Medicare: Hospice wage index,
[Federal Register: August 4, 1999 (Volume 64, Number 149)]
[Notices]
[Page 42393-42403]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr04au99-89]
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[HCFA-1054-N]
RIN 0938-AJ62
Medicare Program; Hospice Wage Index
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Notice.
SUMMARY: This notice announces the annual update to the hospice wage index as required by statute. This update is effective October 1, 1999. The wage index is used to reflect local differences in wage levels. The hospice wage index methodology and values are based on recommendations of a negotiated rulemaking advisory committee and were originally published in the Federal Register on August 8, 1997. This update is the third year of a 3-year transition period. The third transition year begins October 1, 1999 and ends September 30, 2000.
EFFECTIVE DATE: This notice is effective on October 1, 1999.
FOR FURTHER INFORMATION CONTACT: Carol Blackford, (410) 786-5909
SUPPLEMENTARY INFORMATION:
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Background
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Statute and Regulations
Hospice Care is an approach to treatment that recognizes that the impending death of an individual warrants a change in the focus from curative care to palliative care (relief of pain and other uncomfortable symptoms). The goal of hospice care is to help terminally ill individuals continue life with minimal disruption to normal activities while remaining primarily in the home environment. A hospice uses an interdisciplinary approach to deliver medical, social, psychological, emotional, and spiritual services through use of a broad spectrum of professional and other caregivers, with the goal of making the individual as physically and emotionally comfortable as possible. Counseling and respite services are available to the family of the hospice patient. Hospice programs consider both the patient and the family as a unit of care.
Section 1861(dd) of the Social Security Act (the Act) provides for coverage of hospice care for terminally ill Medicare beneficiaries who elect to receive care from a participating hospice. The statutory authority for payment to hospices participating in the Medicare program is contained in section 1814(i) of the Act.
Our regulations at 42 CFR part 418 (issued on December 16, 1983, effective for hospice services furnished on or after November 1, 1983) established eligibility requirements and payment standards and procedures, defined covered services, and delineated the conditions a hospice must meet to be approved for participation in the Medicare program. Subpart G of part 418 provides for payment to hospices based on one of four prospectively determined rates for each day in which a qualified Medicare beneficiary is under the care of a hospice. The four rate categories are routine home care, continuous home care, inpatient respite care, and general inpatient care. Payment rates are established for each category.
Section 4442 of the Balanced Budget Act of 1997, Public Law 105-C3, amended section 1814 (i)(2) of the Act to require payment for routine and continuous home care to be made based on the geographic location at which the service is furnished. The site of service provision was effective October 1, 1997 and was implemented through a Program Memorandum (transmittal A-97-11) issued in September of 1997.
Section 418.306(c), that requires the rates to be adjusted by a wage index, was revised on August 8, 1997, through publication of a final rule in the Federal Register (62 FR 42860). This rule implemented a new methodology for calculating the hospice wage index that was based on the recommendations of a negotiated rulemaking committee. The committee reached consensus on a methodology and the resulting committee statement, describing that consensus, was included as an attachment to the August 8, 1997 hospice wage index final rule. The provisions of the final hospice wage index rule are as follows:
‹bullet› The revised hospice wage index will be phased in over a 3- year transition period. For the first year of the transition period, a blended index was calculated by adding two-thirds of the 1983 index value for an area to one-third of the revised wage index value for that area. During the second year of the transition period, the calculation was similar, except that the blend was one-third of the 1983 index value and two-thirds of the revised wage index value for that area. During the third transition year, the revised wage index will be fully implemented. The first transition year occurred October 1, 1997 through September 30, 1998. The second transition year occurred October 1, 1998 through September 30, 1999.
‹bullet› All hospice wage index values of 0.8 or greater are subject to a budget neutrality adjustment to ensure that Medicare does not pay any more in the aggregate than it would have paid with the previous wage index. The budget neutrality adjustment is calculated by multiplying the hospice wage index for a given area by the budget neutrality adjustment factor. The budget neutrality adjustment is to be applied annually, both during and after the transition period.
‹bullet› All hospice wage index values below 0.8 receive the greater of the following adjustments--the wage index floor, a 15 percent increase, subject to a maximum wage index value of 0.8; or, the budget neutrality adjustment.
‹bullet› The wage index is to be updated annually, in the Federal Register, based on the most current available hospital wage data.
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Update to the Hospice Wage Index
The third year of the 3-year transition period begins October 1, 1999 and ends September 30, 2000. In accordance with the agreement signed by members of the Hospice Wage Index Negotiated Rulemaking Committee, we are using 1998 hospital area wage index data, including any changes to the definitions of Metropolitan Statistical Areas
[[Page 42394]]
(MSAs), that allow us to publish this notice at least 4 months in advance of the October 1, 1999 effective date.
Additionally, the wage index value for hospices in counties that are no longer in the same MSA as they were in 1983 will no longer be blended with the wage index for the original MSA designation. These hospices will receive the full wage index for their current MSA designation. All wage index values are adjusted by a budget neutrality factor of 1.065982 and are subject to the wage index floor adjustment, if applicable. All of the calculations described above have been completed by us and are built into the wage index values reflected in both Tables A and B below. A detailed description of the method used to compute the hospice wage index is contained in both the September 4, 1996 (61 FR 46579) hospice wage index proposed rule and the August 8, 1997 (62 FR 42860) hospice wage index final rule.
Because the hospice wage index is calculated using the pre- reclassified hospital wage index, it is important to note that the method for calculating the Puerto Rico hospital wage index was changed with the publication of the Hospital Inpatient Prospective Payment System (PPS) and Fiscal Year 1998 Rates final rule in August 29, 1997 (62 FR 45984 and 45986). The Puerto Rico hospital wage index is calculated in the same manner as the national wage index, but is based solely on Puerto Rico's wage data. As explained in the PPS final rule, the total adjusted salaries are added to fringe benefits for all hospitals in Puerto Rico and then divided by the sum by the total hours for Puerto Rico to arrive at an overall average hourly wage. For each labor market area in Puerto Rico, the hospital wage index is calculated by dividing the area average hourly wage by the overall Puerto Rico average hourly wage.
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Tables
Table A--Hospice Wage Index for Urban Areas
Urban area (constituent MSA code No.
counties or county
Wage index \2\ equivalents) \1\
0040.................... Abilene, TX...................
0.8508 Taylor, TX 0060.................... Aguadilla, PR.................
0.5436 Aguada, PR Aguadilla, PR Moca, PR 0080.................... Akron, OH.....................
1.0553 Portage, OH Summit, OH 0120.................... Albany, GA....................
0.8501 Dougherty, GA Lee, GA 0160.................... Albany-Schenectady-Troy, NY
0.9178 Albany, NY Montgomery, NY Rensselaer, NY Saratoga, NY Schenectady, NY Schoharie, NY 0200.................... Albuquerque, NM...............
0.9181 Bernalillo, NM Sandoval, NM Valencia, NM 0220.................... Alexandria, LA................
0.9089 Rapides, LA 0240.................... Allentown-Bethlehem-Easton, PA
1.0877 Carbon, PA Lehigh, PA Northampton, PA 0280.................... Altoona, PA...................
0.9951 Blair, PA 0320.................... Amarillo, TX..................
0.9033 Potter, TX Randall, TX 0380.................... Anchorage, AK.................
1.3664 Anchorage, AK 0440.................... Ann Arbor, MI.................
1.1761 Lenawee, MI Livingston, MI Washtenaw, MI 0450.................... Anniston, AL..................
0.9229 Calhoun, AL 0460.................... Appleton-Oshkosh-Neenah, WI
0.9407 Calumet, WI Outagamie, WI Winnebago, WI 0470.................... Arecibo, PR...................
0.5597 Arecibo, PR Camuy, PR Hatillo, PR 0480.................... Asheville, NC.................
0.9530 Buncombe, NC Madison, NC 0500.................... Athens, GA....................
0.9245 Clarke, GA Madison, GA Oconee, GA 0520.................. Atlanta, GA...................
1.0569 Barrow, GA 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
1.2297 Atlantic, NJ Cape May, NJ 0600.................... Augusta-Aiken, GA-SC .........
0.9842 Columbia, GA McDuffie, GA Richmond, GA Aiken, SC Edgefield, SC 0640.................... Austin-San Marcos, TX
0.9361 Bastrop, TX Caldwell, TX Hays, TX Travis, TX Williamson, TX 0680.................... Bakersfield, CA ..............
1.0160 Kern, CA 0720.................... Baltimore, MD ................
1.0278 Anne Arundel, MD Baltimore, MD Baltimore City, MD Carroll, MD Harford, MD Howard, MD Queen Anne's, MD 0733.................... Bangor, ME ...................
1.0099 Penobscot, ME 0743.................... Barnstable-Yarmouth, MA
1.6397 Barnstable, MA 0760.................... Baton Rouge, LA...............
0.9457 Ascension, LA East Baton Rouge, LA Livingston, LA West Baton Rouge, LA 0840.................... Beaumont-Port Arthur, TX
0.9230 Hardin, TX Jefferson, TX Orange, TX 0860.................... Bellingham, WA................
1.2188 Whatcom, WA 0870.................... Benton Harbor, MI.............
0.9094 Berrien, MI 0875.................... Bergen-Passaic, NJ............
1.2990 Bergen, NJ Passaic, NJ 0880.................... Billings, MT..................
0.9746 Yellowstone, MT 0920.................... Biloxi-Gulfport-Pascagoula, MS
0.8822 Hancock, MS Harrison, MS Jackson, MS 0960.................... Binghamton, NY................
0.9657 Broome, NY Tioga, NY 1000.................... Birmingham, AL................
0.9672 Blount, AL
[[Page 42395]]
Jefferson, AL St. Clair, AL Shelby, AL 1010.................... Bismarck, ND..................
0.8555 Burleigh, ND Morton, ND 1020.................... Bloomington, IN
0.9557 Monroe, IN 1040.................... Bloomington-Normal, IL
0.9435 McLean, IL 1080.................... Boise City, ID................
0.9764 Ada, ID Canyon, ID 1123.................... Boston-Worcester-Lawrence-
1.2013 Lowell-Brockton, MA-NH 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
1.0700 Boulder, CO 1145.................... Brazoria, TX..................
0.9494 Brazoria, TX 1150.................... Bremerton, WA.................
1.1784 Kitsap, WA 1240.................... Brownsville-Harlingen-San
0.8780 Benito, TX Cameron, TX 1260.................... Bryan-College Station, TX
0.8336 Brazos, TX 1280.................... Buffalo-Niagara Falls, NY
1.0220 Erie, NY Niagara, NY 1303.................... Burlington, VT................
1.0209 Chittenden, VT Franklin, VT Grand Isle, VT 1310.................... Caguas, PR....................
0.5060 Caguas, PR Cayey, PR Cidra, PR Gurabo, PR San Lorenzo, PR 1320.................... Canton-Massillon, OH
0.9394 Carroll, OH Stark, OH 1350.................... Casper, WY....................
0.9275 Natrona, WY 1360.................... Cedar Rapids, IA..............
0.9396 Linn, IA 1400.................... Champaign-Urbana, IL
0.9299 Champaign, IL 1440.................... Charleston-North Charleston,
0.9715 SC Berkeley, SC Charleston, SC Dorchester, SC 1480.................... Charleston, WV................
0.9583 Kanawha, WV Putnam, WV 1520.................... Charlotte-Gastonia-Rock Hill,
1.0325 NC-SC Cabarrus, NC Gaston, NC Lincoln, NC Mecklenburg, NC Rowan, NC Stanly, NC Union, NC York, SC 1540.................... Charlottesville, VA...........
1.0950 Albemarle, VA Charlottesville City, VA Fluvanna, VA Greene, VA 1560.................... Chattanooga, TN-GA
0.9673 Catoosa, GA Dade, GA Walker, GA Hamilton, TN Marion, TN 1580.................... Cheyenne, WY..................
0.8687 Laramie, WY 1600.................... Chicago, IL...................
1.1151 Cook, IL DeKalb, IL Du Page, IL Grundy, IL Kane, IL Kendall, IL Lake, IL McHenry, IL Will, IL 1620.................... Chico-Paradise, CA
1.0814 Butte, CA 1640.................... Cincinnati, OH-KY-IN
1.0228 Brown, OH Clermont, OH Hamilton, OH Warren, OH Boone, KY Campbell, KY Gallatin, KY Grant, KY Kenton, KY Pendleton, KY Dearborn, IN Ohio, IN 1660.................... Clarksville-Hopkinsville, TN-
0.8570 KY Christian, KY Montgomery, TN 1680.................... Cleveland-Lorain-Elyria, OH
1.0538 Ashtabula, OH Cuyahoga, OH Geauga, OH Lake, OH Lorain, OH Medina, OH 1720.................... Colorado Springs, CO
1.0010 El Paso, CO 1740.................... Columbia, MO..................
0.9532 Boone, MO 1760.................... Columbia, SC..................
0.9903 Lexington, SC Richland, SC 1800.................... Columbus, GA-AL...............
0.9073 Chattahochee, GA Harris, GA Muscogee, GA Russell, AL 1840.................... Columbus, OH..................
1.0426 Delaware, OH Fairfield, OH Franklin, OH Licking, OH Madison, OH Pickaway, OH 1880.................... Corpus Christi, TX............
0.9075 Nueces, TX San Patricio, TX 1900.................... Cumberland, MD-WV
0.8786 Allegany, MD Mineral, WV 1920.................... Dallas, TX....................
0.9987 Collin, TX Dallas, TX Denton, TX Ellis, TX Henderson, TX Hunt, TX Kaufman, TX Rockwall, TX 1950.................... Danville, VA..................
0.9641 Danville City, VA Pittsylvania, VA 1960.................... Davenport-Moline-Rock Island,
0.8968 IA-IL Scott, IA Henry, IL Rock Island, IL 2000.................... Dayton-Springfield, OH
1.0239 Clark, OH Greene, OH Miami, OH Montgomery, OH 2020.................... Daytona Beach, FL
0.9737 Flagler, FL Volusia, FL 2030.................... Decatur, AL...................
0.8776 Lawrence, AL Morgan, AL 2040.................... Decatur, IL...................
0.8565 Macon, IL 2080.................... Denver, CO....................
1.1013 Adams, CO Arapahoe, CO
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Denver, CO Douglas, CO Jefferson, CO 2120.................... Des Moines, IA................
0.9005 Dallas, IA Polk, IA Warren, IA 2160.................... Detroit, MI...................
1.1240 Lapeer, MI Macomb, MI Monroe, MI Oakland, MI St. Clair, MI Wayne, MI 2180.................... Dothan, AL....................
0.8413 Dale, AL Houston, AL 2190.................... Dover, DE.....................
0.9981 Kent, DE 2200.................... Dubuque, IA...................
0.8765 Dubuque, IA 2240.................... Duluth-Superior, MN-WI
1.0619 St. Louis, MN Douglas, WI 2281.................... Dutchess County, NY
1.1225 Dutchess, NY 2290.................... Eau Claire, WI................
0.9139 Chippewa, WI Eau Claire, WI 2320.................... El Paso, TX...................
0.9823 El Paso, TX 2330.................... Elkhart-Goshen, IN............
0.9919 Elkhart, IN 2335.................... Elmira, NY....................
0.8997 Chemung, NY 2340.................... Enid, OK......................
0.8510 Garfield, OK 2360.................... Erie, PA......................
0.9883 Erie, PA 2400.................... Eugene-Springfield, OR
1.1932 Lane, OR 2440.................... Evansville-Henderson, IN-KY
0.9091 Posey, IN Vanderburgh, IN Warrick, IN Henderson, KY 2520.................... Fargo-Moorhead, ND-MN
1.0148 Clay, MN Cass, ND 2560.................... Fayetteville, NC
0.8943 Cumberland, NC 2580.................... Fayetteville-Springdale-
0.9182 Rogers, AR. Benton, AR Washington, AR 2620.................... Flagstaff, AZ-UT..............
1.0109 Coconino, AZ Kane, UT 2640.................... Flint, MI.....................
1.1759 Genesee, MI 2650.................... Florence, AL..................
0.8182 Colbert, AL Lauderdale, AL 2655.................... Florence, SC..................
0.9062 Florence, SC 2670.................... Fort Collins-Loveland, CO
1.1481 Larimer, CO 2680.................... Ft. Lauderdale, FL............
1.0454 Broward, FL 2700.................... Fort Myers-Cape Coral, FL
0.9532 Lee, FL 2710.................... Fort Pierce-Port St. Lucie, FL
1.0917 Martin, FL St. Lucie, FL 2720.................... Fort Smith, AR-OK
0.8126 Crawford, AR Sebastian, AR Sequoyah, OK 2750.................... Fort Walton Beach, FL
0.9183 Okaloosa, FL 2760.................... Fort Wayne, IN................
0.9644 Adams, IN Allen, IN De Kalb, IN Huntington, IN Wells, IN Whitley, IN 2800.................... Fort Worth-Arlington, TX
1.0360 Hood, TX Johnson, TX Parker, TX Tarrant, TX 2840.................... Fresno, CA....................
1.1406 Fresno, CA Madera, CA 2880.................... Gadsden, AL...................
0.9358 Etowah, AL 2900.................... Gainesville, FL...............
1.0077 Alachua, FL 2920.................... Galveston-Texas City, TX
1.1613 Galveston, TX 2960.................... Gary, IN......................
1.0058 Lake, IN Porter, IN 2975.................... Glens Falls, NY...............
0.9050 Warren, NY Washington, NY 2980.................... Goldsboro, NC.................
0.9093 Wayne, NC 2985.................... Grand Forks, ND-MN
0.9419 Grand Forks, ND Polk, MN 2995.................... Grand Junction, CO
0.8825 Mesa, CO 3000.................... Grand Rapids-Muskegon-Holland,
1.0629 MI Allegan, MI Kent, MI Muskegon, MI Ottawa, MI 3040.................... Great Falls, MT...............
0.9457 Cascade, MT 3060.................... Greeley, CO...................
1.0081 Weld, CO 3080.................... Green Bay, WI.................
0.9760 Brown, WI 3120.................... Greensboro-Winston-Salem-High
1.0177 Point, NC Alamance, NC Davidson, NC Davie, NC Forsyth, NC Guilford, NC Randolph, NC Stokes, NC Yadkin, NC 3150.................... Greenville, NC................
1.0056 Pitt, NC 3160.................... Greenville-Spartanburg-
0.9830 Anderson, SC Anderson, SC Cherokee, SC Greenville, SC Pickens, SC Spartanburg, SC 3180.................... Hagerstown, MD................
1.0855 Washington, MD 3200.................... Hamilton-Middletown, OH
0.9842 Butler, OH 3240.................... Harrisburg-Lebanon-Carlisle,
1.0724 PA Cumberland, PA Dauphin, PA Lebanon, PA Perry, PA 3283.................... Hartford, CT..................
1.2612 Hartford, CT Litchfield, CT Middlesex, CT Tolland, CT 3285.................... Hattiesburg, MS...............
0.8000 Forrest, MS Lamar, MS 3290.................... Hickory-Morganton-Lenoir, NC
0.9492 Alexander, NC Burke, NC Caldwell, NC Catawba, NC 3320.................... Honolulu, HI..................
1.2269 Honolulu, HI 3350.................... Houma, LA.....................
0.8738 Lafourche, LA Terrebonne, LA 3360.................... Houston, TX...................
1.0541 Chambers, TX Fort Bend, TX Harris, TX Liberty, TX Montgomery, TX Waller, TX
[[Page 42397]]
3400.................... Huntington-Ashland, WV-KY-OH
1.0284 Boyd, KY Carter, KY Greenup, KY Lawrence, OH Cabell, WV Wayne, WV 3440.................... Huntsville, AL................
0.8938 Limestone, AL Madison, AL 3480.................... Indianapolis, IN..............
1.0480 Boone, IN Hamilton, IN Hancock, IN Hendricks, IN Johnson, IN Madison, IN Marion, IN Morgan, IN Shelby, IN 3500.................... Iowa City, IA.................
1.0107 Johnson, IA 3520.................... Jackson, MI...................
0.9833 Jackson, MI 3560.................... Jackson, MS...................
0.8839 Hinds, MS Madison, MS Rankin, MS 3580.................... Jackson, TN...................
0.9125 Madison, TN Chester, TN 3600.................... Jacksonville, FL..............
0.9487 Clay, FL Duval, FL Nassau, FL St. Johns, FL 3605.................... Jacksonville, NC..............
0.8055 Onslow, NC 3610.................... Jamestown, NY.................
0.8165 Chautauqua, NY 3620.................... Janesville-Beloit, WI
0.9648 Rock, WI 3640.................... Jersey City, NJ...............
1.2363 Hudson, NJ 3660.................... Johnson City-Kingsport-
0.9352 Bristol, TN-VA Carter, TN Hawkins, TN Sullivan, TN Unicoi, TN Washington, TN Bristol City, VA Scott, VA Washington, VA 3680.................... Johnstown, PA.................
0.9188 Cambria, PA Somerset, PA 3700.................... Jonesboro, AR.................
0.8000 Craighead, AR 3710.................... Joplin, MO....................
0.8392 Jasper, MO Newton, MO 3720.................... Kalamazoo-Battlecreek, MI
1.2079 Calhoun, MI Kalamazoo, MI Van Buren, MI 3740.................... Kankakee, IL..................
1.0039 Kankakee, IL 3760.................... Kansas City, KS-MO
1.0281 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...................
0.9731 Kenosha, WI 3810.................... Killeen-Temple, TX............
1.0776 Bell, TX Coryell, TX 3840.................... Knoxville, TN.................
0.9506 Anderson, TN Blount, TN Knox, TN Loudon, TN Sevier, TN Union, TN 3850.................... Kokomo, IN....................
0.9887 Howard, IN Tipton, IN 3870.................... La Crosse, WI-MN..............
0.9501 Houston, MN La Crosse, WI 3880.................... Lafayette, LA.................
0.8800 Acadia, LA Lafayette, LA St. Landry, LA St. Martin, LA 3920.................... Lafayette, IN.................
0.9424 Clinton, IN Tippecanoe, IN 3960.................... Lake Charles, LA..............
0.818 Calcasieu, LA 3980.................... Lakeland-Winter Haven, FL
0.9529 Polk, FL 4000.................... Lancaster, PA.................
1.0192 Lancaster, PA 40...................... Lansing-East Lansing, MI
1.0756 Clinton, MI Eaton, MI Ingham, MI 4080.................... Laredo, TX....................
0.8000 Webb, TX 4100.................... Las Cruces, NM................
0.9455 Dona Ana, NM 4120.................... Las Vegas, NV-AZ
1.2166 Mohave, AZ Clarke, NV Nye, NV 4150.................... Lawrence, KS..................
0.9226 Douglas, KS 4200.................... Lawton, OK....................
0.271 Comanche, OK 4243.................... Lewiston-Auburn, ME
0.9753 Androscoggin, ME 4280.................... Lexington, KY.................
0.9067 Bourbon, KY Clark, KY Fayette, KY Jessamine, KY Madison, KY Scott, KY Woodford, KY 4320.................... Lima, OH......................
0.9539 Allen, OH Auglaize, OH 4360.................... Lincoln, NE...................
0.9917 Lancaster, NE 4400.................... Little Rock-North Little Rock,
0.9064 AR Faulkner, AR Lonoke, AR Pulaski, AR Saline, AR 4420.................... Longview-Marshall, TX
0.9272 Gregg, TX Harrison, TX Upshur, TX 4480.................... Los Angeles-Long Beach, CA
1.2882 Los Angeles, CA 4520.................... Louisville, KY-IN.............
0.9693 Clark, IN Floyd, IN Harrison, IN Scott, IN Bullitt, KY Jefferson, KY Oldham, KY 4600.................... Lubbock, TX...................
0.9057 Lubbock, TX 4640.................... Lynchburg, VA.................
0.9487 Amherst, VA Bedford, VA Bedford City, VA Campbell, VA Lynchburg City, VA 4680.................... Macon, GA.....................
0.9573 Bibb, GA Houston, GA Jones, GA Peach, GA Twiggs, GA 4720.................... Madison, WI...................
1.0679 Dane, WI 4800.................... Mansfield, OH.................
0.9097 Crawford, OH Richland, OH 4840.................... Mayaguez, PR..................
0.5061 Anasco, PR Cabo Rojo, PR
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Hormigueros, PR Mayaguez, PR Sabana Grande, PR San German, PR 4880.................... McAllen-Edinburg-Mission, TX
0.9480 Hidalgo, TX 4890.................... Medford-Ashland, OR
1.0681 Jackson, OR 4900.................... Melbourne-Titusville-Palm Bay,
0.9824 FL Brevard, Fl 4920.................... Memphis, TN-AR-MS
0.8913 Crittenden, AR DeSoto, MS Fayette, TN Shelby, TN Tipton, TN 4940.................... Merced, CA....................
1.0695 Merced, CA 5000.................... Miami, FL.....................
1.0678 Dade, FL 5015.................... Middlesex-Somerset-Hunterdon,
1.1888 NJ Hunterdon, NJ Middlesex, NJ Somerset, NJ 5080.................... Milwaukee-Waukesha, WI
0.9973 Milwaukee, WI Ozaukee, WI Washington, WI Waukesha, WI 5120.................... Minneapolis-St. Paul, MN-WI
1.1570 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..................
0.9795 Missoula, MT 5160.................... Mobile, AL....................
0.8930 Baldwin, AL Mobile, AL 5170.................... Modesto, CA...................
1.1029 Stanislaus, CA 5190.................... Monmouth-Ocean, NJ
1.2064 Monmouth, NJ Ocean, NJ 5200.................... Monroe, LA....................
0.8761 Ouachita, LA 5240.................... Montgomery, AL................
0.8337 Autauga, AL Elmore, AL Montgomery, AL 5280.................... Muncie, IN....................
1.0035 Delaware, IN 5330.................... Myrtle Beach, SC..............
0.8719 Horry, SC 5345.................... Naples, FL....................
1.0848 Collier, FL 5360.................... Nashville, TN.................
1.0106 Cheatham, TN Davidson, TN Dickson, TN Robertson, TN Rutherford TN Sumner, TN Williamson, TN Wilson, TN 5380.................... Nassau-Suffolk, NY
1.4490 Nassau, NY Suffolk, NY 5483.................... New Haven-Bridgeport-Stamford-
1.3141 Waterbury-Danbury, CT Fairfield, CT New Haven, CT 5523.................... New London-Norwich, CT
1.2382 New London, CT 5560.................... New Orleans, LA...............
0.9924 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..................
1.5415 Bronx, NY Kings, NY New York, NY Putnam, NY Queens, NY Richmond, NY Rockland, NY Westchester, NY 5640.................... Newark, NJ....................
1.2649 Essex, NJ Morris, NJ Sussex, NJ Union, NJ Warren, NJ 5660.................... Newburgh, NY-PA...............
1.1891 Orange, NY Pike, PA 5720.................... Norfolk-Virginia Beach-Newport
0.8821 News, VA-NC. Currituck, NC Chesapeake City, VA Gloucester, VA Hampton City, VA James City, VA Isle of Wight, 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...................
1.5982 Alameda, CA Contra Costa, CA 5790.................... Ocala, FL.....................
0.9756 Marion, FL 5800.................... Odessa-Midland, TX
0.9227 Ector, TX Midland, TX 5880.................... Oklahoma City, OK
0.9283 Canadian, OK Cleveland, OK Logan, OK McClain, OK Oklahoma, OK Pottawatomie, OK 5910.................... Olympia, WA...................
1.2282 Thurston, WA
.............. 5920.................... Omaha, NE-IA..................
1.0630 Pottawattamie, IA Cass, NE Douglas, NE Sarpy, NE Washington, NE 5945.. Orange County, CA
1.2282 Orange, CA 5960.................... Orlando, FL...................
1.0460 Lake, FL Orange, FL Osceola, FL Seminole, FL 5990.................... Owensboro, KY.................
0.8284 Daviess, KY 6015.................... Panama City, FL...............
0.9068 Bay, FL 6020.................... Parkersburg-Marietta, WV-OH...
0.8545 Washington, OH Wood, WV 6080.................... Pensacola, FL.................
0.8790 Escambia, FL Santa Rosa, FL 6120.................... Peoria-Pekin, IL..............
0.8590 Peoria, IL Tazewell, IL Woodford, IL 6160.................... Philadelphia, PA-NJ
1.2120 Burlington, NJ Camden, NJ Gloucester, NJ Salem, NJ
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Bucks, PA Chester, PA Delaware, PA Montgomery, PA Philadelphia, PA 6200.................... Phoenix-Mesa, AZ..............
1.0224 Maricopa, AZ Pinal, AZ 6240.................... Pine Bluff, AR................
0.8434 Jefferson, AR 6280.................... Pittsburgh, PA................
1.0435 Allegheny, PA Beaver, PA Butler, PA Fayette, PA Washington, PA Westmoreland, PA 6323.................... Pittsfield, MA................
1.1533 Berkshire, MA 6340.................... Pocatello, ID.................
0.9372 Bannock, ID 6360.................... Ponce, PR.....................
0.5506 Guayanilla, PR Juana Diaz, PR Penuelas, PR Ponce, PR Villalba, PR Yauco, PR 6403.................... Portland, ME..................
1.0192 Cumberland, ME Sagadahoc, ME York, ME 6440.................... Portland-Vancouver, OR-WA
1.1916 Clackamas, OR Columbia, OR Multnomah, OR Washington, OR Yamhill, OR Clark, WA 6483.................... Providence-Warwick-Pawtucket,
1.1514 RI Bristol, RI Kent, RI Newport, RI Providence, RI Washington, RI 6520.................... Provo-Orem, UT................
1.0537 Utah, UT 6560.................... Pueblo, CO....................
0.9287 Pueblo, CO 6580.................... Punta Gorda, FL...............
0.9627 Charlotte, FL 6600.................... Racine, WI....................
0.9732 Racine, WI 6640.................... Raleigh-Durham-Chapel Hill, NC
1.0459 Chatham, NC Durham, NC Franklin, NC Johnston, NC Orange, NC Wake, NC 6660.................... Rapid City, SD................
0.8750 Pennington, SD 6680.................... Reading, PA...................
0.9843 Berks, PA 6690.................... Redding, CA...................
1.2640 Shasta, CA 6720.................... Reno, NV......................
1.1827 Washoe, NV 6740.................... Richland-Kennewick-Pasco, WA
1.0966 Benton, WA Franklin, WA 6760.................... Richmond-Petersburg, VA
0.9819 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.................... Rivee-San Bernardino, CA
1.1467 San Bernardino, CA 6800.................... Roanoke, VA...................
0.9070 Botetourt, VA Roanoke, VA Roanoke City, VA Salem City, VA 6820.................... Rochester, MN.................
1.2470 Olmsted, MN 6840.................... Rochester, NY.................
1.0294 Genesee, NY Livingston, NY Ontario, NY Ontario, NY Orleans, NY Wayne NY 6880.................... Rockford, IL..................
0.9183 Boone, IL Ogle, IL Winnebago, IL 6895.................... Rocky Mount, NC...............
0.9607 Edgecombe, NC Nash, NC 6920.................... Sacramento, CA................
1.2751 El Dorado, CA Placer, CA Sacramento, CA 6960.................... Saginaw-Bay City-Midland, MI
1.0113 Bay, MI Midland, MI Saginaw, MI 6980.................... St. Cloud, MN.................
1.0219 Benton, MN Stearns, MN 7000.................... St. Joseph, MO................
1.0541 Andrew, MO Buchanan, MO 7040.................... St. Louis, MO-IL..............
0.9755 Franklin, MO Jefferson, MO Lincoln, MO St. Charles, MO St. Louis, MO St. Louis City, MO Warren, MO Clinton, IL Jersey, IL Madison, IL Monore, IL St. Clair, IL 7080.................... Salem, OR.....................
1.0557 Marion, OR Polk, OR 7120.................... Salinas, CA...................
1.6141 Monterey, CA 7160.................... Salt Lake City-Ogden, UT
1.0018 Davis, UT Salt Lake, UT Weber, UT 7200.................... San Angelo, TX................
0.8150 Tom Green, TX 7240.................... San Antonio, TX...............
0.8634 Bexar, TX Comal, TX Guadalupe, TX Wilson, TX 7320.................... San Diego, CA.................
1.3074 San Diego, CA 7360.................... San Francisco, CA.............
1.4878 Marin, CA San Francisco, CA San Mateo, CA 7400.................... San Jose, CA..................
1.4739 Santa Clara, CA 7440.................... San Juan-Bayamon, PR
0.5316 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
[[Page 42400]]
Yabucoa, PR 7460.................... San Luis Obispo-Atascadero-
1.2007 Paso Robles, CA San Luis Obispo, CA 7480.................... Santa Barbara-Santa Maria-
1.1933 Lompoc, CA Santa Barbara, CA 7485.................... Santa Cruz-Watsonville, CA
1.4903 Santa Cruz, CA 7490.................... Santa Fe, NM..................
1.0289 Los Alamos, NM Santa Fe, NM 7500.................... Santa Rosa, CA................
1.4494 Sonoma, CA 7510.................... Sarasota-Bradenton, FL
1.0161 Manatee, FL Sarasota, FL 7520.................... Savannah, GA..................
1.0724 Bryan, GA Chatham, GA Effingham, GA 7560.................... Scranton--Wilkes-Barre--
0.8847 Hazleton, PA Columbia, PA Lackawanna, PA Luzerne, PA Wyoming, PA 7600.................... Seattle-Bellevue-Everett, WA
1.2287 Island, WA King, WA Snohomish, WA 7610.................... Sharon, PA....................
0.9431 Mercer, PA 7620.................... Sheboygan, WI.................
0.8768 Sheboygan, WI 7640.................... Sherman-Denison, TX
0.9135 Grayson, TX 7680.................... Shreveport-Bossier City, LA
1.0005 Bossier, LA Caddo, LA Webster, LA 7720.................... Sioux City, IA-NE.............
0.9041 Woodbury, IA Dakota, NE 7760.................... Sioux Falls, SD...............
0.9500 Lincoln, SD Minnehaha, SD 7800.................... South Bend, IN................
1.0510 St. Joseph, IN 7840.................... Spokane, WA...................
1.1649 Spokane, WA 7880.................... Springfield, IL...............
0.9295 Menard, IL Sangamon, IL 7920.................... Springfield, MO...............
0.8604 Christian, MO Greene, MO Webster, MO 8003.................... Springfield, MA...............
1.1715 Hampden, MA Hampshire, MA 8050.................... State College, PA.............
1.0072 Centre, PA 8080.................... Steubenville-Weirton, OH-WV
0.8984 Jefferson, OH Brooke, WV Hancock, WV 8120.................... Stockton-Lodi, CA.............
1.1806 San Joaquin, CA 8140.................... Sumter, SC....................
0.8663 Sumter, SC 8160.................... Syracuse, NY..................
1.0020 Cayuga, NY Madison, NY Onondaga, NY Oswego, NY 8200.................... Tacoma, WA....................
1.1065 Pierce, WA 8240.................... Tallahassee, FL...............
0.9006 Gadsden, FL Leon, FL 8280.................... Tampa-St. Petersburg-
0.9714 Clearwater, FL. Hernando, FL Hillsborough, FL Pasco, FL Pinellas, FL 8320.................... Terre Haute, IN...............
0.9584 Clay, IN Vermillion, IN Vigo, IN 8360.................... Texarkana, AR-Texarkana, TX
0.9067 Miller, AR Bowie, TX 8400.................... Toledo, OH....................
1.0650 Fulton, OH Lucas, OH Wood, OH 8440.................... Topeka, KS....................
1.0459 Shawnee, KS 8480.................... Trenton, NJ...................
1.1202 Mercer, NJ 8520.................... Tucson, AZ....................
0.9624 Pima, AZ 8560.................... Tulsa, OK.....................
0.9021 Creek, OK Osage, OK Rogers, OK Tulsa, OK Wagoner, OK 8600.................... Tuscaloosa, AL................
0.8145 Tuscaloosa, AL 8640.................... Tyler, TX.....................
0.9400 Smith, TX 8680.................... Utica-Rome, NY................
0.8973 Herkimer, NY Oneida, NY 8720.................... Vallejo-Fairfield-Napa, CA
1.4298 Napa, CA Solano, CA 8735.................... Ventura, CA...................
1.1741 Ventura, CA 8750.................... Victoria, TX..................
0.8934 Victoria, TX 8760.................... Vineland-Millville-Bridgeton,
1.1129 NJ Cumberland, NJ 8780.................... Visalia-Tulare-Porterville, CA
1.0748 Tulare, CA 8800.................... Waco, TX......................
0.8923 McLennan, TX 8840.................... Washington, DC-MD-VA-WV
1.1520 District of Columbia, DC Calvert, MD Charles, MD Frederick, MD Montgomery, MD Prince Georges, MD Alexandria City, VA Arlington, VA Clarke, VA Culpeper, VA Fairfax, VA Fairfax City, VA Falls Church City, VA Fauquier, VA Fredericksburg City, VA King George, VA Loudoun, VA Manassas City, VA Manassas Park City, VA Prince William, VA Spotsylvania, VA Stafford, VA Warren, VA Berkeley, WV Jefferson, WV 8920.................... Waterloo-Cedar Falls, IA
0.8483 Black Hawk, IA 8940.................... Wausau, WI....................
1.0375 Marathon, WI 8960.................... West Palm Beach-Boca Raton, FL
1.0893 Palm Beach, FL 9000.................... Wheeling, WV-OH...............
0.8130 Belmont, OH Marshall, WV Ohio, WV 9040.................... Wichita, KS...................
0.9485 Butler, KS Harvey, KS Sedgwick, KS 9080.................... Wichita Falls, TX.............
0.8347 Archer, TX Wichita, TX 9140.................... Williamsport, PA..............
0.9121 Lycoming, PA 9160.................... Wilmington-Newark, DE-MD
1.2651 New Castle, DE
[[Page 42401]]
Cecil, MD 9200.................... Wilmington, NC................
0.9959 Brunswick, NC New Hanover, NC 9260.................... Yakima, WA....................
1.0999 Yakima, WA 9270.................... Yolo, CA......................
1.1974 Yolo, CA 9280.................... York, PA......................
1.0031 York, PA 9320.................... Youngstown-Warren, OH
1.0463 Columbiana, OH Mahoning, OH Trumbull, OH 9340.................... Yuba City, CA.................
1.1582 Sutter, CA Yuba, CA 9360.................... Yuma, AZ......................
1.0722 Yuma, AZ
\1\ This column lists each MSA area name (in italics) and each county , or county equivalent, in the MSA area. Counties not listed in this Table are considered to be Rural Areas. Wage Index values for these areas are found in Table B. \2\ Wage index values are based on FY 1998 hospital cost report data prior to reclassification. This wage index is further adjusted. Wage index values greater than 0.8 are subject to a budget neutrality adjustment of 1.065982. Wage index values below 0.8 are adjusted to be the greater of a 15 percent increase, subject to a maximum wage index value of 0.8, or an adjustment by multiplying the hospital wage index value for a given area by the budget neutrality adjustment. All of these adjustments have been completed by HCFA and are built into the wage index values reflected in this table.
Table B.--WAGE INDEX FOR RURAL AREAS
Wage MSA code No.
Nonurban area
Index
\3\-- 9901........................ Alabama......................... 0.8000 9902........................ Alaska.......................... 1.3250 9903........................ Arizona......................... 0.8516 9904........................ Arkansas........................ 0.8000 9905........................ California...................... 1.0637 9906........................ Colorado........................ 0.8993 9907........................ Connecticut..................... 1.2871 9908........................ Delaware........................ 0.9388 9910........................ Florida......................... 0.9463 9911........................ Georgia......................... 0.8408 9912........................ Hawaii.......................... 1.1630 9913........................ Idaho........................... 0.9036 9914........................ Illinois........................ 0.8438 9915........................ Indiana......................... 0.8933 9916........................ Iowa............................ 0.8290 9917........................ Kansas.......................... 0.8000 9918........................ Kentucky........................ 0.8362 9919........................ Louisiana....................... 0.8000 9920........................ Maine........................... 0.9026 9921........................ Maryland........................ 0.9119 9922........................ Massachusetts................... 1.1549 9923........................ Michigan........................ 0.9461 9924........................ Minnesota....................... 0.9162 9925........................ Mississippi..................... 0.8000 9926........................ Missouri........................ 0.8000 9927........................ Montana......................... 0.8952 9928........................ Nebraska........................ 0.8180 9929........................ Nevada.......................... 0.9867 9930........................ New Hampshire................... 1.0916 9931........................ New Jersey \4\.................. ........ 9932........................ New Mexico...................... 0.8815 9933........................ New York........................ 0.9155 9934........................ North Carolina.................. 0.8647 9935........................ North Dakota.................... 0.8000 9936........................ Ohio............................ 0.9081 9937........................ Oklahoma........................ 0.8000 9938........................ Oregon.......................... 1.0564 9939........................ Pennsylvania.................... 0.9236 9940........................ Puerto Rico..................... 0.4692 9941........................ Rhode Island \4\................ ........ 9942........................ South Carolina.................. 0.8577 9943........................ South Dakota.................... 0.8003 9944........................ Tennessee....................... 0.8000 9945........................ Texas........................... 0.8064 9946........................ Utah............................ 0.9444 9947........................ Vermont......................... 1.0037 9948........................ Virgin Islands.................. 0.5276 9949........................ Virginia........................ 0.8375 9950........................ Washington...................... 1.1181 9951........................ West Virginia................... 0.8395 9952........................ Wisconsin....................... 0.9286 9953........................ Wyoming......................... 0.9347 9965........................ Guam............................ 0.9611
\3\ Wage index values are based on FY 1998 hospital cost report data prior to reclassification. This wage index is further adjusted. Wage index values greater than 0.8 are subject to a budget neutrality adjustment of 1.065982. Wage index values below 0.8 are adjusted to be the greater of a 15 percent increase, subject to a maximum wage index value of 0.8, or an adjustment by multiplying the hospital wage index value for a given area by the budget neutrality adjustment. All of these adjustments have been completed by HCFA and are built into the wage index values reflected in this table. \4\ All counties within the State are classified as urban.
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Regulatory Impact Statement
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Background
We have examined the impacts of this notice as required by Executive Order 12866, the Unfunded Mandate Reform Act, and the Regulatory Flexibility Act (RFA) (Pub. L. 96-354). In this notice, we identified an impact on hospices as a result of changes in the way we compute the hospice wage index. The change in the methodology for computing the wage index was determined through a negotiated rulemaking committee and implemented in the August 8, 1997 final rule (62 FR 42860). This notice only describes the effects of those changes in conjunction with the annual update to the hospice wage index. We believe these changes to be insignificant. 1. Executive Order 12866 and RFA
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). We have determined that this notice is not an economically significant rule under this Executive Order. The RFA requires agencies to analyze options for regulatory relief for small businesses. For purposes of the RFA, States and individuals are not considered small entities. However, most providers, physicians, and health care suppliers are small entities, either by nonprofit status or by having revenues of $5 million or less annually. Approximately 73 percent of Medicare certified hospices are identified as being voluntary, government, or other agency, and therefore are considered small entities. Because the National Hospice Organization estimates that approximately 65 percent of hospice patients are Medicare beneficiaries, we have not considered other sources of revenue in this analysis.
As discussed below, both urban and rural areas in Puerto Rico will experience the most significant decrease, 7.6 and 11.6 percent respectively, in payments under this wage index. Looking at the effects of this rule on Puerto Rico, we see that 21 of the 29 hospices in urban Puerto Rico can be considered small entities that will experience an 7.6 percent decrease in Medicare payments. Therefore, we anticipate this rule will have a significant impact on a substantial number of small entities. However, the methodology for the hospice wage index was previously determined by consensus through a negotiated rulemaking committee that included representatives of national hospice associations; rural, urban, large and small hospices; multi-site hospices; and consumer groups. Based on all of the options considered, the committee determined that the methodology described in the committee statement, and adopted into the August 8, 1997 final rule, was favorable for the hospice community as a whole, as well as for the beneficiaries that they serve. Therefore, we believe that mitigating the effects of small entities has been taken into consideration.
[[Page 42402]]
2. Congressional Review
Section 804(2) of Title 5, United States Code (as added by section 251 of Public Law 104-121 rule of the Public Law), specifies that a ``major rule'' is any rule that the Office of Management and Budget finds is likely to result in--
‹bullet› An annual effect on the economy of $100 million or more;
‹bullet› A major increase in costs or prices for consumers, individual industries, Federal, State, or local government agencies, or geographic regions; or
‹bullet› Significant adverse effects on competition, employment, investment, productivity, innovation, or on the ability of United States-based enterprises to compete with foreign-based enterprises in domestic and export markets.
We estimate that the impact of this notice will not be $100 million or more; therefore, this rule is not a major rule as defined in Title 5, United States Code, section 804(2) and is not being forwarded to Congress for a 60-day review period. 3. Unfunded Mandate
The Unfunded Mandate Reform Act of 1995 also requires (in section 202) that agencies prepare an assessment of anticipated costs and benefits for any rule that may result in an annual expenditure by State, local, and tribal governments, in the aggregate, or by the private sector, of $100 million or more. The notice has no consequential effect on State, local, or tribal governments. We believe the private sector costs of this rule fall below the threshold, as well. 4. Rural Hospital Impact
Section 1102(b) of the Act requires us to prepare a regulatory impact analysis for any notice that may have a significant impact on the operations of a substantial number of small rural hospitals. Such an analysis must conform to the provisions of section 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 a Metropolitan Statistical Area and has fewer than 50 beds.
Because this notice has no direct impact on small hospitals, in accordance with 5 U.S.C. 604, the Secretary certifies that this notice will not have a significant impact on the operations of a substantial number of small rural hospitals.
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Anticipated Effects
This impact analysis compares hospice payments under the FY 1999 hospice wage index (Column 3 of the table) to the estimated payments using the FY 2000 wage index (Column 4). The wage index blend for the second transition year (FY 1999) was one-third of the 1983 wage index added to two-thirds of the new wage index. The third transition year (FY 2000) fully implements the revised wage index. The data used in developing the quantitative analysis for this notice were obtained from the December 1998 update of the national claims history file of all bills submitted during fiscal year 1998. We deleted bills from hospices that have since closed. In addition to the information contained in Table C below, we have compared estimated payments using the original 1983 hospice wage index to estimated payments using the FY 2000 wage index and determined the new wage index methodology to be budget neutral as required by the negotiated rulemaking committee agreement.
Table C demonstrates the results of our analysis. In Column 2 of the table (below) we indicate the number of routine home care days that were included in our analysis, although the analysis was performed on all types of hospice care. Column 3 of the table indicates payments that were made using the FY 1999 wage index. Column 4 of Table C is based on FY 1998 claims and estimates payments to be made to hospices using the FY 2000 wage index. The final column, which compares Columns 3 and 4, shows the percent change in estimated hospice payments made based on the category of the hospice.
Table C categorizes hospices by various geographic and provider characteristics. The first row displays the results of the impact analysis for all Medicare certified hospices. The second and third rows of the table categorize hospices according to their geographic location (urban and rural). There are 1,375 hospices located in urban areas included in our analysis and 786 hospices located in rural areas. The next two groupings in the table indicate the number of hospices by census region, also broken down by urban and rural hospices. The sixth grouping shows the impact on hospices based on the size of the hospice's program. We determined that the majority of hospice payments are made at the routine home care rate. Therefore, we based the size of each individual hospice's program on the number of routine home care days provided in 1998. The next grouping shows the impact on hospices by type of ownership. The final grouping shows the impact on hospices defined by whether they are provider-based or freestanding.
The results of our analysis show that the greatest increases are for urban and rural hospices in the New England region, 3.0 percent and 2.7 percent respectively, and for rural hospices in the Pacific region, with 2.3 percent. The greatest decreases, besides Puerto Rico, are the urban West South Central and urban East North Central regions with 2.7 percent and 2.0 percent respectively. The most dramatic shift occurs in Puerto Rico, where urban payments decrease by 7.6 percent and rural payments decrease by 11.6 percent.
With the FY 99wage index, Puerto Rico experienced a 11.6 percent decrease for urban areas and a 12.3 percent decrease for rural areas. The total percentage decrease in payments Puerto Rico will experience with the new hospice wage index is 21 percent for urban areas and 26.3 percent for rural areas, which is consistent with the estimated impact information HCFA provided to the negotiated rulemaking committee during their deliberations. Since the wage index values for the Puerto Rico region are more than 15 percent below the 1983 wage index value of 0.8, this region is most affected by the revision to the wage index floor. However, as mentioned above, Puerto Rico's hospital wage index is calculated in the same manner as the national hospital wage index but is based solely on Puerto Rico's wage data. This has an impact on Puerto Rico's hospice wage index in that the hospice wage index is calculated using the pre-reclassified hospital wage index.
Small hospice programs show small increases while larger programs experience only a negligible decrease. Government-based hospices show slight increases in payment due to the wage index change while proprietary hospices show slight decreases. Finally, freestanding hospices show slight decreases in their wage index values while provider-based hospice programs show small increases.
We have reviewed this notice under the threshold criteria of Executive Order 12612. We have determined that it does not significantly affect the rights, roles, and responsibilities of States.
[[Page 42403]]
Table C.--Impact of Hospice Wage Index Change
Estimated Number of Payments payments Percent Number of routine using FY using FY change in hospices home care 1999 wage 2000 wage hospice days in index in index in payments thousands thousands thousands (1)
(2)
(3)
(4)
(5)
All............................................
2,161 18,455 2,135,750 2,128,347
-0.3 Urban Hospices.................................
1,375 15,717 1,877,146 1,868,228
-0.5 Rural Hospices.................................
786
2,738 258,604 260,118
0.6 Region (Urban):
New England................................
98
607 79,780 82,145
3.0
Middle Atlantic............................
176
1,970 249,012 252,129
1.3
South Atlantic.............................
188
3,509 433,746 433,786
0.0
East North Central.........................
223
2,546 301,352 295,253
-2.0
East South Central.........................
101
890 92,734 91,468
-1.4
West North Central.........................
98
930 97,912 98,233
0.3
West South Central.........................
185
2,090 224,483 218,502
-2.7
Mountain...................................
90
945 125,720 123,558
-1.7
Pacific....................................
187
2,028 257,817 259,665
0.7
Puerto Rico................................
29
203 14,592 13,489
-7.6 Region (Rural):
New England................................
25
69
7,178
7,372
2.7
Middle Atlantic............................
36
162 16,287 16,306
0.1
South Atlantic.............................
115
601 55,752 55,890
0.2
East North Central.........................
132
490 46,469 46,864
0.9
East South Central.........................
81
376 34,460 34,534
0.2
West North Central.........................
168
358 33,204 33,579
1.1
West South Central.........................
88
279 24,492 24,408
-0.3
Mountain...................................
84
181 17,817 17,872
0.3
Pacific....................................
54
202 21,593 22,098
2.3
Puerto Rico................................
3
19
1,352
1,195
-11.6 Size (Routine Home Care Days):
0-1,754 Days...............................
540
457 46,196 46,452
0.6
1,754-4,373 Days...........................
539
1,603 164,904 164,822
0.0
4,372-9,681 Days...........................
541
3,616 385,755 385,020
-0.2
9,681+Days.................................
541 12,778 1,538,895 1,532,054
-0.4 Type of Ownership:
Voluntary..................................
1,374 12,342 1,427,656 1,427,863
0.0
Proprietary................................
574
5,535 648,731 640,829
-1.2
Government.................................
180
494 50,974 51,319
0.7
Other......................................
33
83
8,389
8,335
-0.6 Hospice Base:
Freestanding...............................
841 10,368 1,211,588 1,202,380
-0.8
Home Health Agency.........................
757
4,852 558,520 559,505
0.3
Hospital...................................
542
3,107 349,520 349,793
0.1
Skilled Nursing Facility...................
21
127 16,597 16,669
0.4
Authority: Section 1814(I) of the Social Security Act (42 U.S.C. 1395f (I)(1))
(Catalog of Federal Domestic Assistance Program No. 93.743 Medicare--Hospital Insurance Program; and No. 93.774, Medicare-- Supplementary Medical Insurance Program)
Dated: May 27, 1999. Nancy-Ann Min DeParle, Administrator.
Dated: July 2, 1999. Donna E. Shalala, Secretary.
[FR Doc. 99-20013Filed7-30-99; 1:30 pm]
BILLING CODE 4120-01-P
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