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Notice

Medicare Program; Hospice Wage Index Fiscal Year 2002

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Information about this document as published in the Federal Register.

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Start Preamble Start Printed Page 49454

AGENCY:

Centers for Medicare & Medicaid Services (CMS), 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, 2001 through September 30, 2002. 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.

EFFECTIVE DATE:

October 1, 2001.

Start Further Info

FOR FURTHER INFORMATION CONTACT:

Lynn Riley, (410) 786-1286

Carol Blackford, (410) 786-5909

End Further Info End Preamble Start Supplemental Information

SUPPLEMENTARY INFORMATION

I. Background

A. 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 inpatient 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 existing regulations under 42 CFR Part 418 establish eligibility requirements and payment standards and procedures, define covered services, and delineate 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.

The regulations at § 418.306(c), which require the rates to be adjusted by a wage index, were revised in the August 8, 1997 final rule published in the Federal Register (62 FR 42860). This rule implemented a new methodology for calculating the hospice wage index based on the recommendations of a negotiated rulemaking committee. The committee reached consensus on the methodology. We included the resulting committee statement, describing that consensus, as an appendix to the August 8, 1997 final rule (62 FR 42883). The provisions of the final hospice wage index rule are as follows:

  • The revised hospice wage index will be calculated using the most current available hospital wage data.
  • The revised hospice wage index was phased in over a 3-year transition period. For the first year of the transition period, October 1, 1997 through September 30, 1998, 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, October 1, 1998 through September 30, 1999, 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. We fully implemented the revised wage index during the third transition period, October 1, 1999 through September 30, 2000.
  • All hospice wage index values of 0.8 or greater are subject to a budget-neutrality adjustment to ensure that we do not pay more in the aggregate than we would have paid under the original 1983 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.
  • 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.
  • The wage index is to be updated annually, in the Federal Register, based on the most current available hospital wage data. These data will include any changes to the definitions of Metropolitan Statistical Areas (MSA).

Section 4441(a) of the Balanced Budget Act of 1997 (BBA) amended section 1814(i)(1)(C)(ii) of the Act to establish updates to hospice rates for fiscal years (FYs) 1998 through 2002. Hospice rates were to be updated by a factor equal to the market basket index, minus 1 percentage point. However, section 131(a) of the Balanced Budget Refinement Act of 1999 (BBRA) changed the payment rates for FYs 2001 and 2002 by increasing the FY 2001 rate by 0.5 percent and the FY 2002 rate by 0.75 percent. Section 131(b) of the BBRA states that any additional payments made under section 131(a) of the BBRA shall not be included in updating the hospice rates after those 2 years.

Section 321(a) of the Medicare, Medicaid and State Child Health Insurance Program (SCHIP) Benefits Improvement and Protection Act (BIPA) amended section 814(i)(1)(C)(ii)(VI) of the Act by increasing Medicare hospice rates for FY 2001 by 5 percentage points. This amendment was applicable to hospice care furnished on or after April 1, 2001. Section 321(b) of BIPA further stipulated that the 5 percent increase in Medicare hospice rates during the period beginning on April 1, 2001 through September 30, 2001 will be treated as the payment rates in effect during the FY 2001. This means that the 5 percent increase was made to the base that is updated annually according to a statutorily dictated percentage of the market basket update, as provided in section 1814(i) of the Act. The new Medicare rates for this time period were announced through HCFA Program Memorandum A-01-04 on January 16, 2001.

Also, section 321(d) of BIPA specified that the Secretary of Health and Human Services use 1.0043 as the hospice wage index value for the Wichita, Kansas MSA in calculating payments for a hospice program providing hospice care in this MSA during FY 2000. CMS's Regional Home Health Intermediaries were instructed, through HCFA Program Memorandum A-01-07, to re-calculate the payment for Medicare hospice services provided during FY 2000 by Medicare hospice providers in the Wichita, Kansas MSA using the new wage index value of 1.0043, and to disburse a lump sum payment reflecting Start Printed Page 49455the difference in the two values that fiscal year.

B. Update to the Hospice Wage Index

This annual update is effective October 1, 2001 through September 30, 2002. In accordance with the agreement signed by the Centers for Medicaid & Medicare Services (CMS) and all other members of the Hospice Wage Index Negotiated Rulemaking Committee, we are using the most current CMS hospital data available, including any changes to the definitions of MSAs. The FY 2001 hospital wage index was the most current hospital wage data available when the FY 2002 wage index values were calculated. We used the pre-reclassified and pre-floor hospital area wage index data.

All wage index values are adjusted by a budget-neutrality factor of 1.064726 and are subject to the wage index floor adjustment, if applicable. We have completed all of the calculations described above and included them in 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 proposed rule published in the Federal Register (61 FR 46579) and the August 8, 1997 final rule published in the Federal Register (62 FR 42860).

1. Metropolitan Statistical Areas

As explained in the September 4, 1996 hospice wage index proposed rule, each hospice's labor market area would be established by the MSA definitions issued by the Office of Management and Budget (OMB) on December 28, 1992 based on the 1990 census, and updated periodically by OMB. Any changes to the MSA definitions would be effective annually and announced in the final rule updating the hospice wage index.

2. MSA Wage Index Values Lower than Rural Values

As explained above, any area not included in an MSA is considered to be nonurban and receives the statewide rural rate. We are aware that in the past, a number of MSAs have had wage index values that were lower than their rural statewide value. This difference is due to variations in local wage data as compared to national wage data. The hospice wage index is computed by dividing the hourly wage rate for an MSA or nonurban area by a national hourly wage rate. Nonurban areas could receive a higher wage index value than urban areas in the same State if the hourly wage rate in the nonurban area increased at a greater rate.

C. Tables

Table A.—Hospice Wage Index for Urban Areas

MSA Code No.Urban area (constituent counties or county equivalents) 1Wage index 2
0040Abilene, TX0.8773
 Taylor, TX
0060Aguadilla, PR0.5050
 Aguada, PR
 Aguadilla, PR
 Moca, PR
0080Akron, OH1.0366
 Portage, OH
 Summit, OH
0120Albany, GA1.0576
 Dougherty, GA
 Lee, GA
0160Albany-Schenectady-Troy, NY0.9102
 Albany, NY
 Montgomery, NY
 Rensselaer, NY
 Saratoga, NY
 Schenectady, NY
 Schoharie, NY
0200Albuquerque, NM0.9727
 Bernalillo, NM
 Sandoval, NM
 Valencia, NM
0220Alexandria, LA0.8649
 Rapides, LA
0240Allentown-Bethlehem-Easton, PA1.0567
 Carbon, PA
 Lehigh, PA
 Northampton, PA
0280Altoona, PA0.9951
 Blair, PA
0320Amarillo, TX0.9279
 Potter, TX
 Randall, TX
0380Anchorage, AK1.3621
 Anchorage, AK
0440Ann Arbor, MI1.1982
 Lenawee, MI
 Livingston, MI
 Washtenaw, MI
0450Anniston, AL0.8820
 Calhoun, AL
0460Appleton-Oshkosh-Neenah, WI0.9638
 Calumet, WI
Start Printed Page 49456
 Outagamie, WI
 Winnebago, WI
0470Arecibo, PR0.8518
 Arecibo, PR
 Camuy, PR
 Hatillo, PR
0480Asheville, NC1.0132
 Buncombe, NC
 Madison, NC
0500Athens, GA1.0369
 Clarke, GA
 Madison, GA
 Oconee, GA
0520Atlanta, GA1.0749
 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
0560Atlantic-Cape May, NJ1.1906
 Atlantic, NJ
 Cape May, NJ
0580Aubrn-Opelika, AL0.8631
 Lee, AL
0600Augusta-Aiken, GA-SC0.9753
 Columbia, GA
 McDuffie, GA
 Richmond, GA
 Aiken, SC
 Edgefield, SC
0640Austin-San Marcos, TX1.0197
 Bastrop, TX
 Caldwell, TX
 Hays, TX
 Travis, TX
 Williamson, TX
0680Bakersfield, CA1.0304
 Kern, CA
0720Baltimore, MD0.9971
 Anne Arundel, MD
 Baltimore, MD
 Baltimore City, MD
 Carroll, MD
 Harford, MD
 Howard, MD
 Queen Anne's, MD
0733Bangor, ME1.0180
 Penobscot, ME
0743Barnstable-Yarmouth, MA1.4735
 Barnstable, MA
0760Baton Rouge, LA0.9414
 Ascension, LA
 East Baton Rouge, LA
 Livingston, LA
 West Baton Rouge, LA
0840Beaumont-Port Arthur, TX0.9310
Start Printed Page 49457
 Hardin, TX
 Jefferson, TX
 Orange, TX
0860Bellingham, WA1.2179
 Whatcom, WA
0870Benton Harbor, MI0.9232
 Berrien, MI
0875Bergen-Passaic, NJ1.2615
 Bergen, NJ
 Passaic, NJ
0880Billings, MT1.0205
 Yellowstone, MT
0920Biloxi-Gulfport-Pascagoula, MS0.8769
 Hancock, MS
 Harrison, MS
 Jackson, MS
0960Binghamton, NY0.9252
 Broome, NY
 Tioga, NY
1000Birmingham, AL0.8999
 Blount, AL
 Jefferson, AL
 St. Clair, AL
 Shelby, AL
1010Bismarck, ND0.8204
 Burleigh, ND
 Morton, ND
1020Bloomington, IN0.9298
 Monroe, IN
1040Bloomington-Normal, IL0.9684
 McLean, IL
1080Boise City, ID0.9589
 Ada, ID
 Canyon, ID
1123Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH1.1882
 Bristol, MA
 Essex, MA
 Middlesex, MA
 Norfolk, MA
 Plymouth, MA
 Suffolk, MA
 Worcester, MA
 Hillsborough, NH
 Merrimack, NH
 Rockingham, NH
 Strafford, NH
1125Boulder-Longmont, CO1.0361
 Boulder, CO
1145Brazoria, TX0.9218
 Brazoria, TX
1150Bremerton, WA1.1685
 Kitsap, WA
1240Brownsville-Harlingen-San Benito, TX0.9287
 Cameron, TX
1260Bryan-College Station, TX0.8770
 Brazos, TX
1280Buffalo-Niagara Falls, NY1.0200
 Erie, NY
 Niagara, NY
1303Burlington, VT1.1430
 Chittenden, VT
 Franklin, VT
 Grand Isle, VT
1310Caguas, PR0.5246
 Caguas, PR
 Cayey, PR
 Cidra, PR
 Gurabo, PR
 San Lorenzo, PR
1320Canton-Massillon, OH0.9140
 Carroll, OH
Start Printed Page 49458
 Stark, OH
1350Casper, WY0.9289
 Natrona, WY
1360Cedar Rapids, IA0.9301
 Linn, IA
1400Champaign-Urbana, IL0.9793
 Champaign, IL
1440Charleston-North Charleston, SC0.9623
 Berkeley, SC
 Charleston, SC
 Dorchester, SC
1480Charleston, WV0.9838
 Kanawha, WV
 Putnam, WV
1520Charlotte-Gastonia-Rock Hill, NC-SC0.9999
 Cabarrus, NC
 Gaston, NC
 Lincoln, NC
 Mecklenburg, NC
 Rowan, NC
 Stanly, NC
 Union, NC
 York, SC
1540Charlottesville, VA1.1487
 Albemarle, VA
 Charlottesville City, VA
 Fluvanna, VA
 Greene, VA
1560Chattanooga, TN-GA1.0469
 Catoosa, GA
 Dade, GA
 Walker, GA
 Hamilton, TN
 Marion, TN
1580Cheyenne, WY0.8846
 Laramie, WY
1600Chicago, IL1.1867
 Cook, IL
 DeKalb, IL
 Du Page, IL
 Grundy, IL
 Kane, IL
 Kendall, IL
 Lake, IL
 McHenry, IL
 Will, IL
1620Chico-Paradise, CA1.0560
 Butte, CA
1640Cincinnati, OH-KY-IN1.0024
 Brown, OH
 Clermont, OH
 Hamilton, OH
 Warren, OH
 Boone, KY
 Campbell, KY
 Gallatin, KY
 Grant, KY
 Kenton, KY
 Pendleton, KY
 Dearborn, IN
 Ohio, IN
1660Clarksville-Hopkinsville, TN-KY0.8735
 Christian, KY
 Montgomery, TN
1680Cleveland-Lorain-Elyria, OH1.0218
 Ashtabula, OH
 Cuyahoga, OH
 Geauga, OH
 Lake, OH
 Lorain, OH
 Medina, OH
Start Printed Page 49459
1720Colorado Springs, CO1.0325
 El Paso, CO
1740Columbia, MO0.9541
 Boone, MO
1760Columbia, SC1.0172
 Lexington, SC
 Richland, SC
1800Columbus, GA-AL0.9123
 Chattahochee, GA
 Harris, GA
 Muscogee, GA
 Russell, AL
1840Columbus, OH1.0242
 Delaware, OH
 Fairfield, OH
 Franklin, OH
 Licking, OH
 Madison, OH
 Pickaway, OH
1880Corpus Christi, TX0.9291
 Nueces, TX
 San Patricio, TX
1890Corvallis, Oregon1.2059
 Benton, OR
1900Cumberland, MD-WV0.8911
 Allegany, MD
 Mineral, WV
1920Dallas, TX1.0555
 Collin, TX
 Dallas, TX
 Denton, TX
 Ellis, TX
 Henderson, TX
 Hunt, TX
 Kaufman, TX
 Rockwall, TX
1950Danville, VA0.9145
 Danville City, VA
 Pittsylvania, VA
1960Davenport-Moline-Rock Island, IA-IL0.9474
 Scott, IA
 Henry, IL
 Rock Island, IL
2000Dayton-Springfield, OH1.0053
 Clark, OH
 Greene, OH
 Miami, OH
 Montgomery, OH
2020Daytona Beach, FL0.9795
 Flagler, FL
 Volusia, FL
2030Decatur, AL0.9086
 Lawrence, AL
 Morgan, AL
2040Decatur, IL0.8651
 Macon, IL
2080Denver, CO1.0840
 Adams, CO
 Arapahoe, CO
 Denver, CO
 Douglas, CO
 Jefferson, CO
2120Des Moines, IA0.9708
 Dallas, IA
 Polk, IA
 Warren, IA
2160Detroit, MI1.1190
 Lapeer, MI
 Macomb, MI
 Monroe, MI
 Oakland, MI
Start Printed Page 49460
 St. Clair, MI
 Wayne, MI
2180Dothan, AL0.8457
 Dale, AL
 Houston, AL
2190Dover, DE1.0730
 Kent, DE
2200Dubuque, IA0.9312
 Dubuque, IA
2240Duluth-Superior, MN-WI1.0681
 St. Louis, MN
 Douglas, WI
2281Dutchess County, NY1.0912
 Dutchess, NY
2290Eau Claire, WI0.9359
 Chippewa, WI
 Eau Claire, WI
2320El Paso, TX0.9951
 El Paso, TX
2330Elkhart-Goshen, IN0.9737
 Elkhart, IN
2335Elmira, NY0.9099
 Chemung, NY
2340Enid, OK0.9167
 Garfield, OK
2360Erie, PA0.9567
 Erie, PA
2400Eugene-Springfield, OR1.1675
 Lane, OR
2440Evansville-Henderson, IN-KY0.8702
 Posey, IN
 Vanderburgh, IN
 Warrick, IN
 Henderson, KY
2520Fargo-Moorhead, ND-MN0.9315
 Clay, MN
 Cass, ND
2560Fayetteville, NC0.9215
 Cumberland, NC
2580Fayetteville-Springdale-Rogers, AR0.8422
 Benton, AR
 Washington, AR
2620Flagstaff, AZ-UT1.1378
 Coconino, AZ
 Kane, UT
2640Flint, MI1.1930
 Genesee, MI
2650Florence, AL0.8109
 Colbert, AL
 Lauderdale, AL
2655Florence, SC0.9345
 Florence, SC
2670Fort Collins-Loveland, CO1.1336
 Larimer, CO
2680Ft. Lauderdale, FL1.0776
 Broward, FL
2700Fort Myers-Cape Coral, FL0.9846
 Lee, FL
2710Fort Pierce-Port St. Lucie, FL1.0155
 Martin, FL
 St. Lucie, FL
2720Fort Smith, AR-OK0.8573
 Crawford, AR
 Sebastian, AR
 Sequoyah, OK
2750Fort Walton Beach, FL1.0229
 Okaloosa, FL
2760Fort Wayne, IN0.9226
 Adams, IN
 Allen, IN
 De Kalb, IN
Start Printed Page 49461
 Huntington, IN
 Wells, IN
 Whitley, IN
2800Forth Worth-Arlington, TX1.0144
 Hood, TX
 Johnson, TX
 Parker, TX
 Tarrant, TX
2840Fresno, CA1.0758
 Fresno, CA
 Madera, CA
2880Gadsden, AL0.8968
 Etowah, AL
2900Gainesville, FL1.0726
 Alachua, FL
2920Galveston-Texas City, TX1.0560
 Galveston, TX
2960Gary, IN1.0066
 Lake, IN
 Porter, IN
2975Glens Falls, NY0.8902
 Warren, NY
 Washington, NY
2980Goldsboro, NC0.8968
 Wayne, NC
2985Grand Forks, ND-MN0.9387
 Grand Forks, ND
 Polk, MN
2995Grand Junction, CO0.9699
 Mesa, CO
3000Grand Rapids-Muskegon-Holland, MI1.0911
 Allegan, MI
 Kent, MI
 Muskegon, MI
 Ottawa, MI
3040Great Falls, MT0.9652
 Cascade, MT
3060Greeley, CO1.0449
 Weld, CO
3080Green Bay, WI0.9822
 Brown, WI
3120Greensboro-Winston-Salem-High Point, NC0.9722
 Alamance, NC
 Davidson, NC
 Davie, NC
 Forsyth, NC
 Guilford, NC
 Randolph, NC
 Stokes, NC
 Yadkin, NC
3150Greenville, NC0.9991
 Pitt, NC
3160Greenville-Spartanburg-Anderson, SC0.9586
 Anderson, SC
 Cherokee, SC
 Greenville, SC
 Pickens, SC
 Spartanburg, SC
3180Hagerstown, MD1.0018
 Washington, MD
3200Hamilton-Middletown, OH0.9648
 Butler, OH
3240Harrisburg-Lebanon-Carlisle, PA0.9994
 Cumberland, PA
 Dauphin, PA
 Lebanon, PA
 Perry, PA
3283Hartford, CT1.2109
 Hartford, CT
 Litchfield, CT
 Middlesex, CT
Start Printed Page 49462
 Tolland, CT
3285Hattiesburg, MS0.8000
 Forrest, MS
 Lamar, MS
3290Hickory-Morganton-Lenoir, NC0.9591
 Alexander, NC
 Burke, NC
 Caldwell, NC
 Catawba, NC
3320Honolulu, HI1.2631
 Honolulu, HI
3350Houma, LA0.8609
 Lafourche, LA
 Terrebonne, LA
3360Houston, TX1.0362
 Chambers, TX
 Fort Bend, TX
 Harris, TX
 Liberty, TX
 Montgomery, TX
 Waller, TX
3400Huntington-Ashland, WV-KY-OH1.0515
 Boyd, KY
 Carter, KY
 Greenup, KY
 Lawrence, OH
 Cabell, WV
 Wayne, WV
3440Huntsville, AL0.9510
 Limestone, AL
 Madison, AL
3480Indianapolis, IN1.0420
 Boone, IN
 Hamilton, IN
 Hancock, IN
 Hendricks, IN
 Johnson, IN
 Madison, IN
 Marion, IN
 Morgan, IN
 Shelby, IN
3500Iowa City, IA1.0282
 Johnson, IA
3520Jackson, MI0.9725
 Jackson, MI
3560Jackson, MS0.9382
 Hinds, MS
 Madison, MS
 Rankin, MS
3580Jackson, TN0.9365
 Madison, TN
 Chester, TN
3600Jacksonville, FL0.9804
 Clay, FL
 Duval, FL
 Nassau, FL
 St. Johns, FL
3605Jacksonville, NC0.8280
 Onslow, NC
3610Jamestown, NY0.8324
 Chautauqua, NY
3620Janesville-Beloit, WI1.0205
 Rock, WI
3640Jersey City, NJ1.2246
 Hudson, NJ
3660Johnson City-Kingsport-Bristol, TN-VA0.8807
 Carter, TN
 Hawkins, TN
 Sullivan, TN
 Unicoi, TN
 Washington, TN
Start Printed Page 49463
 Bristol City, VA
 Scott, VA
 Washington, VA
3680Johnstown, PA0.9419
 Cambria, PA
 Somerset, PA
3700Jonesboro, AR0.8339
 Craighead, AR
3710Joplin, MO0.8675
 Jasper, MO
 Newton, MO
3720Kalamazoo-Battlecreek, MI1.1130
 Calhoun, MI
 Kalamazoo, MI
 Van Buren, MI
3740Kankakee, IL1.05423
 Kankakee, IL
3760Kansas City, KS-MO1.0144
 Johnson, KS
 Leavenworth, KS
 Miami, KS
 Wyandotte, KS
 Cass, MO
 Clay, MO
 Clinton, MO
 Jackson, MO
 LaFayette, MO
 Platte, MO
 Ray, MO
3800Kenosha, WI1.0233
 Kenosha, WI
3810Kileen-Temple, TX1.0774
 Bell, TX
 Coryell, TX
3840Knoxville, TN0.8880
 Anderson, TN
 Blount, TN
 Loudon, TN
 Sevier, TN
 Union, TN
3850Kokomo, IN1.0134
 Howard, IN
 Tipton, IN
3870La Crosse, WI-MN0.9807
 Houston, MN
 La Crosse, WI
3880Lafayette, LA0.9040
 Acadia, LA
 Lafayette, LA
 St. Landry, LA
 St. Martin, LA
3920Lafayette, IN0.9406
 Clinton, IN
 Tippecanoe, IN
3960Lake Charles, LA0.8000
 Calcasieu, LA
3980Lakeland-Winter Haven, FL0.9837
 Polk, FL
4000Lancater, PA0.9858
 Lancaster, PA
4040Lansing-East Lansing, MI1.0577
 Clinton, MI
 Eaton, MI
 Ingham, MI
4080Laredo, TX0.8697
 Webb, TX
4100Las Cruces, NM0.9218
 Dona Ana, NM
4120Las Vegas, NV-AZ1.1495
 Mohave, AZ
 Clarke, NV
Start Printed Page 49464
 Nye, NV
4150Lawrence, KS0.8720
 Douglas, KS
4200 Lawton, OK 0.9578
 Comanche, OK
4243Lewiston-Auburn, ME0.9621
 Androscoggin, ME
4280Lexington, KY0.9440
 Bourbon, KY
 Clark, KY
 Fayette, KY
 Jessamine, KY
 Madison, KY
 Scott, KY
 Woodford, KY
4320Lima, OH0.9923
 Allen, OH
 Auglaize, OH
4360Lincoln, NE1.0249
 Lancaster, NE
4400Little Rock-North Little Rock, AR0.9482
 Faulkner, AR
 Lonoke, AR
 Pulaski, AR
 Saline, AR
4420Longview-Marshall, TX0.9499
 Gregg, TX
 Harrison, TX
 Upshur, TX
4480Los Angeles-Long Beach, CA1.2772
 Los Angeles, CA
4520Louisville, KY-IN0.9955
 Clark, IN
 Floyd, IN
 Harrison, IN
 Scott, IN
 Bullitt, KY
 Jefferson, KY
 Oldham, KY
4600Lubbock, TX0.9410
 Lubbock, TX
4640Lynchburg, VA0.9441
 Amherst, VA
 Bedford, VA
 Bedford City, VA
 Campbell, VA
 Lynchburg City, VA
4680Macon, GA0.9555
 Bibb, GA
 Houston, GA
 Jones, GA
 Peach, GA
 Twiggs, GA
4720Madison, WI1.0936
 Dane, WI
4800Mansfield, OH0.9252
 Crawford, OH
 Richland, OH
4840Mayaguez, PR0.5277
 Anasco, PR
 Cabo Rojo, PR
 Hormigueros, PR
 Mayaguez, PR
 Sabana Grande, PR
 San German, PR
4880McAllen-Edinburg-Mission, TX0.9120
 Hidalgo, TX
4890Medford-Ashland, OR1.1014
 Jackson, OR
4900Melbourne-Titusville-Palm Bay, FL1.0315
 Brevard, FL
Start Printed Page 49465
4920Memphis, TN-AR-MS0.9288
 Crittenden, AR
 DeSoto, MS
 Fayette, TN
 Shelby, TN
 Tipton, TN
4940Merced, CA1.0270
 Merced, CA
5000Miami, FL1.0710
 Dade, FL
5015Middlesex-Somerset-Hunterdon, NJ1.1792
 Hunterdon, NJ
 Middlesex, NJ
 Somerset, NJ
5080Milwaukee-Waukesha, WI1.0399
 Milwaukee, WI
 Ozaukee, WI
 Washington, WI
 Waukesha, WI
5120Minneapolis-St. Paul, MN-WI1.1730
 Anoka, MN
 Carver, MN
 Chisago, MN
 Dakota, MN
 Hennepin, MN
 Isanti, MN
 Ramsey, MN
 Scott, MN
 Sherbune, MN
 Washington, MN
 Wright, MN
 Pierce, WI
 St. Croix, WI
5140Missoula, MT0.9874
 Missoula, MT
5160Mobile, AL0.8691
 Baldwin, AL
 Mobile, AL
5170Modesto, CA1.1069
 Stanislaus, CA
5190Monmouth-Ocean, NJ1.2008
 Monmouth, NJ
 Ocean, NJ
5200Monroe, LA0.8939
 Ouachita, LA
5240Montgomery, AL0.8148
 Autauga, AL
 Elmore, AL
 Montgomery, AL
5280Muncie, IN1.1679
 Delaware, IN
5330Myrtle Beach, SC0.8986
 Horry, SC
5345Naples, FL1.0286
 Collier, FL
5360Nashville, TN1.0104
 Cheatham, TN
 Davidson, TN
 Dickson, TN
 Robertson, TN
 Rutherford, TN
 Sumner, TN
 Williamson, TN
 Wilson, TN
5380Nassau-Suffolk, NY1.4834
 Nassau, NY
 Suffolk, NY
5483New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT1.3093
 Fairfield, CT
 New Haven, CT
5523New London-Norwich, CT1.2844
Start Printed Page 49466
 New London, CT
5560New Orleans, LA0.9897
 Jefferson, LA
 Orleans, LA
 Plaquemines, LA
 St. Bernard, LA
 St. Charles, LA
 St. James, LA
 St. John The Baptist, LA
 St. Tammany, LA
5600New York, NY1.5599
 Bronx, NY
 Kings, NY
 New York, NY
 Putnam, NY
 Queens, NY
 Richmond, NY
 Rockland, NY
 Westchester, NY
5640Newark, NJ1.2603
 Essex, NJ
 Morris, NJ
 Sussex, NJ
 Union, NJ
 Warren, NJ
5660Newburgh, NY-PA1.1549
 Orange, NY
 Pike, PA
5720Norfolk-Virginia Beach-Newport News, VA-NC0.8956
 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
5775Oakland, CA1.5953
 Alameda, CA
 Contra Costa, CA
5790Ocala, FL0.9841
 Marion, FL
5800Odessa-Midland, TX0.9801
 Ector, TX
 Midland, TX
5880Oklahoma City, OK0.9393
 Canadian, OK
 Cleveland, OK
 Logan, OK
 McClain, OK
 Oklahoma, OK
 Pottawatomie, OK
5910Olympia, WA1.1368
 Thurston, WA
5920Omaha, NE-IA1.0192
 Pottawattamie, IA
 Cass, NE
 Douglas, NE
 Sarpy, NE
 Washington, NE
5945Orange County, CA1.2209
 Orange, CA
5960Orlando, FL1.0232
 Lake, FL
Start Printed Page 49467
 Orange, FL
 Osceola, FL
 Seminole, FL
5990Owensboro, KY0.8687
 Daviess, KY
6015Panama City, FL0.9593
 Bay, FL
6020Parkersburg-Marietta, WV-OH0.8810
 Washington, OH
 Wood, WV
6080Pensacola, FL0.8705
 Escambia, FL
 Santa Rosa, FL
6120Peoria-Pekin, IL0.9205
 Peoria, IL
 Tazewell, IL
 Woodford, IL
6160Philadelphia, PA-NJ1.1645
 Burlington, NJ
 Camden, NJ
 Gloucester, NJ
 Salem, NJ
 Bucks, PA
 Chester, PA
 Delaware, PA
 Montgomery, PA
 Philadelphia, PA
6200Phoenix-Mesa, AZ1.0295
 Maricopa, AZ
 Pinal, AZ
6240Pine Bluff, AR0.8295
 Jefferson, AR
6280Pittsburgh, PA1.0371
 Allegheny, PA
 Beaver, PA
 Butler, PA
 Fayette, PA
 Washington, PA
 Westmoreland, PA
6323Pittsfield, MA1.0954
 Berkshire, MA
6340Pocatello, ID0.9663
 Bannock, ID
6360Ponce, PR0.5757
 Guayanilla, PR
 Juana Diaz, PR
 Penuelas, PR
 Ponce, PR
 Villalba, PR
 Yauco, PR
6403Portland, ME1.0379
 Cumberland, ME
 Sagadahoc, ME
 York, ME
6440Portland-Vancouver, OR-WA1.1616
 Clackamas, OR
 Columbia, OR
 Multnomah, OR
 Washington, OR
 Yamhill, OR
 Clark, WA
6483Providence-Warwick-Pawtucket, RI1.1567
 Bristol, RI
 Kent, RI
 Newport, RI
 Providence, RI
 Washington, RI
6520Provo-Orem, UT1.0678
 Utah, UT
6560Pueblo, CO0.9386
 Pueblo, CO
Start Printed Page 49468
6580Punta Gorda, FL1.0235
 Charlotte, FL
6600Racine, WI0.9845
6640Raleigh-Durham-Chapel Hill, NC1.0270
 Chatham, NC
 Durham, NC
 Franklin, NC
 Johnston, NC
 Orange, NC
 Wake, NC
6660Rapid City, SD0.9439
 Pennington, SD
6680Reading, PA0.9744
 Berks, PA
6690Redding, CA1.2419
 Shasta, CA
6720Reno, NV1.1233
 Washoe, NV
6740Richland-Kennewick-Pasco, WA1.2202
 Benton, WA
 Franklin, WA
6760Richmond-Petersburg, VA1.0239
 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
6780Riverside-San Bernardino, CA1.1966
 Riverside, CA
 San Bernardino, CA
6800Roanoke, VA0.9316
 Botetourt, VA
 Roanoke, VA
 Roanoke City, VA
 Salem City, VA
6820Rochester, MN1.2047
 Olmsted, MN
6840Rochester, NY0.9776
 Genesee, NY
 Livingston, NY
 Monroe, NY
 Ontario, NY
 Orleans, NY
 Wayne, NY
6880Rockford, IL0.9390
 Boone, IL
 Ogle, IL
 Winnebago, IL
6895Rocky Mount, NC0.9422
 Edgecombe, NC
 Nash, NC
6920Sacramento, CA1.2723
 El Dorado, CA
 Placer, CA
 Sacramento, CA
6960Saginaw-Bay City-Midland, MI1.0195
 Bay, MI
 Midland, MI
 Saginaw, MI
6980St. Cloud, MN1.0664
 Benton, MN
 Stearns, MN
7000St. Joseph, MO0.9658
Start Printed Page 49469
 Andrew, MO
 Buchanan, MO
7040St. Louis, MO-IL0.9635
 Franklin, MO
 Jefferson, MO
 Lincoln, MO
 St. Charles, MO
 St. Louis, MO
 St. Louis City, MO
 Warren, MO
 Clinton, IL
 Jersey, IL
 Madison, IL
 Monroe, IL
 St. Clair, IL
7080Salem, OR1.0848
 Marion, OR
 Polk, OR
7120Salinas, CA1.5441
 Monterey, CA
7160Salt Lake City-Ogden, UT1.0442
 Davis, UT
 Salt Lake, UT
 Weber, UT
7200San Angelo, TX0.8606
 Tom Green, TX
7240San Antonio, TX0.9135
 Bexar, TX
 Comal, TX
 Guadalupe, TX
 Wilson, TX
7320San Diego, CA1.2547
 San Diego, CA
7360San Francisco, CA1.5072
 Marin, CA
 San Francisco, CA
 San Mateo, CA
7400San Jose, CA1.4536
 Santa Clara, CA
7440San Juan-Bayamon, PR0.5394
 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
7460San Luis Obispo-Atascadero-Paso Robles, CA1.1364
Start Printed Page 49470
 San Luis Obispo, CA
7480Santa Barbara-Santa Maria-Lompoc, CA1.1283
 Santa Barbara, CA
7485Santa Cruz-Watsonville, CA1.4949
 Santa Cruz, CA
7490Santa Fe, NM1.1219
 Los Alamos, NM
 Santa Fe, NM
7500Santa Rosa, CA1.3465
 Sonoma, CA
7510Sarasota-Bradenton, FL1.0444
 Manatee, FL
 Sarasota, FL
7520Savannah, GA1.0325
 Bryan, GA
 Chatham, GA
 Effingham, GA
7560Scranton-Wilkes-Barre-Hazleton, PA0.8966
 Columbia, PA
 Lackawanna, PA
 Luzerne, PA
 Wyoming, PA
7600Seattle-Bellevue-Everett, WA1.1708
 Island, WA
 King, WA
 Snohomish, WA
7610Sharon, PA0.8441
 Mercer, PA
7620Sheboygan, WI0.8921
 Sheboygan, WI
7640Sherman-Denison, TX0.9257
 Grayson, TX
7680Shreveport-Bossier City, LA0.9316
 Bossier, LA
 Caddo, LA
 Webster, LA
7720Sioux City, IA-NE0.9021
 Woodbury, IA
 Dakota, NE
7760Sioux Falls, SD0.9359
 Lincoln, SD
 Minnehaha, SD
7800South Bend, IN1.0647
 St. Joseph, IN
7840Spokane, WA1.1193
 Spokane, WA
7880Springfield, IL0.9247
 Menard, IL
 Sangamon, IL
7920Springfield, MO0.9037
 Christian, MO
 Greene, MO
 Webster, MO
8003Springfield, MA1.1325
 Hampden, MA
 Hampshire, MA
8050State College, PA0.9623
 Centre, PA
8080Steubenville-Weirton, OH-WV0.9101
 Jefferson, OH
 Brooke, WV
 Hancock, WV
8120Stockton-Lodi, CA1.1317
 San Joaquin, CA
8140Sumter, SC0.8806
 Sumter, SC
8160Syracuse, NY1.0167
 Cayuga, NY
 Madison, NY
 Onondaga, NY
 Oswego, NY
Start Printed Page 49471
8200Tacoma, WA1.2312
 Pierce, WA
8240Tallahassee, FL0.9098
 Gadsden, FL
 Leon, FL
8280Tampa-St. Petersburg-Clearwater, FL0.9563
 Hernando, FL
 Hillsborough, FL
 Pasco, FL
 Pinellas, FL
8320Terre Haute, IN0.8841
 Clay, IN
 Vermillion, IN
 Vigo, IN
8360Texarkana, AR-Texarkana, TX0.8904
 Miller, AR
 Bowie, TX
8400Toledo, OH1.0468
 Fulton, OH
 Lucas, OH
 Wood, OH
8440Topeka, KS0.9707
 Shawnee, KS
8480Trenton, NJ1.0793
 Mercer, NJ
8520Tucson, AZ0.9363
 Pima, AZ
8560Tulsa, OK0.9001
 Creek, OK
 Osage, OK
 Rogers, OK
 Tulsa, OK
 Wagoner, OK
8600Tuscaloosa, AL0.8586
 Tuscaloosa, AL
8640Tyler, TX1.0013
 Smith, TX
8680Utica-Rome, NY0.9114
 Herkimer, NY
 Oneida, NY
8720Vallejo-Fairfield-Napa, CA1.3679
 Napa, CA
 Solano, CA
8735Ventura, CA1.1744
 Ventura, CA
8750Victoria, TX0.8682
 Victoria, TX
8760Vineland-Millville-Bridgeton, NJ1.1181
 Cumberland, NJ
8780Visalia-Tulare-Porterville, CA1.0169
 Tulare, CA
8800Waco, TX0.8852
 McLennan, TX
8840Washington, DC-MD-VA-WV1.1451
 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
Start Printed Page 49472
 Manassas City, VA
 Manassas Park City, VA
 Prince William, VA
 Spotsylvania, VA
 Stafford, VA
 Warren, VA
 Berkeley, WV
 Jefferson, WV
8920Waterloo-Cedar Falls, IA0.8948
 Black Hawk, IA
8940Wausau, WI1.0028
 Marathon, WI
8960West Palm Beach-Boca Raton, FL1.0309
 Palm Beach, FL
9000Wheeling, WV-OH0.8234
 Belmont, OH
 Marshall, WV
 Ohio, WV
9040Wichita, KS1.0162
 Butler, KS
 Harvey, KS
 Sedgwick, KS
9080Wichita Falls, TX0.8164
 Archer, TX
 Wichita, TX
9140Williamsport, PA0.8935
 Lycoming, PA
9160Wilmington-Newark, DE-MD1.1915
 New Castle, DE
 Cecil, MD
9200Wilmington, NC1.0011
 Brunswick, NC
 New Hanover, NC
9260Yakima, WA1.0548
 Yakima, WA
9270Yolo, CA1.0859
 Yolo, CA
9280York, PA0.9864
 York, PA
9320Youngstown-Warren, OH1.0161
 Columbiana, OH
 Mahoning, OH
 Trumbull, OH
9340Yuba City, CA1.1399
 Sutter, CA
 Yuba, CA
9360Yuma, AZ1.0146
 Yuma, AZ
1 This column lists each MSA area name 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 1997 hospital cost report data before reclassification. This wage index is further adjusted. Wage index values greater than 0.8 are subject to a budget-neutrality adjustment of 1.064726. 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. We have completed all of these adjustments and included them in the wage index values reflected in this table.

Table B.—Wage Index for Rural Areas

MSA Code No.Nonurban areaWage index 3
9901Alabama0.8000
9902Alaska1.3194
9903Arizona0.8855
9904Arkansas0.8000
9905California1.0499
9906Colorado0.9548
9907Connecticut1.2473
9908Delaware0.9661
9910Florida0.9496
9911Georgia0.8868
Start Printed Page 49473
9912Hawaii1.1775
9913Idaho0.9240
9914Illinois0.8688
9915Indiana0.9159
9916Iowa0.8550
9917Kansas0.8097
9918Kentucky0.8444
9919Louisiana0.8178
9920Maine0.9333
9921Maryland0.9211
9922Massachusetts1.1929
9923Michigan0.9569
9924Minnesota0.9456
9925Mississippi0.8000
9926Missouri0.8196
9927Montana0.9250
9928Nebraska0.8634
9929Nevada0.9830
9930New Hampshire1.0482
9931New Jersey 4
9932New Mexico0.9047
9933New York0.9049
9934North Carolina0.8987
9935North Dakota0.8215
9936Ohio0.9231
9937Oklahoma0.8000
9938Oregon1.0788
9939Pennsylvania0.9133
9940Puerto Rico0.4904
9941Rhode Island 4
9942South Carolina0.8912
9943South Dakota0.8060
9944Tennessee0.8345
9945Texas0.8000
9946Utah0.9622
9947Vermont0.9874
9948Virgin Islands0.7252
9949Virginia0.8719
9950Washington1.1109
9951West Virginia0.8764
9952Wisconsin0.9455
9953Wyoming0.9388
9965Guam1.0233
3 Wage index values are based on FY 1997 hospital cost report data before reclassification. This wage index is further adjusted. Wage index values greater than 0.8 are subject to a budget-neutrality adjustment of 1.064726. 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. We have completed all of these adjustments and have included them in the wage index values reflected in this table.
4 All counties within the State are classified as urban.

II. Regulatory Impact Statement

A. Overall Impact

We have examined the impacts of this notice as required by Executive Order 12866 (September 1993, Regulatory Planning & Review) and the Regulatory Flexibility Act (RFA) (September 19, 1980 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). We recognize that the BIPA adjusted hospice payments upward by 5 percent; however, we did not do a separate analysis of the impact of this payment adjustment. We used the new rates adjusted by the BIPA when estimating the payments to be made under the new wage index and when calculating the budget-neutrality adjustment factor. Overall, we believe the changes included in this notice to be insignificant.

Executive Order 12866 directs agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis (RIA) must be prepared for major rules with economically significant effects ($100 million or more in any 1 year). We have determined that this notice is not an economically significant rule under this Executive Order.

The RFA requires agencies to determine whether a rule will have a significant economic impact on a substantial number of small entities. For purposes of the RFA, small entities include small businesses, nonprofit organizations and government agencies. Start Printed Page 49474Most hospital and most other providers and suppliers are small entities, either by nonprofit status or by having revenues of $5 million or less annually. For purposes of the RFA, most hospices are small entities. Approximately 73 percent of Medicare certified hospices are identified as voluntary, government, or other agencies, and, therefore, are considered small entities. Because the National Hospice and Palliative Care Organization estimates that approximately 70 percent of hospice patients are Medicare beneficiaries, we have not considered other sources of revenue in this analysis.

As discussed below, the estimated decreases in payment to hospices overall are very slight. The effects of this notice indicate that on a regional basis, urban hospices in the New England, Middle Atlantic, South Atlantic, East South Central and Pacific regions will experience a slight decrease in payments. The payment decreases range from a minimum of 0.2 percent (East South Central region) to a maximum of 0.7 percent (New England region). The mid-range of the decrease in estimated payments for urban hospices falls within the Middle Atlantic urban region with a 0.4 percent decrease. Rural hospices in the New England and Middle Atlantic regions will also experience a slight decrease in payments, 0.9 and 0.3 percent respectively. Therefore, based on an analysis of the wage index changes for FY 2002, hospices in the urban and rural areas of the New England and Middle Atlantic regions will be impacted the most. This payment decrease to these small entities indicates that this notice will have a significant impact on a substantial number of small entities. However, nationwide, hospices will receive an overall slight increase in estimated payments. We estimate that total hospice payments will increase by 0.5 percent, or $13,632,000. Urban hospices will receive an increase in estimated payments of 0.3 percent and rural hospices will receive an increase in estimated payments of 1.3 percent.

We would like to emphasize that 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 the options considered, the committee agreed on the methodology described in the committee statement, and adopted it into regulation in the August 8, 1997 final rule. The committee also agreed that this was favorable for the hospice community as well as for beneficiaries. Therefore, we believe that mitigating any negative effects on small entities has been taken into consideration.

In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. This 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 an MSA and has fewer than 100 beds.

Section 202 of the Unfunded Mandate Reform Act of 1995 also requires that agencies assess anticipated costs and benefits before issuing any rule that may result in an expenditure in any 1 year by State, local, and tribal governments, in the aggregate, or by the private sector, in any 1 year of $110 million or more. This notice has no consequential effect on State, local, or tribal governments. We believe the private sector costs of this notice fall below the threshold as well.

We have reviewed this notice under the threshold criteria of Executive Order 13132, Federalism, and have determined that this notice will not have any negative impact on the rights, roles, and responsibilities of State, local, or tribal governments.

B. Anticipated Effects

We have compared estimated payments using the FY 1983 hospice wage index to estimated payments using the FY 2002 wage index and determined the current hospice rates to be budget-neutral. This impact analysis compares hospice payments using the FY 2001 hospice wage index to the estimated payments using the FY 2002 wage index. The data used in developing the quantitative analysis for this notice were obtained from the March 2001 update of the national claims history file of all bills submitted during FY 2000. We deleted bills from hospices that have since closed.

Table C demonstrates the results of our analysis. In Column 2 of Table C, 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 Table C indicates payments that were made using the FY 2001 wage index. Column 4 of Table C is based on FY 2000 claims and estimates payments to be made to hospices using the FY 2002 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). Our analysis indicated that there are 1,319 hospices located in urban areas and 824 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 2000. 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 shows that the greatest increases in payment are for urban areas in the East North Central and West South Central Regions, with a 1.8 percent and 1.9 percent increase, respectively. The greatest decreases in payment are for urban and rural areas in the New England and Middle Atlantic regions.

The breakdown by size, type of ownership, and facility base showed an increase in payments to all hospice programs. Small hospice programs showed significant increases of about 5 percent, while larger programs experienced only a negligible increase. In terms of hospice base, freestanding hospices showed the greatest estimated payment increase while hospices affiliated with home health agencies and skilled nursing facilities showed the smallest amount of payment increase.Start Printed Page 49475

Table C.—Impact of Hospice Wage Index Change

Number of hospices (1)Number of routine home care days in thousands (2)Payments using FY 2001 wage index in thousands (3)Estimated payments using FY 2002 wage index in thousands (4)Percent change in hospice payments (5)
(By Geographic Location)
All Hospices2,14323,7652,995,0143,008,6460.5
Urban Hospices1,31920,0782,616,1982,624,8740.3
Rural Hospices8243,687378,816383,7721.3
By Region—Urban:
New England8966298,78098,045-0.7
Middle Atlantic1692,302321,614320,170-0.4
South Atlantic1844,402618,316616,008-0.4
East North Central2253,246408,377415,8501.8
East South Central951,312148,758148,457-0.2
West North Central941,220139,067139,5500.3
West South Central1782,752324,985331,1031.9
Mountain871,358186,025187,0930.6
Pacific1712,553350,437348,589-0.5
Puerto Rico2727019,84020,0100.9
By Region—Rural:
New England26677,8257,752-0.9
Middle Atlantic3518219,86219,798-0.3
South Atlantic12276378,34380,1492.3
East North Central13859561,82762,5351.1
East South Central8264963,74264,4651.1
West North Central17843945,18745,5770.9
West South Central9847945,05145,7931.6
Mountain8624025,76226,2231.8
Pacific5625129,68729,9460.9
Puerto Rico3221,5301,5330.2
(Skilled)
Routine Home Care Days:
0-1,754 Days38634737,27739,0564.8
1,754-4,373 Days4801,429154,353156,2561.2
4,373-9,681 Days5403,600412,953414,4770.4
9,681 + Days73618,0442,348,7552,357,3980.4
Type of Ownership:
Voluntary1,33615,1081,904,9831,913,1430.4
Proprietary5907,9581,011,3731,016,7570.5
Government18359466,78266,8400.1
Other3410511,87711,9060.2
Hospice Base:
Freestanding91014,4011,826,2421,840,2890.8
Home Health Agency6805,446688,646687,239-0.2
Hospital5363,789460,963461,9800.2
Skilled Nursing Facility1712919,16319,138-0.1

C. Conclusion

We have determined, and we certify, that this rule will have a significant economic impact on a substantial number of small entities. However, we are not preparing analyses for either the RFA or Section 1102(b) of the Act because the methodology for the hospice wage index was previously determined by consensus through a negotiated rulemaking committee. Based on the options considered, the committee agreed on the methodology described in the committee statement, and adopted it into regulation in the August 8, 1997 final rule. The committee, which included representatives of national hospice associates, rural, urban, large and small hospice, multi-site hospice, and consumer groups, agreed that this was favorable for the hospice community as well as for beneficiaries. Therefore, we believe that mitigating any negative effects on small entities has been taken into consideration.

OMB Review

In accordance with the provisions of Executive Order 12866, the Office of Management and Budget reviewed this regulation.

Start Authority

Authority: Section 1814(i) of the Social Security Act (42 U.S.C. 1395f (i)(1))(Catalog of Federal Domestic Assistance Program No. 93.773 Medicare—Hospital Insurance Program; and No. 93.774, Medicare—Supplementary Medical Insurance Program)

End Authority Start Signature

Dated: July 10, 2001.

Thomas A. Scully,

Administrator, Centers for Medicare & Medicaid Services.

Dated: August 31, 2001.

Tommy G. Thompson,

Secretary.

End Signature End Supplemental Information

[FR Doc. 01-23820 Filed 9-20-01; 9:51 am]

BILLING CODE 4210-01-P