................. 18.3519 19.3109 20.9575 19.5384

110070 ............................................................................................................. 18.2264 21.0227 17.3438 18.7743

110071 ............................................................................................................. 14.8902 14.5984 18.8321 15.8863

110072 ............................................................................................................. 12.4303 12.7877 12.7625 12.6652

110073 ............................................................................................................. 15.1377 15.4261 16.4658 15.6663

110074 ............................................................................................................. 20.7572 21.3945 22.3769 21.5169

110075 ............................................................................................................. 17.0067 18.5199 20.1757 18.5793

110076 ............................................................................................................. 20.4430 21.2867 21.9798 21.2384

110078 ............................................................................................................. 24.7069 22.3718 24.0893 23.6954

110079 ............................................................................................................. 20.1385 21.0593 22.1070 21.0913

110080 ............................................................................................................. 23.4336 18.4768 19.1839 20.1449

110082 ............................................................................................................. 22.0078 23.8768 24.2358 23.3923

110083 ............................................................................................................. 21.3578 23.1219 23.1463 22.5746

110086 ............................................................................................................. 14.9756 18.2815 16.6374 16.5417

110087 ............................................................................................................. 20.5420 21.7773 22.7069 21.7189

110089 ............................................................................................................. 18.5761 18.5587 19.0889 18.7374

110091 ............................................................................................................. 21.3789 19.5114 21.5328 20.7784

110092 ............................................................................................................. 15.0890 17.3479 16.9725 16.4433

110093 ............................................................................................................. 14.8049 * 16.9827 15.7486

110094 ............................................................................................................. 13.8658 14.5641 16.9503 15.0650

110095 ............................................................................................................. 15.9478 16.4670 17.2273 16.5433

110096 ............................................................................................................. 16.3202 16.8541 17.4157 16.8647

110097 ............................................................................................................. 15.6164 15.5811 17.4558 16.1121

110098 ............................................................................................................. 14.0067 16.3532 16.0597 15.3226

110100 ............................................................................................................. 20.3764 18.6978 19.0764 19.3213

110101 ............................................................................................................. 11.7278 10.8187 18.8491 12.7872

110103 ............................................................................................................. 11.9352 13.6842 21.1837 14.0859

110104 ............................................................................................................. 15.3184 15.7781 15.8542 15.6538

110105 ............................................................................................................. 16.5196 16.8909 16.7775 16.7306

110107 ............................................................................................................. 17.3921 19.3609 19.3897 18.7335

110108 ............................................................................................................. 15.1401 19.7938 25.2161 19.3940

110109 ............................................................................................................. 16.3703 15.9359 16.4031 16.2270

110111 ............................................................................................................. 17.3215 18.5108 18.3951 18.0800

110112 ............................................................................................................. 19.1288 19.0619 19.8617 19.3018

110113 ............................................................................................................. 15.1896 16.8179 15.9532 15.9721

110114 ............................................................................................................. 15.1303 14.6888 16.4812 15.4358

110115 ............................................................................................................. 24.8332 43.9427 22.9566 28.0177

110118 ............................................................................................................. 15.3992 20.5368 19.7509 18.5122

110120 ............................................................................................................. 15.1878 15.2589 17.7429 15.9886

110121 ............................................................................................................. 15.5792 16.2711 19.1640 17.0021

110122 ............................................................................................................. 18.8497 21.1385 21.1469 20.3688

110124 ............................................................................................................. 17.1306 17.5732 18.3366 17.6460

110125 ............................................................................................................. 17.3254 19.1311 18.0692 18.1623

110127 ............................................................................................................. 13.7612 14.6143 20.3765 16.2641

110128 ............................................................................................................. 18.9705 18.1845 18.0835 18.4293

110129 ............................................................................................................. 18.1208 18.9388 19.0001 18.6851

110130 ............................................................................................................. 13.0779 16.0580 14.6011 14.6559

110132 ............................................................................................................. 15.0231 16.0419 16.3943 15.8158

110134 ............................................................................................................. 11.5583 12.5723 18.6076 14.6296

110135 ............................................................................................................. 17.0834 17.4380 17.3504 17.2967

110136 ............................................................................................................. 16.1680 18.0639 16.9629 16.8702

22756

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

110140 ............................................................................................................. 17.8806 17.8870 17.7915 17.8571

110141 ............................................................................................................. 12.5051 13.2501 14.4935 13.4024

110142 ............................................................................................................. 12.3029 14.6144 13.9525 13.5947

110143 ............................................................................................................. 21.6898 20.1603 22.5926 21.5352

110144 ............................................................................................................. 17.9766 16.8685 17.5112 17.4397

110146 ............................................................................................................. 17.6068 16.1316 17.1835 16.9320

110149 ............................................................................................................. 22.2256 17.7535 32.1975 23.0615

110150 ............................................................................................................. 18.7724 20.2644 21.2909 20.0962

110152 ............................................................................................................. 14.7674 15.3996 15.1324 15.1011

110153 ............................................................................................................. 18.6862 19.2744 20.5068 19.4781

110154 ............................................................................................................. 14.8067 14.9636 17.3761 15.6408

110155 ............................................................................................................. 17.1370 15.5306 16.5146 16.3434

110156 ............................................................................................................. 15.3422 14.7477 16.3876 15.4698

110161 ............................................................................................................. 20.8657 21.7153 22.2861 21.6563

110163 ............................................................................................................. 18.2016 20.4202 18.6088 18.9884

110164 ............................................................................................................. 19.4946 20.2074 21.2301 20.2993

110165 ............................................................................................................. 18.9974 21.2577 20.8030 20.3401

110166 ............................................................................................................. 19.8510 20.5882 20.5637 20.3331

110168 ............................................................................................................. 19.8178 20.6646 21.8508 20.8181

110169 ............................................................................................................. 18.7189 20.6385 22.6648 20.4216

110171 ............................................................................................................. 20.0874 23.7893 25.5187 22.6232

110172 ............................................................................................................. 25.4390 23.3730 23.6761 24.1702

110174 ............................................................................................................. 14.2978 13.7339 14.6199 14.1905

110176 ............................................................................................................. 22.3971 * * 22.3971

110177 ............................................................................................................. 19.5888 20.7187 21.2661 20.5227

110178 ............................................................................................................. 16.8555 18.8306 * 17.8083

110179 ............................................................................................................. 20.5161 22.7841 22.8884 21.9497

110181 ............................................................................................................. 13.7195 14.0941 12.9798 13.6399

110183 ............................................................................................................. 21.1797 23.3826 22.5148 22.3473

110184 ............................................................................................................. 20.9465 22.1970 22.1920 21.7791

110185 ............................................................................................................. 16.2487 16.7246 17.7925 16.9013

110186 ............................................................................................................. 17.3398 17.4287 18.3013 17.6927

110187 ............................................................................................................. 21.4462 20.1154 19.8419 20.4516

110188 ............................................................................................................. 20.0548 24.8376 23.7089 22.6478

110189 ............................................................................................................. 18.8627 22.2715 20.8786 20.7023

110190 ............................................................................................................. 19.4318 18.5728 18.3649 18.7761

110191 ............................................................................................................. 19.1065 20.2033 21.4033 20.2583

110192 ............................................................................................................. 20.7660 21.4951 21.0390 21.1032

110193 ............................................................................................................. 18.7807 20.6380 20.7867 20.0518

110194 ............................................................................................................. 15.0937 15.1480 14.8115 15.0165

110195 ............................................................................................................. 10.5227 13.9135 12.7261 12.3146

110198 ............................................................................................................. 26.1898 24.1999 24.4684 24.9086

110200 ............................................................................................................. 17.2129 18.1862 16.0807 17.1358

110201 ............................................................................................................. 19.2438 20.4699 21.0011 20.2421

110203 ............................................................................................................. 20.2958 26.8148 22.7453 23.1944

110204 ............................................................................................................. 20.5728 19.7317 30.7342 21.7754

110205 ............................................................................................................. 26.1154 21.1435 21.3617 22.7145

110207 ............................................................................................................. 12.8710 12.9727 14.7154 13.5335

110208 ............................................................................................................. 14.8907 15.1742 15.6161 15.1789

110209 ............................................................................................................. 20.4640 17.9190 18.6404 18.9942

110211 ............................................................................................................. 21.8226 20.9372 26.9151 23.1427

110212 ............................................................................................................. 12.6583 11.8545 14.3790 12.8830

110213 ............................................................................................................. 13.1976 14.3651 * 13.7453

110215 ............................................................................................................. * 20.1928 18.1539 19.0047

110216 ............................................................................................................. * * 27.1878 27.1878

110217 ............................................................................................................. * * 34.0758 34.0758

120001 ............................................................................................................. 26.7134 27.9213 29.0427 27.8237

120002 ............................................................................................................. 24.3780 25.0744 25.2021 24.8896

120003 ............................................................................................................. 23.8452 25.9059 23.9115 24.5394

120004 ............................................................................................................. 24.0456 23.9208 24.8632 24.2413

120005 ............................................................................................................. 20.5380 23.3975 24.1662 22.6197

120006 ............................................................................................................. 23.7151 25.0895 25.8943 24.8700

120007 ............................................................................................................. 23.2684 22.7200 22.8772 22.9509

22757

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

120009 ............................................................................................................. 19.0216 17.4693 16.4621 17.5649

120010 ............................................................................................................. 25.3976 25.1480 24.1923 24.8868

120011 ............................................................................................................. 33.5459 35.0582 37.2759 35.3313

120012 ............................................................................................................. 22.5219 23.1144 21.8507 22.5391

120014 ............................................................................................................. 24.0467 22.8866 24.0359 23.6453

120015 ............................................................................................................. 29.0747 32.9906 42.6465 33.1800

120016 ............................................................................................................. 29.4104 27.9127 45.6878 31.2151

120018 ............................................................................................................. 25.6088 24.5031 31.1879 26.2841

120019 ............................................................................................................. 21.9199 22.9341 25.5659 23.4285

120021 ............................................................................................................. 19.4236 23.4508 23.1839 21.8865

120022 ............................................................................................................. 17.9306 21.7868 19.0792 19.4460

120024 ............................................................................................................. 22.2846 29.4808 32.2514 26.8486

120025 ............................................................................................................. 19.0197 20.1065 50.6376 21.3455

120026 ............................................................................................................. 23.2237 26.0787 25.1314 24.7719

120027 ............................................................................................................. 24.5549 24.7255 24.4535 24.5737

120028 ............................................................................................................. 23.4873 27.5023 27.0897 25.8902

130001 ............................................................................................................. 24.9511 18.8471 17.6306 20.1752

130002 ............................................................................................................. 16.1853 16.6620 16.9867 16.6200

130003 ............................................................................................................. 19.9499 21.7313 22.3600 21.3642

130005 ............................................................................................................. 20.1678 20.7169 21.2386 20.7149

130006 ............................................................................................................. 18.8705 19.3392 20.4614 19.5797

130007 ............................................................................................................. 19.8442 20.8338 21.8107 20.8426

130008 ............................................................................................................. 12.9177 12.5506 13.6018 12.9892

130009 ............................................................................................................. 18.2958 19.1837 15.9701 17.7296

130010 ............................................................................................................. 21.4325 17.6795 17.5119 18.7875

130011 ............................................................................................................. 19.0816 20.5031 20.1147 19.9190

130012 ............................................................................................................. 22.6153 22.9813 24.9976 23.5891

130013 ............................................................................................................. 19.2170 17.4038 15.1129 17.1523

130014 ............................................................................................................. 17.9836 18.9769 19.1105 18.6941

130015 ............................................................................................................. 15.2662 15.7233 18.5913 16.3849

130016 ............................................................................................................. 16.9987 17.3942 19.0516 17.7864

130017 ............................................................................................................. 16.8822 17.1710 19.6875 17.7220

130018 ............................................................................................................. 17.9651 19.7368 19.8425 19.2288

130019 ............................................................................................................. 17.2317 18.6648 19.1711 18.3322

130021 ............................................................................................................. 12.2562 12.8588 15.6155 13.6528

130022 ............................................................................................................. 19.5040 16.5270 18.9127 18.2241

130024 ............................................................................................................. 18.3789 19.3634 19.0703 18.9600

130025 ............................................................................................................. 15.2691 17.5213 16.4627 16.4881

130026 ............................................................................................................. 20.5535 21.5934 21.8106 21.3093

130027 ............................................................................................................. 20.7044 21.4279 20.5344 20.8883

130028 ............................................................................................................. 18.2074 19.1093 20.9674 19.4388

130029 ............................................................................................................. 20.3153 18.4263 18.7694 19.1364

130030 ............................................................................................................. 18.3981 17.8440 17.5759 17.9347

130031 ............................................................................................................. 17.6458 16.2397 16.7766 16.8967

130034 ............................................................................................................. 18.8164 16.9873 18.9483 18.2785

130035 ............................................................................................................. 20.4708 19.3478 20.7770 20.1943

130036 ............................................................................................................. 13.7942 13.7933 13.6362 13.7373

130037 ............................................................................................................. 17.7374 18.8071 18.6856 18.3986

130043 ............................................................................................................. 16.0686 16.5102 16.7904 16.4511

130044 ............................................................................................................. 13.1816 17.8160 13.4513 14.6424

130045 ............................................................................................................. 16.4655 16.0990 19.0208 17.0869

130048 ............................................................................................................. 15.0924 16.0899 16.7900 15.9311

130049 ............................................................................................................. 20.3928 20.3129 22.4440 21.0760

130054 ............................................................................................................. 17.7802 17.2729 17.7085 17.5766

130056 ............................................................................................................. 15.6551 14.6862 20.9476 16.5492

130058 ............................................................................................................. 17.7462 * * 17.7462

130060 ............................................................................................................. 20.8508 21.8662 22.7399 21.8288

130061 ............................................................................................................. 16.7839 15.4006 14.7394 15.6929

130062 ............................................................................................................. 15.1086 16.5672 19.8157 17.1915

130063 ............................................................................................................. * 15.9441 18.8024 17.8420

140001 ............................................................................................................. 15.4448 16.3372 17.7990 16.4814

140002 ............................................................................................................. 19.2575 19.0248 19.9284 19.3999

140003 ............................................................................................................. 18.0001 21.2886 17.8595 18.9466

22758

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

140004 ............................................................................................................. 17.5200 15.7042 17.4574 16.8965

140005 ............................................................................................................. 10.8718 11.6127 12.3002 11.5858

140007 ............................................................................................................. 22.4015 22.9799 23.0743 22.8202

140008 ............................................................................................................. 21.2844 21.6548 22.0157 21.6522

140010 ............................................................................................................. 25.2227 31.8207 28.4268 28.3237

140011 ............................................................................................................. 17.2856 17.8676 18.6164 17.9499

140012 ............................................................................................................. 19.4406 23.0653 21.0475 21.1353

140013 ............................................................................................................. 17.3488 18.3060 19.6722 18.4213

140014 ............................................................................................................. 20.7563 22.4737 23.0372 21.9976

140015 ............................................................................................................. 15.0232 16.6735 17.6805 16.4314

140016 ............................................................................................................. 12.5363 13.1278 14.4938 13.3972

140018 ............................................................................................................. 21.4147 22.3070 24.6202 22.7573

140019 ............................................................................................................. 15.3435 16.6548 16.4254 16.1654

140024 ............................................................................................................. 14.6674 16.8271 15.3782 15.5912

140025 ............................................................................................................. 16.9489 16.9462 18.5135 17.4713

140026 ............................................................................................................. 15.9557 16.6612 18.3220 16.9446

140027 ............................................................................................................. 17.5023 18.7553 19.2149 18.5013

140029 ............................................................................................................. 21.0358 22.8322 26.0833 23.2140

140030 ............................................................................................................. 22.4414 21.9475 22.1760 22.1946

140031 ............................................................................................................. 15.9442 19.5731 17.6067 17.6942

140032 ............................................................................................................. 17.3363 18.1058 19.0383 18.1645

140033 ............................................................................................................. 22.5583 24.1722 25.1639 23.9291

140034 ............................................................................................................. 19.1482 19.5278 19.7903 19.4886

140035 ............................................................................................................. 12.9963 15.2649 15.5040 14.5633

140036 ............................................................................................................. 17.0419 18.5771 19.1076 18.2935

140037 ............................................................................................................. 12.5012 13.0764 14.1083 13.2105

140038 ............................................................................................................. 17.6094 18.3035 18.4624 18.1246

140040 ............................................................................................................. 16.2462 19.9267 16.7450 17.5895

140041 ............................................................................................................. 17.2829 17.6582 23.7556 19.4569

140042 ............................................................................................................. 15.6092 15.4095 15.8892 15.6354

140043 ............................................................................................................. 18.9464 19.4683 20.1176 19.5022

140045 ............................................................................................................. 20.6541 15.5807 17.7799 17.9528

140046 ............................................................................................................. 16.4621 18.9763 18.6371 18.0097

140047 ............................................................................................................. 16.3298 17.1539 13.3610 15.4382

140048 ............................................................................................................. 20.5773 24.0913 22.7155 22.4684

140049 ............................................................................................................. 21.5937 28.4958 26.9483 25.7338

140051 ............................................................................................................. 20.8455 23.8264 23.0662 22.5696

140052 ............................................................................................................. 19.6045 19.6409 17.5433 18.8875

140053 ............................................................................................................. 17.8218 19.1892 19.5761 18.8494

140054 ............................................................................................................. 26.1497 22.1921 23.2565 23.8024

140055 ............................................................................................................. 14.8031 16.3404 14.3603 15.1391

140058 ............................................................................................................. 17.2716 17.4927 18.6861 17.8100

140059 ............................................................................................................. 15.3934 15.0195 * 15.1978

140061 ............................................................................................................. 15.9612 17.3012 18.2039 17.1185

140062 ............................................................................................................. 27.0912 28.0877 28.6768 27.9630

140063 ............................................................................................................. 22.3882 25.3641 24.0303 23.8508

140064 ............................................................................................................. 19.2549 19.1023 18.9379 19.0960

140065 ............................................................................................................. 23.1610 24.1128 25.3336 24.1516

140066 ............................................................................................................. 16.1759 17.3902 13.6491 15.5770

140067 ............................................................................................................. 18.4031 19.3267 19.5292 19.0846

140068 ............................................................................................................. 18.8739 19.9691 21.6188 20.0995

140069 ............................................................................................................. 16.1453 16.7544 17.3879 16.7949

140070 ............................................................................................................. 19.2995 22.9678 22.7153 21.2244

140074 ............................................................................................................. 19.0077 19.3504 21.6052 19.9120

140075 ............................................................................................................. 22.5083 21.6313 21.0600 21.7539

140077 ............................................................................................................. 16.6447 17.5305 17.3647 17.1709

140079 ............................................................................................................. 21.9205 23.3020 23.6928 22.9153

140080 ............................................................................................................. 20.9999 21.0739 22.0345 21.3383

140081 ............................................................................................................. 15.5103 16.2247 16.9808 16.1897

140082 ............................................................................................................. 22.6227 23.8960 29.6534 24.8396

140083 ............................................................................................................. 18.1349 19.3145 21.0096 19.4873

140084 ............................................................................................................. 20.0133 20.9709 22.3467 21.0939

140086 ............................................................................................................. 17.3717 18.3803 19.1613 18.3356

22759

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

140087 ............................................................................................................. 18.3639 16.1009 17.1147 17.1839

140088 ............................................................................................................. 24.2568 25.2369 22.0679 23.8109

140089 ............................................................................................................. 17.2086 17.6366 18.3157 17.7164

140090 ............................................................................................................. 23.5888 26.4325 27.0060 25.4162

140091 ............................................................................................................. 20.7039 20.9018 21.9322 21.1441

140093 ............................................................................................................. 19.1469 18.2899 20.1528 19.1437

140094 ............................................................................................................. 20.6129 21.4709 21.9383 21.3227

140095 ............................................................................................................. 21.5376 24.0549 23.3001 22.8780

140097 ............................................................................................................. 16.8997 17.5081 21.1719 18.4160

140100 ............................................................................................................. 19.0588 21.3581 23.1399 21.1571

140101 ............................................................................................................. 26.0894 21.5473 21.7186 22.8766

140102 ............................................................................................................. 15.0777 17.1500 17.5729 16.5644

140103 ............................................................................................................. 17.8586 19.2783 18.1303 18.4145

140105 ............................................................................................................. 20.9068 22.6573 22.6913 22.0594

140107 ............................................................................................................. 12.7573 13.7533 11.8383 12.6800

140108 ............................................................................................................. 28.6028 25.4742 26.9971 26.9964

140109 ............................................................................................................. 15.4724 15.7465 14.5498 15.2467

140110 ............................................................................................................. 18.8112 19.1822 19.2888 19.0728

140112 ............................................................................................................. 16.2399 17.6856 17.6974 17.1885

140113 ............................................................................................................. 17.9151 19.0592 18.8593 18.5977

140114 ............................................................................................................. 20.4808 21.1639 21.8154 21.1561

140115 ............................................................................................................. 20.0939 21.1926 21.0433 20.7564

140116 ............................................................................................................. 21.8290 23.1177 23.7281 22.8966

140117 ............................................................................................................. 19.6445 21.5671 20.4740 20.5537

140118 ............................................................................................................. 23.0797 23.5952 24.2708 23.6385

140119 ............................................................................................................. 26.5042 29.1419 27.2387 27.6111

140120 ............................................................................................................. 14.8375 18.0743 17.9716 16.8874

140121 ............................................................................................................. 9.5268 16.0397 16.6993 13.2257

140122 ............................................................................................................. 23.7473 24.6470 25.8773 24.7639

140124 ............................................................................................................. 26.9706 27.1906 27.9517 27.3458

140125 ............................................................................................................. 17.0974 17.6759 16.9735 17.2524

140127 ............................................................................................................. 19.4259 19.8973 17.5075 18.9895

140128 ............................................................................................................. 17.6751 19.4955 23.1327 20.0664

140129 ............................................................................................................. 15.2494 18.2639 20.2868 17.8627

140130 ............................................................................................................. 23.7682 22.2285 23.1873 23.0442

140132 ............................................................................................................. 23.0443 23.5475 23.3054 23.2992

140133 ............................................................................................................. 19.9083 21.4090 21.1453 20.7897

140135 ............................................................................................................. 17.6927 17.8100 17.3985 17.6268

140137 ............................................................................................................. 16.5141 16.8969 18.6330 17.3470

140138 ............................................................................................................. 14.5877 16.7420 17.1968 16.2121

140139 ............................................................................................................. 16.5794 14.0619 11.0397 13.5138

140140 ............................................................................................................. 15.2985 17.8243 17.6845 16.9747

140141 ............................................................................................................. 15.1782 17.5204 19.1097 17.2133

140143 ............................................................................................................. 18.7616 19.1862 18.9984 18.9893

140144 ............................................................................................................. 19.7913 21.3245 22.2864 21.1022

140145 ............................................................................................................. 16.6111 17.5471 18.1788 17.4556

140146 ............................................................................................................. 23.7400 21.9573 19.9704 21.7285

140147 ............................................................................................................. 24.8191 16.1336 18.8049 19.2135

140148 ............................................................................................................. 19.5026 18.6598 17.9816 18.6917

140150 ............................................................................................................. 27.8485 27.3378 26.7896 27.3222

140151 ............................................................................................................. 19.3016 21.3896 20.0310 20.2086

140152 ............................................................................................................. 22.4270 24.6333 24.9613 23.9173

140155 ............................................................................................................. 17.3131 19.9738 19.5083 18.8605

140158 ............................................................................................................. 22.2666 22.7639 22.7988 22.5990

140160 ............................................................................................................. 17.8822 17.7691 17.7921 17.8132

140161 ............................................................................................................. 19.0448 20.0948 20.3799 19.8258

140162 ............................................................................................................. 18.4167 19.6464 20.3452 19.4479

140164 ............................................................................................................. 18.6120 18.7806 18.6589 18.6860

140165 ............................................................................................................. 15.4186 14.9156 14.7223 15.0080

140166 ............................................................................................................. 17.5434 17.5496 18.2503 17.7751

140167 ............................................................................................................. 16.5671 17.1479 17.6525 17.1325

140168 ............................................................................................................. 16.4638 16.6770 17.7453 16.9752

140170 ............................................................................................................. 14.1360 16.1621 16.4107 15.5211

22760

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

140171 ............................................................................................................. 14.7316 14.1637 15.0237 14.6354

140172 ............................................................................................................. 20.7982 23.8431 21.0186 21.8883

140173 ............................................................................................................. 18.4788 15.1487 16.3924 16.7054

140174 ............................................................................................................. 19.9216 20.5339 40.5916 23.4138

140176 ............................................................................................................. 21.4129 23.2866 24.0512 22.8950

140177 ............................................................................................................. 18.1692 18.2648 15.0827 17.1204

140179 ............................................................................................................. 22.6989 21.1948 21.9258 21.9422

140180 ............................................................................................................. 23.2536 22.4548 22.5661 22.7489

140181 ............................................................................................................. 20.5461 20.8709 21.9155 21.0777

140182 ............................................................................................................. 20.7013 22.0170 22.5552 21.7590

140184 ............................................................................................................. 14.9763 17.8155 17.2401 16.6194

140185 ............................................................................................................. 17.3616 17.6514 18.2867 17.7696

140186 ............................................................................................................. 18.9878 22.7890 21.0934 20.9521

140187 ............................................................................................................. 17.6910 17.9201 18.3331 17.9863

140188 ............................................................................................................. 14.8373 15.2479 16.1907 15.4001

140189 ............................................................................................................. 19.0791 21.0616 20.6627 20.2758

140190 ............................................................................................................. 15.8770 16.3366 17.5263 16.5534

140191 ............................................................................................................. 24.7368 25.8835 25.2628 25.2833

140193 ............................................................................................................. 15.5196 15.8022 17.4057 16.2409

140197 ............................................................................................................. 17.9828 18.6394 19.3774 18.6752

140199 ............................................................................................................. 18.8333 18.3507 18.0450 18.4044

140200 ............................................................................................................. 21.6508 21.5220 20.0559 21.0333

140202 ............................................................................................................. 22.1800 22.1939 22.2334 22.2042

140203 ............................................................................................................. 20.7854 19.9194 21.0848 20.5915

140205 ............................................................................................................. 17.2369 17.4751 20.0784 18.0505

140206 ............................................................................................................. 20.5096 21.3295 22.5109 21.4570

140207 ............................................................................................................. 20.2048 21.9779 22.3905 21.3996

140208 ............................................................................................................. 23.9441 25.9900 26.2527 25.3856

140209 ............................................................................................................. 17.7889 18.1206 20.1557 18.6405

140210 ............................................................................................................. 12.6648 15.6899 14.8248 14.4319

140211 ............................................................................................................. 20.9615 21.8891 22.6265 21.8594

140213 ............................................................................................................. 26.2041 27.0645 23.9146 25.7381

140215 ............................................................................................................. 14.4544 15.9949 15.2893 15.2456

140217 ............................................................................................................. 23.3192 24.8229 25.4896 24.5129

140218 ............................................................................................................. 15.0750 14.9459 14.9851 15.0038

140220 ............................................................................................................. 16.7341 17.6370 17.8450 17.4280

140223 ............................................................................................................. 21.4725 24.9249 24.8504 23.6225

140224 ............................................................................................................. 22.9945 25.8668 32.8061 26.7812

140228 ............................................................................................................. 18.6731 19.6988 19.7113 19.3775

140230 ............................................................................................................. 16.5979 18.0918 18.2983 17.6740

140231 ............................................................................................................. 21.6062 23.9176 24.5019 23.4404

140233 ............................................................................................................. 18.3703 19.4542 21.8857 19.8854

140234 ............................................................................................................. 18.7156 18.9945 * 18.8552

140236 ............................................................................................................. 13.1341 * 12.9253 13.0112

140239 ............................................................................................................. 18.8785 18.8127 19.6792 19.1309

140240 ............................................................................................................. 24.2141 23.6860 24.4498 24.1185

140242 ............................................................................................................. 22.6679 24.5428 25.1416 24.1471

140245 ............................................................................................................. 15.5554 13.4839 14.2481 14.3597

140246 ............................................................................................................. 12.8238 13.4639 11.6267 12.5798

140250 ............................................................................................................. 23.4127 25.0876 23.6449 24.0578

140251 ............................................................................................................. 20.5813 21.4385 21.8059 21.2700

140252 ............................................................................................................. 24.4856 25.2246 24.9718 24.8965

140253 ............................................................................................................. 16.7356 18.5511 19.5858 18.2440

140258 ............................................................................................................. 21.1321 23.2973 25.0755 23.1842

140271 ............................................................................................................. 15.3606 15.5079 12.0079 14.1590

140275 ............................................................................................................. 17.9597 20.1699 23.8171 20.5857

140276 ............................................................................................................. 23.7163 26.6777 25.3078 25.2303

140280 ............................................................................................................. 18.8420 20.2360 18.8300 19.2649

140281 ............................................................................................................. 23.3433 24.0192 25.2719 24.2302

140285 ............................................................................................................. 14.7087 18.1181 17.3787 16.8092

140286 ............................................................................................................. 19.9500 20.3735 22.1015 20.8673

140288 ............................................................................................................. 21.8213 25.2327 24.4331 23.7989

140289 ............................................................................................................. 16.4542 17.1388 18.1747 17.3055

22761

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

140290 ............................................................................................................. 21.2384 21.1784 22.8465 21.7717

140291 ............................................................................................................. 22.4352 25.0911 24.9537 24.1790

140292 ............................................................................................................. 22.7136 20.8560 21.4533 21.6516

140294 ............................................................................................................. 17.5226 17.7226 17.7301 17.6645

140297 ............................................................................................................. 21.4692 * * 21.4692

140300 ............................................................................................................. 23.2560 25.3662 27.8436 25.5898

150001 ............................................................................................................. 21.6990 22.8109 24.0620 22.8643

150002 ............................................................................................................. 18.7568 19.3401 19.7035 19.2828

150003 ............................................................................................................. 19.3117 19.7661 20.8636 19.9824

150004 ............................................................................................................. 19.7020 20.3685 21.2449 20.4349

150005 ............................................................................................................. 18.9964 20.6260 21.1610 20.2631

150006 ............................................................................................................. 20.0433 20.8158 20.6523 20.5130

150007 ............................................................................................................. 19.5255 20.1826 20.6635 20.1487

150008 ............................................................................................................. 20.9684 21.4545 21.8457 21.4285

150009 ............................................................................................................. 18.2168 18.7073 18.5540 18.4858

150010 ............................................................................................................. 18.4776 21.7125 20.5570 20.1836

150011 ............................................................................................................. 19.1957 18.3742 18.3041 18.6202

150012 ............................................................................................................. 20.5193 22.4751 22.1402 21.6785

150013 ............................................................................................................. 16.0043 17.0352 16.9327 16.6522

150014 ............................................................................................................. 21.2812 22.0143 21.5168 21.6212

150015 ............................................................................................................. 22.0452 22.5409 21.9037 22.1546

150017 ............................................................................................................. 18.8898 18.7664 19.5361 19.0702

150018 ............................................................................................................. 19.5612 20.4947 20.7080 20.2547

150019 ............................................................................................................. 15.2892 16.6327 17.8585 16.5672

150020 ............................................................................................................. 14.4592 15.1120 16.6600 15.3745

150021 ............................................................................................................. 19.0162 19.5096 21.5636 20.0344

150022 ............................................................................................................. 17.9206 19.1555 17.9222 18.3309

150023 ............................................................................................................. 18.6641 18.3598 19.0270 18.6729

150024 ............................................................................................................. 17.8311 18.4140 19.0380 18.3973

150025 ............................................................................................................. 18.1490 17.7007 12.7222 15.7084

150026 ............................................................................................................. 20.5085 18.8417 22.4284 20.5038

150027 ............................................................................................................. 16.4846 17.3284 18.0335 17.2600

150029 ............................................................................................................. 21.7414 23.0546 23.2454 22.7440

150030 ............................................................................................................. 17.3296 17.9992 18.6947 18.0196

150031 ............................................................................................................. 18.0060 17.2429 18.3463 17.8675

150032 ............................................................................................................. 20.6391 * * 20.6391

150033 ............................................................................................................. 21.6854 21.8768 22.7658 22.1130

150034 ............................................................................................................. 21.2868 22.1317 23.1533 22.1845

150035 ............................................................................................................. 19.8177 20.4477 21.2374 20.5107

150036 ............................................................................................................. 20.3848 20.8692 21.4567 20.9448

150037 ............................................................................................................. 17.7868 21.7109 24.0213 21.0127

150038 ............................................................................................................. 20.2503 21.2193 22.0572 21.2025

150039 ............................................................................................................. 17.4919 18.4729 19.6215 18.5025

150042 ............................................................................................................. 17.1241 18.1632 20.0557 18.3464

150043 ............................................................................................................. 17.9834 19.0120 20.1741 18.9948

150044 ............................................................................................................. 17.6432 18.4381 19.1309 18.4093

150045 ............................................................................................................. 17.0395 16.8121 18.1670 17.3563

150046 ............................................................................................................. 17.3210 17.6342 18.2543 17.7460

150047 ............................................................................................................. 24.8819 19.7441 22.0305 22.1067

150048 ............................................................................................................. 16.9573 19.3329 19.1648 18.5048

150049 ............................................................................................................. 16.8529 17.0141 18.5099 17.4307

150050 ............................................................................................................. 17.1442 16.8354 17.7354 17.2410

150051 ............................................................................................................. 18.1990 19.0130 19.1637 18.7924

150052 ............................................................................................................. 15.3618 15.8590 17.3750 16.2411

150053 ............................................................................................................. 18.7463 19.1421 18.8632 18.9165

150054 ............................................................................................................. 17.3296 17.3825 18.3916 17.7528

150056 ............................................................................................................. 23.2991 22.4087 21.5774 22.2457

150057 ............................................................................................................. 16.8630 16.5882 16.9736 16.8076

150058 ............................................................................................................. 20.9537 20.8178 23.0807 21.5904

150059 ............................................................................................................. 20.8004 21.2535 22.7360 21.5830

150060 ............................................................................................................. 16.0098 17.0743 18.0032 17.0216

150061 ............................................................................................................. 17.2141 17.3887 19.7968 18.0770

150062 ............................................................................................................. 18.4110 20.5415 20.8274 20.0239

22762

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

150063 ............................................................................................................. 21.0899 22.0925 22.6525 21.9213

150064 ............................................................................................................. 17.0309 18.1400 20.3865 18.5718

150065 ............................................................................................................. 19.0051 19.8913 21.2153 20.0425

150066 ............................................................................................................. 14.5977 15.3373 19.5313 16.4634

150067 ............................................................................................................. 17.0829 18.2926 18.8862 18.0821

150069 ............................................................................................................. 17.3918 21.5310 23.3969 20.9447

150070 ............................................................................................................. 17.1992 17.9260 18.0827 17.7417

150071 ............................................................................................................. 14.7306 13.4760 13.5111 13.9122

150072 ............................................................................................................. 16.1091 16.2054 15.0765 15.7702

150073 ............................................................................................................. 19.0292 22.2968 * 20.5664

150074 ............................................................................................................. 18.8597 20.4175 20.1054 19.7802

150075 ............................................................................................................. 14.9786 15.5603 16.7532 15.7414

150076 ............................................................................................................. 22.3407 22.9382 22.6424 22.6387

150077 ............................................................................................................. 17.5750 * * 17.5750

150078 ............................................................................................................. 19.0096 19.2718 19.9668 19.4018

150079 ............................................................................................................. 15.4545 17.2436 18.0265 16.8569

150082 ............................................................................................................. 17.8796 17.5265 17.8162 17.7421

150084 ............................................................................................................. 22.9159 23.2506 23.9940 23.3857

150086 ............................................................................................................. 17.3442 18.9735 18.2185 18.1968

150088 ............................................................................................................. 19.4475 18.9869 20.3366 19.5726

150089 ............................................................................................................. 22.9458 23.8791 21.3690 22.6571

150090 ............................................................................................................. 19.0595 20.7726 21.0945 20.2459

150091 ............................................................................................................. 19.8912 20.4053 22.4640 20.9087

150092 ............................................................................................................. 15.9174 16.7434 16.9179 16.5364

150094 ............................................................................................................. 18.3410 16.5788 17.5244 17.5067

150095 ............................................................................................................. 17.1187 17.1324 19.2749 17.7838

150096 ............................................................................................................. 20.0281 23.2764 20.2897 21.1086

150097 ............................................................................................................. 18.3103 19.3802 19.7751 19.1545

150098 ............................................................................................................. 14.2953 15.0943 13.8800 14.4383

150099 ............................................................................................................. 18.9718 22.4229 * 20.3545

150100 ............................................................................................................. 17.4776 18.4148 19.8066 18.6620

150101 ............................................................................................................. 17.5554 16.4604 15.9718 16.6097

150102 ............................................................................................................. 11.5034 19.7426 23.7180 17.1422

150103 ............................................................................................................. 17.3064 18.4781 18.7036 18.2137

150104 ............................................................................................................. 17.2642 17.6981 20.0765 18.3399

150105 ............................................................................................................. 19.1709 20.0431 22.4412 20.4692

150106 ............................................................................................................. 18.9097 16.1510 15.7497 16.7986

150109 ............................................................................................................. 18.2289 18.8077 19.6344 18.8790

150110 ............................................................................................................. 18.5752 18.6627 21.9336 19.5289

150111 ............................................................................................................. 16.1707 18.4556 19.2355 17.8619

150112 ............................................................................................................. 19.8155 20.4109 20.5253 20.2569

150113 ............................................................................................................. 19.1988 20.3780 19.6603 19.7455

150114 ............................................................................................................. 16.9638 19.5183 17.9877 18.1743

150115 ............................................................................................................. 17.0627 17.4315 18.2882 17.5968

150122 ............................................................................................................. 19.3545 18.7139 17.7867 18.6097

150123 ............................................................................................................. 15.1552 14.1105 15.1583 14.8238

150124 ............................................................................................................. 15.0706 14.6245 15.6449 15.1149

150125 ............................................................................................................. 20.3198 20.6735 21.3115 20.7738

150126 ............................................................................................................. 20.2958 21.3697 20.6857 20.7640

150127 ............................................................................................................. 22.8129 17.1994 17.0052 18.8048

150128 ............................................................................................................. 19.9205 18.5100 19.5158 19.3219

150129 ............................................................................................................. 23.4718 24.7711 28.6211 25.2796

150130 ............................................................................................................. 16.4144 18.1971 18.4846 17.6635

150132 ............................................................................................................. 19.4805 20.1684 20.9443 20.1836

150133 ............................................................................................................. 16.4910 17.3966 16.0923 16.6709

150134 ............................................................................................................. 17.0612 19.2526 19.3632 18.5912

150136 ............................................................................................................. 19.2819 20.1245 21.8097 20.3987

150145 ............................................................................................................. * 16.6851 * 16.6851

150146 ............................................................................................................. * * 19.0204 19.0204

160001 ............................................................................................................. 19.0279 18.6035 19.0085 18.8767

160002 ............................................................................................................. 15.3724 15.9534 16.6003 15.9668

160003 ............................................................................................................. 15.7747 16.0862 16.2208 16.0221

160005 ............................................................................................................. 15.2320 17.6153 17.9405 16.9144

22763

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

160007 ............................................................................................................. 15.6638 13.2101 15.1738 14.6237

160008 ............................................................................................................. 14.9698 15.9742 16.6410 15.8545

160009 ............................................................................................................. 16.0919 16.8391 17.9886 16.9591

160012 ............................................................................................................. 16.5409 16.4827 16.7112 16.5761

160013 ............................................................................................................. 17.0602 18.3996 18.6304 18.0298

160014 ............................................................................................................. 15.0861 15.9086 16.7146 15.8981

160016 ............................................................................................................. 18.3710 19.6322 19.9747 19.3376

160018 ............................................................................................................. 14.1634 14.5946 15.6141 14.7975

160020 ............................................................................................................. 14.4135 15.4712 15.5384 15.1417

160021 ............................................................................................................. 15.4860 16.5049 16.7617 16.2368

160023 ............................................................................................................. 14.2015 15.0665 15.0099 14.7723

160024 ............................................................................................................. 18.9548 19.7050 19.4764 19.3806

160026 ............................................................................................................. 18.6624 18.8379 19.5260 19.0040

160027 ............................................................................................................. 15.7403 16.3477 16.9417 16.3376

160028 ............................................................................................................. 20.5416 19.9595 21.0000 20.4893

160029 ............................................................................................................. 20.4003 20.4678 21.3457 20.7382

160030 ............................................................................................................. 17.9860 19.9508 19.6182 19.1837

160031 ............................................................................................................. 15.2831 15.2448 16.1267 15.5484

160032 ............................................................................................................. 16.1820 17.3202 18.3168 17.2888

160033 ............................................................................................................. 18.3736 18.8673 18.8205 18.6982

160034 ............................................................................................................. 14.5053 15.0019 16.5957 15.3739

160035 ............................................................................................................. 15.9199 15.2211 16.3991 15.8029

160036 ............................................................................................................. 19.1984 17.8849 17.4558 18.1820

160037 ............................................................................................................. 18.3968 19.0532 19.5211 18.9895

160039 ............................................................................................................. 17.6272 17.4758 17.8647 17.6551

160040 ............................................................................................................. 16.8295 18.1949 18.0667 17.6917

160041 ............................................................................................................. 15.4700 16.7850 17.4435 16.5782

160043 ............................................................................................................. 15.6261 15.6909 14.8564 15.3356

160044 ............................................................................................................. 16.0385 16.7439 17.8323 16.9072

160045 ............................................................................................................. 20.1154 20.1236 19.4334 19.7761

160046 ............................................................................................................. 14.7672 14.5655 16.2737 15.1831

160047 ............................................................................................................. 16.6926 18.3593 19.0787 18.0537

160048 ............................................................................................................. 13.1417 14.6144 15.6856 14.5140

160049 ............................................................................................................. 13.3614 14.5457 15.5673 14.5017

160050 ............................................................................................................. 16.4161 17.4912 17.7878 17.2198

160051 ............................................................................................................. 14.2660 14.6400 16.4261 15.1036

160052 ............................................................................................................. 17.5509 18.0941 21.7647 19.2313

160054 ............................................................................................................. 15.7093 16.1753 16.1981 16.0321

160055 ............................................................................................................. 14.0647 14.7600 15.1674 14.6539

160056 ............................................................................................................. 15.3758 16.1575 17.0172 16.1537

160057 ............................................................................................................. 17.4101 18.1776 19.1378 18.2553

160058 ............................................................................................................. 20.3402 21.1159 22.1061 21.1598

160060 ............................................................................................................. 15.9527 16.0436 17.2825 16.3968

160061 ............................................................................................................. 17.5707 17.3215 16.6061 17.1891

160062 ............................................................................................................. 14.4433 17.8086 17.4388 16.4393

160063 ............................................................................................................. 16.2960 16.8834 16.3583 16.5061

160064 ............................................................................................................. 19.9135 20.5496 21.0458 20.5185

160065 ............................................................................................................. 16.5087 16.9373 17.1043 16.8758

160066 ............................................................................................................. 16.2651 17.1875 17.9971 17.1716

160067 ............................................................................................................. 17.8551 17.8514 16.7833 17.4322

160068 ............................................................................................................. 15.8526 17.9892 19.0572 17.5565

160069 ............................................................................................................. 18.4857 19.7280 19.1640 19.1095

160070 ............................................................................................................. 15.6647 16.7017 18.4588 16.9299

160072 ............................................................................................................. 14.1920 14.9536 14.4141 14.5422

160073 ............................................................................................................. 15.0526 11.8261 11.4997 12.6736

160074 ............................................................................................................. 16.4772 19.5092 17.9513 18.0038

160075 ............................................................................................................. 17.8870 19.4948 18.4613 18.6342

160076 ............................................................................................................. 17.3086 17.9381 17.8824 17.7060

160077 ............................................................................................................. 11.4028 12.8826 13.6658 12.6451

160079 ............................................................................................................. 17.7050 17.6187 18.6333 17.9899

160080 ............................................................................................................. 17.8143 18.6687 19.4925 18.6704

160081 ............................................................................................................. 16.5150 17.0052 17.4466 17.0164

160082 ............................................................................................................. 18.7630 19.6499 19.5322 19.3143

22764

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

160083 ............................................................................................................. 18.4078 20.6189 19.7542 19.5937

160085 ............................................................................................................. 18.5510 18.0063 21.2557 19.2281

160086 ............................................................................................................. 16.4558 17.3271 17.5308 17.0998

160088 ............................................................................................................. 17.5331 20.2331 22.3655 19.9346

160089 ............................................................................................................. 16.7419 16.9538 17.3449 17.0079

160090 ............................................................................................................. 16.6002 17.1090 17.9614 17.2461

160091 ............................................................................................................. 12.1893 12.8516 14.2573 13.0755

160092 ............................................................................................................. 15.7979 15.5011 17.0633 16.0971

160093 ............................................................................................................. 15.9525 17.7457 18.5675 17.5141

160094 ............................................................................................................. 16.5609 18.7653 17.6094 17.6731

160095 ............................................................................................................. 14.2649 15.1895 15.2722 14.9322

160097 ............................................................................................................. 15.2079 15.9263 16.6790 15.9380

160098 ............................................................................................................. 15.5385 16.3135 16.8670 16.2509

160099 ............................................................................................................. 13.7864 13.9053 15.0880 14.2533

160101 ............................................................................................................. 17.8654 18.3705 18.9788 18.3824

160102 ............................................................................................................. 18.3631 18.8765 20.1161 19.0875

160103 ............................................................................................................. 17.1519 17.0973 18.2741 17.4869

160104 ............................................................................................................. 19.7387 18.8301 17.4829 18.7797

160106 ............................................................................................................. 16.6624 16.9639 17.3474 16.9910

160107 ............................................................................................................. 16.5622 18.0634 18.0097 17.5762

160108 ............................................................................................................. 15.4183 16.0529 16.7779 16.0861

160109 ............................................................................................................. 16.4885 16.5593 17.9873 16.9740

160110 ............................................................................................................. 18.8056 19.1420 20.6215 19.5351

160111 ............................................................................................................. 13.1689 14.1644 14.9965 14.0808

160112 ............................................................................................................. 16.2829 16.8332 17.2450 16.7911

160113 ............................................................................................................. 14.5838 14.7097 15.4834 14.9308

160114 ............................................................................................................. 15.5812 16.1423 16.5006 16.0651

160115 ............................................................................................................. 15.7566 15.8995 16.5654 16.0764

160116 ............................................................................................................. 16.6927 16.9534 16.6993 16.7818

160117 ............................................................................................................. 17.2914 17.9410 18.7615 17.9848

160118 ............................................................................................................. 15.8351 17.2523 19.4472 17.5046

160120 ............................................................................................................. 12.5642 10.5992 15.6789 12.4454

160122 ............................................................................................................. 18.5214 18.9252 18.1469 18.5357

160124 ............................................................................................................. 17.1642 18.0908 19.1600 18.1198

160126 ............................................................................................................. 17.7397 17.8142 19.4903 18.3068

160129 ............................................................................................................. 15.8914 16.7131 17.2112 16.5953

160130 ............................................................................................................. 15.4477 16.0528 15.6666 15.7242

160131 ............................................................................................................. 14.6874 15.4898 16.0424 15.4292

160134 ............................................................................................................. 13.3246 13.4743 15.3012 14.0359

160135 ............................................................................................................. 16.3294 18.2682 18.7711 17.7744

160138 ............................................................................................................. 15.7076 16.8699 17.1491 16.5906

160140 ............................................................................................................. 18.7962 18.4007 18.5630 18.5823

160142 ............................................................................................................. 16.1372 16.2875 18.1467 16.8318

160143 ............................................................................................................. 15.9240 16.6154 17.4497 16.6799

160145 ............................................................................................................. 15.1745 13.9152 16.9092 15.2763

160146 ............................................................................................................. 16.3532 16.6024 17.7010 16.8728

160147 ............................................................................................................. 18.3917 17.4880 19.4041 18.3938

160151 ............................................................................................................. 15.7384 16.8257 17.2177 16.5833

160152 ............................................................................................................. 15.2179 15.6170 15.9500 15.5914

160153 ............................................................................................................. 19.6927 20.2316 21.2085 20.3741

170001 ............................................................................................................. 17.4383 17.9304 17.9218 17.7616

170004 ............................................................................................................. 13.0635 15.0636 16.1442 14.7434

170006 ............................................................................................................. 19.3075 17.2192 17.5982 17.9438

170008 ............................................................................................................. 13.9009 14.9124 16.8412 15.1327

170009 ............................................................................................................. 19.5867 20.7795 23.1349 21.2143

170010 ............................................................................................................. 17.8995 18.7384 19.4584 18.6890

170012 ............................................................................................................. 16.7886 17.8719 18.3965 17.6979

170013 ............................................................................................................. 17.8949 18.6454 19.4667 18.6963

170014 ............................................................................................................. 17.3379 17.9349 18.4616 17.9223

170015 ............................................................................................................. 15.8887 16.5750 17.1302 16.5216

170016 ............................................................................................................. 19.6393 19.2130 20.0675 19.6307

170017 ............................................................................................................. 17.8690 17.7958 19.5994 18.4143

170018 ............................................................................................................. 14.2759 15.2984 15.3237 14.9817

22765

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

170019 ............................................................................................................. 16.6611 15.2094 16.9362 16.2597

170020 ............................................................................................................. 16.1460 17.3400 18.1325 17.2351

170022 ............................................................................................................. 17.9383 18.5309 19.1888 18.5543

170023 ............................................................................................................. 19.3585 19.1351 19.2441 19.2444

170024 ............................................................................................................. 13.0566 13.6803 14.3604 13.6835

170025 ............................................................................................................. 16.3716 17.8667 18.7182 17.6087

170026 ............................................................................................................. 13.3122 15.0470 14.8974 14.3412

170027 ............................................................................................................. 16.3859 17.3604 17.8690 17.2095

170030 ............................................................................................................. 15.2397 14.6530 15.9282 15.2488

170031 ............................................................................................................. 13.4670 13.9601 14.2151 13.8715

170032 ............................................................................................................. 14.4835 15.6093 16.3449 15.4817

170033 ............................................................................................................. 16.0529 16.4059 19.1952 17.1087

170034 ............................................................................................................. 14.6349 15.8202 16.9586 15.7633

170035 ............................................................................................................. 15.6240 18.5885 17.0945 17.0832

170036 ............................................................................................................. 14.1732 * * 14.1732

170038 ............................................................................................................. 14.2092 14.7776 13.8582 14.2922

170039 ............................................................................................................. 14.2952 15.8635 17.0774 15.7642

170040 ............................................................................................................. 20.1419 21.6440 19.4713 20.4318

170041 ............................................................................................................. 11.4691 11.7566 12.4488 11.8690

170044 ............................................................................................................. 14.7801 15.3011 17.3254 15.8168

170045 ............................................................................................................. 12.1066 14.0875 24.6556 16.5680

170049 ............................................................................................................. 18.5821 19.9415 20.7921 19.8083

170051 ............................................................................................................. 14.1572 15.0889 16.4851 15.2703

170052 ............................................................................................................. 14.6176 15.0108 15.2283 14.9500

170053 ............................................................................................................. 9.0407 16.5102 14.6133 11.9759

170054 ............................................................................................................. 12.7655 14.4353 14.6354 13.9214

170055 ............................................................................................................. 14.9875 16.9800 18.2607 16.7698

170056 ............................................................................................................. 14.8656 17.0442 18.2840 16.8012

170057 ............................................................................................................. 15.0892 13.0007 * 13.9776

170058 ............................................................................................................. 18.3389 18.6983 19.5415 18.8159

170060 ............................................................................................................. 17.2271 17.3482 18.9853 17.7512

170061 ............................................................................................................. 14.1380 15.6527 15.0258 14.9459

170063 ............................................................................................................. 11.3284 12.8082 14.1185 12.6216

170064 ............................................................................................................. 12.4183 * * 12.4183

170066 ............................................................................................................. 14.4790 15.5322 16.2891 15.4168

170067 ............................................................................................................. 12.7846 14.7492 14.9921 14.1535

170068 ............................................................................................................. 15.8175 15.1790 17.0022 15.9795

170070 ............................................................................................................. 12.8158 14.2445 14.0627 13.7083

170072 ............................................................................................................. 13.3379 12.6329 12.7709 12.9159

170073 ............................................................................................................. 16.4690 17.5368 17.7056 17.2186

170074 ............................................................................................................. 14.4009 17.5537 17.3699 16.4326

170075 ............................................................................................................. 11.2598 12.4212 13.6816 12.5950

170076 ............................................................................................................. 13.5820 14.5866 14.6109 14.2394

170077 ............................................................................................................. 12.7244 13.5235 13.9104 13.3651

170079 ............................................................................................................. 14.2859 13.5261 11.5902 13.1470

170080 ............................................................................................................. 12.2012 12.6014 14.8293 13.1562

170081 ............................................................................................................. 12.5122 13.8077 14.6823 13.7421

170082 ............................................................................................................. 12.3902 12.8563 13.7464 12.9855

170084 ............................................................................................................. 12.1611 12.5410 13.0519 12.5742

170085 ............................................................................................................. 14.5069 15.4518 17.5422 15.9150

170086 ............................................................................................................. 19.8496 20.4068 19.7182 19.9991

170088 ............................................................................................................. 11.7505 13.4542 13.4860 12.9031

170089 ............................................................................................................. 18.0823 18.8136 15.4860 17.4574

170090 ............................................................................................................. 11.2747 11.9147 10.9444 11.3947

170092 ............................................................................................................. 12.8507 * * 12.8507

170093 ............................................................................................................. 12.7780 13.5490 14.0276 13.4193

170094 ............................................................................................................. 17.7091 20.1985 21.2035 19.6936

170095 ............................................................................................................. 15.7469 15.5463 15.3532 15.5482

170097 ............................................................................................................. 15.8504 16.4608 17.6255 16.6758

170098 ............................................................................................................. 14.1026 15.5259 16.6210 15.4425

170099 ............................................................................................................. 13.5509 13.6033 14.3370 13.8072

170100 ............................................................................................................. 14.4700 * * 14.4700

170101 ............................................................................................................. 12.8847 14.5629 18.0143 14.7718

22766

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

170102 ............................................................................................................. 13.2434 13.6321 14.2048 13.6933

170103 ............................................................................................................. 16.6578 17.2844 17.9530 17.2887

170104 ............................................................................................................. 19.7645 20.6182 20.9336 20.4421

170105 ............................................................................................................. 15.9290 16.5408 16.7403 16.4083

170106 ............................................................................................................. 14.6773 18.5479 17.7467 16.9030

170109 ............................................................................................................. 16.9421 17.2629 16.9782 17.0622

170110 ............................................................................................................. 15.5549 16.9823 18.5731 17.1658

170112 ............................................................................................................. 13.3908 14.3855 15.4049 14.4270

170113 ............................................................................................................. 13.3935 13.9038 14.6486 13.9920

170114 ............................................................................................................. 14.5116 14.4545 16.0283 14.9432

170115 ............................................................................................................. 12.6815 12.6997 12.9216 12.7709

170116 ............................................................................................................. 15.7566 16.8714 18.0591 16.9087

170117 ............................................................................................................. 15.2818 15.7875 16.8237 15.8968

170119 ............................................................................................................. 13.9673 15.1990 15.2708 14.7822

170120 ............................................................................................................. 16.2122 17.6748 17.4917 17.1241

170122 ............................................................................................................. 20.1266 20.0615 20.5347 20.2343

170123 ............................................................................................................. 21.4168 23.1697 23.5468 22.6616

170124 ............................................................................................................. 10.2089 11.1249 15.0596 11.8247

170126 ............................................................................................................. 12.1268 12.8096 13.5736 12.8129

170128 ............................................................................................................. 14.9919 14.8891 14.1676 14.6301

170131 ............................................................................................................. 13.0978 10.1000 * 11.3849

170133 ............................................................................................................. 17.1103 18.0243 15.7918 16.8958

170134 ............................................................................................................. 14.2252 14.1085 14.6799 14.3402

170137 ............................................................................................................. 17.4151 17.8290 19.3118 18.1884

170139 ............................................................................................................. 13.3896 14.1967 14.3001 13.9545

170142 ............................................................................................................. 17.3234 * 17.7134 17.5177

170143 ............................................................................................................. 15.8802 15.6509 16.0415 15.8575

170144 ............................................................................................................. 16.0860 19.0929 20.4392 18.4073

170145 ............................................................................................................. 16.7499 17.1837 19.0142 17.6442

170146 ............................................................................................................. 19.9725 20.9075 21.7919 20.9132

170147 ............................................................................................................. 16.2829 22.3017 17.8070 18.7377

170148 ............................................................................................................. 17.2497 16.9183 19.9697 17.9186

170150 ............................................................................................................. 15.4283 15.5651 15.9072 15.6422

170151 ............................................................................................................. 13.3674 13.8934 14.3668 13.8637

170152 ............................................................................................................. 13.6846 14.9139 15.6423 14.7323

170160 ............................................................................................................. 13.3087 13.7108 14.4732 13.8369

170164 ............................................................................................................. 15.5597 16.6542 17.4072 16.5279

170166 ............................................................................................................. 17.5681 27.5567 12.7507 18.3396

170171 ............................................................................................................. 13.8059 12.5200 13.1792 13.1761

170175 ............................................................................................................. 17.8802 19.0232 19.9694 18.9232

170176 ............................................................................................................. 20.3194 21.3400 23.0743 21.5773

170180 ............................................................................................................. * 16.6921 8.6352 11.8552

170182 ............................................................................................................. 14.1971 22.2164 21.0546 19.7649

170183 ............................................................................................................. 19.0919 20.3505 19.5182 19.7036

170184 ............................................................................................................. 27.0152 * * 27.0152

180001 ............................................................................................................. 19.5188 17.9906 20.4885 19.3882

180002 ............................................................................................................. 18.1348 17.9669 17.5798 17.8819

180004 ............................................................................................................. 15.9921 17.2581 17.7149 16.9654

180005 ............................................................................................................. 20.6280 21.1390 22.4634 21.3796

180006 ............................................................................................................. 11.2254 11.4398 10.3400 11.0123

180007 ............................................................................................................. 17.1997 17.6776 17.9491 17.6005

180009 ............................................................................................................. 20.8103 21.4730 21.0608 21.1163

180010 ............................................................................................................. 17.5452 19.1100 19.6311 18.7406

180011 ............................................................................................................. 16.9311 17.1050 19.0526 17.8588

180012 ............................................................................................................. 18.7350 18.7223 18.9481 18.8031

180013 ............................................................................................................. 17.4487 18.2354 19.6031 18.4802

180014 ............................................................................................................. 20.8033 21.4856 21.3242 21.1722

180016 ............................................................................................................. 18.8422 19.8892 21.1458 20.0187

180017 ............................................................................................................. 15.1699 15.4140 15.6583 15.4240

180018 ............................................................................................................. 18.9020 17.1692 15.4575 17.0460

180019 ............................................................................................................. 16.7648 17.3970 17.2177 17.1400

180020 ............................................................................................................. 17.7782 17.7288 18.0111 17.8397

180021 ............................................................................................................. 15.1627 15.4580 17.0618 15.8957

22767

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

180023 ............................................................................................................. 15.2219 15.8803 17.4717 16.1885

180024 ............................................................................................................. 15.3299 16.1731 16.5040 15.9951

180025 ............................................................................................................. 17.1688 14.1841 15.4180 15.4826

180026 ............................................................................................................. 14.1571 14.6804 15.0118 14.6082

180027 ............................................................................................................. 14.8869 16.4116 17.5286 16.2087

180028 ............................................................................................................. 19.3519 19.5276 15.7005 18.0068

180029 ............................................................................................................. 18.0191 17.7729 17.7248 17.8352

180030 ............................................................................................................. 17.0234 17.3430 17.9543 17.4342

180031 ............................................................................................................. 13.7862 13.9844 13.1848 13.6178

180032 ............................................................................................................. 16.0941 16.8318 17.2784 16.7976

180033 ............................................................................................................. 13.7667 17.7344 15.4131 15.5472

180034 ............................................................................................................. 17.3158 15.3369 16.3991 16.3000

180035 ............................................................................................................. 19.4485 20.1305 21.3666 20.2870

180036 ............................................................................................................. 19.1922 19.8398 19.8830 19.6408

180037 ............................................................................................................. 18.8053 19.9737 21.2184 19.9797

180038 ............................................................................................................. 17.1643 17.7626 18.4077 17.7880

180040 ............................................................................................................. 19.4450 19.5337 20.6296 19.8636

180041 ............................................................................................................. 15.1703 15.0785 16.3699 15.5655

180042 ............................................................................................................. 16.2924 16.7691 17.1519 16.7450

180043 ............................................................................................................. 16.6077 16.8027 13.8503 15.6793

180044 ............................................................................................................. 17.8196 18.5571 19.4984 18.6534

180045 ............................................................................................................. 17.7272 17.7130 20.8455 18.9499

180046 ............................................................................................................. 17.9096 19.2523 21.2465 19.4702

180047 ............................................................................................................. 15.0354 16.2304 18.6938 16.6027

180048 ............................................................................................................. 19.5681 18.3442 17.7816 18.5208

180049 ............................................................................................................. 16.0799 16.4319 16.5459 16.3594

180050 ............................................................................................................. 18.4753 17.8540 17.1493 17.7884

180051 ............................................................................................................. 15.6796 16.3960 17.5441 16.5170

180053 ............................................................................................................. 14.6299 15.9284 15.8994 15.5002

180054 ............................................................................................................. 16.3875 19.4858 20.0946 18.5771

180055 ............................................................................................................. 14.6446 15.2663 15.8422 15.2446

180056 ............................................................................................................. 16.6240 17.0056 17.5728 17.0694

180058 ............................................................................................................. 14.3562 15.9685 14.5355 14.9226

180059 ............................................................................................................. 14.2605 13.3955 14.7032 14.1102

180060 ............................................................................................................. 7.2139 * * 7.2139

180063 ............................................................................................................. 11.9120 13.1036 12.4448 12.4785

180064 ............................................................................................................. 14.4872 15.2424 15.5066 15.0871

180065 ............................................................................................................. 20.0286 12.0629 11.1934 13.8815

180066 ............................................................................................................. 18.5635 19.2981 19.7883 19.2237

180067 ............................................................................................................. 18.5288 20.6322 19.8756 19.6602

180069 ............................................................................................................. 17.2956 17.7911 16.2916 17.1149

180070 ............................................................................................................. 13.8370 13.1923 15.9362 14.2840

180072 ............................................................................................................. 17.8554 16.9021 17.2347 17.3229

180075 ............................................................................................................. 15.0701 * * 15.0701

180078 ............................................................................................................. 19.1615 21.1170 21.7116 20.6787

180079 ............................................................................................................. 13.4072 15.1636 15.9048 14.8197

180080 ............................................................................................................. 15.8327 16.4989 16.6428 16.3363

180087 ............................................................................................................. 14.9660 14.9167 15.6089 15.1555

180088 ............................................................................................................. 22.5349 22.0374 22.4148 22.3261

180092 ............................................................................................................. 16.3099 18.2405 18.3597 17.6633

180093 ............................................................................................................. 16.8286 17.0132 17.9623 17.2606

180094 ............................................................................................................. 12.5074 13.5490 13.6233 13.2263

180095 ............................................................................................................. 13.3991 13.8021 13.9050 13.6989

180099 ............................................................................................................. 13.6988 13.3631 13.2991 13.4593

180101 ............................................................................................................. 19.5644 18.4883 * 18.9778

180102 ............................................................................................................. 17.8751 17.9618 18.5018 18.0941

180103 ............................................................................................................. 19.2182 19.8965 20.3774 19.8456

180104 ............................................................................................................. 18.8730 18.9281 19.4139 19.0718

180105 ............................................................................................................. 14.0811 15.2394 16.6997 15.2994

180106 ............................................................................................................. 13.6062 14.3505 15.2895 14.3903

180108 ............................................................................................................. 14.6222 14.8187 13.9862 14.4793

180115 ............................................................................................................. 17.1079 16.7003 16.9096 16.9026

180116 ............................................................................................................. 16.9389 18.0392 18.2848 17.7647

22768

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

180117 ............................................................................................................. 18.3821 17.7857 23.0192 19.6584

180118 ............................................................................................................. 12.1533 15.8597 16.9250 14.8270

180120 ............................................................................................................. 17.8145 16.1591 15.3115 16.3371

180121 ............................................................................................................. 14.5134 15.0983 20.0494 16.3330

180122 ............................................................................................................. 16.9678 18.5094 18.1930 17.8754

180123 ............................................................................................................. 18.9995 21.0613 21.1067 20.4023

180124 ............................................................................................................. 18.4064 17.4994 18.7682 18.2003

180125 ............................................................................................................. 19.7341 19.6416 14.9314 17.5744

180126 ............................................................................................................. 12.3959 12.9228 14.3551 13.2733

180127 ............................................................................................................. 17.3452 19.2581 17.5540 18.0362

180128 ............................................................................................................. 17.0508 17.6385 18.2817 17.6802

180129 ............................................................................................................. 17.8600 16.8378 22.3536 18.8696

180130 ............................................................................................................. 19.0110 19.8192 20.6684 19.8450

180132 ............................................................................................................. 17.2657 17.7744 19.1884 18.0615

180133 ............................................................................................................. 22.2325 21.6794 21.7800 21.8995

180134 ............................................................................................................. 13.6287 13.1935 12.5041 13.1008

180136 ............................................................................................................. 17.7146 17.3542 * 17.5359

180138 ............................................................................................................. 18.6149 19.3692 19.9343 19.3216

180139 ............................................................................................................. 18.7679 18.7198 18.0041 18.4600

180140 ............................................................................................................. 20.3953 16.8152 15.2719 17.3915

180141 ............................................................................................................. 20.0075 20.9820 23.8930 21.4590

180142 ............................................................................................................. * * 20.7510 20.7510

190001 ............................................................................................................. 17.0159 17.6832 18.1514 17.6263

190002 ............................................................................................................. 18.8381 19.1924 19.8834 19.2931

190003 ............................................................................................................. 22.1543 19.7749 19.9121 20.4811

190004 ............................................................................................................. 17.5385 17.7710 18.3620 17.8959

190005 ............................................................................................................. 16.7149 17.2422 17.3078 17.0856

190006 ............................................................................................................. 17.7335 17.8036 17.5911 17.7112

190007 ............................................................................................................. 13.6014 13.8189 14.4720 13.9833

190008 ............................................................................................................. 16.8916 18.6664 19.2456 18.2327

190009 ............................................................................................................. 14.2085 15.3555 15.9731 15.1819

190010 ............................................................................................................. 17.0192 16.2805 16.5020 16.6088

190011 ............................................................................................................. 15.1715 15.9534 15.6351 15.5881

190013 ............................................................................................................. 16.5706 16.8181 15.5019 16.2739

190014 ............................................................................................................. 17.0170 17.0959 17.7761 17.3018

190015 ............................................................................................................. 18.1943 18.6266 18.9896 18.6153

190017 ............................................................................................................. 15.7894 16.2393 17.5381 16.5250

190018 ............................................................................................................. 16.9761 15.0668 11.1898 14.5841

190019 ............................................................................................................. 17.4006 18.5257 18.3788 18.1281

190020 ............................................................................................................. 17.3084 17.5256 17.6840 17.5059

190025 ............................................................................................................. 16.0738 18.6369 15.8910 16.9047

190026 ............................................................................................................. 17.2166 18.1622 18.5015 17.9532

190027 ............................................................................................................. 16.1856 17.0827 17.4761 16.9034

190029 ............................................................................................................. 17.1103 16.5239 19.1967 17.5497

190033 ............................................................................................................. 10.7448 * * 10.7448

190034 ............................................................................................................. 16.5066 16.8503 18.0754 17.1513

190036 ............................................................................................................. 19.9456 20.1780 19.1695 19.7802

190037 ............................................................................................................. 12.0237 17.6945 19.9878 16.0686

190039 ............................................................................................................. 17.1687 19.4713 19.0376 18.5119

190040 ............................................................................................................. 20.3180 21.4634 21.7075 21.1804

190041 ............................................................................................................. 17.8975 17.6646 18.0991 17.8870

190043 ............................................................................................................. 12.5660 15.5580 15.5618 14.5094

190044 ............................................................................................................. 17.1984 17.2892 17.4471 17.3108

190045 ............................................................................................................. 21.6948 21.6107 21.2853 21.5139

190046 ............................................................................................................. 19.3538 19.7964 20.4273 19.8671

190048 ............................................................................................................. 16.3404 16.6683 16.8136 16.6153

190049 ............................................................................................................. 16.4250 17.2280 17.7417 17.1570

190050 ............................................................................................................. 15.3771 16.1980 16.2854 15.9545

190053 ............................................................................................................. 12.4980 13.2159 13.0080 12.9160

190054 ............................................................................................................. 16.4683 19.1738 18.9059 18.1924

190059 ............................................................................................................. 15.8443 15.6942 15.8373 15.7915

190060 ............................................................................................................. 18.3689 14.7186 17.5317 16.6606

190064 ............................................................................................................. 19.9047 20.4482 18.2466 19.4909

22769

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

190065 ............................................................................................................. 19.3856 20.9927 18.4695 19.5739

190071 ............................................................................................................. 13.5908 14.4827 16.4138 14.8320

190077 ............................................................................................................. 12.8290 15.7805 16.5536 15.0793

190078 ............................................................................................................. 13.4990 14.8826 16.9383 14.8793

190079 ............................................................................................................. 17.2909 17.7120 17.9403 17.6368

190081 ............................................................................................................. 12.0190 15.3198 14.9707 14.2301

190083 ............................................................................................................. 16.1374 18.8895 18.4951 17.8399

190086 ............................................................................................................. 14.9295 15.8694 16.5074 15.7738

190088 ............................................................................................................. 19.6328 20.5531 19.9362 20.0391

190089 ............................................................................................................. 12.7879 13.0503 15.0395 13.5823

190090 ............................................................................................................. 16.5580 16.6664 * 16.6122

190092 ............................................................................................................. 18.0655 * * 18.0655

190095 ............................................................................................................. 15.7316 16.2287 17.3258 16.3915

190098 ............................................................................................................. 19.2175 20.4897 21.0847 20.2301

190099 ............................................................................................................. 18.9255 19.9018 * 19.4679

190102 ............................................................................................................. 19.0477 20.0300 20.5106 19.8707

190103 ............................................................................................................. 15.5698 12.1389 14.4158 13.8580

190106 ............................................................................................................. 17.7468 18.5813 * 18.1836

190109 ............................................................................................................. 14.5288 15.5767 15.8187 15.3068

190110 ............................................................................................................. 12.9925 15.8052 15.7313 14.8387

190111 ............................................................................................................. 20.0376 19.7514 20.6508 20.1574

190112 ............................................................................................................. 19.2067 21.0232 22.0741 20.6951

190113 ............................................................................................................. 18.9922 12.5777 * 15.7380

190114 ............................................................................................................. 12.9083 12.6366 13.9209 13.1568

190115 ............................................................................................................. 20.4914 20.2473 22.3441 21.0026

190116 ............................................................................................................. 12.5881 15.5481 17.3757 15.1678

190118 ............................................................................................................. 12.9537 14.7876 16.3776 14.7222

190120 ............................................................................................................. 13.6938 13.9591 17.2309 14.9846

190122 ............................................................................................................. 14.8255 15.4793 15.3742 15.2287

190124 ............................................................................................................. 22.3825 20.6222 20.1206 20.9375

190125 ............................................................................................................. 18.6287 20.4517 19.8298 19.6458

190128 ............................................................................................................. 19.7127 20.4688 20.8770 20.3583

190130 ............................................................................................................. 12.4307 15.1467 14.0379 13.8956

190131 ............................................................................................................. 19.5984 20.7565 18.8958 19.7536

190133 ............................................................................................................. 13.4750 13.5383 15.1393 13.9917

190134 ............................................................................................................. 12.6774 12.1749 12.4507 12.4351

190135 ............................................................................................................. 21.3511 21.6875 21.1206 21.3903

190136 ............................................................................................................. 11.3250 12.4091 15.1662 13.0730

190138 ............................................................................................................. 22.7088 * * 22.7088

190140 ............................................................................................................. 12.0285 14.2256 14.6829 13.6611

190142 ............................................................................................................. 14.9820 15.4861 16.2280 15.5517

190144 ............................................................................................................. 16.8360 16.2068 18.4405 17.1561

190145 ............................................................................................................. 13.9893 15.2345 16.2505 15.1638

190146 ............................................................................................................. 20.0941 21.2825 22.0000 21.1693

190147 ............................................................................................................. 14.3219 14.4345 14.7202 14.4910

190148 ............................................................................................................. 14.0180 16.6337 15.5338 15.4604

190149 ............................................................................................................. 15.1862 17.5997 16.4722 16.4169

190151 ............................................................................................................. 11.9190 14.7333 15.5210 14.0028

190152 ............................................................................................................. 20.3951 22.2070 22.0319 21.4716

190155 ............................................................................................................. 11.0800 * * 11.0800

190156 ............................................................................................................. 12.4786 15.7478 16.0442 14.6766

190158 ............................................................................................................. 19.6164 20.4637 20.4078 20.1474

190160 ............................................................................................................. 18.4746 17.1003 18.4662 18.0078

190161 ............................................................................................................. 14.6295 15.5737 15.9280 15.3544

190162 ............................................................................................................. 19.5027 20.6143 20.1962 20.0440

190164 ............................................................................................................. 16.3328 15.1783 18.2379 16.4778

190167 ............................................................................................................. 16.2880 16.6681 17.7611 16.9143

190170 ............................................................................................................. 13.5772 14.1750 14.5222 14.0895

190173 ............................................................................................................. 19.6362 23.6398 22.5148 21.9224

190175 ............................................................................................................. 20.6908 19.3625 20.1330 20.0312

190176 ............................................................................................................. 18.8205 24.0574 22.0869 21.4121

190177 ............................................................................................................. 20.3177 18.6715 19.7794 19.5846

190178 ............................................................................................................. 10.4941 11.0657 12.0372 11.1714

22770

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

190182 ............................................................................................................. 20.0267 20.2855 20.7102 20.3281

190183 ............................................................................................................. 16.1064 16.7671 16.0752 16.3134

190184 ............................................................................................................. 14.8645 17.2044 19.8436 17.2547

190185 ............................................................................................................. 19.3707 20.1444 20.3479 19.9607

190186 ............................................................................................................. 16.3586 18.7568 17.4078 17.5306

190189 ............................................................................................................. 26.5419 * * 26.5419

190190 ............................................................................................................. 18.6656 17.4642 15.8985 17.1134

190191 ............................................................................................................. 18.1353 20.4975 19.6911 19.4475

190196 ............................................................................................................. 14.8699 17.9225 18.6138 17.2784

190197 ............................................................................................................. 17.9166 19.5569 20.2082 19.2721

190199 ............................................................................................................. 13.4222 16.0637 15.3522 14.6078

190200 ............................................................................................................. 19.4148 22.0391 21.6852 21.0397

190201 ............................................................................................................. 19.1432 18.7079 19.7539 19.2099

190202 ............................................................................................................. 17.8959 * * 17.8959

190203 ............................................................................................................. 21.3096 21.7350 21.7931 21.5975

190204 ............................................................................................................. 21.2119 21.4624 20.7215 21.1251

190205 ............................................................................................................. 18.1007 19.6587 19.3737 19.0483

190206 ............................................................................................................. 20.0648 21.7012 21.3307 21.0222

190207 ............................................................................................................. 17.6712 20.5082 19.0961 19.1272

190208 ............................................................................................................. 14.6096 20.0065 16.9641 17.1855

190218 ............................................................................................................. 18.1627 19.7518 19.2992 19.0335

190223 ............................................................................................................. 19.2550 * * 19.2550

190227 ............................................................................................................. 12.1086 * * 12.1086

190231 ............................................................................................................. 16.8850 15.8287 17.7247 16.7665

190235 ............................................................................................................. 18.2702 * * 18.2702

190236 ............................................................................................................. 22.1837 19.3395 21.1982 20.9440

190238 ............................................................................................................. * * 20.6799 20.6799

190239 ............................................................................................................. * * 19.7601 19.7601

190240 ............................................................................................................. * * 14.3579 14.3579

200001 ............................................................................................................. 17.4890 18.0527 18.1207 17.8991

200002 ............................................................................................................. 18.7745 19.3629 22.9761 20.4367

200003 ............................................................................................................. 16.7389 16.9566 18.1540 17.2860

200006 ............................................................................................................. 19.7984 17.6586 21.0922 19.4856

200007 ............................................................................................................. 17.8859 18.7992 18.0655 18.2525

200008 ............................................................................................................. 20.5020 21.7489 21.2206 21.1621

200009 ............................................................................................................. 20.6433 22.2280 21.3591 21.4199

200012 ............................................................................................................. 17.0130 18.3484 20.0235 18.4600

200013 ............................................................................................................. 16.4933 18.0566 18.2737 17.6653

200015 ............................................................................................................. 20.1117 * * 20.1117

200016 ............................................................................................................. 17.6623 18.0866 17.4335 17.7276

200017 ............................................................................................................. 19.6462 17.2930 * 18.7598

200018 ............................................................................................................. 17.2422 18.5397 18.2644 17.9737

200019 ............................................................................................................. 18.6399 19.2348 20.1070 19.3592

200020 ............................................................................................................. 20.5967 22.4526 22.5506 21.8845

200021 ............................................................................................................. 19.4052 19.9133 20.7565 20.0011

200023 ............................................................................................................. 14.9164 16.1707 18.8427 16.3595

200024 ............................................................................................................. 18.6518 19.4329 21.0233 19.7086

200025 ............................................................................................................. 19.0659 20.2259 20.4823 19.9499

200026 ............................................................................................................. 17.2842 18.1194 17.8759 17.7682

200027 ............................................................................................................. 18.2775 18.5659 19.6658 18.8842

200028 ............................................................................................................. 16.9306 19.5708 19.9218 18.7752

200031 ............................................................................................................. 15.9043 16.2217 16.3382 16.1598

200032 ............................................................................................................. 17.9160 18.9315 19.6907 18.8137

200033 ............................................................................................................. 21.4031 21.8634 22.0783 21.7858

200034 ............................................................................................................. 19.2407 20.1519 20.4939 19.9679

200037 ............................................................................................................. 18.2419 18.6713 19.2304 18.7348

200038 ............................................................................................................. 19.2147 23.3851 21.9205 21.5084

200039 ............................................................................................................. 20.2901 19.8589 20.2311 20.1007

200040 ............................................................................................................. 19.2970 19.5503 19.0188 19.2835

200041 ............................................................................................................. 17.6559 19.3563 18.4593 18.4719

200043 ............................................................................................................. 16.5368 16.7224 18.3804 17.1882

200050 ............................................................................................................. 18.0805 20.1214 13.1684 16.5253

200051 ............................................................................................................. 19.5925 22.1525 22.0712 21.5149

22771

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

200052 ............................................................................................................. 15.1216 17.2099 17.8551 16.7641

200055 ............................................................................................................. 17.1729 18.8422 18.6877 18.2119

200062 ............................................................................................................. 16.5139 17.2273 18.2221 17.3074

200063 ............................................................................................................. 19.6658 19.9331 25.6527 21.3771

200066 ............................................................................................................. 16.3431 17.0289 17.1538 16.8395

210001 ............................................................................................................. 18.7266 20.4841 18.6617 19.2372

210002 ............................................................................................................. 22.8448 19.9219 20.4315 21.0189

210003 ............................................................................................................. 25.3730 20.3446 26.0447 23.6583

210004 ............................................................................................................. 23.5884 24.2909 24.9760 24.2880

210005 ............................................................................................................. 19.6162 21.4929 21.3829 20.7876

210006 ............................................................................................................. 17.7721 18.9436 19.3682 18.7016

210007 ............................................................................................................. 21.5415 23.1007 23.8840 22.8043

210008 ............................................................................................................. 19.5006 21.1768 21.2895 20.6531

210009 ............................................................................................................. 21.8111 20.5447 20.7479 21.0282

210010 ............................................................................................................. 14.3783 18.7197 19.5908 17.3758

210011 ............................................................................................................. 21.2422 21.4862 21.4043 21.3727

210012 ............................................................................................................. 23.4317 20.7203 21.3977 21.7764

210013 ............................................................................................................. 18.8455 19.7288 19.4505 19.3405

210015 ............................................................................................................. 16.6898 16.1912 18.6087 17.1516

210016 ............................................................................................................. 22.1469 23.8739 26.5193 24.0991

210017 ............................................................................................................. 17.1747 18.8928 18.5079 18.1448

210018 ............................................................................................................. 21.4055 22.2135 22.8553 22.1574

210019 ............................................................................................................. 19.0899 19.3046 20.6025 19.6453

210022 ............................................................................................................. 21.8160 22.6389 24.3016 22.9230

210023 ............................................................................................................. 21.7988 23.1950 22.9989 22.6719

210024 ............................................................................................................. 19.5645 20.6011 21.1669 20.3654

210025 ............................................................................................................. 19.5704 19.5876 21.2769 20.0208

210026 ............................................................................................................. 11.6440 12.1348 13.3494 12.4124

210027 ............................................................................................................. 18.4862 17.6855 17.1060 17.7943

210028 ............................................................................................................. 18.8623 19.6408 19.4157 19.3091

210029 ............................................................................................................. 22.3876 21.2167 22.7191 22.0801

210030 ............................................................................................................. 21.0169 21.7403 20.9574 21.2261

210031 ............................................................................................................. 15.5873 16.2299 * 15.9014

210032 ............................................................................................................. 18.4983 17.7228 20.1955 18.7972

210033 ............................................................................................................. 19.9144 20.8053 23.7588 21.3886

210034 ............................................................................................................. 16.1216 15.7322 25.0849 18.5047

210035 ............................................................................................................. 20.6092 20.2731 20.8317 20.5720

210037 ............................................................................................................. 18.7361 18.3072 20.5528 19.2053

210038 ............................................................................................................. 23.2616 23.4971 24.9762 23.8679

210039 ............................................................................................................. 20.7291 19.9901 21.3559 20.7067

210040 ............................................................................................................. 25.0770 21.5014 23.4252 23.3184

210043 ............................................................................................................. 18.5891 19.6474 22.4000 20.0973

210044 ............................................................................................................. 22.2438 22.5781 23.0917 22.6329

210045 ............................................................................................................. 9.6862 11.6086 12.1467 11.1781

210048 ............................................................................................................. 22.3923 23.0537 24.6921 23.3434

210049 ............................................................................................................. 17.6697 19.0821 19.3022 18.6991

210051 ............................................................................................................. 20.7633 22.4335 23.6476 22.3235

210054 ............................................................................................................. 23.5122 22.3559 23.2730 23.0396

210055 ............................................................................................................. 20.1012 29.2539 26.5272 25.0062

210056 ............................................................................................................. 20.9445 19.2662 22.9654 21.0453

210057 ............................................................................................................. 22.5717 23.8289 26.0076 24.0668

210058 ............................................................................................................. 21.4976 22.0753 16.3191 20.0884

210059 ............................................................................................................. 23.1274 22.6766 25.6052 23.5899

210060 ............................................................................................................. * * 26.5846 26.5846

210061 ............................................................................................................. 20.0203 17.2240 16.1931 17.8181

220001 ............................................................................................................. 26.3207 21.9369 22.9064 22.9526

220002 ............................................................................................................. 22.5808 24.1285 24.7920 23.8005

220003 ............................................................................................................. 19.1383 16.9246 17.9319 17.9948

220004 ............................................................................................................. 20.0058 * * 20.0058

220006 ............................................................................................................. 22.1228 22.3085 22.6469 22.3611

220008 ............................................................................................................. 21.8873 24.4691 22.0796 22.7689

220010 ............................................................................................................. 21.9226 21.8582 22.0067 21.9297

220011 ............................................................................................................. 28.5673 26.1827 29.5290 28.2047

22772

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

220012 ............................................................................................................. 29.5051 32.0829 31.2303 30.9286

220015 ............................................................................................................. 21.7813 22.5773 23.1893 22.4843

220016 ............................................................................................................. 23.1440 23.3750 23.0951 23.2050

220017 ............................................................................................................. 25.2630 22.4605 24.9576 24.2129

220019 ............................................................................................................. 19.1264 19.5613 19.8551 19.5190

220020 ............................................................................................................. 19.9925 21.4152 22.2245 21.2040

220021 ............................................................................................................. 23.6313 * * 23.6313

220023 ............................................................................................................. 18.7625 16.1885 * 18.0910

220024 ............................................................................................................. 21.5871 21.5363 21.9316 21.6947

220025 ............................................................................................................. 19.9398 20.7882 22.8593 21.1235

220028 ............................................................................................................. 22.0721 22.8036 21.0630 21.9530

220029 ............................................................................................................. 21.8711 23.1509 25.6560 23.4858

220030 ............................................................................................................. 14.5383 18.5441 18.7429 17.2580

220031 ............................................................................................................. 28.1584 30.2430 29.3091 29.1415

220033 ............................................................................................................. 20.4120 20.0695 20.2601 20.2365

220035 ............................................................................................................. 21.9974 21.6396 23.1892 22.2365

220036 ............................................................................................................. 24.1570 24.6470 24.4091 24.3977

220038 ............................................................................................................. 22.3494 22.6518 22.3162 22.4382

220041 ............................................................................................................. 23.1483 23.4720 27.5034 24.5999

220042 ............................................................................................................. 25.2852 25.0779 26.0473 25.4181

220046 ............................................................................................................. 22.4677 22.7068 23.3149 22.8459

220049 ............................................................................................................. 23.0283 26.0025 26.3191 25.1679

220050 ............................................................................................................. 20.8345 22.0144 22.5265 21.7871

220051 ............................................................................................................. 20.4765 21.1033 21.7357 21.0973

220052 ............................................................................................................. 23.1376 23.7650 23.5225 23.4708

220053 ............................................................................................................. 21.2679 19.1280 * 20.2813

220055 ............................................................................................................. 21.5706 21.3743 * 21.4727

220057 ............................................................................................................. 23.0010 25.3902 25.8064 24.6606

220058 ............................................................................................................. 20.1888 19.9369 26.8345 22.1915

220060 ............................................................................................................. 26.1753 28.0843 28.0794 27.4392

220062 ............................................................................................................. 20.0560 20.4685 20.2254 20.2505

220063 ............................................................................................................. 20.9547 20.3951 20.8079 20.7132

220064 ............................................................................................................. 22.1785 22.3260 22.7497 22.4060

220065 ............................................................................................................. 20.1974 20.1364 20.1424 20.1584

220066 ............................................................................................................. 20.4586 20.7826 21.7186 21.0071

220067 ............................................................................................................. 25.7414 26.4443 27.5405 26.5452

220068 ............................................................................................................. 6.4548 * * 6.4548

220070 ............................................................................................................. 19.7678 19.7528 19.0333 19.5401

220071 ............................................................................................................. 24.6508 25.6184 26.8257 25.6808

220073 ............................................................................................................. 25.8680 25.6025 26.1328 25.8683

220074 ............................................................................................................. 24.0523 25.6390 24.8429 25.0647

220075 ............................................................................................................. 21.5418 22.8057 22.5329 22.2794

220076 ............................................................................................................. 24.7783 22.6668 23.2795 23.6106

220077 ............................................................................................................. 24.8019 25.2646 25.5336 25.1941

220079 ............................................................................................................. 21.0090 22.6256 17.9964 20.4339

220080 ............................................................................................................. 20.5007 21.5238 22.1971 21.3825

220081 ............................................................................................................. 25.3370 29.1726 29.6682 28.0686

220082 ............................................................................................................. 20.0175 21.6726 22.1453 21.2140

220083 ............................................................................................................. 23.0759 23.9156 22.5815 23.1732

220084 ............................................................................................................. 24.6624 23.6641 21.3072 23.1862

220086 ............................................................................................................. 30.4649 23.8705 27.6595 26.7829

220088 ............................................................................................................. 23.3783 22.9067 23.4258 23.2384

220089 ............................................................................................................. 21.7884 23.0965 25.4106 23.3099

220090 ............................................................................................................. 21.6353 22.0041 23.2456 22.2523

220092 ............................................................................................................. 17.0409 18.5239 24.2591 19.3548

220094 ............................................................................................................. 21.9853 * * 21.9853

220095 ............................................................................................................. 21.4468 21.4831 21.7851 21.5735

220098 ............................................................................................................. 20.8596 21.5906 23.1547 21.8533

220100 ............................................................................................................. 25.3484 25.7077 27.5841 26.2007

220101 ............................................................................................................. 24.3260 25.9204 27.0711 25.7662

220104 ............................................................................................................. 27.5297 28.0021 28.7258 28.0695

220105 ............................................................................................................. 21.6873 21.4129 21.9185 21.6684

220106 ............................................................................................................. 24.5518 25.6577 25.9277 25.3659

22773

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

220107 ............................................................................................................. 20.2719 * * 20.2719

220108 ............................................................................................................. 22.6372 21.9115 23.4975 22.6709

220110 ............................................................................................................. 29.1927 28.7071 28.8697 28.9201

220111 ............................................................................................................. 23.0475 23.8066 24.7510 23.8707

220116 ............................................................................................................. 24.9744 26.1662 32.0049 27.4579

220118 ............................................................................................................. 30.5213 * * 30.5213

220119 ............................................................................................................. 22.8586 23.3216 23.8785 23.3181

220123 ............................................................................................................. 27.3063 25.8994 32.4678 28.6276

220126 ............................................................................................................. 20.9557 22.5218 22.9620 22.1062

220128 ............................................................................................................. 20.5636 * * 20.5636

220133 ............................................................................................................. 35.2747 25.4596 29.3911 30.0324

220135 ............................................................................................................. 25.0798 25.6522 26.6636 25.7967

220153 ............................................................................................................. 23.8981 22.9592 * 23.4152

220154 ............................................................................................................. 22.1261 22.4770 21.1563 22.0118

220163 ............................................................................................................. 27.3527 29.1143 29.6933 28.6971

220171 ............................................................................................................. 23.4340 24.5553 25.2585 24.4462

230001 ............................................................................................................. 19.2015 19.8020 20.0438 19.6841

230002 ............................................................................................................. 21.9058 22.7991 23.3790 22.7047

230003 ............................................................................................................. 19.6118 19.8420 21.2215 20.2501

230004 ............................................................................................................. 22.0310 23.1036 20.5005 21.8004

230005 ............................................................................................................. 19.4040 18.5644 17.0943 18.3438

230006 ............................................................................................................. 18.4681 19.1041 20.4978 19.3271

230007 ............................................................................................................. 19.4339 15.5538 * 18.1334

230012 ............................................................................................................. 18.6663 15.0803 * 16.5807

230013 ............................................................................................................. 20.6322 20.8018 22.2211 21.1847

230015 ............................................................................................................. 20.4264 20.1104 20.6464 20.3967

230017 ............................................................................................................. 20.3975 22.2822 22.4824 21.6902

230019 ............................................................................................................. 21.3222 22.2622 22.1491 21.9247

230020 ............................................................................................................. 21.3206 22.1280 22.1198 21.8771

230021 ............................................................................................................. 18.5670 18.9636 19.8256 19.1973

230022 ............................................................................................................. 19.7598 18.8006 21.9129 20.1618

230024 ............................................................................................................. 27.9551 23.7326 24.9664 25.4314

230027 ............................................................................................................. 18.0285 14.6950 19.6393 17.2624

230029 ............................................................................................................. 21.0636 19.4911 22.1092 20.9014

230030 ............................................................................................................. 17.7040 18.3916 18.6230 18.2489

230031 ............................................................................................................. 17.5352 19.3162 19.9465 18.8845

230032 ............................................................................................................. 20.6821 21.8845 24.8930 22.4347

230034 ............................................................................................................. 17.2302 19.0473 19.4366 18.6363

230035 ............................................................................................................. 17.5607 17.5109 17.7490 17.6051

230036 ............................................................................................................. 21.7565 23.2119 23.8398 22.9390

230037 ............................................................................................................. 19.0688 20.4747 23.2751 20.8659

230038 ............................................................................................................. 23.3876 23.5251 21.9692 22.9521

230040 ............................................................................................................. 20.3897 21.4393 20.7841 20.8605

230041 ............................................................................................................. 19.0278 20.3131 21.7364 20.3273

230042 ............................................................................................................. 19.4937 22.1043 21.0266 20.8816

230046 ............................................................................................................. 25.9482 25.5696 25.3206 25.6107

230047 ............................................................................................................. 20.6379 21.5381 22.4279 21.5449

230053 ............................................................................................................. 22.1781 25.4968 25.5139 24.3278

230054 ............................................................................................................. 19.5427 20.6963 20.8014 20.3482

230055 ............................................................................................................. 19.8381 20.7932 20.8908 20.4862

230056 ............................................................................................................. 16.4101 16.0766 18.9203 17.0117

230058 ............................................................................................................. 18.2349 20.4165 21.0303 19.9623

230059 ............................................................................................................. 19.5098 19.9240 20.7092 20.0517

230060 ............................................................................................................. 17.8716 19.8021 19.4211 19.0237

230062 ............................................................................................................. 16.2952 17.1540 18.8039 17.3634

230063 ............................................................................................................. 20.2211 20.4171 * 20.3143

230065 ............................................................................................................. 21.1507 22.3459 22.3216 22.0094

230066 ............................................................................................................. 21.5116 22.1768 23.0475 22.2618

230069 ............................................................................................................. 21.7909 23.2076 24.1210 23.0181

230070 ............................................................................................................. 20.0645 20.2505 21.5666 20.8098

230071 ............................................................................................................. 22.1556 22.9052 23.1337 22.7304

230072 ............................................................................................................. 20.4308 20.6944 20.4456 20.5245

230075 ............................................................................................................. 19.4316 20.0545 22.5866 20.6203

22774

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

230076 ............................................................................................................. 23.8201 24.4547 24.7010 24.2886

230077 ............................................................................................................. 20.3937 21.0178 19.7982 20.3917

230078 ............................................................................................................. 16.2486 17.5577 17.9868 17.2435

230080 ............................................................................................................. 18.9084 19.7687 20.2104 19.6745

230081 ............................................................................................................. 17.9510 19.0345 19.0199 18.6644

230082 ............................................................................................................. 17.7417 18.2992 19.0419 18.3501

230085 ............................................................................................................. 17.5447 20.2096 23.4996 20.3924

230086 ............................................................................................................. 16.9754 18.9420 20.1857 18.6805

230087 ............................................................................................................. 15.7694 18.9034 19.9700 18.0112

230089 ............................................................................................................. 21.3914 23.9100 22.6994 22.6194

230092 ............................................................................................................. 18.9567 20.0145 20.8313 19.9501

230093 ............................................................................................................. 20.1928 20.4655 20.6425 20.4363

230095 ............................................................................................................. 16.7830 17.3313 17.6444 17.2565

230096 ............................................................................................................. 22.5613 22.8410 22.7785 22.7256

230097 ............................................................................................................. 20.0960 21.2854 21.1254 20.8481

230099 ............................................................................................................. 20.2529 21.1933 21.7513 21.0709

230100 ............................................................................................................. 13.1107 17.1336 17.3842 16.0282

230101 ............................................................................................................. 18.6098 20.0932 20.5315 19.7445

230103 ............................................................................................................. 19.6014 22.7696 11.3429 17.7532

230104 ............................................................................................................. 23.4703 23.1457 24.1238 23.5809

230105 ............................................................................................................. 20.8765 21.5210 22.6098 21.6727

230106 ............................................................................................................. 18.3508 20.7997 21.6825 20.2936

230107 ............................................................................................................. 14.6673 16.5966 17.1386 15.9949

230108 ............................................................................................................. 17.4231 18.8631 20.3437 18.8600

230110 ............................................................................................................. 17.8017 18.9825 19.7262 18.8384

230113 ............................................................................................................. 11.1676 14.9411 * 12.8926

230115 ............................................................................................................. 16.4728 18.4050 19.2636 18.0559

230116 ............................................................................................................. 16.3563 16.5419 14.5692 15.7763

230117 ............................................................................................................. 23.9389 25.9318 25.6797 25.1927

230118 ............................................................................................................. 21.7089 21.3028 20.6797 21.2068

230119 ............................................................................................................. 23.9568 21.1918 22.5415 22.5507

230120 ............................................................................................................. 19.6400 18.5264 20.3306 19.4421

230121 ............................................................................................................. 20.0786 20.3158 21.3342 20.5789

230122 ............................................................................................................. 18.0903 20.9078 * 19.5648

230124 ............................................................................................................. 18.8938 20.3608 18.6352 19.2618

230125 ............................................................................................................. 15.3497 * * 15.3497

230128 ............................................................................................................. 23.5787 24.9081 24.0724 24.1436

230130 ............................................................................................................. 22.5204 23.5170 22.1775 22.7280

230132 ............................................................................................................. 26.1727 26.6386 26.2269 26.3491

230133 ............................................................................................................. 17.5688 17.6894 17.1058 17.4473

230134 ............................................................................................................. 15.3248 * * 15.3248

230135 ............................................................................................................. 22.7401 22.5258 20.5637 22.0738

230137 ............................................................................................................. 18.3431 19.1813 * 18.7522

230141 ............................................................................................................. 23.0496 22.1299 22.4570 22.5592

230142 ............................................................................................................. 20.1242 22.2940 23.3483 21.7608

230143 ............................................................................................................. 16.4468 16.3043 16.7948 16.5112

230144 ............................................................................................................. 20.9906 22.1108 23.3502 22.1007

230145 ............................................................................................................. 16.5986 20.2542 19.2638 18.8354

230146 ............................................................................................................. 18.6293 20.5044 21.1818 20.1337

230147 ............................................................................................................. 20.5144 21.8496 23.2755 21.8616

230149 ............................................................................................................. 14.1740 20.7691 18.8005 17.7545

230151 ............................................................................................................. 20.8884 22.1713 23.1152 21.9998

230153 ............................................................................................................. 17.3280 19.5633 18.7403 18.5291

230154 ............................................................................................................. 14.5846 15.4456 15.4362 15.1635

230155 ............................................................................................................. 16.9857 17.2076 20.5409 18.1875

230156 ............................................................................................................. 23.6126 24.7587 25.5835 24.6629

230157 ............................................................................................................. 19.7197 20.3667 17.3571 19.2380

230159 ............................................................................................................. 18.8426 20.0749 * 19.3914

230162 ............................................................................................................. 17.7689 21.4636 21.7148 20.3064

230165 ............................................................................................................. 23.3147 23.0106 23.2019 23.1727

230167 ............................................................................................................. 20.3210 21.5048 22.1550 21.3066

230169 ............................................................................................................. 22.8606 23.0652 24.3780 23.4313

230171 ............................................................................................................. 14.9595 13.3863 17.1282 15.0778

22775

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

230172 ............................................................................................................. 20.2191 20.6417 21.4675 20.7898

230174 ............................................................................................................. 20.8542 23.0272 22.7304 22.1820

230175 ............................................................................................................. 21.8097 16.8909 * 19.0428

230176 ............................................................................................................. 21.8618 22.7772 23.8883 22.8410

230178 ............................................................................................................. 16.0818 16.9156 17.3030 16.7485

230180 ............................................................................................................. 15.4837 15.8769 18.5744 16.6297

230184 ............................................................................................................. 17.2928 19.0604 19.7717 18.6605

230186 ............................................................................................................. * 19.5337 16.4977 18.0186

230188 ............................................................................................................. 15.5563 15.7112 16.2975 15.8821

230189 ............................................................................................................. 15.9089 16.6838 17.9218 16.8493

230190 ............................................................................................................. 23.7134 26.8196 26.4687 25.7543

230191 ............................................................................................................. 17.1221 19.0013 18.4861 18.1647

230193 ............................................................................................................. 20.1805 19.7066 19.2961 19.7939

230195 ............................................................................................................. 22.3745 21.7775 22.5842 22.2594

230197 ............................................................................................................. 21.6184 24.0184 23.3951 22.9141

230199 ............................................................................................................. 18.4012 19.4451 20.6580 19.5586

230201 ............................................................................................................. 15.3206 17.2141 18.0787 16.9556

230204 ............................................................................................................. 22.9506 25.4181 23.4966 23.9387

230205 ............................................................................................................. 13.8861 14.3788 15.9314 14.6555

230207 ............................................................................................................. 20.3538 20.6375 21.2483 20.7256

230208 ............................................................................................................. 17.1501 16.0733 15.8925 16.3949

230211 ............................................................................................................. 17.5087 18.6744 21.8581 19.0214

230212 ............................................................................................................. 22.1370 23.3021 24.2611 23.2193

230213 ............................................................................................................. 15.3159 15.1908 15.5469 15.3407

230216 ............................................................................................................. 19.5921 20.3359 21.0710 20.3422

230217 ............................................................................................................. 20.9510 21.2707 22.2698 21.4978

230219 ............................................................................................................. 20.7018 19.1549 20.0442 19.9745

230221 ............................................................................................................. 21.5000 * * 21.5000

230222 ............................................................................................................. 20.8430 22.1785 22.0823 21.7090

230223 ............................................................................................................. 21.4990 21.1528 22.2627 21.6325

230227 ............................................................................................................. 21.3801 23.7259 22.7599 22.5824

230230 ............................................................................................................. 22.5346 22.2385 22.3092 22.3585

230232 ............................................................................................................. 12.6373 * * 12.6373

230235 ............................................................................................................. 15.9466 16.8684 17.7197 16.8275

230236 ............................................................................................................. 23.2178 24.3835 25.9676 24.5556

230239 ............................................................................................................. 19.2349 18.0942 17.8168 18.3625

230241 ............................................................................................................. 18.8451 19.1000 20.0497 19.3344

230244 ............................................................................................................. 21.0758 21.7413 22.2697 21.6892

230253 ............................................................................................................. 21.9497 20.5945 21.0433 21.1989

230254 ............................................................................................................. 21.2786 21.9402 22.6335 21.9383

230257 ............................................................................................................. 20.4721 19.6982 21.3695 20.4944

230259 ............................................................................................................. 21.1519 22.2393 22.3969 21.9147

230264 ............................................................................................................. 15.1818 17.1319 17.4864 16.5360

230269 ............................................................................................................. 22.8138 23.3105 24.0992 23.4229

230270 ............................................................................................................. 20.0803 22.6187 21.5711 21.3628

230273 ............................................................................................................. 23.4000 22.9199 22.8715 23.0744

230275 ............................................................................................................. 17.5975 17.7487 20.8985 18.2554

230276 ............................................................................................................. 18.5750 21.3722 25.8709 21.5415

230277 ............................................................................................................. 22.5012 23.1456 23.9771 23.2364

230278 ............................................................................................................. 16.6645 18.2110 * 17.3814

230279 ............................................................................................................. 16.0437 17.6973 17.8074 17.2147

230280 ............................................................................................................. 14.2249 15.6654 18.3497 15.8025

230283 ............................................................................................................. * 27.9480 22.5082 24.9202

240001 ............................................................................................................. 22.8480 24.6207 25.6936 24.3586

240002 ............................................................................................................. 23.0240 22.7981 23.2225 23.0151

240004 ............................................................................................................. 23.9195 25.1908 23.8151 24.2981

240005 ............................................................................................................. 16.9775 17.9563 20.3193 18.3770

240006 ............................................................................................................. 27.1133 25.1602 23.0715 24.9568

240007 ............................................................................................................. 16.9802 17.7625 19.0850 17.9138

240008 ............................................................................................................. 21.8068 20.2158 23.3783 21.6628

240009 ............................................................................................................. 16.6910 16.8965 17.1187 16.9211

240010 ............................................................................................................. 23.6323 23.6477 25.4752 24.2587

240011 ............................................................................................................. 18.9559 20.5192 21.5875 20.3298

22776

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

240013 ............................................................................................................. 18.9705 20.3282 21.7544 20.2656

240014 ............................................................................................................. 21.8560 23.0025 24.3446 23.0734

240016 ............................................................................................................. 19.8624 20.4017 22.2011 20.8274

240017 ............................................................................................................. 17.2325 18.3585 18.9272 18.1627

240018 ............................................................................................................. 19.0671 20.8501 18.4268 19.4219

240019 ............................................................................................................. 20.9869 22.1501 23.1477 22.1062

240020 ............................................................................................................. 19.5727 21.1937 20.8849 20.5389

240021 ............................................................................................................. 17.3968 18.7515 20.1457 18.6569

240022 ............................................................................................................. 19.1554 21.7889 21.3234 20.7594

240023 ............................................................................................................. 20.3923 21.5087 22.8224 21.4999

240025 ............................................................................................................. 17.2464 18.8345 20.0308 18.7384

240027 ............................................................................................................. 16.2531 19.1017 16.7758 17.3367

240028 ............................................................................................................. 19.3781 19.7918 25.1934 21.5071

240029 ............................................................................................................. 17.9880 21.1329 20.0164 19.6781

240030 ............................................................................................................. 18.4358 18.8547 20.1653 19.1669

240031 ............................................................................................................. 18.0652 18.1566 19.3983 18.5009

240036 ............................................................................................................. 20.3270 22.2460 22.1721 21.6421

240037 ............................................................................................................. 18.4564 19.2345 20.1195 19.3188

240038 ............................................................................................................. 26.3539 25.3061 24.3957 25.3169

240040 ............................................................................................................. 19.9022 20.4813 23.1352 21.0482

240041 ............................................................................................................. 19.2127 19.2864 21.8655 20.0389

240043 ............................................................................................................. 17.3064 17.7335 16.9859 17.3013

240044 ............................................................................................................. 18.9217 18.8411 20.3339 19.3394

240045 ............................................................................................................. 20.9873 21.1396 24.1557 22.0716

240047 ............................................................................................................. 21.8576 22.6152 23.8098 22.7467

240048 ............................................................................................................. 23.3110 * * 23.3110

240049 ............................................................................................................. 22.1345 * * 22.1345

240050 ............................................................................................................. 24.5027 25.2983 21.6499 22.6550

240051 ............................................................................................................. 18.2287 19.9195 22.5855 20.1307

240052 ............................................................................................................. 19.2190 20.7749 * 19.9948

240053 ............................................................................................................. 21.1987 22.9611 23.8858 22.7864

240056 ............................................................................................................. 22.2927 23.4226 23.7139 23.1375

240057 ............................................................................................................. 23.2377 24.2159 24.3404 23.9501

240058 ............................................................................................................. 14.9141 14.9697 18.1695 15.9021

240059 ............................................................................................................. 21.9575 23.6215 23.7808 23.1092

240061 ............................................................................................................. 25.5581 27.2603 25.9951 26.2655

240063 ............................................................................................................. 23.5426 23.7866 24.4031 23.9101

240064 ............................................................................................................. 20.7602 23.2860 22.6742 22.2043

240065 ............................................................................................................. 12.5547 12.7867 14.8734 13.4307

240066 ............................................................................................................. 22.0542 23.0698 24.1143 23.1023

240069 ............................................................................................................. 19.1834 19.8282 21.7991 20.2573

240071 ............................................................................................................. 19.1913 20.2101 21.1721 20.2070

240072 ............................................................................................................. 18.0015 21.1824 20.9529 20.0007

240073 ............................................................................................................. 15.6318 16.0840 17.3559 16.3592

240075 ............................................................................................................. 21.1934 21.2654 21.4157 21.2934

240076 ............................................................................................................. 21.0702 21.8795 22.3280 21.7859

240077 ............................................................................................................. 14.9493 15.3794 20.3445 16.8827

240078 ............................................................................................................. 22.7122 23.9150 25.1082 23.9382

240079 ............................................................................................................. 17.8206 18.4338 18.8345 18.3648

240080 ............................................................................................................. 23.7286 24.3399 25.5619 24.7160

240082 ............................................................................................................. 18.0272 18.3555 18.7995 18.3952

240083 ............................................................................................................. 19.2922 19.7637 21.0317 20.0094

240084 ............................................................................................................. 19.6078 19.4739 21.7421 20.2965

240085 ............................................................................................................. 18.0214 22.5736 20.9778 20.5540

240086 ............................................................................................................. 15.3302 16.9392 18.1401 16.9654

240087 ............................................................................................................. 17.0624 18.8352 21.3323 19.0315

240088 ............................................................................................................. 21.0202 21.6858 23.1056 21.8928

240089 ............................................................................................................. 18.4171 20.7239 21.1989 20.0227

240090 ............................................................................................................. 18.0490 19.2968 19.2166 18.8331

240093 ............................................................................................................. 18.6788 18.7092 20.2400 19.2268

240094 ............................................................................................................. 20.5705 20.9446 22.0247 21.2053

240096 ............................................................................................................. 18.3365 20.1644 21.0417 19.7961

240097 ............................................................................................................. 23.6230 24.2662 27.7781 25.0667

22777

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

240098 ............................................................................................................. 20.6036 21.3467 24.2296 22.0643

240099 ............................................................................................................. 14.3759 14.4649 15.4964 14.7485

240100 ............................................................................................................. 19.1921 20.8302 18.9953 19.6501

240101 ............................................................................................................. 17.7478 19.2120 20.0872 18.9539

240102 ............................................................................................................. 15.5644 14.6067 16.3659 15.5008

240103 ............................................................................................................. 16.8805 19.1540 18.7510 18.2532

240104 ............................................................................................................. 24.0175 23.2178 23.5351 23.5902

240105 ............................................................................................................. 14.7904 14.3965 * 14.6094

240106 ............................................................................................................. 23.7818 23.5148 23.5005 23.6022

240107 ............................................................................................................. 19.0299 20.3983 20.9004 20.0558

240108 ............................................................................................................. 16.4605 15.3547 18.2427 16.5529

240109 ............................................................................................................. 13.1537 13.5537 16.3216 14.2359

240110 ............................................................................................................. 17.2834 19.4828 21.0675 19.2326

240111 ............................................................................................................. 17.0408 17.2100 17.8617 17.3567

240112 ............................................................................................................. 15.3246 15.8350 16.6242 15.9307

240114 ............................................................................................................. 15.4919 16.2505 17.3682 16.3794

240115 ............................................................................................................. 22.1575 23.7765 23.8675 23.3187

240116 ............................................................................................................. 15.1757 16.6731 18.3520 16.6014

240117 ............................................................................................................. 17.5676 18.0636 17.9941 17.8845

240119 ............................................................................................................. 22.4981 20.6126 21.8289 21.5894

240121 ............................................................................................................. 21.3747 23.4018 22.2266 22.3266

240122 ............................................................................................................. 18.0396 19.1811 21.2876 19.5090

240123 ............................................................................................................. 15.5968 16.5098 18.3941 16.7420

240124 ............................................................................................................. 19.0505 19.4400 20.4728 19.6473

240125 ............................................................................................................. 13.1505 12.3627 14.9708 13.5694

240127 ............................................................................................................. 14.7670 15.8966 17.9724 16.1476

240128 ............................................................................................................. 16.0759 17.2513 16.3608 16.5520

240129 ............................................................................................................. 15.4226 14.4212 16.5209 15.4258

240130 ............................................................................................................. 15.6477 14.9399 16.4271 15.6650

240132 ............................................................................................................. 24.4998 23.0669 23.1452 23.5239

240133 ............................................................................................................. 18.5216 19.2126 19.5294 19.1081

240135 ............................................................................................................. 13.6014 14.3069 15.7015 14.4270

240137 ............................................................................................................. 19.1770 20.3750 21.5073 20.3195

240138 ............................................................................................................. 13.7359 15.2062 16.7332 15.1922

240139 ............................................................................................................. 17.0163 20.8053 20.5496 19.6213

240141 ............................................................................................................. 21.9909 23.8066 23.1009 22.9648

240142 ............................................................................................................. 20.6139 25.2770 29.2238 24.5024

240143 ............................................................................................................. 14.2790 16.6172 * 15.4691

240144 ............................................................................................................. 15.8710 18.2604 21.4469 18.2664

240145 ............................................................................................................. 14.9997 17.2778 19.0689 17.4197

240146 ............................................................................................................. 16.7496 16.0652 16.5412 16.4544

240148 ............................................................................................................. 11.3388 18.8779 19.5204 16.6060

240150 ............................................................................................................. 12.8255 13.8786 20.8331 15.4453

240152 ............................................................................................................. 20.2020 21.1678 22.4744 21.2973

240153 ............................................................................................................. 15.6079 16.5412 19.3336 17.0363

240154 ............................................................................................................. 17.0625 17.5769 21.5052 18.6158

240155 ............................................................................................................. 20.4189 19.8762 20.9385 20.4180

240157 ............................................................................................................. 14.6914 17.4168 15.2821 15.8915

240160 ............................................................................................................. 16.6034 15.9492 15.9014 16.1454

240161 ............................................................................................................. 15.4160 15.7996 16.8809 15.9681

240162 ............................................................................................................. 19.0404 16.6292 19.1542 18.1964

240163 ............................................................................................................. 17.8714 18.8320 20.4760 18.9698

240166 ............................................................................................................. 16.3907 17.3233 19.4131 17.7688

240169 ............................................................................................................. 18.6155 16.6725 16.3958 17.2174

240170 ............................................................................................................. 17.6501 18.8762 20.3779 18.9004

240171 ............................................................................................................. 16.7237 17.2886 18.5172 17.5402

240172 ............................................................................................................. 16.0711 18.2852 20.8606 18.2323

240173 ............................................................................................................. 16.7411 17.2655 18.5190 17.5028

240179 ............................................................................................................. 16.6464 17.5116 20.4007 18.1225

240184 ............................................................................................................. 14.3996 15.3793 16.8917 15.4746

240187 ............................................................................................................. 17.5154 19.9230 21.2736 19.5789

240193 ............................................................................................................. 16.3004 17.8226 18.4664 17.4827

240196 ............................................................................................................. 23.2666 24.3472 25.3479 24.3358

22778

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

240200 ............................................................................................................. 14.7295 14.3415 14.9076 14.6539

240207 ............................................................................................................. 23.3339 24.1127 25.2814 24.2879

240210 ............................................................................................................. 23.8391 24.2218 24.5664 24.2274

240211 ............................................................................................................. 20.5548 19.7399 30.6260 22.1746

250001 ............................................................................................................. 18.1407 18.4233 19.2756 18.6319

250002 ............................................................................................................. 15.6036 17.2501 18.6938 17.1218

250003 ............................................................................................................. 15.6560 17.6539 16.7570 16.6622

250004 ............................................................................................................. 17.1177 17.8868 18.3860 17.7913

250005 ............................................................................................................. 12.0032 12.5993 12.5834 12.3909

250006 ............................................................................................................. 15.7036 16.9048 17.5192 16.6995

250007 ............................................................................................................. 19.1555 19.2913 19.7562 19.3984

250008 ............................................................................................................. 13.3179 14.1760 15.8506 14.4224

250009 ............................................................................................................. 16.1847 18.5610 17.7283 17.5396

250010 ............................................................................................................. 13.3372 13.3905 14.6101 13.7324

250012 ............................................................................................................. 18.4756 14.1623 16.7579 16.4800

250015 ............................................................................................................. 11.0747 13.5274 11.7249 11.9737

250017 ............................................................................................................. 17.3006 17.9410 20.5976 18.5334

250018 ............................................................................................................. 13.4707 11.9311 13.1687 12.7895

250019 ............................................................................................................. 17.1501 16.7425 18.0956 17.3536

250020 ............................................................................................................. 14.0618 13.4476 16.2698 14.4562

250021 ............................................................................................................. 9.0772 9.4318 10.5844 9.6552

250023 ............................................................................................................. 13.5440 13.9116 12.3434 13.2963

250024 ............................................................................................................. 11.5940 12.7127 12.9899 12.4525

250025 ............................................................................................................. 17.8890 19.0390 20.3625 19.2022

250027 ............................................................................................................. 12.4241 14.9519 14.5445 13.9032

250029 ............................................................................................................. 14.8456 16.4834 16.0682 15.8412

250030 ............................................................................................................. 13.6277 17.3636 26.6173 19.2750

250031 ............................................................................................................. 18.7663 17.9715 18.3825 18.3676

250032 ............................................................................................................. 17.2983 17.1339 17.5957 17.3467

250033 ............................................................................................................. 15.7646 17.8257 15.0941 16.2509

250034 ............................................................................................................. 18.1269 16.6988 17.0399 17.2230

250035 ............................................................................................................. 17.4148 15.2353 16.8349 16.3942

250036 ............................................................................................................. 13.7928 15.8445 16.1913 15.3676

250037 ............................................................................................................. 10.3212 15.4325 12.7156 12.4979

250038 ............................................................................................................. 13.6207 16.8454 17.7019 16.0182

250039 ............................................................................................................. 16.5105 14.1556 15.1409 15.2552

250040 ............................................................................................................. 15.6367 17.3430 18.3364 17.1495

250042 ............................................................................................................. 16.4728 16.3867 17.6050 16.8239

250043 ............................................................................................................. 13.6492 16.0729 16.6500 15.4718

250044 ............................................................................................................. 16.7462 16.1218 16.7321 16.5323

250045 ............................................................................................................. 19.4788 22.0839 21.8988 21.2480

250047 ............................................................................................................. 12.0953 13.3706 14.7461 13.3242

250048 ............................................................................................................. 15.7073 16.8932 17.6649 16.7793

250049 ............................................................................................................. 10.7578 11.6715 12.1635 11.5642

250050 ............................................................................................................. 13.9220 14.3949 15.1159 14.4819

250051 ............................................................................................................. 9.6017 9.3464 10.4900 9.8032

250057 ............................................................................................................. 14.2863 15.9237 16.1838 15.4582

250058 ............................................................................................................. 15.4206 15.5327 15.7197 15.5555

250059 ............................................................................................................. 14.2997 16.2845 16.6494 15.7755

250060 ............................................................................................................. 7.9882 13.0301 16.1804 11.2768

250061 ............................................................................................................. 13.9655 11.0308 11.5108 11.9846

250063 ............................................................................................................. 14.9743 13.2540 13.3092 13.7869

250065 ............................................................................................................. 12.6803 12.8853 13.6904 13.0682

250066 ............................................................................................................. 14.3274 15.6760 16.1742 15.4025

250067 ............................................................................................................. 15.2871 16.4120 16.8522 16.2039

250068 ............................................................................................................. 11.4272 13.6768 13.4127 12.8087

250069 ............................................................................................................. 15.7653 17.8960 16.8980 16.8834

250071 ............................................................................................................. 11.2079 14.3781 12.3488 12.5425

250072 ............................................................................................................. 16.9263 18.2218 18.9487 18.0776

250076 ............................................................................................................. * 10.5098 * 10.5098

250077 ............................................................................................................. 11.4135 12.2564 13.7404 12.5026

250078 ............................................................................................................. 15.4571 15.6336 15.9627 15.6858

250079 ............................................................................................................. 19.0587 16.2712 16.5835 17.1998

22779

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

250081 ............................................................................................................. 16.1412 17.3325 19.0358 17.4600

250082 ............................................................................................................. 14.0249 16.0975 17.1427 15.7611

250083 ............................................................................................................. 9.2019 14.2634 16.6065 13.1746

250084 ............................................................................................................. 19.7390 17.0189 20.6429 19.0165

250085 ............................................................................................................. 13.8487 14.3797 15.4477 14.5716

250088 ............................................................................................................. 16.7514 17.8674 18.2736 17.6409

250089 ............................................................................................................. 13.0481 13.4238 14.3027 13.5884

250093 ............................................................................................................. 15.0918 15.2044 16.1506 15.4926

250094 ............................................................................................................. 17.8539 18.0852 18.5063 18.1422

250095 ............................................................................................................. 16.3574 17.0039 17.4217 16.9079

250096 ............................................................................................................. 17.0713 19.0688 19.0584 18.3546

250097 ............................................................................................................. 18.4099 16.9905 15.5741 16.9320

250098 ............................................................................................................. 14.3017 13.1341 * 13.6607

250099 ............................................................................................................. 14.4142 14.8528 15.1265 14.8018

250100 ............................................................................................................. 16.6033 17.1682 17.8688 17.2128

250101 ............................................................................................................. 16.3083 18.4685 17.7194 17.5079

250102 ............................................................................................................. 20.0190 23.9329 18.9348 20.8793

250104 ............................................................................................................. 17.5421 18.2502 18.7651 18.1832

250105 ............................................................................................................. 14.5986 14.5401 15.5133 14.8921

250107 ............................................................................................................. 13.6296 15.1496 15.0737 14.6455

250109 ............................................................................................................. 14.5496 22.1551 21.3867 18.8951

250112 ............................................................................................................. 14.2023 15.5610 16.3640 15.3179

250117 ............................................................................................................. 14.5171 16.1225 16.9787 15.9014

250119 ............................................................................................................. 12.7379 15.2199 16.1218 14.6728

250120 ............................................................................................................. 14.4126 15.3433 16.7182 15.4420

250122 ............................................................................................................. 17.7079 18.9417 19.2990 18.6619

250123 ............................................................................................................. 17.4068 18.8690 18.7863 18.3698

250124 ............................................................................................................. 12.6677 13.1823 13.2490 13.0310

250125 ............................................................................................................. 14.4867 20.8895 21.2660 18.4338

250126 ............................................................................................................. 14.7083 18.2355 21.9101 17.8900

250128 ............................................................................................................. 12.9968 14.0048 16.1418 14.4375

250131 ............................................................................................................. 10.2765 12.6056 12.4557 11.6657

250134 ............................................................................................................. 17.9755 17.0671 18.5142 17.8554

250136 ............................................................................................................. 18.0538 18.9689 21.3497 19.3579

250138 ............................................................................................................. 17.5999 18.4028 20.4550 18.6918

250141 ............................................................................................................. 17.1247 19.0113 19.6692 18.6505

250145 ............................................................................................................. 11.4047 10.2507 11.2120 10.9506

250146 ............................................................................................................. 13.2763 14.4924 14.7781 14.1955

250148 ............................................................................................................. 14.8234 18.0980 19.4233 17.4956

250149 ............................................................................................................. 12.9840 12.9569 15.2318 13.7102

250150 ............................................................................................................. * * 21.8599 21.8599

260001 ............................................................................................................. 17.5520 18.0971 19.7805 18.4701

260002 ............................................................................................................. 20.5878 22.1183 21.6400 21.4524

260003 ............................................................................................................. 14.3537 14.6553 15.4482 14.8108

260004 ............................................................................................................. 13.7528 13.0133 13.7035 13.4793

260005 ............................................................................................................. 19.7058 19.5554 23.9681 21.0036

260006 ............................................................................................................. 18.9408 19.7467 20.0994 19.6144

260008 ............................................................................................................. 16.2451 13.8495 16.8893 15.5719

260009 ............................................................................................................. 17.9364 18.5080 18.2863 18.2469

260011 ............................................................................................................. 18.3378 19.1027 19.5059 18.9819

260012 ............................................................................................................. 14.4594 14.3645 17.1662 15.3316

260013 ............................................................................................................. 15.5388 15.9884 16.1825 15.8932

260015 ............................................................................................................. 21.3327 16.5822 17.8817 18.4578

260017 ............................................................................................................. 15.8013 16.7916 14.7406 15.7355

260018 ............................................................................................................. 12.2293 12.0060 12.5301 12.2688

260019 ............................................................................................................. 23.6727 18.6113 * 20.6992

260020 ............................................................................................................. 21.8585 20.5142 20.2241 20.8205

260021 ............................................................................................................. 17.5694 22.1017 21.6237 20.1803

260022 ............................................................................................................. 19.3454 17.2462 17.7772 17.8898

260023 ............................................................................................................. 15.8235 16.4705 17.8649 16.6827

260024 ............................................................................................................. 13.4737 15.2356 15.7815 14.8371

260025 ............................................................................................................. 14.9377 15.4935 17.0965 15.8836

260027 ............................................................................................................. 21.0084 21.2977 21.3033 21.2013

22780

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

260029 ............................................................................................................. 17.4744 19.7484 21.1858 19.3784

260030 ............................................................................................................. 11.2434 12.5118 11.9215 11.8847

260031 ............................................................................................................. 18.3039 19.4921 19.6943 19.1343

260032 ............................................................................................................. 20.8097 20.1988 19.6728 20.2222

260034 ............................................................................................................. 17.8986 17.4233 20.4902 18.5746

260035 ............................................................................................................. 12.5886 13.1065 13.0071 12.9052

260036 ............................................................................................................. 18.3128 16.7430 18.8104 17.9282

260039 ............................................................................................................. 14.1980 14.1866 14.6644 14.3527

260040 ............................................................................................................. 15.3853 17.3099 18.0140 16.9033

260042 ............................................................................................................. 17.4459 18.7567 18.7514 18.2697

260044 ............................................................................................................. 17.1177 15.9927 15.9206 16.3491

260047 ............................................................................................................. 17.2768 19.0112 19.2247 18.5386

260048 ............................................................................................................. 21.4309 20.0885 21.0602 20.8622

260050 ............................................................................................................. 18.7366 15.6908 16.8520 17.0991

260052 ............................................................................................................. 17.7502 18.0553 18.0914 17.9657

260053 ............................................................................................................. 12.0098 15.2236 16.5166 14.4005

260054 ............................................................................................................. 17.3708 20.0199 19.9510 19.1024

260055 ............................................................................................................. 13.7961 12.0118 15.4214 13.6790

260057 ............................................................................................................. 15.3276 17.4636 19.7144 17.7259

260059 ............................................................................................................. 15.7887 16.1000 17.0546 16.3478

260061 ............................................................................................................. 15.0099 14.7175 15.7112 15.1405

260062 ............................................................................................................. 20.2655 20.1477 21.3138 20.5946

260063 ............................................................................................................. 16.8474 18.2309 18.6551 17.9110

260064 ............................................................................................................. 16.5033 16.5934 17.8033 16.9429

260065 ............................................................................................................. 18.4654 19.4382 20.0975 19.3238

260066 ............................................................................................................. 14.4163 14.9640 15.3460 14.8934

260067 ............................................................................................................. 12.1588 14.2249 15.1837 13.8617

260068 ............................................................................................................. 19.8261 20.2418 19.4240 19.8242

260070 ............................................................................................................. 21.6873 * 13.9510 17.3672

260073 ............................................................................................................. 13.0075 14.2550 15.9182 14.4333

260074 ............................................................................................................. 15.4480 19.0350 19.8915 18.1123

260077 ............................................................................................................. 18.2594 18.6473 19.4482 18.8035

260078 ............................................................................................................. 15.4754 15.6381 14.9463 15.3700

260079 ............................................................................................................. 14.8281 14.2985 16.1453 15.0169

260080 ............................................................................................................. 12.5631 13.5384 14.6832 13.5392

260081 ............................................................................................................. 18.9629 21.0151 20.3053 20.0653

260082 ............................................................................................................. 15.7880 15.9407 15.9858 15.9090

260085 ............................................................................................................. 19.5153 20.4669 20.5247 20.1531

260086 ............................................................................................................. 14.8730 14.3164 15.2927 14.8291

260091 ............................................................................................................. 19.6081 19.9987 21.4056 20.5321

260094 ............................................................................................................. 15.8705 18.0085 18.5395 17.5281

260095 ............................................................................................................. 19.7672 19.6944 20.3468 19.9375

260096 ............................................................................................................. 21.7176 23.0282 22.5972 22.4661

260097 ............................................................................................................. 15.7899 16.5582 19.0632 17.1704

260100 ............................................................................................................. 15.7324 15.7047 16.6523 16.0345

260102 ............................................................................................................. 16.3653 20.1264 20.6361 18.8983

260103 ............................................................................................................. 17.3541 18.5957 19.7146 18.4987

260104 ............................................................................................................. 19.1158 21.0138 20.3176 20.0928

260105 ............................................................................................................. 20.8006 24.7223 24.8181 23.3052

260107 ............................................................................................................. 18.4618 19.8422 19.6490 19.2823

260108 ............................................................................................................. 19.2422 19.4609 20.0034 19.5906

260109 ............................................................................................................. 13.4400 13.9129 14.8181 14.0725

260110 ............................................................................................................. 16.9952 17.8375 18.3227 17.7209

260113 ............................................................................................................. 14.8968 14.6756 16.2223 15.2316

260115 ............................................................................................................. 17.8971 19.2259 17.4698 18.2033

260116 ............................................................................................................. 14.5715 16.2774 14.9812 15.2548

260119 ............................................................................................................. 16.2000 16.8836 17.2942 16.7641

260120 ............................................................................................................. 17.1269 16.3755 16.4904 16.6414

260122 ............................................................................................................. 14.5390 14.9697 16.0931 15.2238

260123 ............................................................................................................. 13.9960 14.6444 14.6822 14.4496

260127 ............................................................................................................. 15.9481 18.3572 18.4026 17.5109

260128 ............................................................................................................. 11.2705 13.0481 12.6414 12.2813

260129 ............................................................................................................. 14.6353 * * 14.6353

22781

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

260131 ............................................................................................................. 19.7491 17.7686 18.4154 18.5978

260134 ............................................................................................................. 16.5834 16.2832 17.5127 16.7877

260137 ............................................................................................................. 15.2169 17.9531 19.4697 17.5188

260138 ............................................................................................................. 21.3885 22.6491 22.1044 22.0654

260141 ............................................................................................................. 17.9598 19.1580 19.1893 18.7555

260142 ............................................................................................................. 16.0299 17.1248 17.3084 16.7937

260143 ............................................................................................................. 11.9389 12.7867 13.9040 12.7859

260147 ............................................................................................................. 13.6568 14.0778 14.7769 14.1672

260148 ............................................................................................................. 10.3383 11.8674 11.3524 11.2072

260158 ............................................................................................................. 12.4020 12.3005 12.7699 12.4966

260159 ............................................................................................................. 18.2232 20.3177 19.7951 19.3893

260160 ............................................................................................................. 16.1922 15.8394 16.5792 16.2009

260162 ............................................................................................................. 20.7103 19.5655 21.4099 20.5728

260163 ............................................................................................................. 14.8051 16.4245 15.8593 15.6940

260164 ............................................................................................................. 14.3089 14.9372 15.1211 14.8191

260166 ............................................................................................................. 19.5343 20.1025 20.3449 20.0093

260172 ............................................................................................................. 12.4851 15.4163 16.0772 14.6285

260173 ............................................................................................................. 11.9777 12.8523 14.2090 13.1471

260175 ............................................................................................................. 16.2940 16.9023 17.5625 16.9246

260176 ............................................................................................................. 19.5449 26.8712 21.6044 22.7500

260177 ............................................................................................................. 20.7457 21.2578 21.9014 21.3180

260178 ............................................................................................................. 21.4080 19.6638 20.2796 20.4480

260179 ............................................................................................................. 20.7397 21.4906 22.7185 21.6624

260180 ............................................................................................................. 18.5398 19.5819 18.9881 19.0361

260183 ............................................................................................................. 20.1940 20.0712 21.3175 20.5306

260186 ............................................................................................................. 18.0588 19.3238 19.6026 19.0698

260188 ............................................................................................................. 18.5772 20.6388 21.6920 20.2650

260189 ............................................................................................................. 10.7518 11.3004 16.4233 12.7425

260190 ............................................................................................................. 18.1639 18.5168 19.4910 18.7481

260191 ............................................................................................................. 19.3386 17.9812 18.1604 18.4767

260193 ............................................................................................................. 20.5055 21.1588 20.2577 20.6284

260195 ............................................................................................................. 15.9518 17.7237 19.7068 17.8042

260197 ............................................................................................................. 16.4605 19.2840 20.5453 18.3884

260198 ............................................................................................................. 17.6381 11.9751 19.7552 15.6949

260200 ............................................................................................................. 18.8755 20.5339 20.6888 20.0233

260205 ............................................................................................................. * 17.6210 * 17.6210

270002 ............................................................................................................. 17.1866 28.9959 19.2387 20.5385

270003 ............................................................................................................. 22.1299 22.0995 22.5019 22.2424

270004 ............................................................................................................. 21.3442 19.6292 19.4834 20.1660

270006 ............................................................................................................. 16.1872 16.0238 17.0715 16.3653

270007 ............................................................................................................. 13.1679 11.3143 13.8824 12.6774

270009 ............................................................................................................. 17.7016 17.2292 20.4393 18.3783

270011 ............................................................................................................. 19.8229 20.2669 21.1653 20.3748

270012 ............................................................................................................. 22.8770 19.7346 19.7878 20.8557

270013 ............................................................................................................. 20.4012 * * 20.4012

270014 ............................................................................................................. 18.5595 19.0872 19.9219 19.1986

270016 ............................................................................................................. 19.7675 19.6717 18.6149 19.4350

270017 ............................................................................................................. 19.5798 21.0800 20.0152 20.2382

270019 ............................................................................................................. 12.7812 18.1099 15.4128 15.4635

270021 ............................................................................................................. 16.6541 17.1787 16.9457 16.9258

270023 ............................................................................................................. 20.3641 22.2639 22.7181 21.7139

270026 ............................................................................................................. 15.6381 17.5102 18.0568 17.0775

270027 ............................................................................................................. 9.7758 13.1392 17.2091 12.8885

270028 ............................................................................................................. 17.2132 21.1492 19.1177 19.1160

270029 ............................................................................................................. 17.8852 16.5666 17.3710 17.2639

270032 ............................................................................................................. 17.0285 17.7393 16.0946 16.9320

270033 ............................................................................................................. 16.4554 16.9602 15.3447 16.2871

270035 ............................................................................................................. 17.6482 16.8295 16.4302 16.9974

270036 ............................................................................................................. 14.0815 14.2537 16.8552 14.8821

270039 ............................................................................................................. 15.3501 15.9368 19.6796 16.7774

270040 ............................................................................................................. 19.1901 18.8145 20.1242 19.3585

270041 ............................................................................................................. 16.7791 19.0327 25.8153 19.7981

270044 ............................................................................................................. 13.4559 16.7710 17.6489 15.9061

22782

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

270046 ............................................................................................................. 17.1048 * * 17.1048

270048 ............................................................................................................. 15.8403 17.0154 18.0666 16.8972

270049 ............................................................................................................. 21.1670 22.2444 22.9547 22.1282

270050 ............................................................................................................. 18.0448 16.7110 19.9356 18.1546

270051 ............................................................................................................. 18.9468 20.2735 20.1950 19.8100

270052 ............................................................................................................. 14.8042 14.4773 11.6737 13.7344

270057 ............................................................................................................. 20.0080 21.1317 20.6714 20.6119

270058 ............................................................................................................. 14.0669 14.7481 16.1412 14.9510

270059 ............................................................................................................. 15.5957 14.7530 19.1808 16.3576

270060 ............................................................................................................. 14.0212 15.2727 20.4148 16.5316

270063 ............................................................................................................. 14.2287 12.6108 15.1049 13.8837

270073 ............................................................................................................. 15.5281 14.4569 16.1937 15.3359

270079 ............................................................................................................. 15.0277 15.6873 16.7048 15.7603

270080 ............................................................................................................. 14.0437 16.3171 15.0705 15.0926

270081 ............................................................................................................. 15.5207 15.6262 16.7389 15.9424

270082 ............................................................................................................. 16.1280 17.3443 23.1245 18.7794

270083 ............................................................................................................. 20.8231 18.4432 17.8554 18.9597

270084 ............................................................................................................. 16.2075 16.6243 16.2958 16.3734

280001 ............................................................................................................. 17.8928 17.3541 18.1831 17.7825

280003 ............................................................................................................. 21.9957 22.3179 23.0213 22.4564

280005 ............................................................................................................. 18.7477 19.2405 23.6949 20.6104

280009 ............................................................................................................. 18.7541 19.8145 20.9643 19.8453

280010 ............................................................................................................. 16.5417 17.4859 20.0462 17.5272

280011 ............................................................................................................. 13.9627 15.8573 15.9614 15.3328

280012 ............................................................................................................. 16.4079 * * 16.4079

280013 ............................................................................................................. 22.1767 22.8063 22.3488 22.4214

280014 ............................................................................................................. 15.2414 15.9596 16.8368 15.9667

280015 ............................................................................................................. 14.6353 17.0281 16.6939 16.1405

280017 ............................................................................................................. 14.1897 14.2059 13.9939 14.1278

280018 ............................................................................................................. 14.8492 15.1328 15.4496 15.1512

280020 ............................................................................................................. 19.3963 19.9667 21.0924 20.2072

280021 ............................................................................................................. 16.6949 17.1048 17.6345 17.1389

280022 ............................................................................................................. 15.7059 16.7179 16.8184 16.3693

280023 ............................................................................................................. 21.2387 25.8494 22.3433 23.0540

280024 ............................................................................................................. 13.9115 14.2186 15.3050 14.4398

280025 ............................................................................................................. 14.2701 15.5850 21.4764 16.6875

280026 ............................................................................................................. 16.0599 16.6861 16.5851 16.4520

280028 ............................................................................................................. 15.8871 17.3176 18.0793 17.1201

280029 ............................................................................................................. 19.0519 23.1292 24.4359 21.9196

280030 ............................................................................................................. 28.7091 24.5366 24.1113 25.6720

280031 ............................................................................................................. 13.2242 13.5654 9.6321 12.1542

280032 ............................................................................................................. 19.3884 18.8964 19.1191 19.1301

280033 ............................................................................................................. 14.9334 15.7583 17.4745 16.1329

280034 ............................................................................................................. 15.2821 * * 15.2821

280035 ............................................................................................................. 15.3304 15.9170 16.6872 15.8969

280037 ............................................................................................................. 16.1684 16.7952 17.1064 16.6926

280038 ............................................................................................................. 16.4685 17.0878 18.2503 17.2635

280039 ............................................................................................................. 15.1916 16.0442 16.1587 15.8239

280040 ............................................................................................................. 18.9717 19.5333 20.7630 19.8033

280041 ............................................................................................................. 13.3901 16.4083 16.5503 15.4920

280042 ............................................................................................................. 15.3029 16.1191 16.6239 16.0122

280043 ............................................................................................................. 15.7858 16.6570 17.5937 16.7160

280045 ............................................................................................................. 14.2741 16.9048 15.7630 15.6286

280046 ............................................................................................................. 13.7155 17.9221 17.3214 16.1724

280047 ............................................................................................................. 18.3743 18.3407 16.6409 17.7457

280048 ............................................................................................................. 14.0702 15.8723 15.8100 15.1939

280049 ............................................................................................................. 15.6343 18.3605 18.4365 17.4677

280050 ............................................................................................................. 15.3413 16.6432 19.9901 17.5838

280051 ............................................................................................................. 15.8504 15.6336 17.1942 16.1502

280052 ............................................................................................................. 13.6489 14.0819 14.1201 13.9629

280054 ............................................................................................................. 17.5819 18.7992 18.7575 18.3765

280055 ............................................................................................................. 12.9933 13.5667 13.8129 13.4587

280056 ............................................................................................................. 14.0151 12.6475 15.6135 14.0018

22783

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

280057 ............................................................................................................. 15.7623 18.0454 20.0686 17.7576

280058 ............................................................................................................. 17.8798 19.6752 21.4868 19.6876

280060 ............................................................................................................. 28.6047 19.7527 20.7022 22.2434

280061 ............................................................................................................. 17.9511 17.1629 18.6370 17.9240

280062 ............................................................................................................. 13.6738 14.4896 15.6018 14.6170

280064 ............................................................................................................. 15.5092 16.2977 16.8330 16.2046

280065 ............................................................................................................. 18.5327 19.2932 20.6502 19.5213

280066 ............................................................................................................. 11.6416 11.6621 11.7207 11.6766

280068 ............................................................................................................. 10.1327 9.4943 10.5987 10.0463

280070 ............................................................................................................. 13.7353 17.7400 22.6201 17.5276

280073 ............................................................................................................. 17.0583 17.4244 17.7698 17.4266

280074 ............................................................................................................. 15.2182 16.4310 16.7879 16.0977

280075 ............................................................................................................. 13.7875 15.5327 13.2230 14.1041

280076 ............................................................................................................. 13.9203 14.8469 16.7488 15.0947

280077 ............................................................................................................. 19.0145 19.2068 20.0148 19.4096

280079 ............................................................................................................. 9.9132 10.4540 16.6117 11.4307

280080 ............................................................................................................. 14.3528 15.3308 16.9487 15.6285

280081 ............................................................................................................. 20.9196 21.0771 20.1127 20.6778

280082 ............................................................................................................. 13.1250 14.3399 14.6173 14.0723

280083 ............................................................................................................. 17.5544 18.2992 21.5336 19.2134

280084 ............................................................................................................. 11.6868 12.5836 13.6536 12.6157

280085 ............................................................................................................. 21.5793 20.4302 20.4825 20.9817

280088 ............................................................................................................. 22.1147 20.2961 * 21.2560

280089 ............................................................................................................. 17.4696 18.1668 18.9567 18.1923

280090 ............................................................................................................. 14.7191 14.1362 15.1274 14.6962

280091 ............................................................................................................. 15.2184 15.8436 16.1866 15.7538

280092 ............................................................................................................. 14.1998 14.1945 14.7912 14.4303

280094 ............................................................................................................. 15.8843 17.6873 16.3474 16.6450

280097 ............................................................................................................. 14.2990 14.1734 13.8223 14.0824

280098 ............................................................................................................. 10.1686 13.0029 12.5875 12.0141

280101 ............................................................................................................. 17.4168 13.5261 16.9973 15.7528

280102 ............................................................................................................. 12.9367 14.0102 * 13.4735

280104 ............................................................................................................. 13.3842 13.2819 16.1207 14.1161

280105 ............................................................................................................. 18.7851 18.6575 21.0735 19.5325

280106 ............................................................................................................. 15.5396 16.1247 16.0679 15.9189

280107 ............................................................................................................. 13.4553 13.3311 14.4679 13.7065

280108 ............................................................................................................. 17.2185 17.5625 17.1961 17.3277

280109 ............................................................................................................. 11.0622 12.6803 12.4408 12.0678

280110 ............................................................................................................. 12.2950 12.7546 14.2136 13.0914

280111 ............................................................................................................. 23.0856 21.8773 19.6283 21.4131

280114 ............................................................................................................. 13.5580 15.7160 17.3076 15.4628

280115 ............................................................................................................. 16.4282 16.7041 18.1480 17.1049

280117 ............................................................................................................. 16.8216 17.7276 18.8279 17.8057

280118 ............................................................................................................. 16.9228 16.8687 18.6524 17.4822

280123 ............................................................................................................. 20.7732 14.0637 11.8582 15.0281

280125 ............................................................................................................. * 16.1332 16.3944 16.2644

290001 ............................................................................................................. 22.4188 22.8226 22.4085 22.5500

290002 ............................................................................................................. 20.9442 17.2554 16.5419 18.3712

290003 ............................................................................................................. 25.0066 22.8840 23.7504 23.8240

290005 ............................................................................................................. 17.8609 19.4888 21.9814 19.6686

290006 ............................................................................................................. 19.8815 21.8070 22.4063 21.4371

290007 ............................................................................................................. 29.6864 29.7706 30.9075 30.1389

290008 ............................................................................................................. 20.2506 20.6190 24.1255 21.5150

290009 ............................................................................................................. 22.7399 23.3620 23.8871 23.3177

290010 ............................................................................................................. 14.4800 15.6423 16.4476 15.5219

290011 ............................................................................................................. 16.4419 20.1564 21.1234 19.0261

290012 ............................................................................................................. 21.5139 21.8275 25.0430 22.8581

290013 ............................................................................................................. 17.0883 18.2713 15.7932 17.0224

290014 ............................................................................................................. 18.3755 18.9743 18.7829 18.7144

290015 ............................................................................................................. 17.8303 22.3487 19.4504 19.7229

290016 ............................................................................................................. 12.7869 14.3542 23.8656 16.2244

290019 ............................................................................................................. 20.9336 21.2509 22.2045 21.4895

290020 ............................................................................................................. 26.1502 20.8733 21.2380 22.7207

22784

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

290021 ............................................................................................................. 21.1250 21.5806 22.8732 21.8512

290022 ............................................................................................................. 24.0856 24.5468 25.4709 24.7290

290027 ............................................................................................................. 16.4289 16.7786 13.4076 15.4211

290032 ............................................................................................................. 22.7882 22.8447 23.4661 23.0210

290036 ............................................................................................................. 18.6112 * 12.9074 15.9259

290038 ............................................................................................................. 23.1402 20.6753 27.7030 22.6435

290039 ............................................................................................................. 25.8004 25.3864 24.6317 25.1994

290041 ............................................................................................................. * * 26.1003 26.1003

290042 ............................................................................................................. * * 18.7527 18.7527

290043 ............................................................................................................. * * 27.9053 27.9053

300001 ............................................................................................................. 21.4192 22.0909 23.8567 22.4761

300003 ............................................................................................................. 23.3777 22.9111 24.1297 23.4634

300005 ............................................................................................................. 19.9876 20.7545 22.2858 20.9804

300006 ............................................................................................................. 18.9331 23.7793 18.9745 20.5179

300007 ............................................................................................................. 19.3447 20.2372 20.2433 19.9403

300008 ............................................................................................................. 16.4649 20.7702 19.6149 18.9666

300009 ............................................................................................................. 20.0057 18.0602 20.0938 19.3221

300010 ............................................................................................................. 19.3833 19.3940 20.2130 19.6671

300011 ............................................................................................................. 21.2429 22.4325 23.0279 22.1850

300012 ............................................................................................................. 23.8859 24.5673 24.5672 24.3274

300013 ............................................................................................................. 18.9664 19.1247 20.1669 19.4250

300014 ............................................................................................................. 19.7969 20.3292 20.1774 20.0987

300015 ............................................................................................................. 19.9308 20.4916 19.6627 20.0406

300016 ............................................................................................................. 18.5037 21.8659 17.8148 19.4173

300017 ............................................................................................................. 22.3408 21.6563 22.7231 22.2428

300018 ............................................................................................................. 20.8947 21.2381 21.6385 21.2565

300019 ............................................................................................................. 20.6090 20.9753 19.6728 20.4155

300020 ............................................................................................................. 21.9725 21.9165 22.6627 22.2032

300021 ............................................................................................................. 17.3477 18.6211 19.3101 18.4253

300022 ............................................................................................................. 17.1864 18.3507 19.1875 18.2148

300023 ............................................................................................................. 20.3909 22.1210 22.1608 21.5715

300024 ............................................................................................................. 17.9460 19.9116 21.5842 19.6334

300028 ............................................................................................................. 18.0515 17.4075 19.9359 18.5255

300029 ............................................................................................................. 20.8961 22.5748 22.5952 22.0043

300033 ............................................................................................................. 19.8506 17.1869 17.1632 17.9333

300034 ............................................................................................................. 23.5215 25.5182 24.3286 24.4526

310001 ............................................................................................................. 27.5967 28.1329 25.3674 26.9474

310002 ............................................................................................................. 27.8735 28.3434 28.9800 28.3940

310003 ............................................................................................................. 27.4152 29.1096 27.2582 27.9096

310005 ............................................................................................................. 23.0493 22.1146 21.7223 22.2720

310006 ............................................................................................................. 21.5557 21.5957 22.0894 21.7417

310008 ............................................................................................................. 24.9483 23.5084 23.6523 24.0400

310009 ............................................................................................................. 23.1906 23.6371 21.1082 22.6736

310010 ............................................................................................................. 21.1064 22.5682 21.7892 21.7942

310011 ............................................................................................................. 23.4038 23.1977 24.2885 23.6223

310012 ............................................................................................................. 26.3249 26.5242 26.5603 26.4724

310013 ............................................................................................................. 22.1062 21.2251 22.0056 21.7900

310014 ............................................................................................................. 28.6964 27.4614 23.1544 26.3494

310015 ............................................................................................................. 26.7584 27.4331 27.5468 27.2399

310016 ............................................................................................................. 26.0518 24.3838 23.8492 24.7461

310017 ............................................................................................................. 26.0703 25.7902 24.5976 25.5018

310018 ............................................................................................................. 24.5312 22.8428 22.4779 23.3087

310019 ............................................................................................................. 23.0888 24.0542 24.9914 24.0619

310020 ............................................................................................................. 19.2663 24.1848 24.4152 22.3484

310021 ............................................................................................................. 22.6456 23.9369 24.5562 23.6719

310022 ............................................................................................................. 20.7276 21.2706 20.8258 20.9386

310024 ............................................................................................................. 22.7831 24.2353 24.9521 23.9428

310025 ............................................................................................................. 22.8129 24.3513 24.1812 23.7695

310026 ............................................................................................................. 23.8726 23.5491 22.1997 23.2228

310027 ............................................................................................................. 21.7666 21.8846 22.5696 22.0722

310028 ............................................................................................................. 23.5188 23.4577 23.9428 23.6444

310029 ............................................................................................................. 23.3801 22.6629 23.5968 23.2088

310031 ............................................................................................................. 25.1780 26.1567 26.8214 26.0435

22785

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

310032 ............................................................................................................. 23.3017 24.3528 24.4098 24.0274

310034 ............................................................................................................. 21.6851 23.2729 23.9672 22.9482

310036 ............................................................................................................. 19.8178 20.1905 24.0906 21.3182

310037 ............................................................................................................. 27.4447 27.7823 29.3440 28.1550

310038 ............................................................................................................. 25.3832 26.7209 30.4319 27.5814

310039 ............................................................................................................. 22.0259 22.1754 22.7317 22.2988

310040 ............................................................................................................. 23.9864 26.1492 24.5150 24.8208

310041 ............................................................................................................. 23.7829 24.8960 23.5559 24.0709

310042 ............................................................................................................. 24.3292 23.2472 * 23.7901

310043 ............................................................................................................. 22.0887 21.9022 21.6128 21.8925

310044 ............................................................................................................. 20.4309 21.6677 23.1076 21.6842

310045 ............................................................................................................. 28.1570 28.4854 28.2393 28.2925

310047 ............................................................................................................. 24.5225 25.1101 26.1921 25.2615

310048 ............................................................................................................. 23.3295 23.6118 25.2088 24.0558

310049 ............................................................................................................. 24.7617 24.8299 26.1668 25.1997

310050 ............................................................................................................. 22.5877 25.1752 24.7988 24.2032

310051 ............................................................................................................. 25.2762 27.1265 26.9716 26.4268

310052 ............................................................................................................. 22.5753 22.9326 23.0520 22.8616

310054 ............................................................................................................. 24.7413 26.1726 27.2074 25.9539

310057 ............................................................................................................. 20.4484 21.1686 22.2572 21.2802

310058 ............................................................................................................. 26.2243 26.5308 26.3765 26.3747

310060 ............................................................................................................. 19.1119 19.1992 20.3713 19.5633

310061 ............................................................................................................. 20.8023 23.2646 33.9582 25.0082

310062 ............................................................................................................. 19.2729 22.9073 * 21.3672

310063 ............................................................................................................. 21.8540 21.9045 21.9181 21.8914

310064 ............................................................................................................. 24.2115 24.8567 25.1096 24.7198

310067 ............................................................................................................. 22.2740 25.0888 23.9278 23.7333

310069 ............................................................................................................. 24.1662 23.7531 24.2916 24.0734

310070 ............................................................................................................. 25.0448 26.0903 28.4556 26.4357

310072 ............................................................................................................. 22.2231 21.7605 22.5611 22.1704

310073 ............................................................................................................. 25.6299 28.5149 26.6390 26.9057

310074 ............................................................................................................. 24.4638 23.8340 23.6327 23.9943

310075 ............................................................................................................. 26.4606 23.3266 23.5841 24.4497

310076 ............................................................................................................. 28.8981 30.0797 33.7139 30.9519

310077 ............................................................................................................. 25.0569 25.2500 26.0801 25.4318

310078 ............................................................................................................. 23.4788 23.8841 24.0587 23.7967

310081 ............................................................................................................. 23.8898 22.0762 22.4086 22.8084

310083 ............................................................................................................. 23.6761 23.8852 24.8204 24.1353

310084 ............................................................................................................. 24.0915 26.6753 24.6049 25.1157

310086 ............................................................................................................. 21.4350 22.1674 22.7566 22.1186

310087 ............................................................................................................. 20.8875 20.7243 21.1297 20.9153

310088 ............................................................................................................. 22.3419 22.3160 23.1722 22.6064

310090 ............................................................................................................. 24.2426 23.8284 24.7947 24.2732

310091 ............................................................................................................. 22.0103 22.7978 23.2969 22.6743

310092 ............................................................................................................. 22.3446 20.5165 20.1062 20.9829

310093 ............................................................................................................. 21.2302 22.4291 23.7251 22.4166

310096 ............................................................................................................. 26.3041 25.1572 24.5759 25.3591

310105 ............................................................................................................. 24.4851 25.5891 26.9400 25.6544

310108 ............................................................................................................. 22.8801 22.4756 25.2476 23.5055

310110 ............................................................................................................. 20.1400 21.8341 23.2594 21.7903

310111 ............................................................................................................. 21.7218 21.1066 22.1022 21.6426

310112 ............................................................................................................. 22.5213 23.6701 24.7914 23.6656

310113 ............................................................................................................. 22.9536 23.6841 23.1961 23.2803

310115 ............................................................................................................. 20.0667 21.7320 21.3837 21.0468

310116 ............................................................................................................. 25.2429 22.9812 23.4566 23.8506

310118 ............................................................................................................. 24.5443 26.4625 26.5492 25.7555

310119 ............................................................................................................. 29.4809 33.6686 32.7858 31.9394

310120 ............................................................................................................. 21.6852 23.9681 23.3200 22.9127

310121 ............................................................................................................. 18.7365 * * 18.7365

320001 ............................................................................................................. 17.8522 19.1150 20.6225 19.1818

320002 ............................................................................................................. 22.4623 22.6175 23.0983 22.7062

320003 ............................................................................................................. 15.3484 15.9504 13.9079 15.0840

320004 ............................................................................................................. 17.2353 18.5824 19.6642 18.5890

22786

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

320005 ............................................................................................................. 19.8698 21.6103 21.0411 20.8577

320006 ............................................................................................................. 18.6472 18.9019 20.3863 19.2674

320009 ............................................................................................................. 17.6400 18.2883 19.3500 18.4218

320011 ............................................................................................................. 16.5481 20.0601 18.4503 18.4082

320012 ............................................................................................................. 15.9972 16.4355 16.7110 16.3828

320013 ............................................................................................................. 23.8390 22.9573 27.8924 25.0936

320014 ............................................................................................................. 15.9666 16.3598 16.8412 16.4003

320016 ............................................................................................................. 18.9296 20.5398 18.7247 19.3888

320017 ............................................................................................................. 18.1545 18.6388 19.4498 18.7392

320018 ............................................................................................................. 18.1944 18.8479 19.2336 18.7690

320019 ............................................................................................................. 19.2600 24.4707 26.9637 23.5577

320021 ............................................................................................................. 17.1647 17.8705 18.6167 17.8360

320022 ............................................................................................................. 15.8391 16.1777 17.1375 16.3840

320023 ............................................................................................................. 16.4170 18.0548 22.5706 18.5691

320030 ............................................................................................................. 16.5266 16.5495 18.6943 17.2018

320031 ............................................................................................................. 13.9914 19.6768 25.1715 19.2605

320032 ............................................................................................................. 18.7536 18.8097 21.1505 19.5091

320033 ............................................................................................................. 20.3137 25.0777 21.0621 21.9427

320035 ............................................................................................................. 25.7392 21.5186 15.0612 19.2882

320037 ............................................................................................................. 17.0846 17.0305 19.8700 17.9947

320038 ............................................................................................................. 16.2896 16.8117 22.2664 18.6619

320046 ............................................................................................................. 19.0033 18.3190 25.1691 21.0078

320048 ............................................................................................................. 19.1705 19.9642 16.8769 18.5918

320063 ............................................................................................................. 19.8320 18.3237 17.3297 18.4052

320065 ............................................................................................................. 16.1046 16.7933 18.6525 17.1721

320067 ............................................................................................................. 57.4818 33.8654 15.3228 25.9798

320068 ............................................................................................................. 18.1809 17.4785 18.4868 18.1081

320069 ............................................................................................................. 11.3058 13.0094 14.4212 12.8497

320074 ............................................................................................................. 18.6545 19.3406 20.2290 19.3600

320079 ............................................................................................................. 17.0696 18.2828 19.5946 18.2729

330001 ............................................................................................................. 25.2067 26.5533 27.3996 26.4208

330002 ............................................................................................................. 26.3926 26.5370 26.9827 26.6287

330003 ............................................................................................................. 18.0549 19.4102 18.8260 18.7489

330004 ............................................................................................................. 19.9573 22.5298 20.9501 21.1368

330005 ............................................................................................................. 24.2795 24.8338 20.9401 22.5763

330006 ............................................................................................................. 25.9186 25.0576 25.8006 25.5856

330007 ............................................................................................................. 18.7956 18.9024 19.3974 18.8931

330008 ............................................................................................................. 18.0684 19.0045 18.5531 18.5296

330009 ............................................................................................................. 30.4220 30.6918 31.3435 30.8056

330010 ............................................................................................................. 14.7382 17.4512 16.5924 16.1266

330011 ............................................................................................................. 18.0419 18.2986 18.6748 18.3483

330012 ............................................................................................................. 31.5135 32.7624 * 32.1317

330013 ............................................................................................................. 19.9929 19.0856 19.7303 19.6038

330014 ............................................................................................................. 27.5704 32.3370 36.6670 32.2107

330016 ............................................................................................................. 17.4069 16.9717 16.8016 17.0572

330019 ............................................................................................................. 32.4515 35.9822 32.8743 33.7601

330020 ............................................................................................................. 14.5488 15.5527 15.1142 15.0641

330023 ............................................................................................................. 24.2708 24.4006 25.6145 24.7662

330024 ............................................................................................................. 33.6175 34.1682 37.3316 34.9189

330025 ............................................................................................................. 16.0290 16.2033 16.8687 16.3599

330027 ............................................................................................................. 32.4959 33.4738 35.5255 33.7629

330028 ............................................................................................................. 27.0752 28.2089 29.5294 28.2349

330029 ............................................................................................................. 16.5552 18.1567 17.0016 17.2536

330030 ............................................................................................................. 15.0551 17.4977 19.1085 16.8779

330033 ............................................................................................................. 16.7497 18.5353 17.0721 17.4766

330034 ............................................................................................................. 30.7840 31.3997 27.7738 30.5701

330036 ............................................................................................................. 24.3239 23.9874 25.2820 24.5370

330037 ............................................................................................................. 16.0026 16.1140 16.4866 16.2081

330038 ............................................................................................................. 16.0153 16.2549 17.3429 16.5336

330039 ............................................................................................................. 12.4666 * * 12.4666

330041 ............................................................................................................. 30.4192 24.5215 31.4871 28.4761

330043 ............................................................................................................. 27.6286 28.7467 27.4661 27.9537

330044 ............................................................................................................. 18.6969 20.0238 19.5219 19.4106

22787

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

330045 ............................................................................................................. 27.1759 28.0758 27.9919 27.7401

330046 ............................................................................................................. 31.9802 32.4189 35.2703 33.1562

330047 ............................................................................................................. 17.6895 18.1815 18.5536 18.1416

330048 ............................................................................................................. 17.6239 17.8787 19.1093 18.1878

330049 ............................................................................................................. 19.3136 19.4993 20.5731 19.7930

330053 ............................................................................................................. 15.6659 17.4430 17.8082 16.9823

330055 ............................................................................................................. 30.7330 36.1109 28.8026 31.5674

330056 ............................................................................................................. 30.2206 30.4525 30.0945 30.2540

330057 ............................................................................................................. 18.6891 18.7478 19.0732 18.8421

330058 ............................................................................................................. 16.9805 17.0014 17.7672 17.2379

330059 ............................................................................................................. 32.2285 34.1705 34.2426 33.4744

330061 ............................................................................................................. 25.0674 25.7331 25.4082 25.4024

330062 ............................................................................................................. 15.2819 17.6067 18.1318 16.9856

330064 ............................................................................................................. 32.8724 33.1269 33.6447 33.2084

330065 ............................................................................................................. 18.3686 19.8940 19.9327 19.3474

330066 ............................................................................................................. 19.9455 19.5611 19.9424 19.8214

330067 ............................................................................................................. 21.2872 20.9443 22.1065 21.4528

330072 ............................................................................................................. 29.3096 30.8019 30.4171 30.1659

330073 ............................................................................................................. 15.8849 16.2898 16.4518 16.2013

330074 ............................................................................................................. 18.1636 18.0005 17.7308 17.9678

330075 ............................................................................................................. 17.4266 17.2298 17.6385 17.4324

330078 ............................................................................................................. 17.4863 16.7949 19.0779 17.7511

330079 ............................................................................................................. 16.7608 17.4555 18.7622 17.6535

330080 ............................................................................................................. 26.8766 29.2686 21.2449 25.8366

330084 ............................................................................................................. 23.0327 18.0435 19.2211 19.8357

330085 ............................................................................................................. 18.7835 20.2926 20.4054 19.8243

330086 ............................................................................................................. 30.6954 31.2980 23.6496 28.6407

330088 ............................................................................................................. 25.6160 25.6626 25.7940 25.6905

330090 ............................................................................................................. 18.6833 19.3954 19.4896 19.1855

330091 ............................................................................................................. 18.5334 19.0953 19.7776 19.1249

330092 ............................................................................................................. 12.6540 14.0671 13.3723 13.3059

330094 ............................................................................................................. 17.7196 17.5585 17.8413 17.7095

330095 ............................................................................................................. 18.5502 20.1073 21.1096 19.8197

330096 ............................................................................................................. 16.5963 17.9641 18.5149 17.6975

330097 ............................................................................................................. 16.9626 16.2169 16.4433 16.5145

330100 ............................................................................................................. 28.1060 27.0661 29.0916 28.0415

330101 ............................................................................................................. 31.3075 32.4105 30.3486 31.0539

330102 ............................................................................................................. 17.5230 17.5755 19.0058 18.0012

330103 ............................................................................................................. 16.5212 15.7197 16.8110 16.3435

330104 ............................................................................................................. 28.7669 31.6471 31.2074 30.5068

330106 ............................................................................................................. 35.8740 40.2686 35.0511 36.9438

330107 ............................................................................................................. 28.0780 28.5580 27.7797 28.1411

330108 ............................................................................................................. 17.0846 17.3605 17.7326 17.3908

330111 ............................................................................................................. 15.2047 19.5314 15.9321 16.7001

330114 ............................................................................................................. 18.2390 17.3522 17.0581 17.5626

330115 ............................................................................................................. 16.5581 17.4430 17.1354 17.0407

330116 ............................................................................................................. 24.2266 24.4622 14.9610 20.6732

330118 ............................................................................................................. 20.7550 20.6936 21.8568 21.0906

330119 ............................................................................................................. 34.7478 34.8385 33.3533 34.3131

330121 ............................................................................................................. 15.8468 16.1052 16.3385 16.0964

330122 ............................................................................................................. 21.2021 20.8204 20.2417 20.7389

330125 ............................................................................................................. 19.7456 19.8494 18.7943 19.4752

330126 ............................................................................................................. 22.6990 23.7938 23.8190 23.4522

330127 ............................................................................................................. 29.3317 31.9046 29.0166 30.1127

330128 ............................................................................................................. 27.8693 29.0222 26.1374 27.7856

330132 ............................................................................................................. 14.7006 15.7633 14.3673 14.9673

330133 ............................................................................................................. 32.3812 37.2494 35.3576 34.8196

330135 ............................................................................................................. 18.3346 18.7120 22.2670 19.6717

330136 ............................................................................................................. 17.6041 18.2422 18.7546 18.1908

330140 ............................................................................................................. 19.5016 19.1438 18.5579 19.0661

330141 ............................................................................................................. 25.1371 26.4956 26.7096 26.0966

330144 ............................................................................................................. 15.5068 14.0566 14.5344 14.7317

330148 ............................................................................................................. 15.0400 16.8151 16.2552 16.0122

22788

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

330151 ............................................................................................................. 13.9700 16.0714 15.8490 15.2603

330152 ............................................................................................................. 29.4818 30.5409 31.2106 30.3169

330153 ............................................................................................................. 17.4996 18.9689 17.7451 18.0540

330157 ............................................................................................................. 20.8239 22.0792 22.3804 21.7687

330158 ............................................................................................................. 26.0476 25.7569 27.1228 26.3184

330159 ............................................................................................................. 18.0211 19.1536 19.6027 18.8964

330160 ............................................................................................................. 30.5678 32.7840 28.8043 30.6325

330162 ............................................................................................................. 27.7162 27.1166 27.6010 27.4784

330163 ............................................................................................................. 20.4555 18.7816 20.7456 19.9795

330164 ............................................................................................................. 19.4831 19.8647 20.8018 20.0537

330166 ............................................................................................................. 14.1815 15.0954 15.4420 14.8722

330167 ............................................................................................................. 31.1834 29.3634 30.2346 30.2561

330169 ............................................................................................................. 33.4462 37.2655 35.4794 35.3665

330171 ............................................................................................................. 25.4314 25.5307 24.8035 25.2597

330175 ............................................................................................................. 16.6851 17.3290 18.3116 17.4443

330177 ............................................................................................................. 14.5378 17.2907 16.3704 16.0830

330179 ............................................................................................................. 12.6857 13.4999 13.8953 13.3684

330180 ............................................................................................................. 15.5304 16.8787 17.7604 16.6634

330181 ............................................................................................................. 32.4718 32.5192 33.0908 32.6900

330182 ............................................................................................................. 30.9260 32.9371 33.5756 32.5197

330183 ............................................................................................................. 19.9964 19.9207 20.1294 20.0163

330184 ............................................................................................................. 27.4859 30.0400 31.3706 29.6316

330185 ............................................................................................................. 26.9496 25.6112 26.8344 26.4445

330188 ............................................................................................................. 18.7208 20.9587 18.8000 19.4696

330189 ............................................................................................................. 17.6585 15.1253 18.4498 16.9610

330191 ............................................................................................................. 18.8586 18.6206 19.0348 18.8384

330193 ............................................................................................................. 29.8042 36.5481 30.2260 31.8162

330194 ............................................................................................................. 35.5748 34.6785 35.2036 35.1664

330195 ............................................................................................................. 31.3915 33.3254 34.8966 33.0747

330196 ............................................................................................................. 28.4465 30.8165 23.7924 27.8886

330197 ............................................................................................................. 16.9990 17.6646 18.3527 17.6922

330198 ............................................................................................................. 23.8113 24.6038 24.8590 24.4203

330199 ............................................................................................................. 27.6605 28.7609 24.3024 26.9772

330201 ............................................................................................................. 30.3293 32.1149 27.8738 30.0899

330202 ............................................................................................................. 30.7869 31.4435 25.5880 29.1884

330203 ............................................................................................................. 19.2353 20.7575 * 19.9954

330204 ............................................................................................................. 29.3662 29.4418 23.6548 27.7204

330205 ............................................................................................................. 19.4642 20.5793 22.3490 20.7832

330208 ............................................................................................................. 25.8201 26.1822 26.6682 26.2220

330209 ............................................................................................................. 24.8834 23.9924 25.1281 24.6749

330211 ............................................................................................................. 19.0968 19.5064 19.5405 19.3836

330212 ............................................................................................................. 21.1777 21.7705 24.7681 22.5597

330213 ............................................................................................................. 18.5066 18.7722 19.6796 18.9552

330214 ............................................................................................................. 32.1966 36.4447 31.4165 33.0084

330215 ............................................................................................................. 17.5818 19.6926 17.9863 18.3902

330218 ............................................................................................................. 21.7072 21.4796 21.1890 21.4557

330219 ............................................................................................................. 22.1476 23.9908 23.4310 23.1411

330221 ............................................................................................................. 32.2081 27.8485 33.4064 31.2763

330222 ............................................................................................................. 17.8140 18.3666 18.8006 18.3281

330223 ............................................................................................................. 17.2754 17.6199 17.8306 17.5845

330224 ............................................................................................................. 21.9728 19.6410 19.2734 20.3025

330225 ............................................................................................................. 25.8043 25.5823 27.0379 26.0910

330226 ............................................................................................................. 17.6708 16.6711 23.2189 18.8201

330229 ............................................................................................................. 16.2509 16.8026 17.5326 16.8453

330230 ............................................................................................................. 28.8625 29.7626 29.6283 29.3810

330231 ............................................................................................................. 29.0917 30.0923 21.4675 27.3980

330232 ............................................................................................................. 19.5042 17.9083 19.1787 18.8569

330233 ............................................................................................................. 33.3008 30.9241 44.1265 35.0751

330234 ............................................................................................................. 33.3286 35.1777 35.0720 34.4830

330235 ............................................................................................................. 19.4532 21.0842 19.5880 20.0417

330236 ............................................................................................................. 30.7017 29.5913 31.3463 30.5397

330238 ............................................................................................................. 14.7951 15.6245 17.3976 15.9047

330239 ............................................................................................................. 17.2808 17.4462 18.5079 17.7328

22789

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

330240 ............................................................................................................. 30.4765 29.7082 23.8099 28.5234

330241 ............................................................................................................. 22.6046 24.6076 23.8638 23.6409

330242 ............................................................................................................. 24.7401 28.2612 27.6384 26.8305

330245 ............................................................................................................. 17.2803 17.6767 18.5221 17.8508

330246 ............................................................................................................. 26.6587 28.1090 28.1205 27.6612

330247 ............................................................................................................. 27.6203 28.5310 27.7465 27.9483

330249 ............................................................................................................. 16.4818 16.2687 17.1320 16.6304

330250 ............................................................................................................. 19.5553 19.5823 19.9619 19.7058

330252 ............................................................................................................. 17.0379 * * 17.0379

330254 ............................................................................................................. 16.7252 18.4057 15.9123 17.0146

330258 ............................................................................................................. 30.4656 29.7426 31.8910 30.6921

330259 ............................................................................................................. 25.2526 26.2661 25.9994 25.8364

330261 ............................................................................................................. 26.1654 25.7244 29.1996 27.0324

330263 ............................................................................................................. 19.6388 20.4149 18.7378 19.6517

330264 ............................................................................................................. 23.1359 22.8672 22.8099 22.9301

330265 ............................................................................................................. 15.6249 18.0193 17.7470 17.0706

330267 ............................................................................................................. 23.5561 24.5183 24.5939 24.2287

330268 ............................................................................................................. 14.6249 13.0595 15.9060 14.5364

330270 ............................................................................................................. 28.2392 34.4254 33.6294 31.8926

330273 ............................................................................................................. 25.8910 23.1511 26.0565 24.9430

330275 ............................................................................................................. 17.4223 19.0548 18.5826 18.2987

330276 ............................................................................................................. 17.7452 18.2870 19.0228 18.3342

330277 ............................................................................................................. 17.1570 18.3169 19.1761 18.2131

330279 ............................................................................................................. 19.9079 19.5983 20.7107 20.0436

330285 ............................................................................................................. 22.4717 23.5264 23.3068 23.0987

330286 ............................................................................................................. 25.0948 26.7633 27.6508 26.5469

330290 ............................................................................................................. 32.5792 33.5056 30.4706 32.2470

330293 ............................................................................................................. 15.3782 16.2158 16.9238 16.1248

330304 ............................................................................................................. 29.3687 26.7683 27.3562 27.8227

330306 ............................................................................................................. 27.6214 27.3798 29.5186 28.1311

330307 ............................................................................................................. 20.7362 21.0673 21.7142 21.1685

330308 ............................................................................................................. 36.8361 * * 36.8361

330314 ............................................................................................................. 24.7399 24.5444 25.9937 25.0514

330316 ............................................................................................................. 28.7872 27.6102 27.9543 28.1177

330327 ............................................................................................................. 16.9724 16.4611 20.3874 17.9258

330331 ............................................................................................................. 31.0405 31.6216 33.1276 32.0298

330332 ............................................................................................................. 27.1554 27.6914 25.3689 26.7855

330333 ............................................................................................................. * 29.1931 39.5812 33.8163

330336 ............................................................................................................. 30.1708 29.7689 29.8294 29.9290

330338 ............................................................................................................. 23.0077 22.4581 21.2670 22.2755

330339 ............................................................................................................. 19.6730 20.0111 20.1028 19.9220

330340 ............................................................................................................. 26.9201 28.8419 28.4129 28.0687

330350 ............................................................................................................. 30.3754 30.8889 30.9763 30.7427

330353 ............................................................................................................. 33.5519 32.1984 34.2431 33.3163

330357 ............................................................................................................. 34.7492 36.5928 33.5805 35.0171

330359 ............................................................................................................. 29.2920 * * 29.2920

330372 ............................................................................................................. 22.5027 28.8482 33.3771 27.5982

330381 ............................................................................................................. 29.2438 31.0091 31.8602 30.6612

330385 ............................................................................................................. 28.8373 35.6722 26.5687 30.6041

330386 ............................................................................................................. 24.6713 17.6383 20.4231 20.5236

330389 ............................................................................................................. 32.4234 30.2505 37.3749 32.9392

330390 ............................................................................................................. 29.7936 31.1577 30.8744 30.5843

330393 ............................................................................................................. 27.9901 26.4958 28.7973 27.7348

330394 ............................................................................................................. 18.7724 19.2392 19.1086 19.0396

330395 ............................................................................................................. 37.6805 32.8749 32.7494 34.3792

330396 ............................................................................................................. 30.7228 34.8648 24.4840 30.2958

330397 ............................................................................................................. 31.0043 33.9061 32.6068 32.3768

330398 ............................................................................................................. 30.3217 28.7707 29.2872 29.6846

330399 ............................................................................................................. 35.5212 32.9100 27.1103 31.5503

330400 ............................................................................................................. * * 16.2707 16.2707

340001 ............................................................................................................. 19.0159 18.1814 19.7093 18.9605

340002 ............................................................................................................. 18.7790 20.8858 20.5253 20.0921

340003 ............................................................................................................. 21.9674 20.2540 19.5145 20.4958

22790

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

340004 ............................................................................................................. 17.8923 19.0695 20.8540 19.2829

340005 ............................................................................................................. 14.0941 15.8205 16.7176 15.5039

340006 ............................................................................................................. 17.8145 16.9818 16.5709 17.0955

340007 ............................................................................................................. 17.1708 17.2356 18.3399 17.5929

340008 ............................................................................................................. 18.3769 21.2889 20.3756 20.0138

340009 ............................................................................................................. 20.5011 20.5023 20.9178 20.6132

340010 ............................................................................................................. 17.6500 18.3380 19.4302 18.4900

340011 ............................................................................................................. 14.9215 13.6554 14.4798 14.3110

340012 ............................................................................................................. 16.6574 18.8701 17.5112 17.6905

340013 ............................................................................................................. 17.4302 20.1747 19.4613 19.0754

340014 ............................................................................................................. 19.9203 20.5748 27.5775 22.0875

340015 ............................................................................................................. 19.0056 20.1562 19.4256 19.5364

340016 ............................................................................................................. 16.3977 17.5404 18.8958 17.5664

340017 ............................................................................................................. 19.2203 19.4192 20.2775 19.6581

340018 ............................................................................................................. 15.1579 14.0930 18.1751 15.6569

340019 ............................................................................................................. 13.5919 14.8980 15.2887 14.5682

340020 ............................................................................................................. 16.7515 18.6334 18.0897 17.8512

340021 ............................................................................................................. 19.6658 19.8020 20.5813 20.0277

340022 ............................................................................................................. 16.7211 17.8178 18.7714 17.7886

340023 ............................................................................................................. 17.2054 18.5414 19.3146 18.3540

340024 ............................................................................................................. 16.6389 17.3824 17.9130 17.3104

340025 ............................................................................................................. 16.8198 17.2648 18.4628 17.5179

340027 ............................................................................................................. 17.2971 18.0816 19.4548 18.2602

340028 ............................................................................................................. 17.7196 18.4787 19.9403 18.7490

340030 ............................................................................................................. 20.0530 21.1420 22.4709 21.2046

340031 ............................................................................................................. 12.3895 14.6951 14.6370 13.8761

340032 ............................................................................................................. 20.4735 20.0049 20.7444 20.4083

340035 ............................................................................................................. 18.0988 20.2312 18.9930 19.1067

340036 ............................................................................................................. 16.9674 18.2190 17.7619 17.6323

340037 ............................................................................................................. 15.5347 16.6576 17.5829 16.5842

340038 ............................................................................................................. 17.0154 17.3762 18.1493 17.5050

340039 ............................................................................................................. 20.1470 20.5876 21.3711 20.7125

340040 ............................................................................................................. 20.1214 20.4282 21.9720 20.8376

340041 ............................................................................................................. 17.7626 15.1419 15.5873 16.0395

340042 ............................................................................................................. 16.6300 16.9298 17.0034 16.8680

340044 ............................................................................................................. 16.3657 18.8687 18.0863 17.7757

340045 ............................................................................................................. 12.4152 13.0538 13.6182 12.9769

340047 ............................................................................................................. 19.6050 20.0602 20.0744 19.9132

340049 ............................................................................................................. 16.4988 19.2050 19.5127 18.2917

340050 ............................................................................................................. 18.5570 20.0090 19.6726 19.4142

340051 ............................................................................................................. 18.5953 16.5617 19.3627 18.0980

340052 ............................................................................................................. 21.3746 22.8173 23.2134 22.4161

340053 ............................................................................................................. 19.4881 20.9495 19.9915 20.1403

340054 ............................................................................................................. 14.4722 15.5993 15.5090 15.2167

340055 ............................................................................................................. 18.1786 19.6056 19.0861 18.9634

340060 ............................................................................................................. 17.9167 18.7137 19.3410 18.6670

340061 ............................................................................................................. 20.8474 21.5385 21.9695 21.4360

340063 ............................................................................................................. 16.9232 17.0249 16.7377 16.9005

340064 ............................................................................................................. 17.2584 20.7125 18.5069 18.8299

340065 ............................................................................................................. 18.3212 17.5414 17.5818 17.8131

340067 ............................................................................................................. 18.6132 19.3785 19.7187 19.2365

340068 ............................................................................................................. 16.7015 16.6305 17.8065 17.0483

340069 ............................................................................................................. 19.9948 21.0840 21.6728 20.9166

340070 ............................................................................................................. 18.6270 19.7796 20.5881 19.6815

340071 ............................................................................................................. 16.3701 17.1424 18.0767 17.2043

340072 ............................................................................................................. 15.6014 16.7400 17.7129 16.7307

340073 ............................................................................................................. 20.6905 21.9761 23.5832 22.0016

340075 ............................................................................................................. 18.2060 18.7090 20.8934 19.2370

340080 ............................................................................................................. 16.8453 22.2533 18.2061 19.0642

340084 ............................................................................................................. 21.7813 17.1532 19.0103 19.0182

340085 ............................................................................................................. 16.2355 17.3462 18.3179 17.3020

340087 ............................................................................................................. 16.6987 17.3884 18.2255 17.4652

340088 ............................................................................................................. 19.8314 21.0226 22.2322 21.0156

22791

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

340089 ............................................................................................................. 13.8633 13.8535 15.4760 14.4308

340090 ............................................................................................................. 17.8457 17.0584 18.6263 17.8484

340091 ............................................................................................................. 19.3955 20.5923 20.2909 20.1016

340093 ............................................................................................................. 15.1615 16.3276 16.8903 16.0870

340094 ............................................................................................................. 15.9568 19.0406 * 17.4328

340096 ............................................................................................................. 17.9764 17.8189 19.4696 18.4348

340097 ............................................................................................................. 21.3700 18.8412 18.2399 19.4192

340098 ............................................................................................................. 20.1671 21.4135 21.9578 21.2065

340099 ............................................................................................................. 15.0888 16.8305 15.3752 15.7269

340101 ............................................................................................................. 15.3610 13.9994 15.6509 14.9555

340104 ............................................................................................................. 15.8729 13.0462 11.5169 13.4465

340105 ............................................................................................................. 18.9007 20.2954 * 19.5963

340106 ............................................................................................................. 18.0769 17.7220 18.1211 17.9704

340107 ............................................................................................................. 16.9503 18.0205 19.3197 18.0904

340109 ............................................................................................................. 17.9576 18.7746 19.0532 18.6067

340111 ............................................................................................................. 14.9247 16.3344 16.5976 15.9665

340112 ............................................................................................................. 14.5966 14.7562 15.5142 14.9625

340113 ............................................................................................................. 20.8821 21.2906 21.7973 21.3226

340114 ............................................................................................................. 20.8195 21.2166 20.7261 20.9197

340115 ............................................................................................................. 18.6700 19.7578 21.7586 20.0594

340116 ............................................................................................................. 19.4786 20.4255 20.6800 20.2116

340119 ............................................................................................................. 16.8537 18.8507 19.3687 18.3855

340120 ............................................................................................................. 14.3822 15.0410 15.8240 15.1047

340121 ............................................................................................................. 15.9686 16.3295 17.8771 16.7251

340123 ............................................................................................................. 16.2227 16.9114 18.9078 17.3848

340124 ............................................................................................................. 14.0462 15.5779 17.4185 15.7171

340125 ............................................................................................................. 19.6252 19.7164 20.2270 19.8478

340126 ............................................................................................................. 17.7214 18.8100 19.2911 18.6445

340127 ............................................................................................................. 17.3849 19.3925 19.3842 18.7105

340129 ............................................................................................................. 19.7332 20.4605 20.5809 20.2641

340130 ............................................................................................................. 19.4430 19.7422 19.8707 19.6940

340131 ............................................................................................................. 18.9361 19.7908 21.3849 20.0481

340132 ............................................................................................................. 16.9369 17.3448 17.5711 17.3015

340133 ............................................................................................................. 14.3501 16.4766 17.2138 16.0568

340137 ............................................................................................................. * 21.0249 31.7702 23.8273

340138 ............................................................................................................. 19.2807 20.7618 * 20.0092

340141 ............................................................................................................. 22.2234 21.3754 22.7090 22.1155

340142 ............................................................................................................. 16.0912 17.1525 18.0766 17.1107

340143 ............................................................................................................. 20.9509 21.3604 24.4098 22.2423

340144 ............................................................................................................. 19.1919 20.9113 22.9183 20.9333

340145 ............................................................................................................. 19.1964 20.1081 20.5002 19.9671

340146 ............................................................................................................. 13.0119 15.9203 17.3051 15.3284

340147 ............................................................................................................. 19.1087 19.6827 20.5069 19.7958

340148 ............................................................................................................. 18.4227 18.5875 18.9912 18.6555

340151 ............................................................................................................. 16.5671 16.7275 18.4733 17.2579

340153 ............................................................................................................. 20.6588 20.6420 20.7533 20.6847

340155 ............................................................................................................. 20.4236 20.5792 22.6127 21.1834

340158 ............................................................................................................. 17.2565 18.1439 19.0843 18.2232

340159 ............................................................................................................. 16.8048 17.3893 19.0255 17.7569

340160 ............................................................................................................. 15.5298 16.1778 16.7170 16.1477

340162 ............................................................................................................. 16.6362 14.3472 * 16.3541

340164 ............................................................................................................. 19.6820 21.2523 21.5769 20.8240

340166 ............................................................................................................. 19.1743 20.0434 20.8270 20.0663

340168 ............................................................................................................. 14.7508 15.2919 15.6071 15.2494

340171 ............................................................................................................. 20.0495 21.5973 22.4779 21.4041

340173 ............................................................................................................. 20.2132 19.3353 21.0898 20.2512

350001 ............................................................................................................. 11.7345 14.9080 16.6551 14.4005

350002 ............................................................................................................. 17.2834 17.5259 18.3459 17.7122

350003 ............................................................................................................. 17.4276 18.2470 19.0720 18.2341

350004 ............................................................................................................. 17.9049 20.6518 23.7016 20.6528

350005 ............................................................................................................. 16.0259 18.3792 19.8486 18.1602

350006 ............................................................................................................. 16.6241 18.4107 19.0343 17.9691

350007 ............................................................................................................. 13.2771 13.3292 14.7114 13.7285

22792

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

350008 ............................................................................................................. 21.6983 20.4777 22.3784 21.4889

350009 ............................................................................................................. 18.2818 19.1611 18.3688 18.6099

350010 ............................................................................................................. 15.2762 16.2808 16.7899 16.1032

350011 ............................................................................................................. 18.4931 18.2008 19.1944 18.6474

350012 ............................................................................................................. 12.7287 15.7033 18.2524 15.6975

350013 ............................................................................................................. 16.6784 16.4579 17.2596 16.7923

350014 ............................................................................................................. 15.7906 16.8403 18.0997 16.8353

350015 ............................................................................................................. 15.8651 16.3397 16.4878 16.2122

350016 ............................................................................................................. 11.6255 11.6524 * 11.6395

350017 ............................................................................................................. 17.7835 17.6278 17.5124 17.6446

350018 ............................................................................................................. 13.6366 14.4928 16.4939 14.8276

350019 ............................................................................................................. 19.4037 19.3063 20.1608 19.6008

350021 ............................................................................................................. 12.6885 16.2898 16.8617 15.2799

350023 ............................................................................................................. 12.7952 17.9048 17.4983 16.4355

350024 ............................................................................................................. 14.3740 14.7529 15.7902 14.9309

350025 ............................................................................................................. 16.2400 17.1199 15.0469 16.0889

350027 ............................................................................................................. 17.1177 15.0835 15.5175 15.9198

350029 ............................................................................................................. 12.7950 13.5219 14.6177 13.6003

350030 ............................................................................................................. 17.3497 17.7209 18.1131 17.7195

350033 ............................................................................................................. 14.8953 14.9012 16.0870 15.2715

350034 ............................................................................................................. 18.3180 18.7245 19.6445 18.8742

350035 ............................................................................................................. 10.1561 10.4570 11.7675 10.7676

350038 ............................................................................................................. 18.7357 17.6666 19.6852 18.6647

350039 ............................................................................................................. 17.3128 17.0361 16.6280 17.0025

350041 ............................................................................................................. 14.6772 14.6680 19.1341 15.9095

350042 ............................................................................................................. 16.7544 16.7402 19.3309 17.4345

350043 ............................................................................................................. 17.1573 16.8876 16.7433 16.9224

350044 ............................................................................................................. 10.5296 10.2154 11.0178 10.5670

350047 ............................................................................................................. 17.9270 14.4628 18.0094 16.8202

350049 ............................................................................................................. 14.5330 14.8019 18.1993 15.6280

350050 ............................................................................................................. 10.5733 11.4921 11.2484 11.0842

350051 ............................................................................................................. 17.5323 17.7279 17.0183 17.4309

350053 ............................................................................................................. 13.9379 14.6398 15.9165 14.8076

350055 ............................................................................................................. 12.3722 14.5691 15.7916 14.3152

350056 ............................................................................................................. 14.7382 14.8293 15.0995 14.8885

350058 ............................................................................................................. 14.3484 15.9378 16.7034 15.7009

350060 ............................................................................................................. 9.5962 10.3666 10.3076 10.0926

350061 ............................................................................................................. 14.5894 15.7269 18.8790 16.4237

360001 ............................................................................................................. 17.3933 17.0791 18.9348 17.8110

360002 ............................................................................................................. 17.3955 18.0139 18.1923 17.9206

360003 ............................................................................................................. 22.0351 22.7471 22.9625 22.5524

360006 ............................................................................................................. 22.0906 21.8048 22.4436 22.1137

360007 ............................................................................................................. 17.0955 18.0941 14.8213 16.6387

360008 ............................................................................................................. 17.8185 18.5439 18.7961 18.3915

360009 ............................................................................................................. 17.5328 18.9322 18.8403 18.4150

360010 ............................................................................................................. 18.0886 19.2288 19.1852 18.8325

360011 ............................................................................................................. 18.9491 19.3835 21.3659 19.9105

360012 ............................................................................................................. 19.2221 19.9881 19.8772 19.7036

360013 ............................................................................................................. 20.8112 20.6021 21.3690 20.9190

360014 ............................................................................................................. 19.8844 20.2390 20.7419 20.2907

360016 ............................................................................................................. 18.7709 17.8065 21.2505 19.1632

360017 ............................................................................................................. 22.4972 21.7543 22.2740 22.1696

360018 ............................................................................................................. 21.3436 23.5219 24.6686 23.0168

360019 ............................................................................................................. 20.1726 18.7147 20.6480 19.8139

360020 ............................................................................................................. 22.9512 21.7806 22.1751 22.3268

360024 ............................................................................................................. 18.5412 19.8508 20.0395 19.4699

360025 ............................................................................................................. 19.2918 20.3638 20.2531 19.9763

360026 ............................................................................................................. 17.0378 18.2222 17.9523 17.7450

360027 ............................................................................................................. 20.3568 21.0406 21.7259 21.0412

360028 ............................................................................................................. 17.2681 17.0177 18.7174 17.5937

360029 ............................................................................................................. 18.2193 18.7622 19.2928 18.7626

360030 ............................................................................................................. 15.3535 17.5748 17.6058 16.8173

360031 ............................................................................................................. 19.8987 19.3858 21.0687 20.1028

22793

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

360032 ............................................................................................................. 17.9274 18.6559 19.8020 18.7667

360034 ............................................................................................................. 15.5649 14.9534 17.9594 16.1258

360035 ............................................................................................................. 20.3358 20.5557 21.1368 20.6811

360036 ............................................................................................................. 19.1835 20.2107 20.9916 20.1250

360037 ............................................................................................................. 22.5240 23.5094 22.4361 22.8217

360038 ............................................................................................................. 19.8921 21.2467 22.7344 21.1378

360039 ............................................................................................................. 17.4033 18.7791 18.8648 18.5318

360040 ............................................................................................................. 18.1238 18.1618 18.7425 18.3503

360041 ............................................................................................................. 18.4244 19.5744 19.7968 19.2697

360042 ............................................................................................................. 16.1187 17.4306 17.1952 16.9328

360044 ............................................................................................................. 16.7925 17.0612 17.6882 17.1993

360045 ............................................................................................................. 21.1814 22.1471 22.4018 21.8209

360046 ............................................................................................................. 19.3198 20.4755 20.4607 20.0909

360047 ............................................................................................................. 15.3399 17.1871 15.2922 15.8884

360048 ............................................................................................................. 21.1719 22.5857 22.4890 22.0646

360049 ............................................................................................................. 18.8084 20.4564 20.8393 20.0008

360050 ............................................................................................................. 12.8888 12.9873 15.0568 13.6080

360051 ............................................................................................................. 20.9461 20.8338 20.8757 20.8844

360052 ............................................................................................................. 20.0182 19.6233 18.7143 19.4845

360054 ............................................................................................................. 16.1875 17.2574 17.4911 16.9860

360055 ............................................................................................................. 23.2671 21.5585 21.3101 22.0600

360056 ............................................................................................................. 18.7606 19.0474 19.9428 19.2810

360057 ............................................................................................................. 13.8094 15.0146 15.8569 14.8518

360058 ............................................................................................................. 17.9178 18.6992 19.3306 18.6392

360059 ............................................................................................................. 21.9689 20.5618 19.3576 20.6833

360062 ............................................................................................................. 20.3111 20.7588 22.2132 21.0473

360063 ............................................................................................................. 22.7866 18.4512 17.5108 19.4998

360064 ............................................................................................................. 20.6416 20.4846 19.6315 20.2734

360065 ............................................................................................................. 19.4531 20.0532 19.6199 19.7128

360066 ............................................................................................................. 20.0285 21.6015 22.8175 21.4937

360067 ............................................................................................................. 14.5687 15.3157 14.2745 14.7189

360068 ............................................................................................................. 21.2199 21.2789 22.5953 21.7071

360069 ............................................................................................................. 17.8329 16.6982 14.6597 16.2292

360070 ............................................................................................................. 17.5300 17.3758 18.8406 17.9171

360071 ............................................................................................................. 23.8013 17.9756 18.9990 20.2321

360072 ............................................................................................................. 17.9697 18.1467 19.0028 18.3949

360074 ............................................................................................................. 18.2614 20.8275 16.3870 18.3729

360075 ............................................................................................................. 18.4733 22.4523 26.0663 21.4074

360076 ............................................................................................................. 19.5864 20.0700 20.3028 19.9910

360077 ............................................................................................................. 20.8202 21.1053 21.5517 21.1550

360078 ............................................................................................................. 20.7940 21.4392 21.4033 21.2167

360079 ............................................................................................................. 22.0033 22.1096 21.6644 21.9274

360080 ............................................................................................................. 16.6414 17.3892 17.6369 17.2080

360081 ............................................................................................................. 19.6354 21.7342 20.4614 20.6451

360082 ............................................................................................................. 22.8585 22.9460 20.7610 22.1460

360083 ............................................................................................................. 18.4635 * * 18.4635

360084 ............................................................................................................. 20.0914 20.4894 22.0492 20.8664

360085 ............................................................................................................. 21.6670 21.9051 22.0445 21.8712

360086 ............................................................................................................. 17.0389 19.5378 19.3701 18.5836

360087 ............................................................................................................. 20.0395 20.1684 20.7969 20.3249

360088 ............................................................................................................. 22.3121 24.0097 24.0822 23.4637

360089 ............................................................................................................. 20.5610 18.3881 18.1941 19.0415

360090 ............................................................................................................. 20.3955 21.0376 20.8971 20.7887

360091 ............................................................................................................. 21.0335 21.3126 21.8447 21.4132

360092 ............................................................................................................. 15.9095 20.4534 21.5073 18.9727

360093 ............................................................................................................. 18.5744 19.3292 19.0261 18.9905

360094 ............................................................................................................. 18.3105 18.8780 20.1227 19.0848

360095 ............................................................................................................. 18.7079 20.4149 19.8521 19.6643

360096 ............................................................................................................. 17.1617 18.2215 16.7129 17.3379

360098 ............................................................................................................. 18.3361 19.5314 19.7705 19.2208

360099 ............................................................................................................. 18.5523 18.5855 19.6241 18.9389

360100 ............................................................................................................. 17.6554 17.8989 18.0434 17.8622

360101 ............................................................................................................. 22.3121 21.3914 20.2635 21.3487

22794

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

360102 ............................................................................................................. 19.7700 19.4345 18.5367 19.2837

360103 ............................................................................................................. 22.6228 * * 22.6228

360106 ............................................................................................................. 16.1843 18.9752 19.1778 18.1964

360107 ............................................................................................................. 18.6195 19.7599 22.1359 20.1794

360108 ............................................................................................................. 16.5076 17.5832 20.0681 18.0497

360109 ............................................................................................................. 19.5162 20.1032 19.9237 19.8530

360112 ............................................................................................................. 22.5676 22.5589 24.6335 23.2167

360113 ............................................................................................................. 22.4584 24.2654 21.4926 22.7777

360114 ............................................................................................................. 16.3288 17.8761 18.7509 17.6758

360115 ............................................................................................................. 18.1859 18.8059 20.5842 19.2284

360116 ............................................................................................................. 18.0835 18.8882 18.8319 18.6000

360118 ............................................................................................................. 18.6098 19.3732 19.9141 19.3196

360121 ............................................................................................................. 21.0979 22.1093 22.2175 21.8088

360123 ............................................................................................................. 19.1313 20.3236 20.9792 20.1480

360125 ............................................................................................................. 18.1756 19.0774 20.5508 19.2432

360126 ............................................................................................................. 20.4558 19.0036 24.5387 21.1181

360127 ............................................................................................................. 16.9228 17.5882 16.4582 16.9587

360128 ............................................................................................................. 15.5823 16.1243 17.0515 16.2361

360129 ............................................................................................................. 15.5241 15.5002 16.6114 15.8783

360130 ............................................................................................................. 15.3356 17.2009 18.4539 16.9275

360131 ............................................................................................................. 18.2897 19.2241 18.4688 18.6543

360132 ............................................................................................................. 18.2733 19.9171 21.3493 19.8413

360133 ............................................................................................................. 19.0349 19.4316 20.3421 19.5683

360134 ............................................................................................................. 20.2383 20.6876 20.8407 20.5767

360136 ............................................................................................................. 17.8473 17.7827 18.2194 17.9464

360137 ............................................................................................................. 20.2581 20.1756 21.6611 20.6928

360140 ............................................................................................................. 19.1263 20.2791 21.2881 20.2299

360141 ............................................................................................................. 22.8496 23.0016 23.4448 23.0886

360142 ............................................................................................................. 17.3154 17.0059 18.3188 17.5468

360143 ............................................................................................................. 20.4378 20.1989 21.0336 20.5552

360144 ............................................................................................................. 21.9159 23.2191 20.9033 21.9858

360145 ............................................................................................................. 19.3907 19.6413 20.0513 19.6956

360147 ............................................................................................................. 16.5898 16.6616 17.6779 16.9779

360148 ............................................................................................................. 18.8914 19.2816 19.1393 19.1100

360149 ............................................................................................................. 18.7891 19.9808 * 19.3785

360150 ............................................................................................................. 20.6253 21.1327 22.3752 21.3686

360151 ............................................................................................................. 17.4863 16.6019 19.2788 17.7101

360152 ............................................................................................................. 21.9978 20.8328 21.6005 21.4611

360153 ............................................................................................................. 14.8948 15.4132 16.7399 15.6460

360154 ............................................................................................................. 13.7761 14.3270 14.3593 14.1608

360155 ............................................................................................................. 20.8977 22.5347 22.4566 21.9588

360156 ............................................................................................................. 17.9155 17.8787 18.9095 18.2225

360159 ............................................................................................................. 20.7119 20.2841 21.5695 20.8609

360161 ............................................................................................................. 19.4122 19.1983 20.3933 19.6539

360162 ............................................................................................................. 18.6084 * * 18.6084

360163 ............................................................................................................. 20.3821 20.7275 21.2689 20.8164

360164 ............................................................................................................. 16.1643 * * 16.1643

360165 ............................................................................................................. 19.4831 18.2571 18.2417 18.6524

360166 ............................................................................................................. 16.9778 18.7321 * 17.8568

360170 ............................................................................................................. 17.1779 16.4653 20.4407 17.9153

360172 ............................................................................................................. 18.4690 18.6720 19.7088 19.0739

360174 ............................................................................................................. 19.0887 19.9725 20.2255 19.8619

360175 ............................................................................................................. 20.4133 21.1685 21.5450 21.0739

360176 ............................................................................................................. 15.4730 15.9430 16.6228 16.0305

360177 ............................................................................................................. 19.4122 18.7898 18.9576 19.0368

360178 ............................................................................................................. 17.3985 18.8704 16.7962 17.7254

360179 ............................................................................................................. 19.1417 21.1309 21.1234 20.4340

360180 ............................................................................................................. 22.0949 21.3826 21.0146 21.4888

360184 ............................................................................................................. 19.3502 19.1224 * 19.2391

360185 ............................................................................................................. 18.6697 18.7291 19.4858 18.9599

360186 ............................................................................................................. 20.8579 18.3246 20.7572 19.9570

360187 ............................................................................................................. 18.0209 18.5109 19.6535 18.7427

360188 ............................................................................................................. 17.5327 17.1044 18.3057 17.6838

22795

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

360189 ............................................................................................................. 17.3713 17.8981 18.5940 17.9373

360192 ............................................................................................................. 20.9980 21.6365 22.7846 21.8042

360193 ............................................................................................................. 17.6874 * * 17.6874

360194 ............................................................................................................. 17.6890 17.1884 17.6140 17.4968

360195 ............................................................................................................. 19.0173 19.9302 20.5828 19.8368

360197 ............................................................................................................. 19.4250 20.0603 20.5062 19.9981

360200 ............................................................................................................. 17.7583 16.2306 17.9623 17.3129

360203 ............................................................................................................. 15.6212 16.3181 15.9609 15.9716

360204 ............................................................................................................. 19.3543 22.2494 * 20.5754

360210 ............................................................................................................. 20.2809 20.9955 21.8629 21.0428

360211 ............................................................................................................. 19.5762 19.9895 20.6081 20.0860

360212 ............................................................................................................. 20.2288 21.1123 20.6987 20.6781

360213 ............................................................................................................. 18.3253 19.4765 19.0584 18.9547

360218 ............................................................................................................. 18.4140 18.9469 18.8204 18.7231

360230 ............................................................................................................. 21.4385 21.9763 20.8042 21.3850

360231 ............................................................................................................. 13.5586 12.9588 14.4168 13.6102

360234 ............................................................................................................. 22.4324 23.2588 19.5102 21.8679

360236 ............................................................................................................. 19.4881 17.8426 19.9971 19.0637

360239 ............................................................................................................. 19.8584 20.1854 19.5907 19.8872

360241 ............................................................................................................. 22.0795 23.5318 25.3741 23.5406

360243 ............................................................................................................. 13.5835 14.8694 * 14.2018

360244 ............................................................................................................. 10.5518 * * 10.5518

360245 ............................................................................................................. 15.0579 16.4622 15.9782 15.8310

360247 ............................................................................................................. 18.1116 16.3092 17.0776 17.0967

360248 ............................................................................................................. 21.6499 * * 21.6499

360249 ............................................................................................................. * * 25.4331 25.4331

370001 ............................................................................................................. 21.2714 22.5214 24.1929 22.6419

370002 ............................................................................................................. 14.0847 14.7315 15.4333 14.7194

370004 ............................................................................................................. 16.7671 19.3236 18.5233 18.1546

370005 ............................................................................................................. 17.3817 15.1654 15.3881 15.9167

370006 ............................................................................................................. 12.9493 16.6484 16.4995 15.3118

370007 ............................................................................................................. 17.1535 15.2905 15.8312 16.0498

370008 ............................................................................................................. 17.3048 16.6566 17.5553 17.1688

370011 ............................................................................................................. 14.6397 14.9701 14.9186 14.8316

370012 ............................................................................................................. 10.8003 11.7265 12.4942 11.6228

370013 ............................................................................................................. 18.0385 19.3398 18.9584 18.7911

370014 ............................................................................................................. 19.6543 20.6512 20.2858 20.2276

370015 ............................................................................................................. 17.8247 17.0319 20.8765 18.5256

370016 ............................................................................................................. 16.6401 19.1191 19.1613 18.3470

370017 ............................................................................................................. 12.9837 12.6400 13.6531 13.1239

370018 ............................................................................................................. 14.2438 18.5107 17.7054 16.6955

370019 ............................................................................................................. 16.8801 14.2277 14.6216 15.1546

370020 ............................................................................................................. 13.4787 14.3798 15.1035 14.3356

370021 ............................................................................................................. 11.2639 12.0474 12.9030 12.0738

370022 ............................................................................................................. 17.9015 17.2344 17.3302 17.4722

370023 ............................................................................................................. 16.8215 17.7630 17.5148 17.3665

370025 ............................................................................................................. 16.3970 17.4988 18.4375 17.4425

370026 ............................................................................................................. 16.8991 18.3371 18.0412 17.7563

370028 ............................................................................................................. 19.7118 18.4445 21.1086 19.7253

370029 ............................................................................................................. 13.8930 16.4924 18.2580 16.0663

370030 ............................................................................................................. 15.4736 16.3269 16.5803 16.1058

370032 ............................................................................................................. 16.6432 18.2821 18.1538 17.7030

370033 ............................................................................................................. 12.3910 13.5216 11.3210 12.4595

370034 ............................................................................................................. 14.5101 15.6386 15.6288 15.2811

370035 ............................................................................................................. 18.9629 25.5764 * 21.9610

370036 ............................................................................................................. 11.4593 12.4026 12.4070 12.0833

370037 ............................................................................................................. 17.7491 16.7012 18.8472 17.7402

370038 ............................................................................................................. 12.8135 13.3084 13.0210 13.0660

370039 ............................................................................................................. 16.2661 15.5206 19.4498 17.0406

370040 ............................................................................................................. 14.2582 14.4672 15.5109 14.7638

370041 ............................................................................................................. 17.4123 16.7356 16.2316 16.8488

370042 ............................................................................................................. 14.6146 14.9175 15.2764 14.9764

370043 ............................................................................................................. 16.0764 15.9534 17.0892 16.3549

22796

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

370045 ............................................................................................................. 12.4352 10.1994 11.3560 11.2236

370046 ............................................................................................................. 18.1499 18.8334 * 18.4831

370047 ............................................................................................................. 15.6716 16.7554 17.8769 16.7444

370048 ............................................................................................................. 17.4356 18.2150 15.6803 17.1206

370049 ............................................................................................................. 19.8397 20.7176 19.4868 19.9892

370051 ............................................................................................................. 12.1816 11.6736 12.5171 12.1083

370054 ............................................................................................................. 16.5598 16.9049 18.0787 17.1343

370056 ............................................................................................................. 18.8774 18.4558 18.1432 18.4804

370057 ............................................................................................................. 14.6564 16.7261 15.1228 15.5054

370059 ............................................................................................................. 16.4578 18.1386 18.3314 17.6259

370060 ............................................................................................................. 15.1169 16.5403 19.3051 16.8157

370063 ............................................................................................................. 17.0645 14.4132 16.7342 16.0603

370064 ............................................................................................................. 8.7499 10.9676 11.9954 10.6741

370065 ............................................................................................................. 16.5638 16.6898 18.1349 17.1281

370071 ............................................................................................................. 14.9472 16.1439 16.4567 15.8354

370072 ............................................................................................................. 14.6497 14.4742 13.6519 14.2760

370076 ............................................................................................................. 12.8568 13.5694 14.3555 13.5818

370077 ............................................................................................................. 17.6236 * * 17.6236

370078 ............................................................................................................. 17.2370 18.4086 19.2412 18.2505

370079 ............................................................................................................. 13.5976 16.6861 16.9201 15.7005

370080 ............................................................................................................. 14.3445 13.9239 14.7323 14.3058

370082 ............................................................................................................. 13.5434 13.9634 15.0669 14.1855

370083 ............................................................................................................. 11.4905 13.1519 13.1316 12.6096

370084 ............................................................................................................. 21.7484 22.0545 13.1197 17.8063

370085 ............................................................................................................. 11.8844 11.2842 48.1271 14.9179

370086 ............................................................................................................. 13.5646 15.4404 11.1900 13.1933

370089 ............................................................................................................. 14.4968 16.0966 17.2638 15.9758

370091 ............................................................................................................. 17.5839 19.1698 20.1860 18.9733

370092 ............................................................................................................. 14.6757 14.9802 15.7678 15.1529

370093 ............................................................................................................. 18.5747 18.4600 19.7008 19.0469

370094 ............................................................................................................. 18.3796 18.0002 19.5462 18.6588

370095 ............................................................................................................. 14.1319 12.6383 13.4202 13.3755

370097 ............................................................................................................. 23.3116 22.9714 23.2056 23.1716

370099 ............................................................................................................. 16.2649 15.4549 18.9823 16.7206

370100 ............................................................................................................. 17.1036 14.0168 18.8274 16.6764

370103 ............................................................................................................. 15.8967 19.2353 18.2685 17.7516

370105 ............................................................................................................. 17.6811 21.3352 20.7890 19.9853

370106 ............................................................................................................. 18.6238 18.5485 18.7413 18.6375

370108 ............................................................................................................. 12.2379 12.3279 12.7470 12.4421

370112 ............................................................................................................. 15.2488 14.8539 15.3039 15.1287

370113 ............................................................................................................. 16.2043 16.1046 17.6107 16.6143

370114 ............................................................................................................. 15.9801 16.5268 17.4009 16.6473

370121 ............................................................................................................. 19.5506 22.5611 21.3099 21.1472

370122 ............................................................................................................. 12.1514 15.0645 15.4375 13.9736

370123 ............................................................................................................. 16.3609 18.9159 19.4409 18.1517

370125 ............................................................................................................. 13.5453 15.6284 13.9436 14.3107

370126 ............................................................................................................. 18.2447 23.9654 15.8020 19.1824

370131 ............................................................................................................. 16.2403 17.5689 15.7261 16.4650

370133 ............................................................................................................. 10.0169 10.9575 12.9545 11.1921

370138 ............................................................................................................. 15.9372 16.4005 17.5551 16.6500

370139 ............................................................................................................. 13.3023 14.8612 14.9964 14.3624

370140 ............................................................................................................. 15.2265 16.0721 17.1393 16.1657

370141 ............................................................................................................. 12.1420 18.4101 20.7798 16.3574

370146 ............................................................................................................. 12.5581 12.6402 13.0399 12.7467

370148 ............................................................................................................. 16.4147 20.6458 20.6612 19.2220

370149 ............................................................................................................. 16.7218 16.1850 17.0929 16.6647

370153 ............................................................................................................. 15.3218 17.8352 16.4669 16.5507

370154 ............................................................................................................. 15.9128 15.5127 15.6093 15.6789

370156 ............................................................................................................. 13.6363 13.9255 14.5696 14.0273

370158 ............................................................................................................. 15.0865 15.6917 15.6994 15.4906

370159 ............................................................................................................. 17.8319 28.0536 21.1267 21.7006

370163 ............................................................................................................. 14.5609 17.6361 20.4217 17.2893

370165 ............................................................................................................. 13.2174 13.0910 13.0375 13.1156

22797

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

370166 ............................................................................................................. 17.8154 17.2849 21.0944 18.6510

370169 ............................................................................................................. 9.4807 12.5243 12.7138 11.5273

370176 ............................................................................................................. 16.0355 15.9476 18.9951 16.9629

370177 ............................................................................................................. 11.8757 11.2536 14.6481 12.5743

370178 ............................................................................................................. 11.6384 10.5726 11.6200 11.2422

370179 ............................................................................................................. 19.2677 17.2829 21.3002 18.9651

370183 ............................................................................................................. 7.6164 10.2945 16.9318 11.0088

370186 ............................................................................................................. 13.3454 13.6192 15.4533 14.1321

370190 ............................................................................................................. 13.7032 14.1397 19.3570 15.3737

370192 ............................................................................................................. 16.7402 18.4614 19.6967 18.2866

370197 ............................................................................................................. 21.5718 * * 21.5718

370198 ............................................................................................................. * 21.3136 * 21.3136

370200 ............................................................................................................. * * 22.5299 22.5299

380001 ............................................................................................................. 22.0255 20.3127 26.4822 22.5494

380002 ............................................................................................................. 19.4764 24.0241 21.9185 21.9840

380003 ............................................................................................................. 24.7434 21.7826 20.9007 22.2865

380004 ............................................................................................................. 23.1432 23.1451 23.3609 23.2208

380005 ............................................................................................................. 23.2415 24.0838 25.0750 24.1485

380006 ............................................................................................................. 20.5375 21.2731 21.3520 21.0653

380007 ............................................................................................................. 24.2933 25.2995 32.2678 27.0282

380008 ............................................................................................................. 21.1888 20.7063 22.1442 21.3538

380009 ............................................................................................................. 25.1702 23.8104 24.3851 24.4234

380010 ............................................................................................................. 19.7477 23.7488 22.7276 21.8451

380011 ............................................................................................................. 21.1353 21.1151 20.3357 20.8683

380013 ............................................................................................................. 20.1038 18.6818 19.8180 19.5721

380014 ............................................................................................................. 23.4819 24.6574 25.9828 24.7413

380017 ............................................................................................................. 23.8231 26.0578 25.3954 25.0552

380018 ............................................................................................................. 22.0776 22.3525 22.9822 22.4971

380019 ............................................................................................................. 20.7700 22.1215 20.8176 21.2209

380020 ............................................................................................................. 21.3556 20.1464 22.9568 21.5448

380021 ............................................................................................................. 20.6358 21.1590 23.8499 21.8371

380022 ............................................................................................................. 21.6110 22.6408 24.5974 22.8841

380023 ............................................................................................................. 19.2357 20.5462 21.3831 20.3976

380025 ............................................................................................................. 24.6738 26.3652 26.9346 25.9824

380026 ............................................................................................................. 19.2663 20.4706 20.6972 20.1525

380027 ............................................................................................................. 20.1576 20.8647 21.5490 20.8958

380029 ............................................................................................................. 18.5699 19.4246 20.1471 19.4015

380031 ............................................................................................................. 22.8346 23.3181 23.1696 23.1091

380033 ............................................................................................................. 23.2881 25.2454 26.7146 25.0303

380035 ............................................................................................................. 21.6533 22.4099 23.9719 22.6232

380036 ............................................................................................................. 19.3269 27.1587 27.2157 23.8613

380037 ............................................................................................................. 21.2347 21.9158 22.1774 21.7911

380038 ............................................................................................................. 25.5750 26.0869 26.7759 26.1419

380039 ............................................................................................................. 22.1235 23.1746 22.8048 22.6937

380040 ............................................................................................................. 21.6378 26.2717 22.5477 23.4095

380042 ............................................................................................................. 19.8096 21.1176 24.4172 21.7244

380047 ............................................................................................................. 21.9511 23.0718 24.2524 23.1258

380048 ............................................................................................................. 18.3847 17.5885 18.3005 18.0671

380050 ............................................................................................................. 18.2486 20.3934 20.3205 19.6254

380051 ............................................................................................................. 21.2358 22.3568 22.3207 21.9927

380052 ............................................................................................................. 17.8741 19.4570 18.6299 18.6300

380055 ............................................................................................................. 21.2459 * * 21.2459

380056 ............................................................................................................. 17.1600 19.5185 18.4961 18.3892

380060 ............................................................................................................. 23.2923 24.2670 25.2553 24.2520

380061 ............................................................................................................. 22.5983 22.3736 22.8781 22.6217

380062 ............................................................................................................. 18.5229 20.7716 18.2148 19.1910

380063 ............................................................................................................. 19.3566 20.4077 * 19.9113

380064 ............................................................................................................. 19.8719 19.9826 22.9160 20.8404

380065 ............................................................................................................. 22.1706 26.1404 22.9608 23.6770

380066 ............................................................................................................. 20.4189 22.0349 23.2794 21.9793

380068 ............................................................................................................. 22.7573 22.3178 * 22.5559

380069 ............................................................................................................. 19.5793 19.8300 20.4882 19.9809

380070 ............................................................................................................. 24.7116 27.2541 27.7790 26.6130

22798

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

380071 ............................................................................................................. 20.4707 22.6386 25.1808 22.8743

380072 ............................................................................................................. 16.3169 19.1553 19.4346 18.3236

380075 ............................................................................................................. 22.1703 22.3625 22.4139 22.3203

380078 ............................................................................................................. 19.1035 20.2507 21.0903 20.1439

380081 ............................................................................................................. 20.5902 20.9882 20.4082 20.6790

380082 ............................................................................................................. 22.5856 22.2275 22.9606 22.5990

380083 ............................................................................................................. 21.8096 21.3859 21.7431 21.6440

380084 ............................................................................................................. 23.6412 24.2844 27.1689 24.9815

380087 ............................................................................................................. 14.0976 16.5309 17.0380 15.8783

380088 ............................................................................................................. 19.5204 21.5225 19.5346 20.1728

380089 ............................................................................................................. 23.7413 19.5255 25.2908 23.0572

380090 ............................................................................................................. 27.0867 29.2702 24.9351 26.9453

380091 ............................................................................................................. 22.8333 27.5560 25.3062 25.1774

390001 ............................................................................................................. 18.6384 19.2989 19.6732 19.2277

390002 ............................................................................................................. 18.0787 21.8353 * 19.8326

390003 ............................................................................................................. 17.2435 17.1371 18.1025 17.4798

390004 ............................................................................................................. 18.8899 19.2277 20.1410 19.4180

390005 ............................................................................................................. 16.4459 17.3506 * 16.9145

390006 ............................................................................................................. 19.6012 20.2959 21.1173 20.3037

390007 ............................................................................................................. 21.4093 21.7506 15.6739 19.2842

390008 ............................................................................................................. 16.7440 17.8297 18.1339 17.5605

390009 ............................................................................................................. 20.1181 20.6507 20.7869 20.5095

390010 ............................................................................................................. 17.2315 17.5127 17.3335 17.3583

390011 ............................................................................................................. 18.0683 18.1717 18.3257 18.1941

390012 ............................................................................................................. 20.0227 20.6523 21.0569 20.5659

390013 ............................................................................................................. 19.3300 19.2698 19.6562 19.4200

390015 ............................................................................................................. 12.9372 13.1337 13.7352 13.2647

390016 ............................................................................................................. 17.0679 16.9892 17.0438 17.0335

390017 ............................................................................................................. 16.2170 16.7493 18.6113 17.1752

390018 ............................................................................................................. 19.1241 21.3626 19.0279 19.8558

390019 ............................................................................................................. 16.3965 16.7848 17.9046 17.0403

390022 ............................................................................................................. 22.8967 21.5064 24.3824 22.9198

390023 ............................................................................................................. 19.5639 21.8270 21.0689 20.8880

390024 ............................................................................................................. 25.0359 24.9437 25.5672 25.1781

390025 ............................................................................................................. 15.7111 15.6155 15.6650 15.6645

390026 ............................................................................................................. 22.7645 22.3902 22.6877 22.6120

390027 ............................................................................................................. 27.6893 26.8878 31.2135 28.5811

390028 ............................................................................................................. 20.1087 22.7700 24.0895 22.1870

390029 ............................................................................................................. 19.6883 21.5729 21.2661 20.8012

390030 ............................................................................................................. 18.3978 17.9580 18.6645 18.3352

390031 ............................................................................................................. 19.5175 19.2755 18.3572 19.0574

390032 ............................................................................................................. 18.1492 17.8041 21.5105 19.0439

390035 ............................................................................................................. 18.5146 20.2029 18.5192 19.0782

390036 ............................................................................................................. 18.8657 19.9880 19.7671 19.5278

390037 ............................................................................................................. 22.2359 21.0616 20.4263 21.2243

390039 ............................................................................................................. 16.5438 17.1046 17.5268 17.0466

390040 ............................................................................................................. 15.1211 15.9612 16.6876 15.9078

390041 ............................................................................................................. 19.5760 19.8080 20.1482 19.8333

390042 ............................................................................................................. 21.1276 22.7693 22.6393 22.1864

390043 ............................................................................................................. 16.3561 17.2607 17.4764 17.0230

390044 ............................................................................................................. 19.5419 20.2813 13.2304 16.8712

390045 ............................................................................................................. 18.4591 18.5574 19.2907 18.7716

390046 ............................................................................................................. 20.4608 20.7303 16.6014 19.0179

390047 ............................................................................................................. 24.5824 27.6661 18.9455 23.5893

390048 ............................................................................................................. 18.3801 19.0920 19.7685 19.0433

390049 ............................................................................................................. 21.1318 21.1217 22.1009 21.4604

390050 ............................................................................................................. 20.9240 22.8808 22.2639 22.0253

390051 ............................................................................................................. 26.0485 25.7910 20.3683 23.9994

390052 ............................................................................................................. 17.0988 20.9306 19.2727 19.0857

390054 ............................................................................................................. 17.4382 17.8852 18.4975 17.9431

390055 ............................................................................................................. 25.8961 24.2211 23.5510 24.5324

390056 ............................................................................................................. 17.1692 17.7858 19.3901 18.0977

390057 ............................................................................................................. 19.7459 20.2059 16.4148 18.5380

22799

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

390058 ............................................................................................................. 19.2543 19.7379 19.8418 19.6169

390060 ............................................................................................................. 13.6276 * * 13.6276

390061 ............................................................................................................. 20.4819 21.2392 23.8722 21.8310

390062 ............................................................................................................. 16.4505 16.6721 17.3750 16.8291

390063 ............................................................................................................. 19.6373 20.0125 19.4965 19.7211

390065 ............................................................................................................. 20.0001 19.9361 15.3313 18.1038

390066 ............................................................................................................. 18.7064 19.8539 18.8152 19.1167

390067 ............................................................................................................. 20.6515 20.9688 21.2031 20.9451

390068 ............................................................................................................. 17.5524 18.3158 19.1109 18.3267

390069 ............................................................................................................. 19.2858 19.6466 * 19.4555

390070 ............................................................................................................. 20.1862 16.1988 21.8549 19.3957

390071 ............................................................................................................. 16.2298 15.7165 16.0100 15.9856

390072 ............................................................................................................. 15.5565 16.3133 16.2919 16.0432

390073 ............................................................................................................. 20.6859 20.5581 21.2623 20.8422

390074 ............................................................................................................. 16.5971 18.4806 18.3093 17.7465

390075 ............................................................................................................. 17.2676 17.9840 18.1131 17.7404

390076 ............................................................................................................. 21.4307 20.2475 21.3290 20.9889

390078 ............................................................................................................. 18.2328 19.2089 19.0156 18.8052

390079 ............................................................................................................. 18.1969 18.3312 18.9269 18.4731

390080 ............................................................................................................. 19.5180 18.8028 21.4768 19.8681

390081 ............................................................................................................. 23.9922 24.8351 * 24.4080

390083 ............................................................................................................. 20.5919 * * 20.5919

390084 ............................................................................................................. 16.3463 16.4026 20.2529 17.4556

390086 ............................................................................................................. 17.2481 18.5265 18.6854 18.1599

390088 ............................................................................................................. 23.4941 23.6173 22.3275 23.2063

390090 ............................................................................................................. 20.6463 21.6437 21.3759 21.2068

390091 ............................................................................................................. 18.3746 18.1569 18.2060 18.2472

390093 ............................................................................................................. 16.6336 17.7171 18.4442 17.6019

390095 ............................................................................................................. 13.0459 16.3357 16.6933 15.2336

390096 ............................................................................................................. 19.3118 19.1171 22.4382 20.4516

390097 ............................................................................................................. 21.4115 23.5963 25.2738 23.2417

390100 ............................................................................................................. 20.3014 20.7859 20.9809 20.6913

390101 ............................................................................................................. 17.0534 17.9499 18.5039 17.8169

390102 ............................................................................................................. 19.4924 19.0461 21.5496 20.0293

390103 ............................................................................................................. 17.7054 18.4312 18.8667 18.3176

390104 ............................................................................................................. 15.9605 15.9008 16.3255 16.0548

390106 ............................................................................................................. 16.2783 16.6666 16.8439 16.6044

390107 ............................................................................................................. 19.1793 19.5178 21.0429 19.9329

390108 ............................................................................................................. 21.2872 21.0899 21.1820 21.1861

390109 ............................................................................................................. 14.6645 16.4597 16.5299 15.8639

390110 ............................................................................................................. 21.3191 21.5282 21.5388 21.4672

390111 ............................................................................................................. 28.7875 27.5193 32.0778 29.4304

390112 ............................................................................................................. 14.0439 14.9427 * 14.5099

390113 ............................................................................................................. 17.9377 19.1945 19.3634 18.8262

390114 ............................................................................................................. 22.9698 19.6295 * 21.2139

390115 ............................................................................................................. 24.7244 23.3461 21.3119 23.0378

390116 ............................................................................................................. 20.6016 21.4877 21.3671 21.1457

390117 ............................................................................................................. 16.9036 17.9393 18.0769 17.6425

390118 ............................................................................................................. 16.8962 18.3440 18.9507 18.0638

390119 ............................................................................................................. 18.5935 18.2951 18.8353 18.5714

390121 ............................................................................................................. 18.6422 20.8780 19.0503 19.5401

390122 ............................................................................................................. 17.4645 17.1902 17.7734 17.4764

390123 ............................................................................................................. 20.8412 20.8344 21.3974 21.0254

390125 ............................................................................................................. 15.9356 16.7983 17.5446 16.7393

390126 ............................................................................................................. 20.9383 20.6498 * 20.8020

390127 ............................................................................................................. 21.8849 21.7724 22.4555 22.0398

390128 ............................................................................................................. 19.4132 19.6792 19.3165 19.4699

390130 ............................................................................................................. 17.3253 17.7049 18.3695 17.7936

390131 ............................................................................................................. 16.8349 16.0986 19.2096 17.3202

390132 ............................................................................................................. 20.5528 21.1931 22.4903 21.3712

390133 ............................................................................................................. 24.6131 23.3489 19.9376 22.5639

390135 ............................................................................................................. 21.2497 21.5782 22.1905 21.6491

390136 ............................................................................................................. 17.6128 16.9737 20.6286 18.3801

22800

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

390137 ............................................................................................................. 16.5598 17.5687 18.5397 17.5480

390138 ............................................................................................................. 18.8601 19.6212 20.6936 19.7394

390139 ............................................................................................................. 22.9351 24.4515 23.2945 23.5528

390142 ............................................................................................................. 26.7954 26.8086 27.9193 27.2106

390145 ............................................................................................................. 20.3393 20.3731 20.4228 20.3787

390146 ............................................................................................................. 17.7020 18.7922 18.6505 18.3503

390147 ............................................................................................................. 21.1085 20.9651 21.2492 21.1067

390150 ............................................................................................................. 19.6575 20.7294 20.3155 20.2474

390151 ............................................................................................................. 20.5084 21.6000 22.5206 21.5535

390152 ............................................................................................................. 19.1525 20.3353 19.4017 19.6203

390153 ............................................................................................................. 23.1183 23.7013 22.5900 23.1296

390154 ............................................................................................................. 15.8478 17.4036 * 16.6285

390156 ............................................................................................................. 21.1629 21.8498 22.5648 21.8420

390157 ............................................................................................................. 19.8268 19.6578 18.9868 19.5005

390158 ............................................................................................................. 21.6045 * * 21.6045

390160 ............................................................................................................. 20.7676 21.4810 19.4463 20.4967

390161 ............................................................................................................. 12.3743 16.4799 * 14.3389

390162 ............................................................................................................. 21.0228 21.4095 21.9188 21.4386

390163 ............................................................................................................. 15.6227 16.8013 17.5312 16.6546

390164 ............................................................................................................. 21.5890 24.6765 24.9750 23.5327

390166 ............................................................................................................. 19.9612 19.0405 * 19.5017

390167 ............................................................................................................. 22.9136 19.8973 * 21.3982

390168 ............................................................................................................. 18.9936 18.7400 18.8863 18.8736

390169 ............................................................................................................. 18.9878 20.2382 22.0547 20.4487

390170 ............................................................................................................. 22.9877 26.5891 * 24.5773

390173 ............................................................................................................. 17.8568 18.5370 18.3816 18.2561

390174 ............................................................................................................. 25.2407 25.4189 25.4110 25.3577

390176 ............................................................................................................. 17.3577 17.8740 20.8368 18.6587

390178 ............................................................................................................. 17.7036 16.6993 17.0534 17.1490

390179 ............................................................................................................. 21.4093 21.6901 21.8593 21.6579

390180 ............................................................................................................. 25.1191 25.7074 * 25.4305

390181 ............................................................................................................. 17.0860 19.4654 23.1403 19.5445

390183 ............................................................................................................. 19.0834 17.8306 17.9848 18.2942

390184 ............................................................................................................. 20.7489 20.8060 20.9349 20.8256

390185 ............................................................................................................. 17.6516 18.8798 19.6989 18.7466

390189 ............................................................................................................. 18.6668 20.0889 5.6954 10.5640

390191 ............................................................................................................. 16.1993 16.3240 17.2270 16.5760

390192 ............................................................................................................. 16.3696 17.4537 17.2512 17.0206

390193 ............................................................................................................. 16.4663 16.7874 18.1209 17.0634

390194 ............................................................................................................. 20.1547 20.7953 21.2689 20.7092

390195 ............................................................................................................. 23.6920 24.6855 23.1069 23.8298

390197 ............................................................................................................. 18.9857 19.2690 19.7956 19.3317

390198 ............................................................................................................. 15.4508 15.9721 15.8833 15.7671

390199 ............................................................................................................. 16.6644 17.0515 17.9068 17.2031

390200 ............................................................................................................. 13.5898 15.1399 14.9496 14.6311

390201 ............................................................................................................. 20.5011 20.6296 20.3533 20.4916

390203 ............................................................................................................. 21.1895 20.9432 21.5141 21.2139

390204 ............................................................................................................. 20.8483 20.1779 22.5626 21.1871

390206 ............................................................................................................. 18.5746 18.4027 * 18.4910

390209 ............................................................................................................. 16.9558 17.4792 18.7059 17.7155

390211 ............................................................................................................. 17.9132 17.8638 18.4213 18.0846

390213 ............................................................................................................. 17.4453 18.8555 19.1553 18.5312

390215 ............................................................................................................. 21.4291 20.7084 21.1303 21.0799

390217 ............................................................................................................. 19.2926 19.1406 19.9837 19.4647

390219 ............................................................................................................. 21.6295 18.8292 19.6226 19.9600

390220 ............................................................................................................. 18.5178 18.7178 * 18.6191

390222 ............................................................................................................. 20.9080 21.5739 22.1548 21.5483

390223 ............................................................................................................. 22.6498 23.6482 21.4738 22.5019

390224 ............................................................................................................. 15.9058 15.3015 * 15.5965

390225 ............................................................................................................. 18.1752 18.6125 18.7290 18.5053

390226 ............................................................................................................. 23.1638 21.8268 21.7882 22.2642

390228 ............................................................................................................. 19.8129 19.4083 19.8180 19.6802

390231 ............................................................................................................. 24.4852 22.7544 19.7578 22.1186

22801

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

390233 ............................................................................................................. 18.7707 19.4887 20.0152 19.4302

390235 ............................................................................................................. 24.6044 25.0857 21.4200 24.0078

390236 ............................................................................................................. 17.0339 16.2397 17.5043 16.9210

390237 ............................................................................................................. 21.7479 19.5230 22.2221 21.1193

390238 ............................................................................................................. * 17.8211 17.1055 17.4821

390242 ............................................................................................................. 18.0943 * * 18.0943

390244 ............................................................................................................. 14.4133 15.4611 8.2241 11.8858

390245 ............................................................................................................. 20.1544 26.0194 * 22.9968

390246 ............................................................................................................. 17.9214 18.9733 18.1348 18.3253

390247 ............................................................................................................. 20.6671 20.9526 21.2151 20.8919

390249 ............................................................................................................. 10.7336 12.7920 13.1657 12.2298

390256 ............................................................................................................. 23.7828 20.9469 20.5812 21.7018

390258 ............................................................................................................. 21.3629 21.9207 22.6852 21.9998

390260 ............................................................................................................. 21.1917 21.9509 15.1540 18.9540

390262 ............................................................................................................. 18.6684 18.2379 * 18.4504

390263 ............................................................................................................. 20.0939 20.6855 20.2304 20.3363

390265 ............................................................................................................. 19.5089 20.3580 20.4950 20.1207

390266 ............................................................................................................. 16.2372 17.1666 17.1290 16.8341

390267 ............................................................................................................. 20.5125 21.2974 19.2665 20.4773

390268 ............................................................................................................. 21.0161 21.3486 22.0909 21.4791

390270 ............................................................................................................. 17.8280 19.0925 9.3834 13.7053

390277 ............................................................................................................. 27.0983 * * 27.0983

390278 ............................................................................................................. 19.2019 18.2865 * 18.7672

390279 ............................................................................................................. 13.6992 14.3241 14.8655 14.2998

390283 ............................................................................................................. * * 22.5490 22.5490

390284 ............................................................................................................. * * 34.3904 34.3904

400001 ............................................................................................................. 9.8615 9.9463 10.5757 10.1359

400002 ............................................................................................................. 9.3063 10.1417 13.0494 10.8249

400003 ............................................................................................................. 9.9865 10.8821 12.4078 11.0633

400004 ............................................................................................................. 8.4811 8.9864 8.5648 8.6695

400005 ............................................................................................................. 7.8494 9.5632 7.7432 8.3858

400006 ............................................................................................................. 10.5281 10.3444 10.1048 10.3288

400007 ............................................................................................................. 7.8637 6.4490 8.0174 7.3754

400009 ............................................................................................................. 8.3727 8.4207 8.8650 8.5497

400010 ............................................................................................................. 11.6642 10.6518 10.8011 10.9779

400011 ............................................................................................................. 5.6825 7.4979 8.5426 7.2512

400012 ............................................................................................................. 7.8134 8.2412 8.4728 8.1883

400013 ............................................................................................................. 8.2066 8.4579 9.2624 8.6839

400014 ............................................................................................................. 9.5354 9.5235 9.4798 9.5126

400015 ............................................................................................................. 10.3326 10.9505 14.4076 11.3577

400016 ............................................................................................................. 12.0743 13.2756 13.3922 12.9125

400017 ............................................................................................................. 8.5675 8.6421 9.2577 8.8024

400018 ............................................................................................................. 9.4534 10.4557 9.7049 9.8618

400019 ............................................................................................................. 10.1512 10.4332 10.8940 10.5307

400021 ............................................................................................................. 9.9121 10.6988 12.1434 10.9538

400022 ............................................................................................................. 11.1204 11.5861 12.2199 11.6336

400024 ............................................................................................................. 7.5594 7.8984 9.2409 8.1615

400026 ............................................................................................................. 7.1236 5.6454 5.8335 6.1312

400027 ............................................................................................................. 8.4862 9.5899 * 9.0120

400028 ............................................................................................................. 8.3991 8.8597 9.1794 8.7817

400031 ............................................................................................................. 9.7826 8.2660 * 8.9857

400032 ............................................................................................................. 9.7291 10.5498 10.0448 10.1074

400044 ............................................................................................................. 11.7484 11.9704 11.9486 11.8844

400048 ............................................................................................................. 8.9224 9.1701 15.1405 10.3604

400061 ............................................................................................................. 12.2770 12.4493 13.0988 12.5813

400079 ............................................................................................................. 7.0830 * 9.7203 8.1082

400087 ............................................................................................................. 10.3972 9.5097 9.8534 9.8687

400094 ............................................................................................................. 7.8208 8.9116 7.9187 8.1829

400098 ............................................................................................................. 7.2098 9.3308 9.7791 8.8630

400102 ............................................................................................................. 7.7288 9.8536 9.9903 9.1668

400103 ............................................................................................................. 10.7316 11.2069 11.5359 11.1167

400104 ............................................................................................................. 9.9416 11.0672 14.8764 11.3347

400105 ............................................................................................................. 10.1726 9.3049 9.0556 9.5335

22802

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

400106 ............................................................................................................. 8.5143 9.3123 9.1611 8.9912

400109 ............................................................................................................. 10.1786 10.9826 11.8760 11.0486

400110 ............................................................................................................. 10.5250 10.3326 10.5277 10.4760

400111 ............................................................................................................. 9.5600 9.5583 10.9665 10.1021

400112 ............................................................................................................. 12.8478 10.1755 * 11.5026

400113 ............................................................................................................. 9.4835 9.2238 8.3168 9.0068

400114 ............................................................................................................. 6.4076 9.0496 7.0510 7.4630

400115 ............................................................................................................. 9.1311 9.8244 8.5487 9.1780

400117 ............................................................................................................. 10.0381 10.2295 10.8756 10.3823

400118 ............................................................................................................. 8.6964 9.4398 11.4051 9.9004

400120 ............................................................................................................. 9.7425 9.5274 10.6584 9.9956

400121 ............................................................................................................. 7.1061 7.8052 9.8322 8.2686

400122 ............................................................................................................. 8.4806 8.1911 7.6413 8.0571

400123 ............................................................................................................. 9.0217 7.8099 10.2367 9.0130

400124 ............................................................................................................. 11.4839 12.0999 12.2452 11.9729

400125 ............................................................................................................. * * 10.2056 10.2056

410001 ............................................................................................................. 22.5322 23.2808 22.0088 22.6048

410004 ............................................................................................................. 22.3212 22.4801 21.0638 22.0103

410005 ............................................................................................................. 21.2407 23.1444 22.7170 22.3365

410006 ............................................................................................................. 21.9798 23.3968 23.8700 23.0621

410007 ............................................................................................................. 20.9489 22.1452 23.1325 22.1106

410008 ............................................................................................................. 22.6133 23.0662 24.9726 23.5244

410009 ............................................................................................................. 24.0769 24.4899 23.9378 24.1687

410010 ............................................................................................................. 27.1426 26.9813 26.7847 26.9663

410011 ............................................................................................................. 24.3676 25.2926 26.0035 25.2143

410012 ............................................................................................................. 21.3337 24.5811 24.1695 23.4018

410013 ............................................................................................................. 25.0050 24.5122 24.8800 24.7951

420002 ............................................................................................................. 20.2049 19.4845 19.6477 19.7465

420004 ............................................................................................................. 19.4079 19.7968 20.8633 20.0389

420005 ............................................................................................................. 15.9906 17.3510 17.9694 17.1171

420006 ............................................................................................................. 18.2374 18.3439 19.1760 18.5687

420007 ............................................................................................................. 17.5783 18.2096 18.6456 18.1319

420009 ............................................................................................................. 17.2515 18.5456 19.8532 18.5742

420010 ............................................................................................................. 17.9141 17.1184 18.0252 17.6914

420011 ............................................................................................................. 14.9944 16.5664 18.0970 16.4913

420014 ............................................................................................................. 16.7219 16.6065 18.0519 17.0894

420015 ............................................................................................................. 17.1802 18.8411 20.1164 18.5841

420016 ............................................................................................................. 18.1451 15.6241 15.5485 16.2939

420018 ............................................................................................................. 19.7285 19.7367 21.8775 20.3791

420019 ............................................................................................................. 15.5521 16.9990 17.1726 16.5419

420020 ............................................................................................................. 17.9011 20.9449 20.2563 19.6716

420023 ............................................................................................................. 20.9663 19.4855 19.3278 19.8743

420026 ............................................................................................................. 21.8968 20.3476 21.8749 21.3678

420027 ............................................................................................................. 18.0774 18.8457 18.4837 18.4697

420029 ............................................................................................................. 18.3557 * * 18.3557

420030 ............................................................................................................. 17.8215 19.1453 20.6448 19.3038

420031 ............................................................................................................. 13.0718 14.1855 8.2516 11.1227

420033 ............................................................................................................. 21.0863 21.7279 23.1303 21.9705

420036 ............................................................................................................. 19.7421 17.6136 21.3791 19.4718

420037 ............................................................................................................. 21.9603 21.7908 22.7099 22.1669

420038 ............................................................................................................. 16.1498 17.6726 18.6568 17.4393

420039 ............................................................................................................. 16.9646 15.8385 18.3017 17.0260

420042 ............................................................................................................. 14.6567 * * 14.6567

420043 ............................................................................................................. 18.3607 19.4521 19.7570 19.1785

420048 ............................................................................................................. 18.0286 18.4367 18.8070 18.4223

420049 ............................................................................................................. 19.2340 17.5854 19.2946 18.6845

420051 ............................................................................................................. 18.2518 19.5001 19.2163 19.0146

420053 ............................................................................................................. 16.5452 16.9599 16.8300 16.7761

420054 ............................................................................................................. 16.5474 18.2702 20.2574 18.3229

420055 ............................................................................................................. 16.1823 19.2048 16.8717 17.3777

420056 ............................................................................................................. 15.5966 14.8695 15.1835 15.1636

420057 ............................................................................................................. 14.5006 15.9849 24.0765 18.1532

420059 ............................................................................................................. 19.1303 15.8160 17.1483 17.3325

22803

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

420061 ............................................................................................................. 16.1310 16.5555 17.3543 16.6881

420062 ............................................................................................................. 18.9513 17.8205 21.3792 19.3650

420064 ............................................................................................................. 15.4531 16.7227 16.0794 16.0985

420065 ............................................................................................................. 19.0645 19.6902 19.9435 19.5673

420066 ............................................................................................................. 15.5001 15.1804 18.0042 16.2261

420067 ............................................................................................................. 18.3106 18.8610 19.7824 19.0239

420068 ............................................................................................................. 17.2144 18.5030 18.5481 18.0958

420069 ............................................................................................................. 16.3189 17.0788 18.1298 17.2134

420070 ............................................................................................................. 17.4486 18.0057 17.3876 17.6174

420071 ............................................................................................................. 18.2878 19.4482 20.3902 19.3836

420072 ............................................................................................................. 12.6013 13.8550 15.0158 13.8117

420073 ............................................................................................................. 19.2011 19.1604 19.8502 19.4076

420074 ............................................................................................................. 13.8038 16.9292 17.7050 16.1034

420075 ............................................................................................................. 16.2946 14.2931 12.8158 14.3372

420078 ............................................................................................................. 20.6818 20.7317 21.2688 20.9023

420079 ............................................................................................................. 18.7710 20.8639 21.0874 20.2636

420080 ............................................................................................................. 24.8321 22.3443 21.9968 22.9897

420081 ............................................................................................................. 20.4211 * * 20.4211

420082 ............................................................................................................. 18.8848 20.4653 21.4326 20.2642

420083 ............................................................................................................. 23.3425 20.1472 22.6376 21.9902

420085 ............................................................................................................. 18.5502 19.9603 21.6791 20.1188

420086 ............................................................................................................. 19.3054 25.7179 20.2878 21.4636

420087 ............................................................................................................. 18.4016 19.1403 19.8388 19.1412

420088 ............................................................................................................. 17.9063 17.1938 19.9919 18.3046

420089 ............................................................................................................. 21.6608 20.2537 20.5360 20.7623

420091 ............................................................................................................. 18.5723 18.8687 20.3092 19.2195

420093 ............................................................................................................. 16.7734 17.4689 18.3902 17.5654

420094 ............................................................................................................. 32.6768 * * 32.6768

430004 ............................................................................................................. 17.8435 18.5438 19.6344 18.6310

430005 ............................................................................................................. 15.8449 16.3059 16.4560 16.2068

430007 ............................................................................................................. 14.0586 14.1078 14.6331 14.2620

430008 ............................................................................................................. 16.7640 17.6640 18.1323 17.5240

430010 ............................................................................................................. 16.1093 17.1766 19.8191 17.5891

430011 ............................................................................................................. 16.4234 16.9848 17.4750 16.9703

430012 ............................................................................................................. 17.7809 17.2775 17.5713 17.5419

430013 ............................................................................................................. 17.2424 18.1338 18.4817 17.9391

430014 ............................................................................................................. 18.4417 16.8925 19.9484 18.3095

430015 ............................................................................................................. 16.4123 18.0019 18.2875 17.5236

430016 ............................................................................................................. 18.9715 19.4759 20.8850 19.7559

430018 ............................................................................................................. 14.9100 14.8854 16.2244 15.3323

430022 ............................................................................................................. 12.9532 13.4905 14.5118 13.6222

430023 ............................................................................................................. 11.6383 12.2331 16.2164 13.2302

430024 ............................................................................................................. 13.9942 15.4709 16.1801 15.3449

430026 ............................................................................................................. 10.8532 * * 10.8532

430027 ............................................................................................................. 18.6367 19.1461 20.2591 19.2968

430028 ............................................................................................................. 16.7185 18.2312 17.1574 17.3521

430029 ............................................................................................................. 15.1010 16.6500 17.6986 16.5066

430031 ............................................................................................................. 12.4631 13.1258 12.4660 12.6792

430033 ............................................................................................................. 14.6423 15.3003 17.3652 15.6688

430034 ............................................................................................................. 12.8513 15.4064 14.2491 14.1740

430036 ............................................................................................................. 13.7807 13.6967 15.6258 14.3461

430037 ............................................................................................................. 15.9545 16.5368 18.1293 16.8632

430038 ............................................................................................................. 11.9419 13.7167 18.4078 14.2118

430040 ............................................................................................................. 13.3722 13.6745 14.4509 13.8057

430041 ............................................................................................................. 12.6235 13.1936 14.8816 13.4964

430043 ............................................................................................................. 13.4288 13.6908 14.9949 14.0204

430044 ............................................................................................................. 16.4488 18.4970 21.0823 18.5195

430047 ............................................................................................................. 15.6227 17.4956 17.9823 16.9377

430048 ............................................................................................................. 17.2589 18.3524 19.6010 18.3783

430049 ............................................................................................................. 14.4354 15.5381 15.2237 15.0640

430051 ............................................................................................................. 17.2139 17.0574 18.8070 17.6987

430054 ............................................................................................................. 13.5011 14.7251 14.8003 14.3524

430056 ............................................................................................................. 11.4117 11.7627 9.7578 10.9731

22804

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

430057 ............................................................................................................. 15.1516 15.4390 17.2805 15.9601

430060 ............................................................................................................. 8.6409 9.0358 10.0176 9.2343

430062 ............................................................................................................. 10.8879 * * 10.8879

430064 ............................................................................................................. 12.7394 14.4367 14.2184 13.7779

430065 ............................................................................................................. 12.7660 * * 12.7660

430066 ............................................................................................................. 13.4380 14.3557 15.6660 14.4524

430073 ............................................................................................................. 14.9784 16.1133 15.3776 15.4839

430076 ............................................................................................................. 12.2452 12.7608 13.9883 12.9521

430077 ............................................................................................................. 17.7126 19.3012 19.8558 18.9586

430079 ............................................................................................................. 12.9780 13.6836 14.1815 13.5924

430087 ............................................................................................................. 10.4491 * * 10.4491

430089 ............................................................................................................. 17.0065 17.8908 17.9790 17.6658

430090 ............................................................................................................. * 21.5239 21.5974 21.5592

430091 ............................................................................................................. * 19.2146 18.1567 18.5152

430092 ............................................................................................................. * * 21.3807 21.3807

430093 ............................................................................................................. * * 19.5013 19.5013

440001 ............................................................................................................. 15.3134 14.8713 15.5897 15.2550

440002 ............................................................................................................. 18.5411 19.1498 20.3740 19.3756

440003 ............................................................................................................. 17.4736 18.3658 19.3042 18.3967

440006 ............................................................................................................. 20.6559 19.6021 21.1072 20.4264

440007 ............................................................................................................. 7.7632 12.1230 14.8959 11.0241

440008 ............................................................................................................. 15.4701 17.2848 18.8994 17.1822

440009 ............................................................................................................. 15.4558 17.8424 17.4831 16.9676

440010 ............................................................................................................. 13.5118 19.9829 16.3283 16.4644

440011 ............................................................................................................. 17.1591 17.6948 18.3375 17.7161

440012 ............................................................................................................. 19.0606 15.9837 19.5537 18.2430

440014 ............................................................................................................. 14.6093 15.9195 16.1143 15.5705

440015 ............................................................................................................. 21.0884 18.2632 22.0659 20.4116

440016 ............................................................................................................. 14.9409 15.4097 16.2964 15.5583

440017 ............................................................................................................. 21.1258 19.6215 20.4426 20.3788

440018 ............................................................................................................. 18.2080 16.4115 17.4995 17.3550

440019 ............................................................................................................. 28.2242 20.0416 21.0768 22.6204

440020 ............................................................................................................. 15.5889 18.1154 17.4666 17.0702

440022 ............................................................................................................. 19.0214 15.8459 * 17.5909

440023 ............................................................................................................. 14.1410 15.4721 16.6111 15.3545

440024 ............................................................................................................. 18.1028 18.4432 18.4046 18.3183

440025 ............................................................................................................. 15.2826 15.8784 16.3140 15.8395

440026 ............................................................................................................. 22.9174 23.0550 23.2566 23.0549

440029 ............................................................................................................. 18.5183 19.4326 20.7050 19.5797

440030 ............................................................................................................. 15.5718 16.2941 16.9925 16.3267

440031 ............................................................................................................. 14.3023 15.5432 17.0211 15.6197

440032 ............................................................................................................. 13.5996 13.9775 13.8140 13.7931

440033 ............................................................................................................. 14.0409 14.5304 13.7328 14.1227

440034 ............................................................................................................. 17.9315 19.5470 19.5135 19.0190

440035 ............................................................................................................. 18.1578 18.9026 19.3034 18.7862

440039 ............................................................................................................. 19.3747 19.9439 21.6560 20.3432

440040 ............................................................................................................. 17.4965 16.3740 16.9275 16.9214

440041 ............................................................................................................. 13.6279 14.6621 14.9545 14.4249

440046 ............................................................................................................. 16.8798 18.1654 19.0756 18.0134

440047 ............................................................................................................. 17.0037 16.6646 17.8092 17.1528

440048 ............................................................................................................. 18.1449 19.4498 21.4993 19.5981

440049 ............................................................................................................. 16.7066 17.9292 20.8371 18.4663

440050 ............................................................................................................. 16.7627 19.1328 18.2511 18.0098

440051 ............................................................................................................. 14.9074 13.1901 16.0421 14.6532

440052 ............................................................................................................. 16.2693 16.6541 * 16.4546

440053 ............................................................................................................. 17.6873 18.5515 19.6494 18.6583

440054 ............................................................................................................. 12.3134 13.8716 13.3967 13.1942

440056 ............................................................................................................. 14.2534 15.9821 16.2742 15.4778

440057 ............................................................................................................. 12.7190 12.7925 13.7257 13.0446

440058 ............................................................................................................. 18.7381 18.8118 16.5104 18.0102

440059 ............................................................................................................. 17.5274 18.5418 19.6018 18.6049

440060 ............................................................................................................. 15.8599 18.0586 19.7916 17.7309

440061 ............................................................................................................. 16.8442 14.9708 24.0082 18.4685

22805

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

440063 ............................................................................................................. 18.2923 19.3222 18.5737 18.7318

440064 ............................................................................................................. 17.6154 17.7652 18.8038 18.0538

440065 ............................................................................................................. 18.6943 18.5825 16.6540 17.9684

440067 ............................................................................................................. 22.0655 16.2811 17.1917 18.2178

440068 ............................................................................................................. 17.4513 19.4695 19.1569 18.6340

440070 ............................................................................................................. 15.0440 13.7035 14.0437 14.2715

440071 ............................................................................................................. 16.2691 17.0186 16.9416 16.7371

440072 ............................................................................................................. 16.7675 17.5995 19.1522 17.8026

440073 ............................................................................................................. 18.5576 19.1714 19.5554 19.1079

440078 ............................................................................................................. 13.0916 15.0849 16.0188 14.6728

440081 ............................................................................................................. 17.9702 18.3587 18.9886 18.4558

440082 ............................................................................................................. 23.0805 22.2857 20.3664 21.8599

440083 ............................................................................................................. 35.0978 14.8525 13.7423 17.4998

440084 ............................................................................................................. 13.3678 13.4378 13.7731 13.5305

440091 ............................................................................................................. 19.7250 19.6114 20.1065 19.8343

440100 ............................................................................................................. 13.9487 13.8437 14.7113 14.1637

440102 ............................................................................................................. 13.9575 14.3510 14.5500 14.2949

440103 ............................................................................................................. 19.2083 20.3052 18.6990 19.3857

440104 ............................................................................................................. 22.3883 22.4403 22.6754 22.4883

440105 ............................................................................................................. 16.0338 16.7131 17.1172 16.6050

440109 ............................................................................................................. 14.2491 16.0446 17.7443 15.8919

440110 ............................................................................................................. 15.9174 21.1716 17.4123 17.8783

440111 ............................................................................................................. 21.0682 23.2425 23.2254 22.5309

440114 ............................................................................................................. 13.6095 14.4997 15.0036 14.3318

440115 ............................................................................................................. 12.9668 17.4514 18.5457 16.2205

440120 ............................................................................................................. 18.2993 17.2384 16.3115 17.2831

440125 ............................................................................................................. 16.1067 15.6588 19.0514 16.9328

440130 ............................................................................................................. 16.6750 17.8223 17.4857 17.3264

440131 ............................................................................................................. 14.6752 15.5048 16.1214 15.4186

440132 ............................................................................................................. 15.9069 16.6553 16.8871 16.4950

440133 ............................................................................................................. 21.5116 21.5313 22.7184 21.8977

440135 ............................................................................................................. 20.9029 19.2010 22.2707 20.8388

440137 ............................................................................................................. 14.6966 14.5632 15.0070 14.7511

440141 ............................................................................................................. 12.4774 13.5308 15.9429 13.7977

440142 ............................................................................................................. 13.0059 15.7287 16.7797 15.0556

440143 ............................................................................................................. 17.8429 17.7821 18.2061 17.9416

440144 ............................................................................................................. 16.6666 17.6415 18.4330 17.5831

440145 ............................................................................................................. 13.6577 17.0608 18.3948 16.1716

440147 ............................................................................................................. 22.0069 21.4304 26.1464 23.0399

440148 ............................................................................................................. 17.6438 19.2435 19.4598 18.7842

440149 ............................................................................................................. 17.1496 16.6923 14.8350 16.2240

440150 ............................................................................................................. 13.0775 20.1411 20.0178 17.1910

440151 ............................................................................................................. 15.4250 17.4248 18.1216 16.9820

440152 ............................................................................................................. 17.8399 21.0287 22.7664 20.2196

440153 ............................................................................................................. 16.0954 16.7769 16.0572 16.3283

440156 ............................................................................................................. 19.6117 29.5557 21.0346 22.8749

440157 ............................................................................................................. 11.3982 16.9265 18.4249 15.5384

440159 ............................................................................................................. 17.6237 17.7158 20.9371 18.4872

440161 ............................................................................................................. 20.7643 21.8013 22.1611 21.5480

440162 ............................................................................................................. 14.4121 14.7637 * 14.5681

440166 ............................................................................................................. 18.1413 19.6684 19.2159 18.9985

440168 ............................................................................................................. 15.9513 18.6535 19.1509 17.9995

440173 ............................................................................................................. 18.4683 18.6402 19.1299 18.7524

440174 ............................................................................................................. 17.0080 17.3294 18.0865 17.4583

440175 ............................................................................................................. 17.6107 20.0802 15.5827 17.7347

440176 ............................................................................................................. 18.7529 18.0294 18.9159 18.5457

440180 ............................................................................................................. 17.3412 19.7773 20.4039 19.2011

440181 ............................................................................................................. 11.8471 16.4878 17.7709 15.0662

440182 ............................................................................................................. 20.3202 17.7487 19.7094 19.1341

440183 ............................................................................................................. 19.4374 22.7067 21.3465 21.1277

440184 ............................................................................................................. 18.0603 17.2037 16.8880 17.4646

440185 ............................................................................................................. 18.7286 19.3870 * 19.0562

440186 ............................................................................................................. 18.5312 19.3948 15.8016 17.9134

22806

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

440187 ............................................................................................................. 16.2530 18.9713 15.3044 16.8551

440189 ............................................................................................................. 16.1906 * 18.5252 17.4309

440192 ............................................................................................................. 19.9669 19.0839 16.5173 18.5279

440193 ............................................................................................................. 18.3952 19.0811 18.2608 18.5816

440194 ............................................................................................................. 20.3343 19.8682 22.2384 20.8427

440197 ............................................................................................................. 23.1080 21.9618 21.3772 22.0839

440200 ............................................................................................................. 16.0619 17.9575 19.5226 17.9170

440203 ............................................................................................................. 16.6132 18.3400 16.2861 17.0710

440206 ............................................................................................................. 15.5462 16.4429 * 16.0270

440209 ............................................................................................................. 14.7466 * * 14.7466

440210 ............................................................................................................. 12.3292 11.0218 11.0719 11.3670

440211 ............................................................................................................. * 14.8972 * 14.8972

440212 ............................................................................................................. * 17.0685 * 17.0685

440213 ............................................................................................................. * 19.5760 * 19.5760

440214 ............................................................................................................. * * 28.0285 28.0285

440215 ............................................................................................................. * * 22.2928 22.2928

450002 ............................................................................................................. 19.9195 21.3749 21.4770 20.9126

450004 ............................................................................................................. 15.2751 16.6723 16.7850 16.2360

450005 ............................................................................................................. 15.5888 18.3600 16.6396 16.8103

450007 ............................................................................................................. 15.7536 16.9681 19.1910 17.3218

450008 ............................................................................................................. 15.7458 17.0832 17.6582 16.7901

450010 ............................................................................................................. 16.0790 16.5001 17.6677 17.0234

450011 ............................................................................................................. 18.0137 17.1942 20.5022 18.5856

450014 ............................................................................................................. 18.2173 17.9495 17.5550 17.8927

450015 ............................................................................................................. 18.4400 18.9895 20.0974 19.1233

450016 ............................................................................................................. 17.3054 18.4463 18.3456 18.0337

450018 ............................................................................................................. 20.4133 21.4788 22.8298 21.4884

450020 ............................................................................................................. 16.9661 17.8415 19.1153 18.0122

450021 ............................................................................................................. 22.6910 23.0843 21.7842 22.5219

450023 ............................................................................................................. 16.6408 16.0831 17.6360 16.7896

450024 ............................................................................................................. 16.5604 17.3518 18.5649 17.4769

450025 ............................................................................................................. 16.4396 17.0004 * 16.7280

450028 ............................................................................................................. 18.4287 18.8764 17.4971 18.2201

450029 ............................................................................................................. 17.6909 17.4716 17.5595 17.5741

450031 ............................................................................................................. 20.8992 22.2222 29.6945 23.8280

450032 ............................................................................................................. 15.2404 17.3317 13.9785 15.3652

450033 ............................................................................................................. 20.8634 19.7437 20.7772 20.4518

450034 ............................................................................................................. 18.9068 19.6721 18.7154 19.0969

450035 ............................................................................................................. 16.8132 20.0951 20.3500 19.0191

450037 ............................................................................................................. 18.6549 19.5411 19.8210 19.3526

450039 ............................................................................................................. 22.0811 19.8143 17.9888 20.0023

450040 ............................................................................................................. 17.5179 16.8534 19.6370 18.0669

450042 ............................................................................................................. 17.5906 19.8921 18.4417 18.6126

450044 ............................................................................................................. 21.0399 24.7961 20.1028 21.8870

450046 ............................................................................................................. 17.0917 18.6536 18.0851 17.8763

450047 ............................................................................................................. 13.9022 13.4486 16.9028 14.6102

450050 ............................................................................................................. 13.0037 14.7669 15.9701 14.4910

450051 ............................................................................................................. 20.0763 21.0236 20.2292 20.4528

450052 ............................................................................................................. 13.5278 13.8881 15.2911 14.2591

450053 ............................................................................................................. 17.3139 17.0467 14.3712 16.3666

450054 ............................................................................................................. 21.9835 22.8960 15.9388 20.5562

450055 ............................................................................................................. 14.8119 15.0433 15.8526 15.2415

450056 ............................................................................................................. 20.0008 21.8436 20.4781 20.7787

450058 ............................................................................................................. 16.9832 18.0967 17.4599 17.5079

450059 ............................................................................................................. 14.2072 15.2168 19.7037 16.2518

450063 ............................................................................................................. 13.8126 14.3815 12.7037 13.6024

450064 ............................................................................................................. 16.4165 17.4093 19.7682 17.8341

450065 ............................................................................................................. 19.6087 21.4934 23.3797 21.3723

450068 ............................................................................................................. 22.6924 22.8998 21.9406 22.5334

450072 ............................................................................................................. 17.3794 19.0111 18.0307 18.1442

450073 ............................................................................................................. 16.6168 17.1002 17.4642 17.0560

450078 ............................................................................................................. 13.4875 11.7265 13.2820 12.8188

450079 ............................................................................................................. 19.4899 21.0518 19.5823 20.0919

22807

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

450080 ............................................................................................................. 16.3147 17.4553 19.5691 17.8032

450081 ............................................................................................................. 16.1653 16.3448 17.5737 16.7023

450082 ............................................................................................................. 13.2952 16.1585 18.1087 15.9363

450083 ............................................................................................................. 20.1830 21.5884 20.8111 20.8940

450085 ............................................................................................................. 14.2167 18.3602 20.0085 17.2728

450087 ............................................................................................................. 21.4764 22.0273 21.8971 21.7995

450090 ............................................................................................................. 13.9101 15.0939 15.7102 14.9065

450092 ............................................................................................................. 15.7316 16.8260 17.9520 16.8805

450094 ............................................................................................................. 19.4249 21.3158 23.0087 21.3016

450096 ............................................................................................................. 16.6300 17.8813 18.6802 17.7158

450097 ............................................................................................................. 18.2740 19.5723 19.7187 19.2252

450098 ............................................................................................................. 15.4796 20.5754 19.1707 18.3853

450099 ............................................................................................................. 22.8834 19.2258 20.4181 20.6312

450101 ............................................................................................................. 16.9628 17.1330 18.1155 17.3801

450102 ............................................................................................................. 18.8465 18.6707 18.5587 18.6892

450104 ............................................................................................................. 15.9781 16.6744 16.9800 16.5575

450107 ............................................................................................................. 20.7359 25.1986 23.0798 22.8910

450108 ............................................................................................................. 16.1451 15.6324 15.2394 15.6277

450109 ............................................................................................................. 12.7654 13.8127 10.7641 12.1774

450110 ............................................................................................................. 21.4421 19.5821 * 20.4354

450111 ............................................................................................................. 19.2749 19.6350 * 19.4562

450112 ............................................................................................................. 14.7610 16.0441 14.3254 14.9837

450113 ............................................................................................................. 18.5356 20.9777 20.8306 19.9901

450118 ............................................................................................................. 15.8317 17.9053 * 16.9195

450119 ............................................................................................................. 18.3166 20.2853 20.1852 19.6454

450121 ............................................................................................................. 18.2278 20.4641 21.6525 20.0695

450123 ............................................................................................................. 19.1912 15.7618 14.1755 16.0237

450124 ............................................................................................................. 21.0925 22.7480 21.9767 21.9459

450126 ............................................................................................................. 17.4512 21.7233 21.4686 19.9524

450128 ............................................................................................................. 15.8881 18.2184 18.1446 17.4552

450130 ............................................................................................................. 17.8722 20.4156 17.4027 18.5777

450131 ............................................................................................................. 17.6163 19.2589 17.4168 18.0711

450132 ............................................................................................................. 18.0745 18.1713 16.8847 17.6996

450133 ............................................................................................................. 19.9259 23.6366 26.0763 23.0339

450135 ............................................................................................................. 20.8065 21.0306 22.0320 21.2622

450137 ............................................................................................................. 23.9555 22.4590 23.1148 23.1794

450140 ............................................................................................................. 18.0743 20.2280 17.2060 18.5255

450143 ............................................................................................................. 14.4623 14.5270 14.8917 14.6528

450144 ............................................................................................................. 16.3037 18.1121 18.7521 17.8369

450145 ............................................................................................................. 14.8441 15.6078 15.8542 15.4241

450146 ............................................................................................................. 14.2041 17.8572 15.5030 15.8115

450147 ............................................................................................................. 18.0664 18.9363 18.5236 18.5193

450148 ............................................................................................................. 22.0269 18.6758 24.1780 21.4997

450149 ............................................................................................................. 24.0005 19.7521 21.7219 21.7182

450150 ............................................................................................................. 15.2061 16.3719 17.8612 16.4235

450151 ............................................................................................................. 14.8373 15.2906 16.4209 15.5098

450152 ............................................................................................................. 17.3780 18.0061 17.7265 17.7015

450153 ............................................................................................................. 19.9447 19.4419 17.3002 18.8465

450154 ............................................................................................................. 13.1810 13.8731 13.9119 13.6623

450155 ............................................................................................................. 23.7678 11.5841 13.3456 14.7760

450157 ............................................................................................................. 14.6623 15.6371 15.3083 15.2158

450160 ............................................................................................................. 8.7503 16.6533 10.6852 11.1452

450162 ............................................................................................................. 22.1981 20.9560 21.9218 21.6852

450163 ............................................................................................................. 16.9811 17.5403 18.1128 17.5693

450164 ............................................................................................................. 20.0368 16.9741 17.7723 18.1030

450165 ............................................................................................................. 15.1561 13.9218 14.3250 14.4625

450166 ............................................................................................................. 10.2801 11.4772 11.0097 10.9389

450169 ............................................................................................................. 15.8793 13.1990 * 14.1674

450170 ............................................................................................................. 14.8131 14.2997 14.3234 14.4821

450176 ............................................................................................................. 16.3031 16.9674 17.2576 16.8653

450177 ............................................................................................................. 14.7280 14.9241 15.2440 14.9810

450178 ............................................................................................................. 16.7550 17.8508 16.0280 16.8828

450181 ............................................................................................................. 14.0192 15.5622 16.9427 15.5485

22808

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

450184 ............................................................................................................. 19.9674 21.1263 18.7419 19.9896

450185 ............................................................................................................. 13.0632 14.0714 11.1599 12.6084

450187 ............................................................................................................. 17.5702 16.6945 18.2036 17.4833

450188 ............................................................................................................. 13.7757 14.3938 15.1954 14.4624

450191 ............................................................................................................. 18.8023 20.1222 20.9512 19.9757

450192 ............................................................................................................. 19.3352 20.3795 21.2497 20.3207

450193 ............................................................................................................. 22.7325 23.1963 23.2623 23.0664

450194 ............................................................................................................. 19.1466 20.5187 20.4842 20.0547

450196 ............................................................................................................. 16.4929 17.1955 18.1011 17.2598

450200 ............................................................................................................. 17.3756 18.7387 19.2228 18.4203

450201 ............................................................................................................. 17.0548 16.9908 16.9500 16.9956

450203 ............................................................................................................. 18.6552 20.6712 19.0752 19.4944

450209 ............................................................................................................. 18.6566 19.0811 19.8943 19.1865

450210 ............................................................................................................. 14.2317 13.9758 16.5059 14.8500

450211 ............................................................................................................. 17.1433 17.9857 18.6419 17.9272

450213 ............................................................................................................. 18.4472 17.7631 18.3953 18.2239

450214 ............................................................................................................. 17.2465 19.0475 20.9959 19.0269

450217 ............................................................................................................. 11.6893 12.8457 12.7647 12.4509

450219 ............................................................................................................. 15.4207 15.3976 17.6884 16.1962

450221 ............................................................................................................. 16.9935 16.3700 15.0701 16.0556

450222 ............................................................................................................. 18.4542 20.3129 19.8967 19.5439

450224 ............................................................................................................. 22.8300 24.9046 16.2265 20.5869

450229 ............................................................................................................. 16.4116 16.4503 16.7853 16.5551

450231 ............................................................................................................. 17.7045 19.1564 18.8419 18.8309

450234 ............................................................................................................. 13.3012 16.1945 16.3955 15.4391

450235 ............................................................................................................. 13.4177 15.2332 16.1851 15.0198

450236 ............................................................................................................. 15.6774 16.6703 16.4957 16.3054

450237 ............................................................................................................. 17.3984 20.7930 18.0874 18.7189

450239 ............................................................................................................. 13.6376 17.1308 17.8401 16.0311

450241 ............................................................................................................. 14.8674 12.5675 16.4240 14.4148

450243 ............................................................................................................. 12.3626 11.9099 13.1754 12.4894

450246 ............................................................................................................. 17.9702 16.5478 16.7959 17.0548

450249 ............................................................................................................. 11.6279 12.0302 11.7658 11.8055

450250 ............................................................................................................. 14.9133 10.2844 13.6787 12.3052

450253 ............................................................................................................. 15.3542 12.2402 13.2177 13.4392

450258 ............................................................................................................. 13.2334 16.0466 16.7337 15.4196

450259 ............................................................................................................. 17.8488 * * 17.8488

450264 ............................................................................................................. 13.8879 13.8929 14.5956 14.1447

450269 ............................................................................................................. 14.9334 12.3594 12.3957 13.0850

450270 ............................................................................................................. 12.7018 12.8381 14.1324 13.1772

450271 ............................................................................................................. 15.4998 16.6319 16.7831 16.3572

450272 ............................................................................................................. 17.9514 19.9331 18.4344 18.7713

450276 ............................................................................................................. 12.7053 13.1155 14.0745 13.3159

450278 ............................................................................................................. 13.7894 14.8291 15.2950 14.5985

450280 ............................................................................................................. 19.4926 22.2984 20.1523 20.6175

450283 ............................................................................................................. 13.8916 14.5664 15.1950 14.5306

450286 ............................................................................................................. 12.1212 * * 12.1212

450288 ............................................................................................................. 15.9878 16.2502 18.3824 16.7799

450289 ............................................................................................................. 18.3478 20.3104 20.0002 19.5531

450292 ............................................................................................................. 19.5050 16.9693 16.1840 17.4483

450293 ............................................................................................................. 14.4281 16.0132 15.8531 15.4701

450296 ............................................................................................................. 20.6628 21.6000 22.3430 21.5410

450299 ............................................................................................................. 17.9678 21.5672 * 19.7778

450303 ............................................................................................................. 12.6720 12.4582 12.8996 12.6812

450306 ............................................................................................................. 13.3165 13.8216 14.3639 13.8801

450307 ............................................................................................................. 16.6779 16.4622 17.0691 16.7424

450309 ............................................................................................................. 16.2055 13.1480 11.4661 13.2592

450315 ............................................................................................................. 20.8043 22.8140 21.4684 21.6913

450320 ............................................................................................................. 19.6331 20.0946 20.6596 20.1159

450321 ............................................................................................................. 13.3932 13.1752 14.6055 13.7332

450322 ............................................................................................................. 12.4570 22.7667 29.1884 20.6852

450324 ............................................................................................................. 17.8697 17.7886 18.6228 18.0773

450327 ............................................................................................................. 16.0935 11.7511 13.3639 13.4001

22809

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

450330 ............................................................................................................. 18.4163 18.9425 19.8066 19.0827

450334 ............................................................................................................. 12.2721 12.8051 13.7850 12.9653

450337 ............................................................................................................. 17.4208 17.1073 25.1355 18.7580

450340 ............................................................................................................. 15.8519 17.6914 * 16.7663

450341 ............................................................................................................. 19.1828 18.9429 * 19.0666

450346 ............................................................................................................. 17.1038 17.5367 18.9475 17.8083

450347 ............................................................................................................. 17.6908 17.1099 19.2848 18.0094

450348 ............................................................................................................. 12.9414 13.9535 13.2741 13.3967

450351 ............................................................................................................. 15.9772 18.4116 18.7311 17.7343

450352 ............................................................................................................. 17.8528 18.7480 20.1871 18.9532

450353 ............................................................................................................. 15.0020 17.7539 16.0003 16.2513

450355 ............................................................................................................. 14.3182 11.9473 11.7765 12.5557

450358 ............................................................................................................. 21.2812 22.3235 23.2886 22.3172

450362 ............................................................................................................. 15.3536 15.8847 18.1747 16.4652

450369 ............................................................................................................. 15.1854 15.2233 14.4262 14.9370

450370 ............................................................................................................. 15.4368 12.6061 14.6709 14.1203

450371 ............................................................................................................. 11.8996 24.6339 16.0236 16.3341

450372 ............................................................................................................. 19.8589 20.0924 19.9926 19.9822

450373 ............................................................................................................. 17.5998 17.4183 17.9531 17.6605

450374 ............................................................................................................. 12.8264 13.6099 15.1750 13.8338

450378 ............................................................................................................. 23.1598 23.5789 23.4599 23.4221

450379 ............................................................................................................. 20.2756 22.7632 22.8756 21.9542

450381 ............................................................................................................. 15.6215 16.4166 15.2513 15.8628

450388 ............................................................................................................. 17.5561 19.2499 18.9920 18.6062

450389 ............................................................................................................. 18.1478 18.1797 18.6769 18.3421

450393 ............................................................................................................. 18.7387 20.2784 22.4992 20.3300

450395 ............................................................................................................. 16.6754 18.3768 17.5097 17.5123

450399 ............................................................................................................. 16.3066 15.7845 15.3491 15.8113

450400 ............................................................................................................. 14.0761 19.5379 18.6668 17.2665

450403 ............................................................................................................. 21.3691 20.1989 22.7969 21.4798

450411 ............................................................................................................. 14.0463 14.4832 14.8054 14.4468

450417 ............................................................................................................. 13.8517 13.4983 15.3591 14.2291

450418 ............................................................................................................. 20.5847 21.9161 21.9690 21.5007

450419 ............................................................................................................. 21.8196 20.6325 22.8505 21.7461

450422 ............................................................................................................. 24.5309 26.4848 28.0257 26.2815

450423 ............................................................................................................. 19.4352 22.7132 * 20.9607

450424 ............................................................................................................. 17.5658 18.9741 18.7478 18.4717

450429 ............................................................................................................. 11.3811 13.8723 * 12.4654

450431 ............................................................................................................. 16.2696 19.6304 20.8421 18.7034

450438 ............................................................................................................. 16.5461 19.5028 14.5873 16.7445

450446 ............................................................................................................. 21.9685 13.0986 20.7592 18.0346

450447 ............................................................................................................. 16.6124 18.0376 18.1815 17.5795

450451 ............................................................................................................. 19.6424 18.8948 18.1921 18.8786

450457 ............................................................................................................. 19.7689 24.7880 19.6569 21.1382

450460 ............................................................................................................. 14.2156 15.1765 14.5364 14.6270

450462 ............................................................................................................. 20.1347 22.6212 17.9464 20.1419

450464 ............................................................................................................. 13.4714 13.2931 15.5908 14.0563

450465 ............................................................................................................. 15.2203 15.5650 15.4731 15.4326

450467 ............................................................................................................. 15.6034 10.6184 16.8658 13.7380

450469 ............................................................................................................. 22.1012 19.6269 21.1652 20.9069

450473 ............................................................................................................. 14.1895 19.9761 19.7148 17.9827

450475 ............................................................................................................. 16.2489 16.3404 16.4898 16.3610

450484 ............................................................................................................. 19.5869 16.8131 18.2663 18.1595

450488 ............................................................................................................. 18.6813 19.3457 19.2173 19.0899

450489 ............................................................................................................. 14.5747 9.9326 15.8517 12.9537

450497 ............................................................................................................. 11.9242 15.0886 15.1284 14.0029

450498 ............................................................................................................. 12.0249 13.8551 14.4713 13.5076

450508 ............................................................................................................. 19.8722 18.8069 18.7309 19.1164

450514 ............................................................................................................. 22.2791 21.3243 20.0144 21.2387

450517 ............................................................................................................. 12.8702 27.8815 14.3191 16.6822

450518 ............................................................................................................. 19.0112 19.8116 21.4888 20.0420

450523 ............................................................................................................. 20.2589 20.0792 20.8894 20.3958

450530 ............................................................................................................. 22.9101 22.8623 21.1634 22.2676

22810

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

450534 ............................................................................................................. 24.0835 19.9376 20.1520 21.2600

450535 ............................................................................................................. 21.2659 19.6645 21.0513 20.6461

450537 ............................................................................................................. 21.7432 20.8438 20.1161 20.8690

450538 ............................................................................................................. 19.6864 * * 19.6864

450539 ............................................................................................................. 14.2536 16.4921 17.7681 16.1703

450544 ............................................................................................................. 19.3848 23.9283 23.8271 21.9636

450545 ............................................................................................................. 16.9674 19.5558 20.2823 18.9428

450547 ............................................................................................................. 13.8074 14.8248 17.8756 15.6065

450551 ............................................................................................................. 13.9069 16.9439 16.6237 15.8128

450558 ............................................................................................................. 20.0164 22.2574 20.7404 21.0120

450559 ............................................................................................................. 13.4572 * * 13.4572

450561 ............................................................................................................. 16.8162 * * 16.8162

450563 ............................................................................................................. 30.3744 19.9218 21.3788 22.6596

450565 ............................................................................................................. 16.4545 16.2652 17.3803 16.7063

450570 ............................................................................................................. 17.7135 18.9532 19.0336 18.5591

450571 ............................................................................................................. 16.9705 17.5598 18.2784 17.6264

450573 ............................................................................................................. 15.6698 12.2502 17.0111 14.8796

450574 ............................................................................................................. 14.2411 14.5965 14.6128 14.4845

450575 ............................................................................................................. 19.0613 19.3925 22.5621 20.3955

450578 ............................................................................................................. 16.8731 15.4783 17.7906 16.6611

450580 ............................................................................................................. 15.3581 15.8321 16.5934 15.9704

450583 ............................................................................................................. 15.5040 15.6580 14.4411 15.1895

450584 ............................................................................................................. 13.3747 14.2321 14.7876 14.1390

450586 ............................................................................................................. 12.8439 14.3773 13.7155 13.6793

450587 ............................................................................................................. 17.1124 17.0230 18.5905 17.5554

450591 ............................................................................................................. 17.9151 17.8981 17.7442 17.8480

450596 ............................................................................................................. 14.8232 22.5420 21.6729 19.1117

450597 ............................................................................................................. 16.1797 17.0776 17.6667 16.9974

450603 ............................................................................................................. 12.7682 11.6442 23.5572 15.3844

450604 ............................................................................................................. 15.4790 16.4535 17.2702 16.4273

450605 ............................................................................................................. 20.1541 21.1400 19.4580 20.2362

450609 ............................................................................................................. 10.7323 15.9753 16.7508 14.5094

450610 ............................................................................................................. 16.7464 18.9924 19.2006 18.3347

450614 ............................................................................................................. 13.8304 17.9853 16.5754 15.9153

450615 ............................................................................................................. 14.7457 14.8562 15.1188 14.9156

450617 ............................................................................................................. 19.5381 20.3387 20.8919 20.3006

450620 ............................................................................................................. 13.7063 15.8380 16.0987 15.2421

450623 ............................................................................................................. 21.8275 22.1950 15.3964 19.4094

450626 ............................................................................................................. 19.7896 18.1673 18.4349 18.7617

450628 ............................................................................................................. 16.8345 20.5611 18.6078 18.6471

450630 ............................................................................................................. 19.1904 21.6876 20.9444 20.5676

450631 ............................................................................................................. 17.5555 20.0417 21.5359 19.4585

450632 ............................................................................................................. 12.7295 11.7587 13.9147 12.7814

450633 ............................................................................................................. 20.7209 19.5183 19.3340 19.8372

450634 ............................................................................................................. 20.2932 23.5333 22.9877 22.3295

450638 ............................................................................................................. 19.6968 23.1437 22.1704 21.6228

450639 ............................................................................................................. 20.3050 23.1936 20.9189 21.4283

450641 ............................................................................................................. 13.5049 16.5125 15.7019 15.1464

450643 ............................................................................................................. 17.4268 18.7054 16.8152 17.6481

450644 ............................................................................................................. 20.7904 23.6587 22.7721 22.2903

450646 ............................................................................................................. 19.9866 19.8274 18.0467 19.2248

450647 ............................................................................................................. 22.4196 24.7981 24.1058 23.8008

450648 ............................................................................................................. 14.7541 14.8488 14.8968 14.8343

450649 ............................................................................................................. 15.8156 16.4496 16.6577 16.3245

450651 ............................................................................................................. 20.7304 22.7664 22.6977 22.1014

450652 ............................................................................................................. 16.6461 13.4389 17.2445 15.4912

450653 ............................................................................................................. 19.2847 18.1834 19.2349 18.8580

450654 ............................................................................................................. 13.8833 14.5258 14.5423 14.3223

450656 ............................................................................................................. 18.7328 17.6723 18.2606 18.1968

450658 ............................................................................................................. 15.1477 16.2657 17.2630 16.2787

450659 ............................................................................................................. 20.5609 22.2550 23.0108 21.9106

450661 ............................................................................................................. 20.2196 19.7160 18.9071 19.5857

450662 ............................................................................................................. 18.6797 18.2284 18.5812 18.4954

22811

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

450665 ............................................................................................................. 15.4395 15.2015 14.3068 14.9933

450666 ............................................................................................................. 19.3456 20.3248 20.2549 19.9584

450668 ............................................................................................................. 18.7218 20.6965 21.0972 20.1590

450669 ............................................................................................................. 22.2832 21.7632 21.4199 21.7939

450670 ............................................................................................................. 18.2030 16.8893 20.2632 18.5133

450672 ............................................................................................................. 21.2079 21.8559 21.4175 21.4876

450673 ............................................................................................................. 13.8444 13.9620 12.4735 13.3217

450674 ............................................................................................................. 20.6151 22.2796 22.2305 21.7310

450675 ............................................................................................................. 23.2587 22.4961 21.4164 22.2737

450677 ............................................................................................................. 18.7905 22.6839 20.6556 20.7200

450678 ............................................................................................................. 20.7453 23.2617 24.1301 22.6596

450683 ............................................................................................................. 21.1748 20.9143 26.4385 22.7231

450684 ............................................................................................................. 22.8552 19.7005 21.9962 21.3850

450686 ............................................................................................................. 15.0122 16.5661 16.4632 15.9861

450688 ............................................................................................................. 20.8988 19.6250 20.1831 20.2348

450690 ............................................................................................................. 22.4118 21.6578 22.4707 22.1725

450694 ............................................................................................................. 18.4917 17.4758 17.4643 17.7613

450696 ............................................................................................................. 17.5701 24.9636 * 21.1885

450697 ............................................................................................................. 15.9259 18.8405 19.4949 18.0008

450698 ............................................................................................................. 14.3983 14.6680 15.2170 14.7605

450700 ............................................................................................................. 15.1153 14.6421 15.9050 15.2506

450702 ............................................................................................................. 21.0157 20.8223 * 20.9141

450703 ............................................................................................................. 18.8029 * * 18.8029

450704 ............................................................................................................. 21.6236 20.9821 20.7987 21.1724

450705 ............................................................................................................. 22.3175 30.0116 20.5505 24.0294

450706 ............................................................................................................. 21.3777 21.2072 22.0884 21.5769

450709 ............................................................................................................. 19.7741 20.8889 22.1490 21.0078

450711 ............................................................................................................. 18.2350 19.8126 19.3400 19.1455

450712 ............................................................................................................. 16.8942 13.6240 15.9298 15.4007

450713 ............................................................................................................. 23.6009 20.8065 21.5813 21.8464

450715 ............................................................................................................. 19.7719 22.0413 22.5711 21.5401

450716 ............................................................................................................. 19.9871 20.5544 20.9088 20.4817

450717 ............................................................................................................. 19.4546 20.7192 20.6551 20.2618

450718 ............................................................................................................. 19.0679 19.6886 22.1765 20.3069

450723 ............................................................................................................. 19.7044 19.7563 20.0191 19.8245

450724 ............................................................................................................. 20.0667 20.3235 20.3706 20.2569

450725 ............................................................................................................. 19.5572 * * 19.5572

450727 ............................................................................................................. 17.7508 13.5458 17.0205 15.9095

450728 ............................................................................................................. 12.9277 17.5284 19.8308 16.6330

450730 ............................................................................................................. 20.9129 22.0819 23.0054 22.0459

450733 ............................................................................................................. 20.3718 20.7693 20.0619 20.4133

450735 ............................................................................................................. 8.0014 13.8767 * 10.0108

450742 ............................................................................................................. 20.7775 22.7655 21.8392 21.8145

450743 ............................................................................................................. 15.9493 18.8937 19.6015 18.1561

450746 ............................................................................................................. 20.7534 12.7904 30.2677 19.9077

450747 ............................................................................................................. 17.3842 19.2585 20.3914 18.9599

450749 ............................................................................................................. 12.9542 16.2130 19.1488 16.2577

450750 ............................................................................................................. 14.7207 14.6914 13.8098 14.4310

450751 ............................................................................................................. 22.2491 21.2198 18.8616 21.0697

450754 ............................................................................................................. 14.8896 16.0860 16.6057 15.9050

450755 ............................................................................................................. 14.7070 17.9904 18.0760 16.8948

450757 ............................................................................................................. 13.9636 13.8675 14.9434 14.2422

450758 ............................................................................................................. 18.6513 21.8669 19.0221 19.8347

450760 ............................................................................................................. 18.0690 17.4852 19.2225 18.2582

450761 ............................................................................................................. 11.1444 13.6152 15.7681 13.3382

450763 ............................................................................................................. 17.5603 18.2123 18.6092 18.1083

450766 ............................................................................................................. 21.8103 22.4348 23.3879 22.5926

450769 ............................................................................................................. 13.6183 14.5858 18.4163 15.2554

450770 ............................................................................................................. 16.8250 16.5458 19.0183 17.4436

450771 ............................................................................................................. 21.5814 22.4542 20.4326 21.4743

450774 ............................................................................................................. 16.5198 17.9964 16.2948 16.9482

450775 ............................................................................................................. 19.9651 19.8897 21.3504 20.4169

450776 ............................................................................................................. 10.1953 15.7750 13.8230 13.0171

22812

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

450777 ............................................................................................................. 19.5923 21.0682 19.0380 19.9747

450779 ............................................................................................................. 22.9697 21.4546 20.8027 21.5263

450780 ............................................................................................................. 15.2800 19.1498 18.9543 17.5846

450785 ............................................................................................................. 18.5475 18.4976 * 18.5211

450788 ............................................................................................................. 20.9806 19.1463 19.0680 19.4275

450794 ............................................................................................................. 18.3981 18.2229 * 18.3485

450795 ............................................................................................................. 14.1682 16.6494 22.5753 17.9737

450796 ............................................................................................................. 17.4472 16.5362 19.2059 17.6627

450797 ............................................................................................................. 18.5901 15.9188 16.4923 16.8594

450798 ............................................................................................................. 9.2165 9.4634 * 9.3327

450801 ............................................................................................................. 16.6095 17.5669 17.9548 17.3668

450802 ............................................................................................................. 18.9018 19.9168 17.1435 18.5477

450803 ............................................................................................................. 16.2047 18.3767 21.6653 19.3492

450804 ............................................................................................................. 20.2223 19.4846 19.0893 19.5891

450807 ............................................................................................................. 13.2256 11.3192 10.7200 11.6398

450808 ............................................................................................................. 45.4728 16.9915 17.4917 21.1577

450809 ............................................................................................................. 19.0266 20.0202 19.5101 19.5395

450811 ............................................................................................................. 18.3847 19.0961 19.9168 19.1389

450812 ............................................................................................................. 20.7383 * * 20.7383

450813 ............................................................................................................. * 15.9166 11.2807 13.4305

450815 ............................................................................................................. * * 21.2741 21.2741

450819 ............................................................................................................. * * 16.5521 16.5521

450820 ............................................................................................................. * * 25.8653 25.8653

450822 ............................................................................................................. * * 24.2740 24.2740

460001 ............................................................................................................. 20.6336 21.7996 22.2735 21.5846

460003 ............................................................................................................. 20.5958 20.0452 22.6289 21.0329

460004 ............................................................................................................. 20.8196 21.3744 21.7234 21.3231

460005 ............................................................................................................. 17.5818 19.7069 22.5252 19.8732

460006 ............................................................................................................. 19.6485 20.6252 21.0700 20.4918

460007 ............................................................................................................. 20.5677 20.8026 21.1773 20.8773

460008 ............................................................................................................. 21.0338 18.8661 19.1153 19.6864

460009 ............................................................................................................. 21.1084 21.9016 22.5295 21.8515

460010 ............................................................................................................. 21.2473 21.9830 22.4948 21.9354

460011 ............................................................................................................. 16.7114 18.8660 19.7731 18.3715

460013 ............................................................................................................. 20.3331 20.7326 20.3976 20.4959

460014 ............................................................................................................. 19.5465 18.3865 18.5370 18.7488

460015 ............................................................................................................. 20.0987 20.6593 21.0470 20.6197

460016 ............................................................................................................. 18.0791 18.2408 21.9105 19.2998

460017 ............................................................................................................. 26.0310 17.7103 18.9929 19.9984

460018 ............................................................................................................. 16.8566 17.6235 17.0063 17.1606

460019 ............................................................................................................. 17.3683 16.2671 17.8690 17.1417

460020 ............................................................................................................. 17.0271 17.3467 17.2663 17.2239

460021 ............................................................................................................. 20.2613 21.0470 21.5174 20.9913

460022 ............................................................................................................. 18.2100 20.1534 21.3614 19.7210

460023 ............................................................................................................. 21.3321 22.3535 22.9265 22.2381

460024 ............................................................................................................. 13.0279 * * 13.0279

460025 ............................................................................................................. 12.5083 19.4247 17.3494 16.5301

460026 ............................................................................................................. 17.3431 19.9241 20.2577 19.0203

460027 ............................................................................................................. 20.8331 21.8868 22.2955 21.6637

460029 ............................................................................................................. 17.2501 20.5154 20.8366 19.2190

460030 ............................................................................................................. 17.2196 17.6071 17.1705 17.3275

460032 ............................................................................................................. 19.5474 21.1006 21.4832 20.7171

460033 ............................................................................................................. 15.7233 19.5372 19.2664 18.1972

460035 ............................................................................................................. 14.2802 16.0021 16.1685 15.4874

460036 ............................................................................................................. 22.3788 23.5893 23.4573 23.1384

460037 ............................................................................................................. 18.7665 18.6850 17.7399 18.3920

460039 ............................................................................................................. 24.4781 24.9134 24.4808 24.6217

460041 ............................................................................................................. 21.6926 21.0623 20.2035 20.9715

460042 ............................................................................................................. 17.8455 18.8814 19.5662 18.7473

460043 ............................................................................................................. 23.8970 24.4779 23.2819 23.8380

460044 ............................................................................................................. 20.6897 21.4696 21.8485 21.3516

460046 ............................................................................................................. 17.1085 18.2224 * 17.6742

460047 ............................................................................................................. 21.3843 23.0433 22.7384 22.4725

22813

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

460049 ............................................................................................................. 18.8206 19.6483 20.8283 19.8892

460050 ............................................................................................................. 26.2485 * * 26.2485

460051 ............................................................................................................. 20.9797 19.4761 22.1758 20.8643

460052 ............................................................................................................. * * 19.8961 19.8961

470001 ............................................................................................................. 19.6108 20.2299 21.3817 20.4021

470003 ............................................................................................................. 22.5949 23.6949 21.6305 22.6336

470004 ............................................................................................................. 18.0952 16.8842 18.1879 17.7051

470005 ............................................................................................................. 21.5151 21.9191 23.1808 22.1962

470006 ............................................................................................................. 18.3898 17.8699 20.2829 18.8123

470008 ............................................................................................................. 19.4136 19.6069 20.1969 19.7378

470010 ............................................................................................................. 19.4652 20.2961 21.0616 20.2790

470011 ............................................................................................................. 21.2014 21.7675 22.2415 21.7386

470012 ............................................................................................................. 18.5162 18.5339 18.9444 18.6579

470015 ............................................................................................................. 19.2552 19.5366 20.2125 19.6399

470018 ............................................................................................................. 20.4161 21.5426 21.2406 21.0610

470020 ............................................................................................................. 18.9884 20.6643 21.5688 20.4558

470023 ............................................................................................................. 20.6391 20.4511 21.7139 20.9439

470024 ............................................................................................................. 20.4087 20.8510 21.9807 21.0777

490001 ............................................................................................................. 24.7604 21.9755 20.0570 22.0422

490002 ............................................................................................................. 12.9871 15.2287 15.7365 14.6222

490003 ............................................................................................................. 18.0034 19.1040 20.3237 19.1299

490004 ............................................................................................................. 18.7731 19.2126 19.7074 19.2382

490005 ............................................................................................................. 16.9087 20.5517 21.3318 19.6257

490006 ............................................................................................................. 15.2276 15.9537 12.3253 14.5928

490007 ............................................................................................................. 18.4330 18.7740 19.9391 19.0604

490009 ............................................................................................................. 22.9513 23.9344 23.7659 23.5499

490010 ............................................................................................................. 18.5780 21.7424 * 19.9381

490011 ............................................................................................................. 18.7508 18.6071 19.3983 18.9085

490012 ............................................................................................................. 13.7788 15.9973 15.2965 15.0022

490013 ............................................................................................................. 16.9324 17.3318 18.2396 17.5085

490014 ............................................................................................................. 24.5557 25.8315 23.5266 24.6242

490015 ............................................................................................................. 19.3608 19.6363 20.0667 19.6821

490017 ............................................................................................................. 17.3152 18.4361 19.4810 18.4236

490018 ............................................................................................................. 17.9433 18.3435 18.5508 18.2858

490019 ............................................................................................................. 17.5309 19.6178 21.0024 19.4180

490020 ............................................................................................................. 17.6655 18.5691 18.9621 18.4232

490021 ............................................................................................................. 19.4490 19.3945 20.0496 19.6794

490022 ............................................................................................................. 20.7223 21.2183 22.9170 21.6052

490023 ............................................................................................................. 18.9587 20.6694 21.5683 20.4224

490024 ............................................................................................................. 16.8904 17.7221 18.4314 17.8400

490027 ............................................................................................................. 14.4234 16.2761 16.7556 15.8360

490030 ............................................................................................................. 10.5029 9.1789 8.6446 9.5559

490031 ............................................................................................................. 15.8213 14.9539 16.0003 15.5875

490032 ............................................................................................................. 21.5592 22.4262 22.0162 21.9790

490033 ............................................................................................................. 18.3265 21.1723 19.2908 19.5511

490037 ............................................................................................................. 15.9704 16.3759 17.0113 16.4399

490038 ............................................................................................................. 15.7099 21.0218 17.6324 17.9048

490040 ............................................................................................................. 22.5237 22.7061 23.9490 23.0684

490041 ............................................................................................................. 16.5542 18.3589 20.8247 18.4498

490042 ............................................................................................................. 15.2717 16.4666 17.0972 16.2668

490043 ............................................................................................................. 20.6775 22.1574 21.5808 21.5222

490044 ............................................................................................................. 17.6282 18.3137 19.7842 18.6148

490045 ............................................................................................................. 19.6325 20.5468 20.6436 20.2902

490046 ............................................................................................................. 18.6112 18.4825 19.5729 18.9042

490047 ............................................................................................................. 17.1631 25.0438 17.5833 19.3625

490048 ............................................................................................................. 17.8907 18.4361 19.5417 18.6005

490050 ............................................................................................................. 22.7129 23.0729 23.3668 23.0530

490052 ............................................................................................................. 16.9363 16.8600 16.4787 16.7609

490053 ............................................................................................................. 15.6883 15.6996 16.8410 16.1062

490054 ............................................................................................................. 15.5516 15.4734 19.5780 16.7024

490057 ............................................................................................................. 19.0668 19.9210 20.3160 19.7770

490059 ............................................................................................................. 20.3744 20.8662 21.4801 20.8999

490060 ............................................................................................................. 19.2006 17.6308 18.5917 18.4363

22814

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

490063 ............................................................................................................. 28.2527 28.6536 31.0113 29.3929

490066 ............................................................................................................. 16.5024 20.6972 15.9322 17.5889

490067 ............................................................................................................. 17.1922 17.0195 17.8487 17.3549

490069 ............................................................................................................. 15.6986 17.3297 19.9963 17.6603

490071 ............................................................................................................. 19.4701 21.8879 23.3511 21.4480

490073 ............................................................................................................. 26.1420 20.7960 26.0957 24.1488

490074 ............................................................................................................. 19.3417 * * 19.3417

490075 ............................................................................................................. 19.1906 18.6983 19.0566 18.9744

490077 ............................................................................................................. 19.7866 21.3670 22.6504 21.2469

490079 ............................................................................................................. 16.4379 17.0815 17.7016 17.0749

490083 ............................................................................................................. 16.6406 * * 16.6406

490084 ............................................................................................................. 16.3846 16.7834 18.0555 17.0646

490085 ............................................................................................................. 16.3979 17.4584 17.6158 17.1539

490088 ............................................................................................................. 15.5982 16.4362 17.9141 16.6068

490089 ............................................................................................................. 15.8618 17.7692 18.2290 17.2642

490090 ............................................................................................................. 16.2785 17.0199 17.4735 16.9381

490091 ............................................................................................................. 19.9949 20.8734 25.0272 21.8088

490092 ............................................................................................................. 15.6893 16.9533 16.7502 16.4464

490093 ............................................................................................................. 16.4767 17.3711 17.8275 17.2502

490094 ............................................................................................................. 16.7880 18.9204 22.3033 19.3562

490095 ............................................................................................................. 18.2495 * * 18.2495

490097 ............................................................................................................. 15.8586 15.5780 16.9518 16.0789

490098 ............................................................................................................. 14.6971 15.1403 16.0488 15.2544

490099 ............................................................................................................. 16.8667 17.9665 18.3985 17.7293

490100 ............................................................................................................. 17.2189 22.5010 * 19.8823

490101 ............................................................................................................. 25.0907 24.7616 23.5502 24.4252

490104 ............................................................................................................. 28.4910 25.6889 27.6495 27.0461

490105 ............................................................................................................. 18.2461 18.5765 21.4428 19.2491

490106 ............................................................................................................. 16.9117 17.6596 22.1448 18.3912

490107 ............................................................................................................. 22.4054 23.5240 22.9283 22.9660

490108 ............................................................................................................. 19.7478 20.2112 24.1232 21.0559

490109 ............................................................................................................. 21.1589 23.6620 25.9475 23.4402

490110 ............................................................................................................. 15.8408 16.5131 18.1561 16.8181

490111 ............................................................................................................. 17.3453 17.1768 17.8510 17.4580

490112 ............................................................................................................. 20.5239 21.4532 22.0815 21.3493

490113 ............................................................................................................. 23.0840 23.2235 23.9043 23.4071

490114 ............................................................................................................. 16.9083 17.3047 18.0359 17.4375

490115 ............................................................................................................. 17.1023 16.5203 23.9711 20.3158

490116 ............................................................................................................. 16.4436 16.6170 17.2040 16.7676

490117 ............................................................................................................. 13.8429 14.0104 14.7944 14.2244

490118 ............................................................................................................. 20.8707 21.4674 21.5687 21.3058

490119 ............................................................................................................. 17.8686 17.9147 18.6046 18.1353

490120 ............................................................................................................. 19.9810 19.3707 20.5777 19.9742

490122 ............................................................................................................. 23.9695 23.8801 25.2027 24.3250

490123 ............................................................................................................. 16.8505 17.7461 19.3056 18.0001

490124 ............................................................................................................. 19.3616 22.0884 21.3818 20.8857

490126 ............................................................................................................. 18.2276 18.6844 20.4294 19.0254

490127 ............................................................................................................. 14.4815 16.0516 16.5993 15.6547

490129 ............................................................................................................. 27.4701 22.5885 28.6868 25.1130

490130 ............................................................................................................. 16.2779 16.4322 17.6943 16.7915

490132 ............................................................................................................. 17.0204 18.6570 18.4671 18.0649

500001 ............................................................................................................. 21.3476 22.1896 23.4901 22.3320

500002 ............................................................................................................. 21.0375 21.6332 19.8476 20.7811

500003 ............................................................................................................. 24.3055 24.2814 24.4333 24.3392

500005 ............................................................................................................. 23.4808 22.3955 21.7512 22.5379

500007 ............................................................................................................. 22.4269 26.0599 21.9911 23.4148

500008 ............................................................................................................. 24.1930 25.3064 25.9291 25.1336

500011 ............................................................................................................. 25.1836 24.0162 24.6554 24.5938

500012 ............................................................................................................. 22.2815 20.7032 24.2799 22.3541

500014 ............................................................................................................. 23.9276 24.3419 24.0990 24.1249

500015 ............................................................................................................. 23.2435 23.9297 24.9923 24.0554

500016 ............................................................................................................. 23.9034 24.3938 24.9439 24.4287

500019 ............................................................................................................. 22.3668 22.4213 23.2054 22.6470

22815

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

500021 ............................................................................................................. 24.4622 25.9198 27.6490 25.9957

500023 ............................................................................................................. 27.1892 26.6535 27.1025 26.9568

500024 ............................................................................................................. 24.0453 23.7472 26.6452 24.7736

500025 ............................................................................................................. 23.9557 26.4810 24.4825 24.9695

500026 ............................................................................................................. 23.3491 23.8005 26.9884 24.7238

500027 ............................................................................................................. 25.0529 22.2158 20.9576 22.6384

500028 ............................................................................................................. 18.8588 19.2675 18.9556 19.0337

500029 ............................................................................................................. 16.8083 17.9237 18.5042 17.7373

500030 ............................................................................................................. 24.1321 24.9039 26.3828 25.1714

500031 ............................................................................................................. 23.3659 29.2707 23.6099 25.1784

500033 ............................................................................................................. 21.3906 22.3527 22.5462 22.1428

500036 ............................................................................................................. 21.8950 22.1096 23.6333 22.5254

500037 ............................................................................................................. 19.6803 20.7139 21.4059 20.6062

500039 ............................................................................................................. 23.3211 23.8918 24.0007 23.7403

500041 ............................................................................................................. 24.8556 23.9608 24.9237 24.5799

500042 ............................................................................................................. 22.1286 22.9125 * 22.5386

500043 ............................................................................................................. 20.2509 20.9459 22.0466 21.0230

500044 ............................................................................................................. 23.1128 23.3364 24.2212 23.5535

500045 ............................................................................................................. 22.0982 20.8881 24.0526 22.2906

500048 ............................................................................................................. 19.3029 22.1906 20.3207 20.5960

500049 ............................................................................................................. 22.9534 24.0489 24.5997 23.8657

500050 ............................................................................................................. 20.9445 22.0065 22.6563 21.9092

500051 ............................................................................................................. 24.4769 24.8203 25.9447 25.1087

500053 ............................................................................................................. 22.0515 23.9397 22.8399 22.9429

500054 ............................................................................................................. 22.9024 22.8829 23.8089 23.1889

500055 ............................................................................................................. 22.8769 23.7446 23.8622 23.5097

500057 ............................................................................................................. 18.0424 18.2737 19.0479 18.4516

500058 ............................................................................................................. 23.3984 24.7882 24.1106 24.0962

500059 ............................................................................................................. 22.5412 23.3506 26.6270 24.1016

500060 ............................................................................................................. 23.5360 25.0233 28.3655 25.4628

500061 ............................................................................................................. 20.3957 21.7013 20.8624 20.9851

500062 ............................................................................................................. 19.4607 18.6329 19.0557 19.0333

500064 ............................................................................................................. 24.5283 25.5748 26.7000 25.6273

500065 ............................................................................................................. 21.4254 21.9308 23.5671 22.3106

500068 ............................................................................................................. 18.6960 19.6574 19.2638 19.2003

500069 ............................................................................................................. 20.6262 21.3592 21.4542 21.1522

500071 ............................................................................................................. 19.3810 19.1906 19.1428 19.2439

500072 ............................................................................................................. 24.4599 25.3928 25.2001 25.0228

500073 ............................................................................................................. 21.4303 21.2469 21.7698 21.4835

500074 ............................................................................................................. 18.6506 18.9679 19.5981 19.0849

500077 ............................................................................................................. 23.2056 22.8536 23.9410 23.3357

500079 ............................................................................................................. 22.9809 24.2036 23.1041 23.4248

500080 ............................................................................................................. 13.8000 15.6630 18.3883 15.5897

500084 ............................................................................................................. 22.2169 23.4032 24.4044 23.3798

500085 ............................................................................................................. 28.6121 21.4403 20.4517 22.7948

500086 ............................................................................................................. 22.3132 23.3288 22.8829 22.8469

500088 ............................................................................................................. 23.6988 23.2701 24.7822 23.9172

500089 ............................................................................................................. 17.9399 18.7080 19.7166 18.7736

500090 ............................................................................................................. 16.3297 16.1576 20.4429 17.2562

500092 ............................................................................................................. 17.2881 16.7913 19.2028 17.7527

500094 ............................................................................................................. 18.1080 18.5835 15.7866 17.6577

500096 ............................................................................................................. 20.9580 21.0151 23.3564 21.7716

500097 ............................................................................................................. 20.8010 19.7706 20.8774 20.4568

500098 ............................................................................................................. 12.9935 16.3511 15.2040 14.9340

500101 ............................................................................................................. 19.4498 19.7337 15.8000 18.3994

500102 ............................................................................................................. 20.3321 20.9389 21.8963 21.0615

500104 ............................................................................................................. 22.5849 22.8154 24.9389 23.3843

500106 ............................................................................................................. 18.7087 18.6041 19.1465 18.7914

500107 ............................................................................................................. 17.2987 18.1201 17.9489 17.8064

500108 ............................................................................................................. 27.2126 26.2939 28.6229 27.3944

500110 ............................................................................................................. 21.4053 21.4553 22.9775 21.9505

500118 ............................................................................................................. 22.9245 23.8397 24.8034 23.8697

500119 ............................................................................................................. 21.5704 22.4373 22.1192 22.0436

22816

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

500122 ............................................................................................................. 21.9135 22.4268 23.5264 22.6230

500123 ............................................................................................................. 19.5855 20.3181 19.6646 19.8819

500124 ............................................................................................................. 24.1473 23.2836 23.7742 23.7287

500125 ............................................................................................................. 16.6272 15.1112 14.7910 15.5165

500129 ............................................................................................................. 23.5952 26.1575 25.4685 25.1115

500132 ............................................................................................................. 19.3567 15.6717 23.1822 19.3937

500134 ............................................................................................................. 20.9570 17.7457 17.2430 18.5700

500139 ............................................................................................................. 20.8816 22.2297 22.3022 21.8369

500141 ............................................................................................................. 22.9358 23.8838 29.9695 25.5485

500143 ............................................................................................................. 17.6031 18.0343 18.2570 17.9797

500146 ............................................................................................................. 17.8558 21.6003 * 19.6218

510001 ............................................................................................................. 17.8282 19.1492 20.0429 18.9855

510002 ............................................................................................................. 17.3409 20.1527 17.0646 18.0884

510005 ............................................................................................................. 14.4330 14.2503 13.8621 14.1872

510006 ............................................................................................................. 17.8821 18.7313 19.9609 18.8717

510007 ............................................................................................................. 20.2483 21.2729 21.7064 21.0952

510008 ............................................................................................................. 17.3653 18.3296 19.0513 18.2388

510012 ............................................................................................................. 16.5037 15.8390 15.6089 15.9887

510013 ............................................................................................................. 16.6194 17.8527 19.5798 17.9628

510015 ............................................................................................................. 14.7904 14.9039 16.7310 15.5192

510016 ............................................................................................................. 12.0276 * * 12.0276

510018 ............................................................................................................. 16.4757 18.5269 18.5358 17.8403

510020 ............................................................................................................. 12.6472 13.1837 14.1211 13.3435

510022 ............................................................................................................. 19.8375 20.1763 21.5770 20.5146

510023 ............................................................................................................. 15.9417 16.0129 16.7777 16.2444

510024 ............................................................................................................. 18.7982 19.0941 18.7461 18.8794

510026 ............................................................................................................. 13.4586 13.6888 13.7952 13.6491

510027 ............................................................................................................. 17.5759 17.2900 18.5945 17.8135

510028 ............................................................................................................. 20.7306 20.0628 19.9208 20.2198

510029 ............................................................................................................. 17.0519 17.7124 18.4668 17.7625

510030 ............................................................................................................. 18.3137 17.4198 17.7603 17.8189

510031 ............................................................................................................. 18.4887 28.6673 18.6341 21.0020

510033 ............................................................................................................. 18.8061 18.4082 18.4718 18.5670

510035 ............................................................................................................. 18.6471 16.5007 18.3164 17.7425

510036 ............................................................................................................. 13.1995 13.4559 13.8786 13.5021

510038 ............................................................................................................. 14.3433 15.8132 15.5576 15.2710

510039 ............................................................................................................. 16.0555 16.9398 17.1461 16.7060

510043 ............................................................................................................. 14.2872 14.0662 13.1308 13.8129

510046 ............................................................................................................. 17.7320 17.3821 18.5896 17.9120

510047 ............................................................................................................. 19.1202 19.8963 20.8101 19.9042

510048 ............................................................................................................. 20.3734 21.0407 17.1647 19.5052

510050 ............................................................................................................. 16.5681 16.9136 18.4036 17.3154

510053 ............................................................................................................. 15.5856 16.1036 17.5798 16.4010

510055 ............................................................................................................. 22.8376 23.7248 24.1069 23.5675

510058 ............................................................................................................. 17.9786 18.4156 18.2634 18.2213

510059 ............................................................................................................. 16.7732 16.5854 16.1044 16.5068

510060 ............................................................................................................. 15.6581 17.5594 * 16.5969

510061 ............................................................................................................. 14.2227 13.8204 14.1968 14.0767

510062 ............................................................................................................. 17.6276 19.3881 18.1588 18.4173

510065 ............................................................................................................. 14.5882 * * 14.5882

510066 ............................................................................................................. 12.7164 12.2943 * 12.5091

510067 ............................................................................................................. 18.1079 16.7161 17.3067 17.3634

510068 ............................................................................................................. 16.2864 18.7938 14.3582 16.2743

510070 ............................................................................................................. 16.3616 18.5146 18.4252 17.8444

510071 ............................................................................................................. 16.2390 17.2148 18.0278 17.1797

510072 ............................................................................................................. 17.6579 15.6262 15.9257 16.4174

510077 ............................................................................................................. 16.4111 18.0668 18.2947 17.6316

510080 ............................................................................................................. 14.7966 17.4485 16.3453 16.1690

510081 ............................................................................................................. 13.0020 13.6359 11.9701 12.8648

510082 ............................................................................................................. 13.6905 17.4538 13.5946 14.7307

510084 ............................................................................................................. 12.4820 17.2395 13.5339 14.4076

510085 ............................................................................................................. 18.6367 17.5624 18.5207 18.2217

510086 ............................................................................................................. 13.7937 13.4763 14.2241 13.8304

22817

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

510088 ............................................................................................................. * * 14.8854 14.8854

520002 ............................................................................................................. 18.3521 19.7447 19.6755 19.2773

520003 ............................................................................................................. 16.4334 17.1248 18.7956 17.5028

520004 ............................................................................................................. 18.1744 19.6512 20.4591 19.4206

520006 ............................................................................................................. 20.4446 21.5313 21.4884 21.1400

520007 ............................................................................................................. 13.1087 16.2001 18.4629 16.0134

520008 ............................................................................................................. 22.8024 22.8024 24.9395 23.5372

520009 ............................................................................................................. 18.5094 18.6002 21.3967 19.4603

520010 ............................................................................................................. 20.3447 22.7703 22.3311 21.8215

520011 ............................................................................................................. 20.3797 20.7410 21.5223 20.8830

520013 ............................................................................................................. 21.6289 20.3965 20.5944 20.8585

520014 ............................................................................................................. 16.3989 17.1646 18.0841 17.1764

520015 ............................................................................................................. 18.3185 18.6078 19.7672 18.9031

520016 ............................................................................................................. 13.2889 17.3018 18.4320 16.1862

520017 ............................................................................................................. 19.3179 19.6008 19.4780 19.4685

520018 ............................................................................................................. 18.6441 21.1941 20.5761 20.1814

520019 ............................................................................................................. 18.3143 19.5440 20.9164 19.5698

520021 ............................................................................................................. 20.0355 21.3471 21.9531 21.1390

520024 ............................................................................................................. 14.6107 14.0175 14.4750 14.3609

520025 ............................................................................................................. 18.1086 18.2430 20.3838 18.8661

520026 ............................................................................................................. 19.8131 21.5453 20.8546 20.7335

520027 ............................................................................................................. 18.9085 19.9324 19.3257 19.4032

520028 ............................................................................................................. 19.1370 21.2852 21.5674 20.6109

520029 ............................................................................................................. 16.7520 19.5750 21.4197 19.2161

520030 ............................................................................................................. 20.0043 20.5039 20.8529 20.4556

520031 ............................................................................................................. 18.7066 20.4814 20.9875 19.9520

520032 ............................................................................................................. 17.9007 19.5697 20.1439 19.2148

520033 ............................................................................................................. 18.8906 19.2954 20.2520 19.4725

520034 ............................................................................................................. 16.6858 17.1282 20.4307 18.0336

520035 ............................................................................................................. 17.0997 18.9452 18.7135 18.2608

520037 ............................................................................................................. 20.0516 20.6686 21.4693 20.7219

520038 ............................................................................................................. 17.7074 19.6294 20.6130 19.3169

520039 ............................................................................................................. 19.5990 20.7641 23.3687 21.1069

520040 ............................................................................................................. 20.7420 20.4677 20.4895 20.5693

520041 ............................................................................................................. 15.3666 17.1959 17.5718 16.7004

520042 ............................................................................................................. 17.6577 18.5843 18.9667 18.4230

520044 ............................................................................................................. 17.7932 18.4014 19.1877 18.4535

520045 ............................................................................................................. 19.6736 20.5917 20.7203 20.3442

520047 ............................................................................................................. 17.8702 18.3048 20.3487 18.7633

520048 ............................................................................................................. 19.1712 20.6583 19.5238 19.7870

520049 ............................................................................................................. 19.5727 20.3559 20.1667 20.0444

520051 ............................................................................................................. 19.7416 21.6497 23.1309 21.4330

520053 ............................................................................................................. 16.4887 17.3945 18.0851 17.3336

520054 ............................................................................................................. 15.9873 15.1747 16.6782 15.9073

520057 ............................................................................................................. 18.3186 19.0872 19.6305 19.0102

520058 ............................................................................................................. 18.1264 19.7283 21.2500 19.7133

520059 ............................................................................................................. 19.8530 20.9913 21.5796 20.8254

520060 ............................................................................................................. 17.1675 17.9258 18.7639 17.9403

520062 ............................................................................................................. 17.8000 19.1482 19.7038 18.8681

520063 ............................................................................................................. 20.7744 19.6136 20.5262 20.3055

520064 ............................................................................................................. 21.4586 22.7423 22.0878 22.0905

520066 ............................................................................................................. 22.4419 22.8837 23.9506 23.0411

520068 ............................................................................................................. 18.0798 18.9943 19.6855 18.9053

520069 ............................................................................................................. 17.9133 20.2934 20.1770 19.3716

520070 ............................................................................................................. 17.8192 18.5938 19.2094 18.5389

520071 ............................................................................................................. 18.7861 18.7304 19.1628 18.8949

520074 ............................................................................................................. 18.6923 20.4601 20.9007 20.0036

520075 ............................................................................................................. 19.0891 19.8457 20.5199 19.8188

520076 ............................................................................................................. 16.5072 17.6088 19.5360 17.8404

520077 ............................................................................................................. 15.5427 17.7830 18.7119 17.3266

520078 ............................................................................................................. 20.5559 21.3380 20.5439 20.8226

520082 ............................................................................................................. 16.7417 17.7405 * 17.1848

520083 ............................................................................................................. 22.5715 23.8849 23.5787 23.3411

22818

——————————

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

520084 ............................................................................................................. 18.9475 20.8427 23.3327 20.9981

520087 ............................................................................................................. 19.3942 20.3624 20.6863 20.1537

520088 ............................................................................................................. 20.1529 20.6312 21.8931 20.8632

520089 ............................................................................................................. 20.6110 21.5456 22.1055 21.4053

520090 ............................................................................................................. 18.0026 18.9343 19.8314 18.9411

520091 ............................................................................................................. 20.0693 20.9927 20.9440 20.6686

520092 ............................................................................................................. 17.5577 17.6500 18.6248 17.9402

520094 ............................................................................................................. 19.7791 20.3611 20.6179 20.2438

520095 ............................................................................................................. 18.5066 20.3269 18.6425 19.1370

520096 ............................................................................................................. 19.2980 19.7757 20.6668 19.9365

520097 ............................................................................................................. 19.6470 20.2354 20.8016 20.2268

520098 ............................................................................................................. 20.0289 22.3348 23.4707 21.9054

520100 ............................................................................................................. 18.3788 18.3832 19.4788 18.7419

520101 ............................................................................................................. 17.8453 19.5186 19.9875 19.1542

520102 ............................................................................................................. 19.8354 20.1898 21.0138 20.3351

520103 ............................................................................................................. 21.2324 19.4809 20.0842 20.2050

520107 ............................................................................................................. 20.5441 20.3747 21.7907 20.8828

520109 ............................................................................................................. 18.6322 19.1303 19.7609 19.1753

520110 ............................................................................................................. 20.0319 20.4494 21.0055 20.5065

520111 ............................................................................................................. 17.2388 17.7834 17.7673 17.6163

520112 ............................................................................................................. 18.1827 19.1797 18.5706 18.6454

520113 ............................................................................................................. 20.5925 21.1485 21.8852 21.2341

520114 ............................................................................................................. 17.3799 16.6616 17.8476 17.2735

520115 ............................................................................................................. 17.3755 18.2980 19.2248 18.2555

520116 ............................................................................................................. 18.5698 19.8509 20.6922 19.7165

520117 ............................................................................................................. 17.4242 18.5414 18.3963 18.1365

520118 ............................................................................................................. 12.4422 4.2326 14.8626 13.8369

520120 ............................................................................................................. 15.6205 18.7437 * 17.3887

520121 ............................................................................................................. 17.5851 19.7305 20.8492 19.5992

520122 ............................................................................................................. 16.7552 16.2436 16.9335 16.6326

520123 ............................................................................................................. 17.4135 17.3980 17.7986 17.5610

520124 ............................................................................................................. 16.3902 17.2619 17.9205 17.1864

520130 ............................................................................................................. 15.1639 15.6845 17.1679 16.0030

520131 ............................................................................................................. 18.8043 18.7295 20.2591 19.2549

520132 ............................................................................................................. 17.2759 15.6379 18.1630 16.9564

520134 ............................................................................................................. 17.6094 18.0953 18.8150 18.1846

520135 ............................................................................................................. 14.4748 15.8246 17.3476 15.9083

520136 ............................................................................................................. 19.9935 19.8480 20.4404 20.0986

520138 ............................................................................................................. 20.8922 21.2260 22.5103 21.5421

520139 ............................................................................................................. 21.2797 20.9988 21.4042 21.2251

520140 ............................................................................................................. 21.4175 21.5207 22.0849 21.6757

520141 ............................................................................................................. 16.9543 * * 16.9543

520142 ............................................................................................................. 17.7003 20.5858 21.9432 19.9586

520144 ............................................................................................................. 16.6231 18.5701 19.9120 18.4107

520145 ............................................................................................................. 17.2356 18.2654 18.7958 18.1015

520146 ............................................................................................................. 15.7318 17.9585 18.2370 17.3448

520148 ............................................................................................................. 16.9293 17.2421 19.1502 17.8057

520149 ............................................................................................................. 13.3032 14.1901 12.8928 13.4360

520151 ............................................................................................................. 18.0771 17.3267 18.7070 18.0230

520152 ............................................................................................................. 21.3333 19.5858 22.5980 21.0747

520153 ............................................................................................................. 15.4467 15.9753 17.0863 16.1441

520154 ............................................................................................................. 17.9229 18.5403 19.5994 18.6875

520156 ............................................................................................................. 19.8396 21.3377 20.9638 20.7243

520157 ............................................................................................................. 17.2784 17.1974 19.6008 18.0185

520159 ............................................................................................................. 18.7423 18.6760 17.7649 18.3871

520160 ............................................................................................................. 18.8444 19.4173 20.1406 19.4824

520161 ............................................................................................................. 18.5742 19.4905 18.7197 18.9334

520170 ............................................................................................................. 22.5033 21.5233 21.0637 21.6831

520171 ............................................................................................................. 15.7316 17.4560 18.0785 17.1053

520173 ............................................................................................................. 20.1410 21.3016 20.5744 20.6635

520177 ............................................................................................................. 21.7609 22.7221 22.9673 22.4954

520178 ............................................................................................................. 17.0411 18.6936 20.9010 18.7748

520188 ............................................................................................................. * 13.9135 * 13.9135

22819

TABLE 2.—HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2000 (1996 WAGE DATA), 2001 (1997

WAGE DATA) AND 2002 (1998 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY

WAGES—Continued

Provider No.

Average

hourly wage

FFY 2000

Average

hourly wage

FFY 2001

Average**

hourly wage

FFY 2002

Average***

hourly wage

(3 years)

530002 ............................................................................................................. 17.5888 19.3273 21.1066 19.4048

530003 ............................................................................................................. 15.7813 16.2139 15.9523 15.9820

530004 ............................................................................................................. 16.1862 15.0497 13.3788 14.7758

530005 ............................................................................................................. 15.1487 13.3529 15.3255 14.5529

530006 ............................................................................................................. 19.3403 18.5894 19.1305 19.0082

530007 ............................................................................................................. 18.0601 18.5161 17.7897 18.1450

530008 ............................................................................................................. 22.9625 18.8349 19.0113 20.0471

530009 ............................................................................................................. 19.4478 22.5009 21.7795 21.2113

530010 ............................................................................................................. 18.9317 21.6092 14.1699 17.7467

530011 ............................................................................................................. 17.4412 18.7354 19.4606 18.5542

530012 ............................................................................................................. 19.4829 18.9923 21.1854 19.8564

530014 ............................................................................................................. 17.3158 18.0869 18.5571 17.9899

530015 ............................................................................................................. 22.6465 22.4568 23.4040 22.8118

530016 ............................................................................................................. 17.7084 18.1562 19.3205 18.4153

530017 ............................................................................................................. 13.7131 16.3478 17.7736 15.9421

530018 ............................................................................................................. 17.8699 18.3783 19.5986 18.6254

530019 ............................................................................................................. 16.7630 18.5430 20.1097 18.3351

530022 ............................................................................................................. 17.8781 18.5002 19.6136 18.7082

530023 ............................................................................................................. 20.7527 20.1948 20.0677 20.3449

530025 ............................................................................................................. 20.3200 21.2598 22.0300 21.1974

530026 ............................................................................................................. 18.9175 17.0118 19.8969 18.4992

530027 ............................................................................................................. 29.7722 18.1664 25.5067 22.9705

530029 ............................................................................................................. 17.7993 16.5092 19.3361 17.7626

530031 ............................................................................................................. 13.3775 18.3322 20.1734 17.2600

530032 ............................................................................................................. 20.2143 21.0361 20.0132 20.4281

* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15, 2001. It does not reflect changes

processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 3A.—3-YEAR AVERAGE

HOURLY WAGE FOR URBAN AREAS

[Based on salaries and hours computed for

Federal fiscal years 2000, 2001, and 2002]

Urban area

Average

hourly

wage

Abilene, TX ................................... 17.6806

Aguadilla, PR ................................ 9.2769

Akron, OH ..................................... 21.5297

Albany, GA ................................... 22.3923

Albany-Schenectady-Troy, NY ..... 18.7002

Albuquerque, NM .......................... 19.8373

Alexandria, LA .............................. 17.4211

Allentown-Bethlehem-Easton, PA 21.3670

Altoona, PA ................................... 20.1636

Amarillo, TX .................................. 18.6302

Anchorage, AK ............................. 27.5223

Ann Arbor, MI ............................... 24.5218

Anniston, AL ................................. 18.1347

Appleton-Oshkosh-Neenah, WI .... 19.6303

Arecibo, PR .................................. 10.1229

Asheville, NC ................................ 19.9864

Athens, GA ................................... 21.2433

Atlanta, GA ................................... 21.9106

Atlantic-Cape May, NJ .................. 24.4342

Auburn-Opelika, AL ...................... 17.4403

Augusta-Aiken, GA–SC ................ 20.3525

Austin-San Marcos, TX ................ 20.2151

Bakersfield, CA ............................. 20.7098

Baltimore, MD ............................... 20.9279

Bangor, ME ................................... 20.7547

Barnstable-Yarmouth, MA ............ 29.3802

TABLE 3A.—3-YEAR AVERAGE HOURLY WAGE FOR URBAN AREAS—Continued

[Based on salaries and hours computed for

Federal fiscal years 2000, 2001, and 2002]

Urban area

Average

hourly

wage

Baton Rouge, LA .......................... 18.6271

Beaumont-Port Arthur, TX ............ 18.6898

Bellingham, WA ............................ 25.1714

Benton Harbor, MI ........................ 18.7937

Bergen-Passaic, NJ ...................... 25.5796

Billings, MT ................................... 21.1153

Biloxi-Gulfport-Pascagoula, MS .... 17.8351

Binghamton, NY ........................... 18.8043

Birmingham, AL ............................ 18.8368

Bismarck, ND ................................ 16.8910

Bloomington, IN ............................ 18.7924

Bloomington-Normal, IL ................ 19.1663

Boise City, ID ................................ 19.6729

Boston-Worcester-Lawrence-Lowell-Brockton, MA–NH ................ 24.5501

Boulder-Longmont, CO ................. 21.3227

Brazoria, TX .................................. 18.3793

Bremerton, WA ............................. 23.7403

Brownsville-Harlingen-San Benito,

TX .............................................. 19.2833

Bryan-College Station, TX ............ 18.7394

Buffalo-Niagara Falls, NY ............. 20.6480

Burlington, VT ............................... 22.4607

Caguas, PR .................................. 10.2778

Canton-Massillon, OH .................. 19.0700

Casper, WY .................................. 19.8564

TABLE 3A.—3-YEAR AVERAGE HOURLY WAGE FOR URBAN AREAS—Continued

[Based on salaries and hours computed for

Federal fiscal years 2000, 2001, and 2002]

Urban area

Average

hourly

wage

Cedar Rapids, IA .......................... 19.1268

Champaign-Urbana, IL ................. 19.9316

Charleston-North Charleston, SC 19.7508

Charleston, WV ............................ 20.0108

Charlotte-Gastonia-Rock Hill, NC–

SC ............................................. 20.3826

Charlottesville, VA ........................ 23.1481

Chattanooga, TN–GA ................... 20.9509

Cheyenne, WY ............................. 17.9899

Chicago, IL ................................... 23.8495

Chico-Paradise, CA ...................... 21.8173

Cincinnati, OH–KY–IN .................. 20.5080

Clarksville-Hopkinsville, TN–KY ... 17.8563

Cleveland-Lorain-Elyria, OH ......... 20.7803

Colorado Springs, CO .................. 20.7284

Columbia, MO ............................... 19.2453

Columbia, SC ............................... 20.5806

Columbus, GA–AL ........................ 18.4599

Columbus, OH .............................. 21.1200

Corpus Christi, TX ........................ 18.5130

Corvallis, OR ................................ 24.7413

Cumberland, MD–WV ................... 18.4566

Dallas, TX ..................................... 20.9635

Danville, VA .................................. 18.9744

Davenport-Moline-Rock Island,

IA–IL .......................................... 19.0733

22820 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 3A.—3-YEAR AVERAGE HOURLY WAGE FOR URBAN AREAS—Continued

[Based on salaries and hours computed for

Federal fiscal years 2000, 2001, and 2002]

Urban area

Average

hourly

wage

Dayton-Springfield, OH ................. 20.3789

Daytona Beach, FL ....................... 19.7030

Decatur, AL ................................... 18.8129

Decatur, IL .................................... 17.6940

Denver, CO ................................... 22.1471

Des Moines, IA ............................. 19.3257

Detroit, MI ..................................... 22.6805

Dothan, AL .................................... 17.1181

Dover, DE ..................................... 21.6106

Dubuque, IA .................................. 18.6795

Duluth-Superior, MN–WI .............. 22.1000

Dutchess County, NY ................... 22.7121

Eau Claire, WI .............................. 19.2432

El Paso, TX .................................. 19.8290

Elkhart-Goshen, IN ....................... 20.3382

Elmira, NY .................................... 18.4943

Enid, OK ....................................... 18.0515

Erie, PA ........................................ 19.4310

Eugene-Springfield, OR ................ 23.8559

Evansville, Henderson, IN–KY ..... 17.5189

Fargo-Moorhead, ND–MN ............ 19.3632

Fayetteville, NC ............................ 19.0183

Fayetteville-Springdale-Rogers,

AR ............................................. 16.7888

Flagstaff, AZ–UT .......................... 22.9479

Flint, MI ......................................... 23.9198

Florence, AL ................................. 16.9094

Florence, SC ................................. 18.9644

Fort Collins-Loveland, CO ............ 22.4773

Fort Lauderdale, FL ...................... 22.1771

Fort Myers-Cape Coral, FL .......... 19.9058

Fort Pierce-Port St. Lucie, FL ...... 21.3915

Fort Smith, AR–OK ....................... 17.3369

Fort Walton Beach, FL ................. 19.5052

Fort Wayne, IN ............................. 19.4642

Fort Worth-Arlington, TX .............. 20.8053

Fresno, CA ................................... 21.9101

Gadsden, AL ................................. 18.7282

Gainesville, FL .............................. 23.1249

Galveston-Texas City, TX ............ 21.5574

Gary, IN ........................................ 20.5266

Glens Falls, NY ............................ 18.3428

Goldsboro, NC .............................. 18.4900

Grand Forks, ND–MN ................... 19.5346

Grand Junction, CO ...................... 20.1153

Grand Rapids-Muskegon-Holland,

MI .............................................. 22.0624

Great Falls, MT ............................. 20.7979

Greeley, CO .................................. 21.0411

Green Bay, WI .............................. 19.9641

Greensboro-Winston-Salem-High

Point, NC ................................... 20.0548

Greenville, NC .............................. 20.8376

Greenville-Spartanburg-Anderson,

SC ............................................. 19.7086

Hagerstown, MD ........................... 19.2372

Hamilton-Middletown, OH ............. 19.7210

Harrisburg-Lebanon-Carlisle, PA .. 20.6541

Hartford, CT .................................. 24.9991

Hattiesburg, MS ............................ 16.3812

Hickory-Morganton-Lenoir, NC ..... 19.9779

Honolulu, HI .................................. 25.2556

Houma, LA .................................... 17.3111

Houston, TX .................................. 20.7505

Huntington-Ashland, WV–KY–OH 21.1928

Huntsville, AL ................................ 19.2325

TABLE 3A.—3-YEAR AVERAGE HOURLY WAGE FOR URBAN AREAS—Continued

[Based on salaries and hours computed for

Federal fiscal years 2000, 2001, and 2002]

Urban area

Average

hourly

wage

Indianapolis, IN ............................. 21.1949

Iowa City, IA ................................. 21.1012

Jackson, MI .................................. 19.7797

Jackson, MS ................................. 18.6455

Jackson, TN .................................. 19.1864

Jacksonville, FL ............................ 19.6584

Jacksonville, NC ........................... 16.8680

Jamestown, NY ............................ 17.1876

Janesville-Beloit, WI ..................... 20.9802

Jersey City, NJ ............................. 24.8343

Johnson City-Kingsport-Bristol,

TN–VA ....................................... 18.5293

Johnstown, PA .............................. 19.0781

Jonesboro, AR .............................. 16.9923

Joplin, MO .................................... 17.7354

Kalamazoo-Battlecreek, MI .......... 22.4822

Kankakee, IL ................................. 20.0356

Kansas City, KS–MO .................... 20.4279

Kenosha, WI ................................. 20.4490

Killeen-Temple, TX ....................... 19.9750

Knoxville, TN ................................ 19.0855

Kokomo, IN ................................... 19.9881

La Crosse, WI–MN ....................... 19.8516

Lafayette, LA ................................ 18.3710

Lafayette, IN ................................. 19.3581

Lake Charles, LA .......................... 16.7150

Lakeland-Winter Haven, FL .......... 19.6666

Lancaster, PA ............................... 20.1757

Lansing-East Lansing, MI ............. 21.3476

Laredo, TX .................................... 17.5925

Las Cruces, NM ............................ 18.7690

Las Vegas, NV–AZ ....................... 24.0639

Lawrence, KS ............................... 18.1884

Lawton, OK ................................... 19.7127

Lewiston-Auburn, ME ................... 19.7957

Lexington, KY ............................... 18.9597

Lima, OH ...................................... 20.0697

Lincoln, NE ................................... 21.3984

Little Rock-North Little Rock, AR 19.2004

Longview-Marshall, TX ................. 18.7809

Los Angeles-Long Beach, CA ...... 26.0786

Louisville, KY–IN .......................... 20.4511

Lubbock, TX ................................. 18.6166

Lynchburg, VA .............................. 19.4241

Macon, GA .................................... 19.2084

Madison, WI .................................. 21.9843

Mansfield, OH ............................... 18.7455

Mayaguez, PR .............................. 10.2295

McAllen-Edinburg-Mission, TX ..... 18.1641

Medford-Ashland, OR ................... 22.6022

Melbourne-Titusville-Palm Bay, FL 20.8444

Memphis, TN–AR–MS .................. 19.0229

Merced, CA ................................... 21.5061

Miami, FL ...................................... 21.8283

Middlesex-Somerset-Hunterdon,

NJ .............................................. 24.6509

Milwaukee-Waukesha, WI ............ 21.3110

Minneapolis-St. Paul, MN–WI ...... 23.8021

Missoula, MT ................................ 20.0852

Mobile, AL ..................................... 17.4552

Modesto, CA ................................. 22.6578

Monmouth-Ocean, NJ .................. 24.1662

Monroe, LA ................................... 18.0030

Montgomery, AL ........................... 16.5093

Muncie, IN .................................... 22.6571

Myrtle Beach, SC ......................... 18.6825

TABLE 3A.—3-YEAR AVERAGE HOURLY WAGE FOR URBAN AREAS—Continued

[Based on salaries and hours computed for

Federal fiscal years 2000, 2001, and 2002]

Urban area

Average

hourly

wage

Naples, FL .................................... 20.9923

Nashville, TN ................................ 20.6183

Nassau-Suffolk, NY ...................... 30.2198

New Haven-Bridgeport-StamfordWaterbury-Danbury, CT ............ 26.6547

New London-Norwich, CT ............ 26.0295

New Orleans, LA .......................... 19.8085

New York, NY ............................... 31.0941

Newark, NJ ................................... 25.6043

Newburgh, NY–PA ....................... 23.8506

Norfolk-Virginia Beach-Newport

News, VA–NC ........................... 18.4034

Oakland, CA ................................. 32.8350

Ocala, FL ...................................... 20.5545

Odessa-Midland, TX ..................... 19.5695

Oklahoma City, OK ....................... 18.8746

Olympia, WA ................................. 23.8947

Omaha, NE–IA ............................. 21.4322

Orange County, CA ...................... 24.7717

Orlando, FL ................................... 20.8479

Owensboro, KY ............................ 17.7880

Panama City, FL ........................... 19.7652

Parkersburg-Marietta, WV–OH ..... 17.9669

Pensacola, FL ............................... 18.0417

Peoria-Pekin, IL ............................ 18.6783

Philadelphia, PA–NJ ..................... 23.6329

Phoenix-Mesa, AZ ........................ 20.7971

Pine Bluff, AR ............................... 16.8497

Pittsburgh, PA ............................... 20.9887

Pittsfield, MA ................................. 22.3291

Pocatello, ID ................................. 19.9570

Ponce, PR .................................... 11.0089

Portland, ME ................................. 20.7444

Portland-Vancouver, OR–WA ....... 23.9502

Providence-Warwick, RI ............... 23.3619

Provo-Orem, UT ........................... 21.5657

Pueblo, CO ................................... 19.0481

Punta Gorda, FL ........................... 20.1726

Racine, WI .................................... 20.1696

Raleigh-Durham-Chapel Hill, NC 21.0052

Rapid City, SD .............................. 18.9541

Reading, PA ................................. 17.8899

Redding, CA ................................. 24.6813

Reno, NV ...................................... 22.8615

Richland-Kennewick-Pasco, WA .. 24.4034

Richmond-Petersburg, VA ............ 20.8459

Riverside-San Bernardino, CA ..... 24.1711

Roanoke, VA ................................ 18.3527

Rochester, MN .............................. 24.8162

Rochester, NY .............................. 19.9290

Rockford, IL .................................. 19.3616

Rocky Mount, NC ......................... 19.3552

Sacramento, CA ........................... 26.0254

Saginaw-Bay City-Midland, MI ..... 20.6078

St. Cloud, MN ............................... 21.3050

St. Joseph, MO ............................. 19.6144

St. Louis, MO–IL ........................... 19.5920

Salem, OR .................................... 21.8859

Salinas, CA ................................... 31.8419

Salt Lake City-Ogden, UT ............ 21.4139

San Angelo, TX ............................ 17.4362

San Antonio, TX ........................... 18.2088

San Diego, CA .............................. 25.4124

San Francisco, CA ....................... 30.6978

San Jose, CA ............................... 29.9903

San Juan-Bayamon, PR ............... 10.2202

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22821

TABLE 3A.—3-YEAR AVERAGE HOURLY WAGE FOR URBAN AREAS—Continued

[Based on salaries and hours computed for

Federal fiscal years 2000, 2001, and 2002]

Urban area

Average

hourly

wage

San Luis Obispo-AtascaderoPaso Robles, CA ...................... 23.3041

Santa Barbara-Santa MariaLompoc, CA .............................. 23.3594

Santa Cruz-Watsonville, CA ......... 30.3548

Santa Fe, NM ............................... 22.5866

Santa Rosa, CA ............................ 27.7113

Sarasota-Bradenton, FL ............... 21.5493

Savannah, GA .............................. 20.9278

Scranton-Wilkes Barre-Hazleton,

PA ............................................. 17.9530

Seattle-Bellevue-Everett, WA ....... 24.0679

Sharon, PA ................................... 17.4923

Sheboygan, WI ............................. 18.1442

Sherman-Denison, TX .................. 19.5991

Shreveport-Bossier City, LA ......... 19.4652

Sioux City, IA–NE ......................... 18.6963

Sioux Falls, SD ............................. 19.3356

South Bend, IN ............................. 21.7219

Spokane, WA ................................ 23.1813

Springfield, IL ................................ 18.6860

Springfield, MO ............................. 18.1563

Springfield, MA ............................. 23.1451

State College, PA ......................... 19.7984

Steubenville-Weirton, OH–WV ..... 18.6797

Stockton-Lodi, CA ......................... 23.2294

Sumter, SC ................................... 17.6174

Syracuse, NY ................................ 20.3619

Tacoma, WA ................................. 25.1530

Tallahassee, FL ............................ 18.3753

Tampa-St. Petersburg-Clearwater,

FL .............................................. 19.5103

Terre Haute, IN ............................. 18.3195

Texarkana, AR-Texarkana, TX ..... 17.9743

Toledo, OH ................................... 21.2747

Topeka, KS ................................... 19.8271

Trenton, NJ ................................... 21.9528

Tucson, AZ ................................... 19.1755

Tulsa, OK ...................................... 18.4006

Tuscaloosa, AL ............................. 17.6510

Tyler, TX ....................................... 20.1434

Utica-Rome, NY ............................ 18.2674

Vallejo-Fairfield-Napa, CA ............ 28.6820

Ventura, CA .................................. 24.2443

Victoria, TX ................................... 17.9789

Vineland-Millville-Bridgeton, NJ .... 22.7446

Visalia-Tulare-Porterville, CA ....... 21.3962

Waco, TX ...................................... 17.7862

Washington, DC–MD–VA–WV ..... 23.8268

Waterloo-Cedar Falls, IA .............. 18.0820

Wausau, WI .................................. 20.4556

West Palm Beach-Boca Raton,

FL .............................................. 21.2892

Wheeling, OH–WV ....................... 16.9419

Wichita, KS ................................... 20.5727

Wichita Falls, TX .......................... 16.8194

Williamsport, PA ........................... 18.2904

Wilmington-Newark, DE–MD ........ 23.9928

Wilmington, NC ............................. 20.9815

Yakima, WA .................................. 22.3174

Yolo, CA ....................................... 21.5151

York, PA ....................................... 18.9397

Youngstown-Warren, OH ............. 20.9566

Yuba City, CA ............................... 23.0076

Yuma, AZ ...................................... 20.4298

TABLE 3B.—3-YEAR AVERAGE

HOURLY WAGE FOR RURAL AREAS

[Based on salaries and hours computed for

Federal fiscal years 2000, 2001, and 2002]

Nonurban area

Average

hourly

wage

Alabama ........................................ 16.1119

Alaska ........................................... 26.3477

Arizona .......................................... 18.5108

Arkansas ....................................... 16.0724

California ....................................... 21.4448

Colorado ....................................... 19.2806

Connecticut ................................... 26.3210

Delaware ....................................... 20.0732

Florida ........................................... 19.2209

Georgia ......................................... 17.8809

Hawaii ........................................... 23.8315

Idaho ............................................. 18.9021

Illinois ............................................ 17.5886

Indiana .......................................... 18.6071

Iowa .............................................. 17.4515

Kansas .......................................... 16.5492

Kentucky ....................................... 17.3334

Louisiana ...................................... 16.4052

Maine ............................................ 18.8730

Maryland ....................................... 18.9527

Massachusetts .............................. 24.6681

Michigan ....................................... 19.4455

Minnesota ..................................... 19.2586

Mississippi .................................... 16.1955

Missouri ........................................ 16.7949

Montana ........................................ 18.5783

Nebraska ...................................... 17.6014

Nevada ......................................... 20.3129

New Hampshire ............................ 21.4174

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

New Mexico .................................. 18.5917

New York ...................................... 18.5351

North Carolina .............................. 18.3321

North Dakota ................................ 16.8478

Ohio .............................................. 18.8435

Oklahoma ..................................... 16.1793

Oregon .......................................... 21.7904

Pennsylvania ................................ 18.4680

Puerto Rico ................................... 9.5092

Rhode Island 1 .............................. ................

South Carolina .............................. 18.2462

South Dakota ................................ 16.6515

Tennessee .................................... 16.8980

Texas ............................................ 16.3672

Utah .............................................. 19.5943

Vermont ........................................ 20.4055

Virginia .......................................... 17.7547

Washington ................................... 22.5228

West Virginia ................................ 17.6572

Wisconsin ..................................... 19.3313

Wyoming ....................................... 19.1675

1All counties within the State are classified

as urban.

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS

Urban area

(Constituent counties)

Wage

index GAF

0040 Abilene, TX ....... 0.8118 0.8669

Taylor, TX

0060 Aguadilla, PR .... 0.4738 0.5996

Aguada, PR

Aguadilla, PR

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index GAF

Moca, PR

0080 Akron, OH ......... 0.9924 0.9948

Portage, OH

Summit, OH

0120 Albany, GA ........ 1.0675 1.0457

Dougherty, GA

Lee, GA

0160 Albany-Schenectady-Troy, NY ............ 0.8597 0.9017

Albany, NY

Montgomery, NY

Rensselaer, NY

Saratoga, NY

Schenectady, NY

Schoharie, NY

0200 Albuquerque,

NM ............................. 0.9855 0.9900

Bernalillo, NM

Sandoval, NM

Valencia, NM

0220 Alexandria, LA ... 0.8137 0.8683

Rapides, LA

0240 Allentown-Bethlehem-Easton, PA ..... 0.9443 0.9615

Carbon, PA

Lehigh, PA

Northampton, PA

0280 Altoona, PA ....... 0.9225 0.9463

Blair, PA

0320 Amarillo, TX ...... 0.8706 0.9095

Potter, TX

Randall, TX

0380 Anchorage, AK .. 1.2605 1.1718

Anchorage, AK

0440 Ann Arbor, MI .... 1.1220 1.0820

Lenawee, MI

Livingston, MI

Washtenaw, MI

0450 Anniston, AL ...... 0.8360 0.8846

Calhoun, AL

0460 Appleton-Oshkosh-Neenah, WI ...... 0.9203 0.9447

Calumet, WI

Outagamie, WI

Winnebago, WI

0470 Arecibo, PR ....... 0.4683 0.5948

Arecibo, PR

Camuy, PR

Hatillo, PR

0480 Asheville, NC .... 0.9307 0.9520

Buncombe, NC

Madison, NC

0500 Athens, GA ........ 0.9956 0.9970

Clarke, GA

Madison, GA

Oconee, GA

0520 1Atlanta, GA ..... 1.0176 1.0120

Barrow, GA

Bartow, GA

Carroll, GA

Cherokee, GA

Clayton, GA

Cobb, GA

Coweta, GA

DeKalb, GA

Douglas, GA

Fayette, GA

22822 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index GAF

Forsyth, GA

Fulton, GA

Gwinnett, GA

Henry, GA

Newton, GA

Paulding, GA

Pickens, GA

Rockdale, GA

Spalding, GA

Walton, GA

0560 Atlantic-Cape

May, NJ ..................... 1.1349 1.0905

Atlantic, NJ

Cape May, NJ

0580 Auburn-Opelika,

AL .............................. 0.8325 0.8820

Lee, AL

0600 Augusta-Aiken,

GA–SC ...................... 1.0090 1.0062

Columbia, GA

McDuffie, GA

Richmond, GA

Aiken, SC

Edgefield, SC

0640 1Austin-San

Marcos, TX ................ 0.9327 0.9534

Bastrop, TX

Caldwell, TX

Hays, TX

Travis, TX

Williamson, TX

0680 2Bakersfield, CA 0.9870 0.9911

Kern, CA

0720 1Baltimore, MD 0.9723 0.9809

Anne Arundel, MD

Baltimore, MD

Baltimore City, MD

Carroll, MD

Harford, MD

Howard, MD

Queen Anne’s, MD

0733 Bangor, ME ....... 0.9559 0.9696

Penobscot, ME

0743 BarnstableYarmouth, MA ........... 1.3539 1.2306

Barnstable, MA

0760 Baton Rouge, LA 0.8258 0.8772

Ascension, LA

East Baton Rouge,

LA

Livingston, LA

West Baton Rouge,

LA

0840 Beaumont-Port

Arthur, TX .................. 0.8508 0.8953

Hardin, TX

Jefferson, TX

Orange, TX

0860 Bellingham, WA 1.1963 1.1306

Whatcom, WA

0870 2Benton Harbor,

MI .............................. 0.9115 0.9385

Berrien, MI

0875 1Bergen-Passaic, NJ ..................... 1.1669 1.1115

Bergen, NJ

Passaic, NJ

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index GAF

0880 Billings, MT ....... 0.9623 0.9740

Yellowstone, MT

0920 Biloxi-GulfportPascagoula, MS ........ 0.8538 0.8974

Hancock, MS

Harrison, MS

Jackson, MS

0960 Binghamton, NY 0.8595 0.9015

Broome, NY

Tioga, NY

1000 Birmingham, AL 0.8648 0.9053

Blount, AL

Jefferson, AL

St. Clair, AL

Shelby, AL

1010 2Bismarck, ND .. 0.7965 0.8557

Burleigh, ND

Morton, ND

1020 2Bloomington,

IN ............................... 0.8757 0.9131

Monroe, IN

1040 BloomingtonNormal, IL ................. 0.8545 0.8979

McLean, IL

1080 Boise City, ID .... 0.9190 0.9438

Ada, ID

Canyon, ID

1123 1, 2BostonWorcester-LawrenceLowell-Brockton, MA–

NH (MA Hospitals) .... 1.1586 1.1061

Bristol, MA

Essex, MA

Middlesex, MA

Norfolk, MA

Plymouth, MA

Suffolk, MA

Worcester, MA

Hillsborough, NH

Merrimack, NH

Rockingham, NH

Strafford, NH

1123 1BostonWorcester-LawrenceLowell-Brockton, MA–

NH (NH Hospitals) .... 1.1483 1.0993

Bristol, MA

Essex, MA

Middlesex, MA

Norfolk, MA

Plymouth, MA

Suffolk, MA

Worcester, MA

Hillsborough, NH

Merrimack, NH

Rockingham, NH

Strafford, NH

1125 BoulderLongmont, CO ........... 0.9836 0.9887

Boulder, CO

1145 Brazoria, TX ...... 0.8299 0.8801

Brazoria, TX

1150 Bremerton, WA 1.0882 1.0596

Kitsap, WA

1240 Brownsville-Harlingen-San Benito, TX 0.8783 0.9150

Cameron, TX

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index GAF

1260 Bryan-College

Station, TX ................ 0.9296 0.9512

Brazos, TX

1280 1Buffalo-Niagara

Falls, NY ................... 0.9405 0.9589

Erie, NY

Niagara, NY

1303 Burlington, VT ... 0.9826 0.9881

Chittenden, VT

Franklin, VT

Grand Isle, VT

1310 Caguas, PR ....... 0.5158 0.6355

Caguas, PR

Cayey, PR

Cidra, PR

Gurabo, PR

San Lorenzo, PR

1320 CantonMassillon, OH ............ 0.9059 0.9346

Carroll, OH

Stark, OH

1350 Casper, WY ....... 0.9606 0.9728

Natrona, WY

1360 Cedar Rapids, IA 0.8711 0.9098

Linn, IA

1400 Champaign-Urbana, IL ..................... 0.9264 0.9490

Champaign, IL

1440 Charleston-North

Charleston, SC .......... 0.9293 0.9510

Berkeley, SC

Charleston, SC

Dorchester, SC

1480 Charleston, WV 0.9369 0.9563

Kanawha, WV

Putnam, WV

1520 1 Charlotte-Gastonia-Rock Hill, NC–

SC ............................. 0.9469 0.9633

Cabarrus, NC

Gaston, NC

Lincoln, NC

Mecklenburg, NC

Rowan, NC

Stanly, NC

Union, NC

York, SC

1540 Charlottesville,

VA ............................. 1.0688 1.0466

Albemarle, VA

Charlottesville City,

VA

Fluvanna, VA

Greene, VA

1560 Chattanooga,

TN–GA ...................... 0.9446 0.9617

Catoosa, GA

Dade, GA

Walker, GA

Hamilton, TN

Marion, TN

1580 2 Cheyenne, WY 0.8855 0.9201

Laramie, WY

1600 1 Chicago, IL ...... 1.1011 1.0682

Cook, IL

DeKalb, IL

DuPage, IL

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22823

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index GAF

Grundy, IL

Kane, IL

Kendall, IL

Lake, IL

McHenry, IL

Will, IL

1620 Chico-Paradise,

CA ............................. 0.9909 0.9938

Butte, CA

1640 1 Cincinnati, OH–

KY–IN ........................ 0.9574 0.9706

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 ........ 0.8481 0.8933

Christian, KY

Montgomery, TN

1680 1 Cleveland-Lorain-Elyria, OH .......... 0.9496 0.9652

Ashtabula, OH

Cuyahoga, OH

Geauga, OH

Lake, OH

Lorain, OH

Medina, OH

1720 Colorado

Springs, CO .............. 0.9754 0.9831

El Paso, CO

1740 Columbia, MO ... 0.8787 0.9153

Boone, MO

1760 Columbia, SC .... 0.9589 0.9717

Lexington, SC

Richland, SC

1800 Columbus, GA–

AL .............................. 0.8471 0.8926

Russell, AL

Chattahoochee, GA

Harris, GA

Muscogee, GA

1840 1 Columbus, OH 0.9724 0.9810

Delaware, OH

Fairfield, OH

Franklin, OH

Licking, OH

Madison, OH

Pickaway, OH

1880 Corpus Christi,

TX .............................. 0.8203 0.8731

Nueces, TX

San Patricio, TX

1890 Corvallis, OR ..... 1.1781 1.1188

Benton, OR

1900 2 Cumberland,

MD–WV (MD Hospitals) ......................... 0.8962 0.9277

Allegany, MD

Mineral, WV

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index GAF

1900 Cumberland,

MD–WV (WV Hospital) .......................... 0.8402 0.8876

Allegany, MD

Mineral, WV

1920 1 Dallas, TX ....... 0.9506 0.9659

Collin, TX

Dallas, TX

Denton, TX

Ellis, TX

Henderson, TX

Hunt, TX

Kaufman, TX

Rockwall, TX

1950 Danville, VA ...... 0.8641 0.9048

Danville City, VA

Pittsylvania, VA

1960 Davenport-Moline-Rock Island, IA–

IL ............................... 0.8790 0.9155

Scott, IA

Henry, IL

Rock Island, IL

2000 Dayton-Springfield, OH .................... 0.9323 0.9531

Clark, OH

Greene, OH

Miami, OH

Montgomery, OH

2020 Daytona Beach,

FL .............................. 0.9069 0.9353

Flagler, FL

Volusia, FL

2030 Decatur, AL ....... 0.8817 0.9174

Lawrence, AL

Morgan, AL

2040 2 Decatur, IL ...... 0.8140 0.8686

Macon, IL

2080 1 Denver, CO ..... 1.0289 1.0197

Adams, CO

Arapahoe, CO

Denver, CO

Douglas, CO

Jefferson, CO

2120 Des Moines, IA 0.8881 0.9219

Dallas, IA

Polk, IA

Warren, IA

2160 1 Detroit, MI ....... 1.0478 1.0325

Lapeer, MI

Macomb, MI

Monroe, MI

Oakland, MI

St. Clair, MI

Wayne, MI

2180 Dothan, AL ........ 0.8005 0.8587

Dale, AL

Houston, AL

2190 Dover, DE ......... 1.0453 1.0308

Kent, DE

2200 Dubuque, IA ...... 0.8617 0.9031

Dubuque, IA

2240 Duluth-Superior,

MN–WI ...................... 1.0401 1.0273

St. Louis, MN

Douglas, WI

2281 Dutchess County, NY ........................ 1.0639 1.0433

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index GAF

Dutchess, NY

2290 2Eau Claire, WI 0.9121 0.9389

Chippewa, WI

Eau Claire, WI

2320 El Paso, TX ....... 0.9162 0.9418

El Paso, TX

2330 Elkhart-Goshen,

IN ............................... 0.9646 0.9756

Elkhart, IN

2335 Elmira, NY ......... 0.8530 0.8968

Chemung, NY

2340 Enid, OK ............ 0.8454 0.8914

Garfield, OK

2360 Erie, PA ............. 0.8911 0.9241

Erie, PA

2400 Eugene-Springfield, OR .................... 1.1485 1.0995

Lane, OR

2440 2Evansville-Henderson, IN–KY (IN

Hospitals) .................. 0.8757 0.9131

Posey, IN

Vanderburgh, IN

Warrick, IN

Henderson, KY

2440 2Evansville-Henderson, IN–KY (KY

Hospitals) .................. 0.8019 0.8597

Posey, IN

Vanderburgh, IN

Warrick, IN

Henderson, KY

2520 Fargo-Moorhead,

ND–MN ..................... 0.9374 0.9567

Clay, MN

Cass, ND

2560 Fayetteville, NC 0.9132 0.9397

Cumberland, NC

2580 FayettevilleSpringdale-Rogers,

AR ............................. 0.7587 0.8277

Benton, AR

Washington, AR

2620 Flagstaff, AZ–UT 1.0678 1.0459

Coconino, AZ

Kane, UT

2640 Flint, MI ............. 1.0920 1.0621

Genesee, MI

2650 Florence, AL ...... 0.7927 0.8529

Colbert, AL

Lauderdale, AL

2655 Florence, SC ..... 0.8843 0.9192

Florence, SC

2670 Fort CollinsLoveland, CO ............ 1.0161 1.0110

Larimer, CO

2680 1Ft. Lauderdale,

FL .............................. 1.0906 1.0612

Broward, FL

2700 Fort Myers-Cape

Coral, FL ................... 0.9380 0.9571

Lee, FL

2710 Fort Pierce-Port

St. Lucie, FL .............. 1.0067 1.0046

Martin, FL

St. Lucie, FL

2720 Fort Smith, AR–

OK ............................. 0.8076 0.8639

22824 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index GAF

Crawford, AR

Sebastian, AR

Sequoyah, OK

2750 2Fort Walton

Beach, FL .................. 0.8733 0.9114

Okaloosa, FL

2760 Fort Wayne, IN .. 0.9186 0.9435

Adams, IN

Allen, IN

De Kalb, IN

Huntington, IN

Wells, IN

Whitley, IN

2800 1Forth Worth-Arlington, TX ................. 0.9452 0.9621

Hood, TX

Johnson, TX

Parker, TX

Tarrant, TX

2840 Fresno, CA ........ 0.9972 0.9981

Fresno, CA

Madera, CA

2880 Gadsden, AL ..... 0.8845 0.9194

Etowah, AL

2900 Gainesville, FL .. 1.2133 1.1416

Alachua, FL

2920 Galveston-Texas

City, TX ..................... 1.0271 1.0185

Galveston, TX

2960 Gary, IN ............. 0.9571 0.9704

Lake, IN

Porter, IN

2975 2Glens Falls, NY 0.8530 0.8968

Warren, NY

Washington, NY

2980 Goldsboro, NC .. 0.8810 0.9169

Wayne, NC

2985 Grand Forks,

ND–MN ..................... 0.9173 0.9426

Polk, MN

Grand Forks, ND

2995 Grand Junction,

CO ............................. 0.9816 0.9874

Mesa, CO

3000 1Grand RapidsMuskegon-Holland,

MI .............................. 1.0161 1.0110

Allegan, MI

Kent, MI

Muskegon, MI

Ottawa, MI

3040 Great Falls, MT 0.9301 0.9516

Cascade, MT

3060 Greeley, CO ...... 0.9604 0.9727

Weld, CO

3080 Green Bay, WI .. 0.9440 0.9613

Brown, WI

3120 1GreensboroWinston-Salem-High

Point, NC ................... 0.9616 0.9735

Alamance, NC

Davidson, NC

Davie, NC

Forsyth, NC

Guilford, NC

Randolph, NC

Stokes, NC

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index GAF

Yadkin, NC

3150 Greenville, NC ... 0.9963 0.9975

Pitt, NC

3160 GreenvilleSpartanburg-Anderson, SC ..................... 0.9110 0.9382

Anderson, SC

Cherokee, SC

Greenville, SC

Pickens, SC

Spartanburg, SC

3180 2 Hagerstown,

MD ............................. 0.8962 0.9277

Washington, MD

3200 Hamilton-Middletown, OH ................... 0.9269 0.9493

Butler, OH

3240 Harrisburg-Lebanon-Carlisle, PA ...... 0.9311 0.9523

Cumberland, PA

Dauphin, PA

Lebanon, PA

Perry, PA

3283 1, 2 Hartford, CT 1.2357 1.1560

Hartford, CT

Litchfield, CT

Middlesex, CT

Tolland, CT

3285 2 Hattiesburg,

MS ............................. 0.7612 0.8296

Forrest, MS

Lamar, MS

3290 Hickory-Morganton-Lenoir, NC ..... 0.9517 0.9667

Alexander, NC

Burke, NC

Caldwell, NC

Catawba, NC

3320 Honolulu, HI ...... 1.1658 1.1108

Honolulu, HI

3350 Houma, LA ........ 0.8043 0.8615

Lafourche, LA

Terrebonne, LA

3360 1 Houston, TX .... 0.9604 0.9727

Chambers, TX

Fort Bend, TX

Harris, TX

Liberty, TX

Montgomery, TX

Waller, TX

3400 Huntington-Ashland, WV–KY–OH ..... 0.9700 0.9794

Boyd, KY

Carter, KY

Greenup, KY

Lawrence, OH

Cabell, WV

Wayne, WV

3440 Huntsville, AL .... 0.8854 0.9200

Limestone, AL

Madison, AL

3480 1 Indianapolis, IN 0.9771 0.9843

Boone, IN

Hamilton, IN

Hancock, IN

Hendricks, IN

Johnson, IN

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index GAF

Madison, IN

Marion, IN

Morgan, IN

Shelby, IN

3500 Iowa City, IA ...... 0.9973 0.9982

Johnson, IA

3520 Jackson, MI ....... 0.9387 0.9576

Jackson, MI

3560 Jackson, MS ..... 0.8589 0.9011

Hinds, MS

Madison, MS

Rankin, MS

3580 Jackson, TN ...... 0.9117 0.9387

Madison, TN

Chester, TN

3600 1 Jacksonville,

FL .............................. 0.9040 0.9332

Clay, FL

Duval, FL

Nassau, FL

St. Johns, FL

3605 2 Jacksonville,

NC ............................. 0.8632 0.9042

Onslow, NC

3610 2 Jamestown, NY 0.8530 0.8968

Chautauqua, NY

3620 Janesville-Beloit,

WI .............................. 0.9840 0.9890

Rock, WI

3640 Jersey City, NJ .. 1.1216 1.0818

Hudson, NJ

3660 Johnson CityKingsport-Bristol, TN–

VA ............................. 0.8540 0.8976

Carter, TN

Hawkins, TN

Sullivan, TN

Unicoi, TN

Washington, TN

Bristol City, VA

Scott, VA

Washington, VA

3680 Johnstown, PA .. 0.8959 0.9275

Cambria, PA

Somerset, PA

3700 Jonesboro, AR .. 0.8523 0.8963

Craighead, AR

3710 Joplin, MO ......... 0.8736 0.9116

Jasper, MO

Newton, MO

3720 KalamazooBattlecreek, MI .......... 1.0696 1.0472

Calhoun, MI

Kalamazoo, MI

Van Buren, MI

3740 Kankakee, IL ..... 0.9268 0.9493

Kankakee, IL

3760 1Kansas City,

KS–MO ...................... 0.9430 0.9606

Johnson, KS

Leavenworth, KS

Miami, KS

Wyandotte, KS

Cass, MO

Clay, MO

Clinton, MO

Jackson, MO

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22825

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index GAF

Lafayette, MO

Platte, MO

Ray, MO

3800 Kenosha, WI ..... 0.9678 0.9778

Kenosha, WI

3810 2Killeen-Temple,

TX .............................. 0.7673 0.8341

Bell, TX

Coryell, TX

3840 Knoxville, TN ..... 0.8904 0.9236

Anderson, TN

Blount, TN

Knox, TN

Loudon, TN

Sevier, TN

Union, TN

3850 Kokomo, IN ....... 0.9290 0.9508

Howard, IN

Tipton, IN

3870 La Crosse, WI–

MN ............................. 0.9328 0.9535

Houston, MN

La Crosse, WI

3880 Lafayette, LA ..... 0.8600 0.9019

Acadia, LA

Lafayette, LA

St. Landry, LA

St. Martin, LA

3920 Lafayette, IN ...... 0.9165 0.9420

Clinton, IN

Tippecanoe, IN

3960 Lake Charles,

LA .............................. 0.7810 0.8443

Calcasieu, LA

3980 Lakeland-Winter

Haven, FL ................. 0.9167 0.9422

Polk, FL

4000 Lancaster, PA ... 0.9413 0.9594

Lancaster, PA

4040 Lansing-East

Lansing, MI ............... 0.9653 0.9761

Clinton, MI

Eaton, MI

Ingham, MI

4080 Laredo, TX ........ 0.7877 0.8492

Webb, TX

4100 2 Las Cruces,

NM ............................. 0.8835 0.9187

Dona Ana, NM

4120 1 Las Vegas,

NV–AZ ....................... 1.1238 1.0832

Mohave, AZ

Clark, NV

Nye, NV

4150 Lawrence, KS .... 0.8756 0.9130

Douglas, KS

4200 Lawton, OK ....... 0.8783 0.9150

Comanche, OK

4243 Lewiston-Auburn, ME ................... 0.9451 0.9621

Androscoggin, ME

4280 Lexington, KY .... 0.8850 0.9197

Bourbon, KY

Clark, KY

Fayette, KY

Jessamine, KY

Madison, KY

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index GAF

Scott, KY

Woodford, KY

4320 Lima, OH ........... 0.9558 0.9695

Allen, OH

Auglaize, OH

4360 Lincoln, NE ........ 1.0272 1.0185

Lancaster, NE

4400 Little Rock-North

Little Rock, AR .......... 0.9053 0.9341

Faulkner, AR

Lonoke, AR

Pulaski, AR

Saline, AR

4420 Longview-Marshall, TX .................... 0.8439 0.8903

Gregg, TX

Harrison, TX

Upshur, TX

4480 1 Los AngelesLong Beach, CA ........ 1.2071 1.1376

Los Angeles, CA

4520 1 Louisville, KY–

IN ............................... 0.9596 0.9722

Clark, IN

Floyd, IN

Harrison, IN

Scott, IN

Bullitt, KY

Jefferson, KY

Oldham, KY

4600 Lubbock, TX ...... 0.8547 0.8981

Lubbock, TX

4640 Lynchburg, VA .. 0.9208 0.9451

Amherst, VA

Bedford, VA

Bedford City, VA

Campbell, VA

Lynchburg City, VA

4680 Macon, GA ........ 0.9077 0.9358

Bibb, GA

Houston, GA

Jones, GA

Peach, GA

Twiggs, GA

4720 Madison, WI ...... 1.0462 1.0314

Dane, WI

4800 Mansfield, OH ... 0.8827 0.9181

Crawford, OH

Richland, OH

4840 Mayaguez, PR .. 0.4917 0.6150

Anasco, PR

Cabo Rojo, PR

Hormigueros, PR

Mayaguez, PR

Sabana Grande, PR

San German, PR

4880 McAllen-Edinburg-Mission, TX ....... 0.8433 0.8898

Hidalgo, TX

4890 Medford-Ashland, OR .................... 1.0433 1.0295

Jackson, OR

4900 MelbourneTitusville-Palm Bay,

FL .............................. 0.9883 0.9920

Brevard, Fl

4920 1 Memphis, TN–

AR–MS ...................... 0.9435 0.9610

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index GAF

Crittenden, AR

DeSoto, MS

Fayette, TN

Shelby, TN

Tipton, TN

4940 Merced, CA ....... 0.9870 0.9911

Merced, CA

5000 1 Miami, FL ........ 0.9934 0.9955

Dade, FL

5015 1 MiddlesexSomerset-Hunterdon,

NJ .............................. 1.1952 1.1299

Hunterdon, NJ

Middlesex, NJ

Somerset, NJ

5080 1 MilwaukeeWaukesha, WI ........... 0.9898 0.9930

Milwaukee, WI

Ozaukee, WI

Washington, WI

Waukesha, WI

5120 1 Minneapolis-St.

Paul, MN–WI ............. 1.1000 1.0674

Anoka, MN

Carver, MN

Chisago, MN

Dakota, MN

Hennepin, MN

Isanti, MN

Ramsey, MN

Scott, MN

Sherburne, MN

Washington, MN

Wright, MN

Pierce, WI

St. Croix, WI

5140 Missoula, MT ..... 0.9453 0.9622

Missoula, MT

5160 Mobile, AL ......... 0.7766 0.8410

Baldwin, AL

Mobile, AL

5170 Modesto, CA ..... 1.0945 1.0638

Stanislaus, CA

5190 1 MonmouthOcean, NJ ................. 1.1514 1.1014

Monmouth, NJ

Ocean, NJ

5200 Monroe, LA ....... 0.8296 0.8799

Ouachita, LA

5240 Montgomery, AL 0.7502 0.8213

Autauga, AL

Elmore, AL

Montgomery, AL

5280 Muncie, IN ......... 0.9689 0.9786

Delaware, IN

5330 Myrtle Beach,

SC ............................. 0.8855 0.9201

Horry, SC

5345 Naples, FL ......... 0.9566 0.9701

Collier, FL

5360 1 Nashville, TN .. 0.9602 0.9726

Cheatham, TN

Davidson, TN

Dickson, TN

Robertson, TN

Rutherford TN

Sumner, TN

22826 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index GAF

Williamson, TN

Wilson, TN

5380 1 Nassau-Suffolk,

NY ............................. 1.3841 1.2493

Nassau, NY

Suffolk, NY

5483 1 2 New HavenBridgeport-StamfordWaterbury-Danbury,

CT ............................. 1.2357 1.1560

Fairfield, CT

New Haven, CT

5523 12 New LondonNorwich, CT .............. 1.2357 1.1560

New London, CT

5560 1 New Orleans,

LA .............................. 0.9054 0.9342

Jefferson, LA

Orleans, LA

Plaquemines, LA

St. Bernard, LA

St. Charles, LA

St. James, LA

St. John The Baptist,

LA

St. Tammany, LA

5600 1 New York, NY 1.3923 1.2544

Bronx, NY

Kings, NY

New York, NY

Putnam, NY

Queens, NY

Richmond, NY

Rockland, NY

Westchester, NY

5640 1 Newark, NJ ..... 1.2004 1.1332

Essex, NJ

Morris, NJ

Sussex, NJ

Union, NJ

Warren, NJ

5660 Newburgh, NY–

PA ............................. 1.1235 1.0830

Orange, NY

Pike, PA

5720 1 Norfolk-Virginia

Beach-Newport

News, VA–NC ........... 0.8630 0.9040

Currituck, NC

Chesapeake City, VA

Gloucester, VA

Hampton City, VA

Isle of Wight, VA

James City, VA

Mathews, VA

Newport News City,

VA

Norfolk City, VA

Poquoson City, VA

Portsmouth City, VA

Suffolk City, VA

Virginia Beach City

VA

Williamsburg City, VA

York, VA

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index GAF

5775 1Oakland, CA ... 1.5416 1.3450

Alameda, CA

Contra Costa, CA

5790 Ocala, FL .......... 0.9579 0.9710

Marion, FL

5800 Odessa-Midland,

TX .............................. 0.9017 0.9316

Ector, TX

Midland, TX

5880 1Oklahoma City,

OK ............................. 0.8728 0.9110

Canadian, OK

Cleveland, OK

Logan, OK

McClain, OK

Oklahoma, OK

Pottawatomie, OK

5910 Olympia, WA ..... 1.1481 1.0992

Thurston, WA

5920 Omaha, NE–IA .. 0.9696 0.9791

Pottawattamie, IA

Cass, NE

Douglas, NE

Sarpy, NE

Washington, NE

5945 1Orange County,

CA ............................. 1.1354 1.0909

Orange, CA

5960 1Orlando, FL ..... 0.9464 0.9630

Lake, FL

Orange, FL

Osceola, FL

Seminole, FL

5990 Owensboro, KY 0.8346 0.8835

Daviess, KY

6015 Panama City, FL 0.9166 0.9421

Bay, FL

6020 ParkersburgMarietta, WV–OH

(WV Hospitals) .......... 0.8192 0.8723

Washington, OH

Wood, WV

6020 2ParkersburgMarietta, WV–OH

(OH Hospitals) .......... 0.8761 0.9134

Washington, OH

Wood, WV

6080 2Pensacola, FL 0.8733 0.9114

Escambia, FL

Santa Rosa, FL

6120 Peoria-Pekin, IL 0.8883 0.9221

Peoria, IL

Tazewell, IL

Woodford, IL

6160 1Philadelphia,

PA–NJ ....................... 1.0626 1.0425

Burlington, NJ

Camden, NJ

Gloucester, NJ

Salem, NJ

Bucks, PA

Chester, PA

Delaware, PA

Montgomery, PA

Philadelphia, PA

6200 1Phoenix-Mesa,

AZ .............................. 0.9654 0.9762

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index GAF

Maricopa, AZ

Pinal, AZ

6240 Pine Bluff, AR ... 0.7837 0.8463

Jefferson, AR

6280 1Pittsburgh, PA 0.9714 0.9803

Allegheny, PA

Beaver, PA

Butler, PA

Fayette, PA

Washington, PA

Westmoreland, PA

6323 2Pittsfield, MA ... 1.1586 1.1061

Berkshire, MA

6340 Pocatello, ID ...... 0.9557 0.9694

Bannock, ID

6360 Ponce, PR ......... 0.5278 0.6456

Guayanilla, PR

Juana Diaz, PR

Penuelas, PR

Ponce, PR

Villalba, PR

Yauco, PR

6403 Portland, ME ..... 0.9501 0.9656

Cumberland, ME

Sagadahoc, ME

York, ME

6440 1Portland-Vancouver, OR–WA ........ 1.1291 1.0867

Clackamas, OR

Columbia, OR

Multnomah, OR

Washington, OR

Yamhill, OR

Clark, WA

6483 1ProvidenceWarwick-Pawtucket,

RI ............................... 1.0781 1.0528

Bristol, RI

Kent, RI

Newport, RI

Providence, RI

Washington, RI

6520 Provo-Orem, UT 0.9967 0.9977

Utah, UT

6560 2Pueblo, CO ..... 0.8909 0.9239

Pueblo, CO

6580 Punta Gorda, FL 0.8818 0.9175

Charlotte, FL

6600 Racine, WI ........ 0.9441 0.9614

Racine, WI

6640 1 Raleigh-Durham-Chapel Hill, NC 0.9901 0.9932

Chatham, NC

Durham, NC

Franklin, NC

Johnston, NC

Orange, NC

Wake, NC

6660 Rapid City, SD .. 0.8971 0.9283

Pennington, SD

6680 2 Reading, PA .... 0.8473 0.8927

Berks, PA

6690 Redding, CA ...... 1.1222 1.0822

Shasta, CA

6720 Reno, NV .......... 1.0456 1.0310

Washoe, NV

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22827

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index GAF

6740 RichlandKennewick-Pasco,

WA ............................ 1.1086 1.0732

Benton, WA

Franklin, WA

6760 Richmond-Petersburg, VA .............. 0.9712 0.9802

Charles City County,

VA

Chesterfield, VA

Colonial Heights City,

VA

Dinwiddie, VA

Goochland, VA

Hanover, VA

Henrico, VA

Hopewell City, VA

New Kent, VA

Petersburg City, VA

Powhatan, VA

Prince George, VA

Richmond City, VA

6780 1 Riverside-San

Bernardino, CA ......... 1.1012 1.0682

Riverside, CA

San Bernardino, CA

6800 2 Roanoke, VA ... 0.8473 0.8927

Botetourt, VA

Roanoke, VA

Roanoke City, VA

Salem City, VA

6820 Rochester, MN .. 1.1595 1.1067

Olmsted, MN

6840 1 Rochester, NY 0.9238 0.9472

Genesee, NY

Livingston, NY

Monroe, NY

Ontario, NY

Orleans, NY

Wayne, NY

6880 Rockford, IL ....... 0.9194 0.9441

Boone, IL

Ogle, IL

Winnebago, IL

6895 Rocky Mount,

NC ............................. 0.9197 0.9443

Edgecombe, NC

Nash, NC

6920 1Sacramento,

CA ............................. 1.1809 1.1206

El Dorado, CA

Placer, CA

Sacramento, CA

6960 Saginaw-Bay

City-Midland, MI ........ 0.9662 0.9767

Bay, MI

Midland, MI

Saginaw, MI

6980 St. Cloud, MN ... 1.0040 1.0027

Benton, MN

Stearns, MN

7000 St. Joseph, MO 0.9113 0.9384

Andrew, MO

Buchanan, MO

7040 1St. Louis, MO–

IL ............................... 0.9024 0.9321

Clinton, IL

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index GAF

Jersey, IL

Madison, IL

Monroe, IL

St. Clair, IL

Franklin, MO

Jefferson, MO

Lincoln, MO

St. Charles, MO

St. Louis, MO

St. Louis City, MO

Warren, MO

7080 2Salem, OR ...... 1.0156 1.0107

Marion, OR

Polk, OR

7120 Salinas, CA ....... 1.4854 1.3112

Monterey, CA

7160 1Salt Lake CityOgden, UT ................ 0.9976 0.9984

Davis, UT

Salt Lake, UT

Weber, UT

7200 San Angelo, TX 0.8288 0.8793

Tom Green, TX

7240 1San Antonio,

TX .............................. 0.8333 0.8826

Bexar, TX

Comal, TX

Guadalupe, TX

Wilson, TX

7320 1San Diego, CA 1.1480 1.0991

San Diego, CA

7360 1San Francisco,

CA ............................. 1.4319 1.2787

Marin, CA

San Francisco, CA

San Mateo, CA

7400 1San Jose, CA .. 1.4249 1.2744

Santa Clara, CA

7440 1San Juan-Bayamon, PR ................ 0.4812 0.6060

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

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index GAF

Vega Alta, PR

Vega Baja, PR

Yabucoa, PR

7460 San Luis

Obispo-AtascaderoPaso Robles, CA ...... 1.1117 1.0752

San Luis Obispo, CA

7480 Santa BarbaraSanta Maria-Lompoc,

CA ............................. 1.0927 1.0626

Santa Barbara, CA

7485 Santa CruzWatsonville, CA ......... 1.4049 1.2621

Santa Cruz, CA

7490 Santa Fe, NM .... 1.0312 1.0213

Los Alamos, NM

Santa Fe, NM

7500 Santa Rosa, CA 1.2727 1.1796

Sonoma, CA

7510 Sarasota-Bradenton, FL ................. 1.0118 1.0081

Manatee, FL

Sarasota, FL

7520 Savannah, GA ... 0.9349 0.9549

Bryan, GA

Chatham, GA

Effingham, GA

7560 2Scranton—

Wilkes-Barre—Hazleton, PA ...................... 0.8473 0.8927

Columbia, PA

Lackawanna, PA

Luzerne, PA

Wyoming, PA

7600 1Seattle-Bellevue-Everett, WA ........ 1.1056 1.0712

Island, WA

King, WA

Snohomish, WA

7610 2Sharon, PA ..... 0.8473 0.8927

Mercer, PA

7620 2Sheboygan, WI 0.9121 0.9389

Sheboygan, WI

7640 ShermanDenison, TX .............. 0.9163 0.9419

Grayson, TX

7680 Shreveport-Bossier City, LA .............. 0.9165 0.9420

Bossier, LA

Caddo, LA

Webster, LA

7720 Sioux City, IA–

NE ............................. 0.8868 0.9210

Woodbury, IA

Dakota, NE

7760 Sioux Falls, SD 0.9245 0.9477

Lincoln, SD

Minnehaha, SD

7800 South Bend, IN 1.0303 1.0207

St. Joseph, IN

7840 Spokane, WA .... 1.0791 1.0535

Spokane, WA

7880 Springfield, IL .... 0.8502 0.8948

Menard, IL

Sangamon, IL

7920 Springfield, MO 0.8666 0.9066

Christian, MO

22828 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index GAF

Greene, MO

Webster, MO

8003 2Springfield, MA 1.1586 1.1061

Hampden, MA

Hampshire, MA

8050 State College,

PA ............................. 0.9239 0.9472

Centre, PA

8080 2SteubenvilleWeirton, OH–WV (OH

Hospitals) .................. 0.8761 0.9134

Jefferson, OH

Brooke, WV

Hancock, WV

8080 SteubenvilleWeirton, OH–WV

(WV Hospitals) .......... 0.8737 0.9117

Jefferson, OH

Brooke, WV

Hancock, WV

8120 Stockton-Lodi,

CA ............................. 1.1114 1.0750

San Joaquin, CA

8140 2Sumter, SC ..... 0.8606 0.9023

Sumter, SC

8160 Syracuse, NY .... 0.9247 0.9478

Cayuga, NY

Madison, NY

Onondaga, NY

Oswego, NY

8200 Tacoma, WA ..... 1.1751 1.1168

Pierce, WA

8240 2Tallahassee,

FL .............................. 0.8733 0.9114

Gadsden, FL

Leon, FL

8280 1Tampa-St. Petersburg-Clearwater,

FL .............................. 0.9095 0.9371

Hernando, FL

Hillsborough, FL

Pasco, FL

Pinellas, FL

8320 2Terre Haute, IN 0.8757 0.9131

Clay, IN

Vermillion, IN

Vigo, IN

8360 Texarkana, ARTexarkana, TX .......... 0.8414 0.8885

Miller, AR

Bowie, TX

8400 Toledo, OH ........ 0.9815 0.9873

Fulton, OH

Lucas, OH

Wood, OH

8440 Topeka, KS ....... 0.9015 0.9315

Shawnee, KS

8480 Trenton, NJ ....... 1.0172 1.0117

Mercer, NJ

8520 Tucson, AZ ........ 0.9002 0.9305

Pima, AZ

8560 Tulsa, OK .......... 0.8949 0.9268

Creek, OK

Osage, OK

Rogers, OK

Tulsa, OK

Wagoner, OK

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index GAF

8600 Tuscaloosa, AL 0.8265 0.8777

Tuscaloosa, AL

8640 Tyler, TX ........... 0.9109 0.9381

Smith, TX

8680 2 Utica-Rome,

NY ............................. 0.8530 0.8968

Herkimer, NY

Oneida, NY

8720 Vallejo-FairfieldNapa, CA .................. 1.3535 1.2303

Napa, CA

Solano, CA

8735 Ventura, CA ...... 1.1088 1.0733

Ventura, CA

8750 Victoria, TX ....... 0.8354 0.8841

Victoria, TX

8760 Vineland-Millville-Bridgeton, NJ ..... 1.0473 1.0322

Cumberland, NJ

8780 2Visalia-TularePorterville, CA ........... 0.9870 0.9911

Tulare, CA

8800 Waco, TX .......... 0.8268 0.8779

McLennan, TX

8840 1Washington,

DC–MD–VA–WV ....... 1.1176 1.0791

District of Columbia,

DC

Calvert, MD

Charles, MD

Frederick, MD

Montgomery, MD

Prince Georges, MD

Alexandria City, VA

Arlington, VA

Clarke, VA

Culpeper, VA

Fairfax, VA

Fairfax City, VA

Falls Church City, VA

Fauquier, VA

Fredericksburg City,

VA

King George, VA

Loudoun, VA

Manassas City, VA

Manassas Park City,

VA

Prince William, VA

Spotsylvania, VA

Stafford, VA

Warren, VA

Berkeley, WV

Jefferson, WV

8920 Waterloo-Cedar

Falls, IA ..................... 0.8608 0.9024

Black Hawk, IA

8940 Wausau, WI ...... 0.9516 0.9666

Marathon, WI

8960 1West Palm

Beach-Boca Raton,

FL .............................. 0.9785 0.9852

Palm Beach, FL

9000 2Wheeling, WV–

OH (WV Hospitals) ... 0.8145 0.8689

Belmont, OH

TABLE 4A.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index GAF

Marshall, WV

Ohio, WV

9000 2Wheeling, WV–

OH (OH Hospitals) .... 0.8761 0.9134

Belmont, OH

Marshall, WV

Ohio, WV

9040 Wichita, KS ....... 0.9541 0.9683

Butler, KS

Harvey, KS

Sedgwick, KS

9080 Wichita Falls, TX 0.8015 0.8594

Archer, TX

Wichita, TX

9140 Williamsport, PA 0.8503 0.8949

Lycoming, PA

9160 Wilmington-Newark, DE–MD .............. 1.0757 1.0512

New Castle, DE

Cecil, MD

9200 Wilmington, NC 0.9971 0.9980

New Hanover, NC

Brunswick, NC

9260 Yakima, WA ...... 1.0690 1.0468

Yakima, WA

9270 2Yolo, CA .......... 0.9870 0.9911

Yolo, CA

9280 2York, PA .......... 0.8473 0.8927

York, PA

9320 YoungstownWarren, OH ............... 0.9480 0.9641

Columbiana, OH

Mahoning, OH

Trumbull, OH

9340 Yuba City, CA ... 1.0479 1.0326

Sutter, CA

Yuba, CA

9360 Yuma, AZ .......... 0.8904 0.9236

Yuma, AZ

1 Large Urban Area

2 Hospitals geographically located in the

area are assigned the statewide rural wage

index for FY 2002.

TABLE 4B.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR RURAL AREAS

Nonurban area Wage

index GAF

Alabama ........................ 0.7483 0.8199

Alaska ........................... 1.2006 1.1334

Arizona .......................... 0.8747 0.9124

Arkansas ....................... 0.7561 0.8258

California ....................... 0.9870 0.9911

Colorado ....................... 0.8909 0.9239

Connecticut ................... 1.2357 1.1560

Delaware ....................... 0.9487 0.9646

Florida ........................... 0.8733 0.9114

Georgia ......................... 0.8341 0.8832

Hawaii ........................... 1.1235 1.0830

Idaho ............................. 0.8820 0.9176

Illinois ............................ 0.8140 0.8686

Indiana .......................... 0.8757 0.9131

Iowa .............................. 0.8194 0.8725

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22829

TABLE 4B.—WAGE INDEX AND CAPITAL

GEOGRAPHIC ADJUSTMENT FACTOR

(GAF) FOR RURAL AREAS—Continued

Nonurban area Wage

index GAF

Kansas .......................... 0.7850 0.8472

Kentucky ....................... 0.8019 0.8597

Louisiana ...................... 0.7755 0.8402

Maine ............................ 0.8714 0.9100

Maryland ....................... 0.8962 0.9277

Massachusetts .............. 1.1586 1.1061

Michigan ....................... 0.9115 0.9385

Minnesota ..................... 0.9109 0.9381

Mississippi .................... 0.7612 0.8296

Missouri ........................ 0.7838 0.8464

Montana ........................ 0.8642 0.9049

Nebraska ...................... 0.8233 0.8753

Nevada ......................... 0.9785 0.9852

New Hampshire ............ 0.9914 0.9941

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

New Mexico .................. 0.8835 0.9187

New York ...................... 0.8530 0.8968

North Carolina .............. 0.8632 0.9042

North Dakota ................ 0.7965 0.8557

Ohio .............................. 0.8761 0.9134

Oklahoma ..................... 0.7646 0.8321

Oregon .......................... 1.0156 1.0107

Pennsylvania ................ 0.8473 0.8927

Puerto Rico ................... 0.4654 0.5923

Rhode Island 1 .............. .............. ..............

South Carolina .............. 0.8606 0.9023

South Dakota ................ 0.7934 0.8534

Tennessee .................... 0.7901 0.8510

Texas ............................ 0.7673 0.8341

Utah .............................. 0.9156 0.9414

Vermont ........................ 0.9576 0.9708

Virginia .......................... 0.8473 0.8927

Washington ................... 1.0301 1.0205

West Virginia ................ 0.8145 0.8689

Wisconsin ..................... 0.9121 0.9389

Wyoming ....................... 0.8855 0.9201 –

1All counties within the State are classified

as urban.

TABLE 4C.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT

FACTOR (GAF) FOR HOSPITALS

THAT ARE RECLASSIFIED

Area Wage

index GAF

Abilene, TX ................... 0.8118 0.8669

Akron, OH ..................... 0.9924 0.9948

Albany, GA ................... 1.0675 1.0457

Albuquerque, NM .......... 0.9748 0.9827

Alexandria, LA .............. 0.8137 0.8683

Allentown-BethlehemEaston, PA ................ 0.9443 0.9615

Altoona, PA ................... 0.9225 0.9463

Amarillo, TX .................. 0.8485 0.8936

Anchorage, AK ............. 1.2605 1.1718

Ann Arbor, MI ............... 1.1220 1.0820

Anniston, AL ................. 0.7922 0.8526

Asheville, NC ................ 0.9307 0.9520

Athens, GA ................... 0.9818 0.9875

Atlanta, GA ................... 1.0066 1.0045

Augusta-Aiken, GA–SC 1.0090 1.0062

Austin-San Marcos, TX 0.9327 0.9534

Barnstable-Yarmouth,

MA ............................. 1.3415 1.2229

TABLE 4C.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT

FACTOR (GAF) FOR HOSPITALS

THAT ARE RECLASSIFIED—Continued

Area Wage

index GAF

Baton Rouge, LA .......... 0.8258 0.8772

Bellingham, WA ............ 1.1427 1.0957

Benton Harbor, MI ........ 0.9115 0.9385

Bergen-Passaic, NJ ...... 1.1669 1.1115

Billings, MT ................... 0.9623 0.9740

Biloxi-GulfportPascagoula, MS ........ 0.8198 0.8728

Binghamton, NY ........... 0.8595 0.9015

Birmingham, AL ............ 0.8648 0.9053

Bismarck, ND ................ 0.7965 0.8557

Bloomington-Normal, IL 0.8545 0.8979

Boise City, ID ................ 0.9190 0.9438

Boston-Worcester-Lawrence-Lowell-Brockton, MA–NH .............. 1.1483 1.0993

Burlington, VT ............... 0.9606 0.9728

Caguas, PR .................. 0.4993 0.6215

Casper, WY .................. 0.9454 0.9623

Champaign-Urbana, IL 0.9264 0.9490

Charleston-North

Charleston, SC .......... 0.9293 0.9510

Charleston, WV ............ 0.8991 0.9298

Charlotte-GastoniaRock Hill, NC–SC ..... 0.9469 0.9633

Chattanooga, TN–GA ... 0.9207 0.9450

Chicago, IL ................... 1.0887 1.0599

Cincinnati, OH–KY–IN .. 0.9574 0.9706

Clarksville-Hopkinsville,

TN–KY ....................... 0.8481 0.8933

Cleveland-Lorain-Elyria,

OH ............................. 0.9496 0.9652

Columbia, MO ............... 0.8787 0.9153

Columbia, SC ............... 0.9264 0.9490

Columbus, GA–AL ........ 0.8471 0.8926

Columbus, OH .............. 0.9724 0.9810

Corpus Christi, TX ........ 0.8203 0.8731

Dallas, TX ..................... 0.9506 0.9659

Davenport-Moline-Rock

Island, IA–IL .............. 0.8790 0.9155

Dayton-Springfield, OH 0.9323 0.9531

Denver, CO ................... 1.0289 1.0197

Des Moines, IA ............. 0.8881 0.9219

Dothan, AL .................... 0.8005 0.8587

Dover, DE ..................... 0.9957 0.9971

Duluth-Superior, MN–WI 1.0299 1.0204

Eau Claire, WI .............. 0.9121 0.9389

Elkhart-Goshen, IN ....... 0.9516 0.9666

Erie, PA ........................ 0.8780 0.9148

Eugene-Springfield, OR 1.1073 1.0723

Fargo-Moorhead, ND–

MN ............................. 0.9247 0.9478

Fayetteville, NC ............ 0.8970 0.9283

Flagstaff, AZ–UT .......... 1.0222 1.0151

Flint, MI ......................... 1.0920 1.0621

Florence, AL ................. 0.7927 0.8529

Florence, SC ................. 0.8843 0.9192

Fort Collins-Loveland,

CO ............................. 1.0161 1.0110

Ft. Lauderdale, FL ........ 1.0906 1.0612

Fort Pierce-Port St.

Lucie, FL ................... 1.0067 1.0046

Fort Smith, AR–OK ....... 0.7889 0.8501

Fort Walton Beach, FL 0.8547 0.8981

Fort Wayne, IN ............. 0.9059 0.9346

Forth Worth-Arlington,

TX .............................. 0.9452 0.9621

TABLE 4C.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT

FACTOR (GAF) FOR HOSPITALS

THAT ARE RECLASSIFIED—Continued

Area Wage

index GAF

Gadsden, AL ................. 0.8446 0.8908

Gainesville, FL .............. 1.1855 1.1236

Grand Forks, ND–MN

(ND Hospitals) ........... 0.9022 0.9319

Grand Forks, ND–MN

(MN Hospital) ............ 0.9109 0.9381

Grand Junction, CO ...... 0.9816 0.9874

Grand Rapids-Muskegon-Holland, MI ..... 1.0052 1.0036

Great Falls, MT ............. 0.9301 0.9516

Greeley, CO .................. 0.9604 0.9727

Green Bay, WI .............. 0.9440 0.9613

Greensboro-WinstonSalem-High Point, NC 0.9474 0.9637

Greenville, NC .............. 0.9751 0.9829

Greenville-SpartanburgAnderson, SC ............ 0.9110 0.9382

Harrisburg-LebanonCarlisle, PA ............... 0.9068 0.9352

Hartford, CT .................. 1.1586 1.1061

Hattiesburg, MS ............ 0.7612 0.8296

Hickory-MorgantonLenoir, NC ................. 0.9517 0.9667

Honolulu, HI .................. 1.1658 1.1108

Houston, TX .................. 0.9604 0.9727

Huntington-Ashland,

WV–KY–OH .............. 0.9286 0.9505

Huntsville, AL ................ 0.8657 0.9060

Indianapolis, IN ............. 0.9666 0.9770

Iowa City, IA ................. 0.9820 0.9876

Jackson, MS ................. 0.8589 0.9011

Jackson, TN .................. 0.8945 0.9265

Jacksonville, FL ............ 0.9040 0.9332

Johnson City-KingsportBristol, TN–VA .......... 0.8540 0.8976

Jonesboro, AR .............. 0.8093 0.8651

Joplin, MO .................... 0.8560 0.8990

Kalamazoo-Battlecreek,

MI .............................. 1.0537 1.0365

Kansas City, KS–MO .... 0.9430 0.9606

Knoxville, TN ................ 0.8904 0.9236

Kokomo, IN ................... 0.9290 0.9508

Lafayette, LA ................ 0.8430 0.8896

Lansing-East Lansing,

MI .............................. 0.9653 0.9761

Las Vegas, NV–AZ ....... 1.1238 1.0832

Lawton, OK ................... 0.8372 0.8854

Lexington, KY ............... 0.8675 0.9072

Lima, OH ...................... 0.9558 0.9695

Lincoln, NE ................... 0.9945 0.9962

Little Rock-North Little

Rock, AR ................... 0.8938 0.9260

Longview-Marshall, TX 0.8439 0.8903

Los Angeles-Long

Beach, CA ................. 1.2071 1.1376

Louisville, KY–IN .......... 0.9481 0.9642

Lubbock, TX ................. 0.8547 0.8981

Lynchburg, VA .............. 0.8897 0.9231

Macon, GA .................... 0.9077 0.9358

Madison, WI .................. 1.0462 1.0314

Mansfield, OH ............... 0.8827 0.9181

Medford-Ashland, OR ... 1.0156 1.0107

Melbourne-TitusvillePalm Bay, FL ............ 0.9883 0.9920

Memphis, TN–AR–MS .. 0.9152 0.9411

Miami, FL ...................... 0.9934 0.9955

22830 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 4C.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT

FACTOR (GAF) FOR HOSPITALS

THAT ARE RECLASSIFIED—Continued

Area Wage

index GAF

Milwaukee-Waukesha,

WI .............................. 0.9898 0.9930

Minneapolis-St. Paul,

MN–WI ...................... 1.1000 1.0674

Missoula, MT ................ 0.9273 0.9496

Mobile, AL ..................... 0.7766 0.8410

Modesto, CA ................. 1.0945 1.0638

Monmouth-Ocean, NJ .. 1.1514 1.1014

Monroe, LA ................... 0.8191 0.8723

Montgomery, AL ........... 0.7502 0.8213

Myrtle Beach, SC ......... 0.8663 0.9064

Nashville, TN ................ 0.9433 0.9608

New Haven-BridgeportStamford-WaterburyDanbury, CT .............. 1.2357 1.1560

New London-Norwich,

CT ............................. 1.1578 1.1055

New Orleans, LA .......... 0.9054 0.9342

New York, NY ............... 1.3923 1.2544

Newark, NJ ................... 1.2004 1.1332

Newburgh, NY–PA ....... 1.0838 1.0567

Norfolk-Virginia BeachNewport News, VA–

NC ............................. 0.8632 0.9042

Oakland, CA ................. 1.5313 1.3388

Odessa-Midland, TX

(TX Hospitals) ........... 0.8769 0.9140

Odessa-Midland, TX

(NM Hospitals) .......... 0.8835 0.9187

Oklahoma City, OK ....... 0.8728 0.9110

Omaha, NE–IA ............. 0.9696 0.9791

Orange County, CA ...... 1.1354 1.0909

Orlando, FL ................... 0.9464 0.9630

Peoria-Pekin, IL ............ 0.8883 0.9221

Philadelphia, PA–NJ ..... 1.0626 1.0425

Pine Bluff, AR ............... 0.7837 0.8463

Pittsburgh, PA ............... 0.9550 0.9690

Pittsfield, MA ................. 1.0018 1.0012

Pocatello, ID ................. 0.9264 0.9490

Portland, ME ................. 0.9501 0.9656

Portland-Vancouver,

OR–WA ..................... 1.1291 1.0867

Provo-Orem, UT ........... 0.9840 0.9890

TABLE 4C.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT

FACTOR (GAF) FOR HOSPITALS

THAT ARE RECLASSIFIED—Continued

Area Wage

index GAF

Raleigh-Durham-Chapel

Hill, NC ...................... 0.9901 0.9932

Rapid City, SD .............. 0.8849 0.9197

Reading, PA ................. 0.8473 0.8927

Redding, CA ................. 1.1222 1.0822

Reno, NV ...................... 1.0456 1.0310

Richland-KennewickPasco, WA ................ 1.0478 1.0325

Richmond-Petersburg,

VA ............................. 0.9712 0.9802

Roanoke, VA ................ 0.8468 0.8924

Rochester, MN .............. 1.1595 1.1067

Rockford, IL .................. 0.9080 0.9360

Sacramento, CA ........... 1.1809 1.1206

Saginaw-Bay City-Midland, MI ..................... 0.9662 0.9767

St. Cloud, MN ............... 1.0040 1.0027

St. Joseph, MO ............. 0.8953 0.9271

St. Louis, MO–IL ........... 0.8911 0.9241

Salinas, CA ................... 1.4738 1.3042

Salt Lake City-Ogden,

UT ............................. 0.9976 0.9984

San Diego, CA .............. 1.1480 1.0991

Santa Fe, NM ............... 1.0013 1.0009

Santa Rosa, CA ............ 1.2408 1.1592

Sarasota-Bradenton, FL 1.0118 1.0081

Savannah, GA .............. 0.9349 0.9549

Seattle-Bellevue-Everett, WA ...................... 1.1056 1.0712

Sherman-Denison, TX .. 0.8899 0.9232

Shreveport-Bossier City,

LA .............................. 0.9165 0.9420

Sioux City, IA–NE ......... 0.8868 0.9210

Sioux Falls, SD ............. 0.9037 0.9330

South Bend, IN ............. 1.0176 1.0120

Spokane, WA ................ 1.0663 1.0449

Springfield, IL ................ 0.8502 0.8948

Springfield, MO ............. 0.8454 0.8914

Stockton-Lodi, CA ......... 1.1114 1.0750

Syracuse, NY ................ 0.9247 0.9478

Tampa-St. PetersburgClearwater, FL .......... 0.9095 0.9371

Texarkana, AR-Texarkana, TX ................ 0.8414 0.8885

TABLE 4C.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT

FACTOR (GAF) FOR HOSPITALS

THAT ARE RECLASSIFIED—Continued

Area Wage

index GAF

Toledo, OH ................... 0.9815 0.9873

Topeka, KS ................... 0.8850 0.9197

Tucson, AZ ................... 0.9002 0.9305

Tulsa, OK ...................... 0.8815 0.9173

Tuscaloosa, AL ............. 0.8265 0.8777

Tyler, TX ....................... 0.8905 0.9237

Victoria, TX ................... 0.8212 0.8738

Waco, TX ...................... 0.8268 0.8779

Washington, DC–MD–

VA–WV ...................... 1.1024 1.0690

Waterloo-Cedar Falls,

IA ............................... 0.8608 0.9024

Wausau, WI .................. 0.9516 0.9666

West Palm Beach-Boca

Raton, FL .................. 0.9785 0.9852

Wichita, KS ................... 0.9218 0.9458

Wichita Falls, TX .......... 0.8015 0.8594

Wilmington-Newark,

DE–MD ...................... 1.0757 1.0512

Rural Alabama .............. 0.7483 0.8199

Rural Florida ................. 0.8733 0.9114

Rural Illinois (IA Hospital) .......................... 0.8194 0.8725

Rural Illinois (MO Hospital) .......................... 0.8140 0.8686

Rural Kentucky ............. 0.8019 0.8597

Rural Louisiana ............. 0.7755 0.8402

Rural Michigan .............. 0.9115 0.9385

Rural Minnesota ........... 0.9109 0.9381

Rural Missouri (AK Hospital) .......................... 0.7838 0.8464

Rural Missouri (KS Hospital) .......................... 0.7850 0.8472

Rural Montana .............. 0.8642 0.9049

Rural Nebraska ............. 0.8233 0.8753

Rural Nevada ................ 0.9219 0.9458

Rural Oregon ................ 1.0156 1.0107

Rural Texas .................. 0.7673 0.8341

Rural Washington ......... 1.0301 1.0205

Rural Wisconsin ............ 0.9121 0.9389

Rural Wyoming ............. 0.8855 0.9201

TABLE 4F.—PUERTO RICO WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF)

Area Wage

index GAF

Wage

index—

Reclass.

hospitals

GAF—

Reclass.

hospitals

Aguadilla, PR ................................................................................................................... 0.9666 0.9770 .................... ....................

Arecibo, PR ...................................................................................................................... 0.9555 0.9693 .................... ....................

Caguas, PR ..................................................................................................................... 1.0523 1.0355 1.0188 1.0128

Mayaguez, PR ................................................................................................................. 1.0031 1.0021 .................... ....................

Ponce, PR ........................................................................................................................ 1.0768 1.0520 .................... ....................

San Juan-Bayamon, PR .................................................................................................. 0.9817 0.9874 .................... ....................

Rural Puerto Rico ............................................................................................................ 0.9495 0.9651 .................... ....................

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22831

TABLE 4G.—PRE-RECLASSIFIED WAGE

INDEX FOR URBAN AREAS

Urban area

(Constituent counties)

Wage

index

0040 Abilene, TX ......................... 0.8057

Taylor, TX

0060 Aguadilla, PR ...................... 0.4738

Aguada, PR

Aguadilla, PR

Moca, PR

0080 Akron, OH ........................... 0.9924

Portage, OH

Summit, OH

0120 Albany, GA .......................... 1.0675

Dougherty, GA

Lee, GA

0160 Albany-Schenectady-Troy,

NY ............................................... 0.8597

Albany, NY

Montgomery, NY

Rensselaer, NY

Saratoga, NY

Schenectady, NY

Schoharie, NY

0200 Albuquerque, NM ................ 0.9855

Bernalillo, NM

Sandoval, NM

Valencia, NM

0220 Alexandria, LA ..................... 0.8121

Rapides, LA

0240 Allentown-Bethlehem-Easton, PA ........................................ 0.9443

Carbon, PA

Lehigh, PA

Northampton, PA

0280 Altoona, PA ......................... 0.9225

Blair, PA

0320 Amarillo, TX ........................ 0.8706

Potter, TX

Randall, TX

0380 Anchorage, AK .................... 1.2454

Anchorage, AK

0440 Ann Arbor, MI ...................... 1.1220

Lenawee, MI

Livingston, MI

Washtenaw, MI

0450 Anniston, AL ........................ 0.8360

Calhoun, AL

0460 Appleton-Oshkosh-Neenah,

WI ................................................ 0.9203

Calumet, WI

Outagamie, WI

Winnebago, WI

0470 Arecibo, PR ......................... 0.4683

Arecibo, PR

Camuy, PR

Hatillo, PR

0480 Asheville, NC ...................... 0.9307

Buncombe, NC

Madison, NC

0500 Athens, GA .......................... 0.9956

Clarke, GA

Madison, GA

Oconee, GA

0520 Atlanta, GA .......................... 1.0176

Barrow, GA

Bartow, GA

Carroll, GA

Cherokee, GA

Clayton, GA

Cobb, GA

Coweta, GA

DeKalb, GA

Douglas, GA

TABLE 4G.—PRE-RECLASSIFIED WAGE

INDEX FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index

Fayette, GA

Forsyth, GA

Fulton, GA

Gwinnett, GA

Henry, GA

Newton, GA

Paulding, GA

Pickens, GA

Rockdale, GA

Spalding, GA

Walton, GA

0560 Atlantic-Cape May, NJ ........ 1.1349

Atlantic, NJ

Cape May, NJ

0580 Auburn-Opelika, AL ............. 0.8325

Lee, AL

0600 Augusta-Aiken, GA–SC ...... 1.0090

Columbia, GA

McDuffie, GA

Richmond, GA

Aiken, SC

Edgefield, SC

0640 Austin-San Marcos, TX ....... 0.9327

Bastrop, TX

Caldwell, TX

Hays, TX

Travis, TX

Williamson, TX

0680 Bakersfield, CA ................... 0.9387

Kern, CA

0720 Baltimore, MD ..................... 0.9723

Anne Arundel, MD

Baltimore, MD

Baltimore City, MD

Carroll, MD

Harford, MD

Howard, MD

Queen Anne’s, MD

0733 Bangor, ME ......................... 0.9559

Penobscot, ME

0743 Barnstable-Yarmouth, MA ... 1.3539

Barnstable, MA

0760 Baton Rouge, LA ................ 0.8258

Ascension, LA

East Baton Rouge, LA

Livingston, LA

West Baton Rouge, LA

0840 Beaumont-Port Arthur, TX .. 0.8508

Hardin, TX

Jefferson, TX

Orange, TX

0860 Bellingham, WA .................. 1.1963

Whatcom, WA

0870 Benton Harbor, MI .............. 0.8912

Berrien, MI

0875 Bergen-Passaic, NJ ............ 1.1549

Bergen, NJ

Passaic, NJ

0880 Billings, MT ......................... 0.9623

Yellowstone, MT

0920 Biloxi-Gulfport-Pascagoula,

MS ............................................... 0.8538

Hancock, MS

Harrison, MS

Jackson, MS

0960 Binghamton, NY .................. 0.8595

Broome, NY

Tioga, NY

1000 Birmingham, AL .................. 0.8648

Blount, AL

TABLE 4G.—PRE-RECLASSIFIED WAGE

INDEX FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index

Jefferson, AL

St. Clair, AL

Shelby, AL

1010 Bismarck, ND ...................... 0.7955

Burleigh, ND

Morton, ND

1020 Bloomington, IN .................. 0.8689

Monroe, IN

1040 Bloomington-Normal, IL ...... 0.8448

McLean, IL

1080 Boise City, ID ...................... 0.9151

Ada, ID

Canyon, ID

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

(NH Hospitals) ............................. 1.1483

Bristol, MA

Essex, MA

Middlesex, MA

Norfolk, MA

Plymouth, MA

Suffolk, MA

Worcester, MA

Hillsborough, NH

Merrimack, NH

Rockingham, NH

Strafford, NH

1125 Boulder-Longmont, CO ....... 0.9836

Boulder, CO

1145 Brazoria, TX ........................ 0.8299

Brazoria, TX

1150 Bremerton, WA ................... 1.0882

Kitsap, WA

1240 Brownsville-Harlingen-San

Benito, TX ................................... 0.8783

Cameron, TX

1260 Bryan-College Station, TX .. 0.9296

Brazos, TX

1280 Buffalo-Niagara Falls, NY ... 0.9405

Erie, NY

Niagara, NY

1303 Burlington, VT ..................... 0.9826

Chittenden, VT

Franklin, VT

Grand Isle, VT

1310 Caguas, PR ......................... 0.5158

Caguas, PR

Cayey, PR

Cidra, PR

Gurabo, PR

San Lorenzo, PR

1320 Canton-Massillon, OH ......... 0.9059

Carroll, OH

Stark, OH

1350 Casper, WY ......................... 0.9606

Natrona, WY

1360 Cedar Rapids, IA ................ 0.8711

Linn, IA

1400 Champaign-Urbana, IL ........ 0.9264

Champaign, IL

1440 Charleston-North Charleston, SC ........................................ 0.9293

Berkeley, SC

Charleston, SC

Dorchester, SC

1480 Charleston, WV ................... 0.9369

Kanawha, WV

Putnam, WV

1520 Charlotte-Gastonia-Rock

Hill, NC–SC ................................. 0.9400

22832 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 4G.—PRE-RECLASSIFIED WAGE

INDEX FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index

Cabarrus, NC

Gaston, NC

Lincoln, NC

Mecklenburg, NC

Rowan, NC

Stanly, NC

Union, NC

York, SC

1540 Charlottesville, VA ............... 1.0688

Albemarle, VA

Charlottesville City, VA

Fluvanna, VA

Greene, VA

1560 Chattanooga, TN–GA ......... 0.9446

Catoosa, GA

Dade, GA

Walker, GA

Hamilton, TN

Marion, TN

1580 Cheyenne, WY .................... 0.8414

Laramie, WY

1600 Chicago, IL .......................... 1.1011

Cook, IL

DeKalb, IL

DuPage, IL

Grundy, IL

Kane, IL

Kendall, IL

Lake, IL

McHenry, IL

Will, IL

1620 Chico-Paradise, CA ............ 0.9909

Butte, CA

1640 Cincinnati, OH–KY–IN ........ 0.9574

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 ............................................... 0.8433

Christian, KY

Montgomery, TN

1680 Cleveland-Lorain-Elyria, OH 0.9496

Ashtabula, OH

Cuyahoga, OH

Geauga, OH

Lake, OH

Lorain, OH

Medina, OH

1720 Colorado Springs, CO ......... 0.9754

El Paso, CO

1740 Columbia, MO ..................... 0.8787

Boone, MO

1760 Columbia, SC ...................... 0.9589

Lexington, SC

Richland, SC

1800 Columbus, GA–AL .............. 0.8471

Russell, AL

Chattahoochee, GA

Harris, GA

Muscogee, GA

1840 Columbus, OH .................... 0.9724

TABLE 4G.—PRE-RECLASSIFIED WAGE

INDEX FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index

Delaware, OH

Fairfield, OH

Franklin, OH

Licking, OH

Madison, OH

Pickaway, OH

1880 Corpus Christi, TX .............. 0.8203

Nueces, TX

San Patricio, TX

1890 Corvallis, OR ....................... 1.1781

Benton, OR

1900 Cumberland, MD–WV (WV

Hospital) ...................................... 0.8402

Allegany, MD

Mineral, WV

1920 Dallas, TX ........................... 0.9506

Collin, TX

Dallas, TX

Denton, TX

Ellis, TX

Henderson, TX

Hunt, TX

Kaufman, TX

Rockwall, TX

1950 Danville, VA ........................ 0.8641

Danville City, VA

Pittsylvania, VA

1960 Davenport-Moline-Rock Island, IA–IL ................................... 0.8790

Scott, IA

Henry, IL

Rock Island, IL

2000 Dayton-Springfield, OH ....... 0.9323

Clark, OH

Greene, OH

Miami, OH

Montgomery, OH

2020 Daytona Beach, FL ............. 0.9069

Flagler, FL

Volusia, FL

2030 Decatur, AL ......................... 0.8817

Lawrence, AL

Morgan, AL

2040 Decatur, IL .......................... 0.8056

Macon, IL

2080 Denver, CO ......................... 1.0289

Adams, CO

Arapahoe, CO

Denver, CO

Douglas, CO

Jefferson, CO

2120 Des Moines, IA ................... 0.8881

Dallas, IA

Polk, IA

Warren, IA

2160 Detroit, MI ........................... 1.0478

Lapeer, MI

Macomb, MI

Monroe, MI

Oakland, MI

St. Clair, MI

Wayne, MI

2180 Dothan, AL .......................... 0.7959

Dale, AL

Houston, AL

2190 Dover, DE ........................... 1.0453

Kent, DE

2200 Dubuque, IA ........................ 0.8617

Dubuque, IA

2240 Duluth-Superior, MN–WI ..... 1.0401

TABLE 4G.—PRE-RECLASSIFIED WAGE

INDEX FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index

St. Louis, MN

Douglas, WI

2281 Dutchess County, NY ......... 1.0639

Dutchess, NY

2290 Eau Claire, WI ..................... 0.8893

Chippewa, WI

Eau Claire, WI

2320 El Paso, TX ......................... 0.9162

El Paso, TX

2330 Elkhart-Goshen, IN ............. 0.9646

Elkhart, IN

2335 Elmira, NY ........................... 0.8530

Chemung, NY

2340 Enid, OK .............................. 0.8454

Garfield, OK

2360 Erie, PA ............................... 0.8911

Erie, PA

2400 Eugene-Springfield, OR ...... 1.1485

Lane, OR

2440 Evansville-Henderson, IN–

KY (IN Hospitals) ........................ 0.7808

Posey, IN

Vanderburgh, IN

Warrick, IN

Henderson, KY

2520 Fargo-Moorhead, ND–MN .. 0.9374

Clay, MN

Cass, ND

2560 Fayetteville, NC ................... 0.9132

Cumberland, NC

2580 Fayetteville-Springdale-Rogers, AR ........................................ 0.7587

Benton, AR

Washington, AR

2620 Flagstaff, AZ–UT ................. 1.0678

Coconino, AZ

Kane, UT

2640 Flint, MI ............................... 1.0920

Genesee, MI

2650 Florence, AL ........................ 0.7875

Colbert, AL

Lauderdale, AL

2655 Florence, SC ....................... 0.8843

Florence, SC

2670 Fort Collins-Loveland, CO .. 1.0161

Larimer, CO

2680 Ft. Lauderdale, FL .............. 1.0407

Broward, FL

2700 Fort Myers-Cape Coral, FL 0.9380

Lee, FL

2710 Fort Pierce-Port St. Lucie,

FL ................................................ 1.0067

Martin, FL

St. Lucie, FL

2720 Fort Smith, AR–OK ............. 0.8076

Crawford, AR

Sebastian, AR

Sequoyah, OK

2750 Fort Walton Beach, FL ........ 0.8695

Okaloosa, FL

2760 Fort Wayne, IN .................... 0.9186

Adams, IN

Allen, IN

De Kalb, IN

Huntington, IN

Wells, IN

Whitley, IN

2800 Forth Worth-Arlington, TX ... 0.9452

Hood, TX

Johnson, TX

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22833

TABLE 4G.—PRE-RECLASSIFIED WAGE

INDEX FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index

Parker, TX

Tarrant, TX

2840 Fresno, CA .......................... 0.9972

Fresno, CA

Madera, CA

2880 Gadsden, AL ....................... 0.8845

Etowah, AL

2900 Gainesville, FL .................... 1.2133

Alachua, FL

2920 Galveston-Texas City, TX ... 1.0271

Galveston, TX

2960 Gary, IN ............................... 0.9571

Lake, IN

Porter, IN

2975 Glens Falls, NY ................... 0.8432

Warren, NY

Washington, NY

2980 Goldsboro, NC .................... 0.8810

Wayne, NC

2985 Grand Forks, ND–MN ......... 0.9173

Polk, MN

Grand Forks, ND

2995 Grand Junction, CO ............ 0.9579

Mesa, CO

3000 Grand Rapids-MuskegonHolland, MI .................................. 1.0161

Allegan, MI

Kent, MI

Muskegon, MI

Ottawa, MI

3040 Great Falls, MT ................... 0.8972

Cascade, MT

3060 Greeley, CO ........................ 0.9604

Weld, CO

3080 Green Bay, WI .................... 0.9269

Brown, WI

3120 Greensboro-Winston-SalemHigh Point, NC ............................ 0.9616

Alamance, NC

Davidson, NC

Davie, NC

Forsyth, NC

Guilford, NC

Randolph, NC

Stokes, NC

Yadkin, NC

3150 Greenville, NC ..................... 0.9963

Pitt, NC

3160 Greenville-Spartanburg-Anderson, SC .................................. 0.9096

Anderson, SC

Cherokee, SC

Greenville, SC

Pickens, SC

Spartanburg, SC

3180 Hagerstown, MD ................. 0.8462

Washington, MD

3200 Hamilton-Middletown, OH ... 0.9269

Butler, OH

3240 Harrisburg-Lebanon-Carlisle, PA ....................................... 0.9311

Cumberland, PA

Dauphin, PA

Lebanon, PA

Perry, PA

3283 Hartford, CT ........................ 1.1536

Hartford, CT

Litchfield, CT

Middlesex, CT

Tolland, CT

TABLE 4G.—PRE-RECLASSIFIED WAGE

INDEX FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index

3285 2 Hattiesburg, MS ................ 0.7559

Forrest, MS

Lamar, MS

3290 Hickory-Morganton-Lenoir,

NC ............................................... 0.9517

Alexander, NC

Burke, NC

Caldwell, NC

Catawba, NC

3320 Honolulu, HI ........................ 1.1653

Honolulu, HI

3350 Houma, LA .......................... 0.8043

Lafourche, LA

Terrebonne, LA

3360 Houston, TX ........................ 0.9604

Chambers, TX

Fort Bend, TX

Harris, TX

Liberty, TX

Montgomery, TX

Waller, TX

3400 Huntington-Ashland, WV–

KY–OH ........................................ 0.9700

Boyd, KY

Carter, KY

Greenup, KY

Lawrence, OH

Cabell, WV

Wayne, WV

3440 Huntsville, AL ...................... 0.8854

Limestone, AL

Madison, AL

3480 Indianapolis, IN ................... 0.9771

Boone, IN

Hamilton, IN

Hancock, IN

Hendricks, IN

Johnson, IN

Madison, IN

Marion, IN

Morgan, IN

Shelby, IN

3500 Iowa City, IA ........................ 0.9973

Johnson, IA

3520 Jackson, MI ......................... 0.9387

Jackson, MI

3560 Jackson, MS ....................... 0.8589

Hinds, MS

Madison, MS

Rankin, MS

3580 Jackson, TN ........................ 0.9117

Madison, TN

Chester, TN

3600 Jacksonville, FL .................. 0.9040

Clay, FL

Duval, FL

Nassau, FL

St. Johns, FL

3605 Jacksonville, NC ................. 0.7710

Onslow, NC

3610 Jamestown, NY ................... 0.8143

Chautauqua, NY

3620 Janesville-Beloit, WI ............ 0.9840

Rock, WI

3640 Jersey City, NJ .................... 1.1216

Hudson, NJ

3660 Johnson City-KingsportBristol, TN–VA ............................ 0.8540

Carter, TN

Hawkins, TN

TABLE 4G.—PRE-RECLASSIFIED WAGE

INDEX FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index

Sullivan, TN

Unicoi, TN

Washington, TN

Bristol City, VA

Scott, VA

Washington, VA

3680 Johnstown, PA .................... 0.8959

Cambria, PA

Somerset, PA

3700 Jonesboro, AR .................... 0.8523

Craighead, AR

3710 Joplin, MO ........................... 0.8736

Jasper, MO

Newton, MO

3720 Kalamazoo-Battlecreek, MI 1.0696

Calhoun, MI

Kalamazoo, MI

Van Buren, MI

3740 Kankakee, IL ....................... 0.9268

Kankakee, IL

3760 Kansas City, KS–MO .......... 0.9430

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 ....................... 0.9678

Kenosha, WI

3810 Killeen-Temple, TX ............. 0.7376

Bell, TX

Coryell, TX

3840 Knoxville, TN ....................... 0.8904

Anderson, TN

Blount, TN

Knox, TN

Loudon, TN

Sevier, TN

Union, TN

3850 Kokomo, IN ......................... 0.9232

Howard, IN

Tipton, IN

3870 La Crosse, WI–MN ............. 0.9328

Houston, MN

La Crosse, WI

3880 Lafayette, LA ....................... 0.8600

Acadia, LA

Lafayette, LA

St. Landry, LA

St. Martin, LA

3920 Lafayette, IN ........................ 0.9165

Clinton, IN

Tippecanoe, IN

3960 Lake Charles, LA ................ 0.7810

Calcasieu, LA

3980 Lakeland-Winter Haven, FL 0.9167

Polk, FL

4000 Lancaster, PA ..................... 0.9413

Lancaster, PA

4040 Lansing-East Lansing, MI ... 0.9653

Clinton, MI

Eaton, MI

Ingham, MI

4080 Laredo, TX .......................... 0.7877

Webb, TX

22834 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 4G.—PRE-RECLASSIFIED WAGE

INDEX FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index

4100 Las Cruces, NM .................. 0.8721

Dona Ana, NM

4120 Las Vegas, NV–AZ ............. 1.1238

Mohave, AZ

Clark, NV

Nye, NV

4150 Lawrence, KS ...................... 0.8756

Douglas, KS

4200 Lawton, OK ......................... 0.8783

Comanche, OK

4243 Lewiston-Auburn, ME .......... 0.9451

Androscoggin, ME

4280 Lexington, KY ...................... 0.8850

Bourbon, KY

Clark, KY

Fayette, KY

Jessamine, KY

Madison, KY

Scott, KY

Woodford, KY

4320 Lima, OH ............................. 0.9558

Allen, OH

Auglaize, OH

4360 Lincoln, NE .......................... 1.0272

Lancaster, NE

4400 Little Rock-North Little

Rock, AR ..................................... 0.9053

Faulkner, AR

Lonoke, AR

Pulaski, AR

Saline, AR

4420 Longview-Marshall, TX ....... 0.8322

Gregg, TX

Harrison, TX

Upshur, TX

4480 Los Angeles-Long Beach,

CA ............................................... 1.2062

Los Angeles, CA

4520 1 Louisville, KY–IN ............... 0.9596

Clark, IN

Floyd, IN

Harrison, IN

Scott, IN

Bullitt, KY

Jefferson, KY

Oldham, KY

4600 Lubbock, TX ........................ 0.8547

Lubbock, TX

4640 Lynchburg, VA .................... 0.9208

Amherst, VA

Bedford, VA

Bedford City, VA

Campbell, VA

Lynchburg City, VA

4680 Macon, GA .......................... 0.9064

Bibb, GA

Houston, GA

Jones, GA

Peach, GA

Twiggs, GA

4720 Madison, WI ........................ 1.0456

Dane, WI

4800 Mansfield, OH ..................... 0.8809

Crawford, OH

Richland, OH

4840 Mayaguez, PR .................... 0.4917

Anasco, PR

Cabo Rojo, PR

Hormigueros, PR

Mayaguez, PR

TABLE 4G.—PRE-RECLASSIFIED WAGE

INDEX FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index

Sabana Grande, PR

San German, PR

4880 McAllen-Edinburg-Mission,

TX ................................................ 0.8433

Hidalgo, TX

4890 Medford-Ashland, OR ......... 1.0433

Jackson, OR

4900 Melbourne-Titusville-Palm

Bay, FL ........................................ 0.9857

Brevard, FL

4920 Memphis, TN–AR–MS ........ 0.9435

Crittenden, AR

DeSoto, MS

Fayette, TN

Shelby, TN

Tipton, TN

4940 Merced, CA ......................... 0.9870

Merced, CA

5000 Miami, FL ............................ 0.9934

Dade, FL

5015 Middlesex-SomersetHunterdon, NJ ............................. 1.1952

Hunterdon, NJ

Middlesex, NJ

Somerset, NJ

5080 Milwaukee-Waukesha, WI .. 0.9898

Milwaukee, WI

Ozaukee, WI

Washington, WI

Waukesha, WI

5120 Minneapolis-St. Paul, MN–

WI ................................................ 1.1000

Anoka, MN

Carver, MN

Chisago, MN

Dakota, MN

Hennepin, MN

Isanti, MN

Ramsey, MN

Scott, MN

Sherburne, MN

Washington, MN

Wright, MN

Pierce, WI

St. Croix, WI

5140 Missoula, MT ....................... 0.9453

Missoula, MT

5160 Mobile, AL ........................... 0.7754

Baldwin, AL

Mobile, AL

5170 Modesto, CA ....................... 1.0945

Stanislaus, CA

5190 Monmouth-Ocean, NJ ......... 1.0930

Monmouth, NJ

Ocean, NJ

5200 Monroe, LA ......................... 0.8296

Ouachita, LA

5240 Montgomery, AL .................. 0.7502

Autauga, AL

Elmore, AL

Montgomery, AL

5280 Muncie, IN ........................... 0.9689

Delaware, IN

5330 Myrtle Beach, SC ................ 0.8855

Horry, SC

5345 Naples, FL ........................... 0.9566

Collier, FL

5360 Nashville, TN ....................... 0.9602

Cheatham, TN

Davidson, TN

TABLE 4G.—PRE-RECLASSIFIED WAGE

INDEX FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index

Dickson, TN

Robertson, TN

Rutherford TN

Sumner, TN

Williamson, TN

Wilson, TN

5380 Nassau-Suffolk, NY ............. 1.3841

Nassau, NY

Suffolk, NY

5483 New Haven-BridgeportStamford-Waterbury-Danbury,

CT ............................................... 1.2267

Fairfield, CT

New Haven, CT

5523 New London-Norwich, CT ... 1.1578

New London, CT

5560 New Orleans, LA ................. 0.9054

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 ..................... 1.3893

Bronx, NY

Kings, NY

New York, NY

Putnam, NY

Queens, NY

Richmond, NY

Rockland, NY

Westchester, NY

5640 Newark, NJ ......................... 1.2004

Essex, NJ

Morris, NJ

Sussex, NJ

Union, NJ

Warren, NJ

5660 Newburgh, NY–PA .............. 1.1235

Orange, NY

Pike, PA

5720 Norfolk-Virginia Beach-Newport News, VA–NC ...................... 0.8629

Currituck, NC

Chesapeake City, VA

Gloucester, VA

Hampton City, VA

Isle of Wight, VA

James City, VA

Mathews, VA

Newport News City, VA

Norfolk City, VA

Poquoson City, VA

Portsmouth City, VA

Suffolk City, VA

Virginia Beach City VA

Williamsburg City, VA

York, VA

5775 Oakland, CA ........................ 1.5416

Alameda, CA

Contra Costa, CA

5790 Ocala, FL ............................ 0.9579

Marion, FL

5800 Odessa-Midland, TX ........... 0.9017

Ector, TX

Midland, TX

5880 Oklahoma City, OK ............. 0.8728

Canadian, OK

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22835

TABLE 4G.—PRE-RECLASSIFIED WAGE

INDEX FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index

Cleveland, OK

Logan, OK

McClain, OK

Oklahoma, OK

Pottawatomie, OK

5910 Olympia, WA ....................... 1.1481

Thurston, WA

5920 Omaha, NE–IA .................... 0.9696

Pottawattamie, IA

Cass, NE

Douglas, NE

Sarpy, NE

Washington, NE

5945 Orange County, CA ............ 1.1242

Orange, CA

5960 Orlando, FL ......................... 0.9464

Lake, FL

Orange, FL

Osceola, FL

Seminole, FL

5990 Owensboro, KY ................... 0.8346

Daviess, KY

6015 Panama City, FL ................. 0.9166

Bay, FL

6020 Parkersburg-Marietta, WV–

OH ............................................... 0.8192

Washington, OH

Wood, WV

6080 Pensacola, FL ..................... 0.8367

Escambia, FL

Santa Rosa, FL

6120 Peoria-Pekin, IL .................. 0.8883

Peoria, IL

Tazewell, IL

Woodford, IL

6160 Philadelphia, PA–NJ ........... 1.0626

Burlington, NJ

Camden, NJ

Gloucester, NJ

Salem, NJ

Bucks, PA

Chester, PA

Delaware, PA

Montgomery, PA

Philadelphia, PA

6200 Phoenix-Mesa, AZ .............. 0.9654

Maricopa, AZ

Pinal, AZ

6240 Pine Bluff, AR ..................... 0.7837

Jefferson, AR

6280 Pittsburgh, PA ..................... 0.9714

Allegheny, PA

Beaver, PA

Butler, PA

Fayette, PA

Washington, PA

Westmoreland, PA

6323 Pittsfield, MA ....................... 1.0396

Berkshire, MA

6340 Pocatello, ID ........................ 0.9557

Bannock, ID

6360 Ponce, PR ........................... 0.5278

Guayanilla, PR

Juana Diaz, PR

Penuelas, PR

Ponce, PR

Villalba, PR

Yauco, PR

6403 Portland, ME ....................... 0.9501

Cumberland, ME

TABLE 4G.—PRE-RECLASSIFIED WAGE

INDEX FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index

Sagadahoc, ME

York, ME

6440 Portland-Vancouver, OR–

WA .............................................. 1.1263

Clackamas, OR

Columbia, OR

Multnomah, OR

Washington, OR

Yamhill, OR

Clark, WA

6483 Providence-Warwick-Pawtucket, RI ..................................... 1.0781

Bristol, RI

Kent, RI

Newport, RI

Providence, RI

Washington, RI

6520 Provo-Orem, UT .................. 0.9967

Utah, UT

6560 Pueblo, CO ......................... 0.8704

Pueblo, CO

6580 Punta Gorda, FL ................. 0.8818

Charlotte, FL

6600 Racine, WI .......................... 0.9441

Racine, WI

6640 Raleigh-Durham-Chapel

Hill, NC ........................................ 0.9901

Chatham, NC

Durham, NC

Franklin, NC

Johnston, NC

Orange, NC

Wake, NC

6660 Rapid City, SD .................... 0.8971

Pennington, SD

6680 Reading, PA ........................ 0.6780

Berks, PA

6690 Redding, CA ........................ 1.1222

Shasta, CA

6720 Reno, NV ............................ 1.0456

Washoe, NV

6740 Richland-Kennewick-Pasco,

WA .............................................. 1.1086

Benton, WA

Franklin, WA

6760 Richmond-Petersburg, VA .. 0.9712

Charles City County, VA

Chesterfield, VA

Colonial Heights City, VA

Dinwiddie, VA

Goochland, VA

Hanover, VA

Henrico, VA

Hopewell City, VA

New Kent, VA

Petersburg City, VA

Powhatan, VA

Prince George, VA

Richmond City, VA

6780 Riverside-San Bernardino,

CA ............................................... 1.1012

Riverside, CA

San Bernardino, CA

6800 Roanoke, VA ....................... 0.8468

Botetourt, VA

Roanoke, VA

Roanoke City, VA

Salem City, VA

6820 Rochester, MN .................... 1.1595

Olmsted, MN

TABLE 4G.—PRE-RECLASSIFIED WAGE

INDEX FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index

6840 Rochester, NY ..................... 0.9238

Genesee, NY

Livingston, NY

Monroe, NY

Ontario, NY

Orleans, NY

Wayne, NY

6880 Rockford, IL ......................... 0.9194

Boone, IL

Ogle, IL

Winnebago, IL

6895 Rocky Mount, NC ................ 0.9197

Edgecombe, NC

Nash, NC

6920 Sacramento, CA .................. 1.1809

El Dorado, CA

Placer, CA

Sacramento, CA

6960 Saginaw-Bay City-Midland,

MI ................................................ 0.9662

Bay, MI

Midland, MI

Saginaw, MI

6980 St. Cloud, MN ..................... 0.9966

Benton, MN

Stearns, MN

7000 St. Joseph, MO ................... 0.9113

Andrew, MO

Buchanan, MO

7040 St. Louis, MO–IL ................. 0.9024

Clinton, IL

Jersey, IL

Madison, IL

Monroe, IL

St. Clair, IL

Franklin, MO

Jefferson, MO

Lincoln, MO

St. Charles, MO

St. Louis, MO

St. Louis City, MO

Warren, MO

7080 Salem, OR .......................... 1.0127

Marion, OR

Polk, OR

7120 Salinas, CA ......................... 1.4854

Monterey, CA

7160 Salt Lake City-Ogden, UT ... 0.9976

Davis, UT

Salt Lake, UT

Weber, UT

7200 San Angelo, TX ................... 0.8288

Tom Green, TX

7240 San Antonio, TX .................. 0.8333

Bexar, TX

Comal, TX

Guadalupe, TX

Wilson, TX

7320 San Diego, CA .................... 1.1480

San Diego, CA

7360 San Francisco, CA .............. 1.4319

Marin, CA

San Francisco, CA

San Mateo, CA

7400 San Jose, CA ...................... 1.4249

Santa Clara, CA

7440 San Juan-Bayamon, PR ..... 0.4812

Aguas Buenas, PR

Barceloneta, PR

Bayamon, PR

22836 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 4G.—PRE-RECLASSIFIED WAGE

INDEX FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index

Canovanas, PR

Carolina, PR

Catano, PR

Ceiba, PR

Comerio, PR

Corozal, PR

Dorado, PR

Fajardo, PR

Florida, PR

Guaynabo, PR

Humacao, PR

Juncos, PR

Los Piedras, PR

Loiza, PR

Luguillo, PR

Manati, PR

Morovis, PR

Naguabo, PR

Naranjito, PR

Rio Grande, PR

San Juan, PR

Toa Alta, PR

Toa Baja, PR

Trujillo Alto, PR

Vega Alta, PR

Vega Baja, PR

Yabucoa, PR

7460 San Luis ObispoAtascadero-Paso Robles, CA ..... 1.1117

San Luis Obispo, CA

7480 Santa Barbara-Santa MariaLompoc, CA ................................ 1.0927

Santa Barbara, CA

7485 Santa Cruz-Watsonville, CA 1.4049

Santa Cruz, CA

7490 Santa Fe, NM ...................... 1.0312

Los Alamos, NM

Santa Fe, NM

7500 Santa Rosa, CA .................. 1.2727

Sonoma, CA

7510 Sarasota-Bradenton, FL ...... 1.0118

Manatee, FL

Sarasota, FL

7520 Savannah, GA ..................... 0.9349

Bryan, GA

Chatham, GA

Effingham, GA

7560 Scranton—Wilkes-Barre—

Hazleton, PA ............................... 0.8071

Columbia, PA

Lackawanna, PA

Luzerne, PA

Wyoming, PA

7600 Seattle-Bellevue-Everett,

WA .............................................. 1.1040

Island, WA

King, WA

Snohomish, WA

7610 Sharon, PA .......................... 0.8013

Mercer, PA

7620 Sheboygan, WI ................... 0.8524

Sheboygan, WI

7640 Sherman-Denison, TX ........ 0.9163

Grayson, TX

7680 Shreveport-Bossier City, LA 0.9165

Bossier, LA

Caddo, LA

Webster, LA

7720 Sioux City, IA–NE ............... 0.8868

Woodbury, IA

TABLE 4G.—PRE-RECLASSIFIED WAGE

INDEX FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index

Dakota, NE

7760 Sioux Falls, SD ................... 0.9245

Lincoln, SD

Minnehaha, SD

7800 South Bend, IN ................... 1.0303

St. Joseph, IN

7840 Spokane, WA ...................... 1.0791

Spokane, WA

7880 Springfield, IL ...................... 0.8502

Menard, IL

Sangamon, IL

7920 Springfield, MO ................... 0.8666

Christian, MO

Greene, MO

Webster, MO

8003 Springfield, MA .................... 1.0747

Hampden, MA

Hampshire, MA

8050 State College, PA ............... 0.9239

Centre, PA

8080 Steubenville-Weirton, OH–

WV (WV Hospitals) ..................... 0.8737

Jefferson, OH

Brooke, WV

Hancock, WV

8120 Stockton-Lodi, CA ............... 1.0939

San Joaquin, CA

8140 Sumter, SC ......................... 0.7884

Sumter, SC

8160 Syracuse, NY ...................... 0.9243

Cayuga, NY

Madison, NY

Onondaga, NY

Oswego, NY

8200 Tacoma, WA ....................... 1.1751

Pierce, WA

8240 Tallahassee, FL .................. 0.8402

Gadsden, FL

Leon, FL

8280 Tampa-St. PetersburgClearwater, FL ............................ 0.8994

Hernando, FL

Hillsborough, FL

Pasco, FL

Pinellas, FL

8320 Terre Haute, IN ................... 0.8498

Clay, IN

Vermillion, IN

Vigo, IN

8360 Texarkana, AR-Texarkana,

TX ................................................ 0.8414

Miller, AR

Bowie, TX

8400 Toledo, OH .......................... 0.9815

Fulton, OH

Lucas, OH

Wood, OH

8440 Topeka, KS ......................... 0.9015

Shawnee, KS

8480 Trenton, NJ ......................... 1.0172

Mercer, NJ

8520 Tucson, AZ .......................... 0.8990

Pima, AZ

8560 Tulsa, OK ............................ 0.8949

Creek, OK

Osage, OK

Rogers, OK

Tulsa, OK

Wagoner, OK

8600 Tuscaloosa, AL ................... 0.8265

TABLE 4G.—PRE-RECLASSIFIED WAGE

INDEX FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index

Tuscaloosa, AL

8640 Tyler, TX ............................. 0.9109

Smith, TX

8680 Utica-Rome, NY .................. 0.8425

Herkimer, NY

Oneida, NY

8720 Vallejo-Fairfield-Napa, CA .. 1.3535

Napa, CA

Solano, CA

8735 Ventura, CA ........................ 1.1088

Ventura, CA

8750 Victoria, TX ......................... 0.8354

Victoria, TX

8760 Vineland-Millville-Bridgeton,

NJ ................................................ 1.0473

Cumberland, NJ

8780 Visalia-Tulare-Porterville,

CA ............................................... 0.9706

Tulare, CA

8800 Waco, TX ............................ 0.8249

McLennan, TX

8840 Washington, DC–MD–VA–

WV .............................................. 1.1176

District of Columbia, DC

Calvert, MD

Charles, MD

Frederick, MD

Montgomery, MD

Prince Georges, MD

Alexandria City, VA

Arlington, VA

Clarke, VA

Culpeper, VA

Fairfax, VA

Fairfax City, VA

Falls Church City, VA

Fauquier, VA

Fredericksburg City, VA

King George, VA

Loudoun, VA

Manassas City, VA

Manassas Park City, VA

Prince William, VA

Spotsylvania, VA

Stafford, VA

Warren, VA

Berkeley, WV

Jefferson, WV

8920 Waterloo-Cedar Falls, IA .... 0.8134

Black Hawk, IA

8940 Wausau, WI ........................ 0.9455

Marathon, WI

8960 West Palm Beach-Boca

Raton, FL .................................... 0.9785

Palm Beach, FL

9000 Wheeling, WV–OH .............. 0.8077

Belmont, OH

Marshall, WV

Ohio, WV

9040 Wichita, KS ......................... 0.9541

Butler, KS

Harvey, KS

Sedgwick, KS

9080 Wichita Falls, TX ................. 0.7933

Archer, TX

Wichita, TX

9140 Williamsport, PA .................. 0.8503

Lycoming, PA

9160 Wilmington-Newark, DE–

MD ............................................... 1.0757

22837

TABLE 4G.—PRE-RECLASSIFIED WAGE

INDEX FOR URBAN AREAS—Continued

Urban area

(Constituent counties)

Wage

index

New Castle, DE

Cecil, MD

9200 Wilmington, NC ................... 0.9971

New Hanover, NC

Brunswick, NC

9260 Yakima, WA ........................ 1.0690

Yakima, WA

9270 Yolo, CA .............................. 0.9830

Yolo, CA

9280 York, PA .............................. 0.7840

York, PA

9320 Youngstown-Warren, OH .... 0.9480

Columbiana, OH

Mahoning, OH

Trumbull, OH

9340 Yuba City, CA ..................... 1.0479

Sutter, CA

Yuba, CA

9360 Yuma, AZ ............................ 0.8904

Yuma, AZ

TABLE 4H.—PRE-RECLASSIFIED WAGE

INDEX FOR RURAL AREAS

Nonurban area Wage

index

Alabama .......................................... 0.7420

Alaska ............................................. 1.2006

Arizona ............................................ 0.8747

Arkansas ......................................... 0.7561

California ......................................... 0.9870

Colorado ......................................... 0.8909

Connecticut ..................................... 1.2357

Delaware ......................................... 0.9487

Florida ............................................. 0.8709

Georgia ........................................... 0.8341

Hawaii ............................................. 1.1235

Idaho ............................................... 0.8820

Illinois .............................................. 0.8140

Indiana ............................................ 0.8757

Iowa ................................................ 0.8194

Kansas ............................................ 0.7850

Kentucky ......................................... 0.8019

Louisiana ........................................ 0.7649

Maine .............................................. 0.8714

Maryland ......................................... 0.8962

Massachusetts ................................ 1.1586

Michigan ......................................... 0.9106

Minnesota ....................................... 0.9109

Mississippi ...................................... 0.7612

Missouri .......................................... 0.7826

Montana .......................................... 0.8642

Nebraska ........................................ 0.8233

TABLE 4H.—PRE-RECLASSIFIED WAGE

INDEX FOR RURAL AREAS—Continued

Nonurban area Wage

index

Nevada ........................................... 0.9785

New Hampshire .............................. 0.9914

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

New Mexico .................................... 0.8835

New York ........................................ 0.8530

North Carolina ................................ 0.8634

North Dakota .................................. 0.7965

Ohio ................................................ 0.8761

Oklahoma ....................................... 0.7646

Oregon ............................................ 1.0150

Pennsylvania .................................. 0.8473

Puerto Rico ..................................... 0.4654

Rhode Island 1 ................................ ..............

South Carolina ................................ 0.8606

South Dakota .................................. 0.7934

Tennessee ...................................... 0.7901

Texas .............................................. 0.7671

Utah ................................................ 0.9156

Vermont .......................................... 0.9576

Virginia ............................................ 0.8473

Washington ..................................... 1.0301

West Virginia .................................. 0.8145

Wisconsin ....................................... 0.9118

Wyoming ......................................... 0.8855 –

1All counties within the State are classified

as urban.

* MEDICARE DATA HAVE BEEN SUPPLEMENTED BY DATA FROM 19 STATES FOR LOW VOLUME DRGS.

** DRGS 469 AND 470 CONTAIN CASES WHICH COULD NOT BE ASSIGNED TO VALID DRGS.

NOTE: ARITHMETIC MEAN IS PRESENTED FOR INFORMATIONAL PURPOSES ONLY.

NOTE: RELATIVE WEIGHTS ARE BASED ON MEDICARE PATIENT DATA AND MAY NOT BE APPROPRIATE FOR OTHER PATIENTS.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 5.—LIST OF DIAGNOSIS RELATED GROUPS (DRGS), RELATIVE WEIGHTING FACTORS, GEOMETRIC AND ARITHMETIC

MEAN LENGTH OF STAY

DRG MDC Type DRG title Relative

weights

Geometric

mean LOS

Arithmetric

mean LOS

1 ........ 01 SURG CRANIOTOMY AGE >17 EXCEPT FOR TRAUMA .................................. 3.2546 7.6 10.2

2 ........ 01 SURG CRANIOTOMY FOR TRAUMA AGE >17 .................................................. 3.3742 8.8 11.1

3 ........ 01 SURG * CRANIOTOMY AGE 0–17 ....................................................................... 1.9527 12.7 12.7

4 ........ 01 SURG SPINAL PROCEDURES ............................................................................ 2.4074 5.5 8.1

5 ........ 01 SURG EXTRACRANIAL VASCULAR PROCEDURES ......................................... 1.3612 2.3 3.2

6 ........ 01 SURG CARPAL TUNNEL RELEASE .................................................................... .7238 2.1 3.0

7 ........ 01 SURG PERIPH & CRANIAL NERVE & OTHER NERV SYST PROC W CC ...... 2.6736 8.5 11.3

8 ........ 01 SURG PERIPH & CRANIAL NERVE & OTHER NERV SYST PROC W/O CC ... 1.3727 2.3 3.4

9 ........ 01 MED SPINAL DISORDERS & INJURIES ........................................................... 1.3411 5.3 7.0

10 ...... 01 MED NERVOUS SYSTEM NEOPLASMS W CC ............................................... 1.2655 5.5 7.2

11 ...... 01 MED NERVOUS SYSTEM NEOPLASMS W/O CC ........................................... .8455 3.3 4.3

12 ...... 01 MED DEGENERATIVE NERVOUS SYSTEM DISORDERS .............................. .8985 4.9 6.3

13 ...... 01 MED MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA ................................. .8107 4.5 5.5

14 ...... 01 MED SPECIFIC CEREBROVASCULAR DISORDERS EXCEPT TIA ............... 1.1667 4.8 6.1

15 ...... 01 MED TRANSIENT ISCHEMIC ATTACK & PRECEREBRAL OCCLUSIONS .... .7349 3.0 3.7

16 ...... 01 MED NONSPECIFIC CEREBROVASCULAR DISORDERS W CC ................... 1.1833 5.1 6.5

17 ...... 01 MED NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC ............... .6706 2.7 3.5

18 ...... 01 MED CRANIAL & PERIPHERAL NERVE DISORDERS W CC ......................... .9762 4.6 5.8

19 ...... 01 MED CRANIAL & PERIPHERAL NERVE DISORDERS W/O CC ..................... .6770 3.1 3.9

20 ...... 01 MED NERVOUS SYSTEM INFECTION EXCEPT VIRAL MENINGITIS ............ 2.7628 9.0 11.4

21 ...... 01 MED VIRAL MENINGITIS ................................................................................... 1.4606 5.6 7.1

22 ...... 01 MED HYPERTENSIVE ENCEPHALOPATHY .................................................... 1.0073 4.0 5.1

23 ...... 01 MED NONTRAUMATIC STUPOR & COMA ....................................................... .8101 3.4 4.4

24 ...... 01 MED SEIZURE & HEADACHE AGE >17 W CC ................................................ 1.0182 4.0 5.3

25 ...... 01 MED SEIZURE & HEADACHE AGE >17 W/O CC ............................................ .5945 2.7 3.3

26 ...... 01 MED SEIZURE & HEADACHE AGE 0–17 ......................................................... .5846 2.3 2.8

27 ...... 01 MED TRAUMATIC STUPOR & COMA, COMA >1 HR ...................................... 1.3456 3.7 5.6

28 ...... 01 MED TRAUMATIC STUPOR & COMA, COMA <1 HR AGE >17 W CC ........... 1.3526 5.2 6.8

29 ...... 01 MED TRAUMATIC STUPOR & COMA, COMA <1 HR AGE >17 W/O CC ....... .6903 3.0 3.8

30 ...... 01 MED * TRAUMATIC STUPOR & COMA, COMA <1 HR AGE 0–17 .................. .3303 2.0 2.0

31 ...... 01 MED CONCUSSION AGE >17 W CC ................................................................ .9098 3.5 4.8

22838

* MEDICARE DATA HAVE BEEN SUPPLEMENTED BY DATA FROM 19 STATES FOR LOW VOLUME DRGS.

** DRGS 469 AND 470 CONTAIN CASES WHICH COULD NOT BE ASSIGNED TO VALID DRGS.

NOTE: ARITHMETIC MEAN IS PRESENTED FOR INFORMATIONAL PURPOSES ONLY.

NOTE: RELATIVE WEIGHTS ARE BASED ON MEDICARE PATIENT DATA AND MAY NOT BE APPROPRIATE FOR OTHER PATIENTS.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 5.—LIST OF DIAGNOSIS RELATED GROUPS (DRGS), RELATIVE WEIGHTING FACTORS, GEOMETRIC AND ARITHMETIC

MEAN LENGTH OF STAY—Continued

DRG MDC Type DRG title Relative

weights

Geometric

mean LOS

Arithmetric

mean LOS

32 ...... 01 MED CONCUSSION AGE >17 W/O CC ............................................................ .5191 2.0 2.6

33 ...... 01 MED * CONCUSSION AGE 0–17 ....................................................................... .2075 1.6 1.6

34 ...... 01 MED OTHER DISORDERS OF NERVOUS SYSTEM W CC ............................ 1.0065 4.2 5.4

35 ...... 01 MED OTHER DISORDERS OF NERVOUS SYSTEM W/O CC ........................ .5886 2.7 3.5

36 ...... 02 SURG RETINAL PROCEDURES .......................................................................... .6586 1.2 1.5

37 ...... 02 SURG ORBITAL PROCEDURES ......................................................................... 1.1220 2.9 4.3

38 ...... 02 SURG PRIMARY IRIS PROCEDURES ................................................................ .4730 2.0 2.6

39 ...... 02 SURG LENS PROCEDURES WITH OR WITHOUT VITRECTOMY .................... .5882 1.5 1.9

40 ...... 02 SURG EXTRAOCULAR PROCEDURES EXCEPT ORBIT AGE >17 .................. .8274 2.4 3.6

41 ...... 02 SURG * EXTRAOCULAR PROCEDURES EXCEPT ORBIT AGE 0–17 .............. .3362 1.6 1.6

42 ...... 02 SURG INTRAOCULAR PROCEDURES EXCEPT RETINA, IRIS & LENS .......... .6273 1.6 2.3

43 ...... 02 MED HYPHEMA .................................................................................................. .4570 2.8 3.3

44 ...... 02 MED ACUTE MAJOR EYE INFECTIONS .......................................................... .6556 4.3 5.2

45 ...... 02 MED NEUROLOGICAL EYE DISORDERS ........................................................ .6765 2.7 3.3

46 ...... 02 MED OTHER DISORDERS OF THE EYE AGE >17 W CC .............................. .7983 3.9 5.0

47 ...... 02 MED OTHER DISORDERS OF THE EYE AGE >17 W/O CC .......................... .5013 2.6 3.4

48 ...... 02 MED * OTHER DISORDERS OF THE EYE AGE 0–17 ..................................... .2962 2.9 2.9

49 ...... 03 SURG MAJOR HEAD & NECK PROCEDURES .................................................. 1.7590 3.8 5.2

50 ...... 03 SURG SIALOADENECTOMY ............................................................................... .8139 1.5 1.9

51 ...... 03 SURG SALIVARY GLAND PROCEDURES EXCEPT SIALOADENECTOMY ..... .7928 1.8 2.7

52 ...... 03 SURG CLEFT LIP & PALATE REPAIR ................................................................ .7608 1.5 1.9

53 ...... 03 SURG SINUS & MASTOID PROCEDURES AGE >17 ........................................ 1.1741 2.3 3.7

54 ...... 03 SURG * SINUS & MASTOID PROCEDURES AGE 0–17 ..................................... .4801 3.2 3.2

55 ...... 03 SURG MISCELLANEOUS EAR, NOSE, MOUTH & THROAT PROCEDURES .. .8500 1.8 2.7

56 ...... 03 SURG RHINOPLASTY .......................................................................................... .8771 2.0 2.7

57 ...... 03 SURG T&A PROC, EXCEPT TONSILLECTOMY &/OR ADENOIDECTOMY

ONLY, AGE >17.

1.1547 2.8 4.2

58 ...... 03 SURG * T&A PROC, EXCEPT TONSILLECTOMY &/OR ADENOIDECTOMY

ONLY, AGE 0–17.

.2726 1.5 1.5

59 ...... 03 SURG TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE >17 .............. .8324 1.9 2.8

60 ...... 03 SURG * TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE 0–17 .......... .2076 1.5 1.5

61 ...... 03 SURG MYRINGOTOMY W TUBE INSERTION AGE >17 .................................... 1.3536 3.2 5.6

62 ...... 03 SURG * MYRINGOTOMY W TUBE INSERTION AGE 0–17 ................................ .2940 1.3 1.3

63 ...... 03 SURG OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES ............ 1.3658 3.3 4.7

64 ...... 03 MED EAR, NOSE, MOUTH & THROAT MALIGNANCY .................................... 1.2289 4.8 6.9

65 ...... 03 MED DYSEQUILIBRIUM ..................................................................................... .5321 2.4 2.9

66 ...... 03 MED EPISTAXIS ................................................................................................. .5538 2.6 3.3

67 ...... 03 MED EPIGLOTTITIS ........................................................................................... .7556 3.0 3.7

68 ...... 03 MED OTITIS MEDIA & URI AGE >17 W CC ..................................................... .6687 3.6 4.3

69 ...... 03 MED OTITIS MEDIA & URI AGE >17 W/O CC ................................................. .4988 2.8 3.4

70 ...... 03 MED OTITIS MEDIA & URI AGE 0–17 .............................................................. .4556 2.5 3.0

71 ...... 03 MED LARYNGOTRACHEITIS ............................................................................ .6714 3.1 4.0

72 ...... 03 MED NASAL TRAUMA & DEFORMITY ............................................................. .6722 2.9 3.7

73 ...... 03 MED OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES AGE >17 ........ .8016 3.6 4.7

74 ...... 03 MED * OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES AGE 0–17 .... .3341 2.1 2.1

75 ...... 04 SURG MAJOR CHEST PROCEDURES ............................................................... 3.2016 8.8 10.8

76 ...... 04 SURG OTHER RESP SYSTEM O.R. PROCEDURES W CC .............................. 2.9628 10.0 12.6

77 ...... 04 SURG OTHER RESP SYSTEM O.R. PROCEDURES W/O CC .......................... 1.2254 4.1 5.4

78 ...... 04 MED PULMONARY EMBOLISM ........................................................................ 1.3317 6.3 7.2

79 ...... 04 MED RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W CC ..... 1.7116 7.6 9.3

80 ...... 04 MED RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W/O CC .9285 5.0 6.0

81 ...... 04 MED * RESPIRATORY INFECTIONS & INFLAMMATIONS AGE 0–17 ............ 1.5125 6.1 6.1

82 ...... 04 MED RESPIRATORY NEOPLASMS .................................................................. 1.4325 6.0 7.6

83 ...... 04 MED MAJOR CHEST TRAUMA W CC .............................................................. .9783 4.8 5.9

84 ...... 04 MED MAJOR CHEST TRAUMA W/O CC .......................................................... .5455 2.9 3.5

85 ...... 04 MED PLEURAL EFFUSION W CC ..................................................................... 1.2505 5.5 6.9

86 ...... 04 MED PLEURAL EFFUSION W/O CC ................................................................. .6776 3.0 3.8

87 ...... 04 MED PULMONARY EDEMA & RESPIRATORY FAILURE ................................ 1.4280 5.5 6.9

88 ...... 04 MED CHRONIC OBSTRUCTIVE PULMONARY DISEASE ............................... .9137 4.5 5.4

89 ...... 04 MED SIMPLE PNEUMONIA & PLEURISY AGE >17 W CC .............................. 1.0636 5.3 6.3

90 ...... 04 MED SIMPLE PNEUMONIA & PLEURISY AGE >17 W/O CC .......................... .6385 3.7 4.3

91 ...... 04 MED SIMPLE PNEUMONIA & PLEURISY AGE 0–17 ....................................... .8141 3.9 4.8

92 ...... 04 MED INTERSTITIAL LUNG DISEASE W CC .................................................... 1.2313 5.6 6.8

93 ...... 04 MED INTERSTITIAL LUNG DISEASE W/O CC ................................................. .7311 3.5 4.2

94 ...... 04 MED PNEUMOTHORAX W CC .......................................................................... 1.2011 5.4 6.9

95 ...... 04 MED PNEUMOTHORAX W/O CC ...................................................................... .5833 3.2 3.9

22839

* MEDICARE DATA HAVE BEEN SUPPLEMENTED BY DATA FROM 19 STATES FOR LOW VOLUME DRGS.

** DRGS 469 AND 470 CONTAIN CASES WHICH COULD NOT BE ASSIGNED TO VALID DRGS.

NOTE: ARITHMETIC MEAN IS PRESENTED FOR INFORMATIONAL PURPOSES ONLY.

NOTE: RELATIVE WEIGHTS ARE BASED ON MEDICARE PATIENT DATA AND MAY NOT BE APPROPRIATE FOR OTHER PATIENTS.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 5.—LIST OF DIAGNOSIS RELATED GROUPS (DRGS), RELATIVE WEIGHTING FACTORS, GEOMETRIC AND ARITHMETIC

MEAN LENGTH OF STAY—Continued

DRG MDC Type DRG title Relative

weights

Geometric

mean LOS

Arithmetric

mean LOS

96 ...... 04 MED BRONCHITIS & ASTHMA AGE >17 W CC .............................................. .7638 4.1 4.9

97 ...... 04 MED BRONCHITIS & ASTHMA AGE >17 W/O CC .......................................... .5664 3.2 3.8

98 ...... 04 MED BRONCHITIS & ASTHMA AGE 0–17 ....................................................... .7073 3.1 4.4

99 ...... 04 MED RESPIRATORY SIGNS & SYMPTOMS W CC ......................................... .6971 2.6 3.3

100 .... 04 MED RESPIRATORY SIGNS & SYMPTOMS W/O CC ..................................... .5206 1.8 2.2

101 .... 04 MED OTHER RESPIRATORY SYSTEM DIAGNOSES W CC .......................... .8605 3.6 4.7

102 .... 04 MED OTHER RESPIRATORY SYSTEM DIAGNOSES W/O CC ...................... .5226 2.1 2.7

103 .... PRE SURG HEART TRANSPLANT .............................................................................. 19.8195 38.6 57.5

104 .... 05 SURG CARDIAC VALVE & OTH MAJOR CARDIOTHORACIC PROC W CARD

CATH.

7.7605 13.2 15.3

105 .... 05 SURG CARDIAC VALVE & OTH MAJOR CARDIOTHORACIC PROC W/O

CARD CATH.

5.6465 8.8 10.4

106 .... 05 SURG CORONARY BYPASS W PTCA ................................................................ 7.4382 10.7 12.3

107 .... 05 SURG CORONARY BYPASS W CARDIAC CATH .............................................. 5.3005 9.7 10.9

108 .... 05 SURG OTHER CARDIOTHORACIC PROCEDURES .......................................... 5.4994 9.2 11.2

109 .... 05 SURG CORONARY BYPASS W/O PTCA OR CARDIAC CATH ......................... 3.8957 7.0 8.0

110 .... 05 SURG MAJOR CARDIOVASCULAR PROCEDURES W CC ............................... 4.1492 8.1 10.2

111 .... 05 SURG MAJOR CARDIOVASCULAR PROCEDURES W/O CC ........................... 2.2835 4.3 5.1

112 .... 05 SURG NO LONGER VALID .................................................................................. .0000 .0 .0

113 .... 05 SURG AMPUTATION FOR CIRC SYSTEM DISORDERS EXCEPT UPPER

LIMB & TOE.

2.6625 9.8 12.8

114 .... 05 SURG UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS 1.6689 7.2 9.3

115 .... 05 SURG PRM CARD PACEM IMPL W AMI, HRT FAIL OR SHK, OR AICD LEAD

OR GN.

3.3784 7.2 9.2

116 .... 05 SURG OTHER PERMANENT CARDIAC PACEMAKER IMPLANT ..................... 2.2011 3.6 4.8

117 .... 05 SURG CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT 1.3197 2.8 4.4

118 .... 05 SURG CARDIAC PACEMAKER DEVICE REPLACEMENT ................................. 1.4322 1.8 2.7

119 .... 05 SURG VEIN LIGATION & STRIPPING ................................................................. 1.3557 3.3 5.3

120 .... 05 SURG OTHER CIRCULATORY SYSTEM O.R. PROCEDURES ......................... 2.3452 6.7 9.9

121 .... 05 MED CIRCULATORY DISORDERS W AMI & MAJOR COMP, DISCHARGED

ALIVE.

1.5799 5.6 6.9

122 .... 05 MED CIRCULATORY DISORDERS W AMI W/O MAJOR COMP, DISCHARGED ALIVE.1.0268 3.2 3.9

123 .... 05 MED CIRCULATORY DISORDERS W AMI, EXPIRED ..................................... 1.5882 3.2 5.0

124 .... 05 MED CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH & COMPLEX DIAG.1.4057 3.6 4.6

125 .... 05 MED CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O

COMPLEX DIAG.

1.0395 2.2 2.8

126 .... 05 MED ACUTE & SUBACUTE ENDOCARDITIS .................................................. 2.6700 10.5 12.9

127 .... 05 MED HEART FAILURE & SHOCK ..................................................................... 1.0110 4.5 5.6

128 .... 05 MED DEEP VEIN THROMBOPHLEBITIS .......................................................... .7343 5.2 5.9

129 .... 05 MED CARDIAC ARREST, UNEXPLAINED ........................................................ 1.0273 1.7 2.8

130 .... 05 MED PERIPHERAL VASCULAR DISORDERS W CC ...................................... .9401 5.0 6.1

131 .... 05 MED PERIPHERAL VASCULAR DISORDERS W/O CC ................................... .5775 3.8 4.5

132 .... 05 MED ATHEROSCLEROSIS W CC ..................................................................... .6490 2.5 3.1

133 .... 05 MED ATHEROSCLEROSIS W/O CC ................................................................. .5567 1.9 2.3

134 .... 05 MED HYPERTENSION ....................................................................................... .5829 2.7 3.4

135 .... 05 MED CARDIAC CONGENITAL & VALVULAR DISORDERS AGE >17 W CC .9117 3.7 4.8

136 .... 05 MED CARDIAC CONGENITAL & VALVULAR DISORDERS AGE >17 W/O

CC.

.5606 2.2 2.8

137 .... 05 MED * CARDIAC CONGENITAL & VALVULAR DISORDERS AGE 0–17 ........ .8150 3.3 3.3

138 .... 05 MED CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC ............ .8231 3.3 4.2

139 .... 05 MED CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC ........ .4973 2.1 2.5

140 .... 05 MED ANGINA PECTORIS .................................................................................. .5367 2.2 2.7

141 .... 05 MED SYNCOPE & COLLAPSE W CC ............................................................... .7231 3.0 3.8

142 .... 05 MED SYNCOPE & COLLAPSE W/O CC ........................................................... .5392 2.2 2.7

143 .... 05 MED CHEST PAIN .............................................................................................. .5198 1.7 2.1

144 .... 05 MED OTHER CIRCULATORY SYSTEM DIAGNOSES W CC .......................... 1.1995 4.3 5.8

145 .... 05 MED OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC ...................... .5919 2.2 2.8

146 .... 06 SURG RECTAL RESECTION W CC .................................................................... 2.7740 9.6 10.8

147 .... 06 SURG RECTAL RESECTION W/O CC ................................................................ 1.6036 6.2 6.7

148 .... 06 SURG MAJOR SMALL & LARGE BOWEL PROCEDURES W CC ..................... 3.5315 11.1 13.1

149 .... 06 SURG MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC ................. 1.5103 6.2 6.7

150 .... 06 SURG PERITONEAL ADHESIOLYSIS W CC ...................................................... 2.9493 10.5 12.2

151 .... 06 SURG PERITONEAL ADHESIOLYSIS W/O CC .................................................. 1.3502 5.3 6.3

152 .... 06 SURG MINOR SMALL & LARGE BOWEL PROCEDURES W CC ...................... 1.9465 7.4 8.7

22840

* MEDICARE DATA HAVE BEEN SUPPLEMENTED BY DATA FROM 19 STATES FOR LOW VOLUME DRGS.

** DRGS 469 AND 470 CONTAIN CASES WHICH COULD NOT BE ASSIGNED TO VALID DRGS.

NOTE: ARITHMETIC MEAN IS PRESENTED FOR INFORMATIONAL PURPOSES ONLY.

NOTE: RELATIVE WEIGHTS ARE BASED ON MEDICARE PATIENT DATA AND MAY NOT BE APPROPRIATE FOR OTHER PATIENTS.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 5.—LIST OF DIAGNOSIS RELATED GROUPS (DRGS), RELATIVE WEIGHTING FACTORS, GEOMETRIC AND ARITHMETIC

MEAN LENGTH OF STAY—Continued

DRG MDC Type DRG title Relative

weights

Geometric

mean LOS

Arithmetric

mean LOS

153 .... 06 SURG MINOR SMALL & LARGE BOWEL PROCEDURES W/O CC .................. 1.1614 5.1 5.6

154 .... 06 SURG STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE >17 W

CC.

4.3487 11.9 14.7

155 .... 06 SURG STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE >17

W/O CC.

1.3356 3.5 4.5

156 .... 06 SURG * STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE 0–17 .8392 6.0 6.0

157 .... 06 SURG ANAL & STOMAL PROCEDURES W CC ................................................. 1.2606 4.4 5.9

158 .... 06 SURG ANAL & STOMAL PROCEDURES W/O CC ............................................. .6237 2.0 2.5

159 .... 06 SURG HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >17 W

CC.

1.3620 4.2 5.4

160 .... 06 SURG HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >17

W/O CC.

.7678 2.2 2.7

161 .... 06 SURG INGUINAL & FEMORAL HERNIA PROCEDURES AGE >17 W CC ........ 1.1388 3.2 4.5

162 .... 06 SURG INGUINAL & FEMORAL HERNIA PROCEDURES AGE >17 W/O CC .... .6145 1.6 1.9

163 .... 06 SURG * HERNIA PROCEDURES AGE 0–17 ....................................................... .6885 2.1 2.1

164 .... 06 SURG APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC ............ 2.3980 7.8 9.0

165 .... 06 SURG APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC ......... 1.3000 4.5 5.0

166 .... 06 SURG APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC ......... 1.4919 4.2 5.4

167 .... 06 SURG APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC ..... .8778 2.2 2.6

168 .... 03 SURG MOUTH PROCEDURES W CC ................................................................. 1.3056 3.6 5.2

169 .... 03 SURG MOUTH PROCEDURES W/O CC ............................................................. .6981 1.8 2.3

170 .... 06 SURG OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC .................... 3.0651 9.6 12.7

171 .... 06 SURG OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W/O CC ................ 1.1773 3.9 5.0

172 .... 06 MED DIGESTIVE MALIGNANCY W CC ............................................................ 1.3972 5.9 7.6

173 .... 06 MED DIGESTIVE MALIGNANCY W/O CC ........................................................ .6929 2.9 3.9

174 .... 06 MED G.I. HEMORRHAGE W CC ....................................................................... .9915 4.1 5.1

175 .... 06 MED G.I. HEMORRHAGE W/O CC ................................................................... .5435 2.6 3.0

176 .... 06 MED COMPLICATED PEPTIC ULCER .............................................................. 1.0908 4.4 5.6

177 .... 06 MED UNCOMPLICATED PEPTIC ULCER W CC .............................................. .8938 3.9 4.8

178 .... 06 MED UNCOMPLICATED PEPTIC ULCER W/O CC .......................................... .6424 2.7 3.2

179 .... 06 MED INFLAMMATORY BOWEL DISEASE ........................................................ 1.0861 5.1 6.4

180 .... 06 MED G.I. OBSTRUCTION W CC ....................................................................... .9581 4.6 5.7

181 .... 06 MED G.I. OBSTRUCTION W/O CC ................................................................... .5245 3.0 3.5

182 .... 06 MED ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17

W CC.

.7959 3.6 4.6

183 .... 06 MED ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17

W/O CC.

.5586 2.4 3.0

184 .... 06 MED ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE 0–

17.

.4123 2.5 3.0

185 .... 03 MED DENTAL & ORAL DIS EXCEPT EXTRACTIONS & RESTORATIONS,

AGE >17.

.8675 3.6 4.8

186 .... 03 MED * DENTAL & ORAL DIS EXCEPT EXTRACTIONS & RESTORATIONS,

AGE 0–17.

.3199 2.9 2.9

187 .... 03 MED DENTAL EXTRACTIONS & RESTORATIONS ......................................... .7960 3.2 4.2

188 .... 06 MED OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W CC ................. 1.1234 4.6 6.0

189 .... 06 MED OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W/O CC ............. .5791 2.5 3.3

190 .... 06 MED OTHER DIGESTIVE SYSTEM DIAGNOSES AGE 0–17 .......................... 1.1905 4.5 7.5

191 .... 07 SURG PANCREAS, LIVER & SHUNT PROCEDURES W CC ............................ 4.6065 12.1 15.5

192 .... 07 SURG PANCREAS, LIVER & SHUNT PROCEDURES W/O CC ........................ 1.8181 6.0 7.0

193 .... 07 SURG BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O

C.D.E. W CC.

3.5045 11.6 13.6

194 .... 07 SURG BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O

C.D.E. W/O CC.

1.7226 6.3 7.3

195 .... 07 SURG CHOLECYSTECTOMY W C.D.E. W CC ................................................... 3.0850 9.4 10.9

196 .... 07 SURG CHOLECYSTECTOMY W C.D.E. W/O CC ............................................... 1.6183 5.3 6.1

197 .... 07 SURG CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W

CC.

2.5761 8.1 9.6

198 .... 07 SURG CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W/O

CC.

1.2114 4.2 4.7

199 .... 07 SURG HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR MALIGNANCY ..... 2.4813 8.3 10.8

200 .... 07 SURG HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR NON-MALIGNANCY.3.1972 8.5 12.0

201 .... 07 SURG OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES .......... 3.8125 12.4 15.6

202 .... 07 MED CIRRHOSIS & ALCOHOLIC HEPATITIS .................................................. 1.3280 5.5 7.0

203 .... 07 MED MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS ............ 1.3598 5.7 7.3

204 .... 07 MED DISORDERS OF PANCREAS EXCEPT MALIGNANCY .......................... 1.2076 4.9 6.2

22841

* MEDICARE DATA HAVE BEEN SUPPLEMENTED BY DATA FROM 19 STATES FOR LOW VOLUME DRGS.

** DRGS 469 AND 470 CONTAIN CASES WHICH COULD NOT BE ASSIGNED TO VALID DRGS.

NOTE: ARITHMETIC MEAN IS PRESENTED FOR INFORMATIONAL PURPOSES ONLY.

NOTE: RELATIVE WEIGHTS ARE BASED ON MEDICARE PATIENT DATA AND MAY NOT BE APPROPRIATE FOR OTHER PATIENTS.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 5.—LIST OF DIAGNOSIS RELATED GROUPS (DRGS), RELATIVE WEIGHTING FACTORS, GEOMETRIC AND ARITHMETIC

MEAN LENGTH OF STAY—Continued

DRG MDC Type DRG title Relative

weights

Geometric

mean LOS

Arithmetric

mean LOS

205 .... 07 MED DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC ........ 1.2206 5.2 6.7

206 .... 07 MED DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W/O CC ..... .7345 3.3 4.1

207 .... 07 MED DISORDERS OF THE BILIARY TRACT W CC ........................................ 1.1138 4.3 5.5

208 .... 07 MED DISORDERS OF THE BILIARY TRACT W/O CC .................................... .6397 2.4 3.0

209 .... 08 SURG MAJOR JOINT & LIMB REATTACHMENT PROCEDURES OF LOWER

EXTREMITY.

1.9943 4.6 5.1

210 .... 08 SURG HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W

CC.

1.7528 6.1 6.9

211 .... 08 SURG HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W/O

CC.

1.2261 4.6 5.0

212 .... 08 SURG * HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE 0–17 .... .8428 11.1 11.1

213 .... 08 SURG AMPUTATION FOR MUSCULOSKELETAL SYSTEM & CONN TISSUE

DISORDERS.

1.9283 7.7 10.0

214 .... 08 SURG NO LONGER VALID .................................................................................. .0000 .0 .0

215 .... 08 SURG NO LONGER VALID .................................................................................. .0000 .0 .0

216 .... 08 SURG BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE.2.3133 8.5 10.9

217 .... 08 SURG WND DEBRID & SKN GRFT EXCEPT HAND, FOR MUSCSKELET &

CONN TISS DIS.

3.1808 11.0 15.1

218 .... 08 SURG LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR

AGE >17 W CC.

1.5448 4.7 5.7

219 .... 08 SURG LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR

AGE >17 W/O CC.

.9972 2.8 3.3

220 .... 08 SURG * LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR

AGE 0–17.

.5814 5.3 5.3

221 .... 08 SURG NO LONGER VALID .................................................................................. .0000 .0 .0

222 .... 08 SURG NO LONGER VALID .................................................................................. .0000 .0 .0

223 .... 08 SURG MAJOR SHOULDER/ELBOW PROC, OR OTHER UPPER EXTREMITY

PROC W CC.

.9734 2.1 2.9

224 .... 08 SURG SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT

PROC, W/O CC.

.7724 1.6 1.9

225 .... 08 SURG FOOT PROCEDURES ............................................................................... 1.1177 3.8 5.3

226 .... 08 SURG SOFT TISSUE PROCEDURES W CC ...................................................... 1.5897 5.2 7.3

227 .... 08 SURG SOFT TISSUE PROCEDURES W/O CC .................................................. .7937 2.1 2.8

228 .... 08 SURG MAJOR THUMB OR JOINT PROC, OR OTH HAND OR WRIST PROC

W CC.

1.0885 2.7 4.0

229 .... 08 SURG HAND OR WRIST PROC, EXCEPT MAJOR JOINT PROC, W/O CC ..... .7168 1.9 2.5

230 .... 08 SURG LOCAL EXCISION & REMOVAL OF INT FIX DEVICES OF HIP &

FEMUR.

1.3559 3.9 5.8

231 .... 08 SURG LOCAL EXCISION & REMOVAL OF INT FIX DEVICES EXCEPT HIP &

FEMUR.

1.4317 3.6 5.4

232 .... 08 SURG ARTHROSCOPY ........................................................................................ .9556 1.8 2.9

233 .... 08 SURG OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W CC ...... 2.0909 6.2 8.4

234 .... 08 SURG OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC .. 1.2075 2.7 3.6

235 .... 08 MED FRACTURES OF FEMUR ......................................................................... .7548 4.1 5.4

236 .... 08 MED FRACTURES OF HIP & PELVIS ............................................................... .6882 3.9 4.9

237 .... 08 MED SPRAINS, STRAINS, & DISLOCATIONS OF HIP, PELVIS & THIGH ..... .5323 3.0 3.7

238 .... 08 MED OSTEOMYELITIS ...................................................................................... 1.4035 7.3 9.3

239 .... 08 MED PATHOLOGICAL FRACTURES & MUSCULOSKELETAL & CONN TISS

MALIGNANCY.

1.0017 5.4 6.7

240 .... 08 MED CONNECTIVE TISSUE DISORDERS W CC ............................................ 1.3701 5.6 7.2

241 .... 08 MED CONNECTIVE TISSUE DISORDERS W/O CC ........................................ .6337 3.3 4.0

242 .... 08 MED SEPTIC ARTHRITIS .................................................................................. 1.0920 5.7 7.2

243 .... 08 MED MEDICAL BACK PROBLEMS ................................................................... .7299 4.0 4.9

244 .... 08 MED BONE DISEASES & SPECIFIC ARTHROPATHIES W CC ...................... .7150 4.1 5.1

245 .... 08 MED BONE DISEASES & SPECIFIC ARTHROPATHIES W/O CC .................. .4655 2.9 3.6

246 .... 08 MED NON-SPECIFIC ARTHROPATHIES .......................................................... .5711 3.2 4.0

247 .... 08 MED SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN

TISSUE.

.5594 2.8 3.5

248 .... 08 MED TENDONITIS, MYOSITIS & BURSITIS ..................................................... .8148 4.1 5.1

249 .... 08 MED AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE..6767 2.7 3.9

250 .... 08 MED FX, SPRN, STRN & DISL OF FOREARM, HAND, FOOT AGE >17 W

CC.

.6809 3.5 4.3

251 .... 08 MED FX, SPRN, STRN & DISL OF FOREARM, HAND, FOOT AGE >17 W/O

CC.

.4555 2.4 2.9

22842

* MEDICARE DATA HAVE BEEN SUPPLEMENTED BY DATA FROM 19 STATES FOR LOW VOLUME DRGS.

** DRGS 469 AND 470 CONTAIN CASES WHICH COULD NOT BE ASSIGNED TO VALID DRGS.

NOTE: ARITHMETIC MEAN IS PRESENTED FOR INFORMATIONAL PURPOSES ONLY.

NOTE: RELATIVE WEIGHTS ARE BASED ON MEDICARE PATIENT DATA AND MAY NOT BE APPROPRIATE FOR OTHER PATIENTS.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 5.—LIST OF DIAGNOSIS RELATED GROUPS (DRGS), RELATIVE WEIGHTING FACTORS, GEOMETRIC AND ARITHMETIC

MEAN LENGTH OF STAY—Continued

DRG MDC Type DRG title Relative

weights

Geometric

mean LOS

Arithmetric

mean LOS

252 .... 08 MED * FX, SPRN, STRN & DISL OF FOREARM, HAND, FOOT AGE 0–17 .... .2525 1.8 1.8

253 .... 08 MED FX, SPRN, STRN & DISL OF UPARM, LOWLEG EX FOOT AGE >17

W CC.

.7398 4.0 5.0

254 .... 08 MED FX, SPRN, STRN & DISL OF UPARM, LOWLEG EX FOOT AGE >17

W/O CC.

.4297 2.8 3.3

255 .... 08 MED * FX, SPRN, STRN & DISL OF UPARM, LOWLEG EX FOOT AGE 0–17 .2941 2.9 2.9

256 .... 08 MED OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES..8170 4.2 5.5

257 .... 09 SURG TOTAL MASTECTOMY FOR MALIGNANCY W CC ................................ .8801 2.2 2.8

258 .... 09 SURG TOTAL MASTECTOMY FOR MALIGNANCY W/O CC ............................. .6970 1.7 1.9

259 .... 09 SURG SUBTOTAL MASTECTOMY FOR MALIGNANCY W CC ......................... .8736 1.8 2.7

260 .... 09 SURG SUBTOTAL MASTECTOMY FOR MALIGNANCY W/O CC ..................... .6431 1.3 1.4

261 .... 09 SURG BREAST PROC FOR NON-MALIGNANCY EXCEPT BIOPSY & LOCAL

EXCISION.

.9218 1.7 2.3

262 .... 09 SURG BREAST BIOPSY & LOCAL EXCISION FOR NON-MALIGNANCY ........ .8377 3.0 4.2

263 .... 09 SURG SKIN GRAFT &/OR DEBRID FOR SKN ULCER OR CELLULITIS W CC 2.1570 9.4 12.7

264 .... 09 SURG SKIN GRAFT &/OR DEBRID FOR SKN ULCER OR CELLULITIS W/O

CC.

1.1826 6.0 7.7

265 .... 09 SURG SKIN GRAFT &/OR DEBRID EXCEPT FOR SKIN ULCER OR

CELLULITIS W CC.

1.6900 5.2 7.6

266 .... 09 SURG SKIN GRAFT &/OR DEBRID EXCEPT FOR SKIN ULCER OR

CELLULITIS W/O CC.

.8435 2.5 3.4

267 .... 09 SURG PERIANAL & PILONIDAL PROCEDURES ............................................... .9421 3.3 4.5

268 .... 09 SURG SKIN, SUBCUTANEOUS TISSUE & BREAST PLASTIC PROCEDURES 1.2255 2.5 3.6

269 .... 09 SURG OTHER SKIN, SUBCUT TISS & BREAST PROC W CC ......................... 1.8049 6.9 9.3

270 .... 09 SURG OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC ..................... .8020 2.6 3.8

271 .... 09 MED SKIN ULCERS ........................................................................................... 1.1503 6.5 8.3

272 .... 09 MED MAJOR SKIN DISORDERS W CC ............................................................ 1.0243 5.2 6.7

273 .... 09 MED MAJOR SKIN DISORDERS W/O CC ........................................................ .5658 3.4 4.2

274 .... 09 MED MALIGNANT BREAST DISORDERS W CC ............................................. 1.1892 5.5 7.2

275 .... 09 MED MALIGNANT BREAST DISORDERS W/O CC ......................................... .6594 3.0 4.6

276 .... 09 MED NON-MALIGANT BREAST DISORDERS .................................................. .6954 4.0 5.0

277 .... 09 MED CELLULITIS AGE >17 W CC .................................................................... .8585 5.1 6.1

278 .... 09 MED CELLULITIS AGE >17 W/O CC ................................................................ .5638 3.9 4.6

279 .... 09 MED * CELLULITIS AGE 0–17 ........................................................................... .6610 4.2 4.2

280 .... 09 MED TRAUMA TO THE SKIN, SUBCUT TISS & BREAST AGE >17 W CC .... .6940 3.5 4.4

281 .... 09 MED TRAUMA TO THE SKIN, SUBCUT TISS & BREAST AGE >17 W/O CC .4591 2.5 3.1

282 .... 09 MED * TRAUMA TO THE SKIN, SUBCUT TISS & BREAST AGE 0–17 ........... .2557 2.2 2.2

283 .... 09 MED MINOR SKIN DISORDERS W CC ............................................................ .7154 3.8 4.9

284 .... 09 MED MINOR SKIN DISORDERS W/O CC ........................................................ .4216 2.5 3.2

285 .... 10 SURG AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, &

METABOL DISORDERS.

2.1315 9.1 11.4

286 .... 10 SURG ADRENAL & PITUITARY PROCEDURES ................................................ 2.2277 5.3 6.9

287 .... 10 SURG SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB

DISORDERS.

1.9616 8.9 11.7

288 .... 10 SURG O.R. PROCEDURES FOR OBESITY ........................................................ 2.1682 4.9 6.0

289 .... 10 SURG PARATHYROID PROCEDURES ............................................................... .9529 1.9 3.0

290 .... 10 SURG THYROID PROCEDURES ......................................................................... .8853 1.7 2.3

291 .... 10 SURG THYROGLOSSAL PROCEDURES ........................................................... .5910 1.5 1.8

292 .... 10 SURG OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W CC ................ 2.7588 9.1 11.9

293 .... 10 SURG OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W/O CC ............. 1.2638 4.5 6.0

294 .... 10 MED DIABETES AGE >35 ................................................................................. .7623 3.8 4.9

295 .... 10 MED DIABETES AGE 0–35 ................................................................................ .7468 3.1 3.9

296 .... 10 MED NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W CC ...... .8632 4.3 5.5

297 .... 10 MED NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W/O CC .. .5070 2.9 3.5

298 .... 10 MED NUTRITIONAL & MISC METABOLIC DISORDERS AGE 0–17 ............... .3944 2.2 2.9

299 .... 10 MED INBORN ERRORS OF METABOLISM ...................................................... .8939 4.3 5.6

300 .... 10 MED ENDOCRINE DISORDERS W CC ............................................................ 1.1234 5.3 6.6

301 .... 10 MED ENDOCRINE DISORDERS W/O CC ........................................................ .6063 3.0 3.8

302 .... 11 SURG KIDNEY TRANSPLANT ............................................................................. 3.2881 7.9 9.3

303 .... 11 SURG KIDNEY, URETER & MAJOR BLADDER PROCEDURES FOR NEOPLASM.2.4853 7.5 9.0

304 .... 11 SURG KIDNEY, URETER & MAJOR BLADDER PROC FOR NON-NEOPL W

CC.

2.4558 7.4 9.7

305 .... 11 SURG KIDNEY, URETER & MAJOR BLADDER PROC FOR NON-NEOPL W/

O CC.

1.1486 3.1 3.8

22843

* MEDICARE DATA HAVE BEEN SUPPLEMENTED BY DATA FROM 19 STATES FOR LOW VOLUME DRGS.

** DRGS 469 AND 470 CONTAIN CASES WHICH COULD NOT BE ASSIGNED TO VALID DRGS.

NOTE: ARITHMETIC MEAN IS PRESENTED FOR INFORMATIONAL PURPOSES ONLY.

NOTE: RELATIVE WEIGHTS ARE BASED ON MEDICARE PATIENT DATA AND MAY NOT BE APPROPRIATE FOR OTHER PATIENTS.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 5.—LIST OF DIAGNOSIS RELATED GROUPS (DRGS), RELATIVE WEIGHTING FACTORS, GEOMETRIC AND ARITHMETIC

MEAN LENGTH OF STAY—Continued

DRG MDC Type DRG title Relative

weights

Geometric

mean LOS

Arithmetric

mean LOS

306 .... 11 SURG PROSTATECTOMY W CC ........................................................................ 1.3006 4.3 6.2

307 .... 11 SURG PROSTATECTOMY W/O CC .................................................................... .6054 1.9 2.3

308 .... 11 SURG MINOR BLADDER PROCEDURES W CC ................................................ 1.6788 4.8 6.9

309 .... 11 SURG MINOR BLADDER PROCEDURES W/O CC ............................................ .8935 1.8 2.3

310 .... 11 SURG TRANSURETHRAL PROCEDURES W CC .............................................. 1.1342 3.3 4.7

311 .... 11 SURG TRANSURETHRAL PROCEDURES W/O CC .......................................... .5952 1.5 1.8

312 .... 11 SURG URETHRAL PROCEDURES, AGE >17 W CC ......................................... 1.0749 3.3 4.8

313 .... 11 SURG URETHRAL PROCEDURES, AGE >17 W/O CC ..................................... .6598 1.8 2.3

314 .... 11 SURG * URETHRAL PROCEDURES, AGE 0–17 ................................................ .4927 2.3 2.3

315 .... 11 SURG OTHER KIDNEY & URINARY TRACT O.R. PROCEDURES ................... 2.1396 4.8 8.2

316 .... 11 MED RENAL FAILURE ....................................................................................... 1.3732 5.6 7.3

317 .... 11 MED ADMIT FOR RENAL DIALYSIS ................................................................. .6157 2.0 2.9

318 .... 11 MED KIDNEY & URINARY TRACT NEOPLASMS W CC ................................. 1.1710 5.0 6.5

319 .... 11 MED KIDNEY & URINARY TRACT NEOPLASMS W/O CC ............................. .5918 2.1 2.8

320 .... 11 MED KIDNEY & URINARY TRACT INFECTIONS AGE >17 W CC .................. .8610 4.6 5.6

321 .... 11 MED KIDNEY & URINARY TRACT INFECTIONS AGE >17 W/O CC .............. .5592 3.3 3.9

322 .... 11 MED KIDNEY & URINARY TRACT INFECTIONS AGE 0–17 ........................... .5234 3.6 4.3

323 .... 11 MED URINARY STONES W CC, &/OR ESW LITHOTRIPSY ........................... .7969 2.5 3.3

324 .... 11 MED URINARY STONES W/O CC .................................................................... .4447 1.6 1.9

325 .... 11 MED KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE >17 W CC ... .6332 3.1 4.0

326 .... 11 MED KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE >17 W/O CC .4118 2.1 2.7

327 .... 11 MED KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE 0–17 ............ .3741 2.8 3.2

328 .... 11 MED URETHRAL STRICTURE AGE >17 W CC ............................................... .7216 2.9 3.8

329 .... 11 MED URETHRAL STRICTURE AGE >17 W/O CC ........................................... .4388 1.6 2.0

330 .... 11 MED * URETHRAL STRICTURE AGE 0–17 ...................................................... .3174 1.6 1.6

331 .... 11 MED OTHER KIDNEY & URINARY TRACT DIAGNOSES AGE >17 W CC .... 1.0625 4.6 6.0

332 .... 11 MED OTHER KIDNEY & URINARY TRACT DIAGNOSES AGE >17 W/O CC .6057 2.6 3.4

333 .... 11 MED OTHER KIDNEY & URINARY TRACT DIAGNOSES AGE 0–17 ............. .8056 4.0 5.4

334 .... 12 SURG MAJOR MALE PELVIC PROCEDURES W CC ........................................ 1.4761 4.0 4.5

335 .... 12 SURG MAJOR MALE PELVIC PROCEDURES W/O CC .................................... 1.1081 3.0 3.2

336 .... 12 SURG TRANSURETHRAL PROSTATECTOMY W CC ....................................... .9149 2.9 3.9

337 .... 12 SURG TRANSURETHRAL PROSTATECTOMY W/O CC ................................... .5769 1.9 2.2

338 .... 12 SURG TESTES PROCEDURES, FOR MALIGNANCY ........................................ 1.2150 3.7 5.6

339 .... 12 SURG TESTES PROCEDURES, NON-MALIGNANCY AGE >17 ........................ 1.2384 3.5 5.5

340 .... 12 SURG * TESTES PROCEDURES, NON-MALIGNANCY AGE 0–17 .................... .2820 2.4 2.4

341 .... 12 SURG PENIS PROCEDURES .............................................................................. 1.2740 1.9 3.1

342 .... 12 SURG CIRCUMCISION AGE >17 ........................................................................ .7866 2.6 3.6

343 .... 12 SURG * CIRCUMCISION AGE 0–17 ..................................................................... .1533 1.7 1.7

344 .... 12 SURG OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR

MALIGNANCY.

1.1746 1.6 2.4

345 .... 12 SURG OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXCEPT FOR

MALIGNANCY.

1.2518 3.9 5.6

346 .... 12 MED MALIGNANCY, MALE REPRODUCTIVE SYSTEM, W CC ...................... 1.0311 4.9 6.4

347 .... 12 MED MALIGNANCY, MALE REPRODUCTIVE SYSTEM, W/O CC .................. .5701 2.3 3.0

348 .... 12 MED * BENIGN PROSTATIC HYPERTROPHY W CC ...................................... .7105 6.2 6.2

349 .... 12 MED * BENIGN PROSTATIC HYPERTROPHY W/O CC .................................. .4357 4.9 4.9

350 .... 12 MED INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM ................. .7173 3.8 4.6

351 .... 12 MED * STERILIZATION, MALE ........................................................................... .2352 1.3 1.3

352 .... 12 MED OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES ....................... .6878 3.0 4.2

353 .... 13 SURG PELVIC EVISCERATION, RADICAL HYSTERECTOMY & RADICAL

VULVECTOMY.

1.8386 5.4 6.8

354 .... 13 SURG UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W

CC.

1.5275 5.1 6.1

355 .... 13 SURG UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W/O

CC.

.9039 3.1 3.3

356 .... 13 SURG FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES..7469 2.0 2.3

357 .... 13 SURG UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY.2.4424 7.5 9.2

358 .... 13 SURG UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC ............... 1.1910 3.7 4.4

359 .... 13 SURG UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC ........... .8191 2.6 2.8

360 .... 13 SURG VAGINA, CERVIX & VULVA PROCEDURES ........................................... .8530 2.4 2.9

361 .... 13 SURG LAPAROSCOPY & INCISIONAL TUBAL INTERRUPTION ...................... 1.0927 2.2 3.0

362 .... 13 SURG * ENDOSCOPIC TUBAL INTERRUPTION ................................................ .3006 1.4 1.4

363 .... 13 SURG D&C, CONIZATION & RADIO-IMPLANT, FOR MALIGNANCY ................ .8149 2.6 3.6

364 .... 13 SURG D&C, CONIZATION EXCEPT FOR MALIGNANCY .................................. .8190 2.9 4.1

22844

* MEDICARE DATA HAVE BEEN SUPPLEMENTED BY DATA FROM 19 STATES FOR LOW VOLUME DRGS.

** DRGS 469 AND 470 CONTAIN CASES WHICH COULD NOT BE ASSIGNED TO VALID DRGS.

NOTE: ARITHMETIC MEAN IS PRESENTED FOR INFORMATIONAL PURPOSES ONLY.

NOTE: RELATIVE WEIGHTS ARE BASED ON MEDICARE PATIENT DATA AND MAY NOT BE APPROPRIATE FOR OTHER PATIENTS.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 5.—LIST OF DIAGNOSIS RELATED GROUPS (DRGS), RELATIVE WEIGHTING FACTORS, GEOMETRIC AND ARITHMETIC

MEAN LENGTH OF STAY—Continued

DRG MDC Type DRG title Relative

weights

Geometric

mean LOS

Arithmetric

mean LOS

365 .... 13 SURG OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES ...... 2.0115 5.8 8.1

366 .... 13 MED MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W CC .................. 1.2739 5.6 7.4

367 .... 13 MED MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W/O CC .............. .5582 2.4 3.2

368 .... 13 MED INFECTIONS, FEMALE REPRODUCTIVE SYSTEM ............................... 1.1384 5.6 7.0

369 .... 13 MED MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS..5584 2.5 3.4

370 .... 14 SURG CESAREAN SECTION W CC ................................................................... 1.0417 4.6 6.1

371 .... 14 SURG CESAREAN SECTION W/O CC ................................................................ .6848 3.3 3.7

372 .... 14 MED VAGINAL DELIVERY W COMPLICATING DIAGNOSES ......................... .5578 2.6 3.3

373 .... 14 MED VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES ..................... .3764 2.0 2.3

374 .... 14 SURG VAGINAL DELIVERY W STERILIZATION &/OR D&C ............................. .7103 2.6 3.2

375 .... 14 SURG VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C ........ .6081 2.1 2.3

376 .... 14 MED POSTPARTUM & POST ABORTION DIAGNOSES W/O O.R. PROCEDURE..4954 2.5 3.2

377 .... 14 SURG POSTPARTUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE.1.6465 3.7 5.6

378 .... 14 MED ECTOPIC PREGNANCY ........................................................................... .7984 2.0 2.4

379 .... 14 MED THREATENED ABORTION ....................................................................... .4502 2.4 3.5

380 .... 14 MED ABORTION W/O D&C ............................................................................... .4196 1.6 2.1

381 .... 14 SURG ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY .6654 1.8 2.5

382 .... 14 MED FALSE LABOR ........................................................................................... .1607 1.2 1.3

383 .... 14 MED OTHER ANTEPARTUM DIAGNOSES W MEDICAL COMPLICATIONS .. .4856 2.8 3.8

384 .... 14 MED OTHER ANTEPARTUM DIAGNOSES W/O MEDICAL COMPLICATIONS..3412 1.6 2.2

385 .... 15 MED * NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE

FACILITY.

1.3696 1.8 1.8

386 .... 15 MED * EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE.4.5165 17.9 17.9

387 .... 15 MED * PREMATURITY W MAJOR PROBLEMS ................................................ 3.0846 13.3 13.3

388 .... 15 MED * PREMATURITY W/O MAJOR PROBLEMS ............................................ 1.8612 8.6 8.6

389 .... 15 MED FULL TERM NEONATE W MAJOR PROBLEMS ..................................... 2.0857 7.9 13.7

390 .... 15 MED NEONATE W OTHER SIGNIFICANT PROBLEMS .................................. 1.1337 3.5 4.3

391 .... 15 MED * NORMAL NEWBORN .............................................................................. .1519 3.1 3.1

392 .... 16 SURG SPLENECTOMY AGE >17 ........................................................................ 3.3890 8.3 10.8

393 .... 16 SURG * SPLENECTOMY AGE 0–17 .................................................................... 1.3416 9.1 9.1

394 .... 16 SURG OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING

ORGANS.

1.8266 5.1 8.1

395 .... 16 MED RED BLOOD CELL DISORDERS AGE >17 ............................................. .8194 3.5 4.7

396 .... 16 MED RED BLOOD CELL DISORDERS AGE 0–17 ........................................... 1.0480 3.9 5.0

397 .... 16 MED COAGULATION DISORDERS ................................................................... 1.2664 4.2 5.6

398 .... 16 MED RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC ................ 1.3049 5.1 6.4

399 .... 16 MED RETICULOENDOTHELIAL & IMMUNITY DISORDERS W/O CC ............ .6690 3.0 3.7

400 .... 17 SURG LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE ..................... 2.9273 7.4 10.5

401 .... 17 SURG LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W CC 2.9814 9.9 12.8

402 .... 17 SURG LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W/O

CC.

1.1619 3.1 4.4

403 .... 17 MED LYMPHOMA & NON-ACUTE LEUKEMIA W CC ...................................... 1.8486 6.8 9.0

404 .... 17 MED LYMPHOMA & NON-ACUTE LEUKEMIA W/O CC .................................. .8711 3.4 4.6

405 .... 17 MED * ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE AGE 0–17 ......... 1.9021 4.9 4.9

406 .... 17 SURG MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ

O.R.PROC W CC.

2.9692 8.4 11.0

407 .... 17 SURG MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ

O.R.PROC W/O CC.

1.2484 3.8 4.7

408 .... 17 SURG MYELOPROLIF DISORD OR POORLY DIFF NEOPL W OTHER

O.R.PROC.

2.2150 6.0 9.2

409 .... 17 MED RADIOTHERAPY ....................................................................................... 1.1469 4.9 6.3

410 .... 17 MED CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS..9972 3.3 4.1

411 .... 17 MED HISTORY OF MALIGNANCY W/O ENDOSCOPY .................................... .4401 1.8 2.3

412 .... 17 MED HISTORY OF MALIGNANCY W ENDOSCOPY ....................................... .6073 1.9 2.4

413 .... 17 MED OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC ... 1.3898 6.1 7.8

414 .... 17 MED OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W/O CC .7422 3.5 4.5

415 .... 18 SURG O.R. PROCEDURE FOR INFECTIOUS & PARASITIC DISEASES ......... 3.8811 12.6 16.2

416 .... 18 MED SEPTICEMIA AGE >17 ............................................................................. 1.6209 6.4 8.1

417 .... 18 MED SEPTICEMIA AGE 0–17 ............................................................................ .8498 4.5 5.3

418 .... 18 MED POSTOPERATIVE & POST-TRAUMATIC INFECTIONS ......................... 1.0452 5.3 6.6

22845

* MEDICARE DATA HAVE BEEN SUPPLEMENTED BY DATA FROM 19 STATES FOR LOW VOLUME DRGS.

** DRGS 469 AND 470 CONTAIN CASES WHICH COULD NOT BE ASSIGNED TO VALID DRGS.

NOTE: ARITHMETIC MEAN IS PRESENTED FOR INFORMATIONAL PURPOSES ONLY.

NOTE: RELATIVE WEIGHTS ARE BASED ON MEDICARE PATIENT DATA AND MAY NOT BE APPROPRIATE FOR OTHER PATIENTS.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 5.—LIST OF DIAGNOSIS RELATED GROUPS (DRGS), RELATIVE WEIGHTING FACTORS, GEOMETRIC AND ARITHMETIC

MEAN LENGTH OF STAY—Continued

DRG MDC Type DRG title Relative

weights

Geometric

mean LOS

Arithmetric

mean LOS

419 .... 18 MED FEVER OF UNKNOWN ORIGIN AGE >17 W CC .................................... .8617 4.0 5.0

420 .... 18 MED FEVER OF UNKNOWN ORIGIN AGE >17 W/O CC ................................ .6114 3.0 3.6

421 .... 18 MED VIRAL ILLNESS AGE >17 ......................................................................... .6646 3.2 3.9

422 .... 18 MED VIRAL ILLNESS & FEVER OF UNKNOWN ORIGIN AGE 0–17 .............. .4800 2.6 3.2

423 .... 18 MED OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES .............. 1.8405 6.7 9.0

424 .... 19 SURG O.R. PROCEDURE W PRINCIPAL DIAGNOSES OF MENTAL ILLNESS 2.4350 10.7 15.6

425 .... 19 MED ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION..6799 3.2 4.2

426 .... 19 MED DEPRESSIVE NEUROSES ....................................................................... .5276 3.5 4.7

427 .... 19 MED NEUROSES EXCEPT DEPRESSIVE ....................................................... .5438 3.6 5.0

428 .... 19 MED DISORDERS OF PERSONALITY & IMPULSE CONTROL ...................... .7200 5.0 7.6

429 .... 19 MED ORGANIC DISTURBANCES & MENTAL RETARDATION ....................... .8357 5.2 6.8

430 .... 19 MED PSYCHOSES ............................................................................................. .7653 6.7 8.9

431 .... 19 MED CHILDHOOD MENTAL DISORDERS ....................................................... .6309 5.0 6.8

432 .... 19 MED OTHER MENTAL DISORDER DIAGNOSES ............................................ .7068 3.4 5.1

433 .... 20 MED ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA .................... .2852 2.3 3.2

434 .... 20 MED NO LONGER VALID .................................................................................. .0000 .0 .0

435 .... 20 MED NO LONGER VALID .................................................................................. .0000 .0 .0

436 .... 20 MED NO LONGER VALID .................................................................................. .0000 .0 .0

437 .... 20 MED NO LONGER VALID .................................................................................. .0000 .0 .0

438 .... 20 NO LONGER VALID .................................................................................. .0000 .0 .0

439 .... 21 SURG SKIN GRAFTS FOR INJURIES ................................................................. 1.9350 6.7 9.5

440 .... 21 SURG WOUND DEBRIDEMENTS FOR INJURIES ............................................. 2.0732 7.1 10.3

441 .... 21 SURG HAND PROCEDURES FOR INJURIES .................................................... .9273 2.3 3.3

442 .... 21 SURG OTHER O.R. PROCEDURES FOR INJURIES W CC .............................. 2.5349 6.8 9.6

443 .... 21 SURG OTHER O.R. PROCEDURES FOR INJURIES W/O CC .......................... .9896 2.7 3.6

444 .... 21 MED TRAUMATIC INJURY AGE >17 W CC ..................................................... .7244 3.4 4.4

445 .... 21 MED TRAUMATIC INJURY AGE >17 W/O CC ................................................. .4713 2.4 3.0

446 .... 21 MED * TRAUMATIC INJURY AGE 0–17 ............................................................ .2949 2.4 2.4

447 .... 21 MED ALLERGIC REACTIONS AGE >17 ........................................................... .4851 1.9 2.5

448 .... 21 MED * ALLERGIC REACTIONS AGE 0–17 ....................................................... .0970 2.9 2.9

449 .... 21 MED POISONING & TOXIC EFFECTS OF DRUGS AGE >17 W CC .............. .8306 2.8 3.9

450 .... 21 MED POISONING & TOXIC EFFECTS OF DRUGS AGE >17 W/O CC .......... .4161 1.6 2.0

451 .... 21 MED * POISONING & TOXIC EFFECTS OF DRUGS AGE 0–17 ..................... .2618 2.1 2.1

452 .... 21 MED COMPLICATIONS OF TREATMENT W CC ............................................. 1.0125 3.8 5.2

453 .... 21 MED COMPLICATIONS OF TREATMENT W/O CC ......................................... .4997 2.2 2.8

454 .... 21 MED OTHER INJURY, POISONING & TOXIC EFFECT DIAG W CC .............. .8713 3.4 4.9

455 .... 21 MED OTHER INJURY, POISONING & TOXIC EFFECT DIAG W/O CC .......... .4617 1.9 2.6

456 .... 22 NO LONGER VALID .................................................................................. .0000 .0 .0

457 .... 22 MED NO LONGER VALID .................................................................................. .0000 .0 .0

458 .... 22 SURG NO LONGER VALID .................................................................................. .0000 .0 .0

459 .... 22 SURG NO LONGER VALID .................................................................................. .0000 .0 .0

460 .... 22 MED NO LONGER VALID .................................................................................. .0000 .0 .0

461 .... 23 SURG O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES.1.1994 2.5 4.6

462 .... 23 MED REHABILITATION ...................................................................................... 1.2033 10.4 12.3

463 .... 23 MED SIGNS & SYMPTOMS W CC .................................................................... .6818 3.4 4.3

464 .... 23 MED SIGNS & SYMPTOMS W/O CC ................................................................ .4630 2.5 3.1

465 .... 23 MED AFTERCARE W HISTORY OF MALIGNANCY AS SECONDARY DIAGNOSIS..6065 2.5 3.6

466 .... 23 MED AFTERCARE W/O HISTORY OF MALIGNANCY AS SECONDARY DIAGNOSIS..6630 2.5 4.2

467 .... 23 MED OTHER FACTORS INFLUENCING HEALTH STATUS ............................ .5762 2.7 4.1

468 .... ............ EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS.3.8458 11.3 14.5

469 .... ............ ** PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS ....... .0000 .0 .0

470 .... ............ ** UNGROUPABLE .................................................................................... .0000 .0 .0

471 .... 08 SURG BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY.2.9929 5.0 5.7

472 .... 22 SURG NO LONGER VALID .................................................................................. .0000 .0 .0

473 .... 17 SURG ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE AGE >17 ............. 3.9044 9.7 15.0

474 .... 04 SURG NO LONGER VALID .................................................................................. .0000 .0 .0

475 .... 04 MED RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT 3.9155 10.0 12.7

476 .... ............ SURG PROSTATIC O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS.2.2902 10.0 12.3

22846 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 5.—LIST OF DIAGNOSIS RELATED GROUPS (DRGS), RELATIVE WEIGHTING FACTORS, GEOMETRIC AND ARITHMETIC

MEAN LENGTH OF STAY—Continued

DRG MDC Type DRG title Relative

weights

Geometric

mean LOS

Arithmetric

mean LOS

477 .... ............ SURG NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL

DIAGNOSIS.

1.9571 6.7 9.3

478 .... 05 SURG OTHER VASCULAR PROCEDURES W CC ............................................. 2.4276 5.9 8.2

479 .... 05 SURG OTHER VASCULAR PROCEDURES W/O CC ......................................... 1.4024 2.8 3.7

480 .... PRE SURG LIVER TRANSPLANT ................................................................................ 10.6132 17.7 22.8

481 .... PRE SURG BONE MARROW TRANSPLANT .............................................................. 7.8889 23.4 25.6

482 .... PRE SURG TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES ............. 3.8343 11.4 14.3

483 .... PRE SURG TRACHEOSTOMY EXCEPT FOR FACE, MOUTH & NECK DIAGNOSES.15.2827 34.0 41.0

484 .... 24 SURG CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA ....................... 5.1265 11.5 14.5

485 .... 24 SURG LIMB REATTACHMENT, HIP AND FEMUR PROC FOR MULTIPLE

SIGNIFICANT TRA.

3.1094 8.5 10.3

486 .... 24 SURG OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA 5.2547 11.0 14.3

487 .... 24 MED OTHER MULTIPLE SIGNIFICANT TRAUMA ............................................ 1.9199 6.3 8.2

488 .... 25 SURG HIV W EXTENSIVE O.R. PROCEDURE ................................................... 5.1474 15.0 19.8

489 .... 25 MED HIV W MAJOR RELATED CONDITION .................................................... 1.8802 7.0 9.4

490 .... 25 MED HIV W OR W/O OTHER RELATED CONDITION ..................................... 1.0475 4.3 5.8

491 .... 08 SURG MAJOR JOINT & LIMB REATTACHMENT PROCEDURES OF UPPER

EXTREMITY.

1.6364 3.0 3.5

492 .... 17 MED CHEMOTHERAPY W ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS.4.8853 13.6 19.0

493 .... 07 SURG LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC ................. 1.8468 4.9 6.3

494 .... 07 SURG LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC ............. .9800 1.9 2.5

495 .... PRE SURG LUNG TRANSPLANT ................................................................................ 8.8879 13.8 16.2

496 .... 08 SURG COMBINED ANTERIOR/POSTERIOR SPINAL FUSION ......................... 5.6865 8.5 10.3

497 .... 08 SURG SPINAL FUSION EXCEPT CERVICAL W CC .......................................... 3.1996 5.8 6.8

498 .... 08 SURG SPINAL FUSION EXCEPT CERVICAL W/O CC ...................................... 2.2996 3.9 4.3

499 .... 08 SURG BACK & NECK PROCEDURES EXCEPT SPINAL FUSION W CC ......... 1.4471 3.8 5.0

500 .... 08 SURG BACK & NECK PROCEDURES EXCEPT SPINAL FUSION W/O CC ..... .9375 2.2 2.6

501 .... 08 SURG KNEE PROCEDURES W PDX OF INFECTION W CC ............................ 2.7466 9.8 12.0

502 .... 08 SURG KNEE PROCEDURES W PDX OF INFECTION W/O CC ........................ 1.5591 5.9 6.9

503 .... 08 SURG KNEE PROCEDURES W/O PDX OF INFECTION ................................... 1.2336 3.3 4.2

504 .... 22 SURG EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT ............................. 13.8097 28.2 33.6

505 .... 22 MED EXTENSIVE 3RD DEGREE BURNS W/O SKIN GRAFT ......................... 1.4893 2.0 3.4

506 .... 22 SURG FULL THICKNESS BURN W SKIN GRAFT OR INHAL INJ W CC OR

SIG TRAUMA.

4.9149 15.7 19.9

507 .... 22 SURG FULL THICKNESS BURN W SKIN GRFT OR INHAL INJ W/O CC OR

SIG TRAUMA.

1.8331 7.2 9.2

508 .... 22 MED FULL THICKNESS BURN W/O SKIN GRFT OR INHAL INJ W CC OR

SIG TRAUMA.

1.2966 6.0 8.3

509 .... 22 MED FULL THICKNESS BURN W/O SKIN GRFT OR INH INJ W/O CC OR

SIG TRAUMA.

.7323 3.7 4.9

510 .... 22 MED NON-EXTENSIVE BURNS W CC OR SIGNIFICANT TRAUMA .............. 1.3509 5.8 8.0

511 .... 22 MED NON-EXTENSIVE BURNS W/O CC OR SIGNIFICANT TRAUMA ........... .7558 3.6 5.1

512 .... PRE SURG SIMULTANEOUS PANCREAS/KIDNEY TRANSPLANT ........................... 6.6413 13.4 16.5

513 .... PRE SURG PANCREAS TRANSPLANT ....................................................................... 6.6497 10.3 13.4

514 .... 05 SURG CARDIAC DEFIBRILLATOR IMPLANT W CARDIAC CATH .................... 6.4169 6.8 9.0

515 .... 05 SURG CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH ................ 5.0652 4.3 6.8

516 .... 05 SURG PERCUTANEOUS CARDIOVASC PROC W AMI ..................................... 2.7250 4.1 5.0

517 .... 05 SURG PERC CARDIO PROC W CORONARY ARTERY STENT W/O AMI ....... 2.1497 1.9 2.7

518 .... 05 SURG PERC CARDIO PROC W/O CORONARY ARTERY STENT OR AMI ..... 1.6673 2.5 3.6

519 .... 08 SURG CERVICAL SPINAL FUSION W CC .......................................................... 2.2654 3.4 5.1

520 .... 08 SURG CERVICAL SPINAL FUSION W/O CC ...................................................... 1.5709 2.0 2.8

521 .... 20 MED ALCOHOL/DRUG ABUSE OR DEPENDENCE W CC ............................. .7354 4.2 5.4

522 .... 20 MED ALC/DRUG ABUSE OR DEPEND W REHABILITATION THERAPY W/O

CC.

.6631 9.0 10.7

523 .... 20 MED ALC/DRUG ABUSE OR DEPEND W/O REHABILITATION THERAPY

W/O CC.

.3983 3.5 4.3

* MEDICARE DATA HAVE BEEN SUPPLEMENTED BY DATA FROM 19 STATES FOR LOW VOLUME DRGS.

** DRGS 469 AND 470 CONTAIN CASES WHICH COULD NOT BE ASSIGNED TO VALID DRGS.

NOTE: GEOMETRIC MEAN IS USED ONLY TO DETERMINE PAYMENT FOR TRANSFER CASES.

NOTE: ARITHMETIC MEAN IS PRESENTED FOR INFORMATIONAL PURPOSES ONLY.

NOTE: RELATIVE WEIGHTS ARE BASED ON MEDICARE PATIENT DATA AND MAY NOT BE APPROPRIATE FOR OTHER PATIENTS.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22847

TABLE 6A.—NEW DIAGNOSIS CODES

Diagnosis

code Description CC MDC DRG

256.31 Premature menopause ......................................................................................... N 13 358, 359, 369

256.39 Other ovarian failure ............................................................................................. N 13 358, 359, 369

277.7 Dysmetabolic Syndrome X ................................................................................... N 10 299

464.00 Acute laryngitis, without mention of obstruction ................................................... N 3

pre

68, 69, 70

482

464.01 Acute laryngitis, with obstruction .......................................................................... N 3

pre

68, 69, 70

482

464.50 Unspecified supraglottis, without mention of obstruction ..................................... N 3

pre

68, 69, 70

482

464.51 Unspecified supraglottis, with obstruction ............................................................ N 3

pre

68, 69, 70

482

521.00 Unspecified dental caries ...................................................................................... N 3

pre

185, 186, 187

482

521.01 Dental caries limited to enamel ............................................................................ N 3

pre

185, 186, 187

482

521.02 Dental caries extending into dentine .................................................................... N 3

pre

185, 186, 187

482

521.03 Dental caries extending into pulp ......................................................................... N 3

pre

185, 186, 187

482

521.04 Arrested dental caries ........................................................................................... N 3

pre

185, 186, 187

482

521.05 Odontoclasia ......................................................................................................... N 3

pre

185, 186, 187

482

521.09 Other dental caries ............................................................................................... N 3

pre

185, 186, 187

482

525.10 Unspecified acquired absence of teeth ................................................................ N 3

pre

185, 186, 187

482

525.11 Loss of teeth due to trauma ................................................................................. N 3

pre

185, 186, 187

482

525.12 Loss of teeth due to periodontal disease ............................................................. N 3

pre

182, 183, 184

482

525.13 Loss of teeth due to caries ................................................................................... N 3

pre

185, 186, 187

482

525.19 Other loss of teeth ................................................................................................ N 3

pre

185, 186, 187

482

530.12 Acute esophagitis .................................................................................................. N 6 182, 183, 184

564.00 Unspecified constipation ....................................................................................... N 6 182, 183, 184

564.01 Slow transit constipation ....................................................................................... N 6 182, 183, 184

564.02 Outlet dysfunction constipation ............................................................................. N 6 182, 183, 184

564.09 Other constipation ................................................................................................. N 6 182, 183, 184

602.3 Dysplasia of prostate ............................................................................................ N 12 352

608.82 Hematospermia ..................................................................................................... N 12 352

608.87 Retrograde ejaculation .......................................................................................... N 12 352

692.76 Sunburn of second degree ................................................................................... N 9 283, 284

692.77 Sunburn of third degree ........................................................................................ N 9 283, 284

718.70 Developmental dislocation of joint, site unspecified ............................................. N 8 256

718.71 Developmental dislocation of joint, shoulder region ............................................. N 8 256

718.72 Developmental dislocation of joint, upper arm ..................................................... N 8 256

718.73 Developmental dislocation of joint, forearm ......................................................... N 8 256

718.74 Developmental dislocation of joint, hand .............................................................. N 8 256

718.75 Developmental dislocation of joint, pelvic region and thigh ................................. N 8 256

718.76 Developmental dislocation of joint, lower leg ....................................................... N 8 256

718.77 Developmental dislocation of joint, ankle and foot ............................................... N 8 256

718.78 Developmental dislocation of joint, other specified sites ...................................... N 8 256

718.79 Developmental dislocation of joint, multiple sites ................................................. N 8 256

733.93 Stress fracture of tibia or fibula ............................................................................ Y 8 239

733.94 Stress fracture of the metatarsals ........................................................................ Y 8 239

733.95 Stress fracture of other bone ................................................................................ Y 8 239

772.10 Intraventricular hemorrhage, unspecified grade ................................................... Y 15 387, 389

772.11 Intraventricular hemorrhage, Grade I ................................................................... Y 15 387, 389

772.12 Intraventricular hemorrhage, Grade II .................................................................. Y 15 387, 389

772.13 Intraventricular hemorrhage, Grade III ................................................................. Y 15 387, 389

772.14 Intraventricular hemorrhage, Grade IV ................................................................. Y 15 387, 389

779.7 Perventricular leukomalacia .................................................................................. Y 15 387, 389

793.80 Unspecified abnormal mammogram ..................................................................... N 9 276

793.81 Mammographic microcalcification ......................................................................... N 9 276

793.89 Other abnormal findings on radiological examination breast ............................... N 9 276

840.7 Superior glenoid labrum lesions (SLAP) .............................................................. N 8

24

253, 254, 255

487

22848 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 6A.—NEW DIAGNOSIS CODES—Continued

Diagnosis

code Description CC MDC DRG

997.71 Vascular complications of mesenteric artery ........................................................ Y 6

15

188, 189, 190

387,1 389 1

997.72 Vascular complications of renal artery ................................................................. Y 11

15

331, 332, 333

387,1 389 1

997.79 Vascular complications of other vessels .............................................................. Y 5

15

130, 131

387,1 389 1

V10.53 Personal history of malignant neoplasm, renal pelvis .......................................... N 17 411, 412

V45.84 Dental restoration status ....................................................................................... N 23 467

V49.82 Dental sealant status ............................................................................................ N 23 467

V83.01 Asymptomatic hemophilia A carrier ...................................................................... N 23 467

V83.02 Symptomatic hemophilia A carrier ........................................................................ N 23 467

TABLE 6B.—NEW PROCEDURE CODES

Procedure

code Description OR MDC DRG

37.28 Intracardiac echocardiography .............................................................................. N

44.32 Percutaneous [endoscopic] gastrojejunostomy .................................................... Y 6

7

10

17

154–156

201

288

400, 406, 407

67.51 Transabdominal cerclage of cervix ....................................................................... Y 13

14

21

24

360

372, 373

442, 443

486

67.59 Other repair of internal cervical os ....................................................................... Y 13

14

21

24

360

372, 373

442, 443

486

75.38 Fetal pulse oximetry .............................................................................................. N

81.30 Refusion of spine, not otherwise specified ........................................................... Y 1

8

21

24

4

497, 498

442, 443

486

81.31 Refusion of Atlas-axis spine ................................................................................. Y 1

8

21

24

4

497, 498

442, 443

486

81.32 Refusion of other cervical spine, anterior technique ............................................ Y 1

8

21

24

4

496, 519, 520

442, 443

486

81.33 Refusion of other cervical spine, posterior technique .......................................... Y 1

8

21

24

4

496, 519, 520

442, 443

486

81.34 Refusion of dorsal and dorsolumbar spine, anterior technique ........................... Y 1

8

21

24

4

496, 497, 498

442, 443

486

81.35 Refusion of dorsal and dorsolumbar spine, posterior technique .......................... Y 1

8

21

24

4

496, 497, 498

442, 443

486

81.36 Refusion of lumbar and lumbosacral spine, anterior technique ........................... Y 1

8

21

24

4

496, 497, 498

442, 443

486

81.37 Refusion of lumbar and lumbosacral spine, lateral transverse process technique.Y 1

8

21

24

4

496, 497, 498

442, 443

486

81.38 Refusion of lumbar and lumbosacral spine, posterior technique ......................... Y 1

8

21

24

4

496, 497, 498

442, 443

486

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22849

TABLE 6B.—NEW PROCEDURE CODES—Continued

Procedure

code Description OR MDC DRG

81.39 Refusion of spine, not elsewhere classified ......................................................... Y 1

8

21

24

4

497, 498

442, 443

486

97.44 Nonoperative removal of heart assist system ...................................................... N

TABLE 6C.—INVALID DIAGNOSIS CODES

Diagnosis

code Description CC MDC DRG

256.3 Other ovarian failure ............................................................................................. N 13 358, 359, 369

464.0 Acute laryngitis ...................................................................................................... N 3

pre

68, 69, 70

482

521.0 Dental caries ......................................................................................................... N 3

pre

185, 186, 187

482

525.1 Loss of teeth due to accident, extraction, or local periodontal disease ............... N 3

pre

185, 186, 187

482

564.0 Constipation .......................................................................................................... N 6 182, 183, 184

772.1 Intraventricular hemorrhage .................................................................................. Y 15 387,389

793.8 Nonspecific abnormal findings on radiological and other examinations of body

structure, breast.

N 9 276

TABLE 6D.—INVALID PROCEDURE CODES

Procedure

code Description OR MDC DRG

67.5 Repair of internal cervical os ................................................................................ Y 13

14

21

24

360

372, 373

442, 442

486

81.09 Refusion of spine, any level or technique ............................................................ Y 1

8

21

24

4

497, 498

442, 443

486

TABLE 6E.—REVISED DIAGNOSIS CODE TITLES

Diagnosis

code Description CC MDC DRG

411.81 Acute coronary occlusion without myocardial infarction ....................................... Y 5 124, 140

493.00 Extrinsic asthma without mention of status asthmaticus or acute exacerbation

or unspecified.

N 4 96, 97, 98

493.10 Intrinsic asthma without mention of status asthmaticus or acute exacerbation or

unspecified.

N 4 96, 97, 98

493.20 Chronic obstructive asthma without mention of status asthmaticus or acute exacerbation or unspecified.Y 4 88

493.90 Asthma, unspecified without mention of status asthmaticus or acute exacerbation or unspecified.N 4 96, 97, 98

V70.7 Examination of participant in clinical trial ............................................................. N 23 467

TABLE 6F.—REVISED PROCEDURE CODES

Procedure

code Description OR MDC DRG

75.34 Other fetal monitoring ........................................................................................... N

22850 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST

CCs that are added to the list are in Table 6F-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and

the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.

*25631 80600 82010 80637 80606 82021 77212 77210

2580 80601 82011 80638 80607 82022 77213 77211

2581 80602 82012 80639 80608 82030 77214 77212

2588 80603 82013 8064 80609 82031 7797 77213

2589 80604 82019 8065 80610 82032 *7729 77214

*25639 80605 82020 80660 80611 8208 77210 7797

2580 80606 82021 80661 80612 8209 77211 *7769

2581 80607 82022 80662 80613 82100 77212 77210

2588 80608 82030 80669 80614 82101 77213 77211

2589 80609 82031 80670 80615 82110 77214 77212

*6023 80610 82032 80671 80616 82111 7797 77213

5960 80611 8208 80672 80617 *7720 *7760 77214

5996 80612 8209 80679 80618 77210 77210 7797

6010 80613 82100 8068 80619 77211 77211 *7797

6012 80614 82101 8069 80620 77212 77212 7722

6013 80615 82110 8080 80621 77213 77213 7797

6021 80616 82111 8082 80622 77214 77214 *7798

78820 80617 *73394 8083 80623 7797 7797 77210

78829 80618 73310 80843 80624 *77210 *7761 77211

*60887 80619 73311 80849 80625 77210 77210 77212

5970 80620 73312 80851 80626 77211 77211 77213

5994 80621 73313 80852 80627 77212 77212 77214

*73310 80622 73314 80853 80628 77213 77213 7797

73393 80623 73315 80859 80629 77214 77214 *9972

73394 80624 73316 8088 80630 7722 7797 99771

73395 80625 73319 8089 80631 7797 *7762 99772

*73311 80626 73393 82000 80632 *77211 77210 99779

73393 80627 73394 82001 80633 77210 77211 *99771

73394 80628 73395 82002 80634 77211 77212 53640

73395 80629 8058 82003 80635 77212 77213 53641

*73312 80630 8059 82009 80636 77213 77214 53642

73393 80631 80600 82010 80637 77214 7797 53649

73394 80632 80601 82011 80638 7722 *7763 56962

73395 80633 80602 82012 80639 7797 77210 9974

*73313 80634 80603 82013 8064 *77212 77211 99771

73393 80635 80604 82019 8065 77210 77212 99772

73394 80636 80605 82020 80660 77211 77213 99779

73395 80637 80606 82021 80661 77212 77214 *99772

*73314 80638 80607 82022 80662 77213 7797 9975

73393 80639 80608 82030 80669 77214 *7764 99771

73394 8064 80609 82031 80670 7722 77210 99772

73395 8065 80610 82032 80671 7797 77211 99779

*73315 80660 80611 8208 80672 *77213 77212 *99779

73393 80661 80612 8209 80679 77210 77213 9972

73394 80662 80613 82100 8068 77211 77214 99771

73395 80669 80614 82101 8069 77212 7797 99772

*73316 80670 80615 82110 8080 77213 *7765 99779

73393 80671 80616 82111 8082 77214 77210 *99791

73394 80672 80617 *73395 8083 7722 77211 99771

73395 80679 80618 73310 80843 7797 77212 99772

*73319 8068 80619 73311 80849 *77214 77213 99779

73393 8069 80620 73312 80851 77210 77214 *99799

73394 8080 80621 73313 80852 77211 7797 99771

73395 8082 80622 73314 80853 77212 *7766 99772

*73393 8083 80623 73315 80859 77213 77210 99779

73310 80843 80624 73316 8088 77214 77211 *99881

73311 80849 80625 73319 8089 7722 77212 99771

73312 80851 80626 73393 82000 7797 77213 99772

73313 80852 80627 73394 82001 *7722 77214 99779

73314 80853 80628 73395 82002 77210 7797 *99883

73315 80859 80629 8058 82003 77211 *7767 99771

73316 8088 80630 8059 82009 77212 77210 99772

73319 8089 80631 80600 82010 77213 77211 99779

73393 82000 80632 80601 82011 77214 77212 *99889

73394 82001 80633 80602 82012 7797 77213 99771

73395 82002 80634 80603 82013 *7728 77214 99772

8058 82003 80635 80604 82019 77210 7797 99779

8059 82009 80636 80605 82020 77211 *7768 *9989

99771

99772

99779

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22851

TABLE 6H.—DELETIONS TO THE CC EXCLUSIONS LIST

CCs that are deleted from the list are in Table 6G—Deletions to the CC Exclusions List. Each of the principal diagnoses is shown with an

asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.

*2563

2580

2581

2588

2589

*7720

7721

*7721

7721

7722

*7722

7721

*7728

7721

*7729

7721

*7760

7721

*7761

7721

*7762

7721

*7763

7721

*7764

7721

*7765

7721

*7766

7721

*7767

7721

*7768

7721

*7769

7721

*7798

7721

22852 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM, SELECTED PERCENTILE LENGTHS OF STAY

[FY2000 MEDPAR update 12/00 Grouper V18.0]

DRG Number

discharges

Arithmetic

mean LOS

10th

percentile

25th

percentile

50th

percentile

75th

percentile

90th

percentile

1 ................................... 33822 8.9935 2 3 6 12 19

2 ................................... 6772 9.9778 3 5 8 13 20

3 ................................... 2 43.5000 35 35 52 52 52

4 ................................... 6035 7.1639 1 2 5 9 15

5 ................................... 93311 3.1649 1 1 2 3 7

6 ................................... 366 2.9672 1 1 2 4 6

7 ................................... 12470 9.9739 2 4 7 12 20

8 ................................... 4164 3.2759 1 1 2 4 7

9 ................................... 1610 6.3491 1 3 5 8 13

10 ................................. 17577 6.5503 2 3 5 8 13

11 ................................. 3128 4.0767 1 2 3 5 8

12 ................................. 46758 5.8962 2 3 4 7 11

13 ................................. 6415 5.2011 2 3 4 6 9

14 ................................. 319523 5.8762 2 3 5 7 11

15 ................................. 145366 3.5498 1 2 3 4 7

16 ................................. 11155 6.0293 2 3 5 7 12

17 ................................. 3519 3.3231 1 2 3 4 6

18 ................................. 25961 5.4162 2 3 4 7 10

19 ................................. 8638 3.6972 1 2 3 5 7

20 ................................. 5629 10.1482 3 5 8 13 20

21 ................................. 1309 6.5516 2 3 5 8 13

22 ................................. 2535 4.8174 1 2 4 6 9

23 ................................. 9464 4.1855 1 2 3 5 8

24 ................................. 52753 4.9830 1 2 4 6 10

25 ................................. 25370 3.2236 1 2 3 4 6

26 ................................. 31 2.7097 1 1 2 3 6

27 ................................. 3441 5.0584 1 1 3 6 11

28 ................................. 11316 6.2100 1 3 5 8 13

29 ................................. 4486 3.6097 1 2 3 5 7

30 ................................. 1 1.0000 1 1 1 1 1

31 ................................. 3488 4.4903 1 2 3 5 8

32 ................................. 1738 2.5621 1 1 2 3 5

33 ................................. 1 1.0000 1 1 1 1 1

34 ................................. 20249 5.0786 1 2 4 6 10

35 ................................. 5728 3.3959 1 2 3 4 6

36 ................................. 3190 1.4649 1 1 1 1 2

37 ................................. 1452 4.0296 1 1 2 5 9

38 ................................. 102 2.6569 1 1 2 3 5

39 ................................. 912 1.9079 1 1 1 2 4

40 ................................. 1545 3.4252 1 1 2 4 7

42 ................................. 2223 2.2852 1 1 1 3 5

43 ................................. 85 3.1882 1 2 3 4 6

44 ................................. 1238 4.9548 2 3 4 6 9

45 ................................. 2444 3.1678 1 2 3 4 6

46 ................................. 3051 4.6834 1 2 4 6 9

47 ................................. 1281 3.2560 1 1 3 4 6

49 ................................. 2241 4.8104 1 2 3 6 9

50 ................................. 2488 1.9425 1 1 1 2 3

51 ................................. 203 2.6995 1 1 1 2 6

52 ................................. 220 1.9318 1 1 1 2 3

53 ................................. 2478 3.5557 1 1 2 4 8

54 ................................. 2 1.5000 1 1 2 2 2

55 ................................. 1505 2.7442 1 1 1 3 6

56 ................................. 503 2.7256 1 1 2 3 5

57 ................................. 708 3.9492 1 1 2 5 9

59 ................................. 107 2.7850 1 1 2 3 5

60 ................................. 2 3.5000 2 2 5 5 5

61 ................................. 231 5.0996 1 1 2 6 12

62 ................................. 3 1.3333 1 1 1 2 2

63 ................................. 2934 4.3889 1 2 3 5 8

64 ................................. 3033 6.1800 1 2 4 8 13

65 ................................. 34466 2.8420 1 1 2 4 5

66 ................................. 6978 3.1635 1 1 2 4 6

67 ................................. 495 3.5960 1 2 3 4 7

68 ................................. 16724 4.1158 1 2 3 5 7

69 ................................. 5435 3.2736 1 2 3 4 6

70 ................................. 24 2.9167 1 2 2 4 5

71 ................................. 82 3.8049 1 2 3 4 7

72 ................................. 883 3.5663 1 2 3 4 6

73 ................................. 6630 4.4065 1 2 3 6 9

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22853

TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM, SELECTED PERCENTILE LENGTHS OF STAY—Continued

[FY2000 MEDPAR update 12/00 Grouper V18.0]

DRG Number

discharges

Arithmetic

mean LOS

10th

percentile

25th

percentile

50th

percentile

75th

percentile

90th

percentile

75 ................................. 39010 9.9124 3 5 7 12 19

76 ................................. 38998 11.2677 3 5 9 14 21

77 ................................. 2352 4.9184 1 2 4 7 10

78 ................................. 32087 6.7848 3 4 6 8 11

79 ................................. 169783 8.4892 3 4 7 11 16

80 ................................. 9018 5.6618 2 3 5 7 10

81 ................................. 4 18.2500 3 3 4 8 58

82 ................................. 61883 6.9447 2 3 5 9 14

83 ................................. 6446 5.5496 2 3 4 7 10

84 ................................. 1508 3.3455 1 2 3 4 6

85 ................................. 20572 6.3122 2 3 5 8 12

86 ................................. 2118 3.6643 1 2 3 5 7

87 ................................. 60110 6.2840 1 3 5 8 12

88 ................................. 389694 5.1207 2 3 4 6 9

89 ................................. 525838 5.9470 2 3 5 7 11

90 ................................. 53895 4.1549 2 3 4 5 7

91 ................................. 54 4.5185 2 2 3 5 10

92 ................................. 13774 6.3499 2 3 5 8 12

93 ................................. 1672 4.0353 1 2 3 5 7

94 ................................. 12030 6.2988 2 3 5 8 12

95 ................................. 1595 3.7179 1 2 3 5 7

96 ................................. 61986 4.6292 2 3 4 6 8

97 ................................. 31444 3.6560 1 2 3 5 7

98 ................................. 18 4.2222 1 2 2 4 6

99 ................................. 18996 3.1991 1 1 2 4 6

100 ............................... 7619 2.1869 1 1 2 3 4

101 ............................... 19997 4.3938 1 2 3 5 9

102 ............................... 5146 2.6570 1 1 2 3 5

103 ............................... 475 46.6021 9 13 25 60 98

104 ............................... 36578 11.3165 7 11 28 60 98

105 ............................... 29726 9.2831 5 6 8 15 98

106 ............................... 3401 11.4963 5 7 10 14 20

107 ............................... 87868 10.3783 5 7 9 12 17

108 ............................... 6048 10.2116 3 5 8 13 19

109 ............................... 60265 7.6926 4 5 6 9 12

110 ............................... 52595 9.2013 2 5 7 11 18

111 ............................... 8545 4.7604 1 2 5 6 8

113 ............................... 42250 12.1885 3 6 9 15 24

114 ............................... 8712 8.3768 2 4 7 10 16

115 ............................... 14329 8.1687 1 4 7 11 16

116 ............................... 330888 3.6061 2 9 7 11 16

117 ............................... 3717 4.1512 1 1 2 5 9

118 ............................... 7667 2.6849 1 1 1 3 6

119 ............................... 1307 4.8829 1 1 3 6 12

120 ............................... 35929 8.1178 1 2 5 10 16

121 ............................... 162112 6.3821 2 3 5 8 12

122 ............................... 78969 3.7027 1 2 3 5 7

123 ............................... 40659 4.5833 1 1 3 6 11

124 ............................... 132801 4.3427 1 2 3 5 8

125 ............................... 80169 2.7657 1 1 2 4 5

126 ............................... 5150 11.6882 3 6 9 14 22

127 ............................... 678903 5.2745 2 3 4 7 10

128 ............................... 9424 5.6175 2 4 5 7 9

129 ............................... 4140 2.7621 1 1 1 3 6

130 ............................... 86009 5.6760 2 3 5 7 10

131 ............................... 28236 4.2426 1 2 4 6 7

132 ............................... 147648 3.0002 1 1 2 4 6

133 ............................... 8321 2.3367 1 1 2 3 4

134 ............................... 36118 3.2406 1 2 3 4 6

135 ............................... 7266 4.5531 1 2 3 6 9

136 ............................... 1221 2.7158 1 1 2 3 5

138 ............................... 194087 3.9932 1 2 3 5 8

139 ............................... 82604 2.5072 1 1 2 3 5

140 ............................... 69724 2.6533 1 1 2 3 5

141 ............................... 90403 3.6691 1 2 3 5 7

142 ............................... 45776 2.6508 1 1 2 3 5

143 ............................... 203918 2.1253 1 1 2 3 4

144 ............................... 81577 5.3196 1 2 4 7 11

145 ............................... 7224 2.7460 1 1 2 3 5

146 ............................... 10683 10.2826 5 7 9 12 17

22854 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM, SELECTED PERCENTILE LENGTHS OF STAY—Continued

[FY2000 MEDPAR update 12/00 Grouper V18.0]

DRG Number

discharges

Arithmetic

mean LOS

10th

percentile

25th

percentile

50th

percentile

75th

percentile

90th

percentile

147 ............................... 2629 6.4196 3 5 6 8 9

148 ............................... 129247 12.1904 5 7 10 15 22

149 ............................... 18462 6.5184 4 5 6 8 9

150 ............................... 19795 11.2770 4 7 10 14 20

151 ............................... 4814 5.8286 2 3 5 8 10

152 ............................... 4381 8.1438 3 5 7 9 14

153 ............................... 2083 5.3711 3 4 5 7 8

154 ............................... 28660 13.1491 4 7 10 16 25

155 ............................... 6596 4.2179 1 2 3 6 8

156 ............................... 4 7.5000 1 1 5 6 18

157 ............................... 7903 5.3790 1 2 4 7 11

158 ............................... 4630 2.5395 1 1 2 3 5

159 ............................... 16309 4.9926 1 2 4 6 10

160 ............................... 11655 2.6619 1 1 2 3 5

161 ............................... 11119 4.2027 1 1 3 5 9

162 ............................... 7199 1.9267 1 1 1 2 4

163 ............................... 5 4.4000 1 1 3 4 13

164 ............................... 4824 8.4279 4 5 7 10 15

165 ............................... 2066 4.8049 2 3 5 6 8

166 ............................... 3532 5.0337 2 2 4 6 10

167 ............................... 3269 2.5990 1 2 2 3 5

168 ............................... 1327 4.7641 1 2 3 6 10

169 ............................... 834 2.3405 1 1 2 3 5

170 ............................... 10975 11.1690 2 5 8 14 22

171 ............................... 1284 4.6597 1 2 4 6 9

172 ............................... 30412 6.9363 2 3 5 9 14

173 ............................... 2685 3.6648 1 1 3 5 7

174 ............................... 240400 4.7974 2 3 4 6 9

175 ............................... 32375 2.9414 1 2 3 4 5

176 ............................... 15101 5.2286 2 3 4 6 10

177 ............................... 9190 4.5348 2 2 4 6 8

178 ............................... 3597 3.0703 1 2 3 4 6

179 ............................... 12291 5.9729 2 3 5 7 11

180 ............................... 85599 5.3567 2 3 4 7 10

181 ............................... 26315 3.4185 1 2 3 4 6

182 ............................... 243506 4.3356 1 2 3 5 8

183 ............................... 83969 2.9155 1 1 2 4 5

184 ............................... 79 2.9620 1 2 2 4 6

185 ............................... 4760 4.5210 1 2 3 6 9

186 ............................... 3 9.3333 1 1 9 18 18

187 ............................... 646 3.9164 1 1 3 5 8

188 ............................... 75558 5.5580 1 2 4 7 11

189 ............................... 11984 3.1542 1 1 2 4 6

190 ............................... 49 7.0204 2 3 4 5 8

191 ............................... 8889 13.7967 4 6 10 17 28

192 ............................... 1105 6.5122 2 4 6 8 11

193 ............................... 5258 12.5369 5 7 10 16 22

194 ............................... 718 6.7869 2 4 6 8 12

195 ............................... 4327 10.1470 4 6 9 12 17

196 ............................... 1162 5.7212 2 4 5 7 10

197 ............................... 18754 8.9335 3 5 7 11 16

198 ............................... 5751 4.5416 2 3 4 6 8

199 ............................... 1704 9.5827 2 4 7 13 20

200 ............................... 1063 10.3518 1 3 7 13 22

201 ............................... 1398 13.7790 3 6 11 17 25

202 ............................... 25975 6.4045 2 3 5 8 13

203 ............................... 29017 6.6364 2 3 5 9 13

204 ............................... 57319 5.7964 2 3 4 7 11

205 ............................... 22900 6.1735 2 3 5 8 12

206 ............................... 1948 3.9168 1 2 3 5 7

207 ............................... 30817 5.0832 1 2 4 6 10

208 ............................... 10061 2.8946 1 1 2 4 6

209 ............................... 343375 5.0786 3 3 4 6 8

210 ............................... 120891 6.8189 3 4 6 8 11

211 ............................... 31665 4.9325 3 4 4 6 7

212 ............................... 6 13.5000 1 4 4 29 29

213 ............................... 9144 8.9604 2 4 7 11 18

216 ............................... 5956 9.6949 2 4 8 12 20

217 ............................... 16333 13.1971 3 5 9 16 28

218 ............................... 21296 5.4123 2 3 4 7 10

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22855

TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM, SELECTED PERCENTILE LENGTHS OF STAY—Continued

[FY2000 MEDPAR update 12/00 Grouper V18.0]

DRG Number

discharges

Arithmetic

mean LOS

10th

percentile

25th

percentile

50th

percentile

75th

percentile

90th

percentile

219 ............................... 19530 3.2240 1 2 3 4 6

220 ............................... 6 4.0000 1 1 3 7 7

223 ............................... 13251 2.8497 1 1 2 3 6

224 ............................... 11112 1.9343 1 1 2 2 3

225 ............................... 5734 4.8575 1 2 3 6 11

226 ............................... 5148 6.5874 1 2 4 8 14

227 ............................... 4695 2.7242 1 1 2 3 5

228 ............................... 2340 3.7970 1 1 2 5 8

229 ............................... 1108 2.4838 1 1 2 3 5

230 ............................... 2365 5.2592 1 2 3 6 11

231 ............................... 11343 4.9395 1 2 3 6 11

232 ............................... 807 2.8872 1 1 1 3 7

233 ............................... 5059 7.5181 2 3 6 10 15

234 ............................... 3168 3.4419 1 1 3 4 7

235 ............................... 5036 5.0473 1 2 4 6 9

236 ............................... 38265 4.8164 1 3 4 6 9

237 ............................... 1687 3.5033 1 2 3 4 6

238 ............................... 7930 8.5212 3 4 6 10 16

239 ............................... 49088 6.2151 2 3 5 8 12

240 ............................... 11318 6.6744 2 3 5 8 13

241 ............................... 3168 3.8570 1 2 3 5 7

242 ............................... 2434 6.6348 2 3 5 8 13

243 ............................... 87407 4.6676 1 2 4 6 9

244 ............................... 12162 4.8047 1 2 4 6 9

245 ............................... 5130 3.4458 1 2 3 4 6

246 ............................... 1386 3.8117 1 2 3 5 7

247 ............................... 16832 3.3990 1 1 3 4 7

248 ............................... 10529 4.8161 1 2 4 6 9

249 ............................... 11336 3.6591 1 1 2 4 8

250 ............................... 3456 4.1062 1 2 3 5 7

251 ............................... 2406 2.8579 1 1 2 4 5

253 ............................... 19677 4.7732 1 3 4 6 9

254 ............................... 10449 3.1906 1 2 3 4 6

255 ............................... 1 3.0000 3 3 3 3 3

256 ............................... 6054 5.0766 1 2 4 6 10

257 ............................... 16333 2.7359 1 1 2 3 5

258 ............................... 15978 1.9342 1 1 2 2 3

259 ............................... 3773 2.6801 1 1 1 2 6

260 ............................... 4896 1.4167 1 1 1 2 2

261 ............................... 1844 2.2749 1 1 1 3 5

262 ............................... 612 3.9477 1 1 3 5 8

263 ............................... 18146 12.0208 3 5 8 14 24

264 ............................... 3608 7.4088 2 4 6 9 14

265 ............................... 3681 6.8036 1 2 4 8 14

266 ............................... 2698 3.3039 1 1 2 4 7

267 ............................... 233 4.2060 1 1 3 6 9

268 ............................... 878 3.4989 1 1 2 4 7

269 ............................... 7390 8.2441 1 3 6 10 17

270 ............................... 2623 3.5783 1 1 2 5 8

271 ............................... 9621 7.6144 2 4 6 9 14

272 ............................... 5459 6.1597 2 3 5 8 12

273 ............................... 1286 4.0420 1 2 3 5 8

274 ............................... 2334 6.5900 1 3 5 8 13

275 ............................... 246 4.3130 1 1 3 5 9

276 ............................... 1177 4.6669 1 2 4 6 8

277 ............................... 85183 5.7309 2 3 5 7 10

278 ............................... 33396 4.4205 2 3 4 6 8

279 ............................... 3 2.3333 1 1 2 4 4

280 ............................... 15577 4.1954 1 2 3 5 8

281 ............................... 7128 3.0464 1 1 3 4 6

282 ............................... 3 1.6667 1 1 2 2 2

283 ............................... 5629 4.5756 1 2 4 6 9

284 ............................... 1868 3.1124 1 1 2 4 6

285 ............................... 6195 10.3080 3 5 8 13 20

286 ............................... 2070 6.4396 2 3 5 7 13

287 ............................... 5676 10.5374 3 5 7 12 21

288 ............................... 2639 5.7704 2 3 4 6 9

289 ............................... 4765 3.0002 1 1 2 3 7

290 ............................... 8753 2.3103 1 1 2 2 4

291 ............................... 65 1.8462 1 1 1 2 3

22856 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM, SELECTED PERCENTILE LENGTHS OF STAY—Continued

[FY2000 MEDPAR update 12/00 Grouper V18.0]

DRG Number

discharges

Arithmetic

mean LOS

10th

percentile

25th

percentile

50th

percentile

75th

percentile

90th

percentile

292 ............................... 4702 10.4872 2 4 8 14 22

293 ............................... 624 5.5096 1 2 4 7 12

294 ............................... 87857 4.6066 1 2 4 6 9

295 ............................... 3277 3.7376 1 2 3 5 7

296 ............................... 235003 5.1556 2 2 4 6 10

297 ............................... 43573 3.4124 1 2 3 4 6

298 ............................... 86 2.8256 1 1 2 3 5

299 ............................... 1178 5.2199 1 2 4 7 10

300 ............................... 15999 6.1363 2 3 5 8 12

301 ............................... 3208 3.6234 1 2 3 4 7

302 ............................... 8018 9.0636 4 5 7 11 19

303 ............................... 19452 8.4231 4 5 7 10 15

304 ............................... 11767 8.7339 2 4 6 11 18

305 ............................... 2984 3.6384 1 2 3 5 7

306 ............................... 7320 5.6291 1 2 3 8 13

307 ............................... 2082 2.2517 1 1 2 3 4

308 ............................... 7463 6.1733 1 2 4 8 14

309 ............................... 4096 2.2954 1 1 2 3 4

310 ............................... 23873 4.4002 1 1 3 6 10

311 ............................... 7963 1.8339 1 1 1 2 3

312 ............................... 1487 4.4654 1 1 3 6 10

313 ............................... 591 2.3316 1 1 1 3 5

315 ............................... 29749 6.9546 1 1 4 9 15

316 ............................... 104601 6.6228 2 3 5 8 13

317 ............................... 1507 2.8779 1 1 2 3 6

318 ............................... 5584 5.9979 1 3 5 8 12

319 ............................... 422 2.7725 1 1 2 3 6

320 ............................... 186678 5.3171 2 3 4 6 10

321 ............................... 30428 3.7951 1 2 3 5 7

322 ............................... 61 4.1475 2 2 3 5 8

323 ............................... 17241 3.2172 1 1 2 4 7

324 ............................... 7479 1.8826 1 1 1 2 3

325 ............................... 8160 3.8241 1 2 3 5 7

326 ............................... 2676 2.6648 1 1 2 3 5

327 ............................... 11 3.0909 1 1 3 4 5

328 ............................... 663 3.6305 1 1 3 5 8

329 ............................... 77 2.0130 1 1 1 2 4

331 ............................... 46045 5.5426 1 3 4 7 11

332 ............................... 4930 3.2917 1 1 2 4 7

333 ............................... 281 5.0569 1 2 4 6 10

334 ............................... 8654 4.4386 2 3 4 5 7

335 ............................... 10721 3.1791 2 2 3 4 5

336 ............................... 9563 3.7848 1 2 3 4 8

337 ............................... 3041 2.1500 1 1 2 3 3

338 ............................... 1226 5.1117 1 2 3 7 11

339 ............................... 1344 4.9821 1 1 3 7 12

340 ............................... 1 1.0000 1 1 1 1 1

341 ............................... 2738 3.1088 1 1 1 3 6

342 ............................... 298 3.4094 1 1 2 4 7

344 ............................... 3502 2.3829 1 1 1 2 5

345 ............................... 410 5.1244 1 2 3 6 10

346 ............................... 4441 5.8726 1 3 4 7 12

347 ............................... 365 2.9479 1 1 2 4 6

350 ............................... 6270 4.3933 1 2 4 5 8

352 ............................... 756 3.9577 1 2 3 5 8

353 ............................... 2533 6.4212 2 3 5 7 12

354 ............................... 7562 5.8375 3 3 4 7 11

355 ............................... 5504 3.2862 2 3 3 4 5

356 ............................... 25128 2.2924 1 1 2 3 4

357 ............................... 5548 8.4874 3 4 7 10 16

358 ............................... 20294 4.3121 2 3 3 5 7

359 ............................... 29890 2.7295 2 2 3 3 4

360 ............................... 15941 2.8557 1 2 2 3 5

361 ............................... 378 2.9233 1 1 2 3 5

363 ............................... 2862 3.4693 1 2 2 3 7

364 ............................... 1644 3.8534 1 1 3 5 8

365 ............................... 1722 7.2410 1 3 5 9 16

366 ............................... 4410 6.7329 1 3 5 8 14

367 ............................... 583 3.0617 1 1 2 4 6

368 ............................... 3110 6.4810 2 3 5 8 12

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22857

TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM, SELECTED PERCENTILE LENGTHS OF STAY—Continued

[FY2000 MEDPAR update 12/00 Grouper V18.0]

DRG Number

discharges

Arithmetic

mean LOS

10th

percentile

25th

percentile

50th

percentile

75th

percentile

90th

percentile

369 ............................... 3133 3.2515 1 1 2 4 7

370 ............................... 1095 5.8429 3 3 4 5 10

371 ............................... 1307 3.6526 2 3 3 4 5

372 ............................... 927 3.2891 1 2 2 3 5

373 ............................... 3734 2.2499 1 2 2 3 3

374 ............................... 120 3.1583 1 2 2 3 4

375 ............................... 10 2.3000 1 2 2 3 4

376 ............................... 247 3.0931 1 2 2 4 6

377 ............................... 48 5.0000 1 1 3 6 12

378 ............................... 157 2.4140 1 1 2 3 4

379 ............................... 337 3.4303 1 1 2 4 6

380 ............................... 58 2.1207 1 1 1 2 5

381 ............................... 152 2.5132 1 1 1 3 5

382 ............................... 45 1.2889 1 1 1 1 2

383 ............................... 1707 3.5817 1 1 2 4 7

384 ............................... 114 2.1842 1 1 1 3 5

385 ............................... 1 1.0000 1 1 1 1 1

389 ............................... 15 11.7333 1 3 6 10 24

390 ............................... 14 4.0000 1 2 3 6 7

391 ............................... 1 4.0000 4 4 4 4 4

392 ............................... 2323 9.6750 3 4 7 12 20

394 ............................... 1870 7.1428 1 2 4 8 16

395 ............................... 86911 4.4001 1 2 3 6 9

396 ............................... 15 4.6667 1 2 4 6 7

397 ............................... 17554 5.1878 1 2 4 7 10

398 ............................... 17526 5.9417 2 3 5 7 11

399 ............................... 1721 3.5758 1 2 3 5 7

400 ............................... 6444 9.1189 1 3 6 12 20

401 ............................... 5581 11.2575 2 5 9 15 23

402 ............................... 1498 4.1128 1 1 3 6 9

403 ............................... 31732 8.0627 2 3 6 10 17

404 ............................... 4639 4.2720 1 2 3 6 9

406 ............................... 2513 9.8607 3 4 7 12 20

407 ............................... 720 4.4417 1 2 4 5 8

408 ............................... 2178 8.0317 1 2 5 10 18

409 ............................... 2822 5.9072 2 3 4 6 12

410 ............................... 33412 3.9069 1 2 4 5 6

411 ............................... 13 2.3077 1 1 2 2 5

412 ............................... 29 2.4483 1 1 2 3 4

413 ............................... 6419 7.0662 2 3 5 9 14

414 ............................... 767 4.2529 1 2 3 5 9

415 ............................... 38683 14.2779 4 6 11 18 28

416 ............................... 183557 7.3848 2 4 6 9 14

417 ............................... 16 5.0000 2 2 4 6 9

418 ............................... 22822 6.1160 2 3 5 7 11

419 ............................... 15294 4.7204 2 2 4 6 9

420 ............................... 3109 3.5002 1 2 3 4 6

421 ............................... 11464 3.7872 1 2 3 5 7

422 ............................... 80 3.0625 1 2 3 4 6

423 ............................... 7452 8.1162 2 3 6 10 16

424 ............................... 1275 13.4204 2 5 9 16 26

425 ............................... 15710 3.9945 1 2 3 5 8

426 ............................... 4443 4.4510 1 2 3 5 9

427 ............................... 1633 4.6418 1 2 3 6 9

428 ............................... 835 6.8192 1 2 4 8 14

429 ............................... 25967 6.3055 2 3 5 7 12

430 ............................... 58669 8.0151 2 3 6 10 16

431 ............................... 313 6.2045 1 3 5 7 11

432 ............................... 469 4.7271 1 2 3 5 9

433 ............................... 5418 3.0945 1 1 2 4 6

439 ............................... 1343 8.4080 1 3 5 10 19

440 ............................... 5131 9.0209 2 3 6 11 20

441 ............................... 601 3.2313 1 1 2 4 7

442 ............................... 15366 8.4839 1 3 6 10 18

443 ............................... 3730 3.4399 1 1 3 4 7

444 ............................... 5185 4.1338 1 2 3 5 8

445 ............................... 2427 2.9250 1 1 2 4 5

447 ............................... 5451 2.4748 1 1 2 3 5

449 ............................... 28048 3.7457 1 1 3 5 8

450 ............................... 6867 2.0051 1 1 1 2 4

22858 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM, SELECTED PERCENTILE LENGTHS OF STAY—Continued

[FY2000 MEDPAR update 12/00 Grouper V18.0]

DRG Number

discharges

Arithmetic

mean LOS

10th

percentile

25th

percentile

50th

percentile

75th

percentile

90th

percentile

451 ............................... 3 1.3333 1 1 1 2 2

452 ............................... 22666 4.8553 1 2 3 6 10

453 ............................... 5068 2.8035 1 1 2 3 6

454 ............................... 3940 4.5652 1 2 3 5 9

455 ............................... 931 2.5994 1 1 2 3 5

461 ............................... 3490 4.3739 1 1 2 5 11

462 ............................... 12994 11.2271 4 6 9 14 21

463 ............................... 21790 4.1239 1 2 3 5 8

464 ............................... 6533 2.9963 1 1 2 4 6

465 ............................... 154 3.4481 1 1 2 4 7

466 ............................... 1470 3.9925 1 1 2 5 9

467 ............................... 534 3.8390 1 1 2 4 8

468 ............................... 58990 12.9159 3 6 10 17 30

471 ............................... 11639 5.5322 3 4 4 6 9

473 ............................... 7599 12.5038 1 3 7 18 32

475 ............................... 107089 11.1800 2 5 9 15 22

476 ............................... 4126 10.8924 2 5 9 14 21

477 ............................... 24823 8.1004 1 3 6 11 17

478 ............................... 106999 7.3166 1 3 5 9 15

479 ............................... 24939 3.5376 1 1 3 5 7

480 ............................... 541 20.4843 7 9 13 25 43

481 ............................... 377 23.9310 10 18 22 27 38

482 ............................... 5686 12.9474 4 7 10 15 25

483 ............................... 42093 39.0315 14 22 33 49 70

484 ............................... 313 12.6773 2 6 10 17 26

485 ............................... 2880 9.5955 4 5 7 11 18

486 ............................... 1856 12.4402 1 5 10 16 25

487 ............................... 3339 7.3612 1 3 6 10 15

488 ............................... 770 17.0078 3 7 13 22 36

489 ............................... 14005 8.4383 2 3 6 10 17

490 ............................... 5378 5.3405 1 2 4 6 10

491 ............................... 12205 3.4483 2 2 3 4 6

492 ............................... 2672 15.6662 3 5 8 25 34

493 ............................... 54859 5.7621 1 3 5 7 11

494 ............................... 29900 2.4482 1 1 2 3 5

495 ............................... 153 15.0261 7 9 12 18 26

496 ............................... 1444 9.5824 4 5 7 12 18

497 ............................... 23721 6.1748 3 4 7 12 18

498 ............................... 22152 3.3273 3 4 6 12 18

499 ............................... 30284 4.6986 1 2 3 6 9

500 ............................... 43962 2.6146 1 1 2 3 5

501 ............................... 2180 10.9670 4 6 8 13 21

502 ............................... 586 6.5648 3 4 5 8 11

503 ............................... 5551 3.9996 1 2 3 5 7

504 ............................... 114 29.5877 9 14 24 41 54

505 ............................... 145 3.3517 1 1 1 3 7

506 ............................... 915 17.4000 4 8 14 22 35

507 ............................... 290 8.2621 2 4 7 11 18

508 ............................... 657 7.4718 2 3 5 9 15

509 ............................... 176 4.5455 1 2 4 6 9

510 ............................... 1619 7.1779 2 3 5 9 15

511 ............................... 602 4.7591 1 2 3 6 10

512 ............................... ........................ ........................ 1 2 3 6 10

513 ............................... ........................ ........................ 1 2 3 6 10

514 ............................... ........................ ........................ 1 2 3 6 10

515 ............................... ........................ ........................ 1 2 3 6 10

516 ............................... ........................ ........................ 1 2 3 6 10

517 ............................... ........................ ........................ 1 2 3 6 10

518 ............................... ........................ ........................ 1 2 3 6 10

519 ............................... ........................ ........................ 1 2 3 6 10

520 ............................... ........................ ........................ 1 2 3 6 10

521 ............................... ........................ ........................ 1 2 3 6 10

522 ............................... ........................ ........................ 1 2 3 6 10

523 ............................... ........................ ........................ 1 2 3 6 10

10811358

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22859

TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM, SELECTED PERCENTILE LENGTHS OF STAY

[FY2000 MEDPAR update 12/00 Grouper V19.0]

DRG Number

discharges

Arithmetic

mean LOS

10th

percentile

25th

percentile

50th

percentile

75th

percentile

90th

percentile

1 ................................... 33822 8.9935 2 3 6 12 19

2 ................................... 6772 9.9778 3 5 8 13 20

3 ................................... 2 43.5000 35 35 52 52 52

4 ................................... 6035 7.1639 1 2 5 9 15

5 ................................... 93311 3.1649 1 1 2 3 7

6 ................................... 366 2.9672 1 1 2 4 6

7 ................................... 12470 9.9739 2 4 7 12 20

8 ................................... 4164 3.2759 1 1 2 4 7

9 ................................... 1610 6.3491 1 3 5 8 13

10 ................................. 17577 6.5503 2 3 5 8 13

11 ................................. 3128 4.0767 1 2 3 5 8

12 ................................. 46758 5.8962 2 3 4 7 11

13 ................................. 6415 5.2011 2 3 4 6 9

14 ................................. 319523 5.8762 2 3 5 7 11

15 ................................. 145366 3.5498 1 2 3 4 7

16 ................................. 11155 6.0293 2 3 5 7 12

17 ................................. 3519 3.3231 1 2 3 4 6

18 ................................. 25961 5.4162 2 3 4 7 10

19 ................................. 8638 3.6972 1 2 3 5 7

20 ................................. 5629 10.1482 3 5 8 13 20

21 ................................. 1309 6.5516 2 3 5 8 13

22 ................................. 2535 4.8174 1 2 4 6 9

23 ................................. 9464 4.1855 1 2 3 5 8

24 ................................. 52753 4.9830 1 2 4 6 10

25 ................................. 25370 3.2236 1 2 3 4 6

26 ................................. 31 2.7097 1 1 2 3 6

27 ................................. 3441 5.0584 1 1 3 6 11

28 ................................. 11316 6.2100 1 3 5 8 13

29 ................................. 4486 3.6097 1 2 3 5 7

30 ................................. 1 1.0000 1 1 1 1 1

31 ................................. 3488 4.4903 1 2 3 5 8

32 ................................. 1738 2.5621 1 1 2 3 5

33 ................................. 1 1.0000 1 1 1 1 1

34 ................................. 20249 5.0786 1 2 4 6 10

35 ................................. 5728 3.3959 1 2 3 4 6

36 ................................. 3190 1.4649 1 1 1 1 2

37 ................................. 1452 4.0296 1 1 2 5 9

38 ................................. 102 2.6569 1 1 2 3 5

39 ................................. 912 1.9079 1 1 1 2 4

40 ................................. 1545 3.4252 1 1 2 4 7

42 ................................. 2223 2.2852 1 1 1 3 5

43 ................................. 85 3.1882 1 2 3 4 6

44 ................................. 1238 4.9548 2 3 4 6 9

45 ................................. 2444 3.1678 1 2 3 4 6

46 ................................. 3051 4.6834 1 2 4 6 9

47 ................................. 1281 3.2560 1 1 3 4 6

49 ................................. 2241 4.8104 1 2 3 6 9

50 ................................. 2488 1.9425 1 1 1 2 3

51 ................................. 203 2.6995 1 1 1 2 6

52 ................................. 220 1.9318 1 1 1 2 3

53 ................................. 2478 3.5557 1 1 2 4 8

54 ................................. 2 1.5000 1 1 2 2 2

55 ................................. 1505 2.7442 1 1 1 3 6

56 ................................. 503 2.7256 1 1 2 3 5

57 ................................. 708 3.9492 1 1 2 5 9

59 ................................. 107 2.7850 1 1 2 3 5

60 ................................. 2 3.5000 2 2 5 5 5

61 ................................. 231 5.0996 1 1 2 6 12

62 ................................. 3 1.3333 1 1 1 2 2

63 ................................. 3003 4.4409 1 2 3 5 9

64 ................................. 3033 6.1800 1 2 4 8 13

65 ................................. 34466 2.8420 1 1 2 4 5

66 ................................. 6978 3.1635 1 1 2 4 6

67 ................................. 495 3.5960 1 2 3 4 7

68 ................................. 16724 4.1158 1 2 3 5 7

69 ................................. 5435 3.2736 1 2 3 4 6

70 ................................. 24 2.9167 1 2 2 4 5

71 ................................. 82 3.8049 1 2 3 4 7

72 ................................. 883 3.5663 1 2 3 4 6

73 ................................. 6630 4.4065 1 2 3 6 9

22860 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM, SELECTED PERCENTILE LENGTHS OF STAY—Continued

[FY2000 MEDPAR update 12/00 Grouper V19.0]

DRG Number

discharges

Arithmetic

mean LOS

10th

percentile

25th

percentile

50th

percentile

75th

percentile

90th

percentile

75 ................................. 39010 9.9124 3 5 7 12 19

76 ................................. 38998 11.2677 3 5 9 14 21

77 ................................. 2352 4.9184 1 2 4 7 10

78 ................................. 32087 6.7848 3 4 6 8 11

79 ................................. 169783 8.4892 3 4 7 11 16

80 ................................. 9018 5.6618 2 3 5 7 10

81 ................................. 4 18.2500 3 3 4 8 58

82 ................................. 61883 6.9447 2 3 5 9 14

83 ................................. 6446 5.5496 2 3 4 7 10

84 ................................. 1508 3.3455 1 2 3 4 6

85 ................................. 20572 6.3122 2 3 5 8 12

86 ................................. 2118 3.6643 1 2 3 5 7

87 ................................. 60110 6.2840 1 3 5 8 12

88 ................................. 389694 5.1207 2 3 4 6 9

89 ................................. 525838 5.9470 2 3 5 7 11

90 ................................. 53895 4.1549 2 3 4 5 7

91 ................................. 54 4.5185 2 2 3 5 10

92 ................................. 13774 6.3499 2 3 5 8 12

93 ................................. 1672 4.0353 1 2 3 5 7

94 ................................. 12030 6.2988 2 3 5 8 12

95 ................................. 1595 3.7179 1 2 3 5 7

96 ................................. 61986 4.6292 2 3 4 6 8

97 ................................. 31444 3.6560 1 2 3 5 7

98 ................................. 18 4.2222 1 2 2 4 6

99 ................................. 18996 3.1991 1 1 2 4 6

100 ............................... 7619 2.1869 1 1 2 3 4

101 ............................... 19997 4.3938 1 2 3 5 9

102 ............................... 5146 2.6570 1 1 2 3 5

103 ............................... 475 46.6021 9 13 25 60 98

104 ............................... 19650 14.1922 6 8 12 17 25

105 ............................... 25952 9.7562 4 6 8 11 17

106 ............................... 3401 11.4963 5 7 10 14 20

107 ............................... 87868 10.3783 5 7 9 12 17

108 ............................... 6047 10.2128 3 5 8 13 19

109 ............................... 60265 7.6926 4 5 6 9 12

110 ............................... 52587 9.2019 2 5 7 11 18

111 ............................... 8545 4.7604 1 2 5 6 8

113 ............................... 42250 12.1885 3 6 9 15 24

114 ............................... 8712 8.3768 2 4 7 10 16

115 ............................... 14329 8.1687 1 4 7 11 16

116 ............................... 91838 4.4683 1 2 3 6 9

117 ............................... 3717 4.1512 1 1 2 5 9

118 ............................... 7667 2.6849 1 1 1 3 6

119 ............................... 1307 4.8829 1 1 3 6 12

120 ............................... 37500 8.5321 1 2 6 11 19

121 ............................... 162112 6.3821 2 3 5 8 12

122 ............................... 78969 3.7027 1 2 3 5 7

123 ............................... 40659 4.5833 1 1 3 6 11

124 ............................... 132801 4.3427 1 2 3 5 8

125 ............................... 80169 2.7657 1 1 2 4 5

126 ............................... 5150 11.6882 3 6 9 14 22

127 ............................... 678903 5.2745 2 3 4 7 10

128 ............................... 9424 5.6175 2 4 5 7 9

129 ............................... 4140 2.7621 1 1 1 3 6

130 ............................... 86009 5.6760 2 3 5 7 10

131 ............................... 28236 4.2426 1 2 4 6 7

132 ............................... 147648 3.0002 1 1 2 4 6

133 ............................... 8321 2.3367 1 1 2 3 4

134 ............................... 36118 3.2406 1 2 3 4 6

135 ............................... 7266 4.5531 1 2 3 6 9

136 ............................... 1221 2.7158 1 1 2 3 5

138 ............................... 194087 3.9932 1 2 3 5 8

139 ............................... 82604 2.5072 1 1 2 3 5

140 ............................... 69724 2.6533 1 1 2 3 5

141 ............................... 90403 3.6691 1 2 3 5 7

142 ............................... 45776 2.6508 1 1 2 3 5

143 ............................... 203918 2.1253 1 1 2 3 4

144 ............................... 81577 5.3196 1 2 4 7 11

145 ............................... 7224 2.7460 1 1 2 3 5

146 ............................... 10683 10.2826 5 7 9 12 17

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22861

TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM, SELECTED PERCENTILE LENGTHS OF STAY—Continued

[FY2000 MEDPAR update 12/00 Grouper V19.0]

DRG Number

discharges

Arithmetic

mean LOS

10th

percentile

25th

percentile

50th

percentile

75th

percentile

90th

percentile

147 ............................... 2629 6.4196 3 5 6 8 9

148 ............................... 129247 12.1904 5 7 10 15 22

149 ............................... 18462 6.5184 4 5 6 8 9

150 ............................... 19795 11.2770 4 7 10 14 20

151 ............................... 4814 5.8286 2 3 5 8 10

152 ............................... 4381 8.1438 3 5 7 9 14

153 ............................... 2083 5.3711 3 4 5 7 8

154 ............................... 28660 13.1491 4 7 10 16 25

155 ............................... 6596 4.2179 1 2 3 6 8

156 ............................... 4 7.5000 1 1 5 6 18

157 ............................... 7903 5.3790 1 2 4 7 11

158 ............................... 4630 2.5395 1 1 2 3 5

159 ............................... 16309 4.9926 1 2 4 6 10

160 ............................... 11655 2.6619 1 1 2 3 5

161 ............................... 11119 4.2027 1 1 3 5 9

162 ............................... 7199 1.9267 1 1 1 2 4

163 ............................... 5 4.4000 1 1 3 4 13

164 ............................... 4824 8.4279 4 5 7 10 15

165 ............................... 2066 4.8049 2 3 5 6 8

166 ............................... 3532 5.0337 2 2 4 6 10

167 ............................... 3269 2.5990 1 2 2 3 5

168 ............................... 1327 4.7641 1 2 3 6 10

169 ............................... 834 2.3405 1 1 2 3 5

170 ............................... 10975 11.1690 2 5 8 14 22

171 ............................... 1284 4.6597 1 2 4 6 9

172 ............................... 30412 6.9363 2 3 5 9 14

173 ............................... 2685 3.6648 1 1 3 5 7

174 ............................... 240400 4.7974 2 3 4 6 9

175 ............................... 32375 2.9414 1 2 3 4 5

176 ............................... 15101 5.2286 2 3 4 6 10

177 ............................... 9190 4.5348 2 2 4 6 8

178 ............................... 3597 3.0703 1 2 3 4 6

179 ............................... 12291 5.9729 2 3 5 7 11

180 ............................... 85599 5.3567 2 3 4 7 10

181 ............................... 26315 3.4185 1 2 3 4 6

182 ............................... 243506 4.3356 1 2 3 5 8

183 ............................... 83969 2.9155 1 1 2 4 5

184 ............................... 79 2.9620 1 2 2 4 6

185 ............................... 4760 4.5210 1 2 3 6 9

186 ............................... 3 9.3333 1 1 9 18 18

187 ............................... 646 3.9164 1 1 3 5 8

188 ............................... 75558 5.5580 1 2 4 7 11

189 ............................... 11984 3.1542 1 1 2 4 6

190 ............................... 49 7.0204 2 3 4 5 8

191 ............................... 8867 13.7982 4 6 10 17 27

192 ............................... 1105 6.5122 2 4 6 8 11

193 ............................... 5258 12.5369 5 7 10 16 22

194 ............................... 718 6.7869 2 4 6 8 12

195 ............................... 4327 10.1470 4 6 9 12 17

196 ............................... 1162 5.7212 2 4 5 7 10

197 ............................... 18754 8.9335 3 5 7 11 16

198 ............................... 5751 4.5416 2 3 4 6 8

199 ............................... 1704 9.5827 2 4 7 13 20

200 ............................... 1063 10.3518 1 3 7 13 22

201 ............................... 1430 13.8098 3 6 11 18 27

202 ............................... 25975 6.4045 2 3 5 8 13

203 ............................... 29017 6.6364 2 3 5 9 13

204 ............................... 57319 5.7964 2 3 4 7 11

205 ............................... 22900 6.1735 2 3 5 8 12

206 ............................... 1948 3.9168 1 2 3 5 7

207 ............................... 30817 5.0832 1 2 4 6 10

208 ............................... 10061 2.8946 1 1 2 4 6

209 ............................... 343375 5.0786 3 3 4 6 8

210 ............................... 120891 6.8189 3 4 6 8 11

211 ............................... 31665 4.9325 3 4 4 6 7

212 ............................... 6 13.5000 1 4 4 29 29

213 ............................... 9144 8.9604 2 4 7 11 18

216 ............................... 5956 9.6949 2 4 8 12 20

217 ............................... 16333 13.1971 3 5 9 16 28

218 ............................... 21296 5.4123 2 3 4 7 10

22862 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM, SELECTED PERCENTILE LENGTHS OF STAY—Continued

[FY2000 MEDPAR update 12/00 Grouper V19.0]

DRG Number

discharges

Arithmetic

mean LOS

10th

percentile

25th

percentile

50th

percentile

75th

percentile

90th

percentile

219 ............................... 19530 3.2240 1 2 3 4 6

220 ............................... 6 4.0000 1 1 3 7 7

223 ............................... 13251 2.8497 1 1 2 3 6

224 ............................... 11112 1.9343 1 1 2 2 3

225 ............................... 5734 4.8575 1 2 3 6 11

226 ............................... 5148 6.5874 1 2 4 8 14

227 ............................... 4695 2.7242 1 1 2 3 5

228 ............................... 2340 3.7970 1 1 2 5 8

229 ............................... 1108 2.4838 1 1 2 3 5

230 ............................... 2365 5.2592 1 2 3 6 11

231 ............................... 11343 4.9395 1 2 3 6 11

232 ............................... 807 2.8872 1 1 1 3 7

233 ............................... 5059 7.5181 2 3 6 10 15

234 ............................... 3168 3.4419 1 1 3 4 7

235 ............................... 5036 5.0473 1 2 4 6 9

236 ............................... 38265 4.8164 1 3 4 6 9

237 ............................... 1687 3.5033 1 2 3 4 6

238 ............................... 7930 8.5212 3 4 6 10 16

239 ............................... 49088 6.2151 2 3 5 8 12

240 ............................... 11318 6.6744 2 3 5 8 13

241 ............................... 3168 3.8570 1 2 3 5 7

242 ............................... 2434 6.6348 2 3 5 8 13

243 ............................... 87407 4.6676 1 2 4 6 9

244 ............................... 12162 4.8047 1 2 4 6 9

245 ............................... 5130 3.4458 1 2 3 4 6

246 ............................... 1386 3.8117 1 2 3 5 7

247 ............................... 16832 3.3990 1 1 3 4 7

248 ............................... 10529 4.8161 1 2 4 6 9

249 ............................... 11336 3.6591 1 1 2 4 8

250 ............................... 3456 4.1062 1 2 3 5 7

251 ............................... 2406 2.8579 1 1 2 4 5

253 ............................... 19677 4.7732 1 3 4 6 9

254 ............................... 10449 3.1906 1 2 3 4 6

255 ............................... 1 3.0000 3 3 3 3 3

256 ............................... 6054 5.0766 1 2 4 6 10

257 ............................... 16333 2.7359 1 1 2 3 5

258 ............................... 15978 1.9342 1 1 2 2 3

259 ............................... 3773 2.6801 1 1 1 2 6

260 ............................... 4896 1.4167 1 1 1 2 2

261 ............................... 1844 2.2749 1 1 1 3 5

262 ............................... 612 3.9477 1 1 3 5 8

263 ............................... 18146 12.0208 3 5 8 14 24

264 ............................... 3608 7.4088 2 4 6 9 14

265 ............................... 3681 6.8036 1 2 4 8 14

266 ............................... 2698 3.3039 1 1 2 4 7

267 ............................... 233 4.2060 1 1 3 6 9

268 ............................... 878 3.4989 1 1 2 4 7

269 ............................... 7390 8.2441 1 3 6 10 17

270 ............................... 2623 3.5783 1 1 2 5 8

271 ............................... 9621 7.6144 2 4 6 9 14

272 ............................... 5459 6.1597 2 3 5 8 12

273 ............................... 1286 4.0420 1 2 3 5 8

274 ............................... 2334 6.5900 1 3 5 8 13

275 ............................... 246 4.3130 1 1 3 5 9

276 ............................... 1177 4.6669 1 2 4 6 8

277 ............................... 85183 5.7309 2 3 5 7 10

278 ............................... 33396 4.4205 2 3 4 6 8

279 ............................... 3 2.3333 1 1 2 4 4

280 ............................... 15577 4.1954 1 2 3 5 8

281 ............................... 7128 3.0464 1 1 3 4 6

282 ............................... 3 1.6667 1 1 2 2 2

283 ............................... 5629 4.5756 1 2 4 6 9

284 ............................... 1868 3.1124 1 1 2 4 6

285 ............................... 6195 10.3080 3 5 8 13 20

286 ............................... 2070 6.4396 2 3 5 7 13

287 ............................... 5676 10.5374 3 5 7 12 21

288 ............................... 2639 5.7704 2 3 4 6 9

289 ............................... 4765 3.0002 1 1 2 3 7

290 ............................... 8753 2.3103 1 1 2 2 4

291 ............................... 65 1.8462 1 1 1 2 3

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22863

TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM, SELECTED PERCENTILE LENGTHS OF STAY—Continued

[FY2000 MEDPAR update 12/00 Grouper V19.0]

DRG Number

discharges

Arithmetic

mean LOS

10th

percentile

25th

percentile

50th

percentile

75th

percentile

90th

percentile

292 ............................... 4654 10.4850 2 4 8 13 21

293 ............................... 624 5.5096 1 2 4 7 12

294 ............................... 87857 4.6066 1 2 4 6 9

295 ............................... 3277 3.7376 1 2 3 5 7

296 ............................... 235003 5.1556 2 2 4 6 10

297 ............................... 43573 3.4124 1 2 3 4 6

298 ............................... 86 2.8256 1 1 2 3 5

299 ............................... 1178 5.2199 1 2 4 7 10

300 ............................... 15999 6.1363 2 3 5 8 12

301 ............................... 3208 3.6234 1 2 3 4 7

302 ............................... 7703 8.8384 4 5 7 10 15

303 ............................... 19452 8.4231 4 5 7 10 15

304 ............................... 11765 8.7340 2 4 6 11 18

305 ............................... 2984 3.6384 1 2 3 5 7

306 ............................... 7320 5.6291 1 2 3 8 13

307 ............................... 2082 2.2517 1 1 2 3 4

308 ............................... 7463 6.1733 1 2 4 8 14

309 ............................... 4096 2.2954 1 1 2 3 4

310 ............................... 23873 4.4002 1 1 3 6 10

311 ............................... 7963 1.8339 1 1 1 2 3

312 ............................... 1487 4.4654 1 1 3 6 10

313 ............................... 591 2.3316 1 1 1 3 5

315 ............................... 30147 7.0663 1 1 4 9 16

316 ............................... 104601 6.6228 2 3 5 8 13

317 ............................... 1507 2.8779 1 1 2 3 6

318 ............................... 5584 5.9979 1 3 5 8 12

319 ............................... 422 2.7725 1 1 2 3 6

320 ............................... 186678 5.3171 2 3 4 6 10

321 ............................... 30428 3.7951 1 2 3 5 7

322 ............................... 61 4.1475 2 2 3 5 8

323 ............................... 17241 3.2172 1 1 2 4 7

324 ............................... 7479 1.8826 1 1 1 2 3

325 ............................... 8160 3.8241 1 2 3 5 7

326 ............................... 2676 2.6648 1 1 2 3 5

327 ............................... 11 3.0909 1 1 3 4 5

328 ............................... 663 3.6305 1 1 3 5 8

329 ............................... 77 2.0130 1 1 1 2 4

331 ............................... 46045 5.5426 1 3 4 7 11

332 ............................... 4930 3.2917 1 1 2 4 7

333 ............................... 281 5.0569 1 2 4 6 10

334 ............................... 8654 4.4386 2 3 4 5 7

335 ............................... 10721 3.1791 2 2 3 4 5

336 ............................... 9563 3.7848 1 2 3 4 8

337 ............................... 3041 2.1500 1 1 2 3 3

338 ............................... 1226 5.1117 1 2 3 7 11

339 ............................... 1344 4.9821 1 1 3 7 12

340 ............................... 1 1.0000 1 1 1 1 1

341 ............................... 2738 3.1088 1 1 1 3 6

342 ............................... 298 3.4094 1 1 2 4 7

344 ............................... 3502 2.3829 1 1 1 2 5

345 ............................... 410 5.1244 1 2 3 6 10

346 ............................... 4441 5.8726 1 3 4 7 12

347 ............................... 365 2.9479 1 1 2 4 6

350 ............................... 6270 4.3933 1 2 4 5 8

352 ............................... 756 3.9577 1 2 3 5 8

353 ............................... 2533 6.4212 2 3 5 7 12

354 ............................... 7562 5.8375 3 3 4 7 11

355 ............................... 5504 3.2862 2 3 3 4 5

356 ............................... 25128 2.2924 1 1 2 3 4

357 ............................... 5548 8.4874 3 4 7 10 16

358 ............................... 20294 4.3121 2 3 3 5 7

359 ............................... 29890 2.7295 2 2 3 3 4

360 ............................... 15941 2.8557 1 2 2 3 5

361 ............................... 378 2.9233 1 1 2 3 5

363 ............................... 2862 3.4693 1 2 2 3 7

364 ............................... 1644 3.8534 1 1 3 5 8

365 ............................... 1722 7.2410 1 3 5 9 16

366 ............................... 4410 6.7329 1 3 5 8 14

367 ............................... 583 3.0617 1 1 2 4 6

368 ............................... 3110 6.4810 2 3 5 8 12

22864 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM, SELECTED PERCENTILE LENGTHS OF STAY—Continued

[FY2000 MEDPAR update 12/00 Grouper V19.0]

DRG Number

discharges

Arithmetic

mean LOS

10th

percentile

25th

percentile

50th

percentile

75th

percentile

90th

percentile

369 ............................... 3133 3.2515 1 1 2 4 7

370 ............................... 1095 5.8429 3 3 4 5 10

371 ............................... 1307 3.6526 2 3 3 4 5

372 ............................... 927 3.2891 1 2 2 3 5

373 ............................... 3734 2.2499 1 2 2 3 3

374 ............................... 120 3.1583 1 2 2 3 4

375 ............................... 10 2.3000 1 2 2 3 4

376 ............................... 247 3.0931 1 2 2 4 6

377 ............................... 48 5.0000 1 1 3 6 12

378 ............................... 157 2.4140 1 1 2 3 4

379 ............................... 337 3.4303 1 1 2 4 6

380 ............................... 58 2.1207 1 1 1 2 5

381 ............................... 152 2.5132 1 1 1 3 5

382 ............................... 45 1.2889 1 1 1 1 2

383 ............................... 1707 3.5817 1 1 2 4 7

384 ............................... 114 2.1842 1 1 1 3 5

385 ............................... 1 1.0000 1 1 1 1 1

389 ............................... 15 11.7333 1 3 6 10 24

390 ............................... 14 4.0000 1 2 3 6 7

391 ............................... 1 4.0000 4 4 4 4 4

392 ............................... 2323 9.6750 3 4 7 12 20

394 ............................... 1870 7.1428 1 2 4 8 16

395 ............................... 86911 4.4001 1 2 3 6 9

396 ............................... 15 4.6667 1 2 4 6 7

397 ............................... 17554 5.1878 1 2 4 7 10

398 ............................... 17526 5.9417 2 3 5 7 11

399 ............................... 1721 3.5758 1 2 3 5 7

400 ............................... 6444 9.1189 1 3 6 12 20

401 ............................... 5581 11.2575 2 5 9 15 23

402 ............................... 1498 4.1128 1 1 3 6 9

403 ............................... 31732 8.0627 2 3 6 10 17

404 ............................... 4639 4.2720 1 2 3 6 9

406 ............................... 2513 9.8607 3 4 7 12 20

407 ............................... 720 4.4417 1 2 4 5 8

408 ............................... 2178 8.0317 1 2 5 10 18

409 ............................... 2822 5.9072 2 3 4 6 12

410 ............................... 33412 3.9069 1 2 4 5 6

411 ............................... 13 2.3077 1 1 2 2 5

412 ............................... 29 2.4483 1 1 2 3 4

413 ............................... 6419 7.0662 2 3 5 9 14

414 ............................... 767 4.2529 1 2 3 5 9

415 ............................... 38683 14.2779 4 6 11 18 28

416 ............................... 183557 7.3848 2 4 6 9 14

417 ............................... 16 5.0000 2 2 4 6 9

418 ............................... 22822 6.1160 2 3 5 7 11

419 ............................... 15294 4.7204 2 2 4 6 9

420 ............................... 3109 3.5002 1 2 3 4 6

421 ............................... 11464 3.7872 1 2 3 5 7

422 ............................... 80 3.0625 1 2 3 4 6

423 ............................... 7452 8.1162 2 3 6 10 16

424 ............................... 1275 13.4204 2 5 9 16 26

425 ............................... 15710 3.9945 1 2 3 5 8

426 ............................... 4443 4.4510 1 2 3 5 9

427 ............................... 1633 4.6418 1 2 3 6 9

428 ............................... 835 6.8192 1 2 4 8 14

429 ............................... 25967 6.3055 2 3 5 7 12

430 ............................... 58669 8.0151 2 3 6 10 16

431 ............................... 313 6.2045 1 3 5 7 11

432 ............................... 469 4.7271 1 2 3 5 9

433 ............................... 5418 3.0945 1 1 2 4 6

439 ............................... 1343 8.4080 1 3 5 10 19

440 ............................... 5131 9.0209 2 3 6 11 20

441 ............................... 601 3.2313 1 1 2 4 7

442 ............................... 15366 8.4839 1 3 6 10 18

443 ............................... 3730 3.4399 1 1 3 4 7

444 ............................... 5185 4.1338 1 2 3 5 8

445 ............................... 2427 2.9250 1 1 2 4 5

447 ............................... 5451 2.4748 1 1 2 3 5

449 ............................... 28048 3.7457 1 1 3 5 8

450 ............................... 6867 2.0051 1 1 1 2 4

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22865

TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM, SELECTED PERCENTILE LENGTHS OF STAY—Continued

[FY2000 MEDPAR update 12/00 Grouper V19.0]

DRG Number

discharges

Arithmetic

mean LOS

10th

percentile

25th

percentile

50th

percentile

75th

percentile

90th

percentile

451 ............................... 3 1.3333 1 1 1 2 2

452 ............................... 22666 4.8553 1 2 3 6 10

453 ............................... 5068 2.8035 1 1 2 3 6

454 ............................... 3940 4.5652 1 2 3 5 9

455 ............................... 931 2.5994 1 1 2 3 5

461 ............................... 3490 4.3739 1 1 2 5 11

462 ............................... 12994 11.2271 4 6 9 14 21

463 ............................... 21790 4.1239 1 2 3 5 8

464 ............................... 6533 2.9963 1 1 2 4 6

465 ............................... 154 3.4481 1 1 2 4 7

466 ............................... 1470 3.9925 1 1 2 5 9

467 ............................... 534 3.8390 1 1 2 4 8

468 ............................... 56874 12.7662 3 6 10 16 25

471 ............................... 11639 5.5322 3 4 4 6 9

473 ............................... 7599 12.5038 1 3 7 18 32

475 ............................... 107089 11.1800 2 5 9 15 22

476 ............................... 4126 10.8924 2 5 9 14 21

477 ............................... 24823 8.1004 1 3 6 11 17

478 ............................... 106997 7.3166 1 3 5 9 15

479 ............................... 24939 3.5376 1 1 3 5 7

480 ............................... 540 20.1370 7 9 13 25 43

481 ............................... 377 23.9310 10 18 22 27 38

482 ............................... 5686 12.9474 4 7 10 15 25

483 ............................... 42087 39.0295 14 22 33 49 70

484 ............................... 313 12.6773 2 6 10 17 26

485 ............................... 2880 9.5955 4 5 7 11 18

486 ............................... 1856 12.4402 1 5 10 16 25

487 ............................... 3339 7.3612 1 3 6 10 15

488 ............................... 770 17.0078 3 7 13 22 36

489 ............................... 14005 8.4383 2 3 6 10 17

490 ............................... 5378 5.3405 1 2 4 6 10

491 ............................... 12205 3.4483 2 2 3 4 6

492 ............................... 2672 15.6662 3 5 8 25 34

493 ............................... 54859 5.7621 1 3 5 7 11

494 ............................... 29900 2.4482 1 1 2 3 5

495 ............................... 153 15.0261 7 9 12 18 26

496 ............................... 1468 9.5320 4 5 7 12 19

497 ............................... 17184 6.5116 3 4 5 7 11

498 ............................... 12708 4.1701 2 3 4 5 6

499 ............................... 30284 4.6986 1 2 3 6 9

500 ............................... 43962 2.6146 1 1 2 3 5

501 ............................... 2180 10.9670 4 6 8 13 21

502 ............................... 586 6.5648 3 4 5 8 11

503 ............................... 5551 3.9996 1 2 3 5 7

504 ............................... 114 29.5877 9 14 24 41 54

505 ............................... 145 3.3517 1 1 1 3 7

506 ............................... 915 17.4000 4 8 14 22 35

507 ............................... 290 8.2621 2 4 7 11 18

508 ............................... 657 7.4718 2 3 5 9 15

509 ............................... 176 4.5455 1 2 4 6 9

510 ............................... 1619 7.1779 2 3 5 9 15

511 ............................... 602 4.7591 1 2 3 6 10

512 ............................... 328 15.2439 7 8 11 17 28

513 ............................... 112 12.6161 6 7 8 12 20

514 ............................... 16927 7.9786 2 3 6 10 16

515 ............................... 3774 6.0297 1 1 4 8 14

516 ............................... 75742 4.7497 2 2 4 6 9

517 ............................... 171198 2.7066 1 1 2 3 6

518 ............................... 47731 3.4397 1 1 2 4 8

519 ............................... 5448 4.7412 1 2 3 6 11

520 ............................... 10509 2.7887 1 1 2 3 6

521 ............................... 22732 5.0204 1 2 4 6 9

522 ............................... 11649 9.7928 3 5 8 12 20

523 ............................... 14818 4.1079 1 2 3 5 7

10916166

22866 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE 8A.—STATEWIDE AVERAGE OPERATING COST-TO-CHARGE RATIOS

FOR URBAN AND RURAL HOSPITALS

(CASE WEIGHTED) MARCH 2001

State Urban Rural

ALABAMA ..................... 0.344 0.410

ALASKA ........................ 0.417 0.696

ARIZONA ...................... 0.356 0.491

ARKANSAS .................. 0.466 0.446

CALIFORNIA ................ 0.339 0.436

COLORADO ................. 0.422 0.577

CONNECTICUT ............ 0.497 0.506

DELAWARE .................. 0.511 0.450

DISTRICT OF COLUMBIA ............................ 0.508 ..............

FLORIDA ...................... 0.352 0.369

GEORGIA ..................... 0.459 0.470

HAWAII ......................... 0.413 0.554

IDAHO .......................... 0.545 0.561

ILLINOIS ....................... 0.406 0.502

INDIANA ....................... 0.524 0.533

IOWA ............................ 0.486 0.612

KANSAS ....................... 0.421 0.635

KENTUCKY .................. 0.479 0.492

LOUISIANA ................... 0.410 0.488

MAINE .......................... 0.615 0.543

MARYLAND .................. 0.759 0.819

MASSACHUSETTS ...... 0.512 0.571

MICHIGAN .................... 0.460 0.563

MINNESOTA ................ 0.494 0.589

MISSISSIPPI ................ 0.452 0.447

MISSOURI .................... 0.405 0.479

MONTANA .................... 0.537 0.594

NEBRASKA .................. 0.449 0.610

NEVADA ....................... 0.306 0.498

NEW HAMPSHIRE ....... 0.549 0.581

NEW JERSEY .............. 0.394 ..............

NEW MEXICO .............. 0.466 0.491

NEW YORK .................. 0.528 0.609

NORTH CAROLINA ..... 0.516 0.464

NORTH DAKOTA ......... 0.620 0.654

OHIO ............................. 0.501 0.570

OKLAHOMA ................. 0.409 0.494

OREGON ...................... 0.613 0.595

PENNSYLVANIA .......... 0.398 0.525

PUERTO RICO ............. 0.486 0.583

RHODE ISLAND ........... 0.520 ..............

SOUTH CAROLINA ...... 0.440 0.463

SOUTH DAKOTA ......... 0.529 0.638

TENNESSEE ................ 0.438 0.453

TEXAS .......................... 0.402 0.494

UTAH ............................ 0.497 0.586

VERMONT .................... 0.572 0.599

VIRGINIA ...................... 0.454 0.494

WASHINGTON ............. 0.583 0.638

WEST VIRGINIA .......... 0.568 0.527

WISCONSIN ................. 0.525 0.611

WYOMING .................... 0.522 0.717

TABLE 8B.—STATEWIDE AVERAGE

CAPITAL COST-TO-CHARGE RATIOS

(CASE WEIGHTED) MARCH 2001

State Ratio

ALABAMA ....................................... 0.044

ALASKA .......................................... 0.058

ARIZONA ........................................ 0.037

ARKANSAS .................................... 0.049

CALIFORNIA .................................. 0.034

COLORADO ................................... 0.045

CONNECTICUT .............................. 0.036

TABLE 8B.—STATEWIDE AVERAGE

CAPITAL COST-TO-CHARGE RATIOS

(CASE WEIGHTED) MARCH 2001—

Continued

State Ratio

DELAWARE .................................... 0.051

DISTRICT OF COLUMBIA ............. 0.040

FLORIDA ........................................ 0.043

GEORGIA ....................................... 0.051

HAWAII ........................................... 0.038

IDAHO ............................................ 0.046

ILLINOIS ......................................... 0.040

INDIANA ......................................... 0.056

IOWA .............................................. 0.050

KANSAS ......................................... 0.050

KENTUCKY .................................... 0.046

LOUISIANA ..................................... 0.048

MAINE ............................................ 0.040

MARYLAND .................................... 0.013

MASSACHUSETTS ........................ 0.053

MICHIGAN ...................................... 0.044

MINNESOTA .................................. 0.047

MISSISSIPPI .................................. 0.044

MISSOURI ...................................... 0.044

MONTANA ...................................... 0.058

NEBRASKA .................................... 0.054

NEVADA ......................................... 0.030

NEW HAMPSHIRE ......................... 0.061

NEW JERSEY ................................ 0.036

NEW MEXICO ................................ 0.045

NEW YORK .................................... 0.051

NORTH CAROLINA ....................... 0.046

NORTH DAKOTA ........................... 0.072

OHIO ............................................... 0.048

OKLAHOMA ................................... 0.046

OREGON ........................................ 0.046

PENNSYLVANIA ............................ 0.039

PUERTO RICO ............................... 0.045

RHODE ISLAND ............................. 0.029

SOUTH CAROLINA ........................ 0.046

SOUTH DAKOTA ........................... 0.059

TENNESSEE .................................. 0.049

TEXAS ............................................ 0.046

UTAH .............................................. 0.047

VERMONT ...................................... 0.052

VIRGINIA ........................................ 0.055

WASHINGTON ............................... 0.063

WEST VIRGINIA ............................ 0.045

WISCONSIN ................................... 0.051

WYOMING ...................................... 0.065

Appendix A—Regulatory Impact

Analysis

I. Introduction

We generally prepare a regulatory

flexibility analysis that is consistent with the

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

601 through 612), unless we certify that a

proposed rule would not have a significant

economic impact on a substantial number of

small entities. For purposes of the RFA, we

consider all hospitals to be small entities. We

estimate the total impact of these changes for

FY 2002 payments compared to FY 2001

payments to be approximately a $1.7 billion

increase. Therefore, we have prepared an

impact analysis for this proposed rule.

Also, 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. Such an

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 define 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). Section 601(g)

of the Social Security Amendments of 1983

(Public Law 98–21) designated hospitals in

certain New England counties as belonging to

the adjacent NECMA. Thus, for purposes of

the hospital inpatient prospective payment

systems, we classify these hospitals as urban

hospitals.

It is clear that the changes being proposed

in this document would affect both a

substantial number of small rural hospitals as

well as other classes of hospitals, and the

effects on some may be significant. Therefore,

the discussion below, in combination with

the rest of this proposed rule, constitutes a

combined regulatory impact analysis and

regulatory flexibility analysis.

We have reviewed this proposed rule

under the threshold criteria of Executive

Order 13132, Federalism, and have

determined that the proposed rule will not

have any negative impact on the rights, roles,

and responsibilities of State, local, or tribal

governments.

Section 202 of the Unfunded Mandate

Reform Act of 1995 (Public Law 104–4) also

requires that agencies assess anticipated costs

and benefits before issuing any proposed rule

(or a final rule that has been preceded by a

proposed rule) that may result in an

expenditure in any one year by State, local,

or tribal governments, in the aggregate, or by

the private sector, of $110 million. This

proposed rule would not mandate any

requirements for State, local, or tribal

governments.

In accordance with the provisions of

Executive Order 12866, this proposed rule

was reviewed by the Office of Management

and Budget.

II. Objectives

The primary objective of the hospital

inpatient prospective payment system is to

create incentives for hospitals to operate

efficiently and minimize unnecessary costs

while at the same time ensuring that

payments are sufficient to adequately

compensate hospitals for their legitimate

costs. In addition, we share national goals of

preserving the Medicare Trust Fund.

We believe the proposed changes would

further each of these goals while maintaining

the financial viability of the hospital industry

and ensuring access to high quality health

care for Medicare beneficiaries. We expect

that these proposed changes would ensure

that the outcomes of this payment system are

reasonable and equitable while avoiding or

minimizing unintended adverse

consequences.

III. Limitations of Our Analysis

As has been the case in our previously

published regulatory impact analyses, the

following quantitative analysis presents the

projected effects of our proposed policy

changes, as well as statutory changes

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22867

effective for FY 2002, on various hospital

groups. We estimate the effects of individual

policy changes by estimating payments per

case while holding all other payment policies

constant. We use the best data available, but

we do not attempt to predict behavioral

responses to our policy changes, and we do

not make adjustments for future changes in

such variables as admissions, lengths of stay,

or case-mix. As we have done in previous

proposed rules, we are soliciting comments

and information about the anticipated effects

of these changes on hospitals and our

methodology for estimating them.

IV. Hospitals Included In and Excluded

From the Prospective Payment System

The prospective payment systems for

hospital inpatient operating and capitalrelated costs encompass nearly all general,

short-term, acute care hospitals that

participate in the Medicare program. There

were 44 Indian Health Service hospitals in

our database, which we excluded from the

analysis due to the special characteristics of

the prospective payment method for these

hospitals. Among other short-term, acute care

hospitals, only the 67 such hospitals in

Maryland remain excluded from the

prospective payment system under the

waiver at section 1814(b)(3) of the Act. Thus,

as of February 2001, we have included 4,583

hospitals in our analysis. This represents

about 80 percent of all Medicareparticipating hospitals. The majority of this

impact analysis focuses on this set of

hospitals.

The remaining 20 percent are specialty

hospitals that are excluded from the

prospective payment system and continue to

be paid on the basis of their reasonable costs

(subject to a rate-of-increase ceiling on their

inpatient operating costs per discharge).

These hospitals include psychiatric,

rehabilitation, long-term care, children’s, and

cancer hospitals. The impacts of our final

policy changes on these hospitals are

discussed below.

V. Impact on Excluded Hospitals and Units

As of February 2001, there were 1,058

specialty hospitals excluded from the

prospective payment system and instead paid

on a reasonable cost basis subject to the rateof-increase ceiling under § 413.40. Broken

down by specialty, there were 517

psychiatric, 203 rehabilitation, 253 long-term

care, 75 children’s, and 10 cancer hospitals.

In addition, there were 1,457 psychiatric

units and 925 rehabilitation units in

hospitals otherwise subject to the prospective

payment system. These excluded units are

also paid in accordance with § 413.40. Under

§ 413.40(a)(2)(i)(A), the rate-of-increase

ceiling is not applicable to the 67 specialty

hospitals and units in Maryland that are paid

in accordance with the waiver at section

1814(b)(3) of the Act.

As required by section 1886(b)(3)(B) of the

Act, the update factor applicable to the rateof-increase limit for excluded hospitals and

units for FY 2002 would be between 0.5 and

3.0 percent, or 0 percent, depending on the

hospital’s or unit’s costs in relation to its

limit for the most recent cost reporting period

for which information is available.

The impact on excluded hospitals and

units of the update in the rate-of-increase

limit depends on the cumulative cost

increases experienced by each excluded

hospital or unit since its applicable base

period. For excluded hospitals and units that

have maintained their cost increases at a

level below the percentage increases in the

rate-of-increase limits since their base period,

the major effect will be on the level of

incentive payments these hospitals and units

receive. Conversely, for excluded hospitals

and units with per-case cost increases above

the cumulative update in their rate-ofincrease limits, the major effect will be the

amount of excess costs that would not be

reimbursed.

We note that, under § 413.40(d)(3), an

excluded hospital or unit whose costs exceed

110 percent of its rate-of-increase limit

receives its rate-of-increase limit plus 50

percent of the difference between its

reasonable costs and 110 percent of the limit,

not to exceed 110 percent of its limit. In

addition, under the various provisions set

forth in § 413.40, certain excluded hospitals

and units can obtain payment adjustments

for justifiable increases in operating costs

that exceed the limit. At the same time,

however, by generally limiting payment

increases, we continue to provide an

incentive for excluded hospitals and units to

restrain the growth in their spending for

patient services.

VI. Graduate Medical Education Impact

A. National Average Per Resident Amount

(PRA)

As discussed in detail in section IV.G.2. of

this proposed rule, we are proposing to

implement section 511 of Public Law 106–

554, which increases the floor of the localityadjusted national average (PRA for the

purposes of computing direct GME payments

for cost reporting periods beginning during

FY 2002. The national average PRA payment

methodology, as provided in section 311 of

Public Law 106–113, establishes a ‘‘floor’’

and ‘‘ceiling’’ based on a locality-adjusted,

updated national average PRA for cost

reporting periods beginning on or after

October 1, 2000 and before October 1, 2005.

Section 511 of Public Law 106–554 increased

the floor from 70 percent to equal 85 percent

of a locality-adjusted national average PRA

for FY 2002.

For this purpose rule, we have calculated

an estimated impact of this proposed policy

on teaching hospital’s PRAs for FY 2002,

making assumptions about update factors

and geographic adjustment factors (GAF) for

each hospital. Generally, using FY 1997 data,

we calculated a floor based on 70 percent of

the national average PRA and a floor based

on 85 percent of the national average PRA.

We then determined the amount of direct

GME payments that would have been paid

had the floor remained at 70 percent of the

national average PRA. Next, we determined

the amount of direct GME payments that

would be paid with the floor increased to

equal 85 percent of the national average PRA.

We subtracted the difference between the two

and inflated the difference to FY 2002 to

determine the impact of this provision.

The figures we use in this impact, except

for the FY 1997 weighted PRA of $68,464, are

estimations and are for demonstrative

purposes only. Hospitals must use the

methodology stated in section IV.G. of this

proposed rule to revise (if appropriate) their

individual PRAs.

In calculating this impact, we used

Medicare cost report data for all cost reports

ending in FY 1997. We excluded hospitals

that file manual cost reports because we did

not have access to their Medicare utilization

data. We also excluded all teaching hospitals

in Maryland, because these hospitals are paid

on a Medicare waiver outside of the

prospective payment system, and those

hospitals’ PRAs do not determine their level

of direct GME payments. For hospitals that

had two cost reporting periods ending in FY

1997, we used the later of the two periods.

A total of 1,231 teaching hospitals were

included in the analysis.

Using the FY 1997 weighted average PRA

of $68,464, we determined an 85 percent

floor of $58,194 for FY 1997. We then

determined that, for cost reporting periods

ending in FY 1997, approximately 562

hospitals had PRAs that were below $58,194

(336 hospitals of these hospitals had PRAs

that were below the 70-percent floor, and 226

hospitals had PRAs that were above the 70-

percent floor but below the 85-percent floor).

The estimated total cost to the Medicare

program in FY 2002 of replacing the PRAs of

the 562 hospitals with the 85-percent floor is

$104.4 million.

B. Closed Training Programs or Hospitals

That Close Their Training Programs

As discussed in IV.G.5, of this proposed

rule, we are proposing to allow a hospital to

receive a temporary adjustment to its FTE

cap to reflect residents added because of the

closure of another hospital’s GME program if

the hospital that closed its program agrees to

temporarily reduce its FTE cap. We have

calculated an estimated impact on the

Medicare program for FY 2002 as a result of

this proposal. We used the best available cost

report data from the FY 1997 HCRIS in our

analysis.

We estimate that approximately 5 to 10

programs, each with an average of 25

residents, close each year without advance

warning, displacing the residents before they

complete their training. Therefore, the

number of residents displaced each year

could be between 125 and 250. We estimated

the impact of this proposed change based on

direct GME and IME payment amounts in FY

1997 to determine a total GME amount and

updated the total with the CPI–U for FY

2002. At most, the estimated impact for this

proposed provision for FY 2002 is moving

payments of between $10 and $20 million

among different hospitals. This would result

from redirecting these payments from the

hospital that closed its program to the

hospital(s) that takes on the residents.

VII. Quantitative Impact Analysis of the

Proposed Policy Changes Under the

Prospective Payment System for Operating

Costs

A. Basis and Methodology of Estimates

In this proposed rule, we are announcing

policy changes and payment rate updates for

22868 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

the prospective payment systems for

operating and capital-related costs. We have

prepared separate impact analyses of the

proposed changes to each system. This

section deals with changes to the operating

prospective payment system.

The data used in developing the

quantitative analyses presented below are

taken from the FY 2000 MedPAR file and the

most current provider-specific file that is

used for payment purposes. Although the

analyses of the changes to the operating

prospective payment system do not

incorporate cost data, the most recently

available hospital cost report data were used

to categorize hospitals. Our analysis has

several qualifications. First, we do not make

adjustments for behavioral changes that

hospitals may adopt in response to these

proposed policy changes. Second, due to the

interdependent nature of the prospective

payment system, it is very difficult to

precisely quantify the impact associated with

each proposed change. Third, we draw upon

various sources for the data used to

categorize hospitals in the tables. In some

cases, particularly the number of beds, there

is a fair degree of variation in the data from

different sources. We have attempted to

construct these variables with the best

available source overall. For individual

hospitals, however, some miscategorizations

are possible.

Using cases in the FY 2000 MedPAR file,

we simulated payments under the operating

prospective payment system given various

combinations of payment parameters. Any

short-term, acute care hospitals not paid

under the general prospective payment

systems (Indian Health Service hospitals and

hospitals in Maryland) are excluded from the

simulations. Payments under the capital

prospective payment system, or payments for

costs other than inpatient operating costs, are

not analyzed here. Estimated payment

impacts of proposed FY 2001 changes to the

capital prospective payment system are

discussed in section IX. of this Appendix.

The proposed changes discussed separately

below are the following:

• The effects of the annual reclassification

of diagnoses and procedures and the

recalibration of the diagnosis-related group

(DRG) relative weights required by section

1886(d)(4)(C) of the Act.

• The effects of changes in hospitals’ wage

index values reflecting wage data from

hospitals’ cost reporting periods beginning

during FY 1998, compared to the FY 1997

wage data.

• The effects of our proposal to increase

the accuracy of the wage index calculation by

changing the overhead allocation method

used so that the salaries and hours of lowerrange, overhead employees and the overhead

wage-related costs associated with the

excluded areas of the hospital are more

accurately removed when calculating the

overhead costs attributable to wages.

• The effects of our proposal to include the

contract labor costs of laboratories and

pharmacies from Worksheet S–3 Part II Lines

9.01 and 9.02 in the wage index calculation.

• The combined effects of our proposed

changes to the wage index data and

calculations and the changes in the DRG

recalibration.

• The effects of geographic

reclassifications by the Medicare Geographic

Classification Review Board (MGCRB) that

will be effective in FY 2002 not including the

effects of our proposed policy to holdharmless other hospitals in an urban area

where certain hospitals are reclassified

elsewhere by including the wage data of

reclassified hospitals in their geographic area

as well as the area to which they are

reclassified.

• The effects of geographic

reclassifications by the MGCRB that will be

effective in FY 2002 including the effects of

our proposed policy to hold-harmless other

hospitals in an urban area where certain

hospitals are reclassified elsewhere by

including the wage data of reclassified

hospitals in their geographic area as well as

the area to which they are reclassified.

• The total change in payments based on

FY 2002 policies relative to payments based

on FY 2001 policies.

To illustrate the impacts of the FY 2002

proposed changes, our analysis begins with

a FY 2002 baseline simulation model using:

the FY 2001 DRG GROUPER (version 18.0);

the FY 2001 wage index; and no MGCRB

reclassifications. Outlier payments are set at

5.1 percent of total DRG plus outlier

payments.

Each proposed and statutory policy change

is then added incrementally to this baseline

model, finally arriving at an FY 2002 model

incorporating all of the changes. This allows

us to isolate the effects of each change.

Our final comparison illustrates the

percent change in payments per case from FY

2001 to FY 2002. Five factors have significant

impacts here. The first is the update to the

standardized amounts. In accordance with

section 1886(d)(3)(A)(iv) of the Act, as

amended by section 301 of Public Law 106–

554, we are proposing to update the large

urban and the other areas average

standardized amounts for FY 2002 using the

most recently forecasted hospital market

basket increase for FY 2002 of 3.1 percent

minus 0.55 percentage points (for an update

of 2.55 percent). Under section 1886(b)(3) of

the Act, the updates to the hospital-specific

amounts for sole community hospitals

(SCHs) and for Medicare-dependent small

rural hospitals (MDHs) is equal to the market

basket increase of 3.1 percent minus 0.55

percentage points (for an update of 2.55

percent).

A second significant factor that impacts

changes in hospitals’ payments per case from

FY 2001 to FY 2002 is the change in MGCRB

status from one year to the next. That is,

hospitals reclassified in FY 2001 that are no

longer reclassified in FY 2002 may have a

negative payment impact going from FY 2001

to FY 2002; conversely, hospitals not

reclassified in FY 2001 that are reclassified

in FY 2002 may have a positive impact. In

some cases, these impacts can be quite

substantial, so if a relatively small number of

hospitals in a particular category lose their

reclassification status, the percentage change

in payments for the category may be below

the national mean. This effect may be

alleviated somewhat by section 304(a) of

Public Law 106–554, which provided that

reclassifications for purposes of the wage

index are for a 3 year period.

A third significant factor is that we

currently estimate that actual outlier

payments during FY 2001 will be 5.9 percent

of actual total DRG payments. When the FY

2001 final rule was published, we projected

FY 2001 outlier payments would be 5.1

percent of total DRG plus outlier payments;

the standardized amounts were offset

correspondingly. The effects of the higher

than expected outlier payments during FY

2001 (as discussed in the Addendum to this

proposed rule) are reflected in the analyses

below comparing our current estimates of FY

2001 payments per case to estimated FY 2002

payments per case.

Fourth, section 213 of Public Law 106–554

provided that all SCHs may receive payment

on the basis of their costs per case during

their cost reporting period that began during

1996. For FY 2001, eligible SCHs that are

rebased receive a hospital-specific rate

comprised of the greater of 50-percent of the

higher of their FY 1982 or FY 1987 hospitalspecific rate or 50-percent of the federal rate,

and 50-percent of their FY 1996 hospitalspecific rate.

Fifth, sections 302 and 303 of Public Law

106–554 affect payments for indirect medical

education (IME) and disproportionate share

hospitals (DSH), respectively. These sections

increased IME and DSH payments during FY

2001 (effective with discharges on or after

April 1, 2001). For FY 2002, section 302

established IME payments at the same level

as FY 2001 (6.5 percent), and section 303

established DSH payments at the adjustment

the hospital would otherwise receive minus

3 percent.

Table I demonstrates the results of our

analysis. The table categorizes hospitals by

various geographic and special payment

consideration groups to illustrate the varying

impacts on different types of hospitals. The

top row of the table shows the overall impact

on the 4,795 hospitals included in the

analysis. This number is 93 fewer hospitals

than were included in the impact analysis in

the FY 2001 final rule (65 FR 47191).

The next four rows of Table I contain

hospitals categorized according to their

geographic location (all urban (which is

further divided into large urban and other

urban) and rural). There are 2,721 hospitals

located in urban areas (MSAs or NECMAs)

included in our analysis. Among these, there

are 1,563 hospitals located in large urban

areas (populations over 1 million), and 1,158

hospitals in other urban areas (populations of

1 million or fewer). In addition, there are

2,074 hospitals in rural areas. The next two

groupings are by bed-size categories, shown

separately for urban and rural hospitals. The

final groupings by geographic location are by

census divisions, also shown separately for

urban and rural hospitals.

The second part of Table I shows hospital

groups based on hospitals’ FY 2002 payment

classifications, including any

reclassifications under section 1886(d)(10) of

the Act. For example, the rows labeled urban,

large urban, other urban, and rural show that

the number of hospitals paid based on these

categorizations (after consideration of

geographic reclassifications) are 2,766, 1,643,

1,123, and 2,029, respectively.

The next three groupings examine the

impacts of the proposed changes on hospitals

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22869

grouped by whether or not they have

residency programs (teaching hospitals that

receive an IME adjustment) or receive DSH

payments, or some combination of these two

adjustments. There are 3,674 non-teaching

hospitals in our analysis, 881 teaching

hospitals with fewer than 100 residents, and

240 teaching hospitals with 100 or more

residents.

In the DSH categories, hospitals are

grouped according to their DSH payment

status, and whether they are considered

urban or rural after MGCRB reclassifications.

Hospitals in the rural DSH categories,

therefore, represent hospitals that were not

reclassified for purposes of the standardized

amount or for purposes of the DSH

adjustment. (They may, however, have been

reclassified for purposes of the wage index.)

We note that section 211 of Public Law 106–

554 reduced the qualifying DSH threshold to

15 percent for all hospitals (this threshold

previously applied to urban hospitals with

100 or more beds and rural hospitals with

500 or more beds). Consequently, many more

hospitals qualify for DSH. In the FY 2001

final rule, there were 3,070 hospitals that did

not receive a DSH adjustment (65 FR 47192).

In Table I, that number declines to 1,879. The

number of urban hospitals with fewer than

100 beds receiving DSH increases from 72

prior to section 211 to 325 after its

implementation. Among rural hospitals with

fewer than 100 beds, 103 received DSH prior

to section 211; for FY 2002 that number

increases to 443.

The next category groups hospitals

considered urban after geographic

reclassification, in terms of whether they

receive the IME adjustment, the DSH

adjustment, both, or neither.

The next five rows examine the impacts of

the proposed changes on rural hospitals by

special payment groups (SCHs, rural referral

centers (RRCs), and MDHs), as well as rural

hospitals not receiving a special payment

designation. The RRCs (165), SCHs (667),

MDHs (328), and SCH and RRCs that are not

included in the SCH or the RRC categories

(69) shown here were not reclassified for

purposes of the standardized amount. There

are 20 RRCs, 1 MDH, 5 SCHs and 2 SCH and

RRCs that will be reclassified as urban for the

standardized amount in FY 2002 and,

therefore, are not included in these rows.

The next two groupings are based on type

of ownership and the hospital’s Medicare

utilization expressed as a percent of total

patient days. These data are taken primarily

from the FY 1999 Medicare cost report files,

if available (otherwise FY 1998 data are

used). Data needed to determine ownership

status or Medicare utilization percentages

were unavailable for 46 and 78 hospitals,

respectively. For the most part, these are new

hospitals.

The next series of groupings concern the

geographic reclassification status of

hospitals. The first grouping displays all

hospitals that were reclassified by the

MGCRB for FY 2002. The next two groupings

separate the hospitals in the first group by

urban and rural status. The final row in Table

I contains hospitals located in rural counties

but deemed to be urban under section

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

TABLE I.—IMPACT ANALYSIS OF CHANGES FOR FY 2002 OPERATING PROSPECTIVE PAYMENT SYSTEM

[Percent changes in payments per case]

Number of

hosps.1

(0)

DRG recalib.2

(1)

New wage

data 3

(2)

New overhead

alloc.4

(3)

Include

contract

labor 5

(4)

DRG & WI

changes 6

(5)

MCGRB

reclassification 7

(6)

Reclassification

hold-harmless

policy 8

(7)

All FY

2001

changes 9

(8)

By Geographic Location:

All hospitals ......... 4,795 0.5 0.2 0.0 0.0 0.0 ¥0.2 0.2 1.9

Urban hospitals ... 2,721 0.6 0.2 0.0 0.0 0.0 ¥0.7 0.2 1.7

Large urban areas

(populations

over 1 million) .. 1,563 0.7 ¥0.1 0.0 0.0 ¥0.1 ¥0.8 0.3 1.5

Other urban areas

(populations of

1 million of

fewer) ............... 1,158 0.5 0.6 0.0 0.0 0.2 ¥0.5 0.1 2.0

Rural hospitals .... 2,074 ¥0.1 0.5 0.1 0.1 ¥0.2 2.7 0.1 3.2

Bed Size (Urban):

0–99 beds ........... 712 ¥0.1 0.3 0.0 0.0 ¥0.4 ¥0.8 0.2 2.1

100–199 beds ..... 943 0.4 0.2 0.0 0.0 ¥0.2 ¥0.7 0.3 1.6

200–299 beds ..... 530 0.6 0.3 0.0 0.1 0.1 ¥0.7 0.3 1.8

300–499 beds ..... 391 0.7 0.1 0.0 0.0 0.0 ¥0.7 0.2 1.6

500 or more beds 145 1.0 0.0 0.0 0.0 0.2 ¥0.6 0.1 1.5

Bed Size (Rural):

0–49 beds ........... 1,209 ¥0.4 0.5 0.1 0.1 ¥0.5 0.4 0.0 3.0

50–99 beds ......... 520 ¥0.2 0.5 0.1 0.1 ¥0.4 1.1 0.0 3.3

100–149 beds ..... 204 ¥0.1 0.6 0.1 0.1 ¥0.1 3.2 0.2 3.0

150–199 beds ..... 75 0.1 0.4 0.1 0.1 ¥0.1 5.2 0.2 3.4

200 or more beds 66 0.3 0.4 0.1 0.1 0.0 5.2 0.1 3.6

Urban by Region:

New England ....... 139 0.6 2.2 ¥0.1 0.0 1.3 ¥0.2 0.0 1.7

Middle Atlantic ..... 417 0.7 ¥1.2 ¥0.1 0.0 ¥1.4 ¥0.8 0.6 0.2

South Atlantic ...... 395 0.7 0.9 0.0 0.0 0.9 ¥0.8 0.3 2.8

East North Central .................... 462 0.5 0.1 0.0 0.1 ¥0.2 ¥0.6 0.1 1.6

East South Central .................... 160 0.6 1.1 0.1 0.0 1.1 ¥0.7 0.0 3.0

West North Central .................... 189 0.6 0.5 0.1 0.1 0.3 ¥0.7 0.0 2.0

West South Central .................... 342 0.7 ¥0.8 0.0 0.0 ¥0.9 ¥0.7 0.0 0.7

Mountain ............. 137 0.6 0.9 0.0 0.0 0.7 ¥0.7 0.0 2.4

Pacific .................. 434 0.7 0.4 0.1 0.0 0.4 ¥0.8 0.2 2.2

Puerto Rico ......... 46 0.4 1.3 0.1 0.0 1.0 ¥0.5 ¥0.3 2.6

Rural by Region:

22870 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE I.—IMPACT ANALYSIS OF CHANGES FOR FY 2002 OPERATING PROSPECTIVE PAYMENT SYSTEM—Continued

[Percent changes in payments per case]

Number of

hosps.1

(0)

DRG recalib.2

(1)

New wage

data 3

(2)

New overhead

alloc.4

(3)

Include

contract

labor 5

(4)

DRG & WI

changes 6

(5)

MCGRB

reclassification 7

(6)

Reclassification

hold-harmless

policy 8

(7)

All FY

2001

changes 9

(8)

New England ....... 49 0.0 0.6 0.1 0.0 ¥0.1 3.0 0.1 3.7

Middle Atlantic ..... 74 0.0 ¥0.2 0.0 0.0 ¥1.0 2.5 0.0 2.2

South Atlantic ...... 267 0.1 0.6 0.1 0.1 0.0 2.9 0.1 3.6

East North Central .................... 273 ¥0.2 0.6 0.0 0.1 ¥0.3 2.2 0.2 2.8

East South Central .................... 263 0.0 0.5 0.1 0.1 ¥0.2 3.3 0.0 3.6

West North Central .................... 479 ¥0.3 0.8 0.2 0.1 ¥0.1 2.1 0.1 2.5

West South Central .................... 331 ¥0.1 0.7 0.1 0.1 0.0 3.5 0.1 4.2

Mountain ............. 194 ¥0.1 0.4 0.2 0.0 ¥0.4 1.9 0.0 2.9

Pacific .................. 139 0.0 ¥0.2 0.1 0.1 ¥0.9 2.3 0.1 2.7

Puerto Rico ......... 5 ¥0.3 3.9 0.1 0.0 2.9 1.9 ¥0.8 8.4

By Payment Classification:

Urban hospitals ... 2,766 0.6 0.2 0.0 0.0 0.0 ¥0.7 0.2 1.7

Large urban areas

(populations

over 1 million) .. 1,643 0.7 ¥0.1 0.0 0.0 ¥0.1 ¥0.7 0.3 1.5

Other urban areas

(populations of

1 million of

fewer) ............... 1,123 0.5 0.6 0.0 0.0 0.2 ¥0.6 0.1 2.0

Rural areas ......... 2,029 ¥0.1 0.5 0.1 0.1 ¥0.2 2.5 0.0 3.2

Teaching Status:

Non-teaching ....... 3,674 0.3 0.4 0.0 0.0 ¥0.1 0.2 0.2 2.2

Fewer than 100

Residents ......... 881 0.6 0.3 0.0 0.0 0.1 ¥0.6 0.2 1.9

100 or more Residents ................ 240 1.0 ¥0.2 0.0 0.0 0.0 ¥0.5 0.1 1.3

Urban DSH:

Non-DSH ............. 1,879 0.4 0.2 0.0 0.0 ¥0.1 ¥0.2 0.3 1.7

100 or more beds 1,378 0.7 0.2 0.0 0.0 0.1 ¥0.7 0.2 1.7

Less than 100

beds ................. 325 0.0 0.4 0.1 0.0 ¥0.3 ¥0.8 0.3 3.3

Rural DSH:

Sole Community

(SCH) ............... 540 ¥0.2 0.4 0.1 0.0 ¥0.5 0.4 0.0 3.1

Referral Center

(RRC) .............. 157 0.2 0.5 0.1 0.1 0.0 5.3 0.1 3.7

Other Rural:

100 or more

beds .......... 73 ¥0.1 0.7 0.1 0.1 ¥0.1 1.3 0.1 3.2

Less than

100 beds .. 443 ¥0.2 0.5 0.1 0.1 ¥0.4 0.6 0.0 4.3

Urban teaching and

DSH:

Both teaching and

DSH ................. 754 0.8 0.1 0.0 0.0 0.0 ¥0.7 0.2 1.6

Teaching and no

DSH ................. 295 0.7 0.2 0.0 0.1 0.0 ¥0.6 0.3 1.6

No teaching and

DSH ................. 949 0.4 0.4 0.0 0.0 0.1 ¥0.6 0.3 2.0

No teaching and

no DSH ............ 768 0.3 0.2 0.0 0.0 ¥0.2 ¥0.6 0.3 1.5

Rural Hospital

Types:

Non special

status hospitals ......... 800 ¥0.3 0.7 0.1 0.1 ¥0.2 0.9 0.0 3.6

RRC ............. 165 0.2 0.5 0.1 0.1 0.0 6.3 0.1 3.6

SCH ............. 667 ¥0.2 0.4 0.1 0.0 ¥0.5 0.4 0.0 2.5

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22871

TABLE I.—IMPACT ANALYSIS OF CHANGES FOR FY 2002 OPERATING PROSPECTIVE PAYMENT SYSTEM—Continued

[Percent changes in payments per case]

Number of

hosps.1

(0)

DRG recalib.2

(1)

New wage

data 3

(2)

New overhead

alloc.4

(3)

Include

contract

labor 5

(4)

DRG & WI

changes 6

(5)

MCGRB

reclassification 7

(6)

Reclassification

hold-harmless

policy 8

(7)

All FY

2001

changes 9

(8)

Medicare-dependent

hospitals

(MDH) ....... 328 ¥0.3 0.5 0.1 0.1 ¥0.5 0.5 0.0 3.2

SCH and

RRC .......... 69 0.1 0.4 0.0 0.0 ¥0.3 2.5 0.0 2.7

Type of Ownership:

Voluntary ............. 2,785 0.6 0.2 0.0 0.0 ¥0.1 ¥0.3 0.2 1.8

Proprietary ........... 777 0.6 0.2 0.1 0.0 0.1 ¥0.3 0.2 2.0

Government ........ 1,187 0.5 0.6 0.1 0.0 0.3 0.1 0.1 2.5

Unknown ............. 46 0.3 1.3 0.0 0.0 0.7 ¥1.7 1.0 2.6

Medicare Utilization as a Percent of Inpatient

Days:

0–25 ............. 396 0.9 0.2 0.0 0.0 0.4 ¥0.5 0.1 2.2

25–50 ........... 1,886 0.7 0.1 0.0 0.0 0.0 ¥0.6 0.2 1.7

50–65 ........... 1,843 0.4 0.4 0.0 0.0 0.0 0.1 0.2 2.2

Over 65 ........ 592 0.2 0.2 0.0 0.1 ¥0.2 0.2 0.3 1.9

Unknown ...... 78 0.5 ¥2.1 ¥0.1 0.0 ¥2.4 ¥0.7 0.1 ¥1.1

Hospitals Reclassified

by the Medicare Geographic Classification Review Board:

FY 2002

Reclassifications:

All Reclassified

Hospitals .......... 636 0.3 0.6 0.0 0.1 0.2 4.5 0.3 2.9

Standardized

Amount

Only .......... 74 0.1 0.7 0.0 0.0 0.0 1.9 1.0 4.0

Wage Index

Only .......... 391 0.3 0.5 0.1 0.1 0.1 5.3 0.1 2.5

Both .............. 58 0.4 0.7 0.0 0.1 0.4 4.1 0.6 0.0

Nonreclassified Hospitals ....................... 4,246 0.6 0.2 0.0 0.0 0.0 ¥0.8 0.2 1.9

All Reclassified Urban

Hospitals ................. 119 0.7 0.8 0.0 0.1 0.6 2.8 0.4 2.0

Urban Nonreclassified

Hospitals .......... 18 0.2 0.5 0.0 0.0 ¥0.2 ¥1.2 1.9 ¥0.6

Standardized

Amount Only 81 0.8 0.7 0.0 0.1 0.6 3.3 0.1 2.2

Wage Index Only 20 0.5 1.4 0.0 0.1 1.1 1.9 2.1 2.5

Both ..................... 2,564 0.6 0.2 0.0 0.0 0.0 ¥0.9 0.2 1.6

All Reclassified Rural

Hospitals ................. 517 0.1 0.5 0.1 0.1 ¥0.1 5.6 0.2 3.6

Standardized

Amount Only .... 19 ¥0.2 0.5 0.1 0.0 ¥0.5 3.9 1.5 2.0

Wage Index Only 475 0.1 0.5 0.1 0.1 ¥0.1 5.5 0.1 3.6

Both ..................... 23 0.1 0.8 0.1 0.1 0.2 7.7 1.5 4.2

Rural Nonreclassified

Hospitals ................. 1,554 ¥0.3 0.5 0.1 0.1 ¥0.4 ¥0.6 0.0 2.8

Other Reclassified

Hospitals (Section

1886(D)(8)(B)) ........ 41 ¥0.1 ¥6.1 0.1 0.1 0.4 0.3 0.1 3.9

1Because data necessary to classify some hospitals by category were missing, the total number of hospitals in each category may not equal

the national total. Discharge data are from FY 2000, and hospital cost report data are from reporting periods beginning in FY 1999 and FY 1998. 2This column displays the payment impact of the recalibration of the DRG weights based on FY 2000 MedPAR data and the DRG reclassification changes, in accordance with section 1886(d)(4)(C) of the Act. 3This column shows the payment effects of updating the data used to calculate the wage index with data from the FY 1998 cost reports. 4This column displays the impact of removing the salaries and hours of lower-range, overhead employees and the overhead wage-related

costs associated with the excluded areas of the hospital from the wage index calculation. 5This column displays the impact of including contract pharmacy and contract laboratory costs and hours in the wage index calculation.

22872 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

6This column displays the combined impact of the reclassification and recalibration of the DRGs, the updated and revised wage data used to

calculate the wage index, the revised overhead allocation, the laboratory and pharmacy contract labor costs, and the budget neutrality adjustment factor for these two changes, in accordance with sections 1886(d)(4)(C)(iii) and 1886(d)(3)(E) of the Act. Thus, it represents the combined

impacts shown in columns 1, 2 3, and 4, and the FY 2002 budget neutrality factor of .992394. 7Shown here are the effects of geographic reclassifications by the Medicare Geographic Classification Review Board (MGCRB). The effects

demonstrate the FY 2002 payment impact of going from no reclassifications to the reclassifications scheduled to be in effect for FY 2002. Reclassification for prior years has no bearing on the payment impacts shown here. 8Shown here are the effects of geographic reclassifications by the MGCRB including the effects of our proposed policy to hold-harmless other

hospitals in an urban area where certain hospitals are reclassified elsewhere by including the wage data of reclassified hospitals in their geographic area as well as the area to which they are reclassified. 9This column shows changes in payments from FY 2001 to FY 2002. It incorporates all of the changes displayed in columns 5, 6, and 7 (the

changes displayed in columns 1, 2, 3, and 4 are included in column 5). It also displays the impact of the FY 2002 update, changes in hospitals’

reclassification status in FY 2002 compared to FY 2001, and the difference in outlier payments from FY 2001 to FY 2002. It also reflects section

213 of Public Law 106–554, which permitted all SCHs to rebase for a 1996 hospital-specific rate. The sum of these columns may be different

from the percentage changes shown here due to rounding and interactive effects.

B. Impact of the Proposed Changes to the

DRG Reclassifications and Recalibration of

Relative Weights (Column 1)

In column 1 of Table I, we present the

combined effects of the DRG reclassifications

and recalibration, as discussed in section II.

of the preamble to this proposed rule. Section

1886(d)(4)(C)(i) of the Act requires us to

annually make appropriate classification

changes and to recalibrate the DRG weights

in order to reflect changes in treatment

patterns, technology, and any other factors

that may change the relative use of hospital

resources.

We compared aggregate payments using

the FY 2001 DRG relative weights (GROUPER

version 18) to aggregate payments using the

proposed FY 2002 DRG relative weights

(GROUPER version 19). Overall payments

increase 0.5 percent due to the DRG

reclassification and recalibration. We note

that, consistent with section 1886(d)(4)(C)(iii)

of the Act, we have applied a budget

neutrality factor to ensure that the overall

payment impact of the DRG changes is

budget neutral. This budget neutrality factor

of 0.992493 is applied to payments in

Column 5.

The DRG changes we are proposing in this

proposed rule would result in higher

payments to urban hospitals (0.6 percent)

and somewhat lower payments to rural

hospitals (-0.1). The changes also would

result in higher payments to larger hospitals

than to smaller hospitals. This impact is

consistent for both urban and rural bed size

groups.

This distributional impact likely results

from the changes we are proposing to major

diagnostic category (MDC) 5 ‘‘Diseases and

Disorders of the Circulatory System.’’ As

described in section II., we are proposing to

remove cardiac defribrillator cases from

DRGs 104 and 105, and create two new DRGs

for these cases. In addition, we are proposing

to revise the basis of the DRG assignment for

cases involving percutaneous transluminal

coronary angioplasty based on whether the

patient experienced an acute myocardial

infarction. Because MDC 5 is a high volume

category, refining the categorizations of these

cases has a noticeable impact.

C. Impact of Updating the Wage Data and the

Proposed Changes to the Wage Index

Calculation (Columns 2, 3 & 4)

Section 1886(d)(3)(E) of the Act requires

that, beginning October 1, 1993, we annually

update the wage data used to calculate the

wage index. In accordance with this

requirement, the proposed wage index for FY

2002 is based on data submitted for hospital

cost reporting periods beginning on or after

October 1, 1997 and before October 1, 1998.

As with column 1, the impact of the new data

on hospital payments is isolated in column

2 by holding the other payment parameters

constant in the two simulations. That is,

column 2 shows the percentage changes in

payments when going from a model using the

FY 2001 wage index (based on FY 1997 wage

data before geographic reclassifications to a

model using the FY 2002 pre-reclassification

wage index based on FY 1998 wage data).

The wage data collected on the FY 1998

cost reports are similar to the data used in

the calculation of the FY 2001 wage index.

For a thorough discussion of the data used

to calculate the wage index, see section III.B

of this proposed rule.

The results indicate that the new wage data

are estimated to provide a 0.2 percent

increase for hospital payments overall (prior

to applying the budget neutrality factor, see

column 5). Rural hospitals appear to

experience the greatest benefit from the

update to the 1998 wage data, with an

increase of 0.5 percent. Rural hospitals in

Nevada, Connecticut and Arizona experience

wage index increases of more than 5 percent.

Rural hospitals in Puerto Rico experience a

3.9 percent increase.

Urban hospitals as a group are not

significantly affected by the updated wage

data. While large urban hospitals appear to

experience a 0.1 percent decline, estimated

payments to urban hospitals overall showed

an increase of 0.2 percent. Payments in other

urban areas increase by 0.6 percent. Among

urban census divisions, the New England

division experiences a 2.2 percent increase,

Middle Atlantic a 1.2 percent decrease, East

South Central a 1.1 percent increase, and

Puerto Rico a 1.3 percent increase.

Columns 3 and 4, respectively, show that

the proposed change to the overhead

calculation and the proposal to include

contract labor costs in the wage index

discussed in detail in Section III.C. of this

proposed rule both appear to have negligible

impacts on hospital payments overall. Urban

hospitals as a group are not effected by these

proposals as there is a 0.0 percent impact to

their payments from each proposed change.

Rural hospitals, however, do appear to

benefit slightly from these changes, as

evidenced by the estimated 0.1 percent

increase in payments to this group.

We note that the wage data used for the

proposed wage index are based upon the data

available as of February 22, 2001 and,

therefore, do not reflect revision requests

received and processed by the fiscal

intermediaries after that date. To the extent

these requests are granted by hospitals’ fiscal

intermediaries, these revisions will be

reflected in the final rule. In addition, we

continue to verify the accuracy of the data for

hospitals with extraordinary changes in their

data from the prior year.

The following chart compares the shifts in

wage index values for labor market areas for

FY 2001 relative to FY 2002. This chart

demonstrates the impact of the proposed

changes for the FY 2002 wage index relative

to the FY 2001 wage index. The majority of

labor market areas (318) experience less than

a 5-percent change. A total of 36 labor market

areas experience an increase of more than 5

percent with 4 having an increase greater

than 10 percent. A total of 13 areas

experience decreases of more than 5-percent.

Of those, 4 decline by 10 percent or more.

Percentage change in

area wage index

values

Number of labor

market areas

FY 2001 FY 2002

Increase more than

10 percent ............. 1 4

Increase more than 5

percent and less

than 10 percent ..... 20 36

Increase or decrease

less than 5 percent 339 318

Decrease more than

5 percent and less

than 10 percent ..... 14 13

Decrease more than

10 percent ............. 1 4

Among urban hospitals, 163 would

experience an increase of between 5 and 10

percent and 16 more than 10 percent. A total

of 33 rural hospitals have increases greater

than 5 percent, but none greater than 10

percent. On the negative side, 121 urban

hospitals have decreases in their wage index

values of at least 5 percent but less than 10

percent. Five urban hospitals have decreases

in their wage index values greater than 10

percent. There are no rural hospitals with

decreases in their wage index values greater

than 5 percent or with increases of more than

10 percent. The following chart shows the

projected impact for urban and rural

hospitals.

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22873

Percentage change in

area wage index values

Number of hospitals

Urban Rural

Increase more than

10 percent ............. 16 0

Increase more than 5

percent and less

than 10 percent ..... 101 15

Increase or decrease

less than 5 percent 2,395 2,135

Decrease more than

5 percent and less

than 10 percent ..... 121 0

Decrease more than

10 percent ............. 5 0

D. Combined Impact of DRG and Wage Index

Changes—Including Budget Neutrality

Adjustment (Column 5)

The impact of DRG reclassifications and

recalibration on aggregate payments is

required by section 1886(d)(4)(C)(iii) of the

Act to be budget neutral. In addition, section

1886(d)(3)(E) of the Act specifies that any

updates or adjustments to the wage index are

to be budget neutral. As noted in the

Addendum to this proposed rule, we

compared simulated aggregate payments

using the FY 2001 DRG relative weights and

wage index to simulated aggregate payments

using the proposed FY 2002 DRG relative

weights and blended wage index. Based on

this comparison, we computed a wage and

recalibration budget neutrality factor of

0.992493. In Table I, the combined overall

impacts of the effects of both the DRG

reclassifications and recalibration and the

updated wage index are shown in column 5.

The 0.0 percent impact for all hospitals

demonstrates that these changes, in

combination with the budget neutrality

factor, are budget neutral.

For the most part, the changes in this

column are the sum of the changes in

columns 1, 2, 3 and 4, minus approximately

0.7 percent attributable to the budget

neutrality factor. There may be some

variation of plus or minus 0.1 percent due to

rounding.

E. Impact of MGCRB Reclassifications

(Columns 6 & 7)

Our impact analysis to this point has

assumed hospitals are paid on the basis of

their actual geographic location (with the

exception of ongoing policies that provide

that certain hospitals receive payments on

bases other than where they are

geographically located, such as hospitals in

rural counties that are deemed urban under

section 1886(d)(8)(B) of the Act). The changes

in column 5 reflect the per case payment

impact of moving from this baseline to a

simulation incorporating the MGCRB

decisions for FY 2002. The changes in

column 6 add in the post-reclassified wage

index values resulting from the proposed

change to include the wage data for a

reclassified hospital in both the area to which

it is reclassified and the area where the

hospital is physically located. As noted

below, these decisions affect hospitals’

standardized amount and wage index area

assignments.

By February 28 of each year, the MGCRB

makes reclassification determinations that

will be effective for the next fiscal year,

which begins on October 1. The MGCRB may

approve a hospital’s reclassification request

for the purpose of using the other area’s

standardized amount, wage index value, or

both.

The proposed FY 2002 wage index values

incorporate all of the MGCRB’s

reclassification decisions for FY 2002. The

wage index values also reflect any decisions

made by the HCFA Administrator through

the appeals and review process for MGCRB

decisions as of February 28, 2001. Additional

changes that result from the Administrator’s

review of MGCRB decisions or a request by

a hospital to withdraw its application will be

reflected in the final rule for FY 2002.

The overall effect of geographic

reclassification is required by section

1886(d)(8)(D) of the Act to be budget neutral.

Therefore, we applied an adjustment of

0.991054 to ensure that the effects of

reclassification are budget neutral. (See

section II.A.4.b. of the Addendum to this

proposed rule.) This results in a larger budget

neutrality offset than the FY 2001 factor of

0.993187. This larger offset is accounted for

by the extension of wage index

reclassifications for 3 years as a result of

section 304 of Public Law 106–554, and our

proposed policy to hold-harmless the

calculation of urban areas’ wage indexes for

reclassifications out of the area (see Column

7). We have identified 162 hospitals that

were reclassified for FY 2001 but not FY

2002, that will nonetheless continue to be

reclassified due to section 304 of Public Law

106–554.

As a group, rural hospitals benefit from

geographic reclassification. Their payments

rise 2.7 percent in Column 6. Payments to

urban hospitals decline 0.7 percent.

Hospitals in other urban areas see a decrease

in payments of 0.5 percent, while large urban

hospitals lose 0.8 percent. Among urban

hospital groups (that is, bed size, census

division, and special payment status),

payments generally decline.

A positive impact is evident among most

of the rural hospital groups. The smallest

increase among the rural census divisions is

1.9 percent for Mountain and Puerto Rico

regions. The largest increases are in rural

West South Central and New England. These

regions receive increases of 3.5 and 3.0

percent respectively.

Among all the hospitals that were

reclassified for FY 2002, the MGCRB changes

are estimated to provide a 4.5 percent

increase in payments. Urban hospitals

reclassified for FY 2002 are anticipated to

receive an increase of 2.8 percent, while rural

reclassified hospitals are expected to benefit

from the MGCRB changes with a 5.6 percent

increase in payments. Overall, among

hospitals that were reclassified for purposes

of the standardized amount only, a payment

increase of 3.3 percent is expected, while

those reclassified for purposes of the wage

index only show a 1.9 percent increase in

payments. Payments to urban and rural

hospitals that did not reclassify are expected

to decrease slightly due to the MGCRB

changes, decreasing by 1.2 for urban

hospitals and 0.6 for rural hospitals. Those

hospitals located in rural counties but

deemed to be urban under section

1886(d)(8)(B) of the Act are expected to

receive an increase in payments of 0.3

percent.

Column 7 shows the impacts of our

proposed policy to include the wage data for

a reclassified hospital in both the area to

which it is reclassified and the area where

the hospital is physically located. This

change affects overall payments by 0.2

percent, partially accounting for the larger

budget neutrality factor compared to FY

2001. The payment impacts are generally

largest in urban hospital groups, with the

largest impact, 0.6 percent, experienced by

urban hospitals in the Middle Atlantic

census division.

The foregoing analysis was based on

MGCRB and HCFA Administrator decisions

made by February 28, 2001. As previously

noted, there may be changes to some MGCRB

decisions through the appeals, review, and

applicant withdrawal process. The outcome

of these cases will be reflected in the analysis

presented in the final rule.

F. All Changes (Column 8)

Column 8 compares our estimate of

payments per case, incorporating all changes

reflected in this proposed rule for FY 2002

(including statutory changes), to our estimate

of payments per case in FY 2001. It includes

the effects of the 2.55 percent update to the

standardized amounts and the hospitalspecific rates for MDHs and SCHs. It also

reflects the 0.8 percentage point difference

between the projected outlier payments in FY

2001 (5.1 percent of total DRG payments) and

the current estimate of the percentage of

actual outlier payments in FY 2001 (5.9

percent), as described in the introduction to

this Appendix and the Addendum to this

proposed rule.

We also note that section 211 of Public

Law 106–554 changed the criteria for

hospitals to qualify for DSH payment status.

Since more hospitals are now eligible to

receive DSH payments for the full FY 2002,

as opposed to for just the second 6 months

of FY 2001, DSH payments to providers in

FY 2002 would increase and this change is

also captured in column 8.

Section 213 of Public Law 106–554

provided that all SCHs may elect to receive

payment on the basis of their costs per case

during their cost reporting period that began

during 1996. For FY 2002, eligible SCHs that

rebase receive a hospital-specific rate

comprised of 50 percent of the higher of their

FY 1982 or FY 1987 hospital-specific rate or

their Federal rate, and 50 percent of their

1996 hospital-specific rate. The impact of

this provision is modeled in column 8 as

well.

There might also be interactive effects

among the various factors comprising the

payment system that we are not able to

isolate. For these reasons, the values in

column 7 may not equal the sum of the

changes in columns 5 and 6, plus the other

impacts that we are able to identify.

Hospitals in urban areas experience a 1.7

percent increase in payments per case

compared to FY 2001. The 0.7 percent

22874 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

negative impact due to reclassification is

offset by a similar negative impact for FY

2001 of 0.4 percent (65 FR 47196). Hospitals

in rural areas, meanwhile, experience a 3.2

percent payment increase. This is primarily

due to the change in the DSH threshold to

15 percent for all hospitals enacted by

section 211 of Public Law 106–554 and

effective for discharges on or after April 1,

2001, and the positive effect of the

reclassification changes (2.7 percent increase,

plus an additional 0.1 percent increase from

the proposal to include the wage data for a

reclassified hospital in both the area to which

it is reclassified and the area where the

hospital is physically located).

The impact of lowering the DSH threshold

is demonstrated in Column 8, although we

would note that the estimated FY 2001

payments do reflect 6 months of payments to

hospitals affected by this change. The

impacts are seen in the rows displaying

urban hospitals with fewer than 100 beds

receiving DSH (3.3 percent increase), and all

rural DSH categories.

Among urban census divisions, payments

increased between 0.2 and 3.0 percent

between FY 2001 and FY 2002. The rural

census division experiencing the smallest

increase in payments was the Mid-Atlantic

region (2.2 percent). The largest increases by

rural hospitals is in Puerto Rico, where

payments appear to increase by 8.4 percent

and West South Central, where payments

appear to increase by 4.2 percent. Rural New

England and South Atlantic regions also

benefited with 3.7 and 3.6 percent

respectively.

Among special categories of rural

hospitals, those hospitals receiving payment

under the hospital-specific methodology

(SCHs, MDHs, and SCH/RRCs) experience

payment increases of 3.1 percent, 3.7 percent,

and 3.2 percent, respectively. This outcome

is primarily related to the fact that, for

hospitals receiving payments under the

hospital-specific methodology, there are no

outlier payments. Therefore, these hospitals

do not experience negative payment impacts

from the decline in outlier payments from FY

2001 to FY 2002 (from 5.9 percent of total

DRG plus outlier payments to 5.1 percent) as

do hospitals paid based on the national

standardized amounts.

Among hospitals that were reclassified for

FY 2002, hospitals overall are estimated to

receive a 2.9 percent increase in payments.

Urban hospitals reclassified for FY 2002 are

anticipated to receive an increase of 2.0

percent, while rural reclassified hospitals are

expected to benefit from reclassification with

a 3.6 percent increase in payments. Overall,

among hospitals reclassified for purposes of

the standardized amount, only a payment

increase of 4.0 percent is expected, while

those hospitals reclassified for purposes of

the wage index only show an expected 2.5

percent increase in payments. Those

hospitals located in rural counties but

deemed to be urban under section

1886(d)(8)(B) of the Act are expected to

receive an increase in payments of 3.9

percent.

TABLE II.—IMPACT ANALYSIS OF CHANGES FOR FY 2001 OPERATING PROSPECTIVE PAYMENT SYSTEM

[Payments per case]

Number

of hosps.

(1)

Average FY

2001

payment per

case 1

(2)

Average FY

2001

payment per

case 1

(3)

All FY 2001

changes

(4)

By Geographic Location:

All hospitals .............................................................................................................. 4,795 6,969 7,100 1.9

Urban hospitals ......................................................................................................... 2,721 7,548 7,674 1.7

Large urban areas (populations over 1 million) ....................................................... 1,563 8,087 8,207 1.5

Other urban areas (populations of 1 million of fewer) ............................................. 1,158 6,854 6,989 2.0

Rural hospitals .......................................................................................................... 2,074 4,705 4,856 3.2

Bed Size (Urban):

0–99 beds ................................................................................................................. 712 5,114 5,220 2.1

100–199 beds ........................................................................................................... 943 6,294 6,397 1.6

200–299 beds ........................................................................................................... 530 7,192 7,320 1.8

300–499 beds ........................................................................................................... 391 8,127 8,261 1.6

500 or more beds ..................................................................................................... 145 9,946 10,099 1.5

Bed Size (Rural):

0–49 beds ................................................................................................................. 1,209 3,922 4,041 3.0

50–99 beds ............................................................................................................... 520 4,410 4,554 3.3

100–149 beds ........................................................................................................... 204 4,780 4,922 3.0

150–199 beds ........................................................................................................... 75 5,291 5,470 3.4

200 or more beds ..................................................................................................... 66 5,961 6,173 3.6

Urban by Region:

New England ............................................................................................................ 139 8,077 8,214 1.7

Middle Atlantic .......................................................................................................... 417 8,561 8,579 0.2

South Atlantic ........................................................................................................... 395 7,183 7,386 2.8

East North Central .................................................................................................... 462 7,210 7,323 1.6

East South Central ................................................................................................... 160 6,771 6,973 3.0

West North Central ................................................................................................... 189 7,287 7,430 2.0

West South Central .................................................................................................. 342 7,039 7,087 0.7

Mountain ................................................................................................................... 137 7,282 7,454 2.4

Pacific ....................................................................................................................... 434 8,840 9,037 2.2

Puerto Rico ............................................................................................................... 46 3,235 3,319 2.6

Rural by Region:

New England ............................................................................................................ 49 5,615 5,821 3.7

Middle Atlantic .......................................................................................................... 74 5,052 5,165 2.2

South Atlantic ........................................................................................................... 267 4,871 5,046 3.6

East North Central .................................................................................................... 273 4,743 4,875 2.8

East South Central ................................................................................................... 263 4,398 4,556 3.6

West North Central ................................................................................................... 479 4,506 4,620 2.5

West South Central .................................................................................................. 331 4,177 4,351 4.2

Mountain ................................................................................................................... 194 5,020 5,166 2.9

Pacific ....................................................................................................................... 139 5,762 5,920 2.7

Puerto Rico ............................................................................................................... 5 2,529 2,742 8.4

By Payment Classification:

Urban hospitals ......................................................................................................... 2,766 7,526 7,652 1.7

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22875

TABLE II.—IMPACT ANALYSIS OF CHANGES FOR FY 2001 OPERATING PROSPECTIVE PAYMENT SYSTEM—Continued

[Payments per case]

Number

of hosps.

(1)

Average FY

2001

payment per

case 1

(2)

Average FY

2001

payment per

case 1

(3)

All FY 2001

changes

(4)

Large urban areas (populations over 1 million) ....................................................... 1,643 8,002 8,121 1.5

Other urban areas (populations of 1 million of fewer) ............................................. 1,123 6,870 7,008 2.0

Rural areas ............................................................................................................... 2,029 4,687 4,838 3.2

Teaching Status:

Non-teaching ............................................................................................................ 3,674 5,605 5,728 2.2

Fewer than 100 Residents ....................................................................................... 881 7,309 7,445 1.9

100 or more Residents ............................................................................................. 240 11,258 11,410 1.3

Urban DSH:

Non-DSH .................................................................................................................. 1,879 6,354 6,461 1.7

100 or more beds ..................................................................................................... 1,378 8,129 8,267 1.7

Less than 100 beds .................................................................................................. 325 4,925 5,089 3.3

Rural DSH:

Sole Community (SCH) ............................................................................................ 540 4,295 4,427 3.1

Referral Center (RRC) .............................................................................................. 157 5,521 5,723 3.7

Other Rural:

100 or more beds .............................................................................................. 73 4,304 4,441 3.2

Less than 100 beds ........................................................................................... 443 3,928 4,095 4.3

Urban teaching and DSH:

Both teaching and DSH ............................................................................................ 754 9,091 9,238 1.6

Teaching and no DSH .............................................................................................. 295 7,562 7,683 1.6

No teaching and DSH .............................................................................................. 949 6,298 6,424 2.0

No teaching and no DSH ......................................................................................... 768 5,932 6,022 1.5

Rural Hospital Types:

Non special status hospitals ............................................................................. 800 4,042 4,186 3.6

RRC ................................................................................................................... 165 5,434 5,630 3.6

SCH ................................................................................................................... 667 4,562 4,676 2.5

Medicare-dependent hospitals (MDH) .............................................................. 328 3,844 3,966 3.2

SCH and RRC ................................................................................................... 69 5,649 5,803 2.7

Type of Ownership:

Voluntary ........................................................................................................... 2,785 7,136 7,261 1.8

Proprietary ......................................................................................................... 777 6,580 6,712 2.0

Government ....................................................................................................... 1,187 6,486 6,651 2.5

Unknown .................................................................................................... 46 6,283 6,449 2.6

Medicare Utilization as a Percent of Inpatient Days:

0–25 ................................................................................................................... 396 9,504 9,713 2.2

25–50 ................................................................................................................. 1,886 8,030 8,164 1.7

50–65 ................................................................................................................. 1,843 6,012 6,142 2.2

Over 65 .............................................................................................................. 592 5,393 5,497 1.9

Unknown ................................................................................................................... 78 10,244 10,132 ¥1.1

Hospitals Reclassified by the Medicare Geographic Classification Review Board: FY

2002 Reclassifications:

All Reclassified Hospitals ......................................................................................... 636 6,153 6,334 2.9

Standardized Amount Only ...................................................................................... 74 5,200 5,407 4.0

Wage Index Only ...................................................................................................... 391 6,004 6,152 2.5

Both .......................................................................................................................... 58 6,818 6,816 0.0

All Nonreclassified Hospitals ........................................................................................... 4,246 7,105 7,236 1.9

All Urban Reclassified Hospitals ..................................................................................... 119 8,253 8,415 2.0

Urban Nonreclassified Hospitals ..................................................................................... 18 6,176 6,136 ¥0.6

Standardized Amount Only ...................................................................................... 81 8,946 9,141 2.2

Wage Index Only ...................................................................................................... 20 6,193 6,346 2.5

Both .......................................................................................................................... 2,564 7,531 7,654 1.6

All Reclassified Rural Hospitals ....................................................................................... 517 5,277 5,466 3.6

Standardized Amount Only ...................................................................................... 19 4,658 4,750 2.0

Wage Index Only ...................................................................................................... 475 5,283 5,472 3.6

Both .......................................................................................................................... 23 5,396 5,622 4.2

Rural Nonreclassified Hospitals ....................................................................................... 1,554 4,153 4,268 2.8

Other Reclassified Hospitals (Section 1886(D)(8)(B)) .................................................... 41 4,841 5,032 3.9

1These payment amounts per case do not reflect any estimates of annual case-mix increase.

Table II presents the projected impact of

the proposed changes for FY 2002 for urban

and rural hospitals and for the different

categories of hospitals shown in Table I. It

compares the estimated payments per case

for FY 2001 with the average estimated per

case payments for FY 2002, as calculated

under our models. Thus, this table presents,

in terms of the average dollar amounts paid

per discharge, the combined effects of the

changes presented in Table I. The percentage

changes shown in the last column of Table

II equal the percentage changes in average

payments from column 8 of Table I.

22876 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

VIII. Impact for Critical Access Hospitals

(CAHs)

There are approximately 365 facilities that

qualify as CAHs. These CAHs are paid based

on reasonable costs for their services to

inpatients and outpatients. We examined

several parts of the proposed rule, as

discussed in detail in section VI.B. of the

preamble, for their potential impact on

CAHs.

A. Exclusion of CAHs From Payment Window

Requirements

In this proposed rule, we are proposing to

clarify the policy that CAHs are not subject

to the payment window provisions of section

1886(a)(3) of the Act. Existing regulations do

not require that these provisions be applied

to CAHs, and we are not aware of specific

situations in which they are now being

applied. Consequently, we do not expect any

increase or decrease in Medicare spending

based on this clarification.

B. Availability of CRNA Pass-Through for

CAHs

Under existing § 412.113(c), CRNA passthrough payment is available only to

hospitals that either qualified for the passthrough of costs of anesthesia services

furnished in calendar year 1989, or employed

or contracted with a qualified nonphysician

anesthetist as of January 1, 1988, to perform

anesthesia services. We are proposing that

certain CAHs that meet the pass-through

criteria would qualify for pass-through

payments. Under the existing criterion, the

only facilities that could qualify for the passthrough as CAHs are those that would have

qualified for the pass-through if they had

elected to continue participating in Medicare

as hospitals rather than converting to CAH

status. We do not expect any increase or

decrease in Medicare spending based on the

proposed change in the regulations.

C. Payment for Emergency Room On-Call

Physicians

In accordance with the amendments made

by section 204 of Public Law 106–544, we are

proposing to recognize as allowable costs,

amounts for reasonable compensation and

related costs for emergency room physicians

who are on call but who are not present on

the premises of a CAH. We expect that at

least some CAHs will elect to compensate

emergency room physicians for being on call,

and that as a result, Medicare spending for

CAH services will increase. However, we do

not have information to develop a reliable

estimate of how many CAHs will make this

election, or how much physician

compensation costs they will incur for on

call time.

D. Treatment of Ambulance Services

Furnished by Certain CAHs

In accordance with the provisions of

section 205 of Public Law 106–554, we are

proposing to amend the existing CAH

regulations to provide for payment to CAHs

for the reasonable costs of ambulance

services furnished by a CAH or an entity

owned or operated by the CAH if certain

statutory requirements are met. We expect

that at least some CAHs or entities owned or

operated by CAHs will be able to qualify for

payment for their ambulance services. To the

extent that CAHs or CAH owned or operated

entities furnish these services under the

conditions specified in the law, ambulance

services will be paid for at higher rates than

would otherwise apply. As a result, Medicare

spending for ambulance services will

increase. However, we do not have sufficient

information or data to develop a reliable

estimate of how many CAHs or entities will

qualify or the dollar amount of ambulance

service costs they will incur.

E. Qualified Practitioners for Preanesthesia

and Postanesthesia Evaluations in CAHs

As discussed in section VI.B. of this

proposed rule, in an effort to eliminate or

minimize potential issues relating to

beneficiary access to medical services in

rural areas, we are proposing to allow CRNAs

who administer the anesthesia to conduct the

preanesthesia and postanesthesia evaluations

in a CAH. As with any licensed independent

health care provider, the proposed change

would not permit CRNAs to practice beyond

his or her licensed scope of practice.

We believe that this proposal would

increase flexibility of providers in furnishing

medical services in rural areas. However, we

do not have information or data to develop

a reliable estimate of how many CRNAs

would be used to conduct preanesthesia and

postanesthesia evaluations in CAHs or what

the associated costs would be.

IX. Impact of Proposed Changes in the

Capital Prospective Payment System

A. General Considerations

We now have cost report data for the 8th

year of the capital prospective payment

system (cost reports beginning in FY 1999)

available through the December 2000 update

of the HCRIS. We also have updated

information on the projected aggregate

amount of obligated capital approved by the

fiscal intermediaries. However, our impact

analysis of payment changes for capitalrelated costs is still limited by the lack of

hospital-specific data on several items. These

are the hospital’s projected new capital costs

for each year, its projected old capital costs

for each year, and the actual amounts of

obligated capital that will be put in use for

patient care and recognized as Medicare old

capital costs in each year. The lack of this

information affects our impact analysis in the

following ways:

• Major investment in hospital capital

assets (for example, in building and major

fixed equipment) occurs at irregular

intervals. As a result, there can be significant

variation in the growth rates of Medicare

capital-related costs per case among

hospitals. We do not have the necessary

hospital-specific budget data to project the

hospital capital growth rate for individual

hospitals.

• Our policy of recognizing certain

obligated capital as old capital makes it

difficult to project future capital-related costs

for individual hospitals. Under § 412.302(c),

a hospital is required to notify its

intermediary that it has obligated capital by

the later of October 1, 1992, or 90 days after

the beginning of the hospital’s first cost

reporting period under the capital

prospective payment system. The

intermediary must then notify the hospital of

its determination whether the criteria for

recognition of obligated capital have been

met by the later of the end of the hospital’s

first cost reporting period subject to the

capital prospective payment system or 9

months after the receipt of the hospital’s

notification. The amount that is recognized

as old capital is limited to the lesser of the

actual allowable costs when the asset is put

in use for patient care or the estimated costs

of the capital expenditure at the time it was

obligated. We have substantial information

regarding fiscal intermediary determinations

of projected aggregate obligated capital

amounts. However, we still do not know

when these projects will actually be put into

use for patient care, the actual amount that

will be recognized as obligated capital when

the project is put into use, or the Medicare

share of the recognized costs. Therefore, we

do not know actual obligated capital

commitments for purposes of the FY 2002

capital cost projections. In Appendix B of

this proposed rule, we discuss the

assumptions and computations that we

employ to generate the amount of obligated

capital commitments for use in the FY 2002

capital cost projections.

In Table III of this section, we present the

redistributive effects that are expected to

occur between ‘‘hold-harmless’’ hospitals

and ‘‘fully prospective’’ hospitals in FY 2002.

In addition, we have integrated sufficient

hospital-specific information into our

actuarial model to project the impact of the

proposed FY 2002 capital payment policies

by the standard prospective payment system

hospital groupings. While we now have

actual information on the effects of the

transition payment methodology and interim

payments under the capital prospective

payment system and cost report data for most

hospitals, we still need to randomly generate

numbers for the change in old capital costs,

new capital costs for each year, and obligated

amounts that will be put in use for patient

care services and recognized as old capital

each year. We continue to be unable to

predict accurately FY 2002 capital costs for

individual hospitals, but with the most

recent data on hospitals’ experience under

the capital prospective payment system,

there is adequate information to estimate the

aggregate impact on most hospital groupings.

B. Projected Impact Based on the Proposed

FY 2002 Actuarial Model

1. Assumptions

In this impact analysis, we model

dynamically the impact of the capital

prospective payment system from FY 2001 to

FY 2002 using a capital cost model. The FY

2002 model, as described in Appendix B of

this proposed rule, integrates actual data

from individual hospitals with randomly

generated capital cost amounts. We have

capital cost data from cost reports beginning

in FY 1989 through FY 1999 as reported on

the December 2000 update of HCRIS, interim

payment data for hospitals already receiving

capital prospective payments through

PRICER, and data reported by the

intermediaries that include the hospitalVerDate 11<MAY>2000 08:37 May 04, 2001 Jkt 194001 PO 00000 Frm 00232 Fmt 4701 Sfmt 4701 E:\FR\FM\04MYP2.SGM pfrm09 PsN: 04MYP2
Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22877

specific rate determinations that have been

made through January 1, 2001 in the

provider-specific file. We used these data to

determine the proposed FY 2002 capital

rates. However, we do not have individual

hospital data on old capital changes, new

capital formation, and actual obligated

capital costs. We have data on costs for

capital in use in FY 1999, and we age that

capital by a formula described in Appendix

B. Therefore, we need to randomly generate

only new capital acquisitions for any year

after FY 1999. All Federal rate payment

parameters are assigned to the applicable

hospital. We will continue to pay regular

exceptions during cost reporting periods

beginning before October 1, 2001 but ending

in FY 2002. However, in FY 2003 and later,

payments will no longer be made under the

regular exceptions provision, hence, we will

no longer require the actuarial model

described in Appendix B of this proposed

rule.

For purposes of this impact analysis, the

proposed FY 2002 actuarial model includes

the following assumptions:

• Medicare inpatient capital costs per

discharge will change at the following rates

during these periods:

AVERAGE PERCENTAGE CHANGE IN

CAPITAL COSTS PER DISCHARGE

Fiscal year Percentage

change

2000 .......................................... 1.39

2001 .......................................... 1.37

2002 .......................................... 2.58

• We estimate that the Medicare case-mix

index will increase by 0.0 percent in FY 2001

and will increase by 1.0 percent in FY 2002.

• The Federal capital rate and the hospitalspecific rate were updated beginning in FY

1996 by an analytical framework that

considers changes in the prices associated

with capital-related costs and adjustments to

account for forecast error, changes in the

case-mix index, allowable changes in

intensity, and other factors. The proposed FY

2002 update is 1.1 percent (see section IV. of

the Addendum to this proposed rule).

2. Results

We have used the actuarial model to

estimate the change in payment for capitalrelated costs from FY 2001 to FY 2002. Table

III shows the effect of the capital prospective

payment system on low capital cost hospitals

and high capital cost hospitals. We consider

a hospital to be a low capital cost hospital

if, based on a comparison of its initial

hospital-specific rate and the applicable

Federal rate, it will be paid under the fully

prospective payment methodology. A high

capital cost hospital is a hospital that, based

on its initial hospital-specific rate and the

applicable Federal rate, will be paid under

the hold-harmless payment methodology. We

are no longer displaying a column for the

hospital-specific payments in Table III since

the FY 2001 transition blend percentage for

fully prospective hospitals is 100 percent of

the Federal rate and zero percent of the

hospital-specific rate, and all hospitals

(except those defined as ‘‘new’’ under

§ 412.300) are paid based on 100 percent of

the Federal rate for FY 2002. Based on our

actuarial model, the breakdown of hospitals

is as follows:

CAPITAL TRANSITION PAYMENT METHODOLOGY FOR FY 2002

Type of hospital Percent of

hospitals

Percent of

discharges

Percent of

capital costs

Percent of

capital payments

Low Cost Hospital ............................................................................................................ 66 62 57 61

High Cost Hospital ........................................................................................................... 34 38 43 39

A low capital cost hospital may request to

have its hospital-specific rate redetermined

based on old capital costs in the current year,

through the later of the hospital’s cost

reporting period beginning in FY 1994 or the

first cost reporting period beginning after

obligated capital comes into use (within the

limits established in § 412.302(c) for putting

obligated capital into use for patient care). If

the redetermined hospital-specific rate is

greater than the adjusted Federal rate, these

hospitals will be paid under the holdharmless payment methodology. Regardless

of whether the hospital became a holdharmless payment hospital as a result of a

redetermination, we continue to show these

hospitals as low capital cost hospitals in

Table III.

Assuming no behavioral changes in capital

expenditures, Table III displays the

percentage change in payments from FY 2001

to FY 2002 using the above described

actuarial model. With the proposed Federal

rate, we estimate aggregate Medicare capital

payments will increase by 3.80 percent in FY

2002. This increase is somewhat lower than

last year’s (5.48 percent) due in part to the

fact that because the transition period ends

after FY 2001, there is no longer an increase

in the Federal blend percentage, which

increased from 90 to 100 percent from FY

2000 to FY 2001, for fully prospective

hospitals.

TABLE III.—IMPACT OF PROPOSED CHANGES FOR FY 2002 ON PAYMENTS PER DISCHARGE

Number of

hospitals Discharges

Adjusted

Federal

payment

Average

Federal

percent

Hold

harmless

payment

Exceptions

payment

Total

payment

Percent

change over

FY 2001

FY 2001 Payments per

Discharge

Low Cost Hospitals 3,128 6,718,804 $626.20 99.70 $2.38 $5.69 $634.27 ....................

Fully Prospective .............. 2,945 6,231,764 627.54 100.00 .................... 5.09 632.63 ....................

100% Federal

Rate ............ 163 451,843 627.89 100.00 .................... 7.75 635.64 ....................

Hold Harmless 20 35,197 367.32 50.30 454.71 85.44 907.47 ....................

High Cost Hospitals .................. 1,577 4,110,246 636.96 97.69 19.34 10.64 666.93 ....................

100% Federal

Rate ............ 1,386 3,744,619 648.86 100.00 .................... 8.82 657.68 ....................

Hold Harmless 191 365,627 515.12 75.29 217.38 29.23 761.73 ....................

Total Hospitals .... 4,705 10,829,050 630.28 98.92 8.82 7.57 646.67 ....................

FY 2002 Payments per

Discharge

Low Cost Hospitals 3,128 6,826,288 647.17 100.00 .................... 3.19 650.36 2.54

22878 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE III.—IMPACT OF PROPOSED CHANGES FOR FY 2002 ON PAYMENTS PER DISCHARGE—Continued

Number of

hospitals Discharges

Adjusted

Federal

payment

Average

Federal

percent

Hold

harmless

payment

Exceptions

payment

Total

payment

Percent

change over

FY 2001

Fully Prospective .............. 2,945 6,331,437 646.59 100.00 .................... 2.96 649.55 2.68

100% Federal

Rate ............ 183 494,852 654.56 100.00 .................... 6.11 660.67 3.94

High Cost Hospitals .................. 1,577 4,176,324 671.77 100.00 .................... 5.72 677.49 1.58

100% Federal

Rate ............ 1,577 4,176,324 671.77 100.00 .................... 5.72 677.49 3.01

Total Hospitals .... 4,705 11,002,612 656.51 100.00 .................... 4.15 660.66 2.16

We project that low capital cost hospitals

paid under the fully prospective payment

methodology will experience an average

increase in payments per case of 2.54

percent, and high capital cost hospitals will

experience an average increase of 1.58

percent. These results are due to the fact that

there is no longer an increase in the Federal

blend percentage with the conclusion of the

capital transition period in FY 2001 for fully

prospective hospitals. Beginning FY 2002, all

hospitals (except those defined as ‘‘new’’

under § 412.300) are paid based on 100

percent of the Federal rate for FY 2002.

For hospitals paid under the fully

prospective payment methodology, the

Federal rate payment percentage remains at

100 percent from FY 2001 (last year of the

transition period) since they no longer

receive payments based on the hospitalspecific rate. The Federal rate payment

percentage in FY 2001 for hospitals paid

under the hold-harmless payment

methodology is based on the hospital’s ratio

of new capital costs to total capital costs. The

average Federal rate payment percentage for

high cost hospitals receiving a hold-harmless

payment for old capital in FY 2001 will

increase from 75.29 percent to 100 percent

since the transition period will have ended.

All hold-harmless hospitals will be paid

based on 100 percent of the Federal rate in

FY 2002. We estimate that high cost hospitals

(paid based on 100 percent of the Federal

rate) will receive a decrease in exceptions

payments from $8.82 per discharge in FY

2001 to $5.72 per discharge in FY 2002. This

is primarily due to the expiration of the

regular exceptions provision in FY 2002.

We are no longer presenting the average

hospital-specific rate payment per discharge

in Table III because the FY 2001 transition

blend percentage for fully prospective

hospitals is 100 percent of the Federal rate

and zero percent of the hospital-specific rate,

and all hospitals (except those defined as

‘‘new’’ under § 412.300) will be paid based

on 100 percent of the Federal rate for FY

2002.

As stated previously, we will continue to

pay regular exceptions for cost reporting

periods beginning before October 1, 2001, but

ending in FY 2002. However, in FY 2003 and

later, regular exception payments will no

longer be made under the regular exceptions

provision, however, eligible hospitals could

receive special exception payments under

§ 412.348(g).

We estimate that regular exceptions

payments will decrease from 1.17 percent of

total capital payments in FY 2001 to 0.63

percent of payments in FY 2002. These

results are primarily due to the expiration of

the regular exceptions after FY 2001 and the

limited nature of the special exceptions

policy in FY 2002. The projected distribution

of the exception payments is shown in the

chart below:

ESTIMATED FY 2002 EXCEPTIONS

PAYMENTS

Type of hospital Number of

hospitals

Percent of

exceptions

payments

Low Capital

Cost ............... 122 48

High Capital

Cost ............... 116 52

Total ....... 238 100

In the past we presented a cross-sectional

summary of hospital groupings by the capital

prospective payment transition period

methodology generated by our actuarial

model (Appendix B). We are no longer

including such a comparison since all

hospitals (except those defined as ‘‘new’’

under § 412.300) will be paid based on 100

percent of the Federal rate in FY 2002 with

the conclusion of the 10-year capital

transition period.

C. Cross-Sectional Analysis of Changes in

Aggregate Payments

We used our FY 2002 actuarial model to

estimate the potential impact of our proposed

changes for FY 2002 on total capital

payments per case, using a universe of 4,705

hospitals. The individual hospital payment

parameters are taken from the best available

data, including: The January 1, 2001 update

to the provider-specific file, cost report data,

and audit information supplied by

intermediaries. In Table IV we present the

results of the cross-sectional analysis using

the results of our actuarial model and the

aggregate impact of the proposed FY 2002

payment policies. As we explain in

Appendix B of this proposed rule, we were

not able to use 90 of the 4,795 hospitals in

our database due to insufficient (missing or

unusable) data. Consequently, the payment

methodology distribution is based on 4,705

hospitals. These data should be fully

representative of the payment methodologies

that will be applicable to hospitals. Columns

3 and 4 show estimates of payments per case

under our model for FY 2001 and FY 2002.

Column 5 shows the total percentage change

in payments from FY 2001 to FY 2002.

Column 6 presents the percentage change in

payments that can be attributed to Federal

rate changes alone.

Federal rate changes represented in

Column 6 include the 1.85 percent increase

in the Federal rate, a 1.0 percent increase in

case mix, changes in the adjustments to the

Federal rate (for example, the effect of the

new hospital wage index on the geographic

adjustment factor), and reclassifications by

the MGCRB. Column 5 includes the effects of

the Federal rate changes represented in

Column 6. Column 5 also reflects the effects

of all other changes, including the change for

all hold-harmless hospitals being paid based

on 100 percent of the Federal rate, and

changes in exception payments. The

comparisons are provided by: (1) Geographic

location, (2) region, and (3) payment

classification.

The simulation results show that, on

average, capital payments per case can be

expected to increase 2.2 percent in FY 2002.

The results show that the effect of the Federal

rate change alone is to increase payments by

3.0 percent. In addition to the increase

attributable to the Federal rate change, a 0.8

percent decrease is attributable to the effects

of all other changes.

Our comparison by geographic location

shows an overall increase in payments to

hospitals in all areas. This comparison also

shows that urban and rural hospitals will

experience slightly different rates of increase

in capital payments per case (2.3 percent and

1.2 percent, respectively). This difference is

due to the lower rate of decrease for urban

hospitals relative to rural hospitals (0.7

percent and 1.7 percent, respectively) from

the effect of all other changes. Urban

hospitals will gain approximately the same as

rural hospitals (3.0 percent versus 2.9

percent, respectively) from the effects of

Federal rate changes alone.

Most regions are estimated to receive

increases in total capital payments per case,

partly due to the fact that payments to all

hospitals (except those defined as ‘‘new’’

under § 412.300) will be based on 100

percent of the Federal rate in FY 2002.

Changes by region vary from a minimum

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22879

maximum decrease of 0.6 percent (Mountain

urban region) to a maximum increase of 3.0

percent (New England urban rural region).

By type of ownership, voluntary hospitals

are projected to have the largest rate of

increase of total payment changes (2.5

percent, a 3.0 percent increase due to the

Federal rate changes, and a 0.5 percent

decrease from the effects of all other

changes). Similarly, payments to government

hospitals will increase 2.2 percent (a 3.0

percent increase due to Federal rate changes,

and a 0.8 percent decrease from the effects

of all other changes), while payments to

proprietary hospitals will increase 0.5

percent (a 2.9 percent increase due to Federal

rate changes, and a 2.4 percent decrease from

the effects of all other changes). This 2.4

percent decrease from all other changes is

primarily due to the estimated decrease in

exceptions payments and the change for all

hold-harmless hospitals being paid based on

100 percent of the Federal rate.

Section 1886(d)(10) of the Act established

the MGCRB. Hospitals may apply for

reclassification for purposes of the

standardized amount, wage index, or both

and for purposes of DSH for FYs 1999

through 2001. Although the Federal capital

rate is not affected, a hospital’s geographic

classification for purposes of the operating

standardized amount does affect a hospital’s

capital payments as a result of the large

urban adjustment factor and the

disproportionate share adjustment for urban

hospitals with 100 or more beds.

Reclassification for wage index purposes also

affects the geographic adjustment factor,

since that factor is constructed from the

hospital wage index.

To present the effects of the hospitals being

reclassified for FY 2001 compared to the

effects of reclassification for FY 2000, we

show the average payment percentage

increase for hospitals reclassified in each

fiscal year and in total. For FY 2001

reclassifications, we indicate those hospitals

reclassified for standardized amount

purposes only, for wage index purposes only,

and for both purposes. The reclassified

groups are compared to all other

nonreclassified hospitals. These categories

are further identified by urban and rural

designation.

Hospitals reclassified for FY 2001 as a

whole are projected to experience a 2.0

percent increase in payments (a 3.0 percent

increase attributable to Federal rate changes

and a 1.0 percent decrease attributable to the

effects of all other changes). Payments to

nonreclassified hospitals will increase

slightly more (2.2 percent) than reclassified

hospitals (2.0 percent) overall. Payments to

nonreclassified hospitals will increase the

same as reclassified hospitals from the

Federal rate changes (3.0 percent), and they

will lose less from the effects of all other

changes (0.8 percent compared to 1.0

percent, respectively).

TABLE IV.—COMPARISON OF TOTAL PAYMENTS PER CASE

[FY 2001 Payments Compared to FY 2002 Payments]

Number of

hospitals

Average FY

2001 payments/case

Average FY

2002

payments/case

All

changes

Portion

attributable to

Federal

rate change

By Geographic Location:

All hospitals ................................................................... 4,705 647 661 2.2 3.0

Large urban areas (populations over 1 million) ........... 1,519 749 766 2.3 3.0

Other urban areas (populations of 1 million or fewer) 1,125 635 650 2.4 3.0

Rural areas ................................................................... 2,061 439 444 1.2 2.9

Urban hospitals ............................................................. 2,644 699 716 2.3 3.0

0–99 beds .............................................................. 654 522 507 –2.8 2.8

100–199 beds ........................................................ 927 596 607 1.8 2.9

200–299 beds ........................................................ 528 667 684 2.6 3.0

300–499 beds ........................................................ 390 739 762 3.1 3.0

500 or more beds .................................................. 145 902 925 2.6 2.9

Rural hospitals .............................................................. 2,061 439 444 1.2 2.9

0–49 beds .............................................................. 1,200 369 372 1.0 2.9

50–99 beds ............................................................ 516 412 416 1.0 2.9

100–149 beds ........................................................ 204 452 457 1.1 2.9

150–199 beds ........................................................ 75 485 495 2.2 2.9

200 or more beds .................................................. 66 548 553 1.0 3.0

By Region:

Urban by Region ........................................................... 2,644 699 716 2.3 3.0

New England ......................................................... 138 745 768 3.0 3.0

Middle Atlantic ....................................................... 407 782 800 2.4 2.9

South Atlantic ........................................................ 393 669 684 2.2 3.0

East North Central ................................................. 448 672 690 2.7 3.0

East South Central ................................................ 156 638 655 2.7 2.9

West North Central ................................................ 181 688 708 2.9 3.0

West South Central ............................................... 321 665 673 1.3 2.9

Mountain ................................................................ 127 702 698 –0.6 2.9

Pacific .................................................................... 427 787 808 2.7 3.0

Puerto Rico ............................................................ 46 295 304 3.1 3.1

Rural by Region ............................................................ 2,061 439 444 1.2 2.9

New England ......................................................... 49 522 534 2.3 3.0

Middle Atlantic ....................................................... 73 463 469 1.5 2.9

South Atlantic ........................................................ 267 457 458 0.1 2.9

East North Central ................................................. 273 449 455 1.4 2.9

East South Central ................................................ 260 410 415 1.2 2.9

West North Central ................................................ 477 422 428 1.4 2.9

West South Central ............................................... 325 390 398 2.1 2.9

Mountain ................................................................ 193 466 467 0.1 2.8

Pacific .................................................................... 139 520 530 2.0 3.0

By Payment Classification:

All hospitals ................................................................... 4,705 647 661 2.2 3.0

Large urban areas (populations over 1 million) ........... 1,599 742 759 2.3 3.0

Other urban areas (populations of 1 million or fewer) 1,090 636 651 2.4 3.0

Rural areas ................................................................... 2,016 437 442 1.2 2.9

22880 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

TABLE IV.—COMPARISON OF TOTAL PAYMENTS PER CASE—Continued

[FY 2001 Payments Compared to FY 2002 Payments]

Number of

hospitals

Average FY

2001 payments/case

Average FY

2002

payments/case

All

changes

Portion

attributable to

Federal

rate change

Teaching Status:

Non-teaching ......................................................... 3,586 533 540 1.3 2.9

Fewer than 100 Residents .................................... 879 675 695 2.9 3.0

100 or more Residents .......................................... 240 999 1,026 2.7 2.9

Urban DSH:

100 or more beds .................................................. 1,374 734 752 2.4 3.0

Less than 100 beds ............................................... 317 489 491 0.4 2.8

Rural DSH:

Sole Community (SCH/EACH) .............................. 540 395 390 –1.3 2.8

Referral Center (RRC/EACH) ................................ 157 504 511 1.4 2.9

Other Rural:

100 or more beds ........................................... 73 409 419 2.4 2.9

Less than 100 beds ........................................ 439 369 380 2.8 3.0

Urban teaching and DSH:

Both teaching and DSH ......................................... 753 814 836 2.7 3.0

Teaching and no DSH ........................................... 294 717 740 3.3 3.0

No teaching and DSH ........................................... 938 585 595 1.7 2.9

No teaching and no DSH ...................................... 704 590 595 0.9 2.9

Rural Hospital Types:

Non special status hospitals .................................. 788 384 394 2.8 3.0

RRC/EACH ............................................................ 165 504 517 2.6 3.0

SCH/EACH ............................................................ 667 423 417 –1.5 2.8

Medicare-dependent hospitals (MDH) ................... 327 363 365 0.7 2.9

SCH, RRC and EACH ........................................... 69 510 508 –0.4 2.8

Hospitals Reclassified by the Medicare Geographic

Classification Review Board:

Reclassification Status During FY01 and FY02: 482 564 576 2.1 3.0

Reclassified During FY02 Only ............................. 153 571 580 1.6 2.9

FY02 Reclassifications:

All Reclassified Hospitals ...................................... 635 566 577 2.0 3.0

All Nonreclassified Hospitals ................................. 4,157 659 674 2.2 3.0

All Urban Reclassified Hospitals ........................... 119 741 763 2.9 3.0

Urban Nonreclassified Hospitals ........................... 2,487 699 715 2.3 3.0

All Reclassified Rural Hospitals ............................ 516 492 499 1.4 2.9

Rural Nonreclassified Hospitals ............................ 1,542 388 392 0.9 2.9

Other Reclassified Hospitals (Section 1886(D)(8)(B)). 41 461 455 –1.3 2.9

Type of Ownership:

Voluntary ................................................................ 2,769 660 677 2.5 3.0

Proprietary ............................................................. 755 639 642 0.5 2.9

Government ........................................................... 1,179 581 594 2.2 3.0

Medicare Utilization as a Percent of Inpatient Days:

0–25 ....................................................................... 389 825 846 2.5 3.0

25–50 ..................................................................... 1,872 736 755 2.5 3.0

50–65 ..................................................................... 1,832 568 580 2.2 3.0

Over 65 .................................................................. 585 522 519 –0.7 2.9

Appendix B: Technical Appendix on

the Capital Cost Model and Required

Adjustments

Under section 1886(g)(1)(A) of the Act, we

set capital prospective payment rates for FY

1992 through FY 1995 so that aggregate

prospective payments for capital costs were

projected to be 10 percent lower than the

amount that would have been payable on a

reasonable cost basis for capital-related costs

in that year. To implement this requirement,

we developed the capital acquisition model

to determine the budget neutrality

adjustment factor. Even though the budget

neutrality requirement expired effective with

FY 1996, we must continue to determine the

recalibration and geographic reclassification

budget neutrality adjustment factor and the

reduction in the Federal and hospital-specific

rates for exceptions payments. To determine

these factors, we must continue to project

capital costs and payments.

We will continue to pay regular exceptions

for cost reporting periods beginning before

October 1, 2001 but ending in FY 2002. In

FY 2003 and later, no payments will be made

under the regular exceptions policy, hence

we will not compute a budget neutrality

factor for regular exceptions in FY 2003 and

later. As described in section V.D. of the

preamble of this proposed rule, the budget

neutrality adjustment for special exceptions

will be based on historical costs.

Consequently, there will be no need to

estimate capital costs with the capital

acquisition model. We will not publish this

appendix after the final rule for the FY 2002

capital rates.

We used the capital acquisition model

from the start of prospective payments for

capital costs through FY 1997. We now have

8 years of cost reports under the capital

prospective payment system. For FY 1998,

we developed a new capital cost model to

replace the capital acquisition model. This

revised model makes use of the data from

these cost reports.

The following cost reports are used in the

capital cost model for this proposed rule: the

December 31, 2000 update of the cost reports

for PPS–IX (cost reporting periods beginning

in FY 1992), PPS–X (cost reporting periods

beginning in FY 1993), PPS–XI (cost

reporting periods beginning in FY 1994),

PPS–XII (cost reporting periods beginning in

FY 1995), PPS–XIII (cost reporting periods

beginning in FY 1996), PPS–XIV (cost

reporting periods beginning in FY 1997),

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22881

PPS–XV (cost reporting periods beginning in

FY 1998), and PPS–XVI (cost reporting

periods beginning in FY 1999). In addition,

to model payments, we use the January 1,

2001 update of the provider-specific file, and

the March 1995 update of the intermediary

audit file.

Since hospitals under alternative payment

system waivers (that is, hospitals in

Maryland) are currently excluded from the

capital prospective payment system, we

excluded these hospitals from our model.

We developed FY 1992 through FY 2001

hospital-specific rates using the providerspecific file and the intermediary audit file.

(We used the cumulative provider-specific

file, which includes all updates to each

hospital’s records, and chose the latest record

for each fiscal year.) We checked the

consistency between the provider-specific

file and the intermediary audit file. We

ensured that increases in the hospitalspecific rates were at least as large as the

published updates (increases) for the

hospital-specific rates each year. We were

able to match hospitals to the files as shown

in the following table:

Source Number of

hospitals

No match .................................. 4

Audit file only ............................ 90

Provider-specific file only .......... 185

Provider-specific and audit file 4,516

Total ............................... 4,795

One hundred eighteen of the 4,795

hospitals had unusable or missing data, or

had no cost reports available. For 52 of the

118 hospitals, we were unable to determine

a hospital-specific rate from the available

cost reports. However, there was adequate

cost information to determine that these

hospitals were paid under the hold-harmless

methodology. Since the hospital-specific rate

is not used to determine payments for

hospitals paid under the hold-harmless

methodology, there was sufficient cost report

information available to include these 52

hospitals in the analysis. We were able to

estimate hospital-specific amounts from the

cost reports as shown in the following table.

Cost report Number of

hospitals

PPS–9 ....................................... 1

PPS–12 ..................................... 1

PPS–13 ..................................... 1

PPS–14 ..................................... 1

PPS–15 ..................................... 2

PPS–16 ..................................... 8

Total ............................... 14

Hence we were able to use 66 (52 plus 14)

of the 118 hospitals. The remaining 52 of the

118 hospitals could not be used in the

analysis because we were not able to estimate

their hospital-specific amount. An additional

38 hospitals could not be used in the analysis

because we could not determine their capital

costs, either because we had no cost reports

for them or because there was insufficient

cost report data. Accordingly, we used 4,705

hospitals for the analysis. Ninety (52 plus 38)

hospitals could not be used in the analysis

because of insufficient (missing or unusable)

information. These hospitals account for

about 0.3 percent of admissions. Therefore,

any effects from the elimination of their cost

report data should be minimal.

We analyzed changes in capital-related

costs (depreciation, interest, rent, leases,

insurance, and taxes) reported in the cost

reports. We found a wide variance among

hospitals in the growth of these costs. For

hospitals with more than 100 beds, the

distribution and mean of these cost increases

were different for large changes in bed-size

(greater than ±20 percent). We also analyzed

changes in the growth in old capital and new

capital for cost reports that provided this

information. For old capital, we limited the

analysis to decreases in old capital. We did

this since the opportunity for most hospitals

to treat ‘‘obligated’’ capital put into service as

old capital has expired. Old capital costs

should decrease as assets become fully

depreciated and as interest costs decrease as

the loan is amortized.

The new capital cost model separates the

hospitals into three mutually exclusive

groups. Hold-harmless hospitals with data on

old capital were placed in the first group. Of

the remaining hospitals, those hospitals with

fewer than 100 beds comprise the second

group. The third group consists of all

hospitals that did not fit into either of the

first two groups. Each of these groups

displayed unique patterns of growth in

capital costs. We found that the gamma

distribution is useful in explaining and

describing the patterns of increase in capital

costs. A gamma distribution is a statistical

distribution that can be used to describe

patterns of growth rates, with the greatest

proportion of rates being at the low end. We

use the gamma distribution to estimate

individual hospital rates of increase as

follows:

(1) For hold-harmless hospitals, old capital

cost changes were fitted to a truncated

gamma distribution, that is, a gamma

distribution covering only the distribution of

cost decreases. New capital costs changes

were fitted to the entire gamma distribution,

allowing for both decreases and increases.

(2) For hospitals with fewer than 100 beds

(small), total capital cost changes were fitted

to the gamma distribution, allowing for both

decreases and increases.

(3) Other (large) hospitals were further

separated into three groups:

• Bed-size decreases over 20 percent

(decrease).

• Bed-size increases over 20 percent

(increase).

• Other (no change).

Capital cost changes for large hospitals

were fitted to gamma distributions for each

bed-size change group, allowing for both

decreases and increases in capital costs. We

analyzed the probability distribution of

increases and decreases in bed size for large

hospitals. We found the probability

somewhat dependent on the prior year

change in bed size and factored this

dependence into the analysis. Probabilities of

bed-size change were determined. Separate

sets of probability factors were calculated to

reflect the dependence on prior year change

in bed size (increase, decrease, and no

change).

The gamma distributions were fitted to

changes in aggregate capital costs for the

entire hospital. We checked the relationship

between aggregate costs and Medicare per

discharge costs. For large hospitals, there was

a small variance, but the variance was larger

for small hospitals. Since costs are used only

for the hold-harmless methodology and to

determine exceptions, we decided to use the

gamma distributions fitted to aggregate cost

increases for estimating distributions of cost

per discharge increases.

Capital costs per discharge calculated from

the cost reports were increased by random

numbers drawn from the gamma distribution

to project costs in future years. Old and new

capital were projected separately for holdharmless hospitals. Aggregate capital per

discharge costs were projected for all other

hospitals. Because the distribution of

increases in capital costs varies with changes

in bed size for large hospitals, we first

projected changes in bed size for large

hospitals before drawing random numbers

from the gamma distribution. Bed-size

changes were drawn from the uniform

distribution with the probabilities dependent

on the previous year bed-size change. The

gamma distribution has a shape parameter

and a scaling parameter. (We used different

parameters for each hospital group, and for

old and new capital.)

We used discharge counts from the cost

reports to calculate capital cost per discharge.

To estimate total capital costs for FY 2000

(the MedPAR data year) and later, we use the

number of discharges from the MedPAR data.

Some hospitals had considerably more

discharges in FY 2000 than in the years for

which we calculated cost per discharge from

the cost report data. Consequently, a hospital

with few cost report discharges would have

a high capital cost per discharge, since fixed

costs would be allocated over only a few

discharges. If discharges increase

substantially, the cost per discharge would

decrease because fixed costs would be

allocated over more discharges. If the

projection of capital cost per discharge is not

adjusted for increases in discharges, the

projection of exceptions would be overstated.

We address this situation by recalculating the

cost per discharge with the MedPAR

discharges if the MedPAR discharges exceed

the cost report discharges by more than 20

percent. We do not adjust for increases of less

than 20 percent because we have not

received all of the FY 2000 discharges, and

we have removed some discharges from the

analysis because they are statistical outliers.

This adjustment reduces our estimate of

exceptions payments, and consequently, the

reduction to the Federal rate for exceptions

is smaller. We will continue to monitor our

modeling of exceptions payments and make

adjustments as needed.

The average national capital cost per

discharge generated by this model is the

combined average of many randomly

generated increases. This average must equal

the projected average national capital cost

per discharge, which we projected separately

22882 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

(outside this model). We adjusted the shape

parameter of the gamma distributions so that

the modeled average capital cost per

discharge matches our projected capital cost

per discharge. The shape parameter for old

capital was not adjusted since we are

modeling the aging of ‘‘existing’’ assets. This

model provides a distribution of capital costs

among hospitals that is consistent with our

aggregate capital projections.

Once each hospital’s capital-related costs

are generated, the model projects capital

payments. We use the actual payment

parameters (for example, the case-mix index

and the geographic adjustment factor) that

are applicable to the specific hospital.

To project capital payments, the model

first assigns the applicable payment

methodology (fully prospective or holdharmless) to the hospital as determined from

the provider-specific file and the cost reports.

The model simulates Federal rate payments

using the assigned payment parameters and

hospital-specific estimated outlier payments.

The case-mix index for a hospital is derived

from the FY 2000 MedPAR file using the FY

2002 DRG relative weights included in

section VI. of the Addendum to this proposed

rule. The case-mix index is increased each

year after FY 2000 based on analysis of past

experiences in case-mix increases. Based on

analysis of recent case-mix increases, we

estimate that case-mix will increase 0.0

percent in FY 2001. We project that case-mix

will increase 1.0 percent in FY 2002. (Since

we are using FY 2000 cases for our analysis,

the FY 2000 increase in case-mix has no

effect on projected capital payments.)

Changes in geographic classification and

revisions to the hospital wage data used to

establish the hospital wage index affect the

geographic adjustment factor. Changes in the

DRG classification system and the relative

weights affect the case-mix index.

Section 412.308(c)(4)(ii) requires that the

estimated aggregate payments for the fiscal

year, based on the Federal rate after any

changes resulting from DRG reclassifications

and recalibration and the geographic

adjustment factor, equal the estimated

aggregate payments based on the Federal rate

that would have been made without such

changes. For FY 2001, the budget neutrality

adjustment factors were 0.99933 for the

national rate and 1.00508 for the Puerto Rico

rate. In determining these factors, we used

the factors from the first half of FY 2001

(October 2000 through March 2001)

published in the August 1, 2000 final rule

since section 547 of Public Law 106–554

specifies that the special increases and

adjustments in effect between April and

October 2001 do not apply for discharges

occurring after FY 2001 and should not be

included in determining the payment rates in

subsequent years.

Since we implemented a separate

geographic adjustment factor for Puerto Rico,

we applied separate budget neutrality

adjustments for the national geographic

adjustment factor and the Puerto Rico

geographic adjustment factor. We applied the

same budget neutrality factor for DRG

reclassifications and recalibration nationally

and for Puerto Rico. Separate adjustments

were unnecessary for FY 1998 and earlier

since the geographic adjustment factor for

Puerto Rico was implemented in FY 1998.

To determine the factors for FY 2002, we

first determined the portions of the Federal

national and Puerto Rico rates that would be

paid for each hospital in FY 2002 based on

its applicable payment methodology. Using

our model, we then compared, separately for

the national rate and the Puerto Rico rate,

estimated aggregate Federal rate payments

based on the FY 2001 DRG relative weights

and the FY 2001 geographic adjustment

factor to estimated aggregate Federal rate

payments based on the FY 2001 relative

weights and the FY 2002 geographic

adjustment factor. In making the comparison,

we held the FY 2002 Federal rate portion

constant and set the other budget neutrality

adjustment factor and the regular and special

exceptions reduction factors to 1.00. To

achieve budget neutrality for the changes in

the national geographic adjustment factor, we

applied an incremental budget neutrality

adjustment of 0.99703 for FY 2002 to the

previous cumulative FY 2001 adjustment of

0.99933, yielding a cumulative adjustment of

0.99637 through FY 2002. For the Puerto

Rico geographic adjustment factor, we

applied an incremental budget neutrality

adjustment of 0.99943 for FY 2002 to the

previous cumulative FY 2001 adjustment of

1.00508, yielding a cumulative adjustment of

1.00450 through FY 2002. We then compared

estimated aggregate Federal rate payments

based on the FY 2001 DRG relative weights

and the FY 2002 geographic adjustment

factors to estimated aggregate Federal rate

payments based on the FY 2002 DRG relative

weights and the FY 2002 geographic

adjustment factors. The incremental

adjustment for DRG classifications and

changes in relative weights would be 0.99428

nationally and for Puerto Rico. The

cumulative adjustments for DRG

classifications and changes in relative

weights and for changes in the geographic

adjustment factors through FY 2002 would be

0.99067 nationally and 0.99876 for Puerto

Rico. The following table summarizes the

adjustment factors for each fiscal year:

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22883

BUDGET NEUTRALITY ADJUSTMENT FOR DRG RECLASSIFICATIONS AND RECALIBRATION AND THE GEOGRAPHIC

ADJUSTMENT FACTORS

Fiscal year

National Puerto Rico

Incremental adjustment Incremental adjustment

Geographic adjustment

factor

DRG reclassifications and

recalibration

Combined Cumulative

Geographic adjustment

factor

DRG reclassifications and

recalibration

Combined Cumulative

1992 ................................................. .................. .................. .................. 1.00000 .................. .................. .................. ..................

1993 ................................................. .................. .................. 0.99800 0.99800 .................. .................. .................. ..................

1994 ................................................. .................. .................. 1.00531 1.00330 .................. .................. .................. ..................

1995 ................................................. .................. .................. 0.99980 1.00310 .................. .................. .................. ..................

1996 ................................................. .................. .................. 0.99940 1.00250 .................. .................. .................. ..................

1997 ................................................. .................. .................. 0.99873 1.00123 .................. .................. .................. ..................

1998 ................................................. .................. .................. 0.99892 1.00015 .................. .................. .................. 1.00000

1999 ................................................. 0.99944 1.00335 1.00279 1.00294 0.99898 1.00335 1.00233 1.00233

2000 ................................................. 0.99857 0.99991 0.99848 1.00142 0.99910 0.99991 0.99901 1.00134

2001 1 ............................................... 0.99846 1.00019 0.99865 0.99933 1.00365 1.00009 1.00374 1.00508

2001 2 ............................................... 3 0.99771 3 1.00009 3 0.99780 0.99922 3 1.00365 3 1.00009 3 1.00374 1.00508

2002 ................................................. 4 0.99703 4 0.99428 4 0.99133 0.99067 4 0.99943 4 0.99428 4 0.99371 0.99876

1Factors effective for the first half of FY 2001 (October 2000 through March 2001).

2Factors effective for the second half of FY 2001 (April 2001 through September 2001).

3 Incremental factors are applied to FY 2000 cumulative factors.

4 Incremental factors are applied to the cumulative factors for the first half of FY 2001.

22884 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

The methodology used to determine the

recalibration and geographic (DRG/GAF)

budget neutrality adjustment factor is similar

to that used in establishing budget neutrality

adjustments under the prospective payment

system for operating costs. One difference is

that, under the operating prospective

payment system, the budget neutrality

adjustments for the effect of geographic

reclassifications are determined separately

from the effects of other changes in the

hospital wage index and the DRG relative

weights. Under the capital prospective

payment system, there is a single DRG/GAF

budget neutrality adjustment factor (the

national rate and the Puerto Rico rate are

determined separately) for changes in the

geographic adjustment factor (including

geographic reclassification) and the DRG

relative weights. In addition, there is no

adjustment for the effects that geographic

reclassification has on the other payment

parameters, such as the payments for serving

low-income patients or the large urban addon payments.

In addition to computing the DRG/GAF

budget neutrality adjustment factor, we used

the model to simulate total payments under

the prospective payment system.

Additional payments under the exceptions

process are accounted for through a

reduction in the Federal and hospital-specific

rates. For FY 2002 additional payments for

the ‘‘regular’’ exceptions are made only for

cost reporting periods that begin before

October 1, 2001. The adjustment for

‘‘special’’ exceptions payments (see

§ 412.348(g)) is described in section V.D. of

the preamble of this proposed rule.

Therefore, we used the model to calculate the

exceptions reduction factor. This exceptions

reduction factor ensures that aggregate

payments under the capital prospective

payment system, including exceptions

payments, are projected to equal the

aggregate payments that would have been

made under the capital prospective payment

system without an exceptions process. In

modeling exceptions for FY 2002, we

calculated exceptions only for qualifying cost

reporting periods. Since changes in the level

of the payment rates change the level of

payments under the exceptions process, the

exceptions reduction factor must be

determined through iteration.

In the August 30, 1991 final rule (56 FR

43517), we indicated that we would publish

each year the estimated payment factors

generated by the model to determine

payments for the next 5 years. Since we will

no longer use the model after the final notice

for the FY 2002 rates, we propose to

discontinue publishing this table after the

final notice for the FY 2002 rates. The table

below provides the actual factors for FYs

1992 through 2001, the proposed factors for

FY 2002, and the estimated factors that

would be applicable through FY 2006. We

caution that these are estimates for FYs 2002

and later, and are subject to revisions

resulting from continued methodological

refinements, receipt of additional data, and

changes in payment policy. We note that in

making these projections, we have assumed

that the cumulative national DRG/GAF

budget neutrality adjustment factor will

remain at 0.99067 (0.99876 for Puerto Rico)

for FY 2002 and later because we do not have

sufficient information to estimate the change

that will occur in the factor for years after FY

2002.

The projections are as follows:

Fiscal year Update factor Exceptions reduction factor

Budget neutrality factor

DRG/GAF adjustment

factor 1

Outlier adjustment factorFederal rate

adjustment

Federal rate

(after outlier

reduction)

1992 ............................. N/A 0.9813 0.9602 ........................ 0.9497 ........................ 415.59

1993 ............................. 6.07 .9756 .9162 .9980 .9496 ........................ 417.29

1994 ............................. 3.04 .9485 .8947 1.0053 .9454 2.9260 378.34

1995 ............................. 3.44 .9734 .8432 .9998 .9414 ........................ 376.83

1996 ............................. 1.20 .9849 N/A .9994 .9536 3.9972 461.96

1997 ............................. 0.70 .9358 N/A .9987 .9481 ........................ 438.92

1998 ............................. 0.90 9659 N/A .9989 .9382 4.8222 371.51

1999 ............................. 0.10 .9783 N/A 1.0028 .9392 ........................ 378.10

2000 ............................. 0.30 .9730 N/A .9985 .9402 ........................ 377.03

2001 5 ........................... 0.90 .9785 N/A .9979 .9409 ........................ 382.03

2002 ............................. 1.10 6.9925 N/A 0.9913 .9426 ........................ 389.09

2003 ............................. 0.60 .9975 N/A 7 1.0000 7.9426 4 1.0255 403.44

2004 ............................. 0.90 .9975 N/A 1.0000 .9426 ........................ 407.07

2005 ............................. 1.10 .9975 N/A 1.0000 .9426 ........................ 411.55

2006 ............................. 1.10 .9975 N/A 1.0000 .9426 ........................ 416.07

1 Note: The incremental change over the previous year.

2 Note: OBRA 1993 adjustment.

3 Note: Adjustment for change in the transfer policy.

4 Note: Balanced Budget Act of 1997 adjustment.

5 Note: Rates are for the first half of FY 2001 (October 1, 2000 through March 31, 2001).

6 Note: Product of general exceptions factor (0.9937) and special exceptions factor (0.9988).

7 Note: Future adjustments are, for purposes of this projection, assumed to remain at the same level.

BILLING CODE 4120–01–P

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22885

Appendix C—Report to Congress

22886 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22887

22888 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

Appendix D: Recommendation of

Update Factors for Operating Cost

Rates of Payment for Inpatient Hospital

Services

I. Background

Several provisions of the Act address the

setting of update factors for inpatient services

furnished in FY 2002 by hospitals subject to

the prospective payment system and by

hospitals or units excluded from the

prospective payment system. Section

1886(b)(3)(B)(i)(XVII) of the Act, as amended

by Section 301 of Public Law 106–554, sets

the FY 2002 percentage increase in the

operating cost standardized amounts equal to

the rate of increase in the hospital market

basket minus 0.55 percent for prospective

payment hospitals in all areas. Section

1886(b)(3)(B)(iv) of the Act sets the FY 2002

percentage increase in the hospital-specific

rates applicable to SCHs and MDHs equal to

the rate set forth in section 1886(b)(3)(B)(i) of

the Act, that is, the same update factor as all

other hospitals subject to the prospective

payment system, or the rate of increase in the

market basket minus 0.55 percentage points.

Under section 1886(b)(3)(B)(ii) of the Act,

the FY 2002 percentage increase in the rateof-increase limits for hospitals and units

excluded from the prospective payment

system ranges from the percentage increase

in the excluded hospital market basket less

a percentage between 0 and 2.5 percentage

points, depending on the hospital’s or unit’s

costs in relation to its limit for the most

recent cost reporting period for which

information is available, or 0 percentage

point if costs do not exceed two-thirds of the

limit.

In accordance with section 1886(d)(3)(A) of

the Act, we are proposing to update the

standardized amounts, the hospital-specific

rates, and the rate-of-increase limits for

hospitals and units excluded from the

prospective payment system as provided in

section 1886(b)(3)(B) of the Act. Based on the

first quarter 2001 forecast of the FY 2002

market basket increase of 3.1 percent for

hospitals and units subject to the prospective

payment system, the proposed update to the

standardized amounts is 2.55 percent (that is,

the market basket rate of increase minus 0.55

percent percentage points) for hospitals in

both large urban and other areas. The

proposed update to the hospital-specific rate

applicable to SCHs and MDHs is also 2.55

percent. The proposed update for hospitals

and units excluded from the prospective

payment system would range from the

percentage increase in the excluded hospital

market basket (currently estimated at 3.0

percent) minus a percentage between 0 and

2.5 percentage points, or 0 percentage points,

resulting in an increase in the rate-of-increase

limit between 0.5 and 3.0 percent, or 0

percent.

Section 1886(e)(4) of the Act requires that

the Secretary, taking into consideration the

recommendations of the Medicare Payment

Advisory Commission (MedPAC),

recommend update factors for each fiscal

year that take into account the amounts

necessary for the efficient and effective

delivery of medically appropriate and

necessary care of high quality. Under section

1886(e)(5) of the Act, we are required to

publish the update factors recommended

under section 1886(e)(4) of the Act.

Accordingly, this Appendix provides the

recommendations of appropriate update

factors and the analysis underlying our

recommendations and our response to

MedPAC’s recommendations concerning the

update factors.

In its March 1, 2001 report, MedPAC stated

that the legislated update of market basket

minus 0.55 percentage points would provide

a reasonable level of payments to hospitals.

MedPAC did not make a separate

recommendation for the hospital-specific rate

applicable to SCHs and MDHs. We discuss

MedPAC’s recommendations concerning the

update factors and our responses to these

recommendations in section III. below.

II. Secretary’s Recommendations

Under section 1886(e)(4) of the Act, we are

recommending that an appropriate update

factor for the standardized amounts is 2.55

percentage points for hospitals located in

large urban and other areas. We are also

recommending an update of 2.55 percentage

points to the hospital-specific rate for SCHs

and MDHs. As MedPAC states in its March

2001 report, there are signs of substantial

improvement in hospitals’ financial

performance in FY 2000 as a result of the

enactment of Public Law 106–113 and Public

Law 106–554. In conjunction with the

various ‘‘give-back’’ provisions in Public Law

106–113 and Public Law 106–554 and the

continuation of positive (MedPAC estimates

12 percent for FY 1999 (page 64)) Medicare

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22889

hospital inpatient margins, we believe these

recommended update factors for FY 2002

would ensure that Medicare acts as a prudent

purchaser and provide incentives to hospitals

for increased efficiency, thereby contributing

to the solvency of the Medicare Part A Trust

Fund.

We recommend that hospitals excluded

from the prospective payment system receive

an update of between 0.5 and 3.0 percentage

points, or 0 percentage points. The update for

excluded hospitals and units is equal to the

increase in the excluded hospital operating

market basket less a percentage between 0

and 2.5 percentage points, or 0 percentage

points, depending on the hospital’s or unit’s

costs in relation to its rate-of-increase limit

for the most recent cost reporting period for

which information is available. The market

basket rate of increase for excluded hospitals

and units is currently forecast at 3.0 percent.

As required by section 1886(e)(4) of the

Act, we have taken into consideration the

recommendations of MedPAC in setting these

recommended update factors. Our responses

to the MedPAC recommendations concerning

the update factors are discussed below.

III. MedPAC Recommendations for Updating

the Prospective Payment System Operating

Standardized Amounts

In its March 2001 Report to Congress,

MedPAC recommended a combined

operating and capital update for hospital

inpatient prospective payment system

payments for FY 2002. With the end of the

transition to fully prospective capital

payments ending with FY 2001, both

operating and capital prospective system

payments will be made using standard

Federal rates adjusted by hospital specific

payment variables. Currently, section

1886(b)(3)(B)(i)(XVII) of the Act sets forth the

FY 2002 percentage increase in the

prospective payment system operating cost

standardized amounts. The prospective

payment system capital update is set at the

discretion of the Secretary under the

framework outlined in § 412.308(c)(1).

MedPAC’s FY 2001 combined operating

and capital update framework uses a

weighted average of HCFA’s forecasts of the

operating (prospective payment system input

price index) and the capital input price

index. This combined market basket was

used to develop an estimate of the change in

overall operating and capital prices. MedPAC

calculated a combined market basket forecast

by weighting the operating market basket

forecast by 0.92 and the capital market basket

forecast by 0.08, since operating costs are

estimated to represent 92 percent of total

hospital costs (capital costs are estimated to

represent the remaining 8 percent of total

hospital costs). MedPAC’s combined market

basket for FY 2002 is estimated to increase

by 2.8 percent, based on HCFA’s December

2000 forecasted operating market basket

increase of 3.0 percent and HCFA’s December

2000 forecasted capital market basket

increase of 0.8 percent.

For FY 2002, MedPAC’s update framework

would support a combined operating and

capital update for hospital inpatient

prospective payment system payments of 1.5

percent to 3.0 percent (or between the

increase in the combined operating and

capital market basket minus 1.3 percentage

points and the increase in the combined

operating and capital market basket plus 0.2

percentage points). In its update

recommendation, MedPAC studied factors

affecting the adequacy of payments in FY

2001 and factors expected to affect hospital

costs in FY 2002. MedPAC concluded, ‘‘there

is no compelling reason to change current

law setting an operating update for fiscal year

2002 of 0.55 percent below the rate of

increase in the operating market basket

‘‘(page 73). MedPAC also notes that while the

number of hospitals with negative inpatient

hospital margins have increased in FY 1999

(from 33.7 percent in 1998 to 36.7 percent in

1999) (page 71), overall high inpatient

Medicare margins generally offset hospital

losses on other lines of Medicare services

(page 68). MedPAC continues to project

substantially improved hospital total margins

for FY 2000 based on performance in the first

half of the fiscal year (page 72).

Response: Our long-term goal is to develop

a single update framework for operating and

capital prospective payments. However, the

operating system update has been

determined by Congress through FY 2003 (as

amended by section 301 of Public Law 106–

554). In the meantime, we intend to maintain

as much consistency as possible with the

current operating framework in order to

facilitate the eventual development of a

unified framework.

We agree with MedPAC’s recommendation

that the current law update for FY 2002 of

the market basket minus 0.55 percentage

points is appropriate for the operating system

update. The following analyses measure

changes in hospital productivity, scientific

and technological advances, practice pattern

changes, changes in case-mix, the effect of

reclassification on recalibration, and forecast

error correction.

A. Productivity

Service level labor productivity is defined

as the ratio of total service output to full-time

equivalent employees (FTEs). While we

recognize that productivity is a function of

many variables (for example, labor, nonlabor

material, and capital inputs), we use the

portion of productivity attributed to direct

labor since this update framework applies to

operating payment. To recognize that we are

apportioning the short-run output changes to

the labor input and not considering the

nonlabor inputs, we weight our productivity

measure by the share of direct labor services

in the market basket to determine the

expected effect on cost per case.

Our recommendation for the service

productivity component is based on

historical trends in productivity and total

output for both the hospital industry and the

general economy, and projected levels of

future hospital service output. MedPAC’s

predecessor, the Prospective Payment

Assessment Commission (ProPAC), estimated

cumulative service productivity growth to be

4.9 percent from 1985 through 1989, or 1.2

percent annually. At the same time, ProPAC

estimated total output growth at 3.4 percent

annually, implying a ratio of service

productivity growth to output growth of 0.35.

Since it is not possible at this time to

develop a productivity measure specific to

Medicare patients, we examined productivity

(output per hour) and output (gross domestic

product) for the economy. Depending on the

exact time period, annual changes in

productivity range from 0.3 to 0.35 percent

of the change in output (that is, a 1.0 percent

increase in output would be correlated with

a 0.3 to 0.35 percent change in output per

hour).

Under our framework, the recommended

update is based in part on expected

productivity—that is, projected service

output during the year, multiplied by the

historical ratio of service productivity to total

service output, multiplied by the share of

direct labor in total operating inputs, as

calculated in the hospital market basket. This

method estimates an expected productivity

improvement in the same proportion to

expected total service growth that has

occurred in the past and assumes that, at a

minimum, growth in FTEs changes

proportionally to the growth in total service

output. Thus, the recommendation allows for

unit productivity to be smaller than the

historical averages in years that output

growth is relatively low and larger in years

that output growth is higher than the

historical averages. Based on the above

estimates from both the hospital industry and

the economy, we have chosen to employ the

range of ratios of productivity change to

output change of 0.30 to 0.35.

The expected change in total hospital

service output is the product of projected

growth in total admissions (adjusted for

outpatient usage), projected real case-mix

growth, expected quality-enhancing intensity

growth, and net of expected decline in

intensity due to reduction of cost-ineffective

practice. Case-mix growth and intensity

numbers for Medicare are used as proxies for

those of the total hospital, since case-mix

increases (used in the intensity measure as

well) are unavailable for non-Medicare

patients. Thus, expected FY 2002 hospital

output growth is simply the sum of the

expected change in intensity (0.3 percent),

projected admissions change (1.6 percent for

FY 2002), and projected real case-mix growth

(1.0 percent), or 2.9 percent. The share of

direct labor services in the market basket

(consisting of wages, salaries, and employee

benefits) is 61.4 percent.

Multiplying the expected change in total

hospital service output (2.9 percent) by the

ratio of historical service productivity change

to total service growth of 0.30 to 0.35 and by

the direct labor share percentage 61.4,

provides our productivity standard of ¥0.6

to ¥0.5 percent.

In past years, MedPAC made an adjustment

for productivity improvement to reflect the

level of improvement in the production of

health care services, without affecting the

quality of those services. Typically, MedPAC

made a downward adjustment in its

framework to reflect expected improvements

in hospital productivity. In its FY 2002

combined update framework, MedPAC did

not make an adjustment for productivity.

Instead, MedPAC believes that the costs

associated with scientific and technological

advances should be financed partially

22890 Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules

through improvements in hospital

productivity. As a result, MedPAC offset its

adjustment for scientific and technological

advances by a fixed standard of expected

productivity growth of 0.5 percent for FY

2002. Our productivity adjustment of ¥0.6 to

¥0.5 percent is consistent with the range of

MedPAC’s fixed standard of expected

productivity growth of 0.5 percent for FY

2002.

B. Intensity

We base our intensity standard on the

combined effect of three separate factors:

changes in the use of quality enhancing

services, changes in the use of services due

to shifts in within-DRG severity, and changes

in the use of services due to reductions of

cost-ineffective practices. For FY 2002, we

recommend an adjustment of 0.2 to 0.3

percent. The basis of this recommendation is

discussed below.

We have no empirical evidence that

accurately gauges the level of qualityenhancing technology changes. A study

published in the Winter 1992 issue of the

Health Care Financing Review,

‘‘Contributions of case mix and intensity

change to hospital cost increases’’ (pages

151–163), suggests that one-third of the

intensity change is attributable to high-cost

technology. The balance was unexplained

but the authors speculated that it is

attributable to fixed costs in service delivery.

Typically, a specific new technology

increases cost in some uses and decreases

cost in other uses. Concurrently, health status

is improved in some situations while in other

situations it may be unaffected or even

worsened using the same technology. It is

difficult to separate out the relative

significance of each of the cost-increasing

effects for individual technologies.

Other things being equal, per-discharge

fixed costs tend to fluctuate in inverse

proportion to changes in volume. Fixed costs

exist whether patients are treated or not. If

volume is declining, per-discharge fixed

costs will rise, but the reverse is true if

volume is increasing.

Following methods developed by HCFA’s

Office of the Actuary for deriving hospital

output estimates from total hospital charges,

we have developed Medicare-specific

intensity measures based on a 5-year average

using FYs 1996 through 2000 MedPAR

billing data. Case-mix constant intensity is

calculated as the change in total Medicare

charges per discharge adjusted for changes in

the average charge per unit of service as

measured by the Consumer Price Index (CPI)

for hospital and related services and changes

in real case-mix. Thus, in order to measure

changes in intensity, one must measure

changes in real case-mix.

We calculate case-mix constant intensity as

the change in total charges per admission,

adjusted for price level changes (the CPI for

hospital and related services), and changes in

real case-mix. Without reliable estimates of

the proportions of the overall annual

intensity increases due, respectively, to

ineffective practice patterns and to the

combination of quality-enhancing new

technologies and within-DRG complexity, we

assume that one-half of the annual increase

is due to each of these factors.

For FY 2002, we have developed a

Medicare-specific intensity measure based on

a 5-year average using FY 1996 through 2000

data. In determining case-mix constant

intensity, we estimate that real case-mix

increase was 1.0 to 1.4 percent each year. The

estimate for those years is supported by past

studies of case-mix change by the RAND

Corporation. The most recent study was ‘‘Has

DRG Creep Crept Up? Decomposing the Case

Mix Index Change Between 1987 and 1988’’

by G. M. Carter, J. P. Newhouse, and D. A.

Relles, R–4098–HCFA/ProPAC (1991). The

study suggested that real case-mix change

was not dependent on total change, but was

usually a fairly steady 1.0 to 1.4 percent per

year. Following that study, we consider up to

1.4 percent of observed case-mix change as

real for FY 1996 through FY 2000.

We calculate case-mix constant intensity as

the change in total charges per admission,

adjusted for price level changes (the CPI for

hospital and related services), and changes in

real case-mix. The average percentage change

in charge per discharge was 4.7 percent and

the average annual change in the CPI for

hospital and related services was 4.2 percent.

Dividing the change in charge per discharge

by the quantity of the real case-mix index

change and the CPI for hospital and related

services yields an average annual change in

intensity of ¥0.9 percent. Assuming the

technology/fixed cost ratio still holds (.33),

technology would account for a ¥0.3 percent

annual decline while fixed costs would

account for a ¥0.6 percent annual decline.

The decline in fixed costs per discharge

makes intuitive sense as volume, measured

by total discharges, has increased during the

period.

For FYs 1995 through 1999, observed casemix index change ranged from a low of ¥0.7

percent to a high of 1.6 percent, with a 5-year

average change of 0.2 percent. If we assume

that the upper bound of real case-mix was 1.0

percent, we estimate that case-mix constant

intensity increased by an average 0.3 percent

during FYs 1996 through 2000, for a

cumulative increase of 1.4 percent. If we

assume that the upper bound of real case-mix

increase was 1.4 percent, we estimate that

case-mix constant intensity increased by an

average 0.2 percent during FYs 1996 through

2000, for a cumulative increase of 1.2

percent. Thus, we are recommending an

intensity adjustment for FY 2002 between 0.2

and 0.3 percent.

MedPAC does not make an adjustment for

intensity per se, but its combined update

recommendation for FY 2002 includes two

categories that we consider to be comparable

with our intensity recommendation. MedPAC

is recommending a 0.0 to 0.5 update for

scientific and technological advances to

account for anticipated uses of emerging

technologies that enhance the quality of

hospital services, but increase costs of

hospital care. MedPAC recognized an

allowance for science and technological

advances of 0.5 percent to 1.0 percent. It

believes that the costs associated with

scientific and technological advances should

be financed at least in part through

improvements in hospital productivity.

Hence, MedPAC offsets its allowance for

science and technology by 0.5 percent for

productivity. In addition, MedPAC includes,

when appropriate, an adjustment for onetime factors expected to affect costs in FY

2002 and the removal of the adjustment for

FY 2002 one-time factors in its science and

technology adjustment. MedPAC concluded

that a one-time adjustment of 0.5 percent for

the Health Insurance Portability and

Accountability Act of 1996 (HIPAA)

regulatory requirements should be reflected

in the FY 2002 payment update.

Additionally, since MedPAC believes that the

costs associated with one-time factors should

not be built permanently into the rates, it

recommended that the FY 2002 payment

rates be reduced by 0.5 percent to offset the

increase it recommended in the FY 2000

update for the costs associated with year

2000 (Y2K) computer improvements. Thus,

MedPAC’s combined FY 2002 adjustment for

science and technological advances is 0.0

percent to 0.5 percent.

MedPAC’s recommendation also takes into

account the trend of some acute care

providers to shift care to a postacute care

facility. While this can occur for many

reasons and the shifting of costs may

maintain or improve quality of care for

Medicare beneficiaries, it leads to an

inappropriate distribution of payments and

reduces the resources available for acute care

providers to pay for services to other

Medicare beneficiaries. We agree with

MedPAC that the site-of-care substitution

effect is real and believe that it is factored

into our intensity recommendation.

C. Change in Case-Mix

Our analysis takes into account projected

changes in case-mix, adjusted for changes

attributable to improved coding practices.

For our FY 2002 update recommendation, we

are projecting a 1.0 percent increase in the

case-mix index. We define real case-mix

change as actual changes in the mix (and

resource requirements) of Medicare patients

as opposed to changes in coding behavior

that result in assignment of cases to higherweighted DRGs, but do not reflect greater

resource requirements. Unlike in past years,

where we differentiated between ‘‘real’’ casemix increase and increases attributable to

changes in coding behavior, we do not

believe changes in coding behavior will

impact the overall case-mix in FY 2002. As

such, for FY 2002, we estimate that real casemix is equal to projected change in case-mix.

Thus, we are recommending a 0.0 percent

adjustment for case-mix.

MedPAC’s analysis indicates that coding

change has reduced case-mix index growth.

In the past, MedPAC has recommended a

negative adjustment when DRG coding

changes has led to case-mix index growth

(upcoding) and has recommended a positive

adjustment when DRG coding changes have

led to a decline in case-mix (downcoding). In

light of evidence that coding had no

significant effect on case-mix change,

MedPAC recommended an adjustment of 0.0

percent for FY 2002.

MedPAC also makes an adjustment for

within-DRG severity. In past years, MedPAC

has included an adjustment for increased

case complexity not captured by the DRG

classification system. MedPAC recognizes

Federal Register / Vol. 66, No. 87 / Friday, May 4, 2001 / Proposed Rules 22891

that as the DRG system matures, it should

account for more of the variation in costs by

DRG assignment, leaving less within-DRG

variation in case complexity and costliness

(page 76). Therefore, MedPAC recommended

an adjustment of 0.0 percent for FY 2002.

D. Effect of FY 2000 DRG Reclassification

and Recalibration

We estimate that DRG reclassification and

recalibration for FY 2000 resulted in a 0.0

percent change in the case-mix index when

compared with the case-mix index that

would have resulted if we had not made the

reclassification and recalibration changes to

the GROUPER.

E. Forecast Error Correction

We make a forecast error correction if the

actual market basket changes differ from the

forecasted market basket by 0.25 percentage

points or more. There is a 2-year lag between

the forecast and the measurement of forecast

error. The estimated market basket

percentage increase used to update the FY

2000 payment rates was 2.9 percent. Our

most recent data indicates the actual FY 2000

increase was 3.6 percent. The resulting

forecast error in the FY 2000 market basket

rate of increase is 0.7 percentage points. This

forecast error is a result of prices for wages,

benefits, and chemicals increasing more

rapidly than expected. Market conditions

enabled hospitals to be less restrictive with

pay increases than initially projected. Prices

for chemicals were underestimated due to the

unanticipated surge in oil prices in FY 2000.

MedPAC also made a recommendation in

its FY 2002 combined update framework to

adjust for any error in the market basket

forecasts used to set FY 2000 payment rates.

It recommended a combined adjustment for

FY 2000 forecast error correction of 0.7

percent. MedPAC determined this forecast

error adjustment by weighting the difference

between the actual and forecasted operating

(92 percent) and capital (8 percent) market

basket increases for FY 2000. The forecasted

FY 2000 operating market basket was 2.9

percent and the actual FY 2000 operating

market basket increase was 3.6 percent. The

FY 2000 capital market basket was forecasted

to increase by 0.6 percent and the actual

market basket increase was 0.9 percent. This

implies that MedPAC’s combined operating

and capital market basket was forecasted at

2.7 percent and the combined actual

operating and capital market basket was 3.4

percent. Accordingly, MedPAC

recommended a 0.7 percent forecast error

correction for its FY 2002 combined update

recommendation.

F. Medicare Policy Change

In developing its update recommendation

for FY 2002, MedPAC includes an

adjustment for Medicare policy changes

affecting financial status in its section of

factors affecting current level of payments.

While MedPAC’s update framework has not

considered such costs in the past, MedPAC

believes that it is appropriate to account for

significant costs incurred as a result of new

Medicare policy. For FY 2002, MedPAC

believes that legislated updates will match

cost growth and that the overall the net

affects of legislative changes (from Public

Law 105–33, Public Law 106–113, and Public

Law 106–554) will be small. Thus, it did not

recommend any additional allowance for

these costs for FY 2002. Accordingly,

MedPAC recommended a 0.0 percent

adjustment for Medicare policy changes in its

update framework for FY 2002.

COMPARISON OF FY 2002 UPDATE RECOMMENDATIONS

HHS MedPAC 1

Market basket MB MB1

Policy Adjustment Factors:

Productivity ............................................................................................................. ¥0.6 to ¥0.5 ..................... (2)

Site-of-Service Substitution .................................................................................... (3) ........................................ ¥2.0 to ¥ 1.0.

Intensity .................................................................................................................. 0.2 to 0.3 ............................

Science & Technology ............................................................................................ ............................................. 0.0 to 0.5.

Real Within DRG Change ...................................................................................... ............................................. (4)

One-Time Factors ................................................................................................... ............................................. 0.0

Medicare Policy Changes ....................................................................................... ............................................. 0.0

Subtotal ........................................................................................................... ¥0.4 to ¥0.2 ..................... ¥2.0 to ¥0.5

Case-Mix Adjustment Factors:

Projected Case-Mix Change .................................................................................. 1.0 ......................................

Real Across DRG Change ..................................................................................... 1.0 ...................................... 0.0

Subtotal ........................................................................................................... 0.0 ...................................... 0.0

Effect of FY 2000 DRG Reclass/Recalibration ...................................................... 0.0 ......................................

Forecast Error Correction 0.7 ...................................... 0.7

Total Recommendation Update ...................................................................... MB + 0.3 to MB + 0.5 ........ MB1 ¥1.3 to MB1 + 0.2.

1 Used HCFA’s December 2000 operating and capital market basket forecast in its combined update recommendation. 2 Included in MedPAC’s Science and Technology Adjustment. 3 Included in HHS’ Intensity Factor. 4 Included in MedPAC’s Case-Mix Adjustment.

While the above analysis would suggest an

update between operating market basket plus

0.3 percentage points and the operating

market basket plus 0.5 percentage points,

consistent with current law, we are

recommending an update of market basket

increase minus 0.55 percentage points (or

2.55 percent). Just as MedPAC believes that

market basket minus 0.55 percentage points

will provide a reasonable level of payments

for FY 2002, we believe that a 2.55 update

factor for FY 2002 will appropriately reflect

current trends in health care delivery,

including the recent decreases in the use of

hospital inpatient services and the

corresponding increase in the use of hospital

outpatient and postacute care services.

Also consistent with current law, we are

recommending that the hospital-specific rates

applicable to SCHs and MDHs be increased

by the same update, 2.55 percentage points.

As MedPAC states in its March 2001 report,

there are signs of substantial improvement in

hospital financial performance in FY 2000. In

conjunction with the various ‘‘give-back’’

provisions in Public Law 106–113 and Public

Law 106–554 and the continuation of

positive (12 percent for FY 1999) Medicare

hospital inpatient margins, we believe these

recommended update factors for FY 2002

would ensure that Medicare acts as a prudent

purchaser and provide incentives to hospitals

for increased efficiency, thereby contributing

to the solvency of the Medicare Part A Trust

Fund.

[FR Doc. 01–11062 Filed 5–3–01; 8:45 am]

BILLING CODE 4120–01–P