68 FR 188 pgs. 55882-55898 - Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Correction
Type: RULEVolume: 68Number: 188Pages: 55882 - 55898
Docket number: [CMS-1469-CN]
FR document: [FR Doc. 03-24549 Filed 9-26-03; 8:45 am]
Agency: Health and Human Services Department
Sub Agency: Centers for Medicare Medicaid Services
Official PDF Version: PDF Version
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare Medicaid Services
42 CFR Parts 409, 411, 413, 440, 483, 488, and 489
[CMS-1469-CN]
RIN 0938-AL90
Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Correction
AGENCY:
Centers for Medicare Medicaid Services (CMS), HHS.
ACTION:
Correction of final rule.
SUMMARY:
This document corrects technical errors that appeared in the final rule published in the Federal Register on August 4, 2003, entitled "Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities."
EFFECTIVE DATE:
This correction is effective October 1, 2003.
FOR FURTHER INFORMATION CONTACT:
Jeanette Kranacs, (410) 786-9385, or Sheila Lambowitz, (410) 786-7605.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 03-19677 of August 4, 2003 (68 FR 46036), there were a number of technical errors that are identified and corrected in the "Correction of Errors" section below. The provisions in this correction document are effective as if they had been included in the document published August 4, 2003. Accordingly, the corrections are effective October 1, 2003.
In previous years, we have issued correction notices with respect to payment rates under the prospective payment system (PPS) for skilled nursing facilities (SNFs), reflecting minor adjustments to the hospital wage index relating to specific Metropolitan Statistical Areas (MSAs). For example, for fiscal year (FY) 2003, we issued a correction notice (December 27, 2002, 67 FR 79123) to update two MSA wage indexes. We did not recalculate the SNF budget neutrality factor as a result of these minor revisions.
However, it was recently determined that computational errors in the hospital wage index calculation process for FY 2004 were of sufficient magnitude to affect all of the published PPS payment rates for inpatient hospital services. A description of those computational errors will be included in a notice specific to the hospital inpatient PPS. As we explained in the August 4, 2003 final rule, the SNF wage index values reflect the wage data used in the FY 2004 inpatient hospital PPS rates, and therefore, we believe it would be appropriate to incorporate corrections to the inpatient hospital wage index. The scope of the resulting corrections to the hospital wage index will, in turn, necessitate revising the budget neutrality factor for the SNF PPS for FY 2004 as well. We note that correcting these computational errors is a purely administrative function that does not result in any change of policy or payment methodology.
Accordingly, in this correction document, we are republishing the SNF PPS payment rate tables (that is, Tables 1 through 9, inclusive) that appeared in the August 4, 2003 final rule, in order to show the corrected rates. (We note that we are not republishing Table 10 (FY 2004 Labor-Related Share (68 FR 46057)), as this table solely involves the relative importance of the various components of the labor-related share, and those figures have not changed from those that appeared in the final rule.) Further, we are republishing Table 11, which displays the projected impact of the FY 2004 SNF PPS payment update, including the variation in impact by region and by certain other facility characteristics. We note that the effect of the corrections being made in this notice is solely distributional in nature and, accordingly, that there is no change in the estimated aggregate expenditures for FY 2004 as set forth in the August 4, 2003 final rule. A further discussion of the projected impact of the FY 2004 SNF PPS payment update can be found in the August 4, 2003 final rule (68 FR 46067). In addition, the FY 2004 budget neutrality factor of 1.005 that appeared in the final rule (68 FR 46047) is hereby revised to 1.0016.
Finally, in the August 4, 2003 final rule (68 FR 46060), we added two radiopharmaceuticals, Zevalin and Bexxar, to the list of chemotherapy drugs that are excluded from consolidated billing (and, thus, are separately billable to Part B when furnished to a SNF resident during a covered Part A stay). We note that Healthcare Common Procedure Coding System (HCPCS) coding for Bexxar is currently in the process of being developed. Further, while the final rule identified HCPCS codes A9522 and A9523 for Zevalin, we note that the outpatient hospital PPS currently uses HCPCS codes G0273 and G0274 for Zevalin instead, and that further revision of these particular codes is possible in the near future. As we stated in the final rule, the consolidated billing exclusions will appear in a Consolidated Billing Annual Update Program Memorandum that we will issue at the end of CY 2003, and will be effective as of January 1, 2004 (68 FR 46059). Accordingly, we are clarifying as an interpretive matter that the HCPCS codes to be utilized in connection with Bexxar and Zevalin include any successor codes that may replace the codes currently listed in the regulation. Such successor codes would be disseminated through program instructions. Once HCPCS coding has been developed for Bexxar (and has been definitively established for Zevalin), we will make revisions, as appropriate, to the particular codes that appear in the regulations text at § 411.15(p)(2)(xii) and § 489.20(s)(12).
II. Correction of Errors
In FR Doc. 03-19677 of August 4, 2003 (68 FR 46036), make the following corrections:
Corrections to Preamble
1. On page 46040, Tables 1 and 2 are revised to read as follows:
| Rate component | Nursing- case-mix | Therapy- case-mix | Therapy- non-case- mix | Non-case- mix |
|---|---|---|---|---|
| Per Diem Amount | $129.52 | $97.56 | $12.85 | $66.10 |
| Rate component | Nursing- case-mix | Therapy- case-mix | Therapy- non-case- mix | Non-case- mix |
|---|---|---|---|---|
| Per Diem Amount | $123.74 | $112.50 | $13.72 | $67.33 |
2. On pages 46042 through 46043, Table 3 is revised to read as follows:
BILLING CODE 4120-01-P
[Federal Register graphic "ER29SE03.054" is not available. Please view the graphic in the PDF version of this document.]
[Federal Register graphic "ER29SE03.055" is not available. Please view the graphic in the PDF version of this document.]
3. On Pages 46044 through 46045, Table 4 is revised to read as follows:
[Federal Register graphic "ER29SE03.056" is not available. Please view the graphic in the PDF version of this document.]
[Federal Register graphic "ER29SE03.057" is not available. Please view the graphic in the PDF version of this document.]
4. On page 46047, in the third column; in the first paragraph, the budget neutrality factor of "1.005" that appears in the penultimate sentence is revised to read "1.0016".
5. On page 46048, Table 5 is revised to read as follows:
[Federal Register graphic "ER29SE03.058" is not available. Please view the graphic in the PDF version of this document.]
6. On page 46049, Table 6 is revised to read as follows:
[Federal Register graphic "ER29SE03.059" is not available. Please view the graphic in the PDF version of this document.]
7. On Pages 46050 through 46056, Table 7 is revised to read as follows:
| Urban area (constituent counties or county equivalents) | Wage index |
|---|---|
| 0040 Abilene, TX | 0.7627 |
| Taylor, TX | |
| 0060 Aguadilla, PR | 0.4306 |
| Aguada, PR | |
| Aguadilla, PR | |
| Moca, PR | |
| 0080 Akron, OH | 0.9246 |
| Portage, OH | |
| Summit, OH | |
| 0120 Albany, GA | 1.0863 |
| Dougherty, GA | |
| Lee, GA | |
| 0160 Albany-Schenectady-Troy, NY | 0.8489 |
| Albany, NY | |
| Montgomery, NY | |
| Rensselaer, NY | |
| Saratoga, NY | |
| Schenectady, NY | |
| Schoharie, NY | |
| 0200 Albuquerque, NM | 0.9300 |
| Bernalillo, NM | |
| Sandoval, NM | |
| Valencia, NM | |
| 0220 Alexandria, LA | 0.8019 |
| Rapides, LA | |
| 0240 Allentown-Bethlehem-Easton, PA | 0.9721 |
| Carbon, PA | |
| Lehigh, PA | |
| Northampton, PA | |
| 0280 Altoona, PA | 0.8806 |
| Blair, PA | |
| 0320 Amarillo, TX | 0.8986 |
| Potter, TX | |
| Randall, TX | |
| 0380 Anchorage, AK | 1.2216 |
| Anchorage, AK | |
| 0440 Ann Arbor, MI | 1.1074 |
| Lenawee, MI | |
| Livingston, MI | |
| Washtenaw, MI | |
| 0450 Anniston, AL | 0.8090 |
| Calhoun, AL | |
| 0460 Appleton-Oshkosh-Neenah, WI | 0.9035 |
| Calumet, WI | |
| Outagamie, WI | |
| Winnebago, WI | |
| 0470 Arecibo, PR | 0.4155 |
| Arecibo, PR | |
| Camuy, PR | |
| Hatillo, PR | |
| 0480 Asheville, NC | 0.9720 |
| Buncombe, NC | |
| Madison, NC | |
| 0500 Athens, GA | 0.9818 |
| Clarke, GA | |
| Madison, GA | |
| Oconee, GA | |
| 0520 Atlanta, GA | 1.0130 |
| Barrow, GA | |
| Bartow, GA | |
| Carroll, GA | |
| Cherokee, GA | |
| Clayton, GA | |
| Cobb, GA | |
| Coweta, GA | |
| De Kalb, GA | |
| Douglas, GA | |
| Fayette, GA | |
| Forsyth, GA | |
| Fulton, GA | |
| Gwinnett, GA | |
| Henry, GA | |
| Newton, GA | |
| Paulding, GA | |
| Pickens, GA | |
| Rockdale, GA | |
| Spalding, GA | |
| Walton, GA | |
| 0560 Atlantic City-Cape May, NJ | 1.0795 |
| Atlantic City, NJ | |
| Cape May, NJ | |
| 0580 Auburn-Opelika, AL | 0.8494 |
| Lee, AL | |
| 0600 Augusta-Aiken, GA-SC | 0.9625 |
| Columbia, GA | |
| McDuffie, GA | |
| Richmond, GA | |
| Aiken, SC | |
| Edgefield, SC | |
| 0640 Austin-San Marcos, TX | 0.9609 |
| Bastrop, TX | |
| Caldwell, TX | |
| Hays, TX | |
| Travis, TX | |
| Williamson, TX | |
| 0680 Bakersfield, CA | 0.9810 |
| Kern, CA | |
| 0720 Baltimore, MD | 0.9919 |
| Anne Arundel, MD | |
| Baltimore, MD | |
| Baltimore City, MD | |
| Carroll, MD | |
| Harford, MD | |
| Howard, MD | |
| Queen Annes, MD | |
| 0733 Bangor, ME | 0.9904 |
| Penobscot, ME | |
| 0743 Barnstable-Yarmouth, MA | 1.2956 |
| Barnstable, MA | |
| 0760 Baton Rouge, LA | 0.8406 |
| Ascension, LA | |
| East Baton Rouge, LA | |
| Livingston, LA | |
| West Baton Rouge, LA | |
| 0840 Beaumont-Port Arthur, TX | 0.8424 |
| Hardin, TX | |
| Jefferson, TX | |
| Orange, TX | |
| 0860 Bellingham, WA | 1.1757 |
| Whatcom, WA | |
| 0870 Benton Harbor, MI | 0.8871 |
| Berrien, MI | |
| 0875 Bergen-Passaic, NJ | 1.1692 |
| Bergen, NJ | |
| Passaic, NJ | |
| 0880 Billings, MT | 0.8961 |
| Yellowstone, MT | |
| 0920 Biloxi-Gulfport-Pascagoula, MS | 0.9029 |
| Hancock, MS | |
| Harrison, MS | |
| Jackson, MS | |
| 0960 Binghamton, NY | 0.8428 |
| Broome, NY | |
| Tioga, NY | |
| 1000 Birmingham, AL | 0.9212 |
| Blount, AL | |
| Jefferson, AL | |
| St. Clair, AL | |
| Shelby, AL | |
| 1010 Bismarck, ND | 0.7965 |
| Burleigh, ND | |
| Morton, ND | |
| 1020 Bloomington, IN | 0.8662 |
| Monroe, IN | |
| 1040 Bloomington-Normal, IL | 0.8832 |
| McLean, IL | |
| 1080 Boise City, ID | 0.9209 |
| Ada, ID | |
| Canyon, ID | |
| 1123 Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH | 1.1233 |
| 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 | 1.0049 |
| Boulder, CO | |
| 1145 Brazoria, TX | 0.8137 |
| Brazoria, TX | |
| 1150 Bremerton, WA | |
| Kitsap, WA | |
| 1240 Brownsville-Harlingen-San Benito, TX | 1.0303 |
| Cameron, TX | |
| 1260 Bryan-College Station, TX | 0.9019 |
| Brazos, TX | |
| 1280 Buffalo-Niagara Falls, NY | 0.9604 |
| Erie, NY | |
| Niagara, NY | |
| 1303 Burlington, VT | 0.9704 |
| Chittenden, VT | |
| Franklin, VT | |
| Grand Isle, VT | |
| 1310 Caguas, PR | 0.4158 |
| Caguas, PR | |
| Cayey, PR | |
| Cidra, PR | |
| Gurabo, PR | |
| San Lorenzo, PR | |
| 1320 Canton-Massillon, OH | 0.9071 |
| Carroll, OH | |
| Stark, OH | |
| 1350 Casper, WY | 0.9095 |
| Natrona, WY | |
| 1360 Cedar Rapids, IA | 0.8874 |
| Linn, IA | |
| 1400 Champaign-Urbana, IL | 0.9907 |
| Champaign, IL | |
| 1440 Charleston-North Charleston, SC | 0.9332 |
| Berkeley, SC | |
| Charleston, SC | |
| Dorchester, SC | |
| 1480 Charleston, WV | 0.8880 |
| Kanawha, WV | |
| Putnam, WV | |
| 1520Charlotte-Gastonia-Rock Hill, NC-SC | 0.9760 |
| Cabarrus, NC | |
| Gaston, NC | |
| Lincoln, NC | |
| Mecklenburg, NC | |
| Rowan, NC | |
| Stanly, NC | |
| Union, NC | |
| York, SC | |
| 1540 Charlottesville, VA | 1.0025 |
| Albemarle, VA | |
| Charlottesville City, VA | |
| Fluvanna, VA | |
| Greene, VA | |
| 1560 Chattanooga, TN-GA | 0.9086 |
| Catoosa, GA | |
| Dade, GA | |
| Walker, GA | |
| Hamilton, TN | |
| Marion, TN | |
| 1580 Cheyenne, WY | 0.8796 |
| Laramie, WY | |
| 1600 Chicago, IL | 1.0892 |
| Cook, IL | |
| De Kalb, IL | |
| Du Page, IL | |
| Grundy, IL | |
| Kane, IL | |
| Kendall, IL | |
| Lake, IL | |
| McHenry, IL | |
| Will, IL | |
| 1620 Chico-Paradise, CA | 1.0193 |
| Butte, CA | |
| 1640 Cincinnati, OH-KY-IN | 0.9413 |
| 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 | 0.8244 |
| Christian, KY | |
| Montgomery, TN | |
| 1680 Cleveland-Lorain-Elyria, OH | 0.9671 |
| Ashtabula, OH | |
| Geauga, OH | |
| Cuyahoga, OH | |
| Lake, OH | |
| Lorain, OH | |
| Medina, OH | |
| 1720 Colorado Springs, CO | 0.9833 |
| El Paso, CO | |
| 1740 Columbia, MO | 0.8695 |
| Boone, MO | |
| 1760 Columbia, SC | 0.8902 |
| Lexington, SC | |
| Richland, SC | |
| 1800 Columbus, GA-AL | 0.8694 |
| Russell, AL | |
| Chattanoochee, GA | |
| Harris, GA | |
| Muscogee, GA | |
| 1840 Columbus, OH | 0.9648 |
| Delaware, OH | |
| Fairfield, OH | |
| Franklin, OH | |
| Licking, OH | |
| Madison, OH | |
| Pickaway, OH | |
| 1880 Corpus Christi, TX | 0.8521 |
| Nueces, TX | |
| San Patricio, TX | |
| 1890 Corvallis, OR | 1.1516 |
| Benton, OR | |
| 1900 Cumberland, MD-WV | 0.8200 |
| Allegany, MD | |
| Mineral, WV | |
| 1920 Dallas, TX | 0.9974 |
| Collin, TX | |
| Dallas, TX | |
| Denton, TX | |
| Ellis, TX | |
| Henderson, TX | |
| Hunt, TX | |
| Kaufman, TX | |
| Rockwall, TX | |
| 1950 Danville, VA | 0.9035 |
| Danville City, VA | |
| Pittsylvania, VA | |
| 1960 Davenport-Moline-Rock Island, IA-IL | 0.8985 |
| Scott, IA | |
| Henry, IL | |
| Rock Island, IL | |
| 2000 Dayton-Springfield, OH | 0.9518 |
| Clark, OH | |
| Greene, OH | |
| Miami, OH | |
| Montgomery, OH | |
| 2020 Daytona Beach, FL | 0.9078 |
| Flagler, FL | |
| Volusia, FL | |
| 2030 Decatur, AL | 0.8828 |
| Lawrence, AL | |
| Morgan, AL | |
| 2040 Decatur, IL | 0.8161 |
| Macon, IL | |
| 2080 Denver, CO | 1.0837 |
| Adams, CO | |
| Arapahoe, CO | |
| Denver, CO | |
| Douglas, CO | |
| Jefferson, CO | |
| 2120 Des Moines, IA | 0.9106 |
| Dallas, IA | |
| Polk, IA | |
| Warren, IA | |
| 2160 Detroit, MI | 1.0101 |
| Lapeer, MI | |
| Macomb, MI | |
| Monroe, MI | |
| Oakland, MI | |
| St. Clair, MI | |
| Wayne, MI | |
| 2180 Dothan, AL | 0.7741 |
| Dale, AL | |
| Houston, AL | |
| 2190 Dover, DE | 0.9805 |
| Kent, DE | |
| 2200 Dubuque, IA | 0.8886 |
| Dubuque, IA | |
| 2240 Duluth-Superior, MN-WI | 1.0171 |
| St. Louis, MN | |
| Douglas, WI | |
| 2281 Dutchess County, NY | 1.0934 |
| Dutchess, NY | |
| 2290 Eau Claire, WI | 0.9064 |
| Chippewa, WI | |
| Eau Claire, WI | |
| 2320 El Paso, TX | 0.9196 |
| El Paso, TX | |
| 2330 Elkhart-Goshen, IN | 0.9783 |
| Elkhart, IN | |
| 2335 Elmira, NY | 0.8377 |
| Chemung, NY | |
| 2340 Enid, OK | 0.8559 |
| Garfield, OK | |
| 2360 Erie, PA | 0.8601 |
| Erie, PA | |
| 2400 Eugene-Springfield, OR | 1.1456 |
| Lane, OR | |
| 2440 Evansville-Henderson, IN-KY | 0.8429 |
| Posey, IN | |
| Vanderburgh, IN | |
| Warrick, IN | |
| Henderson, KY | |
| 2520 Fargo-Moorhead, ND-MN | 0.9797 |
| Clay, MN | |
| Cass, ND | |
| 2560 Fayetteville, NC | 0.8986 |
| Cumberland, NC | |
| 2580 Fayetteville-Springdale-Rogers, AR | 0.8396 |
| Benton, AR | |
| Washington, AR | |
| 2620 Flagstaff, AZ-UT | 1.1333 |
| Coconino, AZ | |
| Kane, UT | |
| 2640 Flint, MI | 1.0858 |
| Genesee, MI | |
| 2650 Florence, AL | 0.7747 |
| Colbert, AL | |
| Lauderdale, AL | |
| 2655 Florence, SC | 0.8709 |
| Florence, SC | |
| 2670 Fort Collins-Loveland, CO | 1.0108 |
| Larimer, CO | |
| 2680 Ft. Lauderdale, FL | 1.0163 |
| Broward, FL | |
| 2700 Fort Myers-Cape Coral, FL | 0.9816 |
| Lee, FL | |
| 2710 Fort Pierce-Port St. Lucie, FL | 1.0008 |
| Martin, FL | |
| St. Lucie, FL | |
| 2720 Fort Smith, AR-OK | 0.8424 |
| Crawford, AR | |
| Sebastian, AR | |
| Sequoyah, OK | |
| 2750 Fort Walton Beach, FL | 0.8966 |
| Okaloosa, FL | |
| 2760 Fort Wayne, IN | 0.9585 |
| Adams, IN | |
| Allen, IN | |
| De Kalb, IN | |
| Huntington, IN | |
| Wells, IN | |
| Whitley, IN | |
| 2800 Forth Worth-Arlington, TX | 0.9359 |
| Hood, TX | |
| Johnson, TX | |
| Parker, TX | |
| Tarrant, TX | |
| 2840 Fresno, CA | 1.0094 |
| Fresno, CA | |
| Madera, CA | |
| 2880 Gadsden, AL | 0.8206 |
| Etowah, AL | |
| 2900 Gainesville, FL | 0.9693 |
| Alachua, FL | |
| 2920 Galveston-Texas City, TX | 0.9279 |
| Galveston, TX | |
| 2960 Gary, IN | 0.9410 |
| Lake, IN | |
| Porter, IN | |
| 2975 Glens Falls, NY | 0.8475 |
| Warren, NY | |
| Washington, NY | |
| 2980 Goldsboro, NC | 0.8622 |
| Wayne, NC | |
| 2985 Grand Forks, ND-MN | 0.8636 |
| Polk, MN | |
| Grand Forks, ND | |
| 2995 Grand Junction, CO | 0.9633 |
| Mesa, CO | |
| 3000 Grand Rapids-Muskegon-Holland, MI | 0.9469 |
| Allegan, MI | |
| Kent, MI | |
| Muskegon, MI | |
| Ottawa, MI | |
| 3040 Great Falls, MT | 0.8809 |
| Cascade, MT | |
| 3060 Greeley, CO | 0.9372 |
| Weld, CO | |
| 3080 Green Bay, WI | 0.9461 |
| Brown, WI | |
| 3120 Greensboro-Winston-Salem-High Point, NC | 0.9166 |
| Alamance, NC | |
| Davidson, NC | |
| Davie, NC | |
| Forsyth, NC | |
| Guilford, NC | |
| Randolph, NC | |
| Stokes, NC | |
| Yadkin, NC | |
| 3150 Greenville, NC | 0.9098 |
| Pitt, NC | |
| 3160 Greenville-Spartanburg-Anderson, SC | 0.9335 |
| Anderson, SC | |
| Cherokee, SC | |
| Greenville, SC | |
| Pickens, SC | |
| Spartanburg, SC | |
| 3180 Hagerstown, MD | 0.9172 |
| Washington, MD | |
| 3200 Hamilton-Middletown, OH | 0.9214 |
| Butler, OH | |
| 3240 Harrisburg-Lebanon-Carlisle, PA | 0.9164 |
| Cumberland, PA | |
| Dauphin, PA | |
| Lebanon, PA | |
| Perry, PA | |
| 3283 Hartford, CT | 1.1555 |
| Hartford, CT | |
| Litchfield, CT | |
| Middlesex, CT | |
| Tolland, CT | |
| 3285 Hattiesburg, MS | 0.7307 |
| Forrest, MS | |
| Lamar, MS | |
| 3290 Hickory-Morganton-Lenoir, NC | 0.9242 |
| Alexander, NC | |
| Burke, NC | |
| Caldwell, NC | |
| Catawba, NC | |
| 3320 Honolulu, HI | 1.1098 |
| Honolulu, HI | |
| 3350 Houma, LA | 0.7748 |
| Lafourche, LA | |
| Terrebonne, LA | |
| 3360 Houston, TX | 0.9834 |
| Chambers, TX | |
| Fort Bend, TX | |
| Harris, TX | |
| Liberty, TX | |
| Montgomery, TX | |
| Waller, TX | |
| 3400 Huntington-Ashland, WV-KY-OH | 0.9595 |
| Boyd, KY | |
| Carter, KY | |
| Greenup, KY | |
| Lawrence, OH | |
| Cabell, WV | |
| Wayne, WV | |
| 3440 Huntsville, AL | 0.9245 |
| Limestone, AL | |
| Madison, AL | |
| 3480 Indianapolis, IN | 0.9916 |
| Boone, IN | |
| Hamilton, IN | |
| Hancock, IN | |
| Hendricks, IN | |
| Johnson, IN | |
| Madison, IN | |
| Marion, IN | |
| Morgan, IN | |
| Shelby, IN | |
| 3500 Iowa City, IA | 0.9548 |
| Johnson, IA | |
| 3520 Jackson, MI | 0.8986 |
| Jackson, MI | |
| 3560 Jackson, MS | 0.8357 |
| Hinds, MS | |
| Madison, MS | |
| Rankin, MS | |
| 3580 Jackson, TN | 0.8984 |
| Chester, TN | |
| Madison, TN | |
| 3600 Jacksonville, FL | 0.9529 |
| Clay, FL | |
| Duval, FL | |
| Nassau, FL | |
| St. Johns, FL | |
| 3605 Jacksonville, NC | 0.8544 |
| Onslow, NC | |
| 3610 Jamestown, NY | 0.7762 |
| Chautaqua, NY | |
| 3620 Janesville-Beloit, WI | 0.9282 |
| Rock, WI | |
| 3640 Jersey City, NJ | 1.1115 |
| Hudson, NJ | |
| 3660 Johnson City-Kingsport-Bristol, TN-VA | 0.8253 |
| Carter, TN | |
| Hawkins, TN | |
| Sullivan, TN | |
| Unicoi, TN | |
| Washington, TN | |
| Bristol City, VA | |
| Scott, VA | |
| Washington, VA | |
| 3680 Johnstown, PA | 0.8158 |
| Cambria, PA | |
| Somerset, PA | |
| 3700 Jonesboro, AR | 0.7794 |
| Craighead, AR | |
| 3710 Joplin, MO | 0.8681 |
| Jasper, MO | |
| Newton, MO | |
| 3720 Kalamazoo-Battle Creek, MI | 1.0500 |
| Calhoun, MI | |
| Kalamazoo, MI | |
| Van Buren, MI | |
| 3740 Kankakee, IL | 1.0419 |
| Kankakee, IL | |
| 3760 Kansas City, KS-MO | 0.9715 |
| Johnson, KS | |
| Leavenworth, KS | |
| Miami, KS | |
| Wyandotte, KS | |
| Cass, MO | |
| Clay, MO | |
| Clinton, MO | |
| Jackson, MO | |
| Lafayette, MO | |
| Platte, MO | |
| Ray, MO | |
| 3800 Kenosha, WI | 0.9761 |
| Kenosha, WI | |
| 3810 Killeen-Temple, TX | 0.9159 |
| Bell, TX | |
| Coryell, TX | |
| 3840 Knoxville, TN | 0.8820 |
| Anderson, TN | |
| Blount, TN | |
| Knox, TN | |
| Loudon, TN | |
| Sevier, TN | |
| Union, TN | |
| 3850 Kokomo, IN | 0.9045 |
| Howard, IN | |
| Tipton, IN | |
| 3870 La Crosse, WI-MN | 0.9247 |
| Houston, MN | |
| La Crosse, WI | |
| 3880 Lafayette, LA | 0.8189 |
| Acadia, LA | |
| Lafayette, LA | |
| St. Landry, LA | |
| St. Martin, LA | |
| 3920 Lafayette, IN | 0.8584 |
| Clinton, IN | |
| Tippecanoe, IN | |
| 3960 Lake Charles, LA | 0.7841 |
| Calcasieu, LA | |
| 3980 Lakeland-Winter Haven, FL | 0.8811 |
| Polk, FL | |
| 4000 Lancaster, PA | 0.9282 |
| Lancaster, PA | |
| 4040 Lansing-East Lansing, MI | 0.9714 |
| Clinton, MI | |
| Eaton, MI | |
| Ingham, MI | |
| 4080 Laredo, TX | 0.8091 |
| Webb, TX | |
| 4100 Las Cruces, NM | 0.8688 |
| Dona Ana, NM | |
| 4120 Las Vegas, NV-AZ | 1.1528 |
| Mohave, AZ | |
| Clark, NV | |
| Nye, NV | |
| 4150 Lawrence, KS | 0.8677 |
| Douglas, KS | |
| 4200 Lawton, OK | 0.8267 |
| Comanche, OK | |
| 4243 Lewiston-Auburn, ME | 0.9383 |
| Androscoggin, ME | |
| 4280 Lexington, KY | 0.8685 |
| Bourbon, KY | |
| Clark, KY | |
| Fayette, KY | |
| Jessamine, KY | |
| Madison, KY | |
| Scott, KY | |
| Woodford, KY | |
| 4320 Lima, OH | 0.9522 |
| Allen, OH | |
| Auglaize, OH | |
| 4360 Lincoln, NE | 1.0033 |
| Lancaster, NE | |
| 4400 Little Rock-North Little Rock, AR | 0.8923 |
| Faulkner, AR | |
| Lonoke, AR | |
| Pulaski, AR | |
| Saline, AR | |
| 4420 Longview-Marshall, TX | 0.9113 |
| Gregg, TX | |
| Harrison, TX | |
| Upshur, TX | |
| 4480 Los Angeles-Long Beach, CA | 1.1795 |
| Los Angeles, CA | |
| 4520 Louisville, KY-IN | 0.9242 |
| Clark, IN | |
| Floyd, IN | |
| Harrison, IN | |
| Scott, IN | |
| Bullitt, KY | |
| Jefferson, KY | |
| Oldham, KY | |
| 4600 Lubbock, TX | 0.8272 |
| Lubbock, TX | |
| 4640 Lynchburg, VA | 0.9134 |
| Amherst, VA | |
| Bedford City, VA | |
| Bedford, VA | |
| Campbell, VA | |
| Lynchburg City, VA | |
| 4680 Macon, GA | 0.8953 |
| Bibb, GA | |
| Houston, GA | |
| Jones, GA | |
| Peach, GA | |
| Twiggs, GA | |
| 4720 Madison, WI | 1.0264 |
| Dane, WI | |
| 4800 Mansfield, OH | 0.9180 |
| Crawford, OH | |
| Richland, OH | |
| 4840 Mayaguez, PR | 0.4795 |
| Anasco, PR | |
| Cabo Rojo, PR | |
| Hormigueros, PR | |
| Mayaguez, PR | |
| Sabana Grande, PR | |
| San German, PR | |
| 4880 McAllen-Edinburg-Mission, TX | 0.8381 |
| Hidalgo, TX | |
| 4890 Medford-Ashland, OR | 1.0772 |
| Jackson, OR | |
| 4900 Melbourne-Titusville-Palm Bay, FL | 0.9776 |
| Brevard, FL | |
| 4920 Memphis, TN-AR-MS | 0.9009 |
| Crittenden, AR | |
| De Soto, MS | |
| Fayette, TN | |
| Shelby, TN | |
| Tipton, TN | |
| 4940 Merced, CA | 0.9690 |
| Merced, CA | |
| 5000 Miami, FL | 0.9894 |
| Dade, FL | |
| 5015 Middlesex-Somerset-Hunterdon, NJ | 1.1366 |
| Hunterdon, NJ | |
| Middlesex, NJ | |
| Somerset, NJ | |
| 5080 Milwaukee-Waukesha, WI | 0.9988 |
| Milwaukee, WI | |
| Ozaukee, WI | |
| Washington, WI | |
| Waukesha, WI | |
| 5120 Minneapolis-St Paul, MN-WI | 1.1001 |
| Anoka, MN | |
| Carver, MN | |
| Chisago, MN | |
| Dakota, MN | |
| Hennepin, MN | |
| Isanti, MN | |
| Ramsey, MN | |
| Scott, MN | |
| Sherburne, MN | |
| Washington, MN | |
| Wright, MN | |
| Pierce, WI | |
| St. Croix, WI | |
| 5140 Missoula, MT | 0.8718 |
| Missoula, MT | |
| 5160 Mobile, AL | 0.7994 |
| Baldwin, AL | |
| Mobile, AL | |
| 5170 Modesto, CA | 1.1275 |
| Stanislaus, CA | |
| 5190 Monmouth-Ocean, NJ | 1.0956 |
| Monmouth, NJ | |
| Ocean, NJ | |
| 5200 Monroe, LA | 0.7922 |
| Ouachita, LA | |
| 5240 Montgomery, AL | 0.7907 |
| Autauga, AL | |
| Elmore, AL | |
| Montgomery, AL | |
| 5280 Muncie, IN | 0.8775 |
| Delaware, IN | |
| 5330 Myrtle Beach, SC | 0.9112 |
| Horry, SC | |
| 5345 Naples, FL | 0.9790 |
| Collier, FL | |
| 5360 Nashville, TN | 0.9855 |
| Cheatham, TN | |
| Davidson, TN | |
| Dickson, TN | |
| Robertson, TN | |
| Rutherford TN | |
| Sumner, TN | |
| Williamson, TN | |
| Wilson, TN | |
| 5380 Nassau-Suffolk, NY | 1.3140 |
| Nassau, NY | |
| Suffolk, NY | |
| 5483 New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT | 1.2385 |
| Fairfield, CT | |
| New Haven, CT | |
| 5523 New London-Norwich, CT | 1.1631 |
| New London, CT | |
| 5560 New Orleans, LA | 0.9174 |
| Jefferson, LA | |
| Orleans, LA | |
| Plaquemines, LA | |
| St. Bernard, LA | |
| St. Charles, LA | |
| St. James, LA | |
| St. John The Baptist, LA | |
| St. Tammany, LA | |
| 5600 New York, NY | 1.4018 |
| Bronx, NY | |
| Kings, NY | |
| New York, NY | |
| Putnam, NY | |
| Queens, NY | |
| Richmond, NY | |
| Rockland, NY | |
| Westchester, NY | |
| 5640 Newark, NJ | 1.1518 |
| Essex, NJ | |
| Morris, NJ | |
| Sussex, NJ | |
| Union, NJ | |
| Warren, NJ | |
| 5660 Newburgh, NY-PA | 1.1509 |
| Orange, NY | |
| Pike, PA | |
| 5720 Norfolk-Virginia Beach-Newport News, VA-NC | 0.8619 |
| 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 | 1.4921 |
| Alameda, CA | |
| Contra Costa, CA | |
| 5790 Ocala, FL | 0.9728 |
| Marion, FL | |
| 5800 Odessa-Midland, TX | 0.9327 |
| Ector, TX | |
| Midland, TX | |
| 5880 Oklahoma City, OK | 0.8984 |
| Canadian, OK | |
| Cleveland, OK | |
| Logan, OK | |
| McClain, OK | |
| Oklahoma, OK | |
| Pottawatomie, OK | |
| 5910 Olympia, WA | 1.0963 |
| Thurston, WA | |
| 5920 Omaha, NE-IA | 0.9745 |
| Pottawattamie, IA | |
| Cass, NE | |
| Douglas, NE | |
| Sarpy, NE | |
| Washington, NE | |
| 5945 Orange County, CA | 1.1372 |
| Orange, CA | |
| 5960 Orlando, FL | 0.9654 |
| Lake, FL | |
| Orange, FL | |
| Osceola, FL | |
| Seminole, FL | |
| 5990 Owensboro, KY | 0.8374 |
| Daviess, KY | |
| 6015 Panama City, FL | 0.8202 |
| Bay, FL | |
| 6020 Parkersburg-Marietta, WV-OH | 0.8039 |
| Washington, OH | |
| Wood, WV | |
| 6080 Pensacola, FL | 0.8707 |
| Escambia, FL | |
| Santa Rosa, FL | |
| 6120 Peoria-Pekin, IL | 0.8734 |
| Peoria, IL | |
| Tazewell, IL | |
| Woodford, IL | |
| 6160 Philadelphia, PA-NJ | 1.0883 |
| Burlington, NJ | |
| Camden, NJ | |
| Gloucester, NJ | |
| Salem, NJ | |
| Bucks, PA | |
| Chester, PA | |
| Delaware, PA | |
| Montgomery, PA | |
| Philadelphia, PA | |
| 6200 Phoenix-Mesa, AZ | 1.0129 |
| Maricopa, AZ | |
| Pinal, AZ | |
| 6240 Pine Bluff, AR | 0.7865 |
| Jefferson, AR | |
| 6280 Pittsburgh, PA | 0.8901 |
| Allegheny, PA | |
| Beaver, PA | |
| Butler, PA | |
| Fayette, PA | |
| Washington, PA | |
| Westmoreland, PA | |
| 6323 Pittsfield, MA | 1.0276 |
| Berkshire, MA | |
| 6340 Pocatello, ID | 0.9042 |
| Bannock, ID | |
| 6360 Ponce, PR | 0.4708 |
| Guayanilla, PR | |
| Juana Diaz, PR | |
| Penuelas, PR | |
| Ponce, PR | |
| Villalba, PR | |
| Yauco, PR | |
| 6403 Portland, ME | 0.9949 |
| Cumberland, ME | |
| Sagadahoc, ME | |
| York, ME | |
| 6440 Portland-Vancouver, OR-WA | 1.1213 |
| Clackamas, OR | |
| Columbia, OR | |
| Multnomah, OR | |
| Washington, OR | |
| Yamhill, OR | |
| Clark, WA | |
| 6483 Providence-Warwick-Pawtucket, RI | 1.0977 |
| Bristol, RI | |
| Kent, RI | |
| Newport, RI | |
| Providence, RI | |
| Washington, RI | |
| 6520 Provo-Orem, UT | 0.9976 |
| Utah, UT | |
| 6560 Pueblo, CO | 0.8778 |
| Pueblo, CO | |
| 6580 Punta Gorda, FL | 0.9510 |
| Charlotte, FL | |
| 6600 Racine, WI | 0.8814 |
| Racine, WI | |
| 6640 Raleigh-Durham-Chapel Hill, NC | 0.9959 |
| Chatham, NC | |
| Durham, NC | |
| Franklin, NC | |
| Johnston, NC | |
| Orange, NC | |
| Wake, NC | |
| 6660 Rapid City, SD | 0.8806 |
| Pennington, SD | |
| 6680 Reading, PA | 0.9133 |
| Berks, PA | |
| 6690 Redding, CA | 1.1352 |
| Shasta, CA | |
| 6720 Reno, NV | 1.0682 |
| Washoe, NV | |
| 6740 Richland-Kennewick-Pasco, WA | 1.0609 |
| Benton, WA | |
| Franklin, WA | |
| 6760 Richmond-Petersburg, VA | 0.9349 |
| Charles City County, VA | |
| Chesterfield, VA | |
| Colonial Heights City, VA | |
| Dinwiddie, VA | |
| Goochland, VA | |
| Hanover, VA | |
| Henrico, VA | |
| Hopewell City, VA | |
| New Kent, VA | |
| Petersburg City, VA | |
| Powhatan, VA | |
| Prince George, VA | |
| Richmond City, VA | |
| 6780 Riverside-San Bernardino, CA | 1.1341 |
| Riverside, CA | |
| San Bernardino, CA | |
| 6800 Roanoke, VA | 0.8700 |
| Botetourt, VA | |
| Roanoke, VA | |
| Roanoke City, VA | |
| Salem City, VA | |
| 6820 Rochester, MN | 1.1739 |
| Olmsted, MN | |
| 6840 Rochester, NY | 0.9430 |
| Genesee, NY | |
| Livingston, NY | |
| Monroe, NY | |
| Ontario, NY | |
| Orleans, NY | |
| Wayne, NY | |
| 6880 Rockford, IL | 0.9666 |
| Boone, IL | |
| Ogle, IL | |
| Winnebago, IL | |
| 6895 Rocky Mount, NC | 0.9076 |
| Edgecombe, NC | |
| Nash, NC | |
| 6920 Sacramento, CA | 1.1845 |
| El Dorado, CA | |
| Placer, CA | |
| Sacramento, CA | |
| 6960 Saginaw-Bay City-Midland, MI | 1.0032 |
| Bay, MI | |
| Midland, MI | |
| Saginaw, MI | |
| 6980 St. Cloud, MN | 0.9506 |
| Benton, MN | |
| Stearns, MN | |
| 7000 St. Joseph, MO | 0.9757 |
| Andrews, MO | |
| Buchanan, MO | |
| 7040 St. Louis, MO-IL | 0.9033 |
| Clinton, IL | |
| Jersey, IL | |
| Madison, IL | |
| Monroe, IL | |
| St. Clair, IL | |
| Franklin, MO | |
| Jefferson, MO | |
| Lincoln, MO | |
| St. Charles, MO | |
| St. Louis, MO | |
| St. Louis City, MO | |
| Warren, MO | |
| Sullivan City, MO | |
| 7080 Salem, OR | 1.0482 |
| Marion, OR | |
| Polk, OR | |
| 7120 Salinas, CA | 1.4339 |
| Monterey, CA | |
| 7160 Salt Lake City-Ogden, UT | 0.9913 |
| Davis, UT | |
| Salt Lake, UT | |
| Weber, UT | |
| 7200 San Angelo, TX | 0.8535 |
| Tom Green, TX | |
| 7240 San Antonio, TX | 0.8870 |
| Bexar, TX | |
| Comal, TX | |
| Guadalupe, TX | |
| Wilson, TX | |
| 7320 San Diego, CA | 1.1147 |
| San Diego, CA | |
| 7360 San Francisco, CA | 1.4514 |
| Marin, CA | |
| San Francisco, CA | |
| San Mateo, CA | |
| 7400 San Jose, CA | 1.4626 |
| Santa Clara, CA | |
| 7440 San Juan-Bayamon, PR | 0.4909 |
| Aguas Buenas, PR | |
| Barceloneta, PR | |
| Bayamon, PR | |
| Canovanas, PR | |
| Carolina, PR | |
| Catano, PR | |
| Ceiba, PR | |
| Comerio, PR | |
| Corozal, PR | |
| Dorado, PR | |
| Fajardo, PR | |
| Florida, PR | |
| Guaynabo, PR | |
| Humacao, PR | |
| Juncos, PR | |
| Los Piedras, PR | |
| Loiza, PR | |
| Luguillo, PR | |
| Manati, PR | |
| Morovis, PR | |
| Naguabo, PR | |
| Naranjito, PR | |
| Rio Grande, PR | |
| San Juan, PR | |
| Toa Alta, PR | |
| Toa Baja, PR | |
| Trujillo Alto, PR | |
| Vega Alta, PR | |
| Vega Baja, PR | |
| Yabucoa, PR | |
| 7460 San Luis Obispo-Atascadero-Paso Robles, CA | 1.1429 |
| San Luis Obispo, CA | |
| 7480 Santa Barbara-Santa Maria-Lompoc, CA | 1.0441 |
| Santa Barbara, CA | |
| 7485 Santa Cruz-Watsonville, CA | 1.2942 |
| Santa Cruz, CA | |
| 7490 Santa Fe, NM | 1.0653 |
| Los Alamos, NM | |
| Santa Fe, NM | |
| 7500 Santa Rosa, CA | 1.2877 |
| Sonoma, CA | |
| 7510 Sarasota-Bradenton, FL | 0.9964 |
| Manatee, FL | |
| Sarasota, FL | |
| 7520 Savannah, GA | 0.9472 |
| Bryan, GA | |
| Chatham, GA | |
| Effingham, GA | |
| 7560 Scranton-Wilkes-Barre-Hazleton, PA | 0.8412 |
| Columbia, PA | |
| Lackawanna, PA | |
| Luzerne, PA | |
| Wyoming, PA | |
| 7600 Seattle-Bellevue-Everett, WA | 1.1562 |
| Island, WA | |
| King, WA | |
| Snohomish, WA | |
| 7610 Sharon, PA | 0.7751 |
| Mercer, PA | |
| 7620 Sheboygan, WI | 0.8624 |
| Sheboygan, WI | |
| 7640 Sherman-Denison, TX | 0.9700 |
| Grayson, TX | |
| 7680 Shreveport-Bossier City, LA | 0.9083 |
| Bossier, LA | |
| Caddo, LA | |
| Webster, LA | |
| 7720 Sioux City, IA-NE | 0.8993 |
| Woodbury, IA | |
| Dakota, NE | |
| 7760 Sioux Falls, SD | 0.9309 |
| Lincoln, SD | |
| Minnehaha, SD | |
| 7800 South Bend, IN | 0.9821 |
| St. Joseph, IN | |
| 7840 Spokane, WA | 1.0901 |
| Spokane, WA | |
| 7880 Springfield, IL | 0.8944 |
| Menard, IL | |
| Sangamon, IL | |
| 7920 Springfield, MO | 0.8457 |
| Christian, MO | |
| Greene, MO | |
| Webster, MO | |
| 8003 Springfield, MA | 1.0543 |
| Hampden, MA | |
| Hampshire, MA | |
| 8050 State College, PA | 0.8740 |
| Centre, PA | |
| 8080 Steubenville-Weirton, OH-WV | 0.8398 |
| Jefferson, OH | |
| Brooke, WV | |
| Hancock, WV | |
| 8120 Stockton-Lodi, CA | 1.0404 |
| San Joaquin, CA | |
| 8140 Sumter, SC | 0.8243 |
| Sumter, SC | |
| 8160 Syracuse, NY | 0.9412 |
| Cayuga, NY | |
| Madison, NY | |
| Onondaga, NY | |
| Oswego, NY | |
| 8200 Tacoma, WA | 1.1116 |
| Pierce, WA | |
| 8240 Tallahassee, FL | 0.8520 |
| Gadsden, FL | |
| Leon, FL | |
| 8280 Tampa-St. Petersburg-Clearwater, FL | 0.9103 |
| Hernando, FL | |
| Hillsborough, FL | |
| Pasco, FL | |
| Pinellas, FL | |
| 8320 Terre Haute, IN | 0.8325 |
| Clay, IN | |
| Vermillion, IN | |
| Vigo, IN | |
| 8360 Texarkana, AR-Texarkana, TX | 0.8150 |
| Miller, AR | |
| Bowie, TX | |
| 8400 Toledo, OH | 0.9381 |
| Fulton, OH | |
| Lucas, OH | |
| Wood, OH | |
| 8440 Topeka, KS | 0.9108 |
| Shawnee, KS | |
| 8480 Trenton, NJ | 1.0517 |
| Mercer, NJ | |
| 8520 Tucson, AZ | 0.8981 |
| Pima, AZ | |
| 8560 Tulsa, OK | 0.9185 |
| Creek, OK | |
| Osage, OK | |
| Rogers, OK | |
| Tulsa, OK | |
| Wagoner, OK | |
| 8600 Tuscaloosa, AL | 0.8212 |
| Tuscaloosa, AL | |
| 8640 Tyler, TX | 0.9404 |
| Smith, TX | |
| 8680 Utica-Rome, NY | 0.8403 |
| Herkimer, NY | |
| Oneida, NY | |
| 8720 Vallejo-Fairfield-Napa, CA | 1.3377 |
| Napa, CA | |
| Solano, CA | |
| 8735 Ventura, CA | 1.1064 |
| Ventura, CA | |
| 8750 Victoria, TX | 0.8184 |
| Victoria, TX | |
| 8760 Vineland-Millville-Bridgeton, NJ | 1.0405 |
| Cumberland, NJ | |
| 8780 Visalia-Tulare-Porterville, CA | 0.9794 |
| Tulare, CA | |
| 8800 Waco, TX | 0.8394 |
| McLennan, TX | |
| 8840 Washington, DC-MD-VA-WV | 1.0904 |
| District of Columbia, DC | |
| Calvert, MD | |
| Charles, MD | |
| Frederick, MD | |
| Montgomery, MD | |
| Prince Georges, MD | |
| Alexandria City, VA | |
| Arlington, VA | |
| Clarke, VA | |
| Culpepper, VA | |
| Fairfax, VA | |
| Fairfax City, VA | |
| Falls Church City, VA | |
| Fauquier, VA | |
| Fredericksburg City, VA | |
| King George, VA | |
| Loudoun, VA | |
| Manassas City, VA | |
| Manassas Park City, VA | |
| Prince William, VA | |
| Spotsylvania, VA | |
| Stafford, VA | |
| Warren, VA | |
| Berkeley, WV | |
| Jefferson, WV | |
| 8920 Waterloo-Cedar Falls, IA | 0.8366 |
| Black Hawk, IA | |
| 8940 Wausau, WI | 0.9692 |
| Marathon, WI | |
| 8960 West Palm Beach-Boca Raton, FL | 0.9798 |
| Palm Beach, FL | |
| 9000 Wheeling, OH-WV | 0.7494 |
| Belmont, OH | |
| Marshall, WV | |
| Ohio, WV | |
| 9040 Wichita, KS | 0.9238 |
| Butler, KS | |
| Harvey, KS | |
| Sedgwick, KS | |
| 9080 Wichita Falls, TX | 0.8341 |
| Archer, TX | |
| Wichita, TX | |
| 9140 Williamsport, PA | 0.8158 |
| Lycoming, PA | |
| 9160 Wilmington-Newark, DE-MD | 1.0882 |
| New Castle, DE | |
| Cecil, MD | |
| 9200 Wilmington, NC | 0.9563 |
| New Hanover, NC | |
| Brunswick, NC | |
| 9260 Yakima, WA | 1.0372 |
| Yakima, WA | |
| 9270 Yolo, CA | 0.9204 |
| Yolo, CA | |
| 9280 York, PA | 0.9119 |
| York, PA | |
| 9320 Youngstown-Warren, OH | 0.9214 |
| Columbiana, OH | |
| Mahoning, OH | |
| Trumbull, OH | |
| 9340 Yuba City, CA | 1.0196 |
| Sutter, CA | |
| Yuba, CA | |
| 9360 Yuma, AZ | 0.8895 |
| Yuma, AZ |
8. On Page 46056, Table 8 is revised as follows:
| Rural area | Wage index |
|---|---|
| Alabama | 0.7492 |
| Alaska | 1.1886 |
| Arizona | 0.9270 |
| Arkansas | 0.7734 |
| California | 1.0027 |
| Colorado | 0.9328 |
| Connecticut | 1.2183 |
| Delaware | 0.9557 |
| Florida | 0.8870 |
| Georgia | 0.8595 |
| Guam | 0.9611 |
| Hawaii | 0.9958 |
| Idaho | 0.8974 |
| Illinois | 0.8254 |
| Indiana | 0.8824 |
| Iowa | 0.8416 |
| Kansas | 0.8034 |
| Kentucky | 0.7973 |
| Louisiana | 0.7458 |
| Maine | 0.8812 |
| Maryland | 0.9125 |
| Massachusetts | 1.0432 |
| Michigan | 0.8884 |
| Minnesota | 0.9330 |
| Mississippi | 0.7778 |
| Missouri | 0.7892 |
| Montana | 0.8800 |
| Nebraska | 0.8822 |
| Nevada | 0.9806 |
| New Hampshire | 1.0030 |
| New Jersey1 | |
| New Mexico | 0.8270 |
| New York | 0.8526 |
| North Carolina | 0.8458 |
| North Dakota | 0.7778 |
| Ohio | 0.8820 |
| Oklahoma | 0.7537 |
| Oregon | 0.9994 |
| Pennsylvania | 0.8378 |
| Puerto Rico | 0.4018 |
| Rhode Island1 | |
| South Carolina | 0.8498 |
| South Dakota | 0.8195 |
| Tennessee | 0.7886 |
| Texas | 0.7780 |
| Utah | 0.8974 |
| Vermont | 0.9307 |
| Virginia | 0.8498 |
| Virgin Islands | 0.7195 |
| Washington | 1.0388 |
| West Virginia | 0.8018 |
| Wisconsin | 0.9304 |
| Wyoming | 0.9110 |
| 1 All counties within the State are classified urban. | |
9. On Page 46057, in the second column, in the first line, "$20,379." is revised to read "$20,371."
10. On Page 46057, Table 9 is revised to read as follows:
| RUG group | Labor | Wage index | Adj. labor | Non-labor | Adj. rate | Percent adjustment | Medi-care days | Payment |
|---|---|---|---|---|---|---|---|---|
| RVC | $267.32 | 0.8740 | $233.64 | $82.70 | $316.34 | * $337.53 | 14 | $4,725 |
| RHA | $206.58 | 0.8740 | $180.55 | $63.91 | $244.46 | * $260.84 | 16 | $4,173 |
| SSC | $172.07 | 0.8740 | $150.39 | $53.24 | $203.63 | * * $244.36 | 30 | $7,331 |
| IA2 | $116.68 | 0.8740 | $101.98 | $36.10 | $138.03 | $138.08 | 30 | $4,142 |
| Total | 90 | $20,371 | ||||||
| * Reflects a 6.7 percent adjustment from section 314 of the BIPA. | ||||||||
| * * Reflects a 20 percent adjustment from section 101(a) of the BBRA. | ||||||||
11. On Page 46069, Table 11 is revised to read as follows:
[Federal Register graphic "ER29SE03.060" is not available. Please view the graphic in the PDF version of this document.]
III. Waiver of Proposed Rulemaking and Delayed Effective Date
We ordinarily publish a notice of proposed rulemaking in the Federal Register to provide a period for public comment before the provisions of a notice take effect. We can waive this procedure, however, if we find good cause that notice-and-comment procedure is impracticable, unnecessary, or contrary to the public interest and incorporate a statement of the finding and the reasons for it into the notice issued. We can also waive the 30-day delayed effective date of the Administrative Procedure Act (5 U.S.C. 553(d)) when there is good cause to do so and we publish in the rule an explanation of our good cause.
We find it unnecessary to undertake notice-and-comment rulemaking because this notice merely provides technical corrections to the regulations. We are not changing our payment methodology, but rather, are simply implementing correctly the payment methodology that we previously proposed, received comment on, and subsequently finalized. Thus, because the public has already had the opportunity to comment on the payment methodology being used to calculate wage indexes, additional comment would be unnecessary.
Further, it would be impracticable at this point in time either to solicit additional comments or to delay the effective date of these changes beyond October 1, 2003. The Social Security Act, in subparagraphs (G) and (H) of section 1888(e)(4), requires the updated SNF PPS rates to be in place at the beginning of each Federal fiscal year. Since the fiscal year begins on October 1, 2003, it is imperative that we ensure that the correct rates are in place and effective by October 1, 2003, and it would not have been possible to publish a notice and receive comments on it in the brief period of time between discovering our error and the October 1, 2003 effective date for the updated SNF PPS rates.
Finally, we believe that engaging in notice and comment prior to making these corrections or delaying the effective date beyond October 1, 2003 would be contrary to the public interest. As a matter of good public policy, the rates used in the SNF PPS should not be based on wage indexes that we now know were miscalculated. The public interest is served by ensuring that the rates used in the SNF PPS are correct and that such rates are in effect for the entire fiscal year. Thus, it would be contrary to the public interest to delay implementing such corrected rates in order either to engage in notice-and-comment rulemaking or to provide for a 30-day delay in the effective date. Therefore, we find good cause to waive notice-and-comment procedures, as well as the 30-day delay in effective date.
(Catalog of Federal Domestic Assistance Program No. 93.773, Medicare-Hospital Insurance; and Program No. 93.774, Medicare-Supplementary Medical Insurance Program)
Dated: September 24, 2003.
Ann Agnew,
Executive Secretary to the Department.
[FR Doc. 03-24549 Filed 9-26-03; 8:45 am]
BILLING CODE 4120-01-P