# Medicare Program; Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates: Final Fiscal Year 2007 Wage Indices and Payment Rates After Application of Revised Occupational Mix Adjustment to Wage Index

> Briefs, arguments, decisions, and more.

URL: https://www.frixlaw.com/law-library/documents/fr%3A06-8471

## Record

- **Collection:** Federal Register
- **Document type:** Notice
- **Published:** October 11, 2006
- **Citation:** 71 FR 59886

## Text

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-1488-N]
RIN 0938-AO12
Medicare Program; Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates: Final Fiscal Year 2007 Wage Indices and Payment Rates After Application of Revised Occupational Mix Adjustment to Wage Index

AGENCY:

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

ACTION:

Notice.

SUMMARY:

This notice contains tables listing the final occupational mix adjusted wage indices, hospital reclassifications, payment rates, impacts, and other related tables as a result of the application of the occupational mix adjustment to 100 percent of the wage index effective for fiscal year (FY) 2007.

DATES:

Effective Date:
This notice is effective on October 1, 2006.

FOR FURTHER INFORMATION CONTACT:

Valerie Miller, (410) 786-4535, Wage Index Issues. Brian Slater, (410) 786-5229, Geographic Reclassification Issues. Marc Hartstein, (410) 786-4548, All Other Issues.

SUPPLEMENTARY INFORMATION:

I. Background

In the August 18, 2006
Federal Register
(71 FR 47870) (hereinafter referred to as the FY 2007 IPPS final rule), we set forth our final rule for the Medicare inpatient prospective payment system (IPPS). Due to the decision in the case
Bellevue Hosp.

Center
v.
Leavitt,
443 F. 3d 163 (2nd Cir. 2006), we stated that we would publish the FY 2007 occupational mix adjusted wage index tables, rates, and impacts on our Web site and in a
Federal Register
document subsequent to the FY 2007 IPPS final rule. (See the FY 2007 IPPS final rule for a full explanation of the reasons for such subsequent publication.) This notice includes such wage index tables, rates, and impacts.

II. Final FY 2007 Occupational Mix Adjusted Wage Indices, Rates, and Impacts

A. Wage Index and Occupational Mix Adjustment

1. Implementation of the New Occupational Mix Adjustment for the FY 2007 Wage Index

The final wage index values for FY 2007 (except those for hospitals receiving wage index adjustments under section 505 of Pub. L. 108-173) are included in Tables 4A-1, 4A-2, 4B, 4C-1, 4C-2, and 4F of the Addendum to this notice and are posted on our Web site at
http://www.cms.hhs.gov/AcuteInpatientPPS/.
For hospitals that are receiving a wage index adjustment under section 505 of Pub. L. 108-173, the hospital's final wage index will reflect the adjustment shown in Table 4J of the Addendum to this notice. Tables 3A and 3B of the Addendum to this notice and on our Web site reflect the 3-year average of the average hourly wage for each labor market area before the redesignation of hospitals, used for FYs 2005, 2006, and 2007. Table 3A lists average hourly wages for urban areas and Table 3B lists these data for rural areas. In addition, Table 2 in the Addendum to this notice includes the occupational mix adjusted average hourly wage for each hospital from the FYs 2001, 2002, and 2003 cost reporting periods. The average hourly wages for FYs 2001 and 2002 reflect a 10 percent occupational mix adjustment using the survey data used to develop the FYs 2005 and 2006 wage indices, respectively. The FY 2003 average hourly wages reflect a 100 percent occupational mix adjustment using the recently collected survey data and were used to calculate the FY 2007 wage index.

2. Proxy Occupational Mix Adjustment for Hospitals With No Survey Data

As stated in the FY 2007 IPPS final rule (71 FR 48014), we have applied the average occupational mix adjustment for a hospital's labor market area to the wage data of hospitals that did not submit occupational mix survey data or that submitted survey data that could not be used because we determined it to be aberrant. For example, a hospital's individual nurse category average hourly wages were out of range (that is, unusually high or low), and the hospital did not provide sufficient documentation to explain the aberrancy, or the hospital did not submit any registered nurse staff salaries or hours data.

In calculating the average occupational mix adjustment factor for an area, we replicated Steps 1 through 6 of the calculation for the occupational mix adjustment (see 71 FR 48009). However, instead of performing these steps at the hospital level, we aggregated the data at the labor market area level. In following these steps, for example, for Core-Based Statistical Areas (CBSAs) that contain providers that did not submit occupational mix survey data, the occupational mix adjustment factor ranged from a low of 0.8944 (CBSA 39820, Redding, CA), to a high of 1.0924 (CBSA 38220, Pine Bluff, AR). Also, in computing a hospital's occupational mix adjusted salaries and wage-related costs for nursing employees (Step 7 of the calculation (see 71 FR 48010)) in the absence of occupational mix survey data, we multiplied the hospital's total salaries and wage-related costs by the percentage of the
area's
total workers attributable to the
area's
total nursing category. There were also two CBSAs in which none of the providers submitted the occupational mix survey (CBSA 49740, Yuma, AZ, and CBSA 25020, Guayama, P.R.). In the absence of any data in these labor market areas, we applied an occupational mix adjustment factor of 1.0 to all providers.

3. Analysis of the Final FY 2007 Wage Index

Using the new occupational mix survey data and applying the occupational mix adjustment to 100 percent of the FY 2007 wage index results in a national average hourly wage of $29.6529 and a Puerto-Rico specific average hourly wage of $13.0943. We calculated the FY 2007 wage index using the Worksheet S-3 cost report data of 3,570 hospitals and occupational mix survey data from 3,239 hospitals (90.7 percent response rate). Although more than 3,239 hospitals submitted occupational mix survey data for the January through March 2006 collection period, we excluded the data for 37 hospitals that did not have FY 2003 Worksheet S-3 cost report data for use in calculating the FY 2007 wage index. Also, we excluded the occupational mix survey data of another 30 hospitals because their data was incomplete or aberrant. Using the occupational mix data of 3,239 hospitals, the FY 2007 national average hourly wages for each occupational mix nursing subcategory as calculated in Step 2 of the occupational mix calculation are as follows:

Occupational mix nursing subcategory

Average
hourly wage

National RN Management
$38.5908

National RN Staff
33.3739

National LPN
19.2721

National Nurse Aides, Orderlies, and Attendants
13.6906

National Medical Assistants
15.6304

National Nurse Category
28.7431

The national average hourly wage for the entire nurse category as computed in Step 5 of the occupational mix calculation is $28.7431. Hospitals with a nurse category average hourly wage (as calculated in Step 4) of greater than national nurse category average hourly wage receive an occupational mix adjustment factor (as calculated in Step 6) of less than 1.0. Hospitals with a nurse category average hourly wage (as calculated in Step 4) of less than national nurse category average hourly wage receive an occupational mix adjustment factor (as calculated in Step 6) of greater than 1.0.

Based on the January through March 2006 occupational mix survey data, we determined (in Step 7 of the occupational mix calculation) that the national percentage of hospital employees in the Nurse category is 42.9 percent, and the national percentage of hospital employees in the All Other Occupations category is 57.1 percent. At the CBSA level, the percentage of hospital employees in the Nurse category ranged from a low of 23.0 percent in one CBSA, to a high of 85.5 percent in another CBSA.

After adjusting the FY 2007 wage indices by 100 percent for occupational mix, the wage index values for a total of 250 hospitals in 73 labor market areas are assigned a statewide rural wage index value (“the rural floor”) according to section 4410 of Pub. L. 105-33, or an imputed floor, for hospitals located in all-urban States, according to § 412.64(h).

a. Effect of the 2006 Occupational Data on the FY 2007 Wage Index (Unadjusted Relative to Adjusted Wage Index).
We compared the FY 2007 unadjusted wage indices for each CBSA to the FY 2007 wage indices adjusted for occupational mix. In implementing an occupational mix adjusted wage index based on the above calculation, the final wage index values for 14 rural areas (29.8 percent) and 201 urban areas (52.1 percent) would decrease as a result of the adjustment. Six rural areas (12.8 percent) and 108 urban areas (28.0 percent) would experience a decrease of 1 percent or greater in their wage index values. The largest negative impacts would be 2.7 percent and 6.0 percent. In addition, 33 rural areas (70.2 percent) and 181 urban areas (46.9 percent) would experience an increase in their wage index values. The largest increase for a rural area would be 3.16 percent and the largest increase for an urban area would be 8.39 percent. Four urban areas would be unaffected. These results indicate that a larger percentage of rural areas benefit from an occupational mix adjustment than do urban areas. However, as was the case with the previous occupational mix data, close to a third of rural CBSAs (29.8 percent) continue to experience a decrease in their wage indices as a result of the occupational mix adjustment.

b. Effect of the 2006 Occupational Mix Survey Data Relative to the 2003 Survey Data.
We also analyzed the effect on the FY 2007 wage index of applying the January through March 2006 occupational mix survey data, relative to applying the 2003 occupational mix survey data. In this analysis, we compared the FY 2007 wage index adjusted 100 percent using 2003 and 2006 survey data. By controlling for changes in hospitals' wage data and geographic reclassification, we determined that the wage index values for 27 rural areas (57.4 percent) and 183 urban areas (47.4 percent) would decrease as a result of applying the 2006 survey data instead of the 2003 survey data. Ten rural areas (21.3 percent) and 96 urban areas (24.9 percent) would experience a decrease of 1 percent or greater in their wage index values. The largest negative impact for a rural area would be 3.6 percent. Six urban areas (1.2 percent) would be decreasing by greater than 5 percent; the largest urban decrease would be 20.9 percent, and the second largest decrease for an urban area would be 7.7 percent. One rural and one urban area would be unaffected by the change in the occupational mix data. In addition, 19 rural areas (40.4 percent) and 202 urban areas (52.3 percent) would experience an increase in their wage index values. The largest increase for a rural area would be 2.6 percent and the largest increase for an urban area would be 7.15 percent.

B. Final FY 2007 Hospital Reclassifications/Redesignations

1. Withdrawals and Terminations

As we stated in the FY 2007 IPPS final rule (71 FR 48020), for FY 2007, rather than hospitals withdrawing or terminating their 3-year reclassifications within 45 days of the publication of the IPPS proposed rule, hospitals would be subject to special procedures unique to FY 2007.

These procedures are as follows:

• Hospitals had 15 days from the display date of the FY 2007 IPPS final rule to notify us of whether, in the absence of viewing the final 100 percent occupational mix-adjusted wage index data, they wish to choose a particular wage index for which they are eligible (such as to definitively maintain, terminate, or withdraw from a reclassification that they received ).

• If we did not receive notice from the hospital within the 15-day timeframe, we made our best efforts to give the hospital the highest wage index among its available options. We made reclassification withdrawal and termination decisions based on what we perceived would be most advantageous to the hospital. (See 71 FR 48020 for an explanation of the reclassifications and adjustment we chose among.) Please note that in some cases we terminated a hospital's Lugar reclassification under section 1886(d)(8)(B) of the Act in order to receive the out-migration adjustment. Because this termination would result in the hospital losing urban status, we published a separate table (Table 9D) identifying these hospitals that move from Lugar/urban status to rural status with the out-migration adjustment. Also, in some cases, we may have made half-year terminations/withdrawals on behalf of section 508 hospitals (or groups containing section 508 hospitals) using the procedures identified in the FY 2007 IPPS final rule. (See 71 FR 48021 for an explanation of the half-year reclassifications that could occur for section 508 hospitals and groups containing section 508 hospitals.

• We have posted the final occupational mix-adjusted wage indices, out-migration adjustments, and our decisions on hospital reclassification on the CMS Web site at
http://www.cms.hhs.gov/AcuteInpatientPPS/WIFN/list.asp.
We have posted the same table on the CMS Web site that appeared in the
Federal Register
final notice of the occupational mix-adjusted wage indices.

• In the FY 2007 IPPS final rule, we acknowledged that hospitals may base termination/withdrawal decisions on factors other than simply what results in the highest wage index for the upcoming fiscal year. For this reason, we allowed a hospital to change a decision that is made by CMS on its behalf. Hospitals now have a 30-day period from the date these final data and our final decisions appear on the CMS Web site to notify CMS in writing, with a copy to the MGCRB, of whether they wish to reverse the reclassification decision made by CMS or to choose another reclassification for which they are eligible. Hospitals are able to

determine the reclassification decision applied on their behalf by reviewing Tables 9A through 9C for hospitals that are reclassified under section 1886(d)(8)(B) of the Act, section 508 of Pub. L. 108-173, or section 1886(d)(10) of the Act. The applicable wage index for these hospitals will be found on Table 2. If a hospital is not listed in Tables 9A through 9C, CMS has made a decision not to reclassify the hospital and its home wage index will apply, including the effect of any out-migration adjustment (if applicable). Again, the wage index that will apply to the hospital is found in Table 2. Any applicable out-migration adjustment for the hospital is found in Table 4J. As indicated above in this section, we are publishing a separate table identifying hospitals that we move from Lugar/urban status to rural status with the out-migration adjustment in Table 9D.

• Requests to reverse a decision made on behalf of a hospital by CMS and to choose another reclassification or adjustment for which the hospital is otherwise eligible must be
received
by CMS no later than 5 p.m., e.s.t., with a copy sent to the MGCRB by October 30, 2006 (or within 30 days from the date the information appears on the CMS Web site at
http://www.cms.hhs.gov/AcuteInpatientPPS/WIFN/list.asp
at the following addresses: Division of Acute Care, C4-08-06, 7500 Security Boulevard, Baltimore, MD 21244, Attn: Marianne Myers; and a copy to Medicare Geographic Classification Review Board, 2520 Lord Baltimore Drive, Suite L, Baltimore, MD 21244-2670.

As required under § 412.273(c), requests by groups of hospitals must be made by all hospitals that are a party to the application or reclassification. The reclassification or adjustment chosen by the hospital must be one for which the hospital would otherwise be eligible had CMS not made the withdrawal or termination decision on the hospital's behalf.

• If a hospital (or group of hospitals) fails to notify CMS that it is revising a determination made on its behalf within 30 days from the date the information appears on the CMS Web site, the decision made by CMS on the hospital's behalf will be final for FY 2007. Therefore, if CMS made a decision on a hospital's (or group of hospitals) behalf to terminate or withdraw a reclassification and the hospital does not reverse or modify CMS's decision within 30 days of posting the decision on the CMS Web site, we will deem the hospital's reclassification is withdrawn or terminated. If the hospital does not reverse or modify CMS's decision within 30 days of posting of the decision on the CMS Web site, once CMS's decision on the hospital's behalf is in effect, it will be treated in the same manner as if the hospital(s) had made the reclassification decision on its own. Thus, for example, because a hospital cannot have overlapping reclassifications, if we decide a hospital should accept a FY 2007 through 2009 reclassification and the hospital does not modify or reverse CMS's decision within 30 days of posting the decision on the CMS Web site, any reclassification the hospital previously had for FY 2006 through 2008 would be permanently terminated.

Hospitals should note that we will not recalculate the wage indices or budget neutrality factors now that CMS has made their decisions regarding what is most advantageous to each hospital using the 100 percent occupational mix-adjusted wage data. That is, we will not further recalculate the wage indices (including any rural floors or imputed rural floors) or standardized amounts based on hospital decisions that further revise decisions made by CMS on the hospitals' behalf.

In addition, we note that rural areas that include a section 508 hospital (specifically a hospital with wages relatively higher than the wages of other hospitals) may experience a decrease in their wage index for the second half of FY 2007. This is because section 508 hospitals are not considered reclassified under section 1886(d)(10) of the Act, and therefore, are not subject to the rule in section 1886(d)(8)(C)(ii) of the Act requiring rural area wage indices to be calculated exclusive of hospitals reclassified under section 1886(d)(10) of the Act, if doing so would increase the rural wage index. Thus, for the first half of the year, a section 508 hospital may be included in the home wage index of a rural area, while the hospitals reclassified under section 1886(d)(10) of the Act are excluded, since such exclusion increases the wage index of the rural area. However, for the second half of the year, the hospital is no longer a section 508 hospital. If the former section 508 hospital is reclassified under section 1886(d)(10) of the Act, it is grouped with other hospitals so reclassified. The high wages of the section 508 hospital may operate such that, for the second half of the year, it is more advantageous for
all
of the reclassified hospitals to be
included
in the wage index of the rural area (rather than excluded as they were in the first half of the year). However, because the other reclassified hospitals are now included in the wage index, and not just the sole section 508 hospital with high wages, the area may see a decline in the wage index. We view this scenario as arising due to the rural area's higher than expected wage index during the first half of the year from including only the section 508 hospital and not any reclassified hospitals. If we did not establish special rules that allowed for one-half year reclassifications, the section 508 hospital likely would have reclassified for the entire year under section 1886(d)(10) of the Act. In that case, the wage index for the second-half of FY 2007 would have applied for the entire year.

2. MGCRB Applications for FY 2008

Section 1886(d)(10)(C)(ii) of the Act indicates that a hospital requesting a change in geographic classification for a fiscal year must submit its application to the MGCRB no later than the first day of the 13-month period ending on September 30 of the preceding fiscal year. Thus, the statute requires that FY 2008 reclassification applications be submitted to the MGCRB no later than September 1, 2006. For this reason, hospitals must have filed a FY 2008 reclassification application by the September 1, 2006 deadline even though the average hourly wage data used to develop the final FY 2007 wage indices was not available.

The MGCRB, in evaluating a hospital's request for reclassification for FY 2008 for the wage index, must utilize the official data used to develop the FY 2007 wage index. The wage data used to support the hospital's wage comparisons must be from the CMS hospital wage survey. Generally, the source for these data is the IPPS final rule. However, the wage tables identifying the 3-year average hourly wages of hospitals were not available in time to include them in the FY 2007 IPPS final rule and by the September 1, 2006 deadline for submitting FY 2008 geographic reclassification applications.

As outlined in § 412.256(c)(2), hospitals with incomplete applications have the opportunity to request that the MGCRB grant a hospital that has submitted an application by September 1, 2006, an extension beyond September 1, 2006, to complete its application. Thus, while hospitals must file an application for reclassification to the MGCRB by September 1, 2006, they are able to supplement the reclassification application with official data used to develop the FY 2007 wage index after filing their initial application.

Therefore, as we stated in the FY 2007 IPPS final rule (71 FR 48022 through 48023), we are allowing hospitals 30 days after the final wage data is posted on the CMS Web site or by October 30,

2006 to file a supplement to the reclassification application they filed by September 1, 2006. The supplement would include the official data (Attachment H in the MGCRB Application) used to develop the FY 2007 wage index. Supplements must be
received
within 30 days this final data is posted on the CMS Web site or by October 30, 2006. The 3-year average hourly wage information necessary for FY 2008 reclassification applications appears in Tables 2, 3A, and 3B of the Addendum to this notice. The information also is available on the CMS Web site at:
http://www.cms.hhs.gov/AcuteInpatientPPS/WIFN/list.asp
and then by accessing the page titled “
MGCRB Reclassification Data for FY 2008 Applications.
” Applications and other information about MGCRB reclassifications may be obtained via the CMS Internet Web site at:
http://www.cms.hhs.gov/mgcrb/,
or by calling the MGCRB at (410) 786-1174. The mailing address of the MGCRB is: 2520 Lord Baltimore Drive, Suite L, Baltimore, MD 21244-2670.

3. Cancellations of Previous Withdrawals or Terminations for FY 2008 and Subsequent Fiscal Years

We are also allowing a 30-day period from the date the final wage data is posted on the CMS Web site to cancel a previous withdrawal or termination in order for a hospital to reinstate its reclassification for FY 2008 (for a FY 2006-2008 reclassification) or FY 2008 and FY 2009 (for a FY 2007-2009 reclassification). Because we have made termination or withdrawal decisions on behalf of hospitals, hospitals should look carefully at these decisions and determine whether they want to cancel such withdrawals or terminations for FY 2008 or FY 2009 if the reclassification time period includes these years. Hospitals must request to reinstate a reclassification that includes FY 2008 within 30 days of posting the Web site data for the reclassification to continue in that year even if they agree with the decision we made on their behalf for FY 2007.

Hospitals must request to reinstate a reclassification that includes FY 2008 within 30 days of when the data are posted to the CMS Web site or by October 30, 2006.

Requests to cancel a withdrawal or termination in order to reinstate a hospital's reclassification for FY 2008 or FY 2009, or both fiscal years, should be forwarded to the following addresses: Medicare Geographic Classification Review Board, 2520 Lord Baltimore Drive, Suite L, Baltimore, MD 21244-2670; and a copy to Division of Acute Care, C4-08-06, 7500 Security Boulevard, Baltimore, MD 21244, Attn: Marianne Myers.

All requests must be received within 30 days of this posting of CMS final wage data and final reclassification decisions on the CMS Web site or by October 30, 2006.

C. Final FY 2007 Prospective Payment Systems Payment Rates for Hospital Operating and Capital Related Costs

As discussed in the FY 2007 IPPS final rule, due to the unusual circumstances imposed by the order of the Court of Appeals for the Second Circuit in the decision in
Bellevue Hospital Center
v.
Leavitt,
we did not publish the final FY 2007 budget neutrality factors, standardized amounts, fixed-loss cost threshold, outlier offset factor, DRG weights, or wage indices in the FY 2007 IPPS final rule. Because the occupational mix adjustment affects the calculation of the outlier threshold as well as the outlier offset and budget neutrality factors that are applied to the standardized amounts, we were only able to provide tentative figures in that final rule. As discussed above in this notice, we are publishing final occupation mix-adjusted wage indices. Accordingly, in this section of this notice, we are discussing the final FY 2007 prospective payment rates for Medicare hospital inpatient operating costs and Medicare hospital inpatient capital-related costs. We calculated these final rates using the methodology we adopted in the FY 2007 IPPS final rule.

We note that, because hospitals excluded from the IPPS are paid on a cost basis (and not by the IPPS), these hospitals were not affected by the tentative figures for standardized amounts, offsets, and budget neutrality factors. Therefore, the rate-of-increase percentages for updating the target amounts for hospitals and hospital units excluded from the IPPS that are effective October 1, 2006 were finalized in the FY 2007 IPPS final rule (71 FR 48164) and are not included in this notice.

1. Final FY 2007 Prospective Payment Rates for Hospital Inpatient Operating Costs

a.
Final FY 2007 Standardized Amount.
We calculated the final FY 2007 standardized amounts using the methodology we adopted in the FY 2007 IPPS final rule. For a complete description of this methodology, please see the FY 2007 IPPS final rule (71 FR 48145 through 48155). Tables 1A and 1B in the Addendum to this notice contain the final national standardized amount that we are applying to all hospitals, except hospitals in Puerto Rico. The final Puerto Rico-specific amounts are shown in Table 1C. The final amounts shown in Tables 1A and 1B differ only in that the labor-related share applied to the final standardized amounts in Table 1A is 69.7 percent, and the labor-related share applied to the final standardized amounts in Table 1B is 62 percent. (The labor-related share is 62 percent for all hospitals (other than those in Puerto Rico) whose wage indices are less than or equal to 1.0000.)

In addition, Tables 1A and 1B include final standardized amounts reflecting the full 3.4 percent update for FY 2007, and final standardized amounts reflecting the 2.0 percentage point reduction to the update (a 1.4 percent update) applicable for hospitals that fail to submit quality data consistent with section 1886(b)(3)(B)(viii) of the Act.

In the FY 2007 IPPS final rule, we did not supply a table that illustrated the changes from the FY 2006 national average standardized amount because we were only setting the standardized amounts tentatively, but we stated that we would provide the table in the subsequent
Federal Register
notice. Therefore, in this notice, we include below a table that details the calculation of the final standardized amounts.

Comparison of FY 2006 Standardized Amounts to Final FY 2007 Single Standardized Amount With Full Update and Reduced Update

Full update
(3.4 percent)

Reduced update
(1.4 percent)

FY 2006 Base Rate, after removing reclassification budget neutrality, demonstration budget neutrality, wage index transition budget neutrality factors and outlier offset (based on the proposed labor and nonlabor market share percentage for FY 2007)

Labor: $3,505.76
Nonlabor: $1,524.03

Labor: $3,505.76.
Nonlabor: $1,524.03.

Final FY 2007 Update Factor
1.034.
1.014.

Final FY 2007 DRG Recalibrations and Wage Index Budget Neutrality Factor
0.995662.
0.995662.

Final FY 2007 Reclassification Budget Neutrality Factor
0.992355.
0.992355.

Adjusted for Blend of FY 2006 DRG Recalibration and Wage Index Budget Neutrality Factors

Labor: $3,581.64
Nonlabor: $1,557.01

Labor: $3,512.37.
Nonlabor: $1,526.90.

Final FY 2007 Outlier Factor
0.948968.
0.948968.

Final FY 2007 Labor Market Wage Index Transition Budget Neutrality Factor
0.999700.
0.999700.

Final Rural Demonstration Budget Neutrality Factor
0.999905.
0.999905.

Final Rate for FY 2007 (after multiplying FY 2006 base rate by above factors) where the wage index is less than or equal to 1.0000

Labor: $3,022.18
Nonlabor: $1,852.31

Labor: $2,963.73.
Nonlabor: $1,816.48.

Final Rate for FY 2007 (after multiplying FY 2006 base rate by above factors) where the wage index is greater than 1.0000

Labor: $3,397.52
Nonlabor: $1,476.97

Labor: $3,331.80.
Nonlabor: $1,448.40.

The final labor-related and nonlabor-related portions of the national average standardized amounts for Puerto Rico hospitals for FY 2007 are set forth in Table 1C in the Addendum to this notice. (The labor-related share applied to the Puerto Rico-specific standardized amount is 58.7 percent, or 62 percent, depending on which is more advantageous to the hospital.

b.
Final Adjustments for Area Wage Levels.
The final occupational mix adjusted wage indices by geographic area are listed in Tables 4A-1, 4A-2, 4B, 4C-1, 4C-2, and 4F in the Addendum to this notice. (These tables are also available on the CMS Web site.)

c.
FY 2007 Final Outlier Fixed-Loss Cost Threshold.
Using the methodology we adopted in the FY 2007 IPPS final rule, we are establishing a final outlier fixed-loss cost threshold for FY 2007 equal to the prospective payment rate for the DRG, plus any IME and DSH payments, and any add-on payments for new technology, plus $24,485.

d.
DRG Weights.
Because we rely on the wage index data as one of the standardizing factors that we use in calculating both the charge-based and the cost-based relative weights that we are blending to set the FY 2007 transitional relative weights, we have recalculated the FY 2007 relative weights. We list the final DRG weights in Table 5 of the Addendum to this notice.

2. Final FY 2007 Prospective Payment Rates for Acute Care Hospital Inpatient Capital-Related Costs

We have calculated the final FY 2007 capital Federal rates, offsets, and budget neutrality factors using the methodology we adopted in the FY 2007 IPPS final rule. For a complete description of this methodology, please see the FY 2007 IPPS final rule (71 FR 48155 through 48156).

a.
Inpatient Hospital Capital-Related Prospective Payment Rate Update.
The factors used in the update framework are not affected by the occupational mix information used to adjust the wage index. Therefore, the update factor for FY 2007 was not revised from the capital PPS standard Federal rate update factor published in the FY 2007 IPPS final rule and remains at 1.10 percent for FY 2007. A full discussion of the update framework is provided in the FY 2007 IPPS final rule (71 FR 48156 through 48158).

b.
Outlier Payment Adjustment Factor.
Based on the final thresholds as set forth in section II.C. of this notice, we estimate that final outlier payments for capital-related costs will equal 4.32 percent for inpatient capital-related payments based on the final Federal rate in FY 2007. Therefore, we are applying a final outlier adjustment factor of 0.9568 to the final capital Federal rate. Thus, we estimate that the percentage of capital outlier payments to total capital standard payments for FY 2007 will be slightly lower than the percentages for FY 2006.

The outlier thresholds for FY 2007 are in section II.C.1. of this notice. For FY 2007, a case qualifies as a cost outlier if the cost for the case plus the IME and DSH payments are greater than the prospective payment rate for the DRG plus $24,485.

c.
Budget Neutrality Adjustment Factor for Changes in DRG Classifications and Weights and the GAF.
Using the methodology discussed in the FY 2007 IPPS final rule (71 FR 48158 through 48161), for FY 2007, we are establishing a final GAF/DRG budget neutrality factor of 0.9986. The GAF/DRG budget neutrality factors are built permanently into the capital rates; that is, they are applied cumulatively in determining the capital Federal rate. This follows from the requirement that estimated aggregate payments each year be no more or less than they would have been in the absence of the annual DRG reclassification and recalibration and changes in the GAF. The final incremental change in the adjustment from FY 2006 to FY 2007 is 0.9986. The final cumulative change in the capital Federal rate due to this adjustment is 0.9906 (the product of the incremental factors for FYs 1993 though 2006 and the final incremental factor of 0.9986 for FY 2007). (We note that averages of the incremental factors that were in effect during FYs 2005 and 2006, respectively, were used in the calculation of the final cumulative adjustment of 0.9986 for FY 2007.)

This factor accounts for DRG reclassifications and recalibration and for changes in the GAF as well as the revised wage index as adjusted by occupational mix data. It also incorporates the effects on the final GAF of FY 2007 geographic reclassification decisions made by the MGCRB compared to FY 2006 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.

d.
Exceptions Payment Adjustment Factor.
The adjustments made to the wage index as a result of the application of occupational mix data had no effect on capital exceptions payments. Therefore, the special exceptions adjustment factor remains at 0.9997 as discussed in section III.A.4. of FY 2007 IPPS final rule (71 FR 48161). We also explained that the adjustments for regular exception payments are no longer necessary as they were only applicable during the capital transition period (cost reporting periods beginning on or after October 1, 1991 and before October 1, 2001).

e.
Capital Standard Federal Rate for FY 2007.
We are providing a chart that shows how each of the factors and adjustments for FY 2007 affected the computation of the final FY 2007 capital Federal rate in comparison to the FY

2006 capital Federal rate. The FY 2007 update factor has the effect of increasing the final capital Federal rate by 1.1 percent compared to the average FY 2006 Federal rate. The final GAF/DRG budget neutrality factor has the effect of decreasing the final capital Federal rate by 0.14 percent. The final FY 2007 outlier adjustment factor has the effect of increasing the final capital Federal rate by 0.56 percent compared to the average FY 2006 capital Federal rate. The FY 2007 exceptions payment adjustment factor remains unchanged from the FY 2006 exceptions payment adjustment factor, and therefore, has a 0.0 percent net effect on the final FY 2007 capital Federal rate. The combined effect of all the changes is to increase the capital Federal rate by 1.52 percent compared to the average FY 2006 capital Federal rate.

Comparison of Factors and Adjustments: FY 2006 Capital Federal Rate and FY 2007 Capital Federal Rate

FY 2006
FY 2007
Change
Percent change

Update Factor
1

1.0080
1.0110
1.0110
1.10

GAF/DRG Adjustment Factor
1

1.0008

3
0.9986

0.9986
−0.14

Outlier Adjustment Factor
2

0.9515

3
0.9568

1.0056
0.56

Exceptions Adjustment Factor
2

0.9997
0.9997
0.0000
0.00

Capital Federal Rate
$420.65

3
$427. 03

1.0152
1.52

1
The update factor and the GAF/DRG budget neutrality factors are built permanently into the capital rates. Thus, for example, the incremental change from FY 2006 to FY 2007 resulting from the application of the final GAF/DRG budget neutrality factor for FY 2007 is 0.9986.

2
The outlier reduction factor and the exceptions adjustment factor are not built permanently into the capital rates; that is, these factors are not applied cumulatively in determining the capital rates. Thus, for example, the net change resulting from the application of the final FY 2007 outlier adjustment factor would be 0.9568/0.9515, or 1.0056.

3
Final factors for FY 2007, as discussed in section II.E. of this notice.

We provided a chart in the FY 2007 IPPS final rule (71 FR 48162) that compared the tentative FY 2007 capital Federal rate to the proposed FY 2007 capital Federal rate (71 FR 24158 through 24159). We are now providing a chart that shows how the final FY 2007 capital Federal rate differs from the tentative FY 2007 capital Federal rate as presented in the FY 2007 IPPS final rule.

Comparison of Factors and Adjustments: FY 2007 Tentative Capital Federal Rate and FY 2007 Final Capital Federal Rate

Tentative

FY 2007
1

Final FY 2007
2

Change
Percent change

Update Factor
1

1.0110
1.0110
0
0

GAF/DRG Adjustment Factor
1

0.9994
0.9986
0.0008
−0.08

Outlier Adjustment Factor
2

0.9568
0.9568
0
0

Exceptions Adjustment Factor
2

0.9997
0.9997
0.0000
0.00

Capital Federal Rate
$427.38
$427.03
0.0008
0.08

1
As published in the FY 2007 IPPS final rule without the application of occupational mix data to the wage index.

2
Final capital inpatient factors and rates after occupational mix adjustment to wage index in accordance with the order of the Second Circuit Court.

As a final comparison, we are providing a chart that shows how the final FY 2007 capital Federal rate differs from the proposed FY 2007 capital Federal rate presented in the FY 2007 IPPS proposed rule (71 FR 24158 through 24159).

Comparison of Factors and Adjustments: Proposed FY 2007 Capital Federal Rate and Final FY 2007 Capital Federal Rate

Proposed FY 2007
Final FY 2007
Change
Percent change

Update Factor
1.0080
1.0110
1.0030
0.30

GAF/DRG Adjustment Factor
1.0012
* 0.9986
0.9974
−0.26

Outlier Adjustment Factor
0.9513
* 0.9568
1.0058
0.58

Exceptions Adjustment Factor
0.9997
0.9997
0.0000
0.00

Capital Federal Rate
$424.42
* $427.03
1.0061
0.61

* Final factors for FY 2007, as discussed in section II.C.2 of this notice.

g.
Special Capital Rate for Puerto Rico Hospitals.
Using the methodology discussed in the FY 2007 IPPS final rule (71 FR 48104), the final FY 2007 special capital rate for Puerto Rico is $203.06. (See the FY 2007 IPPS final rule (71 FR 48163) for additional information on the calculation of FY 2007 capital PPS payments.)

D. Final FY 2007 Inpatient Operating and Capital-Related Impacts

1. Final FY 2007 Inpatient Operating Impacts (Quantitative Effects of the Final Occupational Mix Adjusted Wage Indices)

The impact analysis for policy changes under the IPPS for operating costs was included in the FY 2007 IPPS final rule. As stated in that impact section (71 FR 48332), we were unable to provide final occupational mix adjusted wage indices because of our obligation to collect new occupational mix survey data consistent with the order of the Court of Appeals in the Second Circuit. We were also unable to provide final relative weights, budget neutrality calculations, the outlier threshold and outlier offsets to the standardized amounts because these figures are all dependent on final wage indices. However, we also indicated that when 100 percent occupational mix adjusted wage data were available, we would recalculate the impacts and provide them in a subsequent
Federal Register
notice prior to October 1, 2006. Now that the new occupational mix survey data are available and the final 100 percent occupational mix adjusted wage data have been prepared, we are providing the final impacts for FY 2007 including the effect of the occupational mix adjusted wage data. Since there are statutory budget neutrality requirements applied to changes in DRGs and recalibration, wage index and geographic reclassifications, our payment estimates for hospitals overall are consistent with our estimate from the FY 2007 IPPS final rule (71 FR 48331). That is, the revisions to these figures do not increase or decrease aggregate total IPPS payments relative to those we earlier calculated. We continue to estimate that the changes in the FY 2007 IPPS final rule, in conjunction with the final IPPS rates included in this notice, will result in an approximate $3.4 billion increase in operating and capital payments. (See the FY 2007 IPPS final rule (71 FR 48331) for a more detailed explanation of how we estimated this $3.4 billion increase).

a.
Analysis of Impact Table I.
Table I displays the results of our analysis of the payment changes for FY 2007 that are affected by use of the 100 percent occupational-mix adjusted wage data using occupational-mix survey data from January through March. These impacts update the tentative ones that were shown in the FY 2007 IPPS final rule. As explained in the FY 2007 IPPS final rule and this notice, the FY 2006 occupational-mix survey data were unavailable in time for the completion of the IPPS final rule that was made available to the public on August 1. In this notice, we are only displaying the columns that were affected by the change to the 100 percent occupational-mix adjusted wage data and therefore we are not reprinting the impacts to the quality data rate difference or the MDH changes from section 5003 of the Deficit Reduction Act that were published in the FY 2007 IPPS final rule. (See the FY 2007 IPPS final rule (71 FR 48333 through 48341) for a full discussion of the FY 2007 regulatory impact analysis.)

Table I 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 3,595 hospitals included in the analysis. 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 2,590 hospitals located in urban areas included in our analysis. Among these, there are 1,441 hospitals located in large urban areas (populations over 1 million), and 1,149 hospitals in other urban areas (populations of 1 million or fewer). In addition, there are 1,005 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 2007 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 (including reclassifications under sections 1886(d)(8)(B) and 1886(d)(8)(E) of the Act, which have implications for capital payments) are 2,607, 1,448, 1,159, and 988, respectively.

The next three groupings examine the impacts of the changes on hospitals grouped by whether or not they have GME residency programs (teaching hospitals that receive an IME adjustment) or receive DSH payments, or some combination of these two adjustments. There are 2,511 non-teaching hospitals in our analysis, 843 teaching hospitals with fewer than 100 residents, and 241 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 for DSH purposes. 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 changes on rural hospitals by special payment groups (sole community hospitals (SCHs), rural referral centers (RRCs), and Medicare dependent hospitals (MDHs)), as well as rural hospitals not receiving a special payment designation. There were 187 RRCs, 376 SCHs, 146 MDHs, 98 hospitals that are both SCHs and RRCs, and 8 hospitals that are both MDHs and RRCs.

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 2004 Medicare cost reports, if available, (otherwise FY 2003 data are used).

The next series of groupings concern the geographic reclassification status of hospitals. The first grouping displays all urban hospitals that were reclassified by the MGCRB for FY 2007. The next grouping shows the MGCRB rural reclassifications. The final three rows in Table I contain hospitals located in urban counties, but deemed to be rural under section 1886(d)(8)(E) of the Act, hospitals located in rural counties but deemed to be urban under section 1886(d)(8)(B) of the Act, and hospitals currently reclassified under section 508 of Pub. L. 108-173, which expires on March 31, 2007.

Table I.—Impact Analysis of Changes for FY 2007

Number of

hospitals
1

(1)

FY 2007 Transitional
1/3
Cost
2/3
charge weights & DRG changes
2
(2)

FY 2007 wage data
3
(3)

FY 2007 DRG, Rel. Wts. and Wage index changes
4
(4)

FY 2007 wage index transition for hospitals moving from urban to rural
5
(5)

FY 2007 MGCRB reclassifications
6
(6)

FY 2007 out-migration adjustment
7
(7)

All FY 2007 changes
8
(8)

All Hospitals
3,595
0.3
0.2
0.0
0.0
0.0
0.1
3.5

By Geographic Location:

Urban hospitals
2,590
0.2
0.1
0.0
0.0
−0.3
0.1
3.4

Large urban areas (populations over 1 million)
1,441
0.4
0.0
−0.1
0.0
−0.4
0.0
3.5

Other urban areas (populations of 1 million or fewer)
1,149
0.1
0.3
0.0
0.0
−0.1
0.2
3.4

Rural hospitals
1,005
0.3
0.3
0.4
0.3
2.1
0.1
3.9

Bed Size (Urban):

0-99 beds
651
0.4
0.1
0.0
0.0
−0.5
0.1
3.5

100-199 beds
867
0.6
0.2
0.3
0.0
−0.1
0.1
3.8

200-299 beds
492
0.3
0.1
0.0
0.0
−0.3
0.1
3.6

300-499 beds
413
0.1
0.2
−0.2
0.0
−0.3
0.1
3.3

500 or more beds
167
0.0
0.1
−0.3
0.0
−0.3
0.0
3.2

Bed Size (Rural):

0-49 beds
348
0.5
0.2
0.6
0.1
0.8
0.2
4.7

50-99 beds
370
0.5
0.2
0.4
0.2
1.1
0.2
4.9

100-149 beds
174
0.4
0.4
0.5
0.5
2.5
0.1
3.6

150-199 beds
68
0.3
0.4
0.3
0.4
3.4
0.1
3.3

200 or more beds
45
0.0
0.3
−0.1
0.0
3.1
0.0
3.0

Urban by Region:

New England
128
0.4
1.1
1.0
0.0
0.3
0.1
3.5

Middle Atlantic
357
0.5
0.6
0.7
0.0
−0.1
0.2
3.9

South Atlantic
388
0.1
−0.2
−0.5
0.0
−0.4
0.0
3.2

East North Central
395
0.2
0.3
0.1
0.0
−0.3
0.0
3.4

East South Central
165
−0.1
−0.6
−1.0
0.0
−0.4
0.1
2.7

West North Central
157
0.0
−0.4
−0.8
0.0
−0.6
0.0
2.8

West South Central
374
0.2
−0.1
−0.3
0.0
−0.5
0.0
3.4

Mountain
149
0.2
0.2
0.0
0.0
−0.2
0.0
3.7

Pacific
424
0.4
0.1
0.1
0.0
−0.3
0.1
3.7

Puerto Rico
53
0.3
−1.4
−1.5
0.0
−0.6
0.0
2.0

Rural by Region:

New England
19
0.5
−0.2
0.1
0.0
2.0
0.1
6.0

Middle Atlantic
72
0.5
0.2
0.5
0.1
2.3
0.0
5.2

South Atlantic
176
0.4
0.4
0.5
0.2
2.2
0.2
3.8

East North Central
125
0.2
−0.2
−0.1
0.1
1.6
0.0
3.8

East South Central
180
0.3
0.6
0.5
0.2
2.5
0.1
3.5

West North Central
116
0.2
0.2
0.2
0.0
2.0
0.1
4.3

West South Central
193
0.4
0.9
0.9
0.5
2.8
0.2
4.1

Mountain
81
0.3
−0.2
−0.1
2.1
0.8
0.1
2.7

Pacific
43
0.3
−0.3
−0.2
0.0
1.8
0.1
3.2

By Payment Classification:

Urban hospitals
2,607
0.2
0.1
0.0
0.0
−0.3
0.1
3.4

Large urban areas (populations over 1 million)
1,448
0.4
0.0
−0.1
0.0
−0.4
0.0
3.5

Other urban areas (populations of 1 million or fewer)
1,159
0.1
0.3
0.0
0.0
−0.1
0.2
3.4

Rural areas
988
0.3
0.3
0.4
0.3
2.0
0.1
4.0

Teaching Status:

Nonteaching
2,511
0.4
0.1
0.1
0.0
0.2
0.1
3.8

Fewer than 100 residents
843
0.2
0.1
−0.1
0.0
−0.2
0.1
3.4

100 or more residents
241
0.1
0.3
−0.1
0.0
−0.3
0.0
3.1

Urban DSH:

Non−DSH
906
0.2
0.1
−0.1
0.0
−0.1
0.1
3.6

100 or more beds
1,520
0.2
0.1
0.0
0.0
−0.3
0.1
3.4

Less than 100 beds
346
0.6
0.0
0.2
0.0
−0.3
0.1
3.6

Rural DSH:

SCH
386
0.3
0.2
0.4
0.2
0.6
0.1
4.6

RRC
199
0.2
0.4
0.3
0.2
3.4
0.0
3.5

Other Rural:

100 or more beds
55
0.6
0.7
0.9
0.9
0.7
0.2
3.5

Less than 100 beds
183
0.6
0.5
0.7
0.4
0.9
0.4
3.8

Urban teaching and DSH:

Both teaching and DSH
815
0.2
0.1
−0.1
0.0
−0.3
0.0
3.3

Teaching and no DSH
201
0.1
0.3
0.0
0.0
−0.1
0.2
3.3

No teaching and DSH
1,051
0.5
0.1
0.1
0.0
−0.1
0.1
3.7

No teaching and no DSH
540
0.3
0.0
−0.2
0.0
−0.3
0.0
3.5

Special Hospital Types:

RRC
187
0.2
0.5
0.3
0.2
3.1
0.1
3.5

SCH
376
0.3
0.1
0.3
0.2
0.4
0.1
3.6

MDH
146
0.5
0.2
0.5
0.0
0.7
0.1
9.0

SCH and RRC
98
0.1
−0.1
−0.1
0.0
1.9
0.0
3.1

MDH and RRC
8
0.3
−0.1
0.3
0.0
1.0
0.0
14.0

Type of Ownership:

Voluntary
2,102
0.2
0.2
0.1
0.0
0.0
0.1
3.5

Proprietary
880
0.4
−0.1
−0.2
0.1
−0.1
0.0
3.5

Government
603
0.3
0.0
−0.2
0.0
0.1
0.1
3.4

Unknown
10
2.2
0.1
1.7
0.0
−0.3
0.2
7.6

Medicare Utilization as a Percent of Inpatient Days:

0-25
243
0.6
−0.1
0.1
0.0
−0.3
0.0
3.6

25-50
1,328
0.2
0.0
−0.2
0.0
−0.4
0.0
3.3

50-65
1,478
0.3
0.3
0.2
0.0
0.4
0.1
3.7

Over 65
462
0.2
0.3
0.1
0.0
0.5
0.1
3.8

Unknown
84
1.0
−0.4
0.1
0.0
−0.5
0.1
4.4

Urban Hospitals Reclassified by the Medicare Geographic Classification Review Board: First Half FY 2007 Reclassifications
281
0.3
0.3
0.1
0.0
2.4
0.0
3.7

Urban Nonreclassified, First Half FY 2007:
2,284
0.2
0.1
−0.1
0.0
−0.6
0.1
3.4

All Urban Hospitals Reclassified Second Half FY 2007:
341
0.3
0.4
0.2
0.0
1.8
0.0
3.5

Urban Nonreclassified Hospitals Second Half FY 2007:
2,224
0.2
0.1
−0.1
0.0
−0.6
0.1
3.4

All Rural Hospitals Reclassified Full Year FY 2007:
369
0.2
0.3
0.2
0.1
3.6
0.0
3.6

Rural Nonreclassified Hospitals Full Year FY 2007:
578
0.5
0.3
0.5
0.6
−0.3
0.3
4.4

All Section 401 Reclassified Hospitals:
30
0.2
0.8
0.8
0.0
−0.1
0.0
5.4

Other Reclassified Hospitals (Section 1886(d)(8)(B))
57
0.6
0.3
0.6
0.0
3.6
0.0
4.4

Section 508 Hospitals
108
0.2
0.6
0.4
0.0
−0.2
0.0
1.9

Specialty Hospitals

Cardiac Specialty Hospitals
21
−2.0
0.0
−2.4
0.0
−0.6
0.0
1.2

1
Because 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 2005, and hospital cost report data are from reporting periods beginning in FY 2004 and FY 2003.

2
This column displays the final payment impact of the changes to the V24 GROUPER and the recalibration of the DRG cost weights based on FY 2005 MedPAR data in accordance with section 1886(d)(4)(C)(iii) of the Act.

3
This column displays the final payment impact of updating the wage index data with the 100 percent occupational mix adjustment applied to the FY 2003 cost report data.

4
This column displays the final payment impact of the 0.995662 budget neutrality factor for DRG and wage index changes (with a 100 percent occupational mix adjustment applied to the wage index) data in accordance with section 1886(d)(4)(C)(iii) of the Act and section 1886(d)(3)(E) of the Act.

5
Shown here are the final effects of providing rural hospitals formerly located in urban areas with urban wage index values in FY 2007. The effects reflected here are budget neutral: this column therefore includes the effect of the 0.999700 adjustment that we have applied to the rates to ensure budget neutrality.

6
Shown here are the final effects of geographic reclassifications by the Medicare Geographic Classification Review Board (MGCRB) and CMS decisions made on behalf of the hospital for FY 2007. The effects demonstrate the FY 2007 payment impact of going from no reclassifications to the reclassifications scheduled to be in effect for FY 2007. Reclassification for prior years has no bearing on the payment impacts shown here. This column reflects the geographic budget neutrality factor of 0.992355.

7
This column displays the final impact of the FY 2007 implementation of section 505 of Pub. L. 108-173, which provides for an increase in a hospital's wage index if the hospital qualifies by meeting a threshold percentage of residents of the county where the hospital is located who commute to work at hospitals in counties with higher wage indices.

8
This column shows final changes in payments from FY 2006 to FY 2007. It incorporates all of the changes displayed in Columns 2, 3, 4,5, and 6 (the changes displayed in Columns 2 and 3 are included in Column 4), as well as those displayed in columns 2 and 3 (related to the quality data differential in the IPPS update and implementation of the MDH DRA provisions) of the FY 2007 IPPS final rule. It also reflects the impact of the FY 2007 update, changes in hospitals' reclassification status in FY 2007 compared to FY 2006, and the changes in payments as a result of continuing the reclassifications under section 508 of Pub. L. 108-173. The product of these impacts may be different from the percentage changes shown here due to rounding and interactive effects.

(1)
Effects of the Changes to the DRG Reclassifications and Relative Cost-Based Weights (Column 2).
In Column 2 of Table I, we present the combined effects of the DRG reclassifications and recalibration, as discussed in section II. of the preamble to the FY 2007 IPPS final rule (71 FR 47879 through 47979). Section 1886(d)(4)(C)(i) of the Act requires us annually to make appropriate classification changes in order to reflect changes in treatment patterns, technology, and any other factors that may change the relative use of hospital resources.

As discussed in the preamble of the FY 2007 IPPS final rule (71 FR 47882 through 47898), we are changing the relative weight calculation methodology from a charge-based to a cost-based method. Further, we are implementing the new methodology under a 3-year transition such that weights in FY 2007 are
1/3
cost-based and
2/3
charge-based. As part of the methodology for determining cost weights, we standardize hospital charges by the wage index to remove the effect of area wage differences. Since the wage index data has been updated to reflect a 100 percent occupational mix adjustment based on the latest survey data available, we recalculated the relative weights for the FY 2007 by standardizing charges using the 100 percent occupational mix adjusted wage indices. The use of occupational mix adjusted wage indices to standardize hospital charges resulted in very small changes to the DRG relative weights. No DRG weight changed by greater or less than 1 percent from those shown in Table 5 of the FY 2007 IPPS final rule. The revised and final FY 2007 DRG relative weights are shown in Table 5 of the Addendum to this notice.

In column 2, we compare aggregate payments using the FY 2007 blended relative weights (GROUPER Version 24) to the FY 2006 DRG relative charge weights (GROUPER Version 23.0) so the percentages shown here illustrate the effect of changes to the DRGs and relative weights. The method of calculating the relative weights and the reclassification changes to the GROUPER are described in more detail in section II. of the preamble to the FY 2007 IPPS final rule. The impacts shown in this column are generally very consistent by hospital category with those shown in column 4 of Table I of the FY 2007 IPPS final rule (71 FR 48335). With the exception of using occupational mix adjusted wage indices to standardize hospital charges, the data and methodology that we modeled in this column are identical to the FY 2007 IPPS final rule. Therefore, any differences in the impacts shown in this column from column 6 of Table I of the FY 2007 IPPS final rule and column 4 of the table above are due to the use of occupational mix adjusted wage data. We note that this column reflects the impact of changes to the DRG classifications and relative weights only and is not budget neutral. Consistent with section 1886(d)(4)(C)(iii) of the Act, we apply a single budget neutrality factor to ensure that the combined overall payment impact of changes to the DRG classification, relative weights, and wage index is budget neutral. The budget neutrality factor for the combined changes to the DRGs, relative weights, and wage index are shown in the table above entitled, “Comparison of FY 2006 Standardized Amounts to Final FY 2007 Single Standardized Amount with Full Update and Reduced Update.”

(2) Effects of Wage Index Changes (Column 3).
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 wage index for FY 2007 is based on data submitted for hospital cost reporting periods beginning on or after October 1, 2002 and before October 1, 2003. In the IPPS FY 2007 IPPS final rule, due to the decision in
Bellevue Hosp. Center
v.
Leavitt,
in which the Court of Appeals for the Second Circuit ordered CMS to apply the occupational mix adjustment to 100 percent of the wage index effective for FY 2007 (see section III.C. of the FY 2007 IPPS final rule for more details of this Court decision (71 FR 48006)), we were unable to show the impact of the 100 percent occupational mix adjustment as the necessary data were unavailable in time for making the final IPPS rule available to the public on August 1. This column now shows the final estimated effect of updating the wage index with wage data from FY 2003 hospital cost reports and moving to a 100 percent occupational mix adjusted wage index using occupational mix survey data for January through March of this year.

The estimated impact on hospital payments of the new wage data with the 100 percent occupational mix adjustment applied using the new survey data is isolated in Column 3 by holding the other payment parameters constant. That is, Column 3 shows the percentage changes in payments when going from a model using the FY 2006 wage index, based on FY 2002 wage data and having a 10-percent occupational mix adjustment applied, to a model using the FY 2007 pre-reclassification wage index, based on FY 2003 wage data with a 100 percent occupational mix adjustment based on the latest occupational mix survey data. The wage data collected on the FY 2003 cost report are the same as the FY 2002 wage data that were used to calculate the FY 2006 wage index.

Hospitals located in urban New England are estimated to receive the greatest benefit from the new wage and occupational mix data. Payments to hospitals in urban New England are estimated to increase 1.1 percent while rural hospitals located in the West South Central region experience an increase of 0.9 percent from these data.

Puerto Rico hospitals see the least benefit from the change to the wage and occupational mix data with a 1.4 percent estimated decrease in payments.

The national average hourly wage increased 5.9 percent compared to FY 2006 from the new wage data. Therefore, the only manner in which to maintain or exceed the previous year's wage index was to match the national 5.9 increase in average hourly wage. Of the 3,491 hospitals with wage data for both FYs 2006 and 2007, 1,706, or 48.9 percent, also experienced an average hourly wage increase of 5.9 percent or more.

The following chart compares the shifts in wage index values for hospitals for FY 2007 relative to FY 2006. Among urban hospitals, 40 will experience an increase of between 5 percent and 10 percent and 15 will experience an increase of more than 10 percent. No rural hospitals will experience an increase greater than 5 percent, but 790 will experience increases between 0 and 5 percent. On the negative side, 79 urban hospitals will experience decreases in their wage index values of at least 5 percent, but less than 10 percent. Eight urban hospitals will experience decreases in their wage index values greater than 10 percent.

The following chart shows the projected impact for urban and rural hospitals:

Percentage change in area wage index
values

Number of
hospitals

Urban
Rural

Increase more than 10 percent
15
0

Increase more than 5 percent and less than 10 percent
40
0

Increase or decrease less than 5 percent
2,354
986

Decrease more than 5 percent and less than 10 percent
79
5

Decrease more than 10 percent
8
4

(3)
Combined Effects of DRG and Wage Index Changes, Including Budget Neutrality Adjustment (Column 4).
Section 1886(d)(4)(C)(iii) of the Act requires that changes to DRG reclassifications and the relative weights cannot increase or decrease aggregate payments. 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 final rule, in determining the budget neutrality factor, we equated simulated aggregate payments for FY 2006 and FY 2007 using the FY 2005 Medicare utilization data after applying the changes to the DRG relative weights and the wage index.

We computed a wage and DRG recalibration budget neutrality factor of 0.995662. The 0.0 percent impact for all hospitals demonstrates that these changes, in combination with the budget neutrality factor, are budget neutral. In Table I, the combined overall impacts of the effects of both the DRG reclassifications and the updated wage index are shown in Column 4. The changes in this column are the sum of the changes in Columns 2 and 3, combined with the budget neutrality factor for the wage index, including the wage index floor for urban areas required by section 4410 of Pub. L. 105-33. There also may be some variation of plus or minus 0.1 percentage point due to rounding. As indicated above, the changes in the relative weights are generally consistent with those we showed in Table I of the FY 2007 IPPS final rule while the impacts due to the wage data may be somewhat different than those shown there because of the new occupational mix survey and a 100 percent adjustment to the wage index. Any changes between column 6 of Table I of the FY 2007 IPPS final rule and column 4 of Table I of this notice are due to use of a 100 percent adjustment for occupational mix and the new survey data.

(4)
Effects of the 3-Year Provision Allowing Urban Hospitals that Were Converted to Rural as a Result of the FY 2005 Labor Market Area Changes to Maintain the Wage Index of the Urban Labor Market Area in Which They Were Formerly Located (Column 5).
To help alleviate the decreased payments for urban hospitals that became rural under the new labor market area definitions, for purposes of the wage index, we adopted a policy in FY 2005 to allow them to maintain the wage index assignment of the MSA where they were located for the 3-year period FY 2005, FY 2006, and FY 2007. Column 5 shows the impact of the remaining labor market area transition, for those hospitals that were urban under the old labor market area designations and are now considered rural hospitals. Section 1886(d)(3)(E) of the Act specifies that any updates or adjustments to the wage index are to be budget neutral. Therefore, we applied a adjustment of 0.999700 to ensure that the effects of reclassification are budget neutral as indicated by the zero effect on payments to hospitals overall. The rural hospital row shows a 0.3 percent benefit from this provision as these hold-harmless hospitals are now classified as geographically rural.

(5)
Effects of MGCRB Reclassifications (Column 6).
Our impact analysis up 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 other bases 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 6 reflect the per case payment impact of moving from this baseline to a simulation incorporating the MGCRB decisions for FY 2007 which affect hospitals' 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 another area's wage index value. The FY 2007 wage index values incorporate all of the MGCRB's reclassification decisions for FY 2007 as well as any decisions made by the CMS Administrator through the appeals and review process.

For FY 2007, as stated in the FY 2006 IPPS final rule (70 FR 47382, August 12, 2005), we established procedural rules under section 1886(d)(10)(D)(v) of the Act to address specific circumstances where individual and group reclassifications involve a section 508 hospital. The rules were designed to recognize the special circumstances of section 508 hospital reclassifications ending midyear during FY 2007 and were intended to allow previously approved reclassifications to continue through March 31, 2007, and new section 1886(d)(10) reclassifications to begin April 1, 2007, upon the conclusion of the section 508 reclassifications. Under these procedural rules, some section 1886(d)(10) hospital reclassifications are only in effect for the second half of the fiscal year.

The first and second half fiscal year section 1886(d)(10) reclassifications permitted under these procedural rules have implications for the calculation of the reclassified wage indices and the reclassification budget neutrality factor. Section 1886(d)(8)(c) of the Act provides requirements for determining the wage index values for hospitals that were reclassified as a result of the MGCRB decisions under 1886(d)(10) of the Act. As provided in the statute, we are required to calculate a separate wage index for hospitals reclassified to an area if including the wage data for the reclassified hospitals would reduce the area wage index by more than 1 percent.

Because of the half-year reclassifications permitted under the procedural rules, in this final rule, we are issuing two separate wage indices for affected areas (one effective from October 1, 2006, through March 31, 2007 and a second reclassified wage index effective April 1, 2007, through September 30, 2007). The FY 2007 wage index values are calculated based on the wage data for hospitals reclassified to the area in the respective half of the fiscal year. The impact of this policy is modeled in Column 6 of Table I of this notice.

The overall effect of geographic reclassification is required by section 1886(d)(8)(D) of the Act to be budget neutral. In this final rule, we are calculating one budget neutrality adjustment that reflects the average of the adjustments required for first and second half fiscal year reclassifications, respectively. Therefore, we applied an adjustment of 0.992355 to ensure that the effects of the section 1886(d)(10) reclassifications are budget neutral. (See section II.A. of the Addendum to FY 2007 IPPS final rule (71 48146).) As noted in section II.B. of this notice, CMS applied reclassification decisions for FY 2007 on behalf of hospitals to give them the highest wage index. Hospitals have 30 days from the date of the posting of these data on the CMS Web site to revise the decision that CMS made on their behalf.

The impacts shown in Column 6 of Table 1 above reflect the CMS reclassification decisions on behalf of hospitals, which reflect the area that would give the hospital the highest wage index using a 100 percent occupational-mix adjustment and the most recent survey data. As a group, rural hospitals benefit most from reclassification. We estimate that their payments will rise 2.1 percent in FY 2007. Payments to urban hospitals will decline by 0.3 percent. Hospitals in other urban areas will experience an overall decrease in payments of 0.1 percent, while hospitals in large urban areas will lose 0.4 percent. Among urban hospital groups (that is, bed size, census division and IME/DSH status), payments generally would decline.

A positive impact is evident among all of the rural hospital groups. The smallest increase among rural census divisions is 0.8 percent for the Mountain region. The largest increases are in the rural West South Central and rural East South Central regions with 2.8 and 2.5 percent, respectively. Urban hospitals reclassified for FY 2007 are expected to receive an increase of 2.4 percent, while rural reclassified hospitals are expected to benefit from the MGCRB changes with a 3.6 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 0.6 percent for urban hospitals and 0.3 percent for rural hospitals.

(6)
Effects of the Wage Index Adjustment for Out-Migration (Column 7).
Section 1886(d)(13) of the Act, as added by section 505 of Pub. L. 108-173, provides for an increase in the wage index for hospitals located in certain counties that have a relatively high percentage of hospital employees who reside in the county, but work in a different area with a higher wage index. Hospitals located in counties that qualify for the payment adjustment are to receive an increase in the wage index that is equal to a weighted average of the difference between the wage index of the resident county and the higher wage index work area(s), weighted by the overall percentage of workers who are employed in an area with a higher wage index.

Using our established criteria, 583 providers in 282 counties are eligible for this adjustment. Due to the statutory formula to calculate the adjustment and the small number of counties that qualify, the impact on hospitals is minimal, with an overall impact on all hospitals of 0.1 percent.

(7)
Effects of All Changes (Column 8).
Column 8 compares our estimate of payments per case between FY 2006 and FY 2007, incorporating all changes reflected in the FY 2007 IPPS final rule and in this notice (including statutory changes). This column reflects the impact of all FY 2007 changes relative to FY 2006, including the impact of the quality data changes and the MDH changes from section 5003 of the DRA (see 70 FR 48335) and the impacts shown in Columns 2 through 8 as well as other factors that are not applied until the final rates are calculated. The average increase for all hospitals is approximately 3.5 percent. This increase includes the effects of the 3.4 percent market basket update. It also reflects the 0.5 percentage point difference between the projected outlier payments in FY 2006 (5.1 percent of total DRG payments) and the current estimate of the percentage of actual outlier payments in FY 2006 (4.6 percent), as described in the introduction to this Appendix and the Addendum to this final rule. As a result, payments are projected to be 0.5 percentage points lower in FY 2006 than originally estimated, resulting in a 0.5 percentage point greater increase for FY 2007 than would otherwise occur. In addition, the impact of section 505 adjustments accounted for a 0.1 percent increase. Indirect medical education formula changes for teaching hospitals under section 502 of Pub. L. 108-173, changes in payments due to the difference between the FY 2006 and FY 2007 wage index values assigned to providers reclassified under section 508 of Pub. L. 108-173, and changes in the incremental increase in payments from section 505 of Pub. L. 108-173 out-migration adjustments account for the remaining −0.6 percent.

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 8 may not equal the product of the percentage changes described above. We estimate that payments will increase across all hospitals in each category shown in column 8.

We estimate that the average payment per case will increase in FY 2007 by 3.5 percent across all hospitals, 3.4 percent for hospitals in urban areas, 3.5 percent for hospitals in large urban areas, 3.4 percent for hospitals in other urban areas and 3.9 percent for hospitals in rural areas.

Among urban census divisions, we estimate the largest payment increases would be 3.9 percent in the Mid Atlantic region and 3.7 percent in the Pacific and Mountain regions. We estimate that the smallest urban increase will be 2.0 percent in Puerto Rico.

Among rural areas, the New England and Middle Atlantic regions would benefit the most from changes in the FY 2007 IPPS final rule, with 6.0 and 5.2 percent increases, respectively. The smallest increase would occur in the Mountain region, with a 2.7 percent increase in payments.

Among special categories of rural hospitals in Column 8, MDH/RRC providers receive an increase in payments of 14.0 percent and MDH providers receive an increase of 9.0 percent, primarily due to the changes to MDH payments set forth in section 5003 of Pub. L. 109-171 (see 70 FR 48062).

Urban hospitals reclassified for the first half of FY 2007 are anticipated to receive an increase of 3.7 percent, while urban hospitals that reclassified for the second half of FY 2007 are expected to receive an increase of 3.5 percent. The same set of rural hospitals is reclassified for the first and second half of FY 2007. Rural hospitals reclassifying for the entire year of FY 2007 are anticipated to receive a 3.6 percent payment increase. 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 4.4 percent. Hospitals that were reclassified under section 508 of Pub. L. 108-173, which is only effective through March 31, 2007, are expected to receive an increase of 1.9 percent. This lower estimated increase in payment than the average for all hospitals is due to the expiration of the higher section 508 wage indices in effect for 6 months of FY 2007.

b.
Analysis of Impact Table II.
Table II presents the projected impact of the changes for FY 2007 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 2006 with the average estimated per case payments for FY 2007, 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.

TABLE II.—Impact Analysis of Changes for FY 2007 Operating Prospective Payment System
[Payments per case]

Number of hospitals
(1)

Average FY 2006 payment per case
1
(2)

Average FY 2007 payment per case
1
(3)

All FY 2007 changes
(4)

All hospitals
3,595
8,540
8,838
3.5

By Geographic Location:

Urban hospitals
2,590
8,951
9,258
3.4

Large urban areas (populations over 1 million)
1,441
9,368
9,692
3.5

Other urban areas (populations of 1 million or fewer)
1,149
8,446
8,731
3.4

Rural hospitals
1,005
6,228
6,474
3.9

Bed Size (Urban):

0-99 beds
651
6,730
6,964
3.5

100-199 beds
867
7,490
7,772
3.8

200-299 beds
492
8,403
8,702
3.6

300-499 beds
413
9,405
9,719
3.3

500 or more beds
167
11,388
11,748
3.2

Bed Size (Rural):

0-49 beds
348
5,222
5,466
4.7

50-99 beds
370
5,622
5,897
4.9

100-149 beds
174
6,199
6,425
3.6

150-199 beds
68
6,933
7,163
3.3

200 or more beds
45
7,898
8,134
3.0

Urban by Region:

New England
128
9,391
9,717
3.5

Middle Atlantic
357
9,833
10,217
3.9

South Atlantic
388
8,476
8,747
3.2

East North Central
395
8,561
8,854
3.4

East South Central
165
8,209
8,433
2.7

West North Central
157
8,689
8,929
2.8

West South Central
374
8,447
8,737
3.4

Mountain
149
8,812
9,140
3.7

Pacific
424
10,742
11,144
3.7

Puerto Rico
53
4,190
4,272
2.0

Rural by Region:

New England
19
8,137
8,627
6.0

Middle Atlantic
72
6,291
6,616
5.2

South Atlantic
176
6,033
6,264
3.8

East North Central
125
6,457
6,700
3.8

East South Central
180
5,973
6,181
3.5

West North Central
116
6,422
6,696
4.3

West South Central
193
5,669
5,902
4.1

Mountain
81
6,589
6,768
2.7

Pacific
43
7,608
7,850
3.2

By Payment Classification:

Urban hospitals
2,607
8,939
9,245
3.4

Large urban areas (populations over 1 million)
1,448
9,357
9,682
3.5

Other urban areas (populations of 1 million or fewer)
1,159
8,431
8,714
3.4

Rural areas
988
6,278
6,530
4.0

Teaching Status:

Non-teaching
2,511
7,124
7,393
3.8

Fewer than 100 Residents
843
8,640
8,932
3.4

100 or more Residents
241
12,605
13,001
3.1

Urban DSH:

Non-DSH
906
7,725
8,001
3.6

100 or more beds
1,520
9,424
9,746
3.4

Less than 100 beds
346
6,159
6,383
3.6

Rural DSH:

SCH
386
5,816
6,080
4.6

RRC
199
6,946
7,186
3.5

Other Rural:

100 or more beds
55
5,737
5,936
3.5

Less than 100 beds
183
5,104
5,301
3.8

Urban teaching and DSH:

Both teaching and DSH
815
10,367
10,707
3.3

Teaching and no DSH
201
8,601
8,889
3.3

No teaching and DSH
1,051
7,617
7,899
3.7

No teaching and no DSH
540
7,283
7,539
3.5

Rural Hospital Types:

RRC
187
7,277
7,529
3.5

SCH
376
6,216
6,439
3.6

MDH
146
5,190
5,657
9.0

SCH and RRC
98
7,408
7,637
3.1

MDH and RRC
8
6,439
7,341
14.0

Unknown

Type of Ownership:

Voluntary
2,102
8,680
8,984
3.5

Proprietary
880
7,714
7,984
3.5

Government
603
8,779
9,078
3.4

Unknown
10
13,196
14,194
7.6

Medicare Utilization as a Percent of Inpatient Days:

0-25
243
12,182
12,620
3.6

25-50
1,328
9,739
10,057
3.3

50-65
1,478
7,438
7,714
3.7

Over 65
462
6,662
6,915
3.8

Unknown
84
9,920
10,354
4.4

Hospitals Reclassified by the Medicare Geographic Classification Review Board: FY 2005 Reclassifications:

Urban Hospitals Reclassified by the Medicare Geographic Classification Review Board: First Half FY 2007 Reclassifications:
281
8,778
9,099
3.7

Urban Nonreclassified, First Half FY 2007:
2,284
8,983
9,288
3.4

All Urban Hospitals Reclassified Second Half FY 2007:
341
9,038
9,351
3.5

Urban Nonreclassified Hospitals Second Half FY 2007:
2,224
8,947
9,253
3.4

All Rural Hospitals Reclassified Second Half FY 2007:
369
6,759
7,004
3.6

Rural Nonreclassified Hospitals Second Half FY 2007:
578
5,559
5,806
4.4

All Section 401 Reclassified Hospitals:
30
7,030
7,408
5.4

Other Reclassified Hospitals (Section 1886(d)(8)(B))
57
5,839
6,097
4.4

Section 508 Hospitals
108
9,268
9,446
1.9

Specialty Hospitals

Cardiac Specialty Hospitals
21
11,363
11,497
1.2

1
These payment amounts per case do not reflect any estimates of annual case-mix increase.

2. Final FY 2007 Capital-Related Impacts (Quantitative Effects of the Final Occupational Mix Adjusted Wage Indices)

(a)
General Considerations.
In accordance with § 412.312, the basic methodology for determining a capital PPS payment is:

(Standard Federal Rate) × (DRG weight) × (Geographic Adjustment Factor (GAF)) × (Large Urban Add-on, if applicable) × (COLA for hospitals located in Alaska and Hawaii) × (1 + Disproportionate Share (DSH) Adjustment Factor + Indirect Medical Education (IME) Adjustment Factor, if applicable).

In addition, hospitals may also receive outlier payments for those cases that qualify under the threshold established for each fiscal year.

The data used in developing the impact analysis presented below are taken from the March 2006 update of the FY 2005 MedPAR file and the March 2006 update of the Provider-Specific File that is used for payment purposes. Although the analyses of the changes to the capital prospective payment system do not incorporate cost data, we used the March 2006 update of the most recently available hospital cost report data (FYs 2003 and 2004) to categorize hospitals. Our analysis has several qualifications. First, we do not make adjustments for behavioral changes that hospitals may adopt in response to policy changes. Second, due to the interdependent nature of the IPPS, it is very difficult to precisely quantify the impact associated with each change. Third, we draw upon various sources for the data used to categorize hospitals in the tables. In some cases (for instance, 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 sources overall. However, for individual hospitals, some miscategorizations are possible.

Using cases from the March 2006 update of the FY 2005 MedPAR file, we simulated payments under the capital PPS for FY 2006 and FY 2007 for a comparison of total payments per case. Any short-term, acute care hospitals not paid under the general IPPS (Indian Health Service hospitals and hospitals in Maryland) are excluded from the simulations.

We modeled payments for each hospital by multiplying the capital Federal rate by the GAF and the hospital's case-mix. We then added estimated payments for indirect medical education, disproportionate share, large urban add-on, and outliers, if applicable. For purposes of this impact analysis, the model includes the following assumptions:

• We estimate that the Medicare case-mix index will increase by 1.0 percent in both FYs 2006 and 2007.

• We estimate that the Medicare discharges will be 13.5 million in FY 2006 and 13.1 million in FY 2007 for a 3.0 percent decrease from FY 2006 to FY 2007.

• The capital Federal rate was 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 FY 2007 update is 1.1 percent (see section II.E.2. of this notice).

• In addition to the FY 2007 update factor, the FY 2007 capital Federal rate was calculated based on a GAF/DRG budget neutrality factor of 0.9986, an outlier adjustment factor of 0.9568, and an exceptions adjustment factor of 0.9997.

(b)
Results.
We used the actuarial model described above to estimate the potential impact of our changes for FY 2007 on total capital payments per case, using a universe of 3,595 hospitals. As described above, the individual hospital payment parameters are taken from the best available data, including the March 2006 update of the FY 2005 MedPAR file, the March 2006 update to the Provider-Specific File, and the most recent cost report data from the March 2006 update of HCRIS. In Table III, we present a comparison of total payments per case for FY 2006 compared to FY 2007 based on the FY 2007 payment policies. Column 2 shows estimates of payments per case under our model for FY 2006. Column 3 shows estimates of payments per case under our model for FY 2007. Column 4 shows the total percentage change in payments from FY 2006 to FY 2007. The change represented in Column 4 includes the 1.1 percent update to the capital Federal rate, a 0.0 percent increase in case-mix, changes in the adjustments to the capital Federal rate (for example, the effect of the hospital wage index on the GAF), and reclassifications by the MGCRB. 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 2.4 percent in FY 2007. In addition to the 1.1 percent increase due to the capital market basket update, this projected increase in capital payments per case is largely attributable to the change in the DRG recalibration process methodology for FY 2007 as discussed in section II.C. of the preamble of the FY 2007 IPPS final rule (71 FR 48006). To a lesser extent, the final outlier factor also contributes to the increase in capital payments per case, while the final GAF has the opposite effect on capital payments (0.2 percent and −0.1 percent, respectively).

The results of our comparisons by geographic location and by region are consistent with the results we expected after applying the changes to the DRG recalibration methodology. The geographic comparison shows that urban hospitals are expected to experience a 2.3 percent increase in IPPS capital payments per case, while rural hospitals are expected to experience a 2.4 percent increase in capital payments per case. This difference is mostly due to the changes to the methodology used to recalibrate DRGs discussed in the FY 2007 IPPS final rule (71 FR 47882). The capital impact is largely consistent with the impacts in the FY 2007 IPPS final rule (71 FR 48348). However the capital GAF is somewhat affected by the wage index changes resulting from using the revised occupational mix survey data and applying a 100 percent occupational mix adjustment. Any changes from the impact presented in the FY 2007 IPPS final rule would be due to the revised wage indices and the new occupational mix adjustment. Due to circumstances described in the FY 2007 IPPS final rule (71 FR 48005), the wage index used in these calculations is final.

All regions are estimated to receive an increase in total capital payments per case from FY 2006 to FY 2007. Changes vary by region from a minimum increase of 0.14 percent in Puerto Rico for (urban) to a maximum increase of 3.1 percent in the West South Central rural region and the Middle Atlantic rural region. The change in payments per case for all hospitals is 2.4 percent and is the same as indicated in the FY 2007 IPPS final rule.

Section 1886(d)(10) of the Act established the MGCRB. Before FY 2005, hospitals could apply to the MGCRB for reclassification for purposes of the standardized amount, wage index, or both. Section 401(c) of Pub. L. 108-173 equalized the standardized amounts under the operating IPPS. Therefore, beginning in FY 2005, there is no longer reclassification for the purposes of the standardized amounts; however, hospitals still may apply for reclassification for purposes of the wage index for FY 2007. Reclassification for wage index purposes also affects the GAF because that factor is constructed from the hospital wage index.

As discussed in the FY 2007 IPPS final rule (71 FR 48067), procedural rules were established in the FY 2006 IPPS final rule (70 FR 47382) to recognize the special circumstances of section 508 hospital reclassifications ending midyear during FY 2007. Under these procedural rules, some section 1886(d)(10) hospital reclassifications are only in effect for the second half of the fiscal year. These half fiscal year reclassifications have implications for the calculation of reclassified wage indices and therefore, affect capital payments because GAF values are calculated from the hospital wage index.

To present the effects of the hospitals being reclassified for FY 2007, we show the average payments per case for reclassified hospitals for each half of FY 2007 compared to the average payments per case for the same time period in FY 2006. The reclassified groups are compared to all other nonreclassified hospitals for the same time period. These categories are further identified by urban and rural designation. In general, the average payments per case in the first half of FY 2007 is the same or 0.1 percent less as the average payments per case in the second half of FY 2007 for each category of reclassified hospitals shown in Table III . The exception to that generalization is rural nonreclassified hospitals, which are expected to have the largest increases in payments, as well as the largest increase from the first half to the second half of FY 2007, that is, 2.7 percent in the first half of FY 2007, and 3.0 percent in the second half of FY 2007. Urban reclassified hospitals are expected to increase 2.6 percent and 2.5 percent in the first and second halves of FY 2007, respectively. Reclassified rural hospitals and nonreclassified urban hospitals are projected to have the same increase of 2.3 percent in the first half, while in the second half, the increase in payments per discharge to urban nonreclassified hospitals will remain at 2.3 percent but payments per discharge to rural reclassified hospitals are expected to decrease by 0.1 percent to 2.2 percent from the first half of FY 2007 to the second half of FY 2007.

Table III.—Comparison of Total Payments Per Case
[FY 2006 payments compared to FY 2007 payments]

Number of hospitals
Average FY 2006 payments/ case
Average FY 2007 payments/ case
Change

By Geographic Location:

All hospitals
3,595
753
771
2.4

Large urban areas (populations over 1 million)
1,441
849
869
2.4

Other urban areas (populations of 1 million or fewer)
1,149
731
747
2.3

Rural areas
1,005
513
526
2.4

Urban hospitals
2,590
796
814
2.3

0-99 beds
651
617
631
2.3

100-199 beds
867
673
690
2.6

200-299 beds
492
751
769
2.4

300-499 beds
413
827
845
2.2

500 or more beds
167
1,005
1,027
2.2

Rural hospitals
1,005
513
526
2.4

0-49 beds
348
422
435
3.1

50-99 beds
370
469
482
2.8

100-149 beds
174
516
528
2.3

150-199 beds
68
564
576
2.2

200 or more beds
45
642
654
1.9

By Region:

Urban by Region
2,590
796
814
2.3

New England
128
853
874
2.5

Middle Atlantic
357
873
898
2.9

South Atlantic
388
755
771
2.0

East North Central
395
782
801
2.5

East South Central
165
720
731
1.6

West North Central
157
783
795
1.6

West South Central
374
740
758
2.4

Mountain
149
787
808
2.6

Pacific
424
920
942
2.4

Puerto Rico
53
347
348
0.1

Rural by Region
1,005
513
526
2.4

New England
19
686
696
1.5

Middle Atlantic
72
518
534
3.1

South Atlantic
176
497
511
2.7

East North Central
125
547
560
2.2

East South Central
180
476
487
2.3

West North Central
116
540
551
2.2

West South Central
193
464
479
3.1

Mountain
81
535
542
1.3

Pacific
43
616
627
1.7

By Payment Classification:

All hospitals
3,595
753
771
2.4

Large urban areas (populations over 1 million)
1,448
848
869
2.4

Other urban areas (populations of 1 million or fewer)
1,159
730
746
2.3

Rural areas
988
515
527
2.4

Teaching Status:

Non-teaching
2,511
630
645
2.5

Fewer than 100 Residents
843
765
782
2.2

100 or more Residents
241
1,100
1,125
2.3

Urban DSH:

100 or more beds
1,520
821
840
2.4

Less than 100 beds
346
543
557
2.5

Rural DSH:

Sole Community (SCH/EACH)
386
464
477
2.7

Referral Center (RRC/EACH)
199
570
582
2.1

Other Rural:

100 or more beds
55
475
486
2.3

Less than 100 beds
183
423
435
3.0

Urban teaching and DSH:

Both teaching and DSH
815
902
922
2.3

Teaching and no DSH
201
816
835
2.3

No teaching and DSH
1,051
667
683
2.5

No teaching and no DSH
540
700
716
2.3

Rural Hospital Types:

Non special status hospitals
2,490
799
818
2.3

RRC/EACH
44
707
722
2.2

SCH/EACH
39
627
640
2.1

Medicare-dependent hospitals (MDH)
18
421
433
2.8

SCH, RRC and EACH
16
736
756
2.7

Hospitals Reclassified by the Medicare Geographic Classification Review Board: FY2007 Reclassifications:

All Urban Reclassified 1st Half
281
777
797
2.6

All Urban Non-Reclassified 1st Half
2,284
799
818
2.3

All Rural Reclassified 1st Half
358
555
568
2.3

All Rural Non-Reclassified 1st Half
589
460
473
2.7

All Urban Reclassified 2nd Half
341
807
826
2.5

All Urban Non-Reclassified 2nd Half
2,224
795
814
2.3

ALL Rural Reclassified 2nd Half
369
559
571
2.2

All Rural Non-Reclassified 2nd Half
578
451
464
3.0

All Section 401 Reclassified Hospitals
30
553
565
2.3

Other Reclassified Hospitals (Section 1886(d)(8)(B))
53
516
528
2.2

Type of Ownership:

Voluntary
2,102
771
790
2.4

Proprietary
880
679
695
2.3

Government
603
740
757
2.3

Medicare Utilization as a Percent of Inpatient Days:

0-25
243
999
1,026
2.7

25-50
1,328
855
874
2.2

50-65
1,478
663
680
2.5

Over 65
462
597
611
2.4

III. Collection of Information Requirements

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

Authority:

Program; No. 93.773 Medicare—Hospital Insurance Program; and No. 93.774, Medicare—Supplementary Medical Insurance Program)

Dated: September 21, 2006.
Mark B. McClellan,
Administrator, , Centers for Medicare & Medicaid Services.
Approved: September 27, 2006.
Michael O. Leavitt,
Secretary.

Addendum

This addendum includes tables referred to throughout the notice which contain data relating to the FY 2007 wage indices and the hospital reclassifications and payment amounts for operating and capital-related costs that are affected by the new occupational mix survey data discussed in section II. of this notice.

Table 1A—National Adjusted Operating Standardized Amounts, Labor/Nonlabor (69.7 Percent Labor Share/30.3 Percent Nonlabor Share If Wage Index Is Greater Than 1)

Table 1B—National Adjusted Operating Standardized Amounts, Labor/Nonlabor (62 Percent Labor Share/38 Percent Nonlabor Share If Wage Index Is Less Than or Equal To 1)

Table 1C—Adjusted Operating Standardized Amounts for Puerto Rico, Labor/Nonlabor

Table 1D—Capital Standard Federal Payment Rate

Table 2—Hospital Case-Mix Indexes for Discharges Occurring in Federal Fiscal Year 2005; Hospital Wage Indexes for Federal Fiscal Year 2007; Hospital Average Hourly Wage for Federal Fiscal Years 2005 (2001 Wage Data), 2006 (2002 Wage Data), and 2007 (2003 Wage Data); Wage Indexes and 3-Year Average of Hospital Average Hourly Wages

Table 3A—FY 2007 and 3-Year Average Hourly Wage for Urban Areas by CBSA

Table 3B—FY 2007 and 3-Year Average Hourly Wage for Rural Areas by CBSA

Table 4A—1—Wage Index and Capital Geographic Adjustment Factor (GAF) for Urban Areas by CBSA—FY 2007

Table 4A—2—Wage Index and Capital Geographic Adjustment Factor (GAF) for Certain Urban Areas by CBSA for the Period April 1 through September 30, 2007

Table 4B—1—Wage Index and Capital Geographic Adjustment Factor (GAF) for Rural Areas by CBSA—FY 2007

Table 4B—2—Wage Index and Capital Geographic Adjustment Factor (GAF) for Certain Rural Areas by CBSA for the Period April 1 through September 30, 2007*

Table 4C—1—Wage Index and Capital Geographic Adjustment Factor (GAF) for Hospitals That Are Reclassified by CBSA—FY 2007

Table 4C—2—Wage Index and Capital Geographic Adjustment Factor (GAF) for Certain Hospitals That Are Reclassified by CBSA for the Period April 1 through September 30, 2007

Table 4F—Puerto Rico Wage Index and Capital Geographic Adjustment Factor (GAF) by CBSA—FY 2007

Table 4J—Out-Migration Adjustment—FY 2007

Table 5—List of Diagnosis-Related Groups (DRGs), Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay (LOS)

Table 9A—Hospital Reclassifications and Redesignations by Individual Hospitals and CBSA for FY 2007

Table 9B—Hospital Reclassifications and Redesignations by Individual Hospital Under Section 508 of Pub. L. 108-173 for FY 2007

Table 9C—Hospitals Redesignated as Rural under Section 1886(d)(8)(E) of the Act for FY 2007

Table 9D—Hospitals who waived Lugar status to receive Out-migration Adjustment

Table 10—Geometric Mean Plus the Lesser of 0.75 of the National Adjusted Operating Standardized Payment Amount (Increased to Reflect the Difference Between Costs and Charges) or 0.75 of One Standard Deviation of Mean Charges by Diagnosis-Related Group (DRG)—September 2006

Table 1A.—National Adjusted Operating Standardized; Labor/Nonlabor
[69.7 Percent Labor Share/30.3 Percent Nonlabor Share If Wage Index Greater Than 1]

Full Update (3.4 Percent)
Labor-related
Nonlabor-related
Reduced Update (1.4 Percent)
Labor-related
Nonlabor-related

$3,397.52
$1,476.97
$3,331.80
$1,448.40

Table 1B.—National Adjusted Operating Standardized Amounts, Labor/Nonlabor
[62 Percent Labor Share/38 Percent Nonlabor Share If Wage Index Less Than or Equal to 1]

Full Update (3.4 Percent)
Labor-related
Nonlabor-related
Reduced Update (1.4 Percent)
Labor-related
Nonlabor-related

$3,022.18
$1,852.31
$2,963.73
$1,816.48

Table 1C.—Adjusted Operating Standardized Amounts for Puerto Rico, Labor/Nonlabor

Rates If Wage Index Greater Than 1
Labor
Nonlabor

Rates If Wage Index
Less Than or Equal to 1

Labor
Nonlabor

National
$3,397.52
$1,476.97
$3,022.18
$1,852.31

Puerto Rico
1,436.12
880.20
1,359.68
956.64

Table 1D.—Capital Standard Federal Payment Rate

Rate

National
$427.03

Puerto Rico
203.03

Table 2.—Hospital Case-Mix Indexes for Discharges Occurring in Federal Fiscal Year 2005; Hospital Wage Indexes for Federal Fiscal Year 2007; Hospital Average Hourly Wages for Federal Fiscal Years 2005 (2001 Wage Data), 2006 (2002 Wage Data), and 2007 (2003 Wage Data); Wage Indexes and 3-Year Average of Hospital Average Hourly Wages

Provider No.

Case-mix index
2

FY 2007 wage index
Average hourly wage FY 2005
Average hourly wage FY 2006

Average hourly wage FY 2007
1

Average hourly wage**
(3 years)

010001
1.4913
0.7664
20.6563
21.6546
22.1989
21.5314

010004
***
*
22.7585
*
*
22.7585

010005
h

1.1262
0.8889
20.4937
22.4906
23.6022
22.2289

010006
1.4596
0.7876
21.0241
23.4823
23.4975
22.6401

010007
1.0707
0.7664
16.8811
18.2430
19.9328
18.3636

010008
0.9820
0.7933
23.8333
20.4591
17.9533
20.5783

010009
0.9668
0.8756
21.6422
23.2229
23.5626
22.8435

010010
h

1.0464
0.9226
22.3021
21.4974
27.0386
23.4333

010011
1.5930
0.8889
24.8166
27.4850
27.6658
26.6785

010012
1.2376
0.8822
21.7622
22.7020
24.4059
22.9524

010015
1.0200
0.7664
20.4732
21.5111
22.3383
21.4818

010016
1.5194
0.8889
23.0414
25.1502
24.6488
24.2708

010018
1.4681
0.8889
20.5888
22.2990
23.7048
22.1788

010019
1.2315
0.7876
20.1336
22.0906
22.8766
21.7323

010021
h

1.2160
0.7664
20.7108
18.6785
19.7367
19.6613

010022
0.9818
0.9699
25.8797
24.5670
25.8403
25.4393

010023
1.9061
0.7933
23.7791
27.6174
25.4272
25.5461

010024
1.6733
0.7933
20.0067
20.7265
22.0819
20.8864

010025
1.2764
0.8371
19.8561
21.2674
22.7635
21.2709

010027
0.7773
0.7664
14.9585
15.3704
16.4681
15.5470

010029
1.5790
0.8371
21.6724
22.6976
23.9007
22.7914

010031
***
*
20.9463
*
*
20.9463

010032
0.8962
0.7664
18.5073
19.1555
19.3311
19.0281

010033
2.0668
0.8889
25.5165
26.3784
27.4181
26.4464

010034
0.9985
0.7933
17.1625
16.9686
17.7457
17.3133

010035
1.2645
0.8889
23.1319
22.2870
24.2425
23.2085

010036
1.1237
0.7664
20.5125
22.9747
21.5796
21.7075

010038
1.3446
0.8059
20.3935
21.4509
23.7039
21.9034

010039
1.6165
0.8967
23.4151
25.8820
26.9919
25.4654

010040
1.5959
0.8060
21.6708
22.8851
24.3207
22.9524

010043
1.0507
0.8889
19.5422
22.5945
21.9775
21.4194

010044
1.0646
0.8889
23.0220
21.4036
22.5009
22.2925

010045
1.1547
0.8889
20.5658
19.8803
20.4927
20.3026

010046
1.4907
0.8060
20.8935
21.6965
23.4219
21.9636

010047
0.8902
0.7819
19.5937
21.0604
26.4851
22.3753

010049
1.1436
0.7664
17.7801
20.2413
21.7888
19.9912

010050
1.0226
0.8889
21.5625
22.1584
22.9620
22.2007

010051
0.8417
0.8761
14.7053
15.2208
18.7700
16.2601

010052
0.8872
0.7767
21.3673
16.4959
25.9233
21.5543

010053
1.0524
*
17.4160
19.0108
*
18.2193

010054
1.0884
0.8756
23.1894
22.5554
23.3624
23.0327

010055
1.5280
0.7664
19.1847
22.3800
22.5396
21.3292

010056
1.5788
0.8889
22.7183
23.7144
23.7398
23.3988

010058
0.9540
0.8889
20.3182
18.5537
19.5091
19.5962

010059
1.0302
0.8756
23.6963
21.3237
23.0012
22.7246

010061
1.0116
0.8170
20.5683
21.9370
24.1185
22.2906

010062
1.0689
0.7664
18.1323
18.3435
21.4805
19.2652

010064
1.6993
0.8889
25.4345
26.1110
24.8155
25.4466

010065
1.4873
0.7933
20.0108
21.3785
23.0477
21.5043

010066
0.8394
0.7664
17.0935
17.6152
19.8692
18.2085

010068
***
*
17.5690
19.0789
22.7156
19.7871

010069
1.0221
0.7664
19.6317
21.3608
23.1243
21.2883

010072
***
*
21.5419
21.8169
24.4989
22.5892

010073
0.9710
0.7664
16.4043
16.4168
18.3963
17.0851

010078
1.5086
0.8059
21.0633
21.6857
23.5279
22.1019

010079
1.1637
0.8967
20.4254
21.8199
22.7337
21.6778

010083
h

1.1649
0.7871
20.2166
22.3041
22.4279
21.6675

010084
1.5041
0.8889
22.5219
24.7127
26.3238
24.5148

010085
1.3171
0.8756
23.7007
24.4710
24.2609
24.1411

010086
1.0946
0.7664
19.4332
18.6081
22.2096
20.0606

010087
1.9800
0.7847
21.6226
22.5225
22.4318
22.1820

010089
1.2666
0.8889
22.2508
22.8448
25.0811
23.4064

010090
1.7203
0.7847
21.4322
23.6948
26.0494
23.6535

010091
0.9645
0.7664
19.4222
18.6912
23.1309
20.2880

010092
1.6031
0.8761
22.0709
24.4592
26.6796
24.3552

010095
0.8478
0.8761
13.4426
13.9326
16.5250
14.6585

010097
0.7204
0.7933
17.1735
16.7548
19.4511
17.7707

010098
1.0596
*
19.6717
14.3076
*
16.5936

010099
0.9988
0.7664
18.1849
18.7909
20.8383
19.2535

010100
h

1.6823
0.7871
20.0027
21.2915
23.8919
21.8071

010101
1.1315
0.7997
21.0085
21.6593
24.2575
22.2800

010102
0.9487
0.7664
19.9196
21.0903
25.6158
22.2527

010103
1.8923
0.8889
24.2201
26.1163
27.8272
26.0578

010104
1.8099
0.8889
24.1929
24.7394
27.6471
25.5331

010108
1.1555
0.7933
23.7803
28.4624
24.6740
25.5797

010109
0.9897
0.8115
21.7128
21.6194
17.6733
20.3002

010110
0.7990
0.7664
19.2706
17.5957
26.0039
20.5257

010112
1.0377
0.7664
17.2963
16.8902
17.1833
17.1259

010113
1.6543
0.7847
20.4181
21.4121
22.3282
21.3874

010114
1.3860
0.8889
21.5319
22.3752
25.6152
23.1874

010115
0.8661
*
17.5985
21.7478
*
19.2200

010118
1.2128
0.8362
18.8560
19.7673
21.4630
20.1843

010119
***
*
21.8215
*
*
21.8215

010120
0.9876
0.7664
20.5855
20.9450
20.9019
20.8146

010121
***
*
17.0329
24.0867
*
19.3686

010125
1.0409
0.7664
16.8419
18.4114
21.5123
18.8320

010126
1.1468
0.7933
23.1856
23.1381
23.9327
23.4131

010128
0.8695
0.7664
17.9354
21.4201
23.6648
21.1327

010129
h

1.0101
0.7968
18.7821
21.3555
22.1574
20.8452

010130
0.9443
0.8889
18.4944
23.2488
23.7528
21.6390

010131
1.3815
0.8967
24.2197
25.7837
26.4297
25.5385

010137
1.2390
0.8889
29.7665
24.7366
27.5782
27.2371

010138
0.6122
0.7664
13.5082
13.8475
16.7601
14.7816

010139
1.5771
0.8889
24.9410
25.3014
26.8726
25.7394

010143
1.1687
0.8889
22.1312
22.0215
26.2762
23.4710

010144
1.5743
0.7847
20.6425
20.8209
22.5133
21.3563

010145
1.3832
0.8761
23.1976
24.9531
24.5092
24.2395

010146
1.1039
0.8059
19.9944
20.8917
22.6586
21.2025

010148
0.8960
0.7664
18.5309
20.5589
23.9246
21.0046

010149
1.2672
0.7933
23.1593
26.5854
24.4805
24.6823

010150
1.0581
0.8152
20.6738
21.6377
23.6081
21.9568

010152
1.1825
0.7847
22.1626
22.6202
22.4075
22.4009

010157
1.1543
0.7876
21.3574
24.3560
23.3829
23.0158

010158
1.1398
0.8065
22.4440
24.3531
23.5533
23.4497

010161
***
*
27.5119
*
*
27.5119

010162
***
*
*
*
33.8778
33.8778

010164
1.1726
0.7997
*
*
*
*

010165
1.5088
0.8967
*
*
*
*

010166
1.6844
0.8761
*
*
*
*

020001
1.6874
1.1916
31.6091
32.8120
35.4232
33.3471

020004
1.1410
1.0702
29.9926
32.0966
31.8004
31.3123

020006
1.2700
1.1916
33.4210
36.0540
34.3752
34.6332

020008
1.2785
1.2055
34.5856
35.9236
36.1251
35.5664

020012
1.3355
1.0993
29.3419
31.8995
32.5975
31.2913

020014
1.1955
1.0702
32.1233
32.0893
29.4472
31.1605

020017
1.9901
1.1916
32.9281
33.5852
35.4119
33.9602

020018
0.9378
1.9343
*
*
*
*

020019
0.9085
1.9343
*
*
*
*

020020
0.8722
*
*
*
*
*

020024
1.1254
1.0702
27.9799
33.0644
29.5195
30.2029

020026
1.6132
1.9343
*
*
*
*

020027
0.8940
1.9343
*
*
*
*

030001
1.4281
1.0146
27.7572
29.9840
32.4791
30.1381

030002
2.0911
1.0146
27.9628
29.0519
30.2200
29.0083

030006
1.6285
0.9390
24.0169
25.8872
27.0599
25.7641

030007
1.4071
1.1073
26.9442
29.6174
31.1928
29.3442

030009
***
*
21.4065
22.3992
26.5408
22.6580

030010
1.3731
0.9390
22.8647
24.8275
28.5684
25.4056

030011
1.4469
0.9390
22.8422
25.1361
28.1423
25.5193

030012
1.3762
0.9748
25.5205
26.3859
27.3895
26.4764

030013
1.4295
0.9269
23.5229
25.7050
27.0111
25.4677

030014
1.4878
1.0146
25.1189
25.6259
29.6582
26.7569

030016
1.2207
1.0146
27.1583
26.7003
29.1980
27.7047

030017
2.0849
1.0146
24.4055
26.2452
30.6008
27.1050

030018
1.2384
1.0146
24.4308
28.9476
29.4567
27.3566

030019
1.3107
1.0146
28.4917
27.3156
29.5921
28.5143

030022
1.5662
1.0146
25.1461
26.4404
30.5710
27.4209

030023
1.6988
1.1538
28.4112
33.8333
34.2142
32.1557

030024
2.0618
1.0146
28.3470
31.6658
31.9247
30.7056

030027
0.9474
*
21.0527
20.4031
*
20.7264

030030
1.5463
1.0146
24.6005
30.2712
32.0993
28.8311

030033
1.2690
1.1073
26.6009
26.6531
28.7508
27.3705

030036
1.4179
1.0146
26.5708
30.3521
30.9834
29.5043

030037
2.2619
1.0146
30.3907
28.6453
31.2878
30.1945

030038
1.6872
1.0146
26.5178
29.5509
29.9314
28.8772

030040
0.9065
0.9269
22.5130
24.8145
27.5322
24.9809

030043
1.2654
0.9269
26.0825
24.7932
26.5834
25.8015

030044
0.8433
*
19.5714
*
*
19.5714

030055
h

1.4168
1.1148
23.1837
24.5202
27.1473
25.0480

030059
***
*
24.7676
*
*
24.7676

030060
1.1881
0.9269
22.3551
24.3523
24.8373
23.8179

030061
1.6331
1.0146
23.4722
25.5529
28.0696
25.7847

030062
1.2612
0.9269
21.9849
23.8068
26.6881
24.2112

030064
1.9613
0.9390
24.6732
25.4922
28.3853
26.2854

030065
1.5988
1.0146
25.6738
27.1646
29.5883
27.5688

030067
1.0785
0.9269
19.1332
20.4376
20.7590
20.1031

030068
1.1498
0.9269
19.7030
20.8846
23.1394
21.2604

030069
h

1.3722
1.1148
25.6243
26.3518
30.2224
27.2876

030071
0.9150
1.4448
*
*
*
*

030073
0.8489
1.4448
*
*
*
*

030074
0.9110
1.4448
*
*
*
*

030077
0.8100
1.4448
*
*
*
*

030078
0.9644
1.4448
*
*
*
*

030080
1.4636
0.9390
24.3573
25.2077
27.1360
25.5290

030083
1.3648
1.0146
24.9269
27.5353
27.4983
26.6771

030084
0.8727
1.4448
*
*
*
*

030085
1.5795
0.9390
23.2070
24.5792
26.8364
24.9731

030087
1.5934
1.0146
26.3878
26.6594
29.5962
27.6820

030088
1.3693
1.0146
23.2478
26.6796
27.8604
25.9831

030089
1.5137
1.0146
26.2166
27.1835
28.9068
27.5504

030092
1.4265
1.0146
25.4127
27.3203
31.7512
28.3500

030093
1.2271
1.0146
23.5623
25.8955
26.4430
25.4779

030094
1.3649
1.0146
26.9985
29.5948
31.5422
29.4037

030099
0.8324
0.9269
26.7996
26.3236
27.1402
26.7623

030100
2.0680
0.9390
*
29.0691
31.5628
30.3333

030101
h

1.4490
1.1148
25.0077
26.1927
27.8302
26.3906

030102
2.6120
1.0146
*
29.0942
31.6285
30.4080

030103
1.6687
1.0146
28.2832
30.1994
31.7322
30.0675

030105
2.3289
1.0146
27.6900
31.3094
31.2970
30.3890

030106
1.6799
1.0146
30.4791
34.7222
32.9840
32.3777

030107
1.9370
1.0146
*
*
35.6197
35.6197

030108
2.0799
1.0146
*
*
*
*

030109
2.6500
1.0146
*
*
16.5905
16.5905

030110
1.4264
1.0146
*
*
31.4852
31.4852

030111
1.0600
0.9390
*
*
*
*

030112
1.9402
1.0146
*
*
*
*

030113
0.9319
1.4448
*
*
*
*

030114
1.3877
0.9390
*
*
*
*

030115
1.3290
1.0146
*
*
*
*

030116
2.1291
*
*
*
*
*

040001
1.0908
0.9027
23.1475
23.7718
22.9327
23.2665

040002
1.2196
0.7475
19.3429
20.1384
21.2021
20.2735

040003
1.2374
*
18.5000
*
*
18.5000

040004
1.6187
0.9027
23.3504
25.0286
27.1741
25.2030

040007
1.7035
0.9704
23.4565
25.7142
40.1291
29.6908

040010
1.3929
0.9027
22.0984
23.0274
24.2315
23.1437

040011
1.0337
0.7475
19.0319
20.3970
21.0968
20.2388

040014
1.4604
0.9265
24.0846
25.3451
26.4777
25.2922

040015
1.0455
0.7475
18.0793
19.2831
20.4279
19.2708

040016
1.6832
0.9704
22.7219
22.1228
25.8056
23.5485

040017
1.1272
0.8816
19.4365
21.9875
21.9147
21.1493

040018
1.0700
0.7850
23.8515
23.6044
24.0026
23.8116

040019
1.1015
0.8984
21.5316
23.7328
23.8705
23.0548

040020
1.5654
0.8984
20.9136
21.6603
22.6497
21.7619

040021
1.2737
0.9704
24.7771
25.6917
25.4047
25.3035

040022
1.5286
0.9027
23.7462
25.4052
29.5000
26.1298

040024
0.6959
*
20.1101
*
*
20.1101

040026
1.5264
0.8829
24.3053
25.4072
27.7931
25.9042

040027
1.4577
0.8412
19.9348
21.1412
21.4252
20.8384

040029
1.5455
0.9704
22.8770
24.0704
24.8409
23.9749

040032
***
*
18.5171
*
*
18.5171

040035
***
*
13.4265
*
*
13.4265

040036
1.6111
0.9704
24.2851
26.3226
27.6234
26.1793

040039
1.2926
0.8353
17.7976
19.5998
21.2712
19.5845

040041
1.1431
0.9265
22.0188
22.1531
23.7787
22.6793

040042
1.3631
0.9307
18.9550
19.9627
21.1716
20.0582

040045
0.9923
*
18.7952
17.2280
*
17.9500

040047
1.1022
0.8353
21.5334
21.9163
22.4250
21.9377

040050
1.1632
0.7475
15.4782
16.3930
17.6906
16.5483

040051
0.9570
0.7475
18.8943
19.1401
21.3342
19.8090

040053
1.0148
*
20.8153
20.7824
*
20.7984

040054
1.1388
0.7475
16.7370
18.2684
18.0510
17.6860

040055
1.5959
0.7850
22.2237
23.3156
23.0448
22.8516

040062
1.7015
0.7850
21.6403
23.3083
23.8994
22.9604

040066
***
*
23.4616
*
*
23.4616

040067
1.0263
0.7475
15.1441
16.8799
19.0471
16.9179

040069
1.0365
0.8984
21.7607
24.4662
24.8060
23.6538

040071
1.4687
0.9265
22.9350
24.3824
25.4680
24.2630

040072
1.0609
0.7475
20.8269
19.9009
22.4741
21.0044

040074
1.1734
0.9704
22.6147
25.2423
25.2700
24.2961

040075
0.9763
*
16.2583
18.3254
*
17.2857

040076
1.0169
0.9265
21.0442
20.6272
23.5742
21.7288

040077
0.9627
*
18.3261
18.2082
*
18.2646

040078
1.6285
0.9265
24.4589
24.5378
23.5915
24.1852

040080
1.0358
0.8345
21.3483
22.3392
24.1921
22.7065

040081
0.8428
0.7475
13.7148
15.1081
16.8436
15.2255

040084
1.1782
0.9704
22.6441
24.7225
27.7626
25.1456

040085
1.0419
0.7475
18.0756
29.8444
22.9916
22.7039

040088
1.3247
0.8688
21.2974
22.6183
22.4860
22.1468

040091
1.2014
0.8107
23.0252
23.1320
24.2398
23.4639

040100
1.3467
0.9265
19.3560
20.0460
21.3051
20.2851

040105
1.0208
*
15.8171
18.2182
*
16.9121

040109
1.1303
*
18.8624
22.8801
*
20.7540

040114
1.7605
0.9704
23.5628
24.8992
26.7581
25.1160

040118
1.4309
0.8345
24.2547
24.7363
26.0389
24.9780

040119
1.4108
0.9265
20.1631
21.0103
24.3680
21.8564

040126
0.8957
*
12.5944
14.0701
15.6984
14.0818

040132
***
*
36.5525
28.1390
*
32.3748

040134
2.4378
0.9704
*
27.3412
31.9325
29.6807

040137
1.3158
0.9704
23.4672
25.2907
25.9979
24.8946

040138
1.3474
0.9027
23.3615
25.7513
27.8584
25.9401

040140
***
*
25.1224
*
*
25.1224

040141
0.8250
0.9027
*
24.0901
26.1041
25.1761

040142
1.4241
0.8829
*
27.9695
21.4222
24.3073

040143
***
*
*
*
37.1976
37.1976

040144
***
*
*
*
21.4007
21.4007

040145
1.7851
0.8345
*
*
*
*

040147
1.7154
0.9704
*
*
*
*

050002
1.3823
1.5617
31.9709
34.1948
35.5184
33.9903

050006
1.6010
1.2203
27.6176
30.5373
33.5751
30.3271

050007
1.4646
1.5419
37.5804
38.7033
43.4440
39.9548

050008
1.3293
1.5445
36.9371
39.1539
49.3166
41.9596

050009
1.7661
1.4095
35.5384
39.6393
43.0584
39.5056

050013
1.9243
1.4095
31.7637
31.9837
35.7592
33.1828

050014
1.1607
1.2986
29.5726
33.0373
36.0305
33.0187

050015
1.2479
1.1202
30.1398
30.7940
32.2188
31.0764

050016
1.3066
1.1305
25.5735
26.2162
24.5768
25.4173

050017
2.0706
1.2986
30.5863
36.6593
39.6653
35.6426

050018
1.1919
1.1686
20.3179
22.3472
23.3204
21.9572

050022
1.5562
1.1202
28.2773
29.8632
31.6467
30.0139

050024
1.1462
1.1202
26.9378
27.5587
29.4062
27.9891

050025
1.9310
1.1202
31.7242
36.1622
33.5466
33.8328

050026
1.5374
1.1202
26.6406
28.3027
31.5250
28.9332

050028
1.2575
1.1202
21.5448
26.6160
27.3826
24.7519

050029
***
*
34.3934
*
*
34.3934

050030
1.2476
1.1202
22.9148
24.9707
27.2945
25.0204

050036
1.6440
1.1202
27.4915
32.7929
33.8000
31.4474

050038
1.5531
1.5324
35.0441
38.7527
44.2265
39.3929

050039
1.6651
1.1202
29.8179
31.6734
35.2630
32.1614

050040
1.3176
1.1686
31.8983
34.3279
35.8322
34.0141

050042
1.4741
1.2203
29.8062
33.9415
37.3760
33.6941

050043
1.6384
1.5617
39.6054
43.1589
45.4887
42.6954

050045
1.2887
1.1202
22.7051
23.8408
25.0150
23.8863

050046
1.1821
1.1525
25.2786
25.6875
26.1926
25.7298

050047
1.7523
1.5445
39.3993
40.9874
55.9367
45.8065

050054
1.2126
1.1202
27.1437
24.1262
21.3650
24.0140

050055
1.2484
1.5445
36.9386
37.5879
42.9516
39.0065

050056
1.3357
1.1686
29.4829
27.9330
30.6126
29.3527

050057
1.6734
1.1202
26.2099
29.4351
30.0236
28.5928

050058
1.5474
1.1686
27.3584
33.8215
33.1409
31.4044

050060
1.5254
1.1202
26.5515
27.3282
29.9762
27.9723

050061
***
*
*
32.2172
*
32.2172

050063
1.3269
1.1686
32.0515
33.3039
34.0906
33.1167

050065
1.8250
1.1525
33.8223
34.0280
34.9110
34.2663

050067
1.1481
1.1735
29.6982
31.9597
38.8070
33.9918

050069
1.6715
1.1525
28.6752
31.2172
34.6353
31.5321

050070
1.2884
1.5419
40.5645
45.3382
47.4099
44.7713

050071
1.2950
1.5617
41.1036
44.9464
50.7602
46.0847

050072
1.2895
1.5617
40.8108
44.2651
49.4344
45.2871

050073
1.2440
1.5617
41.3430
45.9765
49.9730
46.2034

050075
1.1895
1.5617
43.7101
47.2356
54.4089
49.0009

050076
1.7287
1.5617
43.0845
46.4990
52.3788
47.8548

050077
1.5565
1.1202
29.6264
32.0245
34.8660
32.3083

050078
1.2226
1.1686
25.6814
31.1425
32.0133
29.3832

050079
1.4970
1.5617
42.7385
47.8597
47.3448
46.0427

050082
1.6400
1.1439
28.9139
37.7783
38.2878
35.2197

050084
1.5674
1.2029
28.2664
33.0179
35.5196
32.1347

050088
***
*
26.4093
25.7385
*
26.0862

050089
1.3319
1.1525
29.4884
33.5323
33.9593
32.4106

050090
1.2881
1.5260
31.1774
32.9584
33.8953
32.6836

050091
1.1230
1.1686
30.1534
30.8560
32.1301
31.0759

050093
1.5061
1.1202
31.1083
33.4119
36.9481
33.8765

050096
1.2727
1.1686
24.2277
24.6680
34.9236
28.0644

050097
***
*
26.6788
*
*
26.6788

050099
1.4964
1.1525
28.7711
31.0437
33.4174
31.1779

050100
1.8441
1.1202
28.0303
29.6949
31.4404
29.7728

050101
1.3366
1.5617
35.4655
40.3195
42.4588
39.5443

050102
1.3128
1.1202
24.9381
29.1364
32.0616
28.5338

050103
1.5647
1.1686
28.7375
34.2529
34.0935
32.3903

050104
1.3779
1.1686
29.1240
29.7326
32.3043
30.4154

050107
1.4629
1.1202
27.6002
33.1358
32.5846
31.0605

050108
1.9357
1.2986
31.4271
35.5711
38.8672
35.5484

050110
1.2698
1.1202
20.0769
26.1453
26.8408
24.0659

050111
1.3184
1.1686
26.6345
28.1588
28.7875
27.9310

050112
1.5285
1.1686
34.0258
36.8026
37.7281
36.2500

050113
1.3113
1.5419
34.2851
33.8064
39.4882
35.9070

050114
1.4274
1.1686
29.2858
31.1294
34.0309
31.5876

050115
1.4751
1.1202
27.5207
30.9288
28.8051
29.0865

050116
1.6889
1.1686
28.8193
34.5110
36.8825
33.4540

050117
2.3561
1.1873
28.2227
32.4414
34.2020
31.0046

050118
1.1820
1.2029
33.0650
35.4044
39.9682
36.1405

050121
1.2703
1.1202
25.5962
27.9537
30.6105
28.1711

050122
1.5505
1.2029
29.7629
34.2416
33.9812
32.7589

050124
1.2995
1.1686
26.7065
28.0288
30.2522
28.3801

050125
1.3913
1.5324
40.9218
41.7020
44.9523
42.5088

050126
1.4154
1.1686
29.6203
29.3360
31.7619
30.2508

050127
1.3262
1.2986
23.6208
26.1222
32.0355
26.5981

050128
1.5338
1.1202
28.3278
31.0662
31.1308
30.2212

050129
1.7927
1.1525
27.8488
32.2680
34.7359
31.8447

050131
1.3098
1.5419
38.6834
40.5321
45.3152
41.4420

050132
1.3859
1.1686
29.4317
35.1544
35.9199
33.5661

050133
1.4906
1.1372
27.6030
31.3530
31.9527
30.3390

050135
1.0146
1.1686
24.9415
24.3927
25.1813
24.9002

050136
1.2800
1.5260
35.2834
37.4560
43.3747
38.6810

050137
1.3472
1.1686
36.5409
38.4827
39.1496
38.1206

050138
2.1425
1.1686
43.8671
46.9557
45.3728
45.4025

050139
1.3186
1.1686
35.1013
37.6217
37.8986
36.8930

050140
1.3895
1.1525
37.5473
39.6269
40.9725
39.4753

050144
1.3908
1.1686
32.4042
33.5109
33.6662
33.2263

050145
1.3605
1.4220
39.5676
42.3134
42.2921
41.4134

050148
1.0941
1.1202
24.7063
27.3005
28.2305
26.7960

050149
1.4779
1.1686
30.1596
33.2270
35.8821
33.4099

050150
1.2279
1.2986
31.5333
31.7560
33.6583
32.3465

050152
1.4758
1.5445
40.3464
43.6487
46.1553
43.4147

050153
1.5471
1.5324
40.4446
43.3190
42.8955
42.2727

050155
***
*
21.8829
21.8550
16.9516
19.9648

050158
1.3036
1.1686
33.6400
35.1326
35.7805
34.9098

050159
1.2083
1.1439
30.8069
31.3199
32.5704
31.6137

050167
1.2947
1.2029
25.9850
28.5179
31.4798
28.6280

050168
1.6535
1.1525
30.8036
33.2506
37.9784
34.1091

050169
1.4280
1.1686
26.2864
27.4644
29.4693
27.8379

050172
1.2615
*
27.1497
28.5604
*
27.8554

050173
1.2388
1.1525
27.6097
30.3582
29.0576
28.9733

050174
1.6319
1.5260
36.3117
40.1747
44.4199
40.3075

050175
1.2512
1.1686
31.5615
30.5733
33.3061
31.8069

050177
***
*
24.7531
25.1442
24.0717
24.6630

050179
1.2169
1.1735
25.8072
27.1155
30.4973
28.0977

050180
1.5858
1.5617
40.8101
40.2504
42.0358
41.0704

050188
1.4240
1.5324
39.3507
39.5110
41.0943
39.9979

050189
1.0412
1.4220
20.0709
29.1280
30.1155
26.4779

050191
1.5121
1.1686
*
34.2091
37.7805
35.9193

050192
1.0053
1.1202
21.2448
27.0424
27.1401
25.1605

050193
1.2486
1.1525
30.7341
29.6421
33.9520
31.4458

050194
1.3581
1.5108
38.6750
40.9096
44.7107
41.4882

050195
1.5046
1.5617
43.9696
48.4358
48.8595
47.1589

050196
1.0903
1.1202
25.2168
32.1933
34.0955
30.7710

050197
2.0246
1.5617
40.8832
48.9052
50.0728
46.5930

050204
1.4506
1.1686
25.2512
28.6423
32.0121
28.5691

050205
1.4300
1.1686
28.0504
27.8611
29.3334
28.4470

050207
1.2588
1.1202
27.0216
29.5215
30.0062
28.8170

050211
1.2854
1.5617
38.3319
41.2166
35.0514
38.0606

050214
***
*
24.4785
23.9972
25.4647
24.6387

050215
1.8352
1.5324
41.6886
43.7985
48.8112
44.7172

050217
1.2206
*
23.6286
*
*
23.6286

050219
1.2040
1.1686
22.9226
22.4065
26.4143
23.9545

050222
1.6335
1.1202
26.3882
29.1094
32.3882
29.4132

050224
1.6696
1.1525
26.7916
29.3143
32.5010
29.5025

050225
1.4619
1.1202
29.5184
29.9656
34.0836
31.3086

050226
1.5853
1.1525
29.2259
30.5867
32.4411
30.8007

050228
1.3602
1.5617
40.1362
42.4226
43.7939
42.1033

050230
1.4633
1.1525
34.1417
32.9555
34.0600
33.7136

050231
1.6358
1.1686
30.1298
30.9607
32.1813
31.1097

050232
1.6119
1.1305
24.4383
27.4099
26.3004
26.0053

050234
1.2193
1.1202
29.2421
29.6560
32.3725
30.4116

050235
1.5333
1.1686
27.8965
29.2979
30.5405
29.2413

050236
1.4058
1.1439
28.1969
32.1647
33.0686
31.1130

050238
1.4869
1.1686
29.1481
31.1764
33.3346
31.3169

050239
1.5982
1.1686
28.2327
31.0963
33.1148
30.8373

050240
1.6431
1.1686
35.2284
35.5735
36.1154
35.6475

050242
1.3743
1.5108
39.7629
44.3130
46.4844
43.6095

050243
1.5345
1.1202
31.8153
31.4883
32.9385
32.1106

050245
1.3329
1.1525
27.0949
28.6527
27.3866
27.7236

050248
1.0132
1.4220
31.6240
35.3864
*
33.4763

050251
1.0297
1.1202
26.5021
27.2675
27.8452
27.2522

050253
***
*
22.2450
24.0044
23.5381
23.1900

050254
1.2450
1.2986
24.1512
27.0041
31.2386
27.5193

050256
1.6386
1.1686
28.4728
29.8194
29.6793
29.3205

050257
0.9830
1.1202
20.8367
21.3216
20.1830
20.7129

050261
1.3082
1.1202
25.3005
27.3234
29.2150
27.4408

050262
2.0811
1.1686
36.1162
44.0256
39.9946
40.0775

050264
1.3604
1.5617
41.3478
41.1211
47.7024
43.4930

050267
***
*
26.7060
*
*
26.7060

050270
0.8638
1.1202
30.0540
32.4812
33.6855
32.1141

050272
1.3489
1.1525
25.9103
27.1989
29.4671
27.5457

050276
1.2459
1.5617
41.2251
39.3778
41.1406
40.5997

050277
1.0096
1.1686
35.8246
32.5213
35.4443
34.4246

050278
1.5335
1.1686
28.0351
29.9244
31.8712
30.0483

050279
1.1779
1.1525
25.5299
27.6573
29.7118
27.6742

050280
1.6857
1.2450
30.6723
35.2030
38.8341
34.8751

050281
1.4210
1.1686
26.2623
27.3824
29.4882
27.7172

050283
1.4252
1.5617
38.5600
43.0638
44.3122
42.0650

050286
***
*
19.4973
*
*
19.4973

050289
1.6373
1.5419
38.6875
41.1774
44.2814
41.4520

050290
1.5790
1.1686
32.6388
34.5482
37.3563
34.8783

050291
1.8385
1.5260
29.6162
35.3653
38.4366
34.3153

050292
1.0979
1.1202
27.0775
26.8879
26.9786
26.9804

050295
1.4627
1.1202
31.5960
36.1950
34.7383
34.3567

050296
1.1644
1.5324
34.9952
39.0061
39.9842
38.1164

050298
1.1633
1.1525
25.8232
27.7416
30.2022
27.9356

050299
1.3599
1.1686
27.7535
31.5435
35.1249
31.6510

050300
1.4916
1.1525
28.3862
30.7148
30.2874
29.8366

050301
1.3253
1.1202
28.5769
31.9995
35.9490
32.3183

050305
1.4147
1.5617
40.9978
44.8630
44.9681
43.6141

050308
1.4700
1.5324
38.0564
43.0691
43.7413
41.6020

050309
1.4129
1.2986
28.9181
34.4145
38.2659
34.1832

050312
***
*
32.6846
33.9022
36.8498
34.2537

050313
1.2209
1.2029
27.5321
31.8003
35.0479
31.7666

050315
1.3325
1.1202
26.1224
28.5933
33.2038
29.4498

050320
1.2498
1.5617
36.3252
40.2352
45.7686
40.6332

050324
1.8676
1.1202
30.9958
32.9792
34.5503
32.9848

050325
1.1370
1.1378
30.2280
30.6117
31.3730
30.7522

050327
1.7458
1.1525
29.8327
33.0087
33.9507
32.3300

050329
1.2527
1.1202
26.8021
26.2120
23.2927
25.4012

050331
1.2280
*
20.9847
20.2692
*
20.6171

050333
1.1134
1.1202
15.3119
23.4009
19.6352
18.9052

050334
1.6668
1.4220
38.7635
40.7467
43.9656
41.1996

050335
1.4584
1.1378
27.4046
28.9403
30.9928
29.1535

050336
1.2343
1.2029
25.3062
28.5659
30.4664
28.2054

050342
1.2359
1.1202
24.7654
26.8507
29.2244
27.0322

050348
1.6978
1.1525
33.2676
37.7898
31.5156
34.1296

050349
0.9599
1.1202
16.9251
17.4791
24.4864
19.6872

050350
1.3676
1.1686
29.4262
31.1833
31.0136
30.5845

050351
1.5247
1.1686
29.3082
30.8661
30.6599
30.2977

050352
1.3521
1.2986
24.2931
33.9362
36.7673
31.5149

050353
1.5321
1.1686
26.6332
31.8291
29.4215
29.2166

050355
***
*
11.2498
*
*
11.2498

050357
1.4364
1.1202
26.7265
32.3095
32.6763
30.1138

050359
1.2192
1.1202
23.6030
25.7739
29.8345
26.4944

050360
1.5305
1.5419
38.8658
37.0769
47.4497
41.1219

050366
1.2087
1.1

[Text truncated at 120,000 characters. The full text is on the page linked above.]

---

Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/fr%3A06-8471. Public record. Not legal advice.