Medicare Program; Changes to the FY 1999 Hospital Inpatient Prospective Payment Wage Index and Standardized Amounts Resulting From Approved Requests for Wage Data Revisions

SUMMARY: This final rule implements revised wage index values,

geographic adjustment factors, operating standardized amounts, and

capital Federal rates for hospitals subject to the inpatient

prospective payment system. These changes result from requests made by

hospitals in response to a final rule with comment period published in

the Federal Register on November 19, 1998. These revisions will be

implemented on a prospective basis.

DATES: Effective date: The provisions of this final rule are effective

March 1, 1999.

FOR FURTHER INFORMATION CONTACT: Stephen Phillips, (410) 786-4531.

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I. Background

Section 1886(d)(3)(E) of the Social Security Act (the Act) requires

that, as part of the methodology for determining prospective payments

to hospitals for inpatient operating costs, the Secretary must adjust

standardized amounts ``for area differences in hospital wage levels by

a factor (established by the Secretary) reflecting the relative

hospital wage level in the geographic area of the hospital compared to

the national average hospital wage level.'' In addition, section

1886(d)(3)(E) of the Act requires that the hospital wage index be

updated annually and that updates or adjustments to the hospital wage

index be budget neutral.

In the July 31, 1998 Federal Register (63 FR 40966), we published

hospital inpatient prospective payment rates and policies for Federal

fiscal year (FY) 1999, including the hospital wage index. The FY 1999

wage index is based on data from Medicare cost reports for cost

reporting periods beginning in FY 1995. These cost report data are

submitted by hospitals and certified by hospitals. Before the

calculation of the FY 1999 hospital wage index was published on July

31, 1998, we provided opportunities to hospitals to request wage data

revisions and to verify wage data in HCFA's files. We established

deadlines for requesting wage data revisions.

Notwithstanding these deadlines, numerous hospitals contacted us to

request revisions to the data reflected in the FY 1999 hospital wage

index. Many of these requests related to issues arising from hospitals'

failure to properly report costs in the first place and failure to

request revisions, or from hospitals' failure to verify the final wage

data. However, it came to our attention that certain aspects of the

development of the FY 1999 wage index may have led to some confusion

among the hospital community.

In light of the totality of the circumstances, in the November 19,

1998 Federal Register (63 FR 64191), we provided hospitals with an

additional opportunity to request limited types of revisions to the

wage data used to calculate the FY 1999 hospital wage index.

II. Provisions of the November 19, 1998 Final Rule With Comment

Period

A. Criteria for Requesting Revisions and Explanation of the Types of

Revisions

We provided a window of opportunity, from November 19, 1998 until

December 3, 1998, for hospitals to request revisions to their FY 1995

wage data, if they met one of the following criteria:

The hospital's data on the May 1998 public use file is

recorded as zero on Line 28 of Worksheet S-3, Part III (wage-related

costs).

The hospital's data on the May 1998 public use file is

recorded as zero in either column 3 or 4 (but not both), with nonzero

data in the other column, for Lines 2, 4, 6, or 33 of Worksheet S-3,

Part III.

The hospital properly requested a wage data revision by

March 9, 1998, the fiscal intermediary approved a revision (as

reflected in a revised Worksheet S-3), but the fiscal intermediary or

HCFA made a data entry or tabulation error.

B. Rationale for Accepting Limited Types of Revisions

As we stated in the November 19, 1998 final rule with comment

period (63 FR 64193), we provided for these limited revisions because

of the totality of the circumstances, including--

The number of hospitals contacting us about the same types

of problems;

The hardship that might result for a number of hospitals

if we did not revise the wage data;

The changes to the Medicare cost report, reflected for the

first time in the FY 1999 wage index;

The revised statutory timetable for publishing the

proposed and final hospital inpatient prospective payment system rules,

effective for the first time for FY 1999 (see section 4644 of the

Balanced Budget Act of 1997); and

The revised timetable for finalizing wage data (including

the revised timetable for releasing the final public use wage data file

and the revised timetable for requesting corrections of data entry and

tabulation errors), applied for the first time in developing the FY

1999 wage index.

[[Page 9379]]

None of these factors, by itself, would be sufficient grounds for

making a mid-year revision. For example, we believe we should not make

a wage index revision merely because a single individual hospital might

receive significantly lower payments as a result of its failure to

properly report costs or its failure to properly request revisions and

verify data. In deciding which types of revisions we would allow, we

considered the factors above not only in combination with each other,

but also in light of the previous opportunities we provided to

hospitals to verify data and request revisions.

We evaluated the totality of the circumstances and decided it was

appropriate to make limited types of revisions. As indicated above, we

believe most problems with wage data arise because hospitals fail to

properly report costs on the cost report, fail to properly request

revisions, or fail to verify the data that the intermediary and HCFA

are using to calculate the wage index. We believed that it was only

necessary or appropriate to consider requests for revisions to the FY

1995 wage data from hospitals who met certain criteria. We noted in the

November 19, 1998 final rule with comment period that, if we permitted

hospitals to request any and all revisions, it would take longer for

hospitals to receive revised wage index values for FY 1999.

Also, we emphasize that this final rule should not be construed as

an acknowledgment that the development of the FY 1999 wage index, as

reflected in the July 31, 1998 Federal Register, was in any way unfair

or unreasonable. Moreover, it should not be construed as an

acknowledgment that mid-year corrections may be appropriate in other

contexts or in other years. Many of our policies reflect balancing the

competing considerations of finality, accuracy, and certainty, and many

aspects of developing payment rates and policies require the use of the

best data available at the time. As stated above, we provided for

limited wage data revisions for FY 1999 because of the totality of the

circumstances in this context.

In addition to the requests for wage data revisions, the November

19, 1998 document provided a 30-day period for public comment, which

ended on December 21, 1998. We received 150 requests from hospitals for

wage data revisions. We also received 12 comments. The actions we took

with regard to these requests and a discussion of the comments we

received follow.

III. Provisions of the Final Rule

A. Implementation of Wage Index Revisions

We reviewed each of the wage data revision requests and the

supporting documentation. If necessary, we contacted the hospital's

fiscal intermediary for additional verification.

Of the 150 requests, we approved full wage data revisions for 101

hospitals. An additional seven hospitals were granted a partial

revision. Requests from 35 hospitals did not meet the criteria for

revision as stated in the November 19 final rule with comment period

and, therefore, were denied. Of the remaining seven requests, we found

that five of the requested wage data revisions were already reflected

in the wage index published in the July 31, 1998 final rule. Two

hospitals withdrew their requests; one determined there was no error in

its data, and the other determined that it would not benefit from the

requested revision.

For each hospital whose wage data were revised, we calculated a

revised average hourly wage following the same methodology described in

the July 31, 1998 final rule (63 FR 40972). We also calculated a

revised national average hourly wage of $20.7771. (The national average

hourly wage in the July 31, 1998 final rule was $20.7325.) As we noted

in the November 19, 1998 final rule with comment period (63 FR 64193),

revising the wage data for some hospitals affects the wage index for

all hospitals, including hospitals that did not request revisions. This

is because the hospital wage index measures relative wage levels across

geographic areas, and reflects the average hourly wage in each labor

market area as well as the national average hourly wage. Thus, since

the revised national average hourly wage is different from that

published in the July 31, 1998 final rule, we must calculate revised

wage index values for all labor market areas. The wage index values for

each labor market area were recalculated by dividing the area's average

hourly wage by the revised national average hourly wage of $20.7771.

Payments to hospitals under the capital prospective payment system

are adjusted for local cost variation based on the hospital wage index

value that is applicable to the hospital (42 FR 413.316). The

adjustment factor equals the hospital wage index applicable to the

hospital raised to the .6848 power, and is applied to 100 percent of

the Federal rate. Therefore, because hospitals' wage index values are

revised as a result of this final rule, the capital geographic

adjustment factor (GAF) is also revised.

For hospitals that have received an adjustment to their wage data

under this window of opportunity, the revised average hourly wages are

set forth in Table 3C of this document. Tables 4A through 4C show the

new wage index values and GAFs applicable for all hospitals effective

for discharges occurring on or after March 1, 1999. Table 4D and 4E

show the revised Metropolitan Statistical Area (MSA) average hourly

wages. Table 4F shows the revised Puerto Rico specific wage index

values and GAFs.

B. Comments and Responses

We received 12 comments in response to our November 19, 1998 final

rule with comment period. Several comments we received concerned the

treatment of the wage data for specific hospitals. These comments were

submitted on behalf of hospitals located in the same labor market area

as a hospital that filed a revision request and supported that

hospital's request for a wage data revision. Other commenters were

critical of the policy set forth in the November 19, 1998 final rule

with comment.

Comment: Several commenters wrote to oppose our policy to apply the

revisions to the wage indexes prospectively. These commenters believe

that we are unfairly penalizing hospitals who qualified for a revision

by not making the changes effective retroactively. The commenters

referred to the negative financial impact upon affected hospitals from

this prospective only policy.

Response: It has been our longstanding policy to make revisions to

the wage index only on a prospective basis. (See, for example, 60 FR

45795 (September 1, 1995), 54 FR 36478 (September 1, 1989), 53 FR 38496

(September 30, 1988), and 49 FR 258 (January 1, 1984).) We believe it

is consistent with the principles of the prospective payment system to

implement these changes in such a way that they do not affect payments

already made to hospitals. Applying changes to the wage index

retroactively would violate the prospective nature of the system. We

note that we could have decided not to permit mid-year revisions at

all.

Comment: We received two comments requesting that we remove from

the wage data file the wage data for two hospitals that are now closed.

The commenters are concerned that because the hospitals are closed,

they could not have requested wage data revisions during the usual wage

index process.

[[Page 9380]]

Response: This comment does not address the provisions of the

November 19, 1998 final rule with comment period. Nevertheless, we note

that we responded to a similar comment in the September 1, 1994 Federal

Register (59 FR 45353). As we explained in that document, we believe it

is appropriate to include the data of a hospital that has closed but

was in operation during the data collection period, because the

hospital's data reflects conditions occurring in the labor market area

during the period. However, we do remove wage data for a closed

hospital if the data appear to be aberrant based on our edits and we

are not able to verify the accuracy of those data because the

documentation is unavailable due to the hospital's closure. Regarding

the two hospitals specifically addressed by the commenters, we did not

remove their data from the FY 1999 wage index because the data did not

appear to be aberrant.

Comment: One commenter, writing on behalf of a hospital, believes

that we should add another category of revisions to the limited types

of revisions permitted under the November 19, 1998 final rule with

comment period. Specifically, the commenter believes that we should

allow its hospital and ``all other similarly situated hospitals'' to

revise wage data ``to include compensation costs for physicians under

contract.'' The commenter argues that, because we previously excluded

contract physician costs as well as physician compensation costs

incurred by related medical schools, it was ``futile for hospitals to

report those costs on the S-3.'' The commenter also suggests that we

failed to give hospitals ``timely notice'' that the cost data at issue

were ``relevant.'' The commenter further argues that there is ``no

rational basis'' for distinguishing the commenter's situation from

those addressed in the November 19 final rule with comment period, and

that it would be arbitrary and capricious for us not to permit the

revision it seeks. To support these conclusions, the commenter asserts

that two of the reasons for providing mid-year revisions apply equally

to this situation.

Response: We do not agree that we should expand our criteria to

permit mid-year revisions to address situations in which hospitals

failed to report contract physician part A costs or the costs of

physicians employed by the home office or a related organization. The

commenter's analysis reflects a fundamental misunderstanding about the

wage data reporting process and about the considerations underlying our

decision to permit certain types of mid-year revisions.

The commenter argues that, because we did not include contract

physician costs or physician compensation costs incurred by related

medical schools in the wage index calculation for previous fiscal

years, ``it was futile for hospitals to report those costs on the S-

3.'' Citing statements in the September 1, 1994 final rule concerning

the wage index calculation, the commenter also states it would have

been ``fruitless'' to report the costs at issue.

Contrary to the reasoning of the commenter, a hospital's obligation

to properly report wage costs is not limited to those costs that the

hospital believes will be included in the wage index for a given fiscal

year. It is inappropriate for a hospital to engage in selective

reporting; that is, it is inappropriate for a hospital to report some

costs properly and other costs improperly depending on whether the

hospital believes that a particular cost will or will not be included

in the wage index. Hospitals are always required to properly report all

costs.

It is important to distinguish between wage data reporting issues

and wage index methodology issues. The Medicare statute requires annual

updates to the hospital wage index. Hospitals know or should know that

each year we might propose and implement changes to the categories of

wage costs that we include in the wage index. Thus, proper reporting of

all categories of wage data is always ``relevant.''

Significantly, the commenter acknowledged that the inclusion of

contract physician part A costs reflects ``good policy reasons.'' Thus,

the commenter does not object to our policy of including the costs at

issue in the wage index calculation; instead, the commenter complains

because the hospital believed we would not implement this ``better

policy'' and thus the hospital did not properly report the costs. To

the extent the commenter had questions about how to report the costs at

issue, we note (as we did in the July 31, 1998 final rule) that the

cost report instructions at section 2806.3 of the Provider

Reimbursement Manual, Part II, instruct hospitals to include the costs

of physician part A services from related organizations or the home

office on Line 33 of Worksheet S-3.

Thus, we believe that the commenter is wrong to the extent it

argues that it is reasonable for a hospital not to properly report wage

costs because we had previously excluded the costs from the wage index

calculation or because the hospital believed that we would not include

the costs in the future. Similarly, the hospital is wrong to the extent

it suggests that it did not have ``timely notice'' that the cost at

issues would be ``relevant.'' As the discussion above reflects, proper

reporting of costs is always relevant and important, and hospitals are

on notice that each year we might propose and implement changes to the

wage index methodology. In fact, we have addressed the issue of

contract physician costs in particular in several previous Federal

Register documents, so hospitals were on notice that we might revise

the wage index methodology to address these costs. Thus, we believe it

was not reasonable for the hospital to improperly report the costs at

issue.

Moreover, in the November 19, 1998 final rule with comment period,

we emphasized that our decision to permit limited types of mid-year

revisions reflected the ``totality of the circumstances,'' and

reflected a number of factors in combination with each other. With

respect to the situation presented by the commenter, we believe that

the totality of the circumstances and consideration of all the factors

does not dictate adding another category of revisions.

The commenter argues, among other things, that adding this

criterion is consistent with two of the factors underlying the final

rule with comment period: the hardship that a number of hospitals will

incur if data is not corrected and the changes to the Medicare cost

report that were reflected for the first time in the FY 1999 wage

index. The commenter does not mention another important factor that we

cited: the number of hospitals contacting us about the same type of

problem. At the time we developed the November 19, 1998 final rule with

comment period, we had no reason to believe that there might be

widespread problems in the reporting of the costs at issue; even as of

today, we have received very few complaints about this issue. The

commenter asserts that omission of physician compensation data should

have been ``apparent'' to both intermediaries and HCFA. However,

something that might be ``apparent'' on close examination might not be

apparent in the context of developing a wage index that takes place

under extremely tight timelines and involves data for thousands of

hospitals. Moreover, the absence of contract physician costs on a

hospital's cost report, by itself, does not on its face necessarily

indicate a problem with the data.

We decided to permit mid-year revisions because certain issues came

to

[[Page 9381]]

our attention shortly after publication of the July 31 final rule. We

considered the totality of the circumstances, and decided to permit

certain types of mid-year revisions based on the information available

at the time we developed the November 19, 1998 final rule with comment

period. We believe it would be inappropriate and impractical to add

another category of revisions at this point. If we added another

category now, we would have to provide another window of opportunity

for all other similarly situated hospitals to submit requests and

supporting documentation; we would then have to evaluate the requests,

calculate revised wage indexes and, if necessary, calculate revised

standardized amounts (which would affect payments to all hospitals). In

light of all the factors, we believe that at this point in the fiscal

year the interests of finality take precedence over any increased

accuracy that might result from providing another window of opportunity

for revisions. Therefore, we are not adopting the commenter's

suggestion to add another category of revisions.

IV. Other Related Issues

A. Budget Neutrality and Adjustment to Standardized Amounts

Under section 1886(d)(3)(E) of the Act, ``adjustments or updates''

to the hospital wage index for a fiscal year ``shall be made in a

manner that assures that aggregate payments * * * in the fiscal year

are not greater than or less than those that would have been made in

the year without such adjustment.'' Accordingly, to the extent that

changes to the hospital wage index affect aggregate payments, we are

revising the budget neutrality adjustments to the standardized amounts

so that aggregate payments ``are not greater than or less than those

that would have been made in the year without adjustment.'' The budget

neutrality factors and the adjustments to the standardized amounts

described here are effective for discharges occurring on or after March

1, 1999.

The budget neutrality factor for changes to the wage index and DRG

reclassification and recalibration is revised from 0.999006 in the July

31, 1998 final rule (63 FR 41007) to 0.998978. Because of the payment

interaction between wage index changes and the diagnosis-related groups

(DRGs), the budget neutrality factor applied to the Puerto Rico

standardized amounts changes slightly, from 0.998912 to 0.998915.

Also, Sec. 412.308(c)(4)(ii) requires that the Federal capital rate

be adjusted so that any changes resulting from the annual DRG

reclassification and recalibration and changes in the GAF are budget

neutral. As stated in the July 31, 1998 final rule (63 FR 41014), the

incremental change in the national GAF/DRG budget neutrality factor

from FY 1998 to FY 1999 applied to the standard Federal capital payment

rate was 1.0027. The cumulative change in the rate due to this

adjustment was 1.0028. These factors are applicable for all discharges

occurring on or after October 1, 1998 and before March 1, 1999. For

discharges occurring on or after March 1, 1999, the incremental change

applicable to the national GAF/DRG budget neutrality factor is 1.0028,

and the cumulative factor is 1.0029. The factors for Puerto Rico

(incremental and cumulative) are unchanged, thus the Puerto Rico rate

will remain unchanged. The hospital-specific rates will also not be

affected by these changes since it is not based on the GAF/DRG budget

neutrality adjustment.

The revised operating standardized amounts and capital rates are

set forth in Tables 1A and 1C through 1F.

B. The Relationship Between Wage Revisions and the MGCRB Process

Under section 1886(d)(10) of the Act, the Medicare Geographic

Classification Review Board (MGCRB) considers applications by hospitals

to be reclassified to another geographic area for purposes of the wage

index. We stated in the November 19, 1998 final rule with comment

period that, for purposes of evaluating a hospital's application for

reclassification for FY 2000, the MGCRB will use hospitals' average

hourly wages incorporating all of the revisions made at the time the

MGCRB rules on the hospital's application.

V. Waiver of 30-Day Delay in the Effective Date

We ordinarily provide a delay of 30 days in the effective date of a

final rule. However, if adherence to this procedure would be

impracticable, unnecessary, or contrary to the public interest, we may

waive the delay in the effective date. As discussed above, we provided

this process for mid-year revisions because of the totality of the

circumstances arising this year. These circumstances include the number

of hospitals contacting us about the same types of wage data problems

(reflecting apparent confusion about certain aspects of the development

of the FY 1999 wage index) and the hardship that might result if we did

not revise the wage data for these hospitals. If we delayed the

implementation of the revised wage index in order to comply with the

30-day delay requirement, we would diminish the extent to which we

address the potential hardship that might result for certain hospitals.

Therefore, we find good cause to waive the 30-day delay in the

effective date. Thus, the changes set forth in this final rule will be

effective for discharges occurring on or after March 1, 1999. This is

the earliest possible effective date given our need to revise and

distribute the PRICER software reflecting these changes.

VI. Regulatory Impact Statement

We have examined the impacts of this final rule as required by

Executive Order 12866 and the Regulatory Flexibility Act (RFA) (Public

Law 96-354). Executive Order 12866 directs agencies to assess all costs

and benefits of available regulatory alternatives and, when regulation

is necessary, to select regulatory approaches that maximize net

benefits (including potential economic, environmental, public health

and safety effects, distributive impacts, and equity). The RFA requires

agencies to analyze options for regulatory relief of small businesses.

For purposes of the RFA, small entities include small businesses,

nonprofit organizations, and government agencies. Most hospitals and

most other providers and suppliers are small entities, either by

nonprofit status or by having revenues of $5 million or less annually.

For purposes of the RFA, all hospitals are considered to be small

entities.

Section 1102(b) of the Act requires us to prepare a regulatory

impact analysis if a rule may have a significant impact on the

operations of a substantial number of small rural hospitals. Such an

analysis must conform to the provisions of section 604 of the RFA. For

purposes of section 1102(b) of the Act, we define a small rural

hospital as a hospital that is located outside of a MSA and has fewer

than 50 beds.

In the November 19, 1998 Federal Register, we indicated that the

final rule with comment period rule was major rule as defined in Title

5, United States Code, section 804(2). However, we stated that the

actual impact of that rule could not be determined prior to reviewing

the revision requests. Based upon our analysis of the redistributive

impacts of the revision to the wage index values and GAFs described

below, we have now determined this is not a major rule under that

section. That is, the total impact of payments redistributed from

hospitals whose payments increased to those whose payments decreased

does not exceed $100 million.

[[Page 9382]]

A. Impact of This Final Rule

As we noted above, we received a total of 150 requests for wage

data revisions, of which 108 were approved. Table A displays the

impacts of these changes on the MSAs for the hospitals receiving

revisions. The first column displays the MSA number, the second the MSA

name (or State name in the case of rural areas). The third column is

the area wage index value published in the July 31, 1998 final rule (63

FR 41052), that is effective for discharges occurring on or after

October 1, 1998 and before March 1, 1999. The fourth column is the wage

index value from Table 4A of this final rule that is effective for

discharges occurring on or after March 1, 1999. The fifth column is the

percentage change in the area wage index value.

Despite the fact that these changes generally increased both the

hospital's and its area's average hourly wage, several areas in which

hospitals had data revisions will experience a decrease in their wage

index value from that published in the July 31, 1998 final rule. This

occurs because the resulting change in the area average hourly wage was

less (in percentage terms) than the change in the national average

hourly wage (which increased by 0.2 percent). In addition, one MSA,

Beaumont-Port Arthur, Texas, has a decrease in its wage index value

because its average hourly wage decreased as a result of the revision

to its wage data.

Nonetheless, most labor market areas in Table A have increases in

their wage index values as a result of the wage data revisions. The

largest increases are in Yolo, California (5.6 percent increase), and

Mayaguez, Puerto Rico (5.1 percent increase). The actual increase in

payments for hospitals in these areas will be slightly less because

only the labor-related portion of the standardized amount is adjusted

by the wage index (just over 71 percent of the standardized amount).

Table A.--Wage Index for MSAS With Revised Area Average Hourly Wages

----------------------------------------------------------------------------------------------------------------

Wage index

--------------------------------

MSA No. MSA name October 1, Percent change

1998 March 1, 1999

----------------------------------------------------------------------------------------------------------------

01........................... RURAL ALABAMA.................... 0.7338 0.7326 -0.16

05........................... RURAL CALIFORNIA................. 0.9959 0.9979 0.20

17........................... RURAL KANSAS..................... 0.7330 0.7319 -0.15

32........................... RURAL NEW MEXICO................. 0.8136 0.8269 1.64

45........................... RURAL TEXAS...................... 0.7441 0.7565 1.67

49........................... RURAL VIRGINIA................... 0.7863 0.7857 -0.08

0320......................... AMARILLO, TX..................... 0.8509 0.8517 0.09

0640......................... AUSTIN-SAN MARCOS, TX............ 0.8442 0.8782 4.03

0680......................... BAKERSFIELD, CA.................. 0.9959 0.9979 0.20

0840......................... BEAUMONT-PORT ARTHUR, TX......... 0.9071 0.8659 -4.54

1123......................... BOSTON-WORCESTER-LAWRENCE-LOWELL- 1.1307 1.1288 -0.17

BROCKTON, MA-NH.

1145......................... BRAZORIA, TX..................... 0.8925 0.8928 0.03

1320......................... CANTON-MASSILLON, OH............. 0.8827 0.8813 -0.16

1520......................... CHARLOTTE-GASTONIA-ROCK HILL, NC- 0.9562 0.9686 1.30

SC.

1600......................... CHICAGO, IL...................... 1.0469 1.0461 -0.08

1920......................... DALLAS, TX....................... 0.9364 0.9348 -0.17

2000......................... DAYTON-SPRINGFIELD, OH........... 0.9584 0.9605 0.22

2080......................... DENVER, CO....................... 1.0059 1.0334 2.73

2340......................... ENID, OK......................... 0.7969 0.7983 0.18

2520......................... FARGO-MOORHEAD, ND-MN............ 0.9537 0.9520 -0.18

2670......................... FORT COLLINS-LOVELAND, CO........ 1.0319 1.0770 4.37

2700......................... FORT MYERS-CAPE CORAL, FL........ 0.8936 0.8942 0.07

2800......................... FORT WORTH-ARLINGTON, TX......... 0.9729 0.9727 -0.02

2840......................... FRESNO, CA....................... 1.0409 1.0700 2.80

2920......................... GALVESTON-TEXAS CITY, TX......... 1.0848 1.0894 0.42

2995......................... GRAND JUNCTION, CO............... 0.9099 0.9116 0.19

3360......................... HOUSTON, TX...................... 0.9904 0.9889 -0.15

4080......................... LAREDO, TX....................... 0.7441 0.7565 1.67

4480......................... LOS ANGELES-LONG BEACH, CA....... 1.2070 1.2116 0.38

4680......................... MACON, GA........................ 0.8629 0.8980 4.07

4840......................... MAYAGUEZ, PR..................... 0.4188 0.4401 5.09

4880......................... MCALLEN-EDINBURG-MISSION, TX..... 0.8506 0.8893 4.55

4920......................... MEMPHIS, TN-AR-MS................ 0.8371 0.8361 -0.12

5080......................... MILWAUKEE-WAUKESHA, WI........... 0.9135 0.9356 2.42

5380......................... NASSAU-SUFFOLK, NY............... 1.3579 1.3593 0.10

5600......................... NEW YORK-NEWARK, NY-NJ-PA........ 1.4431 1.4461 0.21

5640......................... NEWARK, NJ....................... 1.0895 1.0914 0.17

5720......................... NORFOLK-VIRGINIA BEACH-NEWPORT 0.8214 0.8275 0.74

NEWS, VA-NC.

5945......................... ORANGE COUNTY, CA................ 1.1472 1.1468 -0.04

6160......................... PHILADELPHIA, PA-NJ.............. 1.1382 1.1370 -0.11

6780......................... RIVERSIDE-SAN BERNADINO, CA...... 1.0141 1.0585 4.38

6920......................... SACRAMENTO, CA................... 1.1864 1.1962 0.83

7160......................... SALT LAKE CITY-OGDEN, UT......... 0.9400 0.9420 0.21

7360......................... SAN FRANCISCO, CA................ 1.3507 1.3563 0.42

7460......................... SAN LUIS OBISPO-ATASCADERO-PASO 1.0739 1.1264 4.89

ROBLES, CA.

7490......................... SANTA FE, NM..................... 0.9623 0.9652 0.30

7680......................... SHREVEPORT-BOSSIER CITY, LA...... 0.9400 0.9386 -0.15

8720......................... VALLEJO-FARIFIELD-NAPA, CA....... 1.2845 1.3311 3.63

8735......................... VENTURA, CA...................... 1.0715 1.0764 0.46

[[Page 9383]]

8840......................... WASHINGTON, DC-MD-VA-WV.......... 1.0812 1.0807 -0.05

9270......................... YOLO, CA......................... 1.0636 1.1233 5.61

----------------------------------------------------------------------------------------------------------------

All other labor market areas' wage index values decrease slightly.

This is because, as noted above, the changes slightly increase the

national average hourly wage from $20.7325 to $20.7771. Therefore, for

areas in which no hospital's average hourly wage was revised, the

area's wage index value decreases slightly because the area's unchanged

average hourly wage is compared to the higher national average hourly

wage. The revision to the wage index is applied only to the labor-

related portion of the standardized amount.

Table B displays the payment impacts for all hospitals.

Specifically, this table compares simulated payments for hospitals

using the wage index and standardized amounts effective with discharges

occurring on or after October 1, 1998 (see the July 31, 1998 final

rule) to simulated payments using the wage index and standardized

amounts published in this final rule. The hospital categories in the

table are identical to those published in the July 31, 1998 final rule

(63 FR 41106). Also, the simulation methodology here is identical to

the methodology described in that final rule. The overall impact is a

0.0 percent change in payments across all hospitals, even though the

average payment per case changes slightly ($1 per case decrease).

Because a $1 per case change in payments is less than 0.1 percent of

total payments, this rounds to 0.0.

The percentage changes across hospital groups are minimal. For the

most part, hospitals receiving revisions are not concentrated in any

particular category; therefore, the impacts are not predictable.

Approximately two-thirds of the wage data revisions approved were for

urban hospitals. This is reflected in the fact that urban hospitals

experience no payment change overall, while rural hospitals experience

a 0.1 percent decrease. Examining urban and rural census divisions,

most categories experience either no change or a 0.1 percent decrease

in payments. For urban hospitals in the Pacific and Mountain census

divisions, payments rise by 0.3 percent and 0.2 percent, respectively.

The largest increase among all categories is for urban hospitals with

fewer than 100 beds that also receive the disproportionate share

adjustment. Payments for this group increase by 0.4 percent.

Because the capital geographic adjustment factors are based upon

the wage indexes, similar impacts will be experienced in capital

payments. In addition, to the extent the Medicare payment methodologies

for other provider types (for example, skilled nursing facilities, home

health agencies, and ambulatory surgical centers) use the hospital wage

index, their payments will likewise be affected. Impacts to these

providers will not be experienced as soon as inpatient hospitals

because these providers' payment rates are updated on different

schedules than inpatient hospital prospective payment rates. Skilled

nursing facilities' payments will be updated using the revised FY 1999

hospital wage index beginning July 1, 1999. Other provider types' will

employ the revised FY 1999 hospital wage index wage index after the end

of the current fiscal year.

Table B.--Impact Analysis of Wage Data Revisions for FY 1999 Operating Prospective Payment System (Payments per

Case)

----------------------------------------------------------------------------------------------------------------

Average

payment per Average

case (for FY payment per

Number of 1999 case (for FY

hospitals discharges 1999 All changes

occuring discharges

before March occuring after

1,1999) March 1, 1999)

(1) (2)\1\ (3)\1\ (4)

----------------------------------------------------------------------------------------------------------------

(BY GEOGRAPHIC LOCATION):

ALL HOSPITALS............................... 4,975 6,707 6,706 0.0

URBAN HOSPITALS............................. 2,810 7,246 7,246 0.0

LARGE URBAN AREAS........................... 1,611 7,758 7,761 0.0

OTHER URBAN AREAS........................... 1,199 6,544 6,540 -0.1

RURAL AREAS................................. 2,165 4,517 4,514 -0.1

BED SIZE (URBAN):

0-99 BEDS................................... 704 4,889 4,894 0.1

100-199 BEDS................................ 937 6,056 6,057 0.0

200-299 BEDS................................ 568 6,851 6,851 0.0

300-499 BEDS................................ 449 7,738 7,737 0.0

500 OR MORE BEDS............................ 152 9,592 9,592 0.0

BED SIZE (RURAL):

0-49 BEDS................................... 1,137 3,701 3,700 0.0

50-99 BEDS.................................. 634 4,207 4,205 -0.1

100-149 BEDS................................ 229 4,662 4,658 -0.1

150-199 BEDS................................ 91 4,894 4,890 -0.1

200 OR MORE BEDS............................ 74 5,704 5,698 -0.1

URBAN BY CENSUS DIVISION:

[[Page 9384]]

NEW ENGLAND................................. 152 7,682 7,673 -0.1

MIDDLE ATLANTIC............................. 425 8,107 8,106 0.0

SOUTH ATLANTIC.............................. 414 6,948 6,946 0.0

EAST NORTH CENTRAL.......................... 476 6,873 6,871 0.0

EAST SOUTH CENTRAL.......................... 162 6,524 6,516 -0.1

WEST NORTH CENTRAL.......................... 189 6,996 6,986 -0.1

WEST SOUTH CENTRAL.......................... 354 6,720 6,719 0.0

MOUNTAIN.................................... 129 6,971 6,982 0.2

PACIFIC..................................... 461 8,245 8,267 0.3

PUERTO RICO................................. 48 3,056 3,058 0.1

RURAL BY CENSUS DIVISION:

NEW ENGLAND................................. 53 5,287 5,282 -0.1

MIDDLE ATLANTIC............................. 80 4,881 4,876 -0.1

SOUTH ATLANTIC.............................. 286 4,694 4,690 -0.1

EAST NORTH CENTRAL.......................... 285 4,553 4,548 -0.1

EAST SOUTH CENTRAL.......................... 269 4,235 4,230 -0.1

WEST NORTH CENTRAL.......................... 500 4,236 4,232 -0.1

WEST SOUTH CENTRAL.......................... 342 4,017 4,021 0.1

MOUNTAIN.................................... 204 4,779 4,778 0.0

PACIFIC..................................... 141 5,643 5,640 -0.1

PUERTO RICO................................. 5 2,370 2,366 -0.2

(BY PAYMENT CATEGORIES):

URBAN HOSPITALS............................. 2,894 7,207 7,207 0.0

LARGE URBAN AREAS........................... 1,698 7,670 7,673 0.0

OTHER URBAN AREAS........................... 1,196 6,530 6,526 -0.1

RURAL AREAS................................. 2,081 4,494 4,491 -0.1

TEACHING STATUS:

NON-TEACHING................................ 3,880 5,450 5,450 0.0

FEWER THAN 100 RESIDENTS.................... 854 7,145 7,144 0.0

100 OR MORE RESIDENTS....................... 241 10,755 10,753 0.0

DISPROPORTIONATE SHARE HOSPITALS (DSH):

NON-DSH..................................... 3,089 5,799 5,798 0.0

URBAN DSH:

100 BEDS OR MORE........................ 1,404 7,843 7,844 0.0

FEWER THAN 100 BEDS..................... 88 5,007 5,028 0.4

RURAL DSH:

SOLE COMMUNITY (SCH).................... 162 4,249 4,247 0.0

REFERRAL CENTERS (RRC).................. 53 5,428 5,422 -0.1

OTHER RURAL DSH HOSP:

100 BEDS OR MORE........................ 60 4,162 4,157 -0.1

FEWER THAN 100 BEDS..................... 119 3,600 3,596 -0.1

URBAN TEACHING AND DSH:

BOTH TEACHING AND DSH....................... 709 8,828 8,827 0.0

TEACHING AND NO DSH......................... 331 7,291 7,289 0.0

NO TEACHING AND DSH......................... 783 6,271 6,275 0.1

NO TEACHING AND NO DSH...................... 1,071 5,612 5,611 0.0

SPECIAL UPDATE HOSPITALS (UNDER SEC. 4401(b) 344 5,236 5,232 -0.1

OF PUBLIC LAW 105-33.......................

RURAL HOSPITAL TYPES:

NONSPECIAL STATUS HOSPITALS................. 888 3,947 3,944 -0.1

RRC......................................... 145 5,286 5,279 -0.1

SCH......................................... 637 4,501 4,501 0.0

MDH......................................... 352 3,753 3,751 0.0

SCH AND RRC................................. 59 5,402 5,399 -0.1

TYPE OF OWNERSHIP:

VOLUNTARY................................... 2,858 6,884 6,883 0.0

PROPRIETARY................................. 671 6,096 6,097 0.0

GOVERNMENT.................................. 1,331 6,209 6,209 0.0

UNKNOWN..................................... 115 7,811 7,819 0.1

MEDICARE UTILIZATION AS A PERCENT OF INPATIENT

DAYS:

0-25........................................ 247 8,754 8,772 0.2

25-50....................................... 1,264 8,127 8,130 0.0

50-65....................................... 1,978 6,134 6,130 -0.1

[[Page 9385]]

OVER 65..................................... 1,371 5,241 5,238 -0.1

UNKNOWN..................................... 115 7,811 7,819 0.1

HOSPITALS RECLASSIFIED BY THE MEDICARE

GEOGRAPHIC REVIEW BOARD:

RECLASSIFICATION STATUS DURING FY98 AND FY99:

RECLASSIFIED DURING:

BOTH FY98 AND FY99...................... 315 5,944 5,942 0.0

URBAN............................... 72 7,302 7,306 0.0

RURAL............................... 243 5,254 5,250 -0.1

RECLASSIFIED DURING:

FY99 ONLY............................... 170 5,427 5,422 -0.1

URBAN............................... 15 8,207 8,203 0.0

RURAL............................... 155 4,960 4,955 -0.1

RECLASSIFIED DURING:

FY98 ONLY............................... 126 6,084 6,079 -0.1

URBAN............................... 53 7,011 7,005 -0.1

RURAL............................... 73 4,188 4,186 -0.1

FY 99 RECLASSIFICATIONS:

ALL RECLASSIFIED HOSP....................... 485 5,763 5,760 -0.1

STAND. AMT. ONLY........................ 94 5,899 5,893 -0.1

WAGE INDEX ONLY......................... 281 5,935 5,935 0.0

BOTH.................................... 47 6,264 6,259 -0.1

NONRECLASS.............................. 4,526 6,786 6,786 0.0

ALL URBAN RECLASSIFIED...................... 87 7,472 7,474 0.0

STAND. AMT. ONLY........................ 26 5,635 5,628 -0.1

WAGE INDEX ONLY......................... 40 8,872 8,884 0.1

BOTH.................................... 21 6,725 6,718 -0.1

NONRECLASSIFIED......................... 2,696 7,249 7,249 0.0

ALL RURAL RECLASSIFIED...................... 398 5,134 5,129 -0.1

STAND. AMT. ONLY........................ 55 4,494 4,491 -0.1

WAGE INDEX ONLY......................... 314 5,194 5,188 -0.1

BOTH.................................... 29 5,231 5,230 0.0

NONRECLASSIFIED......................... 1,767 4,127 4,124 -0.1

OTHER RECLASSIFIED HOSPITALS (SECTION 27 4,714 4,716 0.0

1886(d)(8)(B)).................................

----------------------------------------------------------------------------------------------------------------

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

VII. Tables

This section contains the tables referred to in the preamble to

this final rule. These tables, which apply to discharges occurring on

or after March 1, 1999 replace or update those published in the July

31, 1998 final rule that are effective for discharges occurring on or

after October 1, 1998 and before March 1, 1999.

Table 1A.--National Adjusted Operating Standardized Amounts, Labor/Nonlabor

----------------------------------------------------------------------------------------------------------------

Large urban areas other areas

----------------------------------------------------------------------------------------------------------------

Labor-related Nonlabor-related Labor-related Nonlabor-related

----------------------------------------------------------------------------------------------------------------

2,783.34................... 1,131.34 2,739.28 1,113.44

----------------------------------------------------------------------------------------------------------------

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

----------------------------------------------------------------------------------------------------------------

Large urban areas Other areas

----------------------------------------------------------------------------------------------------------------

Labor Nonlabor Labor Nonlabor

----------------------------------------------------------------------------------------------------------------

National........................................ 2,759.94 1,121.83 2,759.94 1,121.83

Puerto Rico..................................... 1,327.81 534.48 1,306.79 526.02

----------------------------------------------------------------------------------------------------------------

[[Page 9386]]

Table 1D.--Capital Standard Federal Payment Rate

------------------------------------------------------------------------

Rate

------------------------------------------------------------------------

National................................................ 378.10

Puerto Rico............................................. 181.10

------------------------------------------------------------------------

Table 1E.--National Adjusted Operating Standardized Amounts for ``Temporary Relief'' Hospitals, Labor/Nonlabor

----------------------------------------------------------------------------------------------------------------

Large urban areas Other areas

----------------------------------------------------------------------------------------------------------------

Labor-related Nonlabor-related Labor-related Nonlabor-related

----------------------------------------------------------------------------------------------------------------

2,791.65................... 1,134.72 2,747.46 1,116.76

----------------------------------------------------------------------------------------------------------------

Table 1F.--Adjusted Operating Standardized Amounts for ``Temporary Relief'' Hospitals, in Puerto Rico, Labor/

Nonlabor

----------------------------------------------------------------------------------------------------------------

Large urban areas Other areas

----------------------------------------------------------------------------------------------------------------

Labor Nonlabor Labor Nonlabor

----------------------------------------------------------------------------------------------------------------

National........................................ 2,768.18 1,125.18 2,768.18 1,125.18

Puerto Rico..................................... 1,331.77 536.08 1,310.69 527.59

----------------------------------------------------------------------------------------------------------------

Table 3C.--Hospital Average Hourly Wage for Federal Fiscal Year 1999:

Wage Index for Hospitals With Wage Data Revisions

------------------------------------------------------------------------

Average

Provider hourly wage

------------------------------------------------------------------------

010120.................................................. 16.27

050060.................................................. 21.10

050088.................................................. 25.57

050129.................................................. 15.62

050152.................................................. 28.62

050177.................................................. 20.30

050299.................................................. 23.85

050327.................................................. 22.33

050352.................................................. 23.58

050382.................................................. 28.37

050390.................................................. 19.91

050410.................................................. 15.01

050419.................................................. 19.93

050421.................................................. 25.00

050438.................................................. 21.35

050455.................................................. 20.80

050485.................................................. 23.81

050537.................................................. 22.00

050578.................................................. 30.66

050590.................................................. 24.48

050592.................................................. 21.53

050667.................................................. 28.01

050684.................................................. 20.34

050694.................................................. 20.81

060011.................................................. 22.10

060030.................................................. 22.48

060063.................................................. 14.88

100012.................................................. 16.74

100124.................................................. 18.02

110107.................................................. 18.54

140103.................................................. 15.98

140208.................................................. 24.68

170019.................................................. 16.42

170045.................................................. 16.16

170049.................................................. 18.45

190041.................................................. 20.28

220049.................................................. 21.15

250044.................................................. 15.41

310063.................................................. 21.57

320002.................................................. 19.62

320003.................................................. 15.94

[[Page 9387]]

320004.................................................. 17.43

320035.................................................. 27.42

330043.................................................. 26.81

330121.................................................. 15.35

330158.................................................. 26.25

330162.................................................. 27.00

330221.................................................. 29.07

330259.................................................. 23.47

330270.................................................. 31.95

330309.................................................. 24.40

330316.................................................. 28.86

330338.................................................. 20.97

330395.................................................. 33.45

340001.................................................. 21.44

340068.................................................. 16.62

350004.................................................. 18.34

360051.................................................. 23.40

360100.................................................. 17.85

370026.................................................. 16.66

390083.................................................. 21.74

390136.................................................. 15.10

400014.................................................. 9.30

410009.................................................. 23.51

440147.................................................. 17.64

440183.................................................. 20.71

440208.................................................. 17.90

450055.................................................. 14.45

450078.................................................. 12.49

450085.................................................. 16.22

450092.................................................. 14.96

450096.................................................. 16.91

450124.................................................. 21.71

450128.................................................. 15.63

450144.................................................. 16.52

450148.................................................. 22.61

450151.................................................. 15.21

450155.................................................. 17.86

450157.................................................. 15.26

450176.................................................. 16.13

450181.................................................. 14.80

450190.................................................. 27.69

450200.................................................. 18.00

450236.................................................. 14.92

450243.................................................. 12.16

450246.................................................. 20.36

450264.................................................. 17.74

450369.................................................. 14.48

450370.................................................. 11.23

450399.................................................. 13.77

450424.................................................. 16.39

450475.................................................. 16.42

450534.................................................. 18.86

450654.................................................. 12.84

450723.................................................. 18.89

450807.................................................. 12.89

460042.................................................. 17.45

460047.................................................. 19.91

490017.................................................. 16.47

490019.................................................. 16.46

490043.................................................. 23.23

490079.................................................. 16.03

500001.................................................. 21.87

520102.................................................. 20.07

520138.................................................. 19.07

520140.................................................. 19.69

------------------------------------------------------------------------

[[Page 9388]]

Table 4A.--Wage Index and Capital Geographic Adjustment Factor (GAF) for

Urban Areas

------------------------------------------------------------------------

Urban area (constituent Wage

counties) index GAF

------------------------------------------------------------------------

0040................ Abilene, TX, Taylor, TX......... 0.8066 0.8631

0060................ Aguadilla, PR, Aguada, PR, 0.4727 0.5986

Aguadilla, PR Moca, PR.

0080................ Akron, OH, Portage, OH, Summit, 0.9933 0.9954

OH.

0120................ Albany, GA, Dougherty, GA, Lee, 0.7975 0.8565

GA.

0160................ Albany-Schenectady-Troy, NY, 0.8610 0.9026

Albany, NY, Montgomery, NY,

Rensselaer, NY, Saratoga, NY,

Schenectady, NY Schoharie, NY.

0200................ Albuquerque, NM, Bernalillo, NM, 0.8613 0.9028

Sandoval, NM, Valencia, NM.

0220................ Alexandria, LA Rapides, LA...... 0.8526 0.8966

0240................ Allentown-Bethlehem-Easton, PA, 1.0204 1.0139

Carbon, PA, Lehigh, PA,

Northampton, PA.

0280................ Altoona, PA, Blair, PA.......... 0.9335 0.9540

0320................ Amarillo, TX, Potter, TX, 0.8517 0.8959

Randall, TX.

0380................ Anchorage, AK, Anchorage, AK.... 1.2979 1.1955

0440................ Ann Arbor, MI, Lenawee, MI, 1.1033 1.0696

Livingston, MI, Washtenaw, MI.

0450................ Anniston, AL, Calhoun, AL....... 0.8658 0.9060

0460................ Appleton-Oshkosh-Neenah, WI, 0.8825 0.9180

Calumet, WI, Outagamie, WI,

Winnebago, WI.

0470................ Arecibo, PR, Arecibo, PR, Camuy, 0.4867 0.6107

PR, Hatillo, PR.

0480................ Asheville, NC, Buncombe, NC, 0.8940 0.9261

Madison, NC.

0500................ Athens, GA, Clarke, GA, Madison, 0.8673 0.9071

GA, Oconee, GA.

0520................ Atlanta, GA,\1\ Barrow, GA, 0.9915 0.9942

Bartow, GA, Carroll, GA,

Cherokee, GA, Clayton, GA,

Cobb, GA, Coweta, GA, DeKalb,

GA, Douglas, GA, Fayette, GA,

Forsyth, GA, Fulton, GA,

Gwinnett, GA, Henry, GA,

Newton, GA, Paulding, GA,

Pickens, GA, Rockdale, GA,

Spalding, GA, Walton, GA.

0560................ Atlantic-Cape May, NJ, Atlantic, 1.0355 1.0242

NJ, Cape May, NJ.

0600................ Augusta-Aiken, GA-SC, Columbia, 0.9233 0.9468

GA, McDuffie, GA, Richmond, GA,

Aiken, SC, Edgefield, SC.

0640................ Austin-San Marcos, TX,\1\ 0.8782 0.9149

Bastrop, TX, Caldwell, TX,

Hays, TX, Travis, TX,

Williamson, TX.

0680................ Bakersfield,\2\ CA, Kern, CA.... 0.9979 0.9986

0720................ Baltimore, MD,\1\ Anne Arundel, 0.9642 0.9753

MD, Baltimore, MD, Baltimore

City, MD, Carroll, MD, Harford,

MD, Howard, MD, Queen Anne's,

MD.

0733................ Bangor, ME, Penobscot, ME....... 0.9474 0.9637

0743................ Barnstable-Yarmouth, MA, 1.5382 1.3430

Barnstable, MA.

0760................ Baton Rouge, LA, Ascension, LA, 0.8872 0.9213

East Baton Rouge, LA,

Livingston, LA, West Baton

Rouge, LA.

0840................ Beaumont-Port Arthur, TX, 0.8659 0.9061

Hardin, TX, Jefferson, TX,

Orange, TX.

0860................ Bellingham, WA, Whatcom, WA..... 1.1434 1.0961

0870................ Benton Harbor, MI,\2\ Berrien, 0.8884 0.9222

MI.

0875................ Bergen-Passaic, NJ,\1\ Bergen, 1.1749 1.1167

NJ, Passaic, NJ.

0880................ Billings, MT, Yellowstone, MT... 0.9143 0.9405

0920................ Biloxi-Gulfport-Pascagoula, MS, 0.8276 0.8785

Hancock, MS, Harrison, MS,

Jackson, MS.

0960................ Binghamton, NY, Broome, NY, 0.9059 0.9346

Tioga, NY.

1000................ Birmingham, AL, Blount, AL, 0.9073 0.9356

Jefferson, AL, St. Clair, AL,

Shelby, AL.

1010................ Bismarck, ND, Burleigh, ND, 0.8025 0.8601

Morton, ND.

1020................ Bloomington, IN, Monroe, IN..... 0.8965 0.9279

1040................ Bloomington-Normal, IL, McLean, 0.8851 0.9198

IL.

1080................ Boise City, ID, Ada, ID, Canyon, 0.9190 0.9438

ID.

1123................ Boston-Worcester-Lawrence-Lowell- 1.1288 1.0865

Brockton, MA-NH,\1\ Bristol, MA

Essex, MA, Middlesex, MA,

Norfolk, MA, Plymouth, MA,

Suffolk, MA, Worcester, MA,

Hillsborough, NH, Merrimack,

NH, Rockingham, NH, Strafford,

NH.

1125................ Boulder-Longmont, CO, Boulder, 1.0038 1.0026

CO.

1145................ Brazoria, TX, Brazoria, TX...... 0.8928 0.9253

1150................ Bremerton, WA, Kitsap, WA....... 1.1055 1.0711

1240................ Brownsville-Harlingen-San 0.8237 0.8756

Benito, TX, Cameron, TX.

1260................ Bryan-College Station, TX, 0.8066 0.8631

Brazos, TX.

1280................ Buffalo-Niagara Falls, NY, Erie, 0.9587 0.9715

NY,\1\ Niagara, NY.

1303................ Burlington, VT, Chittenden, VT, 0.9596 0.9722

Franklin, VT, Grand Isle, VT.

1310................ Caguas, PR, Caguas, PR, Cayey, 0.4410 0.5708

PR, Cidra, PR, Gurabo, PR, San

Lorenzo, PR.

1320................ Canton-Massillon, OH, Carroll, 0.8813 0.9171

OH, Stark, OH.

1350................ Casper, WY, Natrona, WY......... 0.9150 0.9410

1360................ Cedar Rapids, IA, Linn, IA...... 0.8814 0.9172

1400................ Champaign-Urbana, IL, Champaign, 0.8770 0.9140

IL.

1440................ Charleston-North Charleston, SC, 0.9114 0.9384

Berkeley, SC, Charleston, SC,

Dorchester, SC.

1480................ Charleston, WV, Kanawha, WV, 0.8990 0.9297

Putnam, WV.

1520................ Charlotte-Gastonia-Rock Hill, NC- 0.9686 0.9784

SC,\1\ Cabarrus, NC, Gaston,

NC, Lincoln, NC, Mecklenburg,

NC, Rowan, NC, Stanly, NC,

Union, NC, York, SC.

1540................ Charlottesville, VA, Albemarle, 1.0272 1.0185

VA, Charlottesville City, VA,

Fluvanna, VA, Greene, VA.

1560................ Chattanooga, TN-GA, Catoosa, GA, 0.9074 0.9356

Dade, GA, Walker, GA, Hamilton,

TN, Marion, TN.

1580................ Cheyenne, WY,\2\ Laramie, WY.... 0.8768 0.9139

1600................ Chicago, IL,\1\ Cook, IL, 1.0461 1.0313

DeKalb, IL, DuPage, IL, Grundy,

IL, Kane, IL, Kendall, IL,

Lake, IL, McHenry, IL, Will, IL.

1620................ Chico-Paradise, CA, Butte, CA... 1.0145 1.0099

1640................ Cincinnati, OH-KY-IN,\1\ 0.9595 0.9721

Dearborn, IN, Ohio, IN, Boone,

KY, Campbell, KY, Gallatin, KY,

Grant, KY, Kenton, KY,

Pendleton, KY, Brown, OH,

Clermont, OH, Hamilton, OH,

Warren, OH.

1660................ Clarksville-Hopkinsville, TN-KY, 0.8213 0.8739

Christian, KY, Montgomery, TN.

1680................ Cleveland-Lorain-Elyria, OH,\1\ 0.9886 0.9922

Ashtabula, OH, Cuyahoga, OH,

Geauga, OH, Lake, OH, Lorain,

OH, Medina, OH.

1720................ Colorado Springs, CO, El Paso, 0.9390 0.9578

CO.

1740................ Columbia, MO, Boone, MO......... 0.8942 0.9263

[[Page 9389]]

1760................ Columbia, SC, Lexington, SC, 0.9290 0.9508

Richland, SC.

1800................ Columbus, GA-AL Russell, AL, 0.8511 0.8955

Chattahoochee, GA, Harris, GA,

Muscogee, GA.

1840................ Columbus, OH,\1\ Delaware, OH, 0.9781 0.9850

Fairfield, OH, Franklin, OH,

Licking, OH, Madison, OH,

Pickaway, OH.

1880................ Corpus Christi, TX, Nueces, TX, 0.8531 0.8969

San Patricio, TX.

1900................ Cumberland, MD-WV (Maryland 0.8555 0.8986

Hospitals),\2\ Allegany, MD,

Mineral, WV.

1900................ Cumberland, MD-WV (West Virginia 0.8242 0.8760

Hospital), Allegany, MD,

Mineral, WV.

1920................ Dallas, TX,\1\ Collin, TX, 0.9348 0.9549

Dallas, TX, Denton, TX, Ellis,

TX, Henderson, TX, Hunt, TX,

Kaufman, TX, Rockwall, TX.

1950................ Danville, VA, Danville City, VA, 0.9045 0.9336

Pittsylvania, VA.

1960................ Davenport-Moline-Rock Island, IA- 0.8413 0.8884

IL, Scott, IA, Henry, IL, Rock

Island, IL.

2000................ Dayton-Springfield, OH, Clark, 0.9605 0.9728

OH, Greene, OH, Miami, OH,

Montgomery, OH.

2020................ Daytona Beach, FL, Flagler, FL, 0.9134 0.9399

Volusia, FL.

2030................ Decatur, AL, Lawrence, AL, 0.8233 0.8753

Morgan, AL.

2040................ Decatur, IL, Macon, IL.......... 0.8035 0.8609

2080................ Denver, CO,\1\ Adams, CO, 1.0334 1.0228

Arapahoe, CO, Denver, CO,

Douglas, CO, Jefferson, CO.

2120................ Des Moines, IA, Dallas, IA, 0.8475 0.8929

Polk, IA, Warren, IA.

2160................ Detroit, MI,\1\ Lapeer, MI, 1.0544 1.0369

Macomb, MI, Monroe, MI,

Oakland, MI, St. Clair, MI,

Wayne, MI.

2180................ Dothan, AL, Dale, AL, Houston, 0.7892 0.8503

AL.

2190................ Dover, DE, Kent, DE............. 0.9363 0.9559

2200................ Dubuque, IA, Dubuque, IA........ 0.8222 0.8745

2240................ Duluth-Superior, MN-WI, St. 1.0009 1.0006

Louis, MN, Douglas, WI.

2281................ Dutchess County, NY, Dutchess, 0.9883 0.9920

NY.

2290................ Eau Claire, WI,\2\ Chippewa, WI, 0.8711 0.9098

Eau Claire, WI.

2320................ El Paso, TX, El Paso, TX........ 0.9215 0.9456

2330................ Elkhart-Goshen, IN, Elkhart, IN. 0.9368 0.9563

2335................ Elmira, NY,\2\ Chemung, NY...... 0.8588 0.9010

2340................ Enid, OK, Garfield, OK.......... 0.7983 0.8570

2360................ Erie, PA, Erie, PA.............. 0.9271 0.9495

2400................ Eugene-Springfield, OR, Lane, OR 1.1193 1.0802

2440................ Evansville-Henderson, IN-KY, 0.8528 0.8967

Posey, IN, Vanderburgh, IN,

Warrick, IN, Henderson, KY.

2520................ Fargo-Moorhead, ND-MN, Clay, MN, 0.9520 0.9669

Cass, ND.

2560................ Fayetteville, NC, Cumberland, NC 0.8389 0.8867

2580................ Fayetteville-Springdale-Rogers, 0.8614 0.9029

AR, Benton, AR, Washington, AR.

2620................ Flagstaff, AZ-UT, Coconino, AZ, 0.9523 0.9671

Kane, UT.

2640................ Flint, MI, Genesee, MI.......... 1.1031 1.0695

2650................ Florence, AL, Colbert, AL, 0.7676 0.8343

Lauderdale, AL.

2655................ Florence, SC, Florence, SC...... 0.8501 0.8947

2670................ Fort Collins-Loveland, CO, 1.0770 1.0521

Larimer, CO.

2680................ Fort Lauderdale, FL,\1\ Broward, 0.9845 0.9894

FL.

2700................ Fort Myers-Cape Coral, FL, Lee, 0.8942 0.9263

FL.

2710................ Fort Pierce-Port St. Lucie, FL, 1.0241 1.0164

Martin, FL, St. Lucie, FL.

2720................ Fort Smith, AR-OK, Crawford, AR, 0.7623 0.8304

Sebastian, AR, Sequoyah, OK.

2750................ Fort Walton Beach, FL,\2\ 0.8877 0.9217

Okaloosa, FL.

2760................ Fort Wayne, IN, Adams, IN, 0.9047 0.9337

Allen, IN, De Kalb, IN,

Huntington, IN, Wells, IN,

Whitley, IN.

2800................ Fort Worth-Arlington, TX,\1\ 0.9727 0.9812

Hood, TX, Johnson, TX, Parker,

TX, Tarrant, TX.

2840................ Fresno, CA, Fresno, CA, Madera, 1.0700 1.0474

CA.

2880................ Gadsden, AL, Etowah, AL......... 0.8780 0.9148

2900................ Gainesville, FL, Alachua, FL.... 0.9462 0.9628

2920................ Galveston-Texas City, TX, 1.0894 1.0604

Galveston, TX.

2960................ Gary, IN, Lake, IN, Porter, IN.. 0.9462 0.9628

2975................ Glens Falls, NY,\2\ Warren, NY, 0.8588 0.9010

Washington, NY.

2980................ Goldsboro, NC, Wayne, NC........ 0.8530 0.8968

2985................ Grand Forks, ND-MN, Polk, MN, 0.8899 0.9232

Grand Forks, ND.

2995................ Grand Junction, CO, Mesa, CO.... 0.9116 0.9386

3000................ Grand Rapids-Muskegon-Holland, 0.9971 0.9980

MI,\1\ Allegan, MI, Kent, MI,

Muskegon, MI, Ottawa, MI.

3040................ Great Falls, MT, Cascade, MT.... 0.9284 0.9504

3060................ Greeley, CO, Weld, CO........... 0.9457 0.9625

3080................ Green Bay, WI, Brown, WI........ 0.9248 0.9479

3120................ Greensboro-Winston-Salem-High 0.9547 0.9688

Point, NC,\1\ Alamance, NC,

Davidson, NC, Davie, NC,

Forsyth, NC Guilford, NC,

Randolph, NC, Stokes, NC,

Yadkin, NC.

3150................ Greenville, NC, Pitt, NC........ 0.9434 0.9609

3160................ Greenville-Spartanburg-Anderson, 0.9222 0.9460

SC, Anderson, SC, Cherokee, SC,

Greenville, SC, Pickens, SC,

Spartanburg, SC.

3180................ Hagerstown, MD, Washington, MD.. 1.0183 1.0125

3200................ Hamilton-Middletown, OH, Butler, 0.9233 0.9468

OH.

3240................ Harrisburg-Lebanon-Carlisle, PA, 1.0060 1.0041

Cumberland, PA, Dauphin, PA,

Lebanon, PA, Perry, PA.

3283................ Hartford, CT,\1\ \2\ Hartford, 1.2074 1.1378

CT, Litchfield, CT, Middlesex,

CT, Tolland, CT.

3285................ Hattiesburg, MS, Forrest,\2\ MS, 0.7312 0.8070

Lamar, MS.

3290................ Hickory-Morganton-Lenoir, NC, 0.8649 0.9054

Alexander, NC, Burke, NC,

Caldwell, NC, Catawba, NC.

3320................ Honolulu, HI, Honolulu, HI...... 1.1510 1.1011

3350................ Houma, LA, Lafourche, LA, 0.8197 0.8727

Terrebonne, LA.

3360................ Houston, TX,\1\ Chambers, TX, 0.9889 0.9924

Fort Bend, TX, Harris, TX,

Liberty, TX, Montgomery, TX,

Waller, TX.

[[Page 9390]]

3400................ Huntington-Ashland, WV-KY-OH, 0.9647 0.9757

Boyd, KY, Carter, KY, Greenup,

KY, Lawrence, OH, Cabell, WV,

Wayne, WV.

3440................ Huntsville, AL, Limestone, AL, 0.8385 0.8864

Madison, AL.

3480................ Indianapolis, IN,\1\ Boone, IN, 0.9831 0.9884

Hamilton, IN, Hancock, IN,

Hendricks, IN, Johnson, IN,

Madison, IN, Marion, IN,

Morgan, IN, Shelby, IN.

3500................ Iowa City, IA, Johnson, IA...... 0.9481 0.9642

3520................ Jackson, MI, Jackson, MI........ 0.9224 0.9462

3560................ Jackson, MS, Hinds, MS, Madison, 0.8292 0.8796

MS, Rankin, MS.

3580................ Jackson, TN, Madison, TN, 0.8560 0.8990

Chester, TN.

3600................ Jacksonville, FL,\1\ Clay, FL, 0.8900 0.9233

Duval, FL, Nassau, FL, St.

Johns, FL.

3605................ Jacksonville, NC,\2\ Onslow, NC. 0.8112 0.8665

3610................ Jamestown, NY,\2\ Chautauqua, NY 0.8588 0.9010

3620................ Janesville-Beloit, WI, Rock, WI. 0.9051 0.9340

3640................ Jersey City, NJ, Hudson, NJ..... 1.1598 1.1069

3660................ Johnson City-Kingsport-Bristol, 0.8773 0.9143

TN-VA, Carter, TN, Hawkins, TN,

Sullivan, TN, Unicoi, TN,

Washington, TN, Bristol City,

VA, Scott, VA, Washington, VA.

3680................ Johnstown, PA,\2\ Cambria, PA, 0.8664 0.9065

Somerset, PA.

3700................ Jonesboro, AR, Craighead, AR.... 0.7579 0.8271

3710................ Joplin, MO, Jasper, MO, Newton, 0.7873 0.8489

MO.

3720................ Kalamazoo-Battlecreek, MI, 1.1331 1.0893

Calhoun, MI, Kalamazoo, MI, Van

Buren, MI.

3740................ Kankakee, IL, Kankakee, IL...... 0.9418 0.9598

3760................ Kansas City, KS-MO,\1\ Johnson, 0.9645 0.9756

KS, Leavenworth, KS, Miami, KS,

Wyandotte, KS, Cass, MO, Clay,

MO, Clinton, MO, Jackson, MO,

Lafayette, MO, Platte, MO, Ray,

MO.

3800................ Kenosha, WI, Kenosha, WI........ 0.9129 0.9395

3810................ Killeen-Temple, TX, Bell, TX, 1.0109 1.0075

Coryell, TX.

3840................ Knoxville, TN, Anderson, TN, 0.8918 0.9246

Blount, TN, Knox, TN, Loudon,

TN, Sevier, TN, Union, TN.

3850................ Kokomo, IN, Howard, IN, Tipton, 0.9275 0.9498

IN.

3870................ La Crosse, WI-MN, Houston, MN, 0.8913 0.9242

La Crosse, WI.

3880................ Lafayette, LA, Acadia, LA, 0.8293 0.8797

Lafayette, LA, St. Landry, LA,

St. Martin, LA.

3920................ Lafayette, IN, Clinton, IN, 0.8909 0.9239

Tippecanoe, IN.

3960................ Lake Charles, LA, Calcasieu, LA. 0.7674 0.8342

3980................ Lakeland-Winter Haven, FL, Polk, 0.8877 0.9217

FL.

4000................ Lancaster, PA, Lancaster, PA.... 0.9561 0.9697

4040................ Lansing-East Lansing, MI, 1.0090 1.0062

Clinton, MI, Eaton, MI, Ingham,

MI.

4080................ Laredo, TX,\2\ Webb, TX......... 0.7565 0.8261

4100................ Las Cruces, NM, Dona Ana, NM.... 0.8970 0.9283

4120................ Las Vegas, NV-AZ,\1\ Mohave, AZ, 1.1413 1.0947

Clark, NV, Nye, NV.

4150................ Lawrence, KS, Douglas, KS....... 0.8655 0.9058

4200................ Lawton, OK, Comanche, OK........ 0.8697 0.9088

4243................ Lewiston-Auburn, ME, 0.9149 0.9409

Androscoggin, ME.

4280................ Lexington, KY, Bourbon, KY, 0.8506 0.8951

Clark, KY, Fayette, KY,

Jessamine, KY, Madison, KY,

Scott, KY, Woodford, KY.

4320................ Lima, OH, Allen, OH, Auglaize, 0.8949 0.9268

OH.

4360................ Lincoln, NE, Lancaster, NE...... 0.9303 0.9517

4400................ Little Rock-North Little Rock, 0.8534 0.8971

AR, Faulkner, AR, Lonoke, AR,

Pulaski, AR, Saline, AR.

4420................ Longview-Marshall, TX, Gregg, 0.8698 0.9089

TX, Harrison, TX, Upshur, TX.

4480................ Los Angeles-Long Beach, CA,\1\ 1.2116 1.1405

Los Angeles, CA.

4520................ Louisville, KY-IN, Clark, IN, 0.9093 0.9370

Floyd, IN, Harrison, IN, Scott,

IN, Bullitt, KY, Jefferson, KY,

Oldham, KY.

4600................ Lubbock, TX, Lubbock, TX........ 0.8496 0.8944

4640................ Lynchburg, VA, Amherst, VA, 0.8900 0.9233

Bedford, VA, Bedford City, VA,

Campbell, VA, Lynchburg City,

VA.

4680................ Macon, GA, Bibb, GA, Houston, 0.8980 0.9290

GA, Jones, GA, Peach, GA,

Twiggs, GA.

4720................ Madison, WI, Dane, WI........... 1.0018 1.0012

4800................ Mansfield, OH, Crawford, OH, 0.8534 0.8971

Richland, OH.

4840................ Mayaguez, PR, Anasco, PR, Cabo 0.4401 0.5700

Rojo, PR, Hormigueros, PR,

Mayaguez, PR, Sabana Grande,

PR, San German, PR.

4880................ McAllen-Edinburg-Mission, TX, 0.8893 0.9228

Hidalgo, TX.

4890................ Medford-Ashland, OR, Jackson, OR 1.0020 1.0014

4900................ Melbourne-Titusville-Palm Bay, 0.9216 0.9456

FL, Brevard, FL.

4920................ Memphis, TN-AR-MS,\1\ 0.8361 0.8846

Crittenden, AR, DeSoto, MS,

Fayette, TN, Shelby, TN,

Tipton, TN.

4940................ Merced, CA, Merced, CA.......... 1.0218 1.0149

5000................ Miami, FL,\1\ Dade, FL.......... 1.0017 1.0012

5015................ Middlesex-Somerset-Hunterdon, 1.0762 1.0516

NJ,\1\ Hunterdon, NJ,

Middlesex, NJ, Somerset, NJ.

5080................ Milwaukee-Waukesha, WI,\1\ 0.9356 0.9554

Milwaukee, WI, Ozaukee, WI,

Washington, WI, Waukesha, WI.

5120................ Minneapolis-St. Paul, MN-WI,\1\ 1.0854 1.0577

Anoka, MN, Carver, MN, Chisago,

MN, Dakota, MN, Hennepin, MN,

Isanti, MN, Ramsey, MN, Scott,

MN, Sherburne, MN, Washington,

MN, Wright, MN, Pierce, WI, St.

Croix, WI.

5140................ Missoula, MT, Missoula, MT...... 0.9189 0.9437

5160................ Mobile, AL, Baldwin, AL, Mobile, 0.8377 0.8858

AL.

5170................ Modesto, CA, Stanislaus, CA..... 1.0346 1.0236

5190................ Monmouth-Ocean, NJ,\1\ Monmouth, 1.1317 1.0884

NJ, Ocean, NJ.

5200................ Monroe, LA, Quachita, LA........ 0.8219 0.8743

5240................ Montgomery, AL, Autauga, AL, 0.7860 0.8480

Elmore, AL, Montgomery, AL.

5280................ Muncie, IN, Delaware, IN........ 0.9414 0.9595

5330................ Myrtle Beach, SC, Horry, SC..... 0.8179 0.8714

[[Page 9391]]

5345................ Naples, FL, Collier, FL......... 1.0177 1.0121

5360................ Nashville, TN,\1\ Cheatham, TN, 0.9480 0.9641

Davidson, TN, Dickson, TN,

Robertson, TN, Rutherford, TN,

Sumner, TN, Williamson, TN,

Wilson, TN.

5380................ Nassau-Suffolk, NY,\1\ Nassau, 1.3593 1.2339

NY, Suffolk, NY.

5483................ New Haven-Bridgeport-Stamford- 1.2245 1.1488

Waterbury-Danbury, CT,\1\

Fairfield, CT, New Haven, CT.

5523................ New London-Norwich, CT,\2\ New 1.2074 1.1378

London, CT.

5560................ New Orleans, LA,\1\ Jefferson, 0.9310 0.9522

LA, Orleans, LA, Plaquemines,

LA, St. Bernard, LA, St.

Charles, LA, St. James, LA, St.

John The Baptist, LA, St.

Tammany, LA.

5600................ New York, NY, Bronx, NY,\1\ 1.4461 1.2874

Kings, NY, New York, NY,

Putnam, NY, Queens, NY,

Richmond, NY, Rockland, NY,

Westchester, NY.

5640................ Newark, NJ,\1\ Essex, NJ, 1.0914 1.0617

Morris, NJ, Sussex, NJ, Union,

NJ, Warren, NJ.

5660................ Newburgh, NY-PA, Orange, NY, 1.1223 1.0822

Pike, PA.

5720................ Norfolk-Virginia Beach-Newport 0.8275 0.8784

News, VA-NC,\1\ Currituck, NC,

Chesapeake City, VA,

Gloucester, VA, Hampton City,

VA, Isle of Wight, VA, James

City, VA, Mathews, VA, Newport

News City, VA, Norfolk City,

VA, Poquoson City, VA,

Portsmouth City, VA, Suffolk

City, VA, Virginia Beach City,

VA, Williamsburg City, VA,

York, VA.

5775................ Oakland, CA,\1\ Alameda, CA, 1.5162 1.3298

Contra Costa, CA.

5790................ Ocala, FL, Marion, FL........... 0.9152 0.9411

5800................ Odessa-Midland, TX, Ector, TX, 0.8664 0.9065

Midland, TX.

58801............... Oklahoma City, OK,\1\ Canadian, 0.8708 0.9096

OK, Cleveland, OK , Logan, OK,

McClain, OK, Oklahoma, OK,

Pottawatomie, OK.

5910................ Olympia, WA, Thurston, WA....... 1.1522 1.1019

59 Omaha, NE-IA, Pottawattamie, IA, 0.9972 0.9981

2 Cass, NE, Douglas, NE, Sarpy,

0. NE, Washington, NE.

5945................ Orange County, CA,\1\ Orange, CA 1.1468 1.0983

5960................ Orlando, FL,\1\ Lake, FL, 0.9813 0.9872

Orange, FL, Osceola, FL,

Seminole, FL.

5990................ Owensboro, KY,\2\ Daviess, KY... 0.7844 0.8468

6015................ Panama City, FL,\2\ Bay, FL..... 0.8877 0.9217

6020................ Parkersburg-Marietta, WV-OH 0.8016 0.8595

(West Virginia Hospitals),\2\

Washington, OH, Wood, WV.

6020................ Parkersburg-Marietta, WV-OH 0.8519 0.8960

(Ohio Hospitals),\2\

Washington, OH, Wood, WV.

6080................ Pensacola, FL,\2\ Escambia, FL, 0.8877 0.9217

Santa Rosa, FL.

6120................ Peoria-Pekin, IL, Peoria, IL, 0.8063 0.8629

Tazewell, IL, Woodford, IL.

6160................ Philadelphia, PA-NJ,\1\ 1.1370 1.0919

Burlington, NJ, Camden, NJ,

Gloucester, NJ, Salem, NJ,

Bucks, PA, Chester, PA,

Delaware, PA, Montgomery, PA,

Philadelphia, PA.

6200................ Phoenix-Mesa, AZ,\1\ Maricopa, 0.9591 0.9718

AZ, Pinal, AZ.

6240................ Pine Bluff, AR, Jefferson, AR... 0.7912 0.8518

6280................ Pittsburgh, PA,\1\ Allegheny, 0.9789 0.9855

PA, Beaver, PA, Butler, PA,

Fayette, PA, Washington, PA,

Westmoreland, PA.

6323................ Pittsfield, MA,\2\ Berkshire, MA 1.0834 1.0564

6340................ Pocatello, ID, Bannock, ID...... 0.8792 0.9156

6360................ Ponce, PR, Guayanilla, PR, Juana 0.4788 0.6039

Diaz, PR, Penuelas, PR, Ponce,

PR, Villalba, PR, Yauco, PR.

6403................ Portland, ME, Cumberland, ME, 0.9574 0.9706

Sagadahoc, ME, York, ME.

6440................ Portland-Vancouver, OR-WA,\1\ 1.1178 1.0792

Clackamas, OR, Columbia, OR,

Multnomah, OR, Washington, OR,

Yamhill, OR, Clark, WA.

6483................ Providence-Warwick-Pawtucket, 1.0801 1.0542

RI,\1\ Bristol, RI, Kent, RI,

Newport, RI, Providence, RI,

Washington, RI.

6520................ Provo-Orem, UT, Utah, UT........ 0.9885 0.9921

6560................ Pueblo, CO, Pueblo, CO.......... 0.8712 0.9099

6580................ Punta Gorda, FL, Charlotte, FL.. 0.9031 0.9326

6600................ Racine, WI, Racine, WI.......... 0.9130 0.9396

6640................ Raleigh-Durham-Chapel Hill, 0.9812 0.9871

NC,\1\ Chatham, NC, Durham, NC,

Franklin, NC, Johnston, NC,

Orange, NC, Wake, NC.

6660................ Rapid City, SD, Pennington, SD.. 0.8208 0.8735

6680................ Reading, PA, Berks, PA.......... 0.9234 0.9469

6690................ Redding, CA, Shasta, CA......... 1.1858 1.1238

6720................ Reno, NV, Washoe, NV............ 1.1095 1.0738

6740................ Richland-Kennewick-Pasco,\2\ WA, 1.0489 1.0332

Benton, WA, Franklin, WA.

6760................ Richmond-Petersburg, VA, Charles 0.9211 0.9453

City County, VA, Chesterfield,

VA, Colonial Heights City, VA,

Dinwiddie, VA, Goochland, VA,

Hanover, VA, Henrico, VA,

Hopewell City, VA, New Kent,

VA, Petersburg City, VA,

Powhatan, VA, Prince George,

VA, Richmond City, VA.

6780................ Riverside-San Bernardino,\1\ CA, 1.0585 1.0397

Riverside, CA, San Bernardino,

CA.

6800................ Roanoke, VA, Botetourt, VA, 0.8509 0.8953

Roanoke, VA, Roanoke City, VA,

Salem City, VA.

6820................ Rochester, MN, Olmsted, MN...... 1.1698 1.1134

6840................ Rochester, NY,\1\ Genesee, NY, 0.9657 0.9764

Livingston, NY, Monroe, NY,

Ontario, NY, Orleans, NY,

Wayne, NY.

6880................ Rockford, IL, Boone, IL, Ogle, 0.8615 0.9029

IL, Winnebago, IL.

6895................ Rocky Mount, NC, Edgecombe, NC, 0.9012 0.9312

Nash, NC.

6920................ Sacramento, CA,\1\ El Dorado, 1.1962 1.1305

CA, Placer, CA, Sacramento, CA.

6960................ Saginaw-Bay City-Midland, MI, 0.9487 0.9646

Bay, MI, Midland, MI, Saginaw,

MI.

6980................ St. Cloud, MN, Benton, MN, 0.9586 0.9715

Stearns, MN.

7000................ St. Joseph, MO, Andrew, MO, 0.9889 0.9924

Buchanan, MO.

7040................ St. Louis, MO-IL,\1\ Clinton, 0.9151 0.9411

IL, Jersey, IL, Madison, IL,

Monroe, IL, St. Clair, IL,

Franklin, MO, Jefferson, MO,

Lincoln, MO, St. Charles, MO,

St. Louis, MO, St. Louis City,

MO, Warren, MO.

7080................ Salem, OR,\2\ Marion, OR, Polk, 0.9912 0.9940

OR.

7120................ Salinas, CA, Monterey, CA....... 1.5142 1.3286

7160................ Salt Lake City-Ogden, UT,\1\ 0.9420 0.9599

Davis, UT, Salt Lake, UT,

Weber, UT.

7200................ San Angelo, TX, Tom Green, TX... 0.7646 0.8321

[[Page 9392]]

7240................ San Antonio, TX,\1\ Bexar, TX, 0.8100 0.8656

Comal, TX, Guadalupe, TX,

Wilson, TX.

7320................ San Diego, CA,\1\ San Diego, CA. 1.2310 1.1529

7360................ San Francisco, CA,\1\ Marin, CA, 1.3563 1.2321

San Francisco, CA, San Mateo,

CA.

7400................ San Jose, CA,\1\ Santa Clara, CA 1.3695 1.2403

7440................ San Juan-Bayamon, PR,\1\ Aguas 0.4623 0.5896

Buenas, PR, Barceloneta, PR,

Bayamon, PR, Canovanas, PR,

Carolina, PR, Catano, PR,

Ceiba, PR, Comerio, PR,

Corozal, PR, Dorado, PR,

Fajardo, PR, Florida, PR,

Guaynabo, PR, Humacao, PR,

Juncos, PR, Los Piedras, PR,

Loiza, PR, Luguillo, PR,

Manati, PR, Morovis, PR,

Naguabo, PR, Naranjito, PR, Rio

Grande, PR, San Juan, PR, Toa

Alta, PR, Toa Baja, PR,

Trujillo Alto, PR, Vega Alta,

PR, Vega Baja, PR, Yabucoa, PR.

7460................ San Luis Obispo-Atascadero-Paso 1.1264 1.0849

Robles, CA, San Luis Obispo, CA.

7480................ Santa Barbara-Santa Maria- 1.1194 1.0803

Lompoc, CA, Santa Barbara, CA.

7485................ Santa Cruz-Watsonville, CA, 1.3981 1.2580

Santa Cruz, CA.

7490................ Santa Fe, NM, Los Alamos, NM, 0.9652 0.9760

Santa Fe, NM.

7500................ Santa Rosa, CA, Sonoma, CA...... 1.3071 1.2013

7510................ Sarasota-Bradenton, FL, Manatee, 0.9532 0.9677

FL, Sarasota, FL.

7520................ Savannah, GA, Bryan, GA, 1.0060 1.0041

Chatham, GA, Effingham, GA.

7560................ Scranton-Wilkes-Barre-Hazleton, 0.8664 0.9065

PA,\2\ Columbia, PA,

Lackawanna, PA, Luzerne, PA,

Wyoming, PA.

7600................ Seattle-Bellevue-Everett, WA,\1\ 1.1535 1.1027

Island, WA, King, WA, Sohomish,

WA.

7610................ Sharon, PA, Mercer, PA.......... 0.8847 0.9195

7620................ Sheboygan, WI,\2\ Sheboygan, WI. 0.8711 0.9098

7640................ Sherman-Denison, TX, Grayson, TX 0.8570 0.8997

7680................ Shreveport-Bossier City, LA, 0.9386 0.9575

Bossier, LA, Caddo, LA,

Webster, LA.

7720................ Sioux City, IA-NE, Woodbury, IA, 0.8481 0.8933

Dakota, NE.

7760................ Sioux Falls, SD, Lincoln, SD, 0.8912 0.9242

Minnehaha, SD.

7800................ South Bend, IN, St. Joseph, IN.. 0.9859 0.9903

7840................ Spokane, WA, Spokane, WA........ 1.0928 1.0627

7880................ Springfield, IL, Menard, IL, 0.8720 0.9105

Sangamon, IL.

7920................ Springfield, MO, Christian, MO, 0.8071 0.8635

Greene, MO, Webster, MO.

8003................ Springfield, MA, Hampden, MA, 1.0834 1.0564

Hampshire, MA.

8050................ State College, PA, Centre, PA... 0.9449 0.9619

8080................ Steubenville-Weirton, OH-WV 0.8519 0.8960

(Ohio Hospitals),\2\ Jefferson,

OH, Brooke, WV, Hancock, WV.

8080................ Steubenville-Weirton, OH-WV 0.8428 0.8895

(West Virginia Hospitals),

Jefferson, OH, Brooke, WV,

Hancock, WV.

8120................ Stockton-Lodi, CA, San Joaquin, 1.1075 1.0724

CA.

8140................ Sumter, SC, Sumter, SC.......... 0.8127 0.8676

8160................ Syracuse, NY, Cayuga, NY, 0.9400 0.9585

Madison, NY, Onondaga, NY,

Oswego, NY.

8200................ Tacoma, WA,\2\ Pierce, WA....... 1.0489 1.0332

8240................ Tallahassee, FL,\2\ Gadsden, FL, 0.8877 0.9217

Leon, FL.

8280................ Tampa-St. Petersburg-Clearwater, 0.9183 0.9433

FL,\1\ Hernando, FL,

Hillsborough, FL, Pasco, FL,

Pinellas, FL.

8320................ Terre Haute, IN, Clay, IN, 0.8991 0.9298

Vermillion, IN, Vigo, IN.

8360................ Texarkana, AR-Texarkana, TX, 0.8506 0.8951

Miller, AR, Bowie, TX.

8400................ Toledo, OH, Fulton, OH, Lucas, 0.9991 0.9994

OH, Wood, OH.

8440................ Topeka, KS, Shawnee, KS......... 0.9812 0.9871

8480................ Trenton, NJ, Mercer, NJ......... 1.0509 1.0346

8520................ Tucson, AZ, Pima, AZ............ 0.9028 0.9324

8560................ Tulsa, OK, Creek, OK, Osage, OK, 0.8463 0.8920

Rogers, OK, Tulsa, OK, Wagoner,

OK.

8600................ Tuscaloosa, AL, Tuscaloosa, AL.. 0.7641 0.8317

8640................ Tyler, TX, Smith, TX............ 0.8818 0.9175

8680................ Utica-Rome, NY,\2\ Herkimer, NY, 0.8588 0.9010

Oneida, NY.

8720................ Vallejo-Fairfield-Napa, CA, 1.3311 1.2164

Napa, CA, Solano, CA.

8735................ Ventura, CA, Ventura, CA........ 1.0764 1.0517

8750................ Victoria, TX, Victoria, TX...... 0.8382 0.8862

8760................ Vineland-Millville-Bridgeton, 1.0440 1.0299

NJ, Cumberland, NJ.

8780................ Visalia-Tulare-Porterville, CA, 1.0083 1.0057

Tulare, CA.

8800................ Waco, TX, McLennan, TX.......... 0.8371 0.8854

8840................ Washington, DC-MD-VA-WV,\1\ 1.0807 1.0546

District of Columbia,

DC,Calvert, MD, Charles, MD,

Frederick, MD, Montgomery, MD,

Prince Georges, MD, Alexandria

City, VA, Arlington, VA,

Clarke, VA, Culpeper, VA,

Fairfax, VA, Fairfax City, VA,

Falls Church City, VA,

Fauquier, VA, Fredericksburg

City, VA, King George, VA,

Loudoun, VA, Manassas City, VA,

Manassas Park City, VA, Prince

William, VA, Spotsylvania, VA,

Stafford, VA, Warren, VA,

Berkeley, WV, Jefferson, WV.

8920................ Waterloo-Cedar Falls, IA, Black 0.8332 0.8825

Hawk, IA.

8940................ Wausau, WI, Marathon, WI........ 0.9733 0.9816

8960................ West Palm Beach-Boca Raton, 1.0181 1.0124

FL,\1\ Palm Beach, FL.

9000................ Wheeling, WV-OH (West Virginia 0.7875 0.8491

Hospitals),\2\ Belmont, OH,

Marshall, WV, Ohio, WV.

9000................ Wheeling, WV-OH (Ohio 0.8519 0.8960

Hospitals),\2\ Belmont, OH,

Marshall, WV, Ohio, WV.

9040................ Wichita, KS, Butler, KS, Harvey, 0.8898 0.9232

KS, Sedgwick, KS.

9080................ Wichita Falls, TX, Archer, TX, 0.7830 0.8458

Wichita, TX.

9140................ Williamsport, PA,\2\ Lycoming, 0.8664 0.9065

PA.

9160................ Wilmington-Newark, DE-MD, New 1.1868 1.1244

Castle, DE, Cecil, MD.

9200................ Wilmington, NC, New Hanover, NC, 0.9343 0.9545

Brunswick, NC.

9260................ Yakima, WA,\2\ Yakima, WA....... 1.0489 1.0332

9270................ Yolo, CA, Yolo, CA.............. 1.1233 1.0829

[[Page 9393]]

9280................ York, PA, York, PA.............. 0.9410 0.9592

9320................ Youngstown-Warren, OH, 0.9815 0.9873

Columbiana, OH, Mahoning, OH,

Trumbull, OH.

9340................ Yuba City, CA, Sutter, CA, Yuba, 1.0865 1.0585

CA.

9360................ Yuma, AZ, Yuma, AZ.............. 1.0058 1.0040

------------------------------------------------------------------------

\1\ Large Urban Area.

\2\ Hospitals geographically located in the area are assigned the

statewide rural wage index for FY 1999.

Table 4B.--Wage Index and Capital Geographic Adjustment Factor (GAF) for

Rural Areas

------------------------------------------------------------------------

Nonurban area Wage index GAF

------------------------------------------------------------------------

Alabama................................. 0.7326 0.8081

Alaska.................................. 1.2430 1.1606

Arizona................................. 0.7989 0.8575

Arkansas................................ 0.7250 0.8023

California.............................. 0.9979 0.9986

Colorado................................ 0.8436 0.8901

Connecticut............................. 1.2074 1.1378

Delaware................................ 0.8807 0.9167

Florida................................. 0.8877 0.9217

Georgia................................. 0.7888 0.8500

Hawaii.................................. 1.0910 1.0615

Idaho................................... 0.8477 0.8930

Illinois................................ 0.7925 0.8528

Indiana................................. 0.8380 0.8860

Iowa.................................... 0.7777 0.8418

Kansas.................................. 0.7319 0.8076

Kentucky................................ 0.7844 0.8468

Louisiana............................... 0.7465 0.8186

Maine................................... 0.8467 0.8923

Maryland................................ 0.8555 0.8986

Massachusetts........................... 1.0834 1.0564

Michigan................................ 0.8884 0.9222

Minnesota............................... 0.8595 0.9015

Mississippi............................. 0.7312 0.8070

Missouri................................ 0.7452 0.8176

Montana................................. 0.8578 0.9003

Nebraska................................ 0.7674 0.8342

Nevada.................................. 0.9256 0.9484

New Hampshire........................... 1.0240 1.0164

New Jersey \1\.......................... .............. ..............

New Mexico.............................. 0.8269 0.8780

New York................................ 0.8588 0.9010

North Carolina.......................... 0.8112 0.8665

North Dakota............................ 0.7497 0.8210

Ohio.................................... 0.8519 0.8960

Oklahoma................................ 0.7124 0.7928

Oregon.................................. 0.9912 0.9940

Pennsylvania............................ 0.8664 0.9065

Puerto Rico............................. 0.4080 0.5412

Rhode Island............................ .............. ..............

South Carolina.......................... 0.8046 0.8617

South Dakota............................ 0.7508 0.8218

Tennessee............................... 0.7492 0.8206

Texas................................... 0.7565 0.8261

Utah.................................... 0.8859 0.9204

Vermont................................. 0.9416 0.9596

Virginia................................ 0.7857 0.8478

Washington.............................. 1.0489 1.0332

West Virginia........................... 0.7875 0.8491

Wisconsin............................... 0.8711 0.9098

Wyoming................................. 0.8768 0.9139

------------------------------------------------------------------------

\1\ All counties within the State are classified as urban.

Table 4C.--Wage Index and Capital Geographic Adjustment Factor (GAF) for

Hospitals That Are Reclassified

------------------------------------------------------------------------

Area Wage index GAF

------------------------------------------------------------------------

Abilene, TX............................. 0.8066 0.8631

[[Page 9394]]

Albany, GA.............................. 0.7888 0.8500

Albuquerque, NM......................... 0.8613 0.9028

Alexandria, LA.......................... 0.8526 0.8966

Allentown-Bethlehem-Easton, PA.......... 1.0204 1.0139

Amarillo, TX............................ 0.8517 0.8959

Anchorage, AK........................... 1.2979 1.1955

Asheville, NC........................... 0.8940 0.9261

Atlanta, GA............................. 0.9915 0.9942

Augusta-Aiken, GA-SC.................... 0.9233 0.9468

Baltimore, MD........................... 0.9642 0.9753

Barnstable-Yarmouth, MA................. 1.4427 1.2853

Baton Rouge, LA......................... 0.8872 0.9213

Benton Harbor, MI....................... 0.8884 0.9222

Bergen-Passaic, NJ...................... 1.1749 1.1167

Billings, MT............................ 0.9143 0.9405

Binghamton, NY.......................... 0.9059 0.9346

Birmingham, AL.......................... 0.9073 0.9356

Bismarck, ND............................ 0.7846 0.8469

Boise City, ID.......................... 0.9190 0.9438

Boston-Worcester-Lawrence-Lowell- 1.1288 1.0865

Brockton, MA-NH........................

Brazoria, TX............................ 0.8928 0.9253

Bryan-College Station, TX............... 0.8066 0.8631

Buffalo-Niagara Falls, NY............... 0.9587 0.9715

Burlington, VT.......................... 0.9596 0.9722

Caguas, PR.............................. 0.4410 0.5708

Canton-Massillon, OH.................... 0.8813 0.9171

Casper, WY.............................. 0.9150 0.9410

Champaign-Urbana, IL.................... 0.8770 0.9140

Charleston-North Charleston, SC......... 0.9114 0.9384

Charleston, WV.......................... 0.8763 0.9135

Charlotte-Gastonia-Rock Hill, NC-SC..... 0.9686 0.9784

Charlottesville, VA..................... 0.9733 0.9816

Chattanooga, TN-GA...................... 0.8869 0.9211

Chicago, IL............................. 1.0461 1.0313

Cincinnati, OH-KY-IN.................... 0.9595 0.9721

Clarksville-Hopkinsville, TN-KY......... 0.8213 0.8739

Cleveland-Lorain-Elyria, OH............. 0.9886 0.9922

Columbia, MO............................ 0.8798 0.9160

Columbus, GA-AL......................... 0.8511 0.8955

Columbus, OH............................ 0.9781 0.9850

Corpus Christi, TX...................... 0.8531 0.8969

Dallas, TX.............................. 0.9348 0.9549

Danville, VA............................ 0.8716 0.9102

Davenport-Moline-Rock Island, IA-IL..... 0.8413 0.8884

Dayton-Springfield, OH.................. 0.9605 0.9728

Denver, CO.............................. 1.0334 1.0228

Des Moines, IA.......................... 0.8475 0.8929

Duluth-Superior, MN-WI.................. 1.0009 1.0006

Dutchess County, NY..................... 0.9883 0.9920

Elkhart-Goshen, IN...................... 0.9368 0.9563

Eugene-Springfield, OR.................. 1.1048 1.0706

Evansville-Henderson, IN-KY............. 0.8415 0.8885

Fargo-Moorhead, ND-MN................... 0.9246 0.9477

Fayetteville, NC........................ 0.8389 0.8867

Flagstaff, AZ-UT........................ 0.9523 0.9671

Flint, MI............................... 1.1031 1.0695

Fort Collins-Loveland, CO............... 1.0770 1.0521

Fort Lauderdale, FL..................... 0.9845 0.9894

Fort Pierce-Port St. Lucie, FL.......... 1.0241 1.0164

Fort Smith, AR-OK....................... 0.7519 0.8226

Fort Walton Beach, FL................... 0.8621 0.9034

Fort Worth-Arlington, TX................ 0.9727 0.9812

Gadsden, AL............................. 0.8780 0.9148

Gainesville, FL......................... 0.9462 0.9628

Goldsboro, NC........................... 0.8335 0.8827

Grand Forks, ND-MN...................... 0.8899 0.9232

Grand Junction, CO...................... 0.9116 0.9386

Grand Rapids-Muskegon-Holland, MI....... 0.9856 0.9901

Great Falls, MT......................... 0.9284 0.9504

Greeley, CO............................. 0.9356 0.9554

Green Bay, WI........................... 0.9248 0.9479

[[Page 9395]]

Greenville, NC.......................... 0.9098 0.9373

Greenville-Spartanburg-Anderson, SC..... 0.9222 0.9460

Harrisburg-Lebanon-Carlisle, PA......... 1.0060 1.0041

Hartford, CT............................ 1.1854 1.1235

Hattiesburg, MS......................... 0.7312 0.8070

Hickory-Morganton-Lenoir, NC............ 0.8649 0.9054

Honolulu, HI............................ 1.1510 1.1011

Houston, TX............................. 0.9889 0.9924

Huntington-Ashland, WV-KY-OH............ 0.9275 0.9498

Huntsville, AL.......................... 0.8223 0.8746

Indianapolis, IN........................ 0.9727 0.9812

Iowa City, IA........................... 0.9362 0.9559

Jackson, MS............................. 0.8292 0.8796

Jackson, TN............................. 0.8560 0.8990

Jacksonville, FL........................ 0.8900 0.9233

Johnson City-Kingsport-Bristol, TN-VA... 0.8773 0.9143

Jonesboro, AR........................... 0.7579 0.8271

Joplin, MO.............................. 0.7873 0.8489

Kalamazoo-Battlecreek, MI............... 1.1078 1.0726

Kansas City, KS-MO...................... 0.9645 0.9756

Knoxville, TN........................... 0.8918 0.9246

Lafayette, LA........................... 0.8293 0.8797

Lansing-East Lansing, MI................ 0.9974 0.9982

Las Cruces, NM.......................... 0.8970 0.9283

Las Vegas, NV-AZ........................ 1.1413 1.0947

Lexington, KY........................... 0.8506 0.8951

Lima, OH................................ 0.8768 0.9139

Lincoln, NE............................. 0.9032 0.9327

Little Rock-North Little Rock, AR....... 0.8534 0.8971

Los Angeles-Long Beach, CA.............. 1.2116 1.1405

Louisville, KY-IN....................... 0.9093 0.9370

Macon, GA............................... 0.8775 0.9144

Madison, WI............................. 1.0018 1.0012

Mansfield, OH........................... 0.8534 0.8971

Memphis, TN-AR-MS....................... 0.8361 0.8846

Merced, CA.............................. 1.0218 1.0149

Milwaukee-Waukesha, WI.................. 0.9356 0.9554

Minneapolis-St. Paul, MN-WI............. 1.0854 1.0577

Modesto, CA............................. 1.0346 1.0236

Monroe, LA.............................. 0.8080 0.8642

Montgomery, AL.......................... 0.7860 0.8480

Myrtle Beach, SC........................ 0.8179 0.8714

Nashville, TN........................... 0.9302 0.9517

New Haven-Bridgeport-Stamford-Waterbury- 1.2245 1.1488

Danbury, CT............................

New London-Norwich, CT.................. 1.1640 1.1096

New Orleans, LA......................... 0.9310 0.9522

New York, NY............................ 1.4461 1.2874

Newburgh, NY-PA......................... 1.1223 1.0822

Oakland, CA............................. 1.5162 1.3298

Odessa-Midland, TX...................... 0.8664 0.9065

Oklahoma City, OK....................... 0.8708 0.9096

Omaha, NE-IA............................ 0.9972 0.9981

Orange County, CA....................... 1.1468 1.0983

Orlando, FL............................. 0.9813 0.9872

Peoria-Pekin, IL........................ 0.8063 0.8629

Philadelphia, PA-NJ..................... 1.1370 1.0919

Pittsburgh, PA.......................... 0.9642 0.9753

Pocatello, ID (Idaho Hospital).......... 0.8654 0.9057

Pocatello, ID (Wyoming Hospitals)....... 0.8768 0.9139

Portland, ME............................ 0.9574 0.9706

Portland-Vancouver, OR-WA............... 1.1178 1.0792

Provo-Orem, UT.......................... 0.9885 0.9921

Raleigh-Durham-Chapel Hill, NC.......... 0.9812 0.9871

Rapid City, SD.......................... 0.8208 0.8735

Reno, NV................................ 1.1095 1.0738

Rochester, MN........................... 1.1698 1.1134

Rockford, IL............................ 0.8615 0.9029

Sacramento, CA.......................... 1.1962 1.1305

Saginaw-Bay City-Midland, MI............ 0.9487 0.9646

St. Cloud, MN........................... 0.9586 0.9715

St. Louis, MO-IL........................ 0.9151 0.9411

[[Page 9396]]

Salt Lake City-Ogden, UT................ 0.9420 0.9599

San Diego, CA........................... 1.2310 1.1529

Santa Fe, NM............................ 0.9516 0.9666

Santa Rosa, CA.......................... 1.2907 1.1909

Seattle-Bellevue-Everett, WA............ 1.1535 1.1027

Sharon, PA.............................. 0.8847 0.9195

Sherman-Denison, TX..................... 0.8249 0.8765

Sioux City, IA-NE....................... 0.8481 0.8933

Sioux Falls, SD......................... 0.8809 0.9168

South Bend, IN.......................... 0.9859 0.9903

Spokane, WA............................. 1.0729 1.0494

Springfield, IL......................... 0.8720 0.9105

Springfield, MO......................... 0.8071 0.8635

State College, PA....................... 0.8793 0.9157

Syracuse, NY............................ 0.9400 0.9585

Tallahassee, FL......................... 0.8500 0.8947

Tampa-St. Petersburg-Clearwater, FL..... 0.9183 0.9433

Texarkana, AR-Texarkana, TX............. 0.8506 0.8951

Toledo, OH.............................. 0.9991 0.9994

Topeka, KS.............................. 0.9588 0.9716

Tucson, AZ.............................. 0.9028 0.9324

Tulsa, OK............................... 0.8359 0.8845

Tuscaloosa, AL.......................... 0.7641 0.8317

Tyler, TX............................... 0.8818 0.9175

Vallejo-Fairfield-Napa, CA.............. 1.3311 1.2164

Victoria, TX............................ 0.8382 0.8862

Washington, DC-MD-VA-WV................. 1.0807 1.0546

Waterloo-Cedar Falls, IA................ 0.8332 0.8825

Wausau, WI.............................. 0.9422 0.9600

Wichita, KS............................. 0.8770 0.9140

Wichita Falls, TX....................... 0.7830 0.8458

Rural Alabama........................... 0.7326 0.8081

Rural Illinois.......................... 0.7925 0.8528

Rural Louisiana......................... 0.7465 0.8186

Rural Massachusetts..................... 1.0399 1.0272

Rural Michigan.......................... 0.8884 0.9222

Rural Minnesota......................... 0.8595 0.9015

Rural Missouri.......................... 0.7452 0.8176

Rural Nevada............................ 0.8832 0.9185

Rural New Mexico........................ 0.8269 0.8780

Rural Oregon............................ 0.9912 0.9940

Rural Washington........................ 1.0489 1.0332

Rural Wyoming........................... 0.8768 0.9139

------------------------------------------------------------------------

Table 4D.--Average Hourly Wage for Urban Areas

------------------------------------------------------------------------

Average

Urban area hourly wage

------------------------------------------------------------------------

Abilene, TX............................................. 16.5825

Aguadilla, PR........................................... 9.8222

Akron, OH............................................... 20.5687

Albany, GA.............................................. 16.5708

Albany-Schenectady-Troy, NY............................. 17.8900

Albuquerque, NM......................................... 17.8958

Alexandria, LA.......................................... 17.7146

Allentown-Bethlehem-Easton, PA.......................... 21.2002

Altoona, PA............................................. 19.3951

Amarillo, TX............................................ 17.6070

Anchorage, AK........................................... 26.6324

Ann Arbor, MI........................................... 22.9238

Anniston, AL............................................ 17.9884

Appleton-Oshkosh-Neenah, WI............................. 18.3354

Arecibo, PR............................................. 10.1129

Asheville, NC........................................... 18.5755

Athens, GA.............................................. 18.0203

Atlanta, GA............................................. 20.6008

Atlantic-Cape May, NJ................................... 23.9678

Augusta-Aiken, GA-SC.................................... 19.1829

Austin-San Marcos, TX................................... 18.2464

Bakersfield, CA......................................... 19.8019

Baltimore, MD........................................... 20.0332

Bangor, ME.............................................. 19.6846

Barnstable-Yarmouth, MA................................. 31.9593

Baton Rouge, LA......................................... 18.4325

Beaumont-Port Arthur, TX................................ 17.9913

Bellingham, WA.......................................... 23.7572

Benton Harbor, MI....................................... 17.7241

Bergen-Passaic, NJ...................................... 25.3184

Billings, MT............................................ 18.9960

Biloxi-Gulfport-Pascagoula, MS.......................... 17.1946

Binghamton, NY.......................................... 18.8217

Birmingham, AL.......................................... 18.8506

Bismarck, ND............................................ 16.6736

Bloomington,IN.......................................... 18.6271

Bloomington-Normal, IL.................................. 18.3900

Boise City, ID.......................................... 19.0323

Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH........ 23.4143

Boulder-Longmont, CO.................................... 20.8550

Brazoria, TX............................................ 18.5041

Bremerton, WA........................................... 22.9686

Brownsville-Harlingen-San Benito, TX.................... 17.1138

Bryan-College Station, TX............................... 16.2473

Buffalo-Niagara Falls, NY............................... 19.9187

Burlington, VT.......................................... 19.8983

Caguas, PR.............................................. 9.1414

Canton-Massillon, OH.................................... 18.3114

Casper, WY.............................................. 18.0774

Cedar Rapids, IA........................................ 18.3134

Champaign-Urbana, IL.................................... 18.1242

[[Page 9397]]

Charleston-North Charleston, SC......................... 18.9373

Charleston, WV.......................................... 18.6776

Charlotte-Gastonia-Rock Hill, NC-SC..................... 20.1245

Charlottesville, VA..................................... 21.3425

Chattanooga, TN-GA...................................... 18.8525

Cheyenne, WY............................................ 16.9321

Chicago, IL............................................. 21.7349

Chico-Paradise, CA...................................... 21.0787

Cincinnati, OH-KY-IN.................................... 19.9348

Clarksville-Hopkinsville, TN-KY......................... 16.7045

Cleveland-Lorain-Elyria, OH............................. 20.5401

Colorado Springs, CO.................................... 19.5098

Columbia, MO............................................ 18.5780

Columbia, SC............................................ 19.3016

Columbus, GA-AL......................................... 17.6831

Columbus, OH............................................ 20.3213

Corpus Christi, TX...................................... 17.6885

Cumberland, MD-WV....................................... 17.1237

Dallas, TX.............................................. 19.4652

Danville, VA............................................ 18.7936

Davenport-Moline-Rock Island, IA-IL..................... 17.4790

Dayton-Springfield, OH.................................. 19.9557

Daytona Beach, FL....................................... 18.9775

Decatur, AL............................................. 17.1056

Decatur, IL............................................. 16.6936

Denver, CO.............................................. 21.4638

Des Moines, IA.......................................... 17.5526

Detroit, MI............................................. 21.9074

Dothan, AL.............................................. 16.3982

Dover, DE............................................... 19.4527

Dubuque, IA............................................. 17.0836

Duluth-Superior, MN-WI.................................. 20.6977

Dutchess County, NY..................................... 21.8781

Eau Claire, WI.......................................... 17.8112

El Paso, TX............................................. 19.1468

Elkhart-Goshen, IN...................................... 19.3331

Elmira, NY.............................................. 17.5367

Enid, OK................................................ 16.5863

Erie, PA................................................ 19.2614

Eugene-Springfield, OR.................................. 23.2566

Evansville, Henderson, IN-KY............................ 17.7198

Fargo-Moorhead, ND-MN................................... 19.7800

Fayetteville, NC........................................ 17.4302

Fayetteville-Springdale-Rogers, AR...................... 17.8965

Flagstaff, AZ-UT........................................ 19.7032

Flint, MI............................................... 22.9184

Florence, AL............................................ 15.9479

Florence, SC............................................ 17.6631

Fort Collins-Loveland, CO............................... 22.3767

Fort Lauderdale, FL..................................... 20.3766

Fort Myers-Cape Coral, FL............................... 18.5790

Fort Pierce-Port St. Lucie, FL.......................... 21.2784

Fort Smith, AR-OK....................................... 15.8375

Fort Walton Beach, FL................................... 17.8995

Fort Wayne, IN.......................................... 18.7962

Fort Worth-Arlington, TX................................ 20.1926

Fresno, CA.............................................. 22.2323

Gadsden, AL............................................. 18.2411

Gainesville, FL......................................... 19.6396

Galveston-Texas City, TX................................ 22.6345

Gary, IN................................................ 19.6025

Glens Falls, NY......................................... 17.6404

Goldsboro, NC........................................... 17.7222

Grand Forks, ND-MN...................................... 18.3589

Grand Junction, CO...................................... 17.2009

Grand Rapids-Muskegon-Holland, MI....................... 20.7161

Great Falls, MT......................................... 18.4336

Greeley, CO............................................. 19.6480

Green Bay, WI........................................... 19.0230

Greensboro-Winston-Salem-High Point, NC................. 19.8355

Greenville, NC.......................................... 19.6007

Greenville-Spartanburg-Anderson, SC..................... 19.1612

Hagerstown, MD.......................................... 21.1564

Hamilton-Middletown, OH................................. 19.1833

Harrisburg-Lebanon-Carlisle, PA......................... 20.9016

Hartford, CT............................................ 24.5817

Hattiesburg, MS......................................... 15.0868

Hickory-Morganton-Lenoir, NC............................ 18.4995

Honolulu, HI............................................ 23.9148

Houma, LA............................................... 17.0314

Houston, TX............................................. 20.5460

Huntington-Ashland, WV-KY-OH............................ 20.0441

Huntsville, AL.......................................... 17.4211

Indianapolis, IN........................................ 20.4258

Iowa City, IA........................................... 19.6992

Jackson, MI............................................. 19.1645

Jackson, MS............................................. 17.2283

Jackson, TN............................................. 17.7852

Jacksonville, FL........................................ 18.4915

Jacksonville, NC........................................ 15.6996

Jamestown, NY........................................... 15.9148

Janesville-Beloit, WI................................... 18.8060

Jersey City, NJ......................................... 24.0964

Johnson City-Kingsport-Bristol, TN-VA................... 18.2276

Johnstown, PA........................................... 17.9084

Jonesboro, AR........................................... 15.3904

Joplin, MO.............................................. 16.3572

Kalamazoo-Battlecreek, MI............................... 23.5418

Kankakee, IL............................................ 19.5674

Kansas City, KS-MO...................................... 20.0387

Kenosha, WI............................................. 18.9676

Killeen-Temple, TX...................................... 21.0041

Knoxville, TN........................................... 18.5294

Kokomo, IN.............................................. 19.2700

La Crosse, WI-MN........................................ 18.5196

Lafayette, LA........................................... 17.1506

Lafayette, IN........................................... 18.3693

Lake Charles, LA........................................ 15.9437

Lakeland-Winter Haven, FL............................... 18.5726

Lancaster, PA........................................... 19.8644

Lansing-East Lansing, MI................................ 20.9650

Laredo, TX.............................................. 15.2556

Las Cruces, NM.......................................... 18.4298

Las Vegas, NV-AZ........................................ 23.7139

Lawrence, KS............................................ 17.9827

Lawton, OK.............................................. 18.0698

Lewiston-Auburn, ME..................................... 19.0090

Lexington, KY........................................... 17.6740

Lima, OH................................................ 18.5932

Lincoln, NE............................................. 19.3291

Little Rock-North Little Rock, AR....................... 17.6667

Longview-Marshall, TX................................... 18.0723

Los Angeles-Long Beach, CA.............................. 25.1088

Louisville, KY-IN....................................... 18.8926

Lubbock, TX............................................. 17.6523

Lynchburg, VA........................................... 18.4907

Macon, GA............................................... 18.6578

Madison, WI............................................. 20.8155

Mansfield, OH........................................... 17.7305

Mayaguez, PR............................................ 9.1443

McAllen-Edinburg-Mission, TX............................ 18.4765

Medford-Ashland, OR..................................... 20.8190

Melbourne-Titusville-Palm Bay, FL....................... 19.1487

Memphis, TN-AR-MS....................................... 17.3726

Merced, CA.............................................. 20.8449

Miami, FL............................................... 20.8119

Middlesex-Somerset-Hunterdon, NJ........................ 23.1702

Milwaukee-Waukesha, WI.................................. 19.4387

Minneapolis-St. Paul, MN-WI............................. 22.5517

Missoula, MT............................................ 19.0914

Mobile, AL.............................................. 17.4040

Modesto, CA............................................. 21.4951

Monmouth-Ocean, NJ...................................... 23.5125

Monroe, LA.............................................. 17.0762

Montgomery, AL.......................................... 16.2493

Muncie, IN.............................................. 19.5589

Myrtle Beach, SC........................................ 16.9930

Naples, FL.............................................. 21.1457

Nashville, TN........................................... 19.6966

Nassau-Suffolk, NY...................................... 28.2430

New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT..... 25.6149

New London-Norwich, CT.................................. 24.1351

New Orleans, LA......................................... 19.3440

New York, NY............................................ 30.0458

Newark, NJ.............................................. 24.6548

Newburgh, NY-PA......................................... 23.1779

Norfolk-Virginia Beach-Newport News, VA-NC.............. 17.1926

Oakland, CA............................................. 31.1506

Ocala, FL............................................... 19.0159

Odessa-Midland, TX...................................... 17.9849

Oklahoma City, OK1...................................... 8.0923

Olympia, WA............................................. 23.9389

Omaha, NE-IA............................................ 20.7181

Orange County, CA....................................... 23.9400

Orlando, FL............................................. 20.3876

Owensboro, KY........................................... 16.1460

Panama City, FL......................................... 17.6753

Parkersburg-Marietta, WV-OH............................. 16.6559

Pensacola, FL........................................... 17.1334

Peoria-Pekin, IL........................................ 16.7415

Philadelphia, PA-NJ..................................... 23.6239

Phoenix-Mesa, AZ........................................ 19.9270

Pine Bluff, AR.......................................... 16.4382

Pittsburgh, PA.......................................... 20.3391

Pittsfield, MA.......................................... 22.4781

Pocatello, ID........................................... 18.2669

Ponce, PR............................................... 9.9487

Portland, ME............................................ 19.8655

Portland-Vancouver, OR-WA............................... 23.2244

Providence-Warwick, RI.................................. 22.4422

Provo-Orem, UT.......................................... 20.5384

Pueblo, CO.............................................. 18.1010

Punta Gorda, FL......................................... 18.7634

Racine, WI.............................................. 18.9687

Raleigh-Durham-Chapel Hill, NC.......................... 20.3867

Rapid City, SD.......................................... 17.0546

Reading, PA............................................. 19.1866

[[Page 9398]]

Redding, CA............................................. 24.6374

Reno, NV................................................ 23.0512

Richland-Kennewick-Pasco, WA............................ 21.3732

Richmond-Petersburg, VA................................. 19.1375

Riverside-San Bernardino, CA............................ 22.3498

Roanoke, VA............................................. 17.6802

Rochester, MN........................................... 24.3054

Rochester, NY........................................... 20.0636

Rockford, IL............................................ 17.8998

Rocky Mount, NC......................................... 18.7242

Sacramento, CA.......................................... 24.8541

Saginaw-Bay City-Midland, MI............................ 19.7109

St. Cloud, MN........................................... 19.9167

St. Joseph, MO.......................................... 20.5465

St. Louis, MO-IL........................................ 19.0136

Salem, OR............................................... 20.5776

Salinas, CA............................................. 31.4614

Salt Lake City-Ogden, UT................................ 19.5264

San Angelo, TX.......................................... 15.8857

San Antonio, TX......................................... 16.8290

San Diego, CA........................................... 25.4828

San Francisco, CA....................................... 28.9989

San Jose, CA............................................ 28.7281

San Juan-Bayamon, PR.................................... 9.6051

San Luis Obispo-Atascadero-Paso Robles, CA.............. 23.4029

Santa Barbara-Santa Maria-Lompoc, CA.................... 23.2580

Santa Cruz-Watsonville, CA.............................. 29.0487

Santa Fe, NM............................................ 20.0537

Santa Rosa, CA.......................................... 28.2508

Sarasota-Bradenton, FL.................................. 19.8054

Savannah, GA............................................ 20.9009

Scranton-Wilkes Barre-Hazleton, PA...................... 17.2431

Seattle-Bellevue-Everett, WA............................ 23.9482

Sharon, PA.............................................. 18.3824

Sheboygan, WI........................................... 17.0899

Sherman-Denison, TX..................................... 17.8053

Shreveport-Bossier City, LA............................. 19.5016

Sioux City, IA-NE....................................... 17.6215

Sioux Falls, SD......................................... 18.5158

South Bend, IN.......................................... 20.4831

Spokane, WA............................................. 22.7055

Springfield, IL......................................... 18.1176

Springfield, MO......................................... 16.7688

Springfield, MA......................................... 22.8337

State College, PA....................................... 19.6319

Steubenville-Weirton, OH-WV............................. 17.5119

Stockton-Lodi, CA....................................... 23.0115

Sumter, SC.............................................. 16.8850

Syracuse, NY............................................ 19.5305

Tacoma, WA.............................................. 21.5661

Tallahassee, FL......................................... 17.5545

Tampa-St. Petersburg-Clearwater, FL..................... 18.9348

Terre Haute, IN......................................... 18.6798

Texarkana, AR-Texarkana, TX............................. 17.6740

Toledo, OH.............................................. 20.7579

Topeka, KS.............................................. 20.3862

Trenton, NJ............................................. 21.8355

Tucson, AZ.............................................. 18.7576

Tulsa, OK............................................... 17.5841

Tuscaloosa, AL.......................................... 15.8762

Tyler, TX............................................... 18.3215

Utica-Rome, NY.......................................... 17.4892

Vallejo-Fairfield-Napa, CA.............................. 27.8686

Ventura, CA............................................. 22.8835

Victoria, TX............................................ 17.4131

Vineland-Millville-Bridgeton, NJ........................ 21.6923

Visalia-Tulare-Porterville, CA.......................... 20.9493

Waco, TX................................................ 17.3923

Washington, DC-MD-VA-WV................................. 22.4534

Waterloo-Cedar Falls, IA................................ 16.5347

Wausau, WI.............................................. 20.2214

West Palm Beach-Boca Raton, FL.......................... 21.2323

Wheeling, OH-WV......................................... 15.8460

Wichita, KS............................................. 18.4872

Wichita Falls, TX....................................... 16.2686

Williamsport, PA........................................ 17.7778

Wilmington-Newark, DE-MD................................ 24.6591

Wilmington, NC.......................................... 19.4129

Yakima, WA.............................................. 21.4371

Yolo, CA................................................ 23.3394

York, PA................................................ 19.5520

Youngstown-Warren, OH................................... 20.3921

Yuba City, CA........................................... 22.5751

Yuma, AZ................................................ 20.8977

------------------------------------------------------------------------

Table 4E.--Average Hourly Wage for Rural Areas

------------------------------------------------------------------------

Average

Nonurban area hourly wage

------------------------------------------------------------------------

Alabama................................................. 15.1554

Alaska.................................................. 25.8250

Arizona................................................. 16.5996

Arkansas................................................ 15.0624

California.............................................. 20.7330

Colorado................................................ 17.5278

Connecticut............................................. 25.0854

Delaware................................................ 18.2993

Florida................................................. 18.4445

Georgia................................................. 16.3888

Hawaii.................................................. 22.6670

Idaho................................................... 17.6129

Illinois................................................ 16.4463

Indiana................................................. 17.4120

Iowa.................................................... 16.1574

Kansas.................................................. 15.2062

Kentucky................................................ 16.2977

Louisiana............................................... 15.4880

Maine................................................... 17.5914

Maryland................................................ 17.7750

Massachusetts........................................... 22.5095

Michigan................................................ 18.4407

Minnesota............................................... 17.8572

Mississippi............................................. 15.1920

Missouri................................................ 15.4837

Montana................................................. 17.4489

Nebraska................................................ 15.9437

Nevada.................................................. 19.2311

New Hampshire........................................... 21.2761

New Jersey \1\.......................................... ..............

New Mexico.............................................. 17.1812

New York................................................ 17.8440

[[Page 9399]]

North Carolina.......................................... 16.8544

North Dakota............................................ 15.5776

Ohio.................................................... 17.6991

Oklahoma................................................ 14.8012

Oregon.................................................. 20.5901

Pennsylvania............................................ 18.0013

Puerto Rico............................................. 8.4766

Rhode Island \1\........................................ ..............

South Carolina.......................................... 16.7176

South Dakota............................................ 15.5989

Tennessee............................................... 15.5660

Texas................................................... 15.7178

Utah.................................................... 18.4060

Vermont................................................. 19.5637

Virginia................................................ 16.3242

Washington.............................................. 21.7934

West Virginia........................................... 16.3620

Wisconsin............................................... 18.0980

Wyoming................................................. 18.2168

------------------------------------------------------------------------

\1\ All counties within the State are classified as urban.

Table 4F.--Puerto Rico Wage Index and Capital Geographic Adjustment Factor (GAF)

----------------------------------------------------------------------------------------------------------------

Wage index--

Area Wage index GAF reclass. GAF--reclass.

hospitals hospitals

----------------------------------------------------------------------------------------------------------------

Aguadilla, PR.................................. 1.0295 1.0201 ............... ..............

Arecibo, PR.................................... 1.0599 1.0406 ............... ..............

Caguas, PR..................................... 0.9603 0.9726 0.9603 0.9726

Mayaguez, PR................................... 0.9584 0.9713 ............... ..............

Ponce, PR...................................... 1.0427 1.0290 ............... ..............

San Juan-Bayamon, PR........................... 1.0067 1.0046 ............... ..............

Rural Puerto Rico.............................. 0.8884 0.9222 ............... ..............

----------------------------------------------------------------------------------------------------------------

(Catalog of Federal Domestic Assistance Program No. 93.773,

Medicare--Hospital Insurance; and Program No. 93.774, Medicare--

Supplementary Medical Insurance Program)

Dated: February 5, 1999.

Nancy-Ann Min DeParle,

Administrator, Health Care Financing Administration.

Approved: February 10, 1999.

Donna E. Shalala,

Secretary.

[FR Doc. 99-4506 Filed 2-19-99; 11:15 am]

BILLING CODE 4120-01-P