Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2006, 29070-29162 [05-9934]
Download as PDF
<![CDATA[
29070
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Part 424
[CMS–1282–P]
RIN 0938–AN65
Medicare Program; Prospective
Payment System and Consolidated
Billing for Skilled Nursing Facilities for
FY 2006
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Proposed rule.
AGENCY:
SUMMARY: This proposed rule would
update the payment rates used under
the prospective payment system (PPS)
for skilled nursing facilities (SNFs), for
fiscal year (FY) 2006, as required by
statute. Annual updates to the PPS rates
are required by section 1888(e) of the
Social Security Act (the Act), as
amended by the Medicare, Medicaid,
and SCHIP Balanced Budget Refinement
Act of 1999 (BBRA), the Medicare,
Medicaid, and State Children’s Health
Insurance Program (SCHIP) Benefits
Improvement and Protection Act of
2000 (BIPA), and the Medicare
Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA),
relating to Medicare payments and
consolidated billing for SNFs. As part of
this year’s annual update, we are
proposing to introduce refinements in
the Resource Utilization Groups, version
III (RUG–III), the case-mix classification
system used under the SNF PPS.
DATES: To be assured consideration,
comments must be received at one of
the addresses provided below, no later
than 5 p.m. on July 12, 2005.
ADDRESSES: In commenting, please refer
to file code CMS–1282–P. Because of
staff and resource limitations, we cannot
accept comments by facsimile (FAX)
transmission.
You may submit comments in one of
three ways (no duplicates, please):
1. Electronically. You may submit
electronic comments on specific issues
in this regulation to https://
www.cms.hhs.gov/regulations/
ecomments. (Attachments should be in
Microsoft Word, WordPerfect, or Excel;
however, we prefer Microsoft Word.)
2. By mail. You may mail written
comments (one original and two copies)
to the following address ONLY: Centers
for Medicare & Medicaid Services,
Department of Health and Human
Services, Attention: CMS–1282–P, P.O.
Box 8016, Baltimore, MD 21244–8016.
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
Please allow sufficient time for mailed
comments to be received before the
close of the comment period.
3. By hand or courier. If you prefer,
you may deliver (by hand or courier)
your written comments (one original
and two copies) before the close of the
comment period to one of the following
addresses. If you intend to deliver your
comments to the Baltimore, Maryland
address, please call telephone number
(410) 786–9994 in advance to schedule
your arrival with one of our staff
members. Room 445–G, Hubert H.
Humphrey Building, 200 Independence
Avenue, SW., Washington, DC 20201; or
7500 Security Boulevard, Baltimore, MD
21244–1850.
(Because access to the interior of the
HHH Building is not readily available to
persons without Federal Government
identification, commenters are
encouraged to leave their comments in
the CMS drop slots located in the main
lobby of the building. A stamp-in clock
is available for persons wishing to retain
a proof of filing by stamping in and
retaining an extra copy of the comments
being filed.)
Comments mailed to the addresses
indicated as appropriate for hand or
courier delivery may be delayed and
received after the comment period.
Submission of comments on
paperwork requirements. You may
submit comments on this document’s
paperwork requirements by mailing
your comments to the addresses
provided at the end of the ‘‘Collection
of Information Requirements’’ section in
this document.
For information on viewing public
comments, see the beginning of the
SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT:
Ellen Gay, (410) 786–4528 (for
information related to the case-mix
classification methodology, and for
information related to swing-bed
providers).
Jeanette Kranacs, (410) 786–9385 (for
information related to the development
of the payment rates, and for
information related to the wage index).
Bill Ullman, (410) 786–5667 (for
information related to coverage
requirements, level of care
determinations, consolidated billing,
and general information).
SUPPLEMENTARY INFORMATION:
Submitting Comments: We welcome
comments from the public on all issues
set forth in this rule to assist us in fully
considering issues and developing
policies. You can assist us by
referencing the file code CMS–1282–P
and the specific ‘‘issue identifier’’ that
PO 00000
Frm 00002
Fmt 4701
Sfmt 4702
precedes the section on which you
choose to comment.
Inspection of Public Comments: All
comments received before the close of
the comment period are available for
viewing by the public, including any
personally identifiable or confidential
business information that is included in
a comment. CMS posts all electronic
comments received before the close of
the comment period on its public Web
site as soon as possible after they have
been received. Hard copy comments
received timely will be available for
public inspection as they are received,
generally beginning approximately 3
weeks after publication of a document,
at the headquarters of the Centers for
Medicare & Medicaid Services, 7500
Security Boulevard, Baltimore,
Maryland 21244, Monday through
Friday of each week from 8:30 a.m. to
4 p.m. To schedule an appointment to
view public comments, phone 1–800–
743–3951.
To assist readers in referencing
sections contained in this document, we
are providing the following Table of
Contents.
Table of Contents
I. Background
A. Current System for Payment of Skilled
Nursing Facility Services Under Part A
of the Medicare Program
B. Requirements of the Balanced Budget
Act of 1997 (the BBA) for Updating the
Prospective Payment System for Skilled
Nursing Facilities
C. The Medicare, Medicaid, and SCHIP
Balanced Budget Refinement Act of 1999
(the BBRA)
D. The Medicare, Medicaid, and SCHIP
Benefits Improvement and Protection
Act of 2000 (the BIPA)
E. The Medicare Prescription Drug,
Improvement, and Modernization Act of
2003 (the MMA)
F. Skilled Nursing Facility Prospective
Payment—General Overview
1. Payment Provisions—Federal Rates
2. Payment Provisions—Initial Transition
Period
G. Use of the Skilled Nursing Facility
Market Basket Index
II. Update of Payment Rates Under the
Prospective Payment System for Skilled
Nursing Facilities
A. Federal Prospective Payment System
1. Costs and Services Covered by the
Federal Rates
2. Methodology Used for the Calculation of
the Federal Rates
B. Case-Mix Adjustment and Other Clinical
Issues
1. Background
2. Case-Mix Refinement Research
a. Data Sources and Analyses
b. Constructing the New RUG–III Groups
c. Development of the Case-Mix Indexes
3. Proposed Refinements to the Case-Mix
Classification System
4. Implementation Issues
E:\FR\FM\19MYP3.SGM
19MYP3
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
5. Assessment Timeframes
6. SNF Certifications and Recertifications
Performed by Nurse Practitioners and
Clinical Nurse Specialists
7. Concurrent Therapy
C. Wage Index Adjustment to Federal Rates
D. Proposed Area Wage Index
1. Proposed Revision of SNF PPS
Geographic Classifications
2. Current SNF PPS Labor Market Areas
Based on MSAs
3. Core-Based Statistical Areas
4. Proposed Revisions to the SNF PPS
Labor Market Areas
a. New England MSAs
b. Metropolitan Divisions
c. Micropolitan Areas
5. Implementation of the Revised Labor
Market Areas
6. Wage Index Data
E. Updates to the Federal Rates
F. Relationship of RUG–III Classification
System to Existing Skilled Nursing
Facility Level-of-Care Criteria
G. Initial Three-Year Transition Period
From Facility Specific to Federal Rates
H. Example of Computation of Adjusted
PPS Rates and SNF Payment
III. The Skilled Nursing Facility Market
Basket Index
A. Use of the Skilled Nursing Facility
Market Basket Percentage
B. Market Basket Forecast Error
Adjustment
C. Federal Rate Update Factor
IV. Consolidated Billing
V. Application of the SNF PPS to SNF
Services Furnished by Swing-Bed
Hospitals
VI. Qualifying Three-Day Inpatient Hospital
Stay Requirement
VII. Provisions of the Proposed Rule
VIII. Collection of Information Requirements
IX. Regulatory Impact Analysis
A. Overall Impact
B. Anticipated Effects
C. Accounting Statement
D. Alternatives Considered
Regulation Text
Addendum: Table 8 (Proposed Wage Index
For Urban Areas Based On Core-Based
Statistical Area (CBSA) Labor Market
Areas); Table 9 (Proposed Wage Index
For Rural Areas Based On CBSA Labor
Market Areas); and Table A
(Metropolitan Statistical Area (MSA)/
CBSA Crosswalk)
In addition, because of the many
terms to which we refer by abbreviation
in this proposed rule, we are listing
these abbreviations and their
corresponding terms in alphabetical
order below:
ADL Activity of Daily Living
AHE Average Hourly Earnings
ARD Assessment Reference Date
BBA Balanced Budget Act of 1997, Pub. L.
105–33
BBRA Medicare, Medicaid and SCHIP
Balanced Budget Refinement Act of 1999,
Pub. L. 106–113
BEA (U.S. Department of Commerce)
Bureau of Economic Analysis
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
BIPA Medicare, Medicaid, and SCHIP
Benefits Improvement and Protection Act
of 2000, Pub. L. 106–554
CAH Critical Access Hospital
CBSA Core-Based Statistical Area
CFR Code of Federal Regulations
CMS Centers for Medicare & Medicaid
Services
CMSA Consolidated Metropolitan
Statistical Area
CPT (Physicians’) Current Procedural
Terminology
DRG Diagnosis Related Group
FI Fiscal Intermediary
FR Federal Register
FY Fiscal Year
GAO Government Accountability Office
HCPCS Healthcare Common Procedure
Coding System
ICD–9–CM International Classification of
Diseases, Ninth Edition, Clinical
Modification
IFC Interim Final Rule with Comment
Period
MDS Minimum Data Set
MEDPAR Medicare Provider Analysis and
Review File
MIP Medicare Integrity Program
MMA Medicare Prescription Drug,
Improvement, and Modernization Act of
2003, Pub. L. 108–173
MSA Metropolitan Statistical Area
NECMA New England County Metropolitan
Area
OIG Office of Inspector General
OMRA Other Medicare Required
Assessment
PCE Personal Care Expenditures
PMSA Primary Metropolitan Statistical
Area
PPI Producer Price Index
PPS Prospective Payment System
PRM Provider Reimbursement Manual
RAI Resident Assessment Instrument
RAP Resident Assessment Protocol
RAVEN Resident Assessment Validation
Entry
RFA Regulatory Flexibility Act, Pub. L. 96–
354
RIA Regulatory Impact Analysis
RUG Resource Utilization Groups
SCHIP State Children’s Health Insurance
Program
SNF Skilled Nursing Facility
STM Staff Time Measure
UMRA Unfunded Mandates Reform Act,
Pub. L. 104–4
I. Background
On July 30, 2004, we published a
notice in the Federal Register (69 FR
45775) that set forth updates to the
payment rates used under the
prospective payment system (PPS) for
skilled nursing facilities (SNFs), for
fiscal year (FY) 2005. Annual updates to
the PPS rates are required by section
1888(e) of the Social Security Act (the
Act), as amended by the Medicare,
Medicaid, and SCHIP Balanced Budget
Refinement Act of 1999 (the BBRA) and
the Medicare, Medicaid, and SCHIP
Benefits Improvement and Protection
Act of 2000 (the BIPA), relating to
PO 00000
Frm 00003
Fmt 4701
Sfmt 4702
29071
Medicare payments and consolidated
billing for SNFs.
A. Current System for Payment of
Skilled Nursing Facility Services Under
Part A of the Medicare Program
Section 4432 of the Balanced Budget
Act of 1997 (the BBA) amended section
1888 of the Act to provide for the
implementation of a per diem PPS for
SNFs, covering all costs (routine,
ancillary, and capital-related) of covered
SNF services furnished to Medicare
beneficiaries under Part A of the
Medicare program, effective for cost
reporting periods beginning on or after
July 1, 1998. In this proposed rule, we
propose to update the per diem payment
rates for SNFs for FY 2006. Major
elements of the SNF PPS include:
• Rates. Per diem Federal rates were
established for urban and rural areas
using allowable costs from FY 1995 cost
reports. These rates also included an
estimate of the cost of services that,
before July 1, 1998, had been paid under
Part B but were furnished to Medicare
beneficiaries in a SNF during a Part A
covered stay. The rates were adjusted
annually using a SNF market basket
index. Rates were case-mix adjusted
using a classification system (Resource
Utilization Groups, version III (RUG–
III)) based on beneficiary assessments
(using the Minimum Data Set (MDS)
2.0). The rates were also adjusted by the
hospital wage index to account for
geographic variation in wages. (In
section II.C of this preamble, we discuss
the wage index adjustment in detail.)
Correction notices were published in
the Federal Register on October 7, 2004
(69 FR 60158) and on December 30,
2004 (69 FR 78445), announcing
corrections to several of the wage
factors. Additionally, as noted in
sections I.C through I.E of this proposed
rule, section 101 of the BBRA, sections
311, 312, and 314 of the BIPA, and
section 511 of the MMA also affect the
payment rate.
• Transition. The SNF PPS included
an initial 3-year, phased transition that
blended a facility-specific payment rate
with the Federal case-mix adjusted rate.
For each cost reporting period after a
facility migrated to the new system, the
facility-specific portion of the blend
decreased and the Federal portion
increased in 25 percentage point
increments. For most facilities, the
facility-specific rate was based on
allowable costs from FY 1995; however,
since the last year of the transition was
FY 2001, all facilities were paid at the
full Federal rate by the following fiscal
year (FY 2002). Therefore, as discussed
in section I.F.2 of this proposed rule, we
are no longer including adjustment
E:\FR\FM\19MYP3.SGM
19MYP3
29072
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
factors related to facility-specific rates
for the coming fiscal year.
• Coverage. The establishment of the
SNF PPS did not change Medicare’s
fundamental requirements for SNF
coverage. However, because RUG–III
classification is based, in part, on the
beneficiary’s need for skilled nursing
care and therapy, we have attempted,
where possible, to coordinate claims
review procedures involving level of
care determinations with the outputs of
beneficiary assessment and RUG–III
classifying activities. We discuss this
coordination in greater detail in section
II.F of this preamble. Moreover, the Part
A SNF benefit has not only level of care
requirements, but also a set of technical,
or ‘‘posthospital’’ requirements as well.
In section VI of this preamble, we
discuss one aspect of the technical
requirement for a qualifying prior
inpatient hospital stay of at least 3
consecutive days, on which we invite
comment.
• Consolidated Billing. The SNF PPS
includes a consolidated billing
provision (described in greater detail in
section IV of this proposed rule) that
requires a SNF to submit consolidated
Medicare bills for almost all of the
services that its residents receive during
the course of a covered Part A stay. (In
addition, this provision places the
Medicare billing responsibility for
physical, occupational, and speechlanguage therapy that the resident
receives during a noncovered stay with
the SNF.) The statute excludes from the
consolidated billing provision a small
list of services—primarily those of
physicians and certain other types of
practitioners—which remain separately
billable to Part B by the outside entity
that furnishes them.
• Application of the SNF PPS to SNF
services furnished by swing-bed
hospitals. Section 1883 of the Act
permits certain small, rural hospitals to
enter into a Medicare swing-bed
agreement, under which the hospital
can use its beds to provide either acute
or SNF care, as needed. For critical
access hospitals (CAHs), Part A pays on
a reasonable cost basis for SNF services
furnished under a swing-bed agreement.
However, in accordance with section
1888(e)(7) of the Act, those swing-bed
SNF services furnished by non-CAH
rural hospitals are paid under the SNF
PPS, effective with cost reporting
periods beginning on or after July 1,
2002. A more detailed discussion of this
provision appears in section V of this
proposed rule.
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
B. Requirements of the Balanced Budget
Act of 1997 (the BBA) for Updating the
Prospective Payment System for Skilled
Nursing Facilities
Section 1888(e)(4)(H) of the Act
requires that we publish in the Federal
Register:
1. The unadjusted Federal per diem
rates to be applied to days of covered
SNF services furnished during the FY.
2. The case-mix classification system
to be applied with respect to these
services during the FY.
3. The factors to be applied in making
the area wage adjustment with respect
to these services.
In the July 30, 1999 final rule (64 FR
41670), we indicated that we would
announce any changes to the guidelines
for Medicare level of care
determinations related to modifications
in the RUG–III classification structure
(see section II.F of this proposed rule).
Along with a number of other
revisions discussed later in this
preamble, this proposed rule provides
the annual updates to the Federal rates
as mandated by the Act.
C. The Medicare, Medicaid, and SCHIP
Balanced Budget Refinement Act of
1999 (the BBRA)
There were several provisions in the
BBRA that resulted in adjustments to
the SNF PPS. These provisions were
described in detail in the final rule that
we published in the Federal Register on
July 31, 2000 (65 FR 46770). In
particular, section 101 of the BBRA
provided for a temporary 20 percent
increase in the per diem adjusted
payment rates for 15 specified RUG–III
groups (SE3, SE2, SE1, SSC, SSB, SSA,
CC2, CC1, CB2, CB1, CA2, CA1, RHC,
RMC, and RMB). Under the law, this
temporary increase remains in effect
until the later of October 1, 2000, or the
implementation of case-mix refinements
in the PPS. A discussion of the case-mix
refinements that we are proposing to
implement appears in section II.B of this
proposed rule. Section 101 also
included a 4 percent across-the-board
increase in the adjusted Federal per
diem payment rates each year for FYs
2001 and 2002, exclusive of the 20
percent increase.
We included further information on
all of the provisions of the BBRA that
affect the SNF PPS in Program
Memoranda A–99–53 and A–99–61
(December 1999), and Program
Memorandum AB–00–18 (March 2000).
In addition, for swing-bed hospitals
with more than 49 (but less than 100)
beds, section 408 of the BBRA provided
for the repeal of certain statutory
restrictions on length of stay and
PO 00000
Frm 00004
Fmt 4701
Sfmt 4702
aggregate payment for patient days,
effective with the end of the SNF PPS
transition period described in section
1888(e)(2)(E) of the Act. In the July 31,
2001 final rule (66 FR 39562), we made
conforming changes to the regulations
in 42 CFR section 413.114(d), effective
for services furnished in cost reporting
periods beginning on or after July 1,
2002, to reflect section 408 of the BBRA.
D. The Medicare, Medicaid, and SCHIP
Benefits Improvement and Protection
Act of 2000 (the BIPA)
The BIPA also included several
provisions that resulted in adjustments
to the PPS for SNFs. These provisions
were described in detail in the final rule
that we published in the Federal
Register on July 31, 2001 (66 FR 39562)
as follows:
• Section 203 of the BIPA exempted
critical access hospital (CAH) swingbeds from the SNF PPS; we included
further information on this provision in
Program Memorandum A–01–09
(January 16, 2001).
• Section 311 of the BIPA eliminated
the 1 percent reduction in the SNF
market basket that the statutory update
formula had previously specified for FY
2001, and changed the 1 percent
reduction specified for FYs 2002 and
2003 to a 0.5 percent reduction. As
discussed in section II.B of this
proposed rule, this provision also
required us to conduct a study of
alternative case-mix classification
systems for the SNF PPS, and to submit
a report to the Congress on the results
of the study.
• Section 312 of the BIPA provided
for a temporary 16.66 percent increase
in the nursing component of the casemix adjusted Federal rate for services
furnished on or after April 1, 2001, and
before October 1, 2002. This section also
required the Government Accountability
Office (GAO) to conduct an audit of SNF
nursing staff ratios and submit a report
to the Congress on whether the
temporary increase in the nursing
component should be continued. GAO
issued this report (GAO–03–176) in
November 2002.
• Section 313 of the BIPA repealed
the consolidated billing requirement for
services (other than physical,
occupational, and speech-language
therapy) furnished to SNF residents
during noncovered stays, effective
January 1, 2001.
• Section 314 of the BIPA adjusted
the payment rates for all of the 14
rehabilitation RUGs (RUC, RUB, RUA,
RVC, RVB, RVA, RHC, RHB, RHA, RMC,
RMB, RMA, RLB, and RLA), in order to
correct an anomaly under which the
existing payment rates for three
E:\FR\FM\19MYP3.SGM
19MYP3
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
particular rehabilitation RUGs—RHC,
RMC, and RMB—were higher than the
rates for some other, more intensive
rehabilitation RUGs. Under the BIPA
adjustment, the temporary increase that
section 101(a) of the BBRA had applied
to the RHC, RMC, and RMB
rehabilitation RUGs was revised from 20
percent to 6.7 percent, and the BIPA
adjustment also applied this temporary
6.7 percent increase to each of the other
11 rehabilitation RUGs.
• Section 315 of the BIPA authorized
us to establish a geographic
reclassification procedure that is
specific to SNFs, but only after
collecting the data necessary to establish
a SNF wage index that is based on wage
data from nursing homes.
We included further information on
several of these provisions in Program
Memorandum A–01–08 (January 16,
2001).
E. The Medicare Prescription Drug,
Improvement, and Modernization Act of
2003 (the MMA)
A provision of the Medicare
Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA)
resulted in a further adjustment to the
PPS for SNFs. Specifically, section 511
of the MMA amended paragraph (12) of
section 1888(e) of the Act to provide for
a temporary 128 percent increase in the
PPS per diem payment for any SNF
resident with Acquired Immune
Deficiency Syndrome (AIDS), effective
with services furnished on or after
October 1, 2004. As discussed in
Transmittal #160 (Change Request
#3291, April 30, 2004), this add-on
applies to claims with diagnosis code
042. Like the temporary add-on
payments created by section 101(a) of
the BBRA (as amended by section 314
of the BIPA), this special AIDS add-on
was not intended to remain in effect
indefinitely. As amended by section 511
of the MMA, section 1888(e)(12)(B) of
the Act specifies that this temporary
increase for patients with AIDS is to
remain in effect only until ‘‘* * * such
date as the Secretary certifies that there
is an appropriate adjustment in the case
mix * * * to compensate for the
increased costs associated with [such]
residents * * *.’’ As discussed
elsewhere in this proposed rule, we are
not proposing at this time to address the
issue of such certification and,
accordingly, the temporary add-on
payments created by section 511 of the
MMA will remain in effect during FY
2006.
The law further provided that the 128
percent increase in payment under the
AIDS add-on is to be ‘‘* * *
determined without regard to any
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
increase’’ under section 101 of the
BBRA (as amended by section 314 of the
BIPA). As explained in the MMA
Conference report, this means that if a
resident qualifies for the temporary 128
percent increase in payment under the
special AIDS add-on, ‘‘the BBRA
temporary RUG add-on does not apply
in this case * * *.’’ (H.R. Conf. Rep. No.
108–391 at 662). The AIDS add-on was
also discussed in Transmittal #160
(Change Request #3291), issued on April
30, 2004, which is available online at
https://www.cms.hhs.gov/manuals/
pm_trans/2004/transmittals/
comm_date_dsc.asp.
In addition, section 410 of the MMA
contained a provision that affects the
consolidated billing requirement, which
we discuss in section IV of this
proposed rule.
F. Skilled Nursing Facility Prospective
Payment—General Overview
The Medicare SNF PPS was
implemented for cost reporting periods
beginning on or after July 1, 1998.
Under the PPS, we pay SNFs through
prospective, case-mix adjusted per diem
payment rates applicable to all covered
SNF services. These payment rates
cover all the costs of furnishing covered
skilled nursing services (routine,
ancillary, and capital-related costs)
other than costs associated with
approved educational activities.
Covered SNF services include posthospital services for which benefits are
provided under Part A and all items and
services that, before July 1, 1998, had
been paid under Part B (other than
physician and certain other services
specifically excluded under the BBA)
but furnished to Medicare beneficiaries
in a SNF during a covered Part A stay.
A complete discussion of these
provisions appears in the May 12, 1998
interim final rule (63 FR 26252).
1. Payment Provisions—Federal Rate
The PPS uses per diem Federal
payment rates based on mean SNF costs
in a base year updated for inflation to
the first effective period of the PPS. We
developed the Federal payment rates
using allowable costs from hospitalbased and freestanding SNF cost reports
for reporting periods beginning in FY
1995. The data used in developing the
Federal rates also incorporated an
estimate of the amounts that would be
payable under Part B for covered SNF
services furnished to individuals during
the course of a covered Part A stay in
a SNF.
In developing the rates for the initial
period, we updated costs to the first
effective year of PPS (the 15-month
period beginning July 1, 1998) using a
PO 00000
Frm 00005
Fmt 4701
Sfmt 4702
29073
SNF market basket, and then
standardized for the costs of facility
differences in case-mix and for
geographic variations in wages.
Providers that received new provider
exemptions from the routine cost limits
were excluded from the database used
to compute the Federal payment rates,
as well as costs related to payments for
exceptions to the routine cost limits. In
accordance with the formula prescribed
in the BBA, we set the Federal rates at
a level equal to the weighted mean of
freestanding costs plus 50 percent of the
difference between the freestanding
mean and weighted mean of all SNF
costs (hospital-based and freestanding)
combined. We computed and applied
separately the payment rates for
facilities located in urban and rural
areas. In addition, we adjusted the
portion of the Federal rate attributable
to wage-related costs by a wage index.
The Federal rate also incorporates
adjustments to account for facility casemix, using a classification system that
accounts for the relative resource
utilization of different patient types.
This classification system, Resource
Utilization Groups, version III (RUG–
III), uses beneficiary assessment data
from the Minimum Data Set (MDS)
completed by SNFs to assign
beneficiaries to one of 44 RUG–III
groups. The May 12, 1998 interim final
rule (63 FR 26252) included a complete
and detailed description of the RUG–III
classification system, and a further
discussion appears in section II.B of this
proposed rule.
The Federal rates in this proposed
rule reflect an update to the rates that
we published for FY 2005 equal to the
full change in the SNF market basket
index. According to section
1888(e)(4)(E)(ii)(IV) of the Act, for FY
2006, we would update the rate by
adjusting the current rates by the full
SNF market basket index.
2. Payment Provisions—Initial
Transition Period
The SNF PPS included an initial,
phased transition from a facility-specific
rate (which reflected the individual
facility’s historical cost experience) to
the Federal case-mix adjusted rate. The
transition extended through the
facility’s first three cost reporting
periods under the PPS, up to and
including the one that began in FY
2001. Accordingly, starting with cost
reporting periods beginning in FY 2002,
we base payments entirely on the
Federal rates and, as indicated in
section II.G of this proposed rule, we no
longer include adjustment factors
related to facility-specific rates for the
coming fiscal year.
E:\FR\FM\19MYP3.SGM
19MYP3
29074
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
G. Use of the Skilled Nursing Facility
Market Basket Index
Section 1888(e)(5) of the Act requires
us to establish a SNF market basket
index that reflects changes over time in
the prices of an appropriate mix of
goods and services included in the
covered SNF services. The SNF market
basket index is used to update the
Federal rates on an annual basis. The
final rule published on July 31, 2001 (66
FR 39562) revised and rebased the
market basket to reflect 1997 total cost
data.
In addition, as explained in the FY
2004 final rule (68 FR 46058, August 4,
2003) and in section III.B of this
proposed rule, the annual update of the
payment rates includes, as appropriate,
an adjustment to account for market
basket forecast error. This adjustment
takes into account the forecast error
from the most recently available fiscal
year for which there are final data, and
is applied whenever the difference
between the forecasted and actual
change in the market basket exceeds a
0.25 percentage point threshold. For FY
2004 (the most recently available fiscal
year for which there are final data), the
estimated increase in the market basket
index was 3.0 percentage points, while
the actual increase was 3.1 percentage
points. Therefore, the payment rates for
FY 2006 do not include a forecast error
adjustment, as the difference between
the estimated and actual amounts of
change does not exceed the 0.25
percentage point threshold. Table 1
below shows the forecasted and actual
market basket amounts for FY 2004.
TABLE 1.—FY 2004 FORECAST ERROR CORRECTION FOR CMS SNF MARKET BASKET
Forecasted
FY 2004 increase *
Index
SNF ....................................................................................................................................................
3.0
Actual FY
2004 increase **
3.1
FY 2004
forecast error
correction ***
0.0
* Published in August 4, 2003 Federal Register; based on second quarter 2003 Global Insight/DRI–WEFA forecast.
** Based on the fourth quarter 2004 Global Insight/DRI–WEFA forecast.
*** The FY 2004 forecast error correction will be applied to the FY 2006 PPS update. Any forecast error less than 0.25 percentage points is not
reflected in the update.
II. Update of Payment Rates Under the
Prospective Payment System for Skilled
Nursing Facilities
A. Federal Prospective Payment System
This proposed rule sets forth a
schedule of Federal prospective
payment rates applicable to Medicare
Part A SNF services beginning October
1, 2005. The schedule incorporates per
diem Federal rates that provide Part A
payment for all costs of services
furnished to a beneficiary in a SNF
during a Medicare-covered stay.
1. Costs and Services Covered by the
Federal Rates
The Federal rates apply to all costs
(routine, ancillary, and capital-related
costs) of covered SNF services other
than costs associated with approved
educational activities as defined in
§ 413.85. Under section 1888(e)(2) of the
Act, covered SNF services include posthospital SNF services for which benefits
are provided under Part A (the hospital
insurance program), as well as all items
and services (other than those services
excluded by statute) that, before July 1,
1998, were paid under Part B (the
supplementary medical insurance
program) but furnished to Medicare
beneficiaries in a SNF during a Part A
covered stay. (These excluded service
categories are discussed in greater detail
in section V.B.2 of the May 12, 1998
interim final rule (63 FR 26295 through
63 FR 26297)).
2. Methodology Used for the Calculation
of the Federal Rates
The proposed FY 2006 rates would
reflect an update using the full amount
of the latest market basket index. The
FY 2006 market basket increase factor is
estimated to be 3.0 percent. Consistent
with previous years, this factor may be
revised in the final rule when later
forecast data are available. For a
complete description of the multi-step
process, see the May 12, 1998 interim
final rule (63 FR 26252). We note that
in accordance with section 101(a) of the
BBRA and section 314 of the BIPA, the
existing, temporary increase in the per
diem adjusted payment rates of 20
percent for certain specified clinically
complex RUGs (and 6.7 percent for
rehabilitation RUGs) remains in effect
until the implementation of case-mix
refinements. (A discussion of the casemix refinements that we now propose to
implement appears in section II.B of this
preamble.)
We used the SNF market basket to
adjust each per diem component of the
Federal rates forward to reflect cost
increases occurring between the
midpoint of the Federal fiscal year
beginning October 1, 2004, and ending
September 30, 2005, and the midpoint
of the Federal fiscal year beginning
October 1, 2005, and ending September
30, 2006, to which the payment rates
apply. In accordance with section
1888(e)(4)(E)(ii)(IV) of the Act, the
payment rates for FY 2006 are updated
by a factor equal to the full market
basket index percentage. The rates
would be further adjusted by a wage
index budget neutrality factor, described
later in this section. The unadjusted
rates are the same under both the
existing 44 group RUG classification
system and the proposed RUG–53
classification system. Tables 2 and 3
reflect the updated components of the
unadjusted Federal rates for FY 2006.
TABLE 2.—FY 2006 UNADJUSTED FEDERAL RATE PER DIEM—URBAN
Nursing—
case-mix
Rate component
Per Diem Amount ....................................................................................................
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00006
Fmt 4701
Sfmt 4702
Therapy—
case-mix
$137.44
E:\FR\FM\19MYP3.SGM
$103.53
19MYP3
Therapy—
non-case-mix
Non-case-mix
$13.63
$70.15
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
29075
TABLE 3.—FY 2006 UNADJUSTED FEDERAL RATE PER DIEM—RURAL
Nursing—
case-mix
Rate component
Per Diem Amount ....................................................................................................
B. Case-Mix Adjustment and Other
Clinical Issues
[If you choose to comment on issues in
this section, please include the caption
‘‘Case-Mix Adjustment and Other
Clinical Issues’’ at the beginning of your
comments.]
Under the BBA, we must publish the
SNF PPS case-mix classification
methodology applicable for the next
Federal FY before August 1 of each year.
As discussed in the following sections,
we propose to begin utilizing a
refinement to the RUG–III case-mix
classification system applicable to the
SNF PPS during FY 2006, and we
specifically solicit comments on the
proposed refinement.
1. Background
The SNF PPS replaced the cost-based
structure that had been in effect since
the inception of the Medicare program.
Under the SNF PPS, providers have
more flexibility in the use of Medicare
funds but are responsible not only for
furnishing the full range of services to
Medicare beneficiaries, but for the cost
effectiveness of their purchasing
decisions. Like the inpatient hospital
PPS, reimbursement for all services,
including therapy and other ancillaries
such as diagnostic tests, supplies, and
pharmacy, were for the first time
included in the SNF Part A ‘‘bundle of
services’’ and reimbursed directly to the
SNF rather than to the actual entity
furnishing the service.
In addition, in response to over a
decade of rapidly rising Medicare SNF
payments, the SNF PPS instituted
controls to adjust for identified
overutilization and inflated charge
structures for therapy and other
ancillary services. By restructuring the
payment system to reflect a more
appropriate expenditure level, there was
an aggregate decrease in Medicare
expenditure levels for the first SNF PPS
year. Providers responded to the SNF
PPS by restructuring their operations
and practice patterns in an effort to
adapt to the new payment structure and
incentives.
These rapid changes in facility
practices and Medicare payment also
generated significant concerns that the
transition to a prospective payment
system would impede access for
beneficiaries with complex medical
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
$131.30
needs and, by decreasing aggregate
payments to SNFs, negatively affect the
quality of care in nursing homes across
the country. The research presented in
this proposed rule was initiated as part
of a broad-based effort to investigate and
respond to access, quality, and payment
concerns raised by industry, advocates,
and other stakeholders.
During the course of this effort, CMS
developed tools to monitor and evaluate
quality of care that are now integral
components of our program oversight
activities, including the use of Quality
Indicators, Quality Measures, and
Nursing Home Compare. As discussed
later in this section, the development of
these new capabilities has also
positioned us to move forward in new
areas. The refinements discussed in this
section are based on research originally
conducted by Abt Associates (and later
validated by the Urban Institute) that
was initiated immediately after the
introduction of the SNF PPS in 1999.
In the BBRA, the Congress acted to
address these access and quality
concerns by enacting a series of
temporary payment adjustments. At
present, only one of these payment
adjustments is still in effect, a 20
percent increase in the per diem
adjusted payment rates for 12 complex
medical RUG–III groups (SE3, SE2, SE1,
SSC, SSB, SSA, CC2, CC1, CB2, CB1,
CA2, and CA1,) and a 6.7 percent
increase to all 14 rehabilitation groups.
This legislation specified that the
payment adjustments would continue
until the later of: (1) October 1, 2000, or
(2) implementation of a refined case-mix
classification system under section
1888(e)(4)(G)(i) of the Act that would
better account for medically complex
patients.
As we noted in the SNF PPS proposed
rule for FY 2001 (65 FR 19190, April 10,
2000), this mandated rate increase was
intended to serve as a temporary,
interim adjustment to the payment rates
and RUG–III case-mix classification
system as published in the final rule of
July 30, 1999, until implementation of
the case-mix refinements described in
the legislation. In that FY 2001
proposed rule, we included a proposal
for an extensive, comprehensive set of
refinements to the existing case-mix
classification system that collectively
would have resulted in expanding the
PO 00000
Frm 00007
Fmt 4701
Sfmt 4702
Therapy—
case-mix
$119.38
Therapy—
non-case-mix
Non-case-mix
$14.56
$71.45
existing 44-group structure to well over
150 groups.
The speed with which we conducted
this initial evaluation of the SNF PPS
demonstrated our commitment to
ensuring the accuracy and equity of the
new payment system, but the evaluation
had important limitations.
Comprehensive SNF PPS data were not
yet available, and the research was
conducted using 1995–1997 data
housed in a large, cross-linked research
database collected from only six states
that had implemented a RUG–III
payment system prior to July 1998
(either through the Federal case-mix
demonstration project or for state
Medicaid payment). These limitations
were explained in the proposed rule
along with our plans to validate the data
using a national SNF PPS database (65
FR 19193, April 10, 2000).
In conducting the validation analyses,
it became clear that the introduction of
the SNF PPS and SNF consolidated
billing had caused changes in facility
practice patterns and billing. Some of
these changes could also have been
related to the use of a national database
and to changing industry practices
during the early stages of the SNF PPS
implementation. While it was still true
that beneficiaries requiring both
rehabilitation and extensive medical
services used greater amounts of
ancillary services, the distribution
patterns for those high-cost ancillaries
(such as medications and respiratory
therapy) had changed from the patterns
in the six-state data. These results, in
conjunction with the high degree of
intra-group and inter-group variability
in ancillary utilization identified in both
the initial and validation analyses,
raised new questions that needed to be
addressed prior to implementing
refinements. For these reasons, we
decided not to implement such
refinements at that time. (See the FY
2001 final rule, 65 FR 46773, July 31,
2000.)
Several months later, the Congress
enacted the BIPA. Of the various
provisions of this legislation that
addressed the SNF PPS, one directive
also addressed the future development
of the SNF PPS. Specifically, section
311(e) of the BIPA directed us to
conduct a study of the different systems
for categorizing patients in Medicare
SNFs in a manner that accounts for the
E:\FR\FM\19MYP3.SGM
19MYP3
29076
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
relative resource utilization of different
patient types and to issue a report with
any appropriate recommendations to the
Congress.
Based upon the broad language
describing the purpose of this study,
and the multi-year timeframe provided
for conducting it, we believe that the
Congress clearly intended for this study
to address comprehensive changes, by
evaluating a number of different
classification systems and considering
the full range of patient types. In
contrast, since the BBRA specifically
ties the duration of its temporary
payment increases to the
implementation of a case-mix
refinement that would ‘‘better account
for medically complex patients,’’ we
believe that even case-mix refinements
of a more incremental nature would
meet this more targeted mandate to
better account for medically complex
patients, and need not await the
completion of the broader changes
envisioned in the BIPA provision.
Moreover, ongoing analysis of the
SNF PPS showed that providers have
adjusted to it, and that the SNF PPS
rates have generally covered the cost of
care to Medicare beneficiaries. For
example, in its March 2005 report,
MedPAC estimated 2005 profit margins
for freestanding SNFs of 13 percent. In
this environment, it is appropriate to
reevaluate the need for maintaining
payment adjustments that were always
intended to be temporary.
2. Case-Mix Refinement Research
a. Data Sources and Analyses
In July 2001, we awarded a contract
to the Urban Institute (Urban) for
performance of research to aid us in
making refinements to the case-mix
classification system under section
1888(e)(4)(G)(i) of the Act and starting
the case-mix study mandated by section
311(e) of the BIPA. The first phase of the
contract focused on developing options
for refining the case-mix classification
system under section 1888(e)(4)(G)(i) of
the Act to account for medically
complex patients. As part of this
research, Urban updated and broadened
the database created for the previous
refinement analyses by using 1999
matched MDS and SNF claims, and
applied the latest cost report data (1998
and 1999) to estimate costs more
accurately for non-therapy ancillary and
other services.
We then used this updated and
broadened database to replicate and
validate the earlier studies conducted by
Abt. The study used Medicare SNF
claims data for calendar year 1999 and
MDS data from our National MDS
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
Repository. We matched the claims to
the MDS assessments upon which they
were based, yielding approximately 2.7
million MDS segments, resulting in
every national facility that billed
Medicare for a Part A SNF stay in 1999
being represented in the database. We
allocated the non-therapy ancillary costs
to the portion of the stay in which they
were most likely to have been incurred
according to a set of decision rules. We
performed comparative analyses of cost
and charge data to other existing
administrative data sets in order to
establish the validity of these data. We
also performed a further regression
analysis of costs and RUG–III groups.
In addition, we constructed anew the
case-mix indexes using our Staff Time
Measurement (STM) study data. The
STM data were collected in 1990, 1995,
and 1997, and are described in the May
12, 1998 interim final rule (63 FR
26252) that implemented the SNF PPS.
Urban then analyzed 270,215 records,
a 10 percent sample of this updated and
broadened database. As expected, our
analyses again verified that non-therapy
ancillary costs are higher for Medicare
beneficiaries who classify into the
Extensive Services category than for
those who classify to other categories. In
these analyses, Urban found that the
addition of a combined Rehabilitation
plus Extensive group improved the
predictive power of the model. These
results were very similar to the
preliminary Abt results discussed in our
FY 2001 proposed rule, and provided
validation for the preliminary Abt
analyses (that is, both studies showed
an increase in the R-square (explanation
of variance) for non-therapy ancillaries
from approximately 4.1 percent in the
44-group model to 8 percent in the 58group model that added nine
Rehabilitation plus Extensive groups).
Urban then replicated its results with
2001 data using the same analytic
protocols. In this study, Urban found
that the addition of a new RUG–III
Rehabilitation plus Extensive category
was consistent with the prior research.
Urban used a 163,386 record test sample
and found that the R-square for nontherapy ancillaries improved to 9.5
percent from the previous result of 4.1
percent mentioned above. The analyses
were repeated on a 170,253 record
validation sample with a comparable
result; that is, an R-square of 10.3
percent.
While maintaining the general
structure of the RUG–III system, we
found that the most viable way to refine
the system at the present time would be
to add groups to the top of the hierarchy
to capture beneficiaries who qualify for
both the Extensive Services category
PO 00000
Frm 00008
Fmt 4701
Sfmt 4702
and the Rehabilitation Therapy
category. In addition, beneficiaries who
qualify for Extensive Services and
receive rehabilitation services have
assumed a larger percentage of the
Medicare patient population in SNFs in
recent years. Therefore, we believe that
the RUG–III case-mix classification
system can provide even more accurate
payment for these beneficiaries if
refined to create a new RUG–III category
for beneficiaries who qualify for both
the Extensive Services and
Rehabilitation Therapy categories.
b. Constructing the New RUG–III Groups
Our research findings showed little or
no correlation between the groups
within the Extensive Services category
(that is, SE1, SE2, SE3) and the level of
rehabilitation services used. For this
reason, the structure for this new
hierarchy level would closely mirror
that of the existing Rehabilitation
Therapy groups. Normally, this
methodology would result in the
creation of 14 new groups, the number
that was originally proposed in the FY
2001 proposed rule. However, for the
reasons discussed below, the more
recent research (Urban 2003) has shown
that a smaller number of RUG–III groups
are sufficient to address the needs of
beneficiaries eligible for a new RUG–III
category, Combined Rehabilitation and
Extensive Care.
First, we found that several of the
groups had very few beneficiaries
assigned to them. In fact, no
beneficiaries at all were assigned to
several of the lowest ADL score
rehabilitation groups. Second, under the
present structure, each Rehabilitation
group is sub-divided into three levels
based on the activities of daily living
(ADL) score. The lowest level ADL score
for the Rehabilitation groups is either 4–
7 or 4–8, and very few beneficiaries
currently classify into those groups. No
beneficiaries who would qualify for the
proposed newly created groups would
classify into such a low ADL score level,
as a minimum ADL score of seven is
required for classification into an
Extensive Care group.
Therefore, it appears that stratification
for the lowest level ADL scores for the
proposed new groups would add
needless complexity and, thus, would
not be warranted. Instead, we propose to
combine that level with the next higher
level, and would no longer use the ADL
scores lower than 7. Thus, the proposed
new groups would be stratified only by
two levels of ADL score. For example,
the Rehabilitation High plus Extensive
Services group would be subdivided
into only two ADL levels, ADL scores of
7–12 and 13–18. This left us with only
E:\FR\FM\19MYP3.SGM
19MYP3
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
one level for Rehabilitation Low plus
Extensive Services and with only two
levels at each of the other sub-categories
in the new category, for a total of 9 new
29077
groups. As a result, we are proposing
the addition of 9 new RUG–III groups.
TABLE 3a.—CROSSWALK BETWEEN EXISTING RUG–III REHABILITATION GROUPS AND THE PROPOSED EXTENSIVE PLUS
REHABILITATION GROUPS
Current rehabilitation
groups
Rehab Ultra ..................................................................................................................................
Rehab Very High ..........................................................................................................................
Rehab High ..................................................................................................................................
Rehab Medium .............................................................................................................................
Rehab Low ...................................................................................................................................
c. Development of the Case-Mix Indexes
We developed the case-mix indexes
for the proposed refined RUG–III system
using the same method used for
calculating the initial SNF PPS case-mix
indexes. The original staff time studies
conducted in 1990, 1995, and 1997
resulted in the assignment of residentspecific and non-resident specific time
(minutes) to individual SNF residents.
In the initial determination of the casemix indexes, the residents were
classified into the 44-group system and
the minutes of staff time, nursing, and
therapy services, where appropriate,
remained associated with those
residents. All of the staff time was
stratified by type of staff providing the
minutes of time (for example, RN, LPN,
etc.), and the minutes were weighted for
salary.
In order to calculate weights for the
proposed refined system, we used the
minutes as originally assigned at the
individual patient level. We reclassified
the patients into the proposed 53 groups
with their associated wage-weighted
minutes of resident-specific and
nonresident-specific staff time. The next
step was to apply these wage-weighted
minutes to the entire sample population
of 26 million days. We multiplied the
population in each group by the wageweighted minutes for each of the staff
types. We then derived an average for
the group using the sum of the wageweighted minutes for all staff (nursing
and therapy staff minutes were
calculated separately) xxdivided by the
total population for that group. The
relative weight was then calculated by
dividing that average by the average
minutes across all of the RUG–III
groups.
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
∑
∑
∑
∑
∑
∑
∑
∑
∑
∑
∑
∑
∑
∑
The nursing weights changed more
than the therapy weights, due to the
redistribution of patients from existing
groups to the newly created proposed
groups. Even though many of the
beneficiaries who move into one of the
proposed new groups are from an
existing therapy group, the therapy
weights are affected only slightly. This
is because the amount of therapy time
does not change significantly between
the existing groups and the proposed
new groups. The therapy groups were
already narrowly stratified by minutes
of therapy provided. The groups’
weights would be affected only to the
extent that the individual beneficiaries
who are reclassified into one of the
proposed new groups have unusually
high or low minutes of therapy within
the specific limits. The nursing weights
are more affected by the
reclassifications, as those are based on
a much broader scope of possible
minute values.
The therapy weights for the nine
proposed Rehabilitation Therapy plus
Extensive Services groups were
identical to those for the comparable
existing RUG–III rehabilitation therapy
groups. Although we are capturing
increased medical/clinical complexity
with the proposed new groups, the
therapy contribution remains the same
as for the existing therapy groups. In
this way, the Rehabilitation High
therapy weight is identical to the new
Rehabilitation High plus Extensive
Services sub-category.
The effect of the increased number of
groups and changes in the case-mix
indexes should be distributional. By this
we mean that the relative weights
assigned to each RUG–III group would
PO 00000
Frm 00009
Fmt 4701
Sfmt 4702
RUC–ADL 16–18. ...
RUB–ADL 9–15 ......
RUA–ADL 4–8 ........
RVC–ADL 16–18. ...
RVB–ADL 9–15. ......
RVA–ADL 4–8 .........
RHC–ADL 13–18. ...
RHB–ADL 8–12 . ....
RHA–ADL 4–7 ........
RHC–ADL 15–18 ....
RHB–ADL 8–14. .....
RHA–ADL 4–7 ........
RLB–ADL 14–18 .....
RLA–ADL 4–13 .......
New combined extensive plus rehabilitation
groups
∑ RUX–ADL 16–18.
∑ RUL–ADL 7–15.
∑ RVX–ADL 16–18.
∑ RVL–ADL 7–15.
∑ RUX–ADL 13–18.
∑ RUL–ADL 7–12.
∑ RUX–ADL 15–18.
∑ RUL–ADL 7–14.
∑ RUX–ADL 7–18
shift so that the proposed new
Rehabilitation plus Extensive groups
would have the highest relative weights
and the weights for other RUG–III
groups would decrease proportionally.
The results of applying these methods
to index calculation worked well and
yielded hierarchically sound indexes for
all of the groups; that is, the indexes for
the highest groups in the hierarchy are
higher than for those below it, and this
pattern holds throughout the proposed
new category.
The nursing indexes in the new
category, as well as in the existing
rehabilitation category, are naturally
more compressed (that is, encompass a
smaller range) than those in the 44group RUG–III rehabilitation groups.
The groups within the new
Rehabilitation plus Extensive category
are more homogeneous than were the
rehabilitation groups of the 44-group
system. By removing the most clinically
complex cases and better accounting for
them by putting them in rehabilitation
groups of their own, both the resulting
proposed new category and the
remaining rehabilitation category groups
would be more homogeneous and,
therefore, the relative weights for each
set of groups would exhibit less
variance.
Next, we simulated payments using
the existing weights compared to the
new weights to ensure that the
refinement did not result in greater or
lesser aggregate payments. The
simulation results showed an almost
exact match in payments under both
case-mix models. However, the
proposed new 53-group model did yield
a slight decrease (less than 1 percent) in
aggregate Medicare payments. To
E:\FR\FM\19MYP3.SGM
19MYP3
29078
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
remove this minor variance, we then
applied a factor of +.02 to calibrate the
nursing indexes and re-ran the
simulation. Using this calibration factor
of +.02, we are able to ensure absolute
parity of aggregate payment under the
53-group RUG–III system compared to
the 44-group system.
Finally, we propose to provide for an
additional adjustment to the nursing
component of the case-mix weights
(which includes non-therapy ancillary
services) for all RUG–53 groups. As
discussed further in section II.B.3 of this
proposed rule, we have reviewed data
that show a high degree of variability in
non-therapy ancillary utilization, not
only within but across RUG groups.
Therefore, we believe that it is
appropriate to adjust the case-mix
weights for all 53 groups (that is, the
existing 44 RUG–III groups plus the 9
new groups that we are proposing to
create in this proposed rule) to better
account for non-therapy ancillary
variability. We would do this under our
authority in section 1888(e)(4)(G)(i) of
the Act to establish an ‘‘appropriate
adjustment to account for case mix
* * * *’’
In determining the size of this
adjustment, we considered not only the
high degree of variability in non-therapy
ancillary costs, but also the absence of
an outlier policy under the SNF PPS.
Accordingly, we looked at the outlier
pool established under another postacute care PPS, the one for inpatient
rehabilitation facility (IRF) services,
which is set at 3 percent of aggregate
expenditures. For the purpose of this
refinement, our calculations employed a
comparable funding level that could be
targeted toward payment of non-therapy
ancillaries. Based on this analysis, we
are proposing an increase to the nursing
component of the case-mix weights (the
component that includes non-therapy
ancillaries) of approximately 8.4
percent, which equates to
approximately 3 percent of aggregate
expenditures under the SNF PPS. The
final RUG–53 nursing indexes are
presented in Tables 4a and 5a. Further
information regarding this adjustment
can be found in section II.B.3 of this
proposed rule.
3. Proposed Refinements to the CaseMix Classification System
[If you choose to comment on issues in
this section, please include the caption
‘‘Proposed Refinements to the Case-Mix
Classification System’’ at the beginning
of your comments.]
We note that, of the various
individual refinements that were
collectively set forth in the FY 2001
proposed rule (65 FR 19194), the
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
particular refinement that entailed the
least amount of added complexity (yet
addressed the medically complex
patient) involved the creation of several
additional groups that would comprise
a new, combined Rehabilitation plus
Extensive Services category. As we
noted in that proposed rule:
There are * * * a significant number
of beneficiaries who would classify into
the Extensive Services category based
on clinical conditions but who, because
they are also receiving rehabilitation
services, classify into one of the
Rehabilitation groups instead (due to
the hierarchical logic of the RUG–III
classification system). These
beneficiaries carry with them the same
non-therapy ancillary costs associated
with their complex clinical needs even
though they are classified into a RUG–
III Rehabilitation category. The high
costs for beneficiaries in the Extensive
Services category suggest that the
payment rate for Extensive Services
should be increased. However,
increasing the payment rate without
further adjustments could adversely
affect provider incentives to provide
therapy to beneficiaries requiring
Extensive Services. Therefore, we
expanded the scope of the proposed
refinement to include new categories for
beneficiaries who qualify for both
Extensive Services and a RUG–III
Rehabilitation category.
Further, as our subsequent research
(discussed in the previous section)
confirmed, the creation of a proposed
new Rehabilitation plus Extensive
category would be a means of
accounting more accurately for the costs
of certain medically complex patients,
with the added benefit of a minimal
degree of added complexity. We note
that, in the past, some support has been
expressed for making this particular
type of modification to the existing casemix classification system.
Therefore, we propose to refine the
case-mix classification system under
section 1888(e)(4)(G)(i) of the Act by
creating a new, combined Rehabilitation
plus Extensive category, that better
accounts for medically complex
patients, as required in section 101 of
the BBRA. Accordingly, the payment
rates set forth in this proposed rule
reflect the use of the refined 53-group
RUG classification system that we are
proposing. The nine groups that we
propose to add to the existing RUG–III
system are as follows:
RUX Rehabilitation Ultra High plus
Extensive Services, High
RUL Rehabilitation Ultra High plus
Extensive Services, Low
RVX Rehabilitation Very High plus
Extensive Services, High
PO 00000
Frm 00010
Fmt 4701
Sfmt 4702
RVL
Rehabilitation Very High plus
Extensive Services, Low
RHX Rehabilitation High plus Extensive
Services, High
RHL Rehabilitation High plus Extensive
Services, Low
RMX Rehabilitation Medium plus Extensive
Services, High
RML Rehabilitation Medium plus Extensive
Services, Low
RLX Rehabilitation Low plus Extensive
Services
We note that, like our current
proposal, the case-mix refinement that
we considered in our FY 2001 proposed
rule would have reconfigured the RUGs
themselves, in a general effort to
allocate payments more accurately
under the SNF PPS. However, that
earlier proposal also included an
additional element, which was intended
to help ensure more accurate allocation
of payments specifically with regard to
non-therapy ancillaries (such as drugs
and medications, laboratory services,
supplies and other equipment). For
example, it proposed moving the nontherapy ancillary costs used in
establishing the nursing case-mix
component of the payment rates to a
separate, newly created ‘‘medical
ancillary’’ component (65 FR 19192,
April 10, 2000). In addition, it suggested
a number of possible models, both
weighted and unweighted, for a new
non-therapy ancillary index (65 FR
19248ff). As noted in the FY 2001 final
rule, these elements ultimately were not
adopted when subsequent research
indicated that their added complexity
would outweigh their increased
predictive power (65 FR 46774, July 31,
2000).
Following the publication of that final
rule, further research in this area
revealed a high degree of variability in
non-therapy ancillary utilization, both
within and across the various RUG–III
groups. This finding suggested that
using an index model to address nontherapy ancillary services might require
the creation of such a high number of
groups as to be impractical.
In fact, the ability of the SNF PPS to
account adequately for non-therapy
ancillary services has been the subject of
attention (and a focus of our research)
since the very inception of the system.
When the Congress originally enacted
the SNF PPS in the BBA, it expressed
concern in the accompanying legislative
history ‘‘* * * that under a prospective
payment system that includes all
services there may be incentives to
decrease the use of ancillary services’
(H. Rep. No. 105–149 at 1318).
Subsequent legislative initiatives, such
as the BBRA mandate to develop casemix refinements that better account for
E:\FR\FM\19MYP3.SGM
19MYP3
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
‘‘medically complex’’ patients, and the
directive in section 311(d) of the BIPA
for the GAO to conduct a study of the
adequacy of Medicare’s SNF payment
rates, can all be viewed in the context
of an ongoing Congressional concern in
this area.
For those reasons, and because the
data that we have show wide variability
in non-therapy ancillary utilization
within each RUG, we believe the
refinement that we now propose should
include not only a reconfiguration of the
RUGs that addresses the accuracy of
payment allocation in general terms, but
also an additional element that
improves the accuracy of payment
allocation and accounts more directly
for cost variations related to nontherapy ancillary services. Accordingly,
as part of our proposed refinement, we
propose to increase the case-mix
indexes of the existing 44 RUG–III
groups (as well as those of the nine
proposed new Rehabilitation plus
Extensive Services RUGs), by
calculating a percentage increase that
would increase aggregate payments.
As noted previously, we have
reviewed data that show great
variability in the ancillary services
(such as pharmacy) utilized by different
SNF residents who are classified into
the same RUG–III group. For example,
two different patients, both classified
into the SE3 group, might utilize
markedly different amounts of ancillary
services for reasons that are not
captured within the current RUG–III
classification methodology. Our data
show that the same is true across all of
the existing 44 RUG–III groups. The
addition of the 9 new groups does not,
in itself, compensate for this
discrepancy. Although the SNF
payment system is designed as a
prospective payment system, under
which SNFs that treat patients grouped
into the same clinical condition should
receive the same base payment, the
variability in ancillary usage that our
data show makes it difficult to account
fully for non-therapy ancillary costs by
adjusting the number of groups.
Therefore, we believe that it is
appropriate, considering the data that
we have available to us, to provide for
an adjustment to each RUG case-mix
weight to account for the variability in
non-therapy ancillaries, using the
authority that we have under section
1888(e)(4)(G)(i) of the Act.
Additionally, we have found a high
degree of variability in non-therapy
ancillaries not only within but across
RUG groups. We have reviewed data
showing that an individual patient who
is classified into a less intensive RUG
may nonetheless be significantly more
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
expensive to treat in terms of nontherapy ancillaries than an individual
patient in a more intensive RUG. The
data that we have do not adequately
explain these discrepancies, and the
addition of the 9 new RUGs does not
eliminate them. Our data show that the
same is true across all 44 RUG–III
groups. We note that in creating the SNF
PPS, the Congress enacted the only PPS
legislation in the Medicare program that
does not establish an outlier policy to
capture high variability in resource
utilization. Therefore, in view of the
data that we have available to us that
demonstrates wide disparities in nontherapy ancillary resources consumed
by patients both within and across
RUG–III groups, we believe that it is
appropriate to adjust the case-mix
weights for all 53 groups (that is, the
existing 44 RUG–III groups plus the 9
new groups that we are proposing to
create in this proposed rule) to better
account for non-therapy ancillary
variability. We would do this by
exercising our authority under section
1888(e)(4)(G)(i) of the Act to establish an
‘‘appropriate adjustment to account for
case mix,’’ in order to maintain access
and quality of care for heavy-care
patients.
In determining the size of this
adjustment, we considered the high
degree of variability in non-therapy
ancillary costs (which was not yet
known at the time that the BBA and the
BBRA were enacted), and the absence of
an outlier policy under the SNF PPS.
Accordingly, we looked at the outlier
pool established under another PPS for
post-acute care, the inpatient
rehabilitation facility prospective
payment system (IRF PPS), which is set
at 3 percent of aggregate expenditures.
For the purpose of this refinement, we
calculated the SNF dollars needed to
achieve a comparable funding level that
could be targeted towards payment of
non-therapy ancillaries. Based on this
analysis, we are proposing an increase
to the nursing component of the casemix weights (the component that
includes non-therapy ancillaries) of
approximately 8.4 percent, which
equates to approximately 3 percent of
aggregate expenditures under the SNF
PPS.
Moreover, we believe that this type of
adjustment can essentially serve as a
proxy for the non-therapy ancillary
index that we proposed previously as a
means of achieving more appropriate
payment for these services, without the
potential drawbacks of our earlier
proposal in terms of complexity and
addressing variability in utilization. In
fact, while we are confident that the
decision to maintain a relatively small
PO 00000
Frm 00011
Fmt 4701
Sfmt 4702
29079
number of RUG groups is correct in
terms of the overall operation of the
SNF PPS, it is still true that this number
of groups made it extremely difficult to
distinguish different levels of nontherapy ancillary use. The problem may
be less severe in other PPSs that use a
greater number of groups. For example,
the IRF PPS was initially structured to
have 100 groups, and the inpatient
hospital PPS (IPPS) has over 500
diagnosis-related groups. Similarly,
there are over 7,000 relative value units
under the resource-based relative value
scale that determines the payment rates
for physician and other Part B services.
By contrast, under this proposed rule,
there will be only 53 RUGs. By
definition, then, there will be wider
variation in the resource needs of
patients classified into a particular RUG.
We, therefore, believe that it is
appropriate to provide for a further
adjustment to the case-mix index to
compensate for these broad
discrepancies.
We note that we are advancing these
proposed changes under our authority
in section 101(a) of the BBRA to
establish case-mix refinements, and that
the changes we are hereby proposing
will represent the final adjustments
made under this authority. Accordingly,
any future changes to the case-mix
weights or other components of the SNF
PPS would be accomplished through
staff time measures and other validated
analytical studies.
As further explained in section II.B.4
of this proposed rule, these additional
payments would partially offset the
expiration of the temporary add-on
payments that will occur, under the
terms of section 101(c) of the BBRA,
upon the implementation of this
proposed case-mix refinement. We
believe that implementing the proposed
case-mix refinement in this manner will
carry out Congressional intent that the
BBRA’s temporary payment add-ons
should not continue indefinitely into
the future, while at the same time
ensuring that payments under the SNF
PPS continue to support the quality of
care furnished in this setting.
Further, the creation of the proposed
new Rehabilitation plus Extensive
Services groups underscores the
importance of ensuring the accuracy of
patient classifications, particularly with
regard to those categories, such as
Extensive Services, that encompass
medically complex patients. One way to
accomplish this could be by ensuring
that the MDS data used in making such
classifications reflect only those services
that are actually furnished during the
SNF stay itself rather than during the
preadmission period (for example,
E:\FR\FM\19MYP3.SGM
19MYP3
29080
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
during the prior qualifying hospital
stay). In the July 30, 1999 SNF PPS final
rule (64 FR 41668 through 41669), we
noted a public comment that questioned
the appropriateness of the MDS’s 14-day
‘‘look-back’’ provision in the specific
context of the SNF level of care
presumption. While we made no
revisions to the look-back provision at
that time, we specifically reserved the
right to reconsider the continued use of
this mechanism in the future.
Subsequent analysis in this area has
focused on the four items contained in
the Special Service section of the MDS
(P1a—IV medications, suctioning,
tracheostomy care, and use of a
ventilator/respirator) that serve to
classify residents into Extensive Care,
the category used for the most medically
complex SNF patients under the RUG–
III classification system. This analysis
indicates that the use of the look-back
provision has caused a significant
number of residents to classify to the
Extensive Services category based solely
on services (such as intravenous
medications) that were furnished
exclusively during the period before
SNF admission. Depending on how
such a proposal was formulated, it has
the potential to reduce overall SNF
payments by better aligning them with
the services actually provided.
Therefore, we seek comment on the
potential savings and other impacts of
revising the MDS Manual instructions to
include only those special care
treatments and programs (MDS Section
P1a) furnished to the resident since
admission or re-admission to the SNF,
similar to the requirement for P1b. We
anticipate that this change can be
accomplished through an update to the
MDS Manual instructions, and will not
involve system changes at the facility,
State agency, or Federal level.
In addition, we are inviting comments
on other policy options that could
enhance the accuracy of the payment
system and improve the quality of care
provided to Medicare beneficiaries
during an SNF stay, without limiting
access to post-acute care. For example,
we have received recommendations to
decrease or eliminate the grace day
period specifically for the 5-day PPS
MDS assessment. We invite comments
on this specific recommendation as well
as decreasing or eliminating the grace
periods associated with all PPS MDS
assessments. Another example of a
possible policy change on which we
invite comment would be whether it
might be appropriate to eliminate the
projection of anticipated therapy
services during the 5-day PPS
assessment. We invite comments on
these and other existing SNF policies
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
that may have an impact on the quality
of care in this setting.
In accordance with section 101 of the
BBRA, implementing these proposed
refinements to the case-mix system
means that the payment rates set forth
in this proposed rule would no longer
reflect the temporary add-ons to the
Federal rates for specified RUG–III
groups. We understand that the
expiration of the temporary payment
increases, provided for in that
legislation, results in a significant
reduction in Medicare’s payments
between FY 2005 and FY 2006. In fact,
MedPAC has consistently urged that,
until CMS can design a new payment
methodology, some or all of the
temporary add-on payments be retained
and allocated towards beneficiaries with
complex medical needs.
While this proposed rule sets forth
refinements to the existing case-mix
classification system and RUG–III
categories, we are soliciting comments
on the economic impact of the resulting
payment changes, as well as their
potential impact on beneficiaries’ access
to quality SNF care. We also invite
comments on possible ways in which
the case-mix classification system itself
might be further modified to help
mitigate the effect of the payment
changes.
We note that the expiration of the
BBRA add-on payments would not
necessarily affect the temporary 128
percent increase in the per diem
adjusted payment rates for SNF
residents with AIDS. In enacting that
temporary increase, the Congress cited
past research indicating that ‘‘* * *
AIDS patients have much higher costs
than other patients in the same resource
utilization groups in skilled nursing
facilities’’ (H. Rep. No. 108–178, Part 2,
at 221). This underscored the Congress’
view that AIDS patients are unique
among SNF residents in that they incur
significantly higher care costs than
residents with other diagnoses,
including those who classify to the same
RUG–III group. We believe that even if
a case-mix refinement can meet the
BBRA criterion of better accounting for
the needs of medically complex patients
generally, this still might not enable the
Secretary to certify under section
1888(e)(12)(B) of the Act ‘‘* * * that
there is an appropriate adjustment in
the case mix * * * to compensate for
the increased costs’’ specifically
associated with this particular group of
patients. Thus, while the
implementation of case-mix refinements
will trigger the expiration of the 20
percent and 6.7 percent add-on
payments under section 101(a) of the
BBRA (as amended by section 314 of the
PO 00000
Frm 00012
Fmt 4701
Sfmt 4702
BIPA), this may not necessarily be the
case for the AIDS add-on payments
under section 511 of the MMA.
Accordingly, pending further
examination of this issue, we believe
that it would be premature at this time
for the Secretary to make the required
certification under section
1888(e)(12)(B) of the Act with respect to
the unique conditions that pertain to the
care of SNF residents with AIDS. As a
result, the 128 percent add-on payments
for SNF residents with AIDS will
remain in effect during FY 2006.
The case-mix adjusted payment rates
are listed separately for urban and rural
SNFs for the existing 44 group RUG and
proposed RUG–53 classification systems
in Tables 4, 4a, 5, and 5a, with the
corresponding case-mix index values.
We also remain committed to our
long-term efforts to monitor the RUG-III
case-mix classification system and to an
ongoing effort to increase the accuracy
and efficiency of the SNF PPS. A series
of analyses, including the studies used
to develop the refinements discussed
above, will be discussed in a
forthcoming report to the Congress. In
this report, we will discuss the findings
and put forth a series of next steps that
will provide a framework for future
progress. In addition, we have posted
data describing the research conducted
by ABT and the Urban Institute on our
SNF PPS Web site at https://
www.cms.hhs.gov/providers/SNF PPS.
Commenters may wish to consult this
material to facilitate a more in depth
understanding of the proposals
contained in this document.
Moreover, we would like to take this
opportunity to discuss our thinking
related to broader initiatives in this area
related to quality of care. Through the
Nursing Home Quality Initiative, the
Long Term Care Task Force and other
forums for collaborative action, CMS
has worked with the SNF industry on
the development of valid quality
measures, and a variety of quality
improvement efforts focused on nursing
homes. These efforts and others have
resulted in improvements in the quality
of care, particularly in facilities that
adopt a culture that promotes quality
through continuous quality initiatives
(CQI), culture change, and other similar
programs. Pay for performance is a tool
that could provide additional support to
improve the quality of care provided in
nursing homes. In this way, we could
recognize and support the ongoing
efforts of nursing homes to improve
quality.
Designing Pay for Performance
programs for the SNF setting presents
some significant issues. While Medicare
beneficiaries are the primary users of
E:\FR\FM\19MYP3.SGM
19MYP3
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
SNF services, only a small percentage of
these beneficiaries (that is,
approximately 10 percent) receive
services that are reimbursed under
Medicare Part A. The majority of
beneficiaries receive services that are
reimbursed by multiple payers,
including Medicare Part B, Medicaid,
and private insurance, and that are
delivered within different parts of a
nursing facility. Therefore, it is not
enough to change practice patterns in
just a part of a nursing home (that is,
skilled units), as Medicare beneficiaries
can be placed anywhere in the facility.
In addition, the focus of the nursing,
rehabilitative, and medical
interventions will typically vary for
persons who are receiving short-term
skilled nursing facility services versus
those persons who are long-term
residents in nursing facilities.
For these reasons, quality measures
must be carefully constructed; that is,
broad-based and designed to effect
change across the mix of patients
residing in the facility. Similarly, we
need to consider how to design effective
incentives; that is, superior performance
measured against pre-established
benchmarks and/or performance
improvements.
In addition, while our efforts to
develop the various post-acute care
PPSs (including the SNF PPS) have
generated substantial improvements
over the preexisting cost-based systems,
each of these individual systems was
developed independently. As a result,
we have focused on phases of a patient’s
illness as defined by a specific site of
service, rather than on the entirety of
the post-acute episode from the
standpoint of the patient rather than the
facility. As the various provider types
(such as SNFs and inpatient
rehabilitation facilities (IRFs)) provide
similar types of services in some cases,
and as the opportunities to provide
similar services in different settings
increase, we need to investigate a more
coordinated approach to payment and
delivery of post-acute services that
focuses on the overall post-acute
episode.
This could entail a strategy of
developing payment policy that is as
neutral as possible regarding provider
and patient decisions about the use of
particular post-acute services. That is,
Medicare should provide payments
sufficient to ensure that beneficiaries
receive high quality care in the most
appropriate setting, so that admissions
and any transfers between settings occur
only when consistent with good care,
rather than to generate additional
revenues. In order to accomplish this
objective, we need to collect and
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
compare clinical data across different
sites of service.
In fact, in the long run, our ability to
compare clinical data across care
settings is one of the benefits that will
be realized as a basic component of our
interest in the use of standardized
electronic health records (EHRs) and
other steps to promote continuity of care
across all settings, including nursing
homes. It is also important to recognize
the complexity of the effort, not only in
developing an integrated assessment
tool that is designed using health
information standards, but in examining
the various provider-centric prospective
payment methodologies and considering
patient-centric payment approaches that
are based on patient characteristics and
outcomes. MedPAC has recently taken a
preliminary look at the challenges in
improving the coordination of our postacute care payment methods, and
suggested that it may be appropriate to
explore additional options for
reimbursing post-acute services. We
agree that CMS, in conjunction with
MedPAC and other stakeholders, should
consider a full range of options in
analyzing our post-acute care payment
methods, including the SNF PPS.
We also want to encourage
incremental changes that will help us
build toward these longer-term
objectives. For example, several
automated medical record tools are now
available that could allow hospitals and
SNFs to coordinate discharge planning
procedures more closely. These tools
can be used to ensure communication of
a standardized data set that can also be
used to establish a comprehensive SNF
care plan. Improved communications
may reduce the incidence of potentially
avoidable re-hospitalizations and other
negative effects on quality of care that
occur when patients are transferred to
SNFs without a full understanding of
their care needs. CMS is looking at ways
that Medicare providers can use these
tools to generate timely data to support
continuity across settings. We are also
interested in comments on payment
reforms that could promote and reward
such continuity, and avoid the medical
complications and additional costs
associated with re-hospitalization.
Some of the ideas discussed here may
exceed CMS’s current statutory
authority. However, we believe that it is
useful to encourage discussion of a
broad range of ideas for debate of the
relative advantages and disadvantages of
the various policies affecting this
important component of the health care
sector, to ensure that our administrative
actions provide maximum support for
further steps toward higher quality post-
PO 00000
Frm 00013
Fmt 4701
Sfmt 4702
29081
acute care. We welcome comments on
these and other approaches.
4. Implementation Issues
[If you choose to comment on issues in
this section, please include the caption
‘‘Implementation Issues’’ at the
beginning of your comments.]
As noted previously in this proposed
rule, the temporary add-on payments
enacted by section 101(a) of the BBRA
expire upon the implementation of casemix refinements. Section 101(c) of the
BBRA specifies that the actual date on
which these temporary add-on
payments are to expire is ‘‘the later of—
(1) October 1, 2000; or (2) the date on
which the Secretary implements a
refined case mix classification system
under section 1888(e)(4)(G)(i) of the
Social Security Act (42 U.S.C.
1395yy(e)(4)(G)(i)) to better account for
medically complex patients’’. Section
1888(e)(4)(G)(i) of the Act, in turn,
specifies that the Secretary shall provide
for an ‘‘appropriate adjustment’’ to
account for case mix.
While this proposed rule sets forth
proposed updates to the SNF PPS
payment rates that are to take effect as
of October 1, 2005, we recognize that
adopting the proposed refinements to
the case-mix classification system will
likely entail significant changes for
SNFs as well as for Medicare
contractors. Therefore, in order to allow
sufficient time for preparation and to
ease the transition to the proposed
refinements, we believe that it would be
appropriate under section
1888(e)(4)(G)(i) of the Act to make a
case-mix adjustment that reflects the
implementation of the refinements
described below.
Accordingly, from October 1, 2005,
through December 31, 2005, we propose
to make payment based entirely on the
existing 44-group RUG–III classification
system. Beginning on January 1, 2006,
we propose to make payment based
entirely on the proposed new RUG–53
classification system. This means that
under the terms of section 101(c) of the
BBRA, the temporary add-on payments
for certain designated RUG–III groups
will expire as of January 1, 2006. We
note that the resulting reduction in
payment will be partially offset by the
increase in the RUG case-mix indexes,
as explained previously in section II.B.3
of this proposed rule. We invite
comments on all aspects of
implementing the proposed case-mix
refinements, including our plan to defer
implementation until January 1, 2006.
Further, along with those matters
relating specifically to the case-mix
classification system, we have identified
a number of broader clinical issues that
E:\FR\FM\19MYP3.SGM
19MYP3
29082
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
we are also taking this opportunity to
address:
5. Assessment Timeframes
We would like to take this
opportunity to clarify existing
requirements regarding completion of
Other Medicare Required Assessments
(OMRAs) for beneficiaries reimbursed
under the SNF PPS. An OMRA is due
8 to 10 days after the cessation of all
therapy (occupational and physical
therapies and speech-language
pathology services) in all situations
where the beneficiary was assigned a
rehabilitation RUG–III group on the
previous assessment.
The ‘‘last day of therapy’’ is the last
day on which a therapy service was
furnished. It is not the day the discharge
order for therapy was received and/or
written on the resident’s medical record.
Therefore, when the last day that
therapy was provided falls on a Friday,
the Saturday and Sunday directly
following are counted as days 1 and 2,
respectively, toward the total 8 to 10
days of the OMRA window. The same
principles apply when the ‘‘midnight
rule’’ is initiated during a beneficiary’s
Part A SNF stay.
In addition, in the relatively
uncommon situations where a resident
starts a leave of absence after the
therapy services have been discontinued
and is out of the facility for part of the
8 to 10 day period during which the
OMRA must be completed, those
therapeutic leave days are to be counted
when determining the OMRA due date.
While this information is not new, we
determined that it would be beneficial
to clarify and remind the public of these
specific issues involving the OMRA.
6. SNF Certifications and
Recertifications Performed by Nurse
Practitioners and Clinical Nurse
Specialists
[If you choose to comment on issues in
this section, please include the caption
‘‘SNF Certifications and Recertifications
Performed by Nurse Practitioners and
Clinical Nurse Specialists’’ at the
beginning of your comments.]
We are taking this opportunity to
clarify the requirement for physician
signature on the certification and
recertification of the need for SNF care
(§ 424.20(e)(2)) as it relates to nurse
practitioners (NPs) and clinical nurse
specialists (CNSs). In section 6028 of the
Omnibus Budget Reconciliation Act of
1989, the Congress amended section
1814(a)(2) of the Act. As amended, the
Act specifies that an NP or CNS ‘‘* * *
who does not have a direct or indirect
employment relationship’’ with the
facility but is working in collaboration
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
with a physician may sign the required
certification (or recertification) for a
beneficiary’s SNF stay. (Section
1819(b)(6)(A) of the Act further specifies
that the medical care of each SNF
resident must be under the supervision
of a physician (see also the regulations
at 42 CFR 483.40(a)(1)).) This provision
that bars NPs and CNSs from having a
direct or indirect employment
relationship with a SNF in order to sign
a certification or recertification of the
need for care is very restrictive. By
contrast, a similar statutory limitation
(see section 1919(b)(6)(A) of the Act) on
the delegation of physician tasks in
Medicaid nursing facilities only bars
NPs, CNSs, and physician assistants
(PAs) from performing delegated tasks if
they are actually employed by the
facility.
Following the enactment of this
legislation, we received numerous
inquiries asking us to define ‘‘direct’’
and ‘‘indirect’’ employment
relationships in greater detail. In the
July 26, 1995 final rule (60 FR 38268),
we stated that factors indicating
whether a NP or CNS has a direct or
indirect employment relationship
include, but are not limited to the
following:
• The facility or someone on its
medical staff has the authority to hire or
fire the nurse;
• The facility or someone on its
medical staff furnishes the equipment or
place to work, sets the hours, and pays
the nurse by the hour, week, or month;
• The facility or someone on its
medical staff restricts the nurse’s ability
to work for someone else or provides
training and requires the nurse to follow
instructions.
We note that the longstanding
common law test, as set forth in
regulations at 20 CFR 404.1005,
404.1007, and 404.1009, continues to
determine the presence of a direct
employment relationship for the
purposes of this provision. However,
numerous inquiries from providers and
other stakeholders continue to request
that we specifically clarify the
definition of an ‘‘indirect’’ employment
relationship in those situations where
no direct employment relationship
exists. Accordingly, we propose to
revise the regulations at § 424.20(e)(2) to
identify the existence of an indirect
employment relationship in terms of the
type of services that the practitioner
performs in the SNF. We note that NPs
and CNSs who are employed by SNFs
not only perform the types of delegated
physician tasks that are permitted under
the long-term care facility requirements
for participation at 42 CFR 483.40(e),
but typically perform general nursing
PO 00000
Frm 00014
Fmt 4701
Sfmt 4702
services as well. We believe that, even
in the absence of a direct employment
relationship, an SNF that has an NP or
CNS perform these general nursing
services is essentially utilizing the NP or
CNS in the same manner as it would an
employee, so that an indirect
employment relationship can be
considered to exist. Accordingly, in
situations where there is no direct
employment relationship between the
SNF and the NP or CNS, we propose
that an indirect employment
relationship exists whenever the NP or
CNS not only performs delegated
physician tasks, but also provides
nursing services under the regulations at
42 CFR 409.21, which include such
services within the scope of coverage
under the Part A SNF benefit. We
believe that this criterion is appropriate,
because there would be a potential
conflict of interest if an NP or CNS who
is engaged in furnishing covered Part A
nursing services to an SNF’s resident
were also permitted to certify as to that
resident’s need for Part A SNF care. We
invite comments on the effects of
establishing our proposed distinction in
this context.
7. Concurrent Therapy
[If you choose to comment on issues in
this section, please include the caption
‘‘Concurrent Therapy’’ at the beginning
of your comments.]
The SNF PPS proposed rule for FY
2002 (66 FR 23991, May 10, 2001)
included a discussion of concurrent
therapy, a practice also known as
‘‘dovetailing.’’ In that discussion, we
noted that this practice involves a single
professional therapist treating more than
one Medicare beneficiary at a time—in
some cases, many more than one
individual at a time. In contrast to group
therapy, in which all participants are
working on some common skill
development, each beneficiary who
receives concurrent therapy likely is not
receiving services that relate to those
needed by any of the other participants.
Although the care that each beneficiary
receives may be prescribed in his or her
individual plan of treatment, it may not
conform to Medicare coverage
guidelines; that is, the therapy is not
being provided individually, and it is
unlikely that the services being
delivered are at the complex skill level
required for coverage by Medicare. We
expressed particular concern over
instances in which facility management
might inappropriately attempt to
increase productivity by coercing a
therapist, against his or her own
professional judgment, to perform
concurrent therapy.
E:\FR\FM\19MYP3.SGM
19MYP3
29083
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
In the SNF PPS final rule for FY 2002
(66 FR 39567, July 31, 2001), we noted
that most of the public comments that
we received on this discussion urged us
to continue to recognize concurrent
therapy as skilled therapy, and
contended that therapists are treating
more than one beneficiary concurrently
only when appropriate. However, others
indicated that our concerns regarding
concurrent therapy were, in fact,
warranted. They reported that since the
implementation of the SNF PPS,
professional therapists are encountering
increased pressure to be more
productive than they have in the past,
including the need to see more than one
patient at a time, and performing
documentation and collaboration with
other members of the care team as nonreimbursed time. In response to the
comments, we acknowledged that
concurrent therapy can have a
legitimate place in the spectrum of care
options available to therapists treating
Medicare beneficiaries, as long as its use
is driven by valid clinical
considerations. However, while we
declined to make any specific policy
changes at that time, we reiterated that
it is inappropriate for a facility to
require, as a condition of employment,
that a therapist agree to treat more than
one beneficiary at a time in situations
where providing treatment in such a
manner would compromise the
therapist’s professional judgment. We
also noted that we might revisit this
issue in the future should the need to do
so arise.
Since that time, we have continued to
encounter reports of facilities that
attempt to override the therapist’s
professional judgment and have
concurrent therapy performed in the
absence of valid clinical considerations.
Accordingly, we believe it is
appropriate at this time to consider once
again whether there is a need to issue
additional guidelines to preclude the
inappropriate provision of concurrent
therapy. We invite comment on the
most effective way to prevent the abuse
of this practice, and to ensure that
concurrent therapy is performed only in
those instances where it is clinically
justified.
We propose to establish an effective
date of January 1, 2006, as the beginning
date for the use of the proposed casemix refinements. Accordingly, from
October 1, 2005, through December 31,
2005, we propose to make payment
based entirely on the existing 44-group
RUG–III classification system. Tables 4,
5, 6, and 7 reflect the corresponding rate
information for the existing 44 group
RUG–III classification system to be used
during this time.
Beginning on January 1, 2006, we
propose to make payment based on the
proposed new RUG–53 classification
system (and, thus, would not include
the add-on payments). Tables 4a, 5a, 6a,
and 7a reflect the corresponding rate
information for the proposed RUG–53
classification system.
Tables 4 and 5 reflect the updated
SNF Federal rates for FY 2006 for the
existing 44 group RUG–III classification
system. Tables 4a and 5a reflect the
updated SNF Federal rates for FY 2006
for the RUG–53 classification system.
The first nine groups listed in the tables
are for new Rehabilitation plus
Extensive Services groups.
TABLE 4.—RUG–44, CASE-MIX ADJUSTED FEDERAL RATES AND ASSOCIATED INDEXES—URBAN
Nursing
index
RUG III category
RUC .........................................................
RUB ..........................................................
RUA ..........................................................
RVC ..........................................................
RVB ..........................................................
RVA ..........................................................
RHC .........................................................
RHB ..........................................................
RHA ..........................................................
RMC .........................................................
RMB .........................................................
RMA .........................................................
RLB ..........................................................
RLA ..........................................................
SE3 ..........................................................
SE2 ..........................................................
SE1 ..........................................................
SSC ..........................................................
SSB ..........................................................
SSA ..........................................................
CC2 ..........................................................
CC1 ..........................................................
CB2 ..........................................................
CB1 ..........................................................
CA2 ..........................................................
CA1 ..........................................................
IB2 ............................................................
IB1 ............................................................
IA2 ............................................................
IA1 ............................................................
BB2 ..........................................................
BB1 ..........................................................
BA2 ..........................................................
BA1 ..........................................................
PE2 ..........................................................
PE1 ..........................................................
PD2 ..........................................................
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
1.30
0.95
0.78
1.13
1.04
0.81
1.26
1.06
0.87
1.35
1.09
0.96
1.11
0.80
1.70
1.39
1.17
1.13
1.05
1.01
1.12
0.99
0.91
0.84
0.83
0.75
0.69
0.67
0.57
0.53
0.68
0.65
0.56
0.48
0.79
0.77
0.72
PO 00000
Therapy
index
2.25
2.25
2.25
1.41
1.41
1.41
0.94
0.94
0.94
0.77
0.77
0.77
0.43
0.43
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
Frm 00015
Fmt 4701
Nursing
component
Therapy
component
Non-case
mix therapy
component
Non-case
mix
component
178.67
130.57
107.20
155.31
142.94
111.33
173.17
145.69
119.57
185.54
149.81
131.94
152.56
109.95
233.65
191.04
160.80
155.31
144.31
138.81
153.93
136.07
125.07
115.45
114.08
103.08
94.83
92.08
78.34
72.84
93.46
89.34
76.97
65.97
108.58
105.83
98.96
232.94
232.94
232.94
145.98
145.98
145.98
97.32
97.32
97.32
79.72
79.72
79.72
44.52
44.52
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
Sfmt 4702
E:\FR\FM\19MYP3.SGM
19MYP3
Total rate
481.76
433.66
410.29
371.44
359.07
327.46
340.64
313.16
287.04
335.41
299.68
281.81
267.23
224.62
317.43
274.82
244.58
239.09
228.09
222.59
237.71
219.85
208.85
199.23
197.86
186.86
178.61
175.86
162.12
156.62
177.24
173.12
160.75
149.75
192.36
189.61
182.74
29084
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE 4.—RUG–44, CASE-MIX ADJUSTED FEDERAL RATES AND ASSOCIATED INDEXES—URBAN—Continued
Nursing
index
RUG III category
PD1
PC2
PC1
PB2
PB1
PA2
PA1
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
0.70
0.65
0.64
0.51
0.50
0.49
0.46
Therapy
index
....................
....................
....................
....................
....................
....................
....................
Nursing
component
Therapy
component
Non-case
mix therapy
component
Non-case
mix
component
96.21
89.34
87.96
70.09
68.72
67.35
63.22
....................
....................
....................
....................
....................
....................
....................
13.63
13.63
13.63
13.63
13.63
13.63
13.63
70.15
70.15
70.15
70.15
70.15
70.15
70.15
Total rate
179.99
173.12
171.74
153.87
152.50
151.13
147.00
TABLE 4A.—RUG–53, CASE-MIX ADJUSTED FEDERAL RATES AND ASSOCIATED INDEXES—URBAN
Nursing
index
RUG–53 category
RUX ..........................................................
RUL ..........................................................
RVX ..........................................................
RVL ..........................................................
RHX ..........................................................
RHL ..........................................................
RMX .........................................................
RML ..........................................................
RLX ..........................................................
RUC .........................................................
RUB ..........................................................
RUA ..........................................................
RVC ..........................................................
RVB ..........................................................
RVA ..........................................................
RHC .........................................................
RHB ..........................................................
RHA ..........................................................
RMC .........................................................
RMB .........................................................
RMA .........................................................
RLB ..........................................................
RLA ..........................................................
SE3 ..........................................................
SE2 ..........................................................
SE1 ..........................................................
SSC ..........................................................
SSB ..........................................................
SSA ..........................................................
CC2 ..........................................................
CC1 ..........................................................
CB2 ..........................................................
CB1 ..........................................................
CA2 ..........................................................
CA1 ..........................................................
IB2 ............................................................
IB1 ............................................................
IA2 ............................................................
IA1 ............................................................
BB2 ..........................................................
BB1 ..........................................................
BA2 ..........................................................
BA1 ..........................................................
PE2 ..........................................................
PE1 ..........................................................
PD2 ..........................................................
PD1 ..........................................................
PC2 ..........................................................
PC1 ..........................................................
PB2 ..........................................................
PB1 ..........................................................
PA2 ..........................................................
PA1 ..........................................................
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
1.80
1.33
1.46
1.26
1.34
1.30
1.83
1.60
1.25
1.21
0.94
0.79
1.16
1.02
0.79
1.15
1.05
0.89
1.09
1.02
0.99
1.08
0.80
1.76
1.41
1.19
1.16
1.07
1.03
1.15
1.01
0.93
0.86
0.85
0.77
0.70
0.68
0.59
0.54
0.69
0.66
0.57
0.49
0.80
0.78
0.74
0.72
0.67
0.65
0.52
0.51
0.50
0.48
PO 00000
Therapy
index
2.24
2.24
1.32
1.32
1.10
1.10
1.03
1.03
0.79
2.24
2.24
2.24
1.32
1.32
1.32
1.10
1.10
1.10
1.03
1.03
1.03
0.79
0.79
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
Frm 00016
Fmt 4701
Nursing
component
Therapy
component
Non-case
mix therapy
component
Non-case
mix component
247.39
182.80
200.66
173.17
184.17
178.67
251.52
219.90
171.80
166.30
129.19
108.58
159.43
140.19
108.58
158.06
144.31
122.32
149.81
140.19
136.07
148.44
109.95
241.89
193.79
163.55
159.43
147.06
141.56
158.06
138.81
127.82
118.20
116.82
105.83
96.21
93.46
81.09
74.22
94.83
90.71
78.34
67.35
109.95
107.20
101.71
98.96
92.08
89.34
71.47
70.09
68.72
65.97
231.91
231.91
136.66
136.66
113.88
113.88
106.64
106.64
81.79
231.91
231.91
231.91
136.66
136.66
136.66
113.88
113.88
113.88
106.64
106.64
106.64
81.79
81.79
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
13.63
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
70.15
Sfmt 4702
E:\FR\FM\19MYP3.SGM
19MYP3
Total rate
549.45
484.86
407.47
379.98
368.20
362.70
428.31
396.69
323.74
468.36
431.25
410.64
366.24
347.00
315.39
342.09
328.34
306.35
326.60
316.98
312.86
300.38
261.89
325.67
277.57
247.33
243.21
230.84
225.34
241.84
222.59
211.60
201.98
200.60
189.61
179.99
177.24
164.87
158.00
178.61
174.49
162.12
151.13
193.73
190.98
185.49
182.74
175.86
173.12
155.25
153.87
152.50
149.75
29085
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE 5.—RUG–44, CASE-MIX ADJUSTED FEDERAL RATES AND ASSOCIATED INDEXES—RURAL
Nursing
index
RUG III category
RUC .........................................................
RUB ..........................................................
RUA ..........................................................
RVC ..........................................................
RVB ..........................................................
RVA ..........................................................
RHC .........................................................
RHB ..........................................................
RHA ..........................................................
RMC .........................................................
RMB .........................................................
RMA .........................................................
RLB ..........................................................
RLA ..........................................................
SE3 ..........................................................
SE2 ..........................................................
SE1 ..........................................................
SSC ..........................................................
SSB ..........................................................
SSA ..........................................................
CC2 ..........................................................
CC1 ..........................................................
CB2 ..........................................................
CB1 ..........................................................
CA2 ..........................................................
CA1 ..........................................................
IB2 ............................................................
IB1 ............................................................
IA2 ............................................................
IA1 ............................................................
BB2 ..........................................................
BB1 ..........................................................
BA2 ..........................................................
BA1 ..........................................................
PE2 ..........................................................
PE1 ..........................................................
PD2 ..........................................................
PD1 ..........................................................
PC2 ..........................................................
PC1 ..........................................................
PB2 ..........................................................
PB1 ..........................................................
PA2 ..........................................................
PA1 ..........................................................
1.30
0.95
0.78
1.13
1.04
0.81
1.26
1.06
0.87
1.35
1.09
0.96
1.11
0.80
1.70
1.39
1.17
1.13
1.05
1.01
1.12
0.99
0.91
0.84
0.83
0.75
0.69
0.67
0.57
0.53
0.68
0.65
0.56
0.48
0.79
0.77
0.72
0.70
0.65
0.64
0.51
0.50
0.49
0.46
Therapy
index
2.25
2.25
2.25
1.41
1.41
1.41
0.94
0.94
0.94
0.77
0.77
0.77
0.43
0.43
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
Nursing
component
Therapy
component
Non-case
mix therapy
component
Non-case
mix component
170.69
124.74
102.41
148.37
136.55
106.35
165.44
139.18
114.23
177.26
143.12
126.05
145.74
105.04
223.21
182.51
153.62
148.37
137.87
132.61
147.06
129.99
119.48
110.29
108.98
98.48
90.60
87.97
74.84
69.59
89.28
85.35
73.53
63.02
103.73
101.10
94.54
91.91
85.35
84.03
66.96
65.65
64.34
60.40
268.61
268.61
268.61
168.33
168.33
168.33
112.22
112.22
112.22
91.92
91.92
91.92
51.33
51.33
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
Total rate
510.75
464.80
442.47
388.15
376.33
346.13
349.11
322.85
297.90
340.63
306.49
289.42
268.52
227.82
309.22
268.52
239.63
234.38
223.88
218.62
233.07
216.00
205.49
196.30
194.99
184.49
176.61
173.98
160.85
155.60
175.29
171.36
159.54
149.03
189.74
187.11
180.55
177.92
171.36
170.04
152.97
151.66
150.35
146.41
TABLE 5A.—RUG–53, CASE-MIX ADJUSTED FEDERAL RATES AND ASSOCIATED INDEXES—RURAL
Nursing
index
RUG–53 category
RUX ..........................................................
RUL ..........................................................
RVX ..........................................................
RVL ..........................................................
RHX ..........................................................
RHL ..........................................................
RMX .........................................................
RML ..........................................................
RLX ..........................................................
RUC .........................................................
RUB ..........................................................
RUA ..........................................................
RVC ..........................................................
RVB ..........................................................
RVA ..........................................................
RHC .........................................................
RHB ..........................................................
RHA ..........................................................
RMC .........................................................
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
Therapy
index
1.8
1.33
1.46
1.26
1.34
1.3
1.83
1.6
1.25
1.21
0.94
0.79
1.16
1.02
0.79
1.15
1.05
0.89
1.09
PO 00000
Frm 00017
2.24
2.24
1.32
1.32
1.10
1.10
1.03
1.03
0.79
2.24
2.24
2.24
1.32
1.32
1.32
1.10
1.10
1.10
1.03
Fmt 4701
Nursing
component
Therapy
component
Non-case
mix therapy
component
Non-case
mix
component
236.34
174.63
191.70
165.44
175.94
170.69
240.28
210.08
164.13
158.87
123.42
103.73
152.31
133.93
103.73
151.00
137.87
116.86
143.12
267.41
267.41
157.58
157.58
131.32
131.32
122.96
122.96
94.31
267.41
267.41
267.41
157.58
157.58
157.58
131.32
131.32
131.32
122.96
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
Sfmt 4702
E:\FR\FM\19MYP3.SGM
19MYP3
Total rate
575.20
513.49
420.73
394.47
378.71
373.46
434.69
404.49
329.89
497.73
462.28
442.59
381.34
362.96
332.76
353.77
340.64
319.63
337.53
29086
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE 5A.—RUG–53, CASE-MIX ADJUSTED FEDERAL RATES AND ASSOCIATED INDEXES—RURAL—Continued
Nursing
index
RUG–53 category
RMB .........................................................
RMA .........................................................
RLB ..........................................................
RLA ..........................................................
SE3 ..........................................................
SE2 ..........................................................
SE1 ..........................................................
SSC ..........................................................
SSB ..........................................................
SSA ..........................................................
CC2 ..........................................................
CC1 ..........................................................
CB2 ..........................................................
CB1 ..........................................................
CA2 ..........................................................
CA1 ..........................................................
IB2 ............................................................
IB1 ............................................................
IA2 ............................................................
IA1 ............................................................
BB2 ..........................................................
BB1 ..........................................................
BA2 ..........................................................
BA1 ..........................................................
PE2 ..........................................................
PE1 ..........................................................
PD2 ..........................................................
PD1 ..........................................................
PC2 ..........................................................
PC1 ..........................................................
PB2 ..........................................................
PB1 ..........................................................
PA2 ..........................................................
PA1 ..........................................................
1.02
0.99
1.08
0.80
1.76
1.41
1.19
1.16
1.07
1.03
1.15
1.01
0.93
0.86
0.85
0.77
0.70
0.68
0.59
0.54
0.69
0.66
0.57
0.49
0.80
0.78
0.74
0.72
0.67
0.65
0.52
0.51
0.50
0.48
C. Wage Index Adjustment to Federal
Rates
Section 1888(e)(4)(G)(ii) of the Act
requires that we adjust the Federal rates
to account for differences in area wage
levels, using a wage index that we find
appropriate. Since the inception of a
PPS for SNFs, we have used hospital
wage data in developing a wage index
to be applied to SNFs. We propose to
continue that practice for FY 2006, as
we continue to believe that in the
absence of SNF-specific wage data,
using the hospital wage index is
appropriate and reasonable for the SNF
PPS.
The wage index adjustment would be
applied to the proposed labor-related
portion of the Federal rate, which is
76.087 percent of the total rate. This
percentage reflects the labor-related
relative importance for FY 2006. The
Therapy
index
1.03
1.03
0.79
0.79
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
Nursing
component
Therapy
component
Non-case
mix therapy
component
Non-case
mix
component
133.93
129.99
141.80
105.04
231.09
185.13
156.25
152.31
140.49
135.24
151.00
132.61
122.11
112.92
111.61
101.10
91.91
89.28
77.47
70.90
90.60
86.66
74.84
64.34
105.04
102.41
97.16
94.54
87.97
85.35
68.28
66.96
65.65
63.02
122.96
122.96
94.31
94.31
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
14.56
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
71.45
labor-related relative importance is
calculated from the SNF market basket,
and approximates the labor-related
portion of the total costs after taking
into account historical and projected
price changes between the base year and
FY 2006. The price proxies that move
the different cost categories in the
market basket do not necessarily change
at the same rate, and the relative
importance captures these changes.
Accordingly, the relative importance
figure more closely reflects the cost
share weights for FY 2006 than the base
year weights from the SNF market
basket.
We calculate the labor-related relative
importance for FY 2006 in four steps.
First, we compute the FY 2006 price
index level for the total market basket
and each cost category of the market
basket. Second, we calculate a ratio for
Total rate
328.34
324.40
307.56
270.80
317.10
271.14
242.26
238.32
226.50
221.25
237.01
218.62
208.12
198.93
197.62
187.11
177.92
175.29
163.48
156.91
176.61
172.67
160.85
150.35
191.05
188.42
183.17
180.55
173.98
171.36
154.29
152.97
151.66
149.03
each cost category by dividing the FY
2006 price index level for that cost
category by the total market basket price
index level. Third, we determine the FY
2006 relative importance for each cost
category by multiplying this ratio by the
base year (FY 1997) weight. Finally, we
sum the FY 2006 relative importance for
each of the labor-related cost categories
(wages and salaries, employee benefits,
nonmedical professional fees, laborintensive services, and capital-related
expenses) to produce the FY 2006 laborrelated relative importance. Tables 6
and 7 show the Federal rates by laborrelated and non-labor-related
components for the existing 44 group
RUG classification system. Tables 6a
and 7a show the Federal rates by laborrelated and non-labor-related
components for the proposed RUG–53
classification system.
TABLE 6.—RUG–44, CASE-MIX ADJUSTED FEDERAL RATES FOR URBAN SNFS BY LABOR AND NON-LABOR COMPONENT
RUG III category
Total rate
RUC ...................................................................................................................................................
RUB ...................................................................................................................................................
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00018
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
481.76
433.66
19MYP3
Labor portion
366.56
329.96
Non-labor
portion
115.20
103.70
29087
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE 6.—RUG–44, CASE-MIX ADJUSTED FEDERAL RATES FOR URBAN SNFS BY LABOR AND NON-LABOR
COMPONENT—Continued
RUG III category
Total rate
RUA ...................................................................................................................................................
RVC ...................................................................................................................................................
RVB ....................................................................................................................................................
RVA ....................................................................................................................................................
RHC ...................................................................................................................................................
RHB ...................................................................................................................................................
RHA ...................................................................................................................................................
RMC ...................................................................................................................................................
RMB ...................................................................................................................................................
RMA ...................................................................................................................................................
RLB ....................................................................................................................................................
RLA ....................................................................................................................................................
SE3 ....................................................................................................................................................
SE2 ....................................................................................................................................................
SE1 ....................................................................................................................................................
SSC ....................................................................................................................................................
SSB ....................................................................................................................................................
SSA ....................................................................................................................................................
CC2 ....................................................................................................................................................
CC1 ....................................................................................................................................................
CB2 ....................................................................................................................................................
CB1 ....................................................................................................................................................
CA2 ....................................................................................................................................................
CA1 ....................................................................................................................................................
IB2 ......................................................................................................................................................
IB1 ......................................................................................................................................................
IA2 ......................................................................................................................................................
IA1 ......................................................................................................................................................
BB2 ....................................................................................................................................................
BB1 ....................................................................................................................................................
BA2 ....................................................................................................................................................
BA1 ....................................................................................................................................................
PE2 ....................................................................................................................................................
PE1 ....................................................................................................................................................
PD2 ....................................................................................................................................................
PD1 ....................................................................................................................................................
PC2 ....................................................................................................................................................
PC1 ....................................................................................................................................................
PB2 ....................................................................................................................................................
PB1 ....................................................................................................................................................
PA2 ....................................................................................................................................................
PA1 ....................................................................................................................................................
410.29
371.44
359.07
327.46
340.64
313.16
287.04
335.41
299.68
281.81
267.23
224.62
317.43
274.82
244.58
239.09
228.09
222.59
237.71
219.85
208.85
199.23
197.86
186.86
178.61
175.86
162.12
156.62
177.24
173.12
160.75
149.75
192.36
189.61
182.74
179.99
173.12
171.74
153.87
152.50
151.13
147.00
Labor portion
312.18
282.62
273.21
249.15
259.18
238.27
218.40
255.20
228.02
214.42
203.33
170.91
241.52
209.10
186.09
181.92
173.55
169.36
180.87
167.28
158.91
151.59
150.55
142.18
135.90
133.81
123.35
119.17
134.86
131.72
122.31
113.94
146.36
144.27
139.04
136.95
131.72
130.67
117.08
116.03
114.99
111.85
Non-labor
portion
98.11
88.82
85.86
78.31
81.46
74.89
68.64
80.21
71.66
67.39
63.90
53.71
75.91
65.72
58.49
57.17
54.54
53.23
56.84
52.57
49.94
47.64
47.31
44.68
42.71
42.05
38.77
37.45
42.38
41.40
38.44
35.81
46.00
45.34
43.70
43.04
41.40
41.07
36.79
36.47
36.14
35.15
TABLE 6A.—RUG–53, CASE-MIX ADJUSTED FEDERAL RATES FOR URBAN SNFS BY LABOR AND NON-LABOR COMPONENT
RUG 53 category
Total rate
RUX ...................................................................................................................................................
RUL ....................................................................................................................................................
RVX ....................................................................................................................................................
RVL ....................................................................................................................................................
RHX ...................................................................................................................................................
RHL ....................................................................................................................................................
RMX ...................................................................................................................................................
RML ...................................................................................................................................................
RLX ....................................................................................................................................................
RUC ...................................................................................................................................................
RUB ...................................................................................................................................................
RUA ...................................................................................................................................................
RVC ...................................................................................................................................................
RVB ....................................................................................................................................................
RVA ....................................................................................................................................................
RHC ...................................................................................................................................................
RHB ...................................................................................................................................................
RHA ...................................................................................................................................................
RMC ...................................................................................................................................................
RMB ...................................................................................................................................................
RMA ...................................................................................................................................................
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00019
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
549.45
484.86
407.47
379.98
368.20
362.70
428.31
396.69
323.74
468.36
431.25
410.64
366.24
347.00
315.39
342.09
328.34
306.35
326.60
316.98
312.86
19MYP3
Labor portion
418.06
368.92
310.03
289.12
280.15
275.97
325.89
301.83
246.32
356.36
328.13
312.44
278.66
264.02
239.97
260.29
249.82
233.09
248.50
241.18
238.05
Non-labor
portion
131.39
115.94
97.44
90.86
88.05
86.73
102.42
94.86
77.42
112.00
103.12
98.20
87.58
82.98
75.42
81.80
78.52
73.26
78.10
75.80
74.81
29088
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE 6A.—RUG–53, CASE-MIX ADJUSTED FEDERAL RATES FOR URBAN SNFS BY LABOR AND NON-LABOR
COMPONENT—Continued
RUG 53 category
Total rate
RLB ....................................................................................................................................................
RLA ....................................................................................................................................................
SE3 ....................................................................................................................................................
SE2 ....................................................................................................................................................
SE1 ....................................................................................................................................................
SSC ....................................................................................................................................................
SSB ....................................................................................................................................................
SSA ....................................................................................................................................................
CC2 ....................................................................................................................................................
CC1 ....................................................................................................................................................
CB2 ....................................................................................................................................................
CB1 ....................................................................................................................................................
CA2 ....................................................................................................................................................
CA1 ....................................................................................................................................................
IB2 ......................................................................................................................................................
IB1 ......................................................................................................................................................
IA2 ......................................................................................................................................................
IA1 ......................................................................................................................................................
BB2 ....................................................................................................................................................
BB1 ....................................................................................................................................................
BA2 ....................................................................................................................................................
BA1 ....................................................................................................................................................
PE2 ....................................................................................................................................................
PE1 ....................................................................................................................................................
PD2 ....................................................................................................................................................
PD1 ....................................................................................................................................................
PC2 ....................................................................................................................................................
PC1 ....................................................................................................................................................
PB2 ....................................................................................................................................................
PB1 ....................................................................................................................................................
PA2 ....................................................................................................................................................
PA1 ....................................................................................................................................................
300.38
261.89
325.67
277.57
247.33
243.21
230.84
225.34
241.84
222.59
211.60
201.98
200.60
189.61
179.99
177.24
164.87
158.00
178.61
174.49
162.12
151.13
193.73
190.98
185.49
182.74
175.86
173.12
155.25
153.87
152.50
149.75
Labor portion
228.55
199.26
247.79
211.19
188.19
185.05
175.64
171.45
184.01
169.36
161.00
153.68
152.63
144.27
136.95
134.86
125.44
120.22
135.90
132.76
123.35
114.99
147.40
145.31
141.13
139.04
133.81
131.72
118.13
117.08
116.03
113.94
Non-labor
portion
71.83
62.63
77.88
66.38
59.14
58.16
55.20
53.89
57.83
53.23
50.60
48.30
47.97
45.34
43.04
42.38
39.43
37.78
42.71
41.73
38.77
36.14
46.33
45.67
44.36
43.70
42.05
41.40
37.12
36.79
36.47
35.81
TABLE 7.—RUG–44, CASE-MIX ADJUSTED FEDERAL RATES FOR RURAL SNFS BY LABOR AND NON-LABOR COMPONENT
RUG III category
Total rate
RUC ...................................................................................................................................................
RUB ...................................................................................................................................................
RUA ...................................................................................................................................................
RVC ...................................................................................................................................................
RVB ....................................................................................................................................................
RVA ....................................................................................................................................................
RHC ...................................................................................................................................................
RHB ...................................................................................................................................................
RHA ...................................................................................................................................................
RMC ...................................................................................................................................................
RMB ...................................................................................................................................................
RMA ...................................................................................................................................................
RLB ....................................................................................................................................................
RLA ....................................................................................................................................................
SE3 ....................................................................................................................................................
SE2 ....................................................................................................................................................
SE1 ....................................................................................................................................................
SSC ....................................................................................................................................................
SSB ....................................................................................................................................................
SSA ....................................................................................................................................................
CC2 ....................................................................................................................................................
CC1 ....................................................................................................................................................
CB2 ....................................................................................................................................................
CB1 ....................................................................................................................................................
CA2 ....................................................................................................................................................
CA1 ....................................................................................................................................................
IB2 ......................................................................................................................................................
IB1 ......................................................................................................................................................
IA2 ......................................................................................................................................................
IA1 ......................................................................................................................................................
BB2 ....................................................................................................................................................
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00020
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
510.75
464.80
442.47
388.15
376.33
346.13
349.11
322.85
297.90
340.63
306.49
289.42
268.52
227.82
309.22
268.52
239.63
234.38
223.88
218.62
233.07
216.00
205.49
196.30
194.99
184.49
176.61
173.98
160.85
155.60
175.29
19MYP3
Labor portion
388.61
353.65
336.66
295.33
286.34
263.36
265.63
245.65
226.66
259.18
233.20
220.21
204.31
173.34
235.28
204.31
182.33
178.33
170.34
166.34
177.34
164.35
156.35
149.36
148.36
140.37
134.38
132.38
122.39
118.39
133.37
Non-labor
portion
122.14
111.15
105.81
92.82
89.99
82.77
83.48
77.20
71.24
81.45
73.29
69.21
64.21
54.48
73.94
64.21
57.30
56.05
53.54
52.28
55.73
51.65
49.14
46.94
46.63
44.12
42.23
41.60
38.46
37.21
41.92
29089
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE 7.—RUG–44, CASE-MIX ADJUSTED FEDERAL RATES FOR RURAL SNFS BY LABOR AND NON-LABOR
COMPONENT—Continued
RUG III category
BB1
BA2
BA1
PE2
PE1
PD2
PD1
PC2
PC1
PB2
PB1
PA2
PA1
Total rate
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
171.36
159.54
149.03
189.74
187.11
180.55
177.92
171.36
170.04
152.97
151.66
150.35
146.41
Labor portion
130.38
121.39
113.39
144.37
142.37
137.38
135.37
130.38
129.38
116.39
115.39
114.40
111.40
Non-labor
portion
40.98
38.15
35.64
45.37
44.74
43.17
42.55
40.98
40.66
36.58
36.27
35.95
35.01
TABLE 7A.—RUG–53 CASE-MIX ADJUSTED FEDERAL RATES FOR RURAL SNFS BY LABOR AND NON-LABOR COMPONENT
RUG–53 category
Total rate
RUX ...................................................................................................................................................
RUL ....................................................................................................................................................
RVX ....................................................................................................................................................
RVL ....................................................................................................................................................
RHX ...................................................................................................................................................
RHL ....................................................................................................................................................
RMX ...................................................................................................................................................
RML ...................................................................................................................................................
RLX ....................................................................................................................................................
RUC ...................................................................................................................................................
RUB ...................................................................................................................................................
RUA ...................................................................................................................................................
RVC ...................................................................................................................................................
RVB ....................................................................................................................................................
RVA ....................................................................................................................................................
RHC ...................................................................................................................................................
RHB ...................................................................................................................................................
RHA ...................................................................................................................................................
RMC ...................................................................................................................................................
RMB ...................................................................................................................................................
RMA ...................................................................................................................................................
RLB ....................................................................................................................................................
RLA ....................................................................................................................................................
SE3 ....................................................................................................................................................
SE2 ....................................................................................................................................................
SE1 ....................................................................................................................................................
SSC ....................................................................................................................................................
SSB ....................................................................................................................................................
SSA ....................................................................................................................................................
CC2 ....................................................................................................................................................
CC1 ....................................................................................................................................................
CB2 ....................................................................................................................................................
CB1 ....................................................................................................................................................
CA2 ....................................................................................................................................................
CA1 ....................................................................................................................................................
IB2 ......................................................................................................................................................
IB1 ......................................................................................................................................................
IA2 ......................................................................................................................................................
IA1 ......................................................................................................................................................
BB2 ....................................................................................................................................................
BB1 ....................................................................................................................................................
BA2 ....................................................................................................................................................
BA1 ....................................................................................................................................................
PE2 ....................................................................................................................................................
PE1 ....................................................................................................................................................
PD2 ....................................................................................................................................................
PD1 ....................................................................................................................................................
PC2 ....................................................................................................................................................
PC1 ....................................................................................................................................................
PB2 ....................................................................................................................................................
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00021
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
575.20
513.49
420.73
394.47
378.71
373.46
434.69
404.49
329.89
497.73
462.28
442.59
381.34
362.96
332.76
353.77
340.64
319.63
337.53
328.34
324.40
307.56
270.80
317.10
271.14
242.26
238.32
226.50
221.25
237.01
218.62
208.12
198.93
197.62
187.11
177.92
175.29
163.48
156.91
176.61
172.67
160.85
150.35
191.05
188.42
183.17
180.55
173.98
171.36
154.29
19MYP3
Labor portion
437.65
390.70
320.12
300.14
288.15
284.15
330.74
307.76
251.00
378.71
351.73
336.75
290.15
276.17
253.19
269.17
259.18
243.20
256.82
249.82
246.83
234.01
206.04
241.27
206.30
184.33
181.33
172.34
168.34
180.33
166.34
158.35
151.36
150.36
142.37
135.37
133.37
124.39
119.39
134.38
131.38
122.39
114.40
145.36
143.36
139.37
137.38
132.38
130.38
117.39
Non-labor
portion
137.55
122.79
100.61
94.33
90.56
89.31
103.95
96.73
78.89
119.02
110.55
105.84
91.19
86.79
79.57
84.60
81.46
76.43
80.71
78.52
77.57
73.55
64.76
75.83
64.84
57.93
56.99
54.16
52.91
56.68
52.28
49.77
47.57
47.26
44.74
42.55
41.92
39.09
37.52
42.23
41.29
38.46
35.95
45.69
45.06
43.80
43.17
41.60
40.98
36.90
29090
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE 7A.—RUG–53 CASE-MIX ADJUSTED FEDERAL RATES FOR RURAL SNFS BY LABOR AND NON-LABOR
COMPONENT—Continued
RUG–53 category
Total rate
PB1 ....................................................................................................................................................
PA2 ....................................................................................................................................................
PA1 ....................................................................................................................................................
Section 1888(e)(4)(G)(ii) of the Act
also requires that we apply this wage
index in a manner that does not result
in aggregate payments that are greater or
lesser than would otherwise be made in
the absence of the wage adjustment. For
FY 2006 (Federal rates effective October
1, 2005), we would apply the most
recent wage index using the hospital
wage data, and apply an adjustment to
fulfill the budget neutrality requirement.
This requirement would be met by
multiplying each of the components of
the unadjusted Federal rates by a factor
equal to the ratio of the volume
weighted mean wage adjustment factor
(using the wage index from the previous
year) to the volume weighted mean
wage adjustment factor, using the wage
index for the FY beginning October 1,
2005. The same volume weights are
used in both the numerator and
denominator and will be derived from
1997 Medicare Provider Analysis and
Review File (MEDPAR) data. The wage
adjustment factor used in this
calculation is defined as the labor share
of the rate component multiplied by the
wage index plus the non-labor share.
The proposed budget neutrality factor
for this year is 1.0011. However, this
may change in the final rule. In order to
give the public a sense of the magnitude
of this adjustment, last year’s factor was
1.0011.
D. Proposed Area Wage Index
Section 1888(e)(4)(G)(ii) of the Act
requires that we adjust the Federal rates
to account for differences in area wage
levels, using a wage index that we find
appropriate. Since the inception of a
PPS for SNFs, we have used hospital
wage data in developing a wage index
to be applied to SNFs. As noted
previously, we are proposing to
continue that practice for FY 2006.
In our July 30, 2004 update notice, we
acknowledged that on June 6, 2003, the
Office of Management and Budget
(OMB) issued ‘‘OMB Bulletin No.03–
04,’’ which announced revised
definitions for Metropolitan Statistical
Areas, and new definitions of
Micropolitan Statistical Areas and
Combined Statistical Areas. A copy of
the Bulletin may be obtained at the
following Internet address: https://
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
www.whitehouse.gov/omb/bulletins/
b03–04.html. At that time, we did not
propose to apply these new definitions
known as the Core-Based Statistical
Areas (CBSAs). After further analysis,
we are proposing to use the OMBrevised definitions to adjust the FY 2006
SNF PPS payment rates. The Hospital
Inpatient PPS (IPPS) is applying these
revised definitions as discussed in the
August 11, 2004 IPPS final rule (69 FR
49207).
1. Proposed Revision of SNF PPS
Geographic Classifications
As discussed in the May 12, 1998 SNF
PPS interim final rule, which
implemented the SNF PPS (63 FR
26252), in establishing an adjustment
for area wage levels under
§ 413.337(a)(ii), the labor-related portion
of a SNF’s Federal prospective payment
is adjusted by using an appropriate
wage index. As set forth in
§ 413.337(a)(ii), a SNF’s wage index is
determined based on the location of the
SNF in an urban or rural area as defined
in § 412.62(f)(1)(ii) and (f)(1)(iii),
respectively. In general, an urban area is
defined as a Metropolitan Statistical
Area (MSA) or New England County
Metropolitan Area (NECMA) as defined
by OMB. Under § 412.62(f)(1)(iii), a
rural area is defined as any area outside
of an urban area. The urban and rural
area geographic classifications defined
in § 412.62(f)(1)(ii) and (f)(1)(iii),
respectively, were used under the IPPS
from FYs 1985 through 2004
(§ 412.63(b)), and have been used under
the SNF PPS since it was implemented
for cost reporting periods beginning on
or after July 1, 1998. The wage index
used for the SNF PPS is calculated using
the IPPS wage index data on the basis
of the labor market area in which the
acute care hospital is located, but
without taking into account geographic
reclassification under sections
1886(d)(8) and (d)(10) of the Act. The
applicable SNF wage index value is
assigned to a SNF on the basis of the
labor market area in which the SNF is
geographically located.
Section 4410 of the BBA provides that
for the purposes of section 1886(d)(3)(E)
of the Act, the area wage index
applicable to hospitals located in an
PO 00000
Frm 00022
Fmt 4701
Sfmt 4702
152.97
151.66
149.03
Labor portion
116.39
115.39
113.39
Non-labor
portion
36.58
36.27
35.64
urban area of a State may not be less
than the area wage index applicable to
hospitals located in rural areas in the
State. Consistent with past SNF policy,
we treat this provision, commonly
referred to as the ‘‘rural floor,’’ as
applicable to acute inpatient hospitals
and not SNFs. Therefore, the hospital
wage index used for SNFs is commonly
referred to as ‘‘pre-floor,’’ indicating that
the ‘‘rural floor’’ provision is not
applied.
The current SNF PPS labor market
areas are defined based on the
definitions of MSAs, Primary MSAs
(PMSAs), and NECMAs issued by the
OMB (commonly referred to collectively
as ‘‘MSAs’’). These MSA definitions,
which are discussed in greater detail
below, are currently used under the SNF
PPS and other prospective payment
systems such as the long-term care
hospital PPS (LTCH PPS), the inpatient
psychiatric facility PPS (IPF PPS), the
home health agency PPS (HHA PPS),
and the inpatient rehabilitation facility
PPS (IRF PPS). In the August 11, 2004
IPPS final rule (67 FR 49026 through
49034), revised labor market area
definitions were adopted under
§ 412.64(b), which were effective
October 1, 2004 for acute care hospitals.
The new standards, CBSAs, were
announced by OMB in late 2000 and are
discussed in greater detail below.
2. Current SNF PPS Labor Market Areas
Based on MSAs
As noted above, we currently define
labor market areas based on the
definitions of MSAs, PMSAs, and
NECMAs issued by the OMB. The OMB
also designates Consolidated MSAs
(CMSAs). A CMSA is a metropolitan
area with a population of one million or
more, comprising two or more PMSAs
(identified by their separate economic
and social character). For purposes of
the wage index, we use the PMSAs
rather than CMSAs because they allow
a more precise breakdown of labor costs.
If a metropolitan area is not designated
as part of a PMSA, we use the
applicable MSA.
These different designations use
counties as the building blocks upon
which they are based. Therefore,
providers are assigned to either an MSA,
E:\FR\FM\19MYP3.SGM
19MYP3
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
PMSA, or NECMA based on whether the
county in which the provider is located
is part of that area. All of the counties
in a State outside a designated MSA,
PMSA, or NECMA are designated as
rural. For the purposes of calculating
the wage index, we combine all of the
counties in a State outside a designated
MSA, PMSA, or NECMA together to
calculate the statewide rural wage index
for each State.
3. Core-Based Statistical Areas
The OMB reviews its Metropolitan
Area (MA) definitions preceding each
decennial census. As discussed in the
August 11, 2004 IPPS final rule (69 FR
49207), in the fall of 1998, the OMB
chartered the Metropolitan Area
Standards Review Committee to
examine the MA standards and develop
recommendations for possible changes
to those standards. Three notices related
to the review of the standards, providing
an opportunity for public comment on
the recommendations of the Committee,
were published in the Federal Register
on the following dates: December 21,
1998 (63 FR 70526); October 20, 1999
(64 FR 56628); and August 22, 2000 (65
FR 51060).
In the December 27, 2000 Federal
Register (65 FR 82228 through 82238),
the OMB announced its new standards.
In that notice, the OMB defines a CoreBased Statistical Area (CBSA),
beginning in 2003, as ‘‘a geographic
entity associated with at least one core
of 10,000 or more population, plus
adjacent territory that has a high degree
of social and economic integration with
the core as measured by commuting
ties.’’ The standards designate and
define two categories of CBSAs: MSAs
and Micropolitan Statistical Areas (65
FR 82235).
According to the OMB, MSAs are
based on urbanized areas of 50,000 or
more population, and Micropolitan
Statistical Areas (referred to in this
discussion as Micropolitan Areas) are
based on urban clusters of at least
10,000 population, but less than 50,000
population. Counties that do not fall
within CBSAs (either MSAs or
Micropolitan Areas) are deemed
‘‘Outside CBSAs.’’ In the past, the OMB
defined MSAs around areas with a
minimum core population of 50,000,
and smaller areas were ‘‘Outside
MSAs.’’ On June 6, 2003, the OMB
announced the new CBSAs, comprised
of MSAs and the new Micropolitan
Areas based on Census 2000 data. (A
copy of the announcement may be
obtained at the following Internet
address: https://www.whitehouse.gov/
omb/bulletins/fy04/b04–03.html.)
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
The new CBSA designations
recognize 49 new (urban) MSAs and 565
new Micropolitan Areas, and revise the
composition of many of the existing
(urban) MSAs. There are 1,090 counties
in MSAs under the new CBSA
designations (previously, there were 848
counties in MSAs). Of these 1,090
counties, 737 are in the same MSA as
they were before the change in
designations, 65 are in a different MSA,
and 288 were not previously designated
to any MSA. There are 674 counties in
Micropolitan Areas. Of these, 41 were
previously in an MSA, while 633 were
not previously designated to an MSA.
There are five counties that previously
were designated to an MSA but are no
longer designated to either an MSA or
a new Micropolitan Area: Carter County,
KY; St. James Parish, LA; Kane County,
UT; Culpepper County, VA; and King
George County, VA. For a more detailed
discussion of the conceptual basis of the
new CBSAs, refer to the August 11, 2004
IPPS final rule (67 FR 49026 through
49034).
4. Proposed Revisions to the SNF PPS
Labor Market Areas
[If you choose to comment on issues in
this section, please include the caption
‘‘Proposed Revisions to the SNF PPS
Labor Market Areas’’ at the beginning of
your comments.]
In its June 6, 2003 announcement, the
OMB cautioned that these new
definitions ‘‘should not be used to
develop and implement Federal, State,
and local nonstatistical programs and
policies without full consideration of
the effects of using these definitions for
such purposes. These areas should not
serve as a general-purpose geographic
framework for nonstatistical activities,
and they may or may not be suitable for
use in program funding formulas.’’
In the SNF PPS update notice for FY
2005 (69 FR 45786, July 30, 2004), we
noted that the recently-published IPPS
proposed rule for FY 2005 had
discussed some of the problems and
concerns associated with using these
new definitions, and had invited public
comment on them. Accordingly, we
decided to defer proposing any new
labor market definitions in the SNF
context at that time, in order to allow
the public sufficient time and
opportunity to consider and provide
comments on this issue. Although the
June 30, 2004 update notice also invited
comments on the possible application of
the new definitions to the SNF PPS, we
received no written comments on the
use of the new definitions specifically
in the SNF context; however, we did
receive a few phone calls inquiring
PO 00000
Frm 00023
Fmt 4701
Sfmt 4702
29091
about the methodology applied in the
August 11, 2004 IPPS final rule (69 FR
49207). We believe that sufficient time
has now elapsed for interested parties to
consider and react to the new OMB
definitions and, accordingly, we are
now proposing to make the changes
discussed below.
We have continued to use MSAs to
define labor market areas for purposes
of the wage index. For the SNF
prospective payment system, the statute
provides the Secretary with broad
authority to use an ‘‘appropriate wage
index as determined by the Secretary.’’
We believe MSAs are a reasonable and
appropriate proxy for developing
geographic areas for purposes of
adjusting for wage differences in SNF
PPS and for many of the same reasons
stated in the various IPPS rules over the
years where this issue has been
exhaustively examined. We also note
that MSAs are used to define labor
market areas for purposes of the wage
index for many of the other Medicare
payment systems (for example, IRF PPS,
HHA PPS, and IPF PPS).
First, historically, Medicare
prospective payment systems have
utilized MA definitions developed by
OMB. For example, in discussing the
adoption of the MSA designation for the
IPPS area labor adjustment, the IPPS
proposed rule for FY 1985 (49 FR 27426,
July 3, 1984) stated:
[i]n administering a national payment
system, we must have a national
classification system built on clear,
objective standards. Otherwise the
program becomes increasingly difficult
to administer because the distinction
between rural and urban hospitals is
blurred. We believe that the MSA
system is the only one that currently
meets the requirements for use as a
classification system in a national
payment program. The MSA
classification system is a statistical
standard developed for use by Federal
agencies in the production, analysis,
and publication of data on metropolitan
areas. The standards have been
developed with the aim of producing
definitions that will be as consistent as
possible for all MSAs nationwide.
In addition, in numerous instances,
the Congress has recognized that the
areas developed by OMB may be used
for differentiating among geographic
areas for Medicare payment purposes.
For example, in the IPPS statutory
sections, the Congress defines an ‘‘urban
area’’ as ‘‘an area within a Metropolitan
Statistical Area (as defined by the Office
of Management and Budget) or within
such similar area as the Secretary has
recognized’’ (section 1886(d)(2)(D) of
the Act). Similarly, in the sections of the
E:\FR\FM\19MYP3.SGM
19MYP3
29092
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
statute governing the guidelines to be
used by the Medicare Geographic
Classification Review Board for
purposes of reclassification, the
Congress directed the Secretary to create
guidelines for ‘‘determining whether the
county in which the hospital is located
should be treated as being a part of a
particular [MSA]’’ (sections
1886(d)(10)(A) and 1886(d)(10)(D)(i)(II)
of the Act). Thus, the Congress has
accepted and ratified the use of MSAs
as an inherently rational manner of
dividing up labor-market areas for
purposes of Medicare payments.
The process used by OMB to develop
the MSAs creates geographic areas
based upon characteristics that we
believe also generally reflect the
characteristics of unified labor market
areas. For example, the CBSAs reflect a
core population plus an adjacent
territory that reflects a high degree of
social and economic integration. This
integration is measured by commuting
ties, thus demonstrating that these areas
may draw workers from the same
general areas. In addition, the most
recent CBSAs reflect the most up to date
information. The OMB reviews its MA
definitions preceding each decennial
census to reflect recent population
changes, and the CBSAs are based on
the Census 2000 data. Finally, in the
context of the IPPS, CMS has reviewed
alternative methods for determining
geographic areas for purposes of the
wage index, and in each case, has
decided to retain the OMB designations
rather than replace these designations
with alternatives.
Because we believe that we have
broad authority to create labor market
areas, and because we also believe that
the OMB’s latest MA designations
accurately reflect the local economies
and wage levels of the areas in which
hospitals are currently located, we are
proposing to adopt the revised labor
market area designations based on the
OMB’s CBSA designations.
When we implemented the wage
index adjustment at § 413.337(a)(ii)
under the SNF PPS in the May 12, 1998
SNF PPS interim final rule (63 FR
26252), we explained that the SNF PPS
wage index adjustment was intended to
reflect the relative hospital wage levels
in the geographic area of the hospital as
compared to the national average
hospital wage level. Because we believe
that the OMB’s CBSA designations
based on Census 2000 data reflect the
most recent available geographic
classifications (MA definitions), we are
proposing to revise the labor market
area definitions used under the SNF
PPS. Specifically, we are proposing to
revise the SNF PPS labor market
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
definitions based on the OMB’s new
CBSA designations (as discussed in
greater detail below) effective for SNF
PPS services occurring on or after
October 1, 2005. Accordingly, we are
proposing to revise § 413.337(a)(ii) to
specify that for services furnished on or
after October 1, 2005, the application of
the wage index under the SNF PPS
would be made on the basis of the
location of the facility in an urban or
rural area as defined in
§ 412.64(b)(1)(ii)(A) through (C).
We note that the OMB’s new CBSA
designations are the same labor market
area definitions implemented under the
IPPS at § 412.64(b), which were effective
for those hospitals beginning October 1,
2004, as discussed in the August 11,
2004 IPPS final rule (69 FR 49026
through 49034). The similarity between
the IPPS and the SNF PPS includes the
adoption in the initial implementation
of the SNF PPS of the same labor market
area definitions under the SNF PPS that
existed under the IPPS at that time, as
well as the use of acute care hospitals’
wage data in calculating the SNF PPS
wage index. Therefore, we believe that
proposing to revise the SNF PPS labor
market area definitions based on OMB’s
CBSA designations is consistent with
our historical practice of generally
modeling SNF PPS wage index policy
after IPPS wage index policy.
Below, we discuss the composition of
the proposed SNF PPS labor market
areas based on the OMB’s new CBSA
designations.
a. New England MSAs
As stated above, under the SNF PPS,
we currently use NECMAs to define
labor market areas in New England,
because these are county-based
designations rather than the 1990 MSA
definitions for New England, which
used minor civil divisions such as cities
and towns. Under the current MSA
definitions, NECMAs provided more
consistency in labor market definitions
for New England compared with the rest
of the country, where MSAs are countybased. Under the new CBSAs, the OMB
has now defined the MSAs and
Micropolitan Areas in New England on
the basis of counties. The OMB also
established New England City and
Town Areas, which are similar to the
previous New England MSAs.
In order to create consistency among
all labor market areas and to maintain
these areas on the basis of counties, we
are proposing to use the county-based
areas for all MSAs in the nation,
including those in New England. Census
2000 has now defined the New England
area based on counties, creating a cityand town-based system as an
PO 00000
Frm 00024
Fmt 4701
Sfmt 4702
alternative. We believe that adopting
county-based labor market areas for the
entire country except those in New
England would lead to inconsistencies
in our designations. Adopting countybased labor market areas for the entire
country provides consistency and
stability in Medicare SNF PPS program
payment because all of the labor market
areas throughout the country, including
New England, would be defined using
the same system (that is, counties)
rather than different systems in different
areas of the country, thus minimizing
programmatic complexity.
In addition, we have consistently
employed a county-based system for
New England for precisely that reason:
To maintain consistency with the labor
market definitions used throughout the
country. We note that this is consistent
with the implementation of the CBSA
designations under the IPPS for New
England (see August 11, 2004 (69 FR
49028)). Accordingly, under the SNF
PPS we are proposing to use the New
England MSAs as determined under the
proposed new CBSA-based labor market
area definitions in defining the
proposed revised SNF PPS labor market
areas.
b. Metropolitan Divisions
Under the OMB’s new CBSA
designations, a Metropolitan Division is
a county or group of counties within a
CBSA that contains a core population of
at least 2.5 million, representing an
employment center, plus adjacent
counties associated with the main
county or counties through commuting
ties. A county qualifies as a main county
if 65 percent or more of its employed
residents work within the county and
the ratio of the number of jobs located
in the county to the number of
employed residents is at least 0.75
percent. A county qualifies as a
secondary county if 50 percent or more,
but less than 65 percent, of its employed
residents work within the county and
the ratio of the number of jobs located
in the county to the number of
employed residents is at least 0.75
percent. After all the main and
secondary counties are identified and
grouped, each additional county that
already has qualified for inclusion in
the MSA falls within the Metropolitan
Division associated with the main/
secondary county or counties with
which the county at issue has the
highest employment interchange
measure. Counties in a Metropolitan
Division must be contiguous (see 65 FR
82236).
As noted above, in the past, the OMB
designated CMSAs as Metropolitan
Areas with a population of one million
E:\FR\FM\19MYP3.SGM
19MYP3
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
or more and comprised of two or more
PMSAs. Under the SNF PPS, we
currently use the PMSAs rather than
CMSAs to define labor market areas
because they comprise a smaller
geographic area with potentially varying
labor costs due to different local
economies. We believe that CMSAs may
be too large an area to reflect accurately
the local labor costs of all of the
individual SNFs included in that
relatively ‘‘large’’ area. Similarly, we
believe that Metropolitan Divisions
under the CBSA designations may be
too large an area to reflect accurately the
local labor costs of all of the individual
SNFs included in that relatively ‘‘large’’
area. Further, Metropolitan Divisions
represent the closest approximation to
PMSAs and, therefore, would most
accurately maintain our current
structuring of the SNF PPS labor market
areas. Therefore, as implemented under
the IPPS (69 FR 49029), we are
proposing to use the Metropolitan
Divisions where applicable (as
described below) under the proposed
new CBSA-based labor market area
definitions.
In addition to being comparable to the
organization of the labor market areas
under current MSA designations, we
believe that proposing to use
Metropolitan Divisions where
applicable (as described below) under
the SNF PPS would result in a more
accurate adjustment for the variation in
local labor market areas for SNFs.
Specifically, if we recognize the
relatively ‘‘larger’’ CBSA that comprises
two or more Metropolitan Divisions as
an independent labor market area for
purposes of the wage index, it would be
too large and would include the data
from too many hospitals to compute a
wage index that would accurately reflect
the various local labor costs of all of the
individual hospitals included in that
relatively ‘‘large’’ CBSA. By proposing
to recognize Metropolitan Divisions
where applicable (as described below)
under the proposed new CBSA-based
labor market area definitions under the
SNF PPS, we believe that the local labor
costs would be more accurately
reflected, thereby resulting in a wage
index adjustment that better reflects the
variation in the local labor costs of the
local economies of the SNFs located in
those relatively ‘‘smaller’’ areas.
Under the CBSA designations, there
are 11 MSAs containing Metropolitan
Divisions: Boston; Chicago; Dallas;
Detroit; Los Angeles; Miami; New York;
Philadelphia; San Francisco; Seattle;
and Washington, D.C. Although these
MSAs were also CMSAs under the prior
definitions, in some cases their areas
have been altered. Under the current
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
SNF PPS MSA designations, Boston was
a single NECMA. Under the proposed
CBSA-based labor market area
designations, it would be comprised of
4 Metropolitan Divisions. Los Angeles
would go from 4 PMSAs under the
current SNF PPS MSA designations to 2
Metropolitan Divisions under the
proposed CBSA-based labor market area
designations. The New York CMSA
would go from 15 PMSAs under the
current SNF PPS MSA designations to
only 4 Metropolitan Divisions under the
proposed CBSA-based labor market area
designations. Five PMSAs in
Connecticut under the current SNF PPS
MSA designations would become
separate MSAs under the proposed
CBSA-based labor market area
designations. The number of PMSAs in
New Jersey, under the current SNF PPS
MSA designations would go from 5 to
2, with the consolidation of 2 New
Jersey PMSAs (Bergen-Passaic and
Jersey City) into the New York-WayneWhite Plains, NY–NJ Division, under
the proposed CBSA-based labor market
area designations. In San Francisco,
under the proposed CBSA-based labor
market area designations there are only
2 Divisions. Currently, there are 6
PMSAs, some of which are now separate
MSAs under the current SNF PPS labor
market area designations.
Under the current SNF PPS labor
market area designations, Cincinnati,
Cleveland, Denver, Houston,
Milwaukee, Portland, Sacramento, and
San Juan are all designated as CMSAs,
but would no longer be designated as
CMSAs under the proposed CBSA-based
labor market area designations. As noted
previously, the population threshold to
be designated a CMSA under the current
SNF PPS labor market area designations
is one million. In most of these cases,
counties currently in a PMSA would
become a separate, independent MSA
under the proposed CBSA-based labor
market area designations, leaving only
the MSA for the core area under the
proposed CBSA-based labor market area
designations.
c. Micropolitan Areas
Under the OMB’s new CBSA
designations, Micropolitan Areas are
essentially a third area definition
consisting primarily of areas that are
currently rural, but also include some or
all of areas that are currently designated
as urban MSAs. As discussed in greater
detail in the August 11, 2004 IPPS final
rule (69 FR 49029 through 49032), how
these areas are treated would have
significant impacts on the calculation
and application of the wage index.
Specifically, whether or not
Micropolitan Areas are included as part
PO 00000
Frm 00025
Fmt 4701
Sfmt 4702
29093
of the respective statewide rural wage
indexes would affect the value of the
Statewide rural wage index of any State
that contains a Micropolitan Area. A
hospital’s classification as urban or rural
affects which hospitals’ wage data are
included in the statewide rural wage
index. As discussed above in section
II.D.3, we combine all of the counties in
a State outside a designated urban area
to calculate the statewide rural wage
index for each State.
Micropolitan Areas included as part
of the statewide rural labor market area
would result in an increase to the
statewide rural wage index because
hospitals located in those Micropolitan
Areas typically have higher labor costs
than other rural hospitals in the State.
Alternatively, as discussed in greater
detail below, if Micropolitan Areas
would be recognized as independent
labor market areas, because there would
be so few hospitals in those areas to
complete a wage index, the wage
indexes for SNFs in those areas could
become relatively unstable as they
would change considerably from year to
year.
We currently use MSAs to define
urban labor market areas and group all
of the hospitals in counties within each
State that are not assigned to an MSA
into a statewide rural labor market area.
Therefore, we used the terms ‘‘urban’’
and ‘‘rural’’ wage indexes in the past for
ease of reference. However, the
introduction of Micropolitan Areas by
the OMB potentially complicates this
terminology because these areas include
many hospitals that are currently
included in the statewide rural labor
market areas.
We are proposing to treat
Micropolitan Areas as rural labor market
areas under the SNF PPS for the reasons
outlined below. That is, counties that
are assigned to a Micropolitan area
under the CBSA designations would be
treated the same as other ‘‘rural’’
counties that are not assigned to either
an MSA (Metropolitan Area) or a
Micropolitan Area. Therefore, in
determining an SNF’s applicable wage
index (based on IPPS hospital wage
index data, as discussed in greater detail
below in section II.D.6 of this preamble),
we propose that a SNF in a Micropolitan
Area under the OMB’s CBSA
designations would be classified as
‘‘rural’’ and would be assigned the
statewide rural wage index for the State
in which it resides.
In the August 11, 2004 IPPS final rule
(69 FR 49029 through 49032), we
discussed the impact of treating
Micropolitan areas as part of the
statewide rural labor market area
instead of treating Micropolitan Areas as
E:\FR\FM\19MYP3.SGM
19MYP3
29094
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
independent labor market areas for
hospitals paid under the IPPS. As
discussed in greater detail in that same
final rule, Micropolitan Areas
encompass smaller populations than
MSAs and tend to include fewer
hospitals per Micropolitan Area.
Thus, since Micropolitan Areas tend
to include fewer hospitals, recognizing
Micropolitan Areas as independent
labor market areas would generally
increase the potential for dramatic shifts
in those areas’ wage indexes from one
year to the next, because a single
hospital (or group of hospitals) could
have a disproportionate effect on the
wage index of the area. Dramatic shifts
in an area’s wage index from year to
year are problematic and create
instability in the payment levels from
year to year, which could make fiscal
planning for SNFs difficult if we
adopted this approach. Therefore, in
order to minimize the potential
instability in payment levels from year
to year, we believe it would be
appropriate to treat Micropolitan Areas
as part of the statewide rural labor
market area under the SNF PPS.
Consistent with the treatment of these
areas under the IPPS, we are proposing
that Micropolitan Areas be considered a
part of the Statewide rural labor market
area. Accordingly, we are proposing that
the SNF PPS Statewide rural wage index
would be determined using acute-care
IPPS hospital wage data from hospitals
located in non-MSA areas and that the
Statewide rural wage index would be
assigned to SNFs located in those areas.
When the revised labor market areas
based on the OMB’s new CBSA
designations were adopted under the
IPPS beginning on October 1, 2004, a
transition to the new designations was
established due to the scope and
magnitude of the change, in order to
mitigate the resulting adverse impact on
certain hospitals. As discussed in the
August 11, 2004 IPPS final rule (69 FR
49032), during FY 2005, a blend of wage
indexes is calculated for those acute
care IPPS hospitals experiencing a drop
in their wage indexes because of the
adoption of the new labor market areas.
Also, as described in that same final
rule (69 FR 49032), under the IPPS,
hospitals that previously had been
located in an urban MSA but became
rural under the new CBSA definitions
are assigned the wage index value of the
urban area to which they belonged
previously, for 3 years (FYs 2005
through FYs 2007).
We recognize that SNFs will be
subject to the same impact as hospitals,
and that some SNFs may experience
decreases in their wage index as a result
of the proposed labor market area
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
changes. At the same time, a significant
number of SNFs will benefit from these
proposed changes. However, as
explained below, we are not proposing
a transition period in this proposed rule.
5. Implementation of the Revised Labor
Market Areas
Under section 1888(e)(4)(G)(ii) of the
Act, the Secretary has the authority to
adjust for geographic variations in labor
costs by using an appropriate wage
index. Moreover, the adjustment must
be made in a manner such that aggregate
payments would not change if such
adjustment were not made.
To facilitate an understanding of the
proposed policies related to the
proposed change to the SNF PPS labor
market areas discussed above, in Table
A (MSA/CBSA Crosswalk) of the
Addendum of this proposed rule, we are
providing a listing of each Social
Security Administration (SSA) State and
county location code; State and county
name; existing MSA-based labor market
area designation; MSA-based wage
index value; CBSA-based labor market
area; and the new CBSA-based wage
index value.
When the revised labor market areas
based on OMB’s new CBSA
designations were adopted under the
IPPS beginning on October 1, 2004, a
transition to the new designations was
established due to the scope and fiscal
impact of these new boundaries. As
discussed in the IPPS final rule (69 FR
49032), during FY 2005, a blend of wage
indexes is calculated for those acute
care IPPS hospitals experiencing a drop
in their wage indexes because of the
adoption of the new labor market areas.
The most significant impacts will
generally be for MSA-based urban
hospitals that were designated as rural
under the CBSA-based designations.
Because the former MSA-based labor
market areas used under the IPPS had
been used for payment for over 10 years,
we believed it was necessary to provide
additional protection, given the scope
and potentially significant implications
(and the subsequent adverse impact) of
these new labor market areas on
numerous acute-care hospitals.
Therefore, we implemented a transition
under the IPPS from the former MSAbased labor market area designation to
the new CBSA-based labor market area
designation for acute-care hospitals that
would receive a lower wage index as a
result of the change in the labor market
area designations.
As we recognize that SNFs may
experience similar changes in their
wage indexes as a result of the proposed
labor market area changes, we carefully
evaluated the impact of the conversion
PO 00000
Frm 00026
Fmt 4701
Sfmt 4702
to the proposed wage index structure.
During our analysis, we found that a
majority of SNFs (61 percent) either
maintained the same wage index or
would get an increased wage index
based on CBSA definitions. Only a very
small number of SNFs (4 percent) would
experience a decline of 5 percent or
more in the wage index based on CBSA
designations. We also found that only a
very small number of SNFs would
experience a change in either rural or
urban designation under the CBSA
based definitions. Furthermore, we
believe the new CBSA definitions may
have a positive impact on many
counties. For example, most counties
which had been included in the rural
definitions under the MSA designations
but are now designated as urban areas
under CBSAs will generally receive an
increase in their wage index.
Although a majority of SNFs would
not be significantly affected, and we
believe that it is not appropriate or
necessary to propose a transition to the
proposed new CBSA-based labor market
areas for the purpose of the SNF PPS
wage index, we recognize that there are
many options in efficiently
implementing the new CBSA geographic
designations. Thus, we considered
several budget neutral options that
would most effectively implement the
adoption of the proposed CBSA
designations as discussed below.
One option we considered institutes a
one-year transition with a blended wage
index for all providers. The wage index
for each provider would consist of a
blend of 50 percent of the FY 2006
MSA-based wage index and 50 percent
of the FY 2006 CBSA-based wage index
(both based on the FY 2002 hospital
wage data). However, we found that
while this would help some SNFs that
would be adversely affected by the
proposed changes to the MSAs, it would
also reduce the wage index values
(compared to fully adopting the CBSA
wage index value) for those SNFs that
would be positively affected by the
changes. In addition, the budget
neutrality factor calculated based on the
blended wage index for all SNFs would
slightly reduce the unadjusted payment
rate for all providers.
A second option we considered was a
one-year transition with a blended wage
index limited to providers that would
experience a decrease due solely to the
changes in the labor market definitions.
Providers that experience a decrease in
their FY 2006 wage index under the
CBSA-based definitions compared to the
wage index they would have received
under the MSA-based definitions (in
both cases using FY 2002 hospital wage
data) would receive a blended wage
E:\FR\FM\19MYP3.SGM
19MYP3
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
index. The wage index for these
providers would consist of a blend of 50
percent of the FY 2006 MSA wage index
and 50 percent of the FY 2006 CBSA
wage index (both based on the FY 2002
hospital wage data). Providers that
would experience a decrease due to
changes in the labor market definitions
would receive the full FY 2006 CBSA
wage index.
When we performed our analysis, we
found that the unadjusted payment
amounts decreased substantially more
under this option than they did either
by using the first option discussed
above or by fully adopting the CBSA
designations. As with the first option,
the positive impact of blending in order
to decrease the impacts for a relatively
small number of SNFs would require
reduced payment rates for all providers,
including the SNFs receiving a blended
wage index.
We also recognize that during FY
2005, as discussed in the August 11,
2004 IPPS final rule (69 FR 49032), a
hold harmless policy under IPPS was
implemented to minimize the overall
impact on hospitals that are currently
designated as urban under the MSA
designations, but would become rural
under the CBSA designations. We
considered adopting a hold harmless
policy for SNFs, to allow facilities that
are currently urban under the MSA
definitions (but become rural under the
CBSA definitions) to maintain their
urban status under the CBSA definitions
for one year. However, our analysis
shows that only an extremely small
number of SNFs would qualify for such
a hold harmless policy. As any
adjustment requires payments to be
made in a budget neutral manner, all
providers would have the payment rates
reduced for the benefit of that small
number of SNFs (1.4 percent) which
lose their urban designations.
Accordingly, we do not believe it is
appropriate or necessary to adopt a hold
harmless policy under the SNF PPS for
facilities that will experience a change
in designation under the CBSA
definitions.
We are proposing to adopt for the SNF
PPS the new CBSA-based labor market
area definitions beginning with the 2006
SNF PPS rate year without a transition
period and without a hold harmless
policy. We also note that OMB in the
past has announced MSA changes on an
annual basis due to population changes
and we have not transitioned these
changes under the SNF PPS.
As noted previously, our data analysis
shows that a minimal number of SNFs
would experience a decrease of more
than 5 percent in the wage index. In
addition, under the CBSA designation,
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
an even smaller number of SNFs would
experience a change from their current
urban or rural designation. Therefore,
the aggregate impact on SNFs under the
MSA-based designations as compared to
the CBSA-based designations does not
result in a dramatic change overall.
As explained above, we believe that it
is not appropriate or necessary to
propose a transition to the proposed
new CBSA-based labor market area for
the SNF PPS wage index adjustment. In
addition, as noted above, we believe the
data suggest that the potential benefit of
a hold harmless policy for an extremely
small number of providers would be
outweighed by the resulting decrease in
payment rates for all providers.
However, we specifically invite public
comments on our proposed approach, as
well as on the various transition options
discussed above.
Finally, we note that section 505 of
the MMA established new section
1886(d)(13) of the Act. The new section
1886(d)(13) requires that the Secretary
establish a process to make adjustments
to the hospital wage index based on
commuting patterns of hospital
employees. We believe that this
requirement for an ‘‘out-commuting’’ or
‘‘out-migration’’ adjustment applies
specifically to the Hospital Inpatient
Prospective Payment System. Therefore,
we will not be establishing such an
adjustment for the SNF PPS.
6. Wage Index Data
[If you choose to comment on issues in
this section, please include the caption
‘‘Wage Index Data’’ at the beginning of
your comments.]
In the FY 2005 SNF PPS update
notice (69 FR 45775, July 30, 2004), we
established SNF PPS wage index values
for the 2005 SNF PPS rate year
calculated from the same data
(generated in cost reporting periods
beginning during FY 2001) used to
compute the FY 2005 acute care
hospital inpatient wage index data,
without taking into account geographic
reclassification under sections
1886(d)(8) and 1886(d)(10) of the Act
and without applying the ‘‘rural floor’’
under section 4410 of the BBA. We
subsequently published correction
notices to update the wage index values.
The SNF wage index values applicable
for services furnished on or after
October 1, 2004 through August 31,
2005 are shown in Table 8 (for urban
areas) and Table 9 (for rural areas) in the
December 30, 2004 correction notice (69
FR 78445).
Acute care hospital inpatient wage
index data is also used to establish the
wage index adjustment used in the
LTCH PPS, IPF PPS, HHA PPS, and IRF
PO 00000
Frm 00027
Fmt 4701
Sfmt 4702
29095
PPS. As we discussed in the May 12,
1998 SNF PPS interim final rule (63 FR
26252), as hospitals that are excluded
from the IPPS are not required to
provide wage-related information on the
Medicare cost report, and because we
would need to establish instructions for
the collection of these SNF data in order
to establish a geographic reclassification
adjustment under the SNF PPS, the
wage adjustment established under the
SNF PPS is based on a SNF’s actual
location without regard to the urban or
rural designation of any related or
affiliated provider.
In this proposed rule, for the FY 2006
SNF PPS rate year, we propose to use
acute care hospital inpatient wage index
data generated from cost reporting
periods beginning during FY 2002
(without taking into account geographic
reclassification under sections
1886(d)(8) and 1886(d)(10) of the Act
and without applying the ‘‘rural floor’’
under section 4410 of the BBA) to
determine the applicable wage index
values under the SNF PPS, because
these data (FY 2002) are the most recent
complete data. We realize that there has
been some interest in developing a SNFspecific wage index. However,
considering the impact of converting to
the new OMB classification
methodology discussed above, we
believe a second major change would be
inappropriate at this time. In making
this decision, one of our primary
concerns is that the combined effect of
changing both the wage area categories
and the actual wage index could result
in an inaccurate impact assessment for
one or both of these changes. As
discussed in several of the previous SNF
PPS rules, we also remain concerned
about the potential volatility and
unreliability of unaudited data (see, for
example, the final rule for FY 2002 (66
FR 39579 through 39596, July 31, 2001),
and the final rule for FY 2004 (68 FR
46045 through 46046, August 3, 2003)).
We are proposing to adopt OMB’s
new labor market designations for CY
2006, effective January 1, 2006. In
adopting the CBSA designations, we
identified some geographic areas where
there were no hospitals, and thus no
hospital wage index data on which to
base the calculation of the FY 2006 SNF
PPS proposed wage index. In addressing
this situation, we are proposing
approaches that we believe serve as
proxies for hospital wage data and
would provide an appropriate standard
that accounts for geographic variation in
labor costs.
The first situation involves rural
locations in Massachusetts and Puerto
Rico. Under these labor market areas,
there are no rural hospitals in those
E:\FR\FM\19MYP3.SGM
19MYP3
29096
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
locations. Because there is no
reasonable proxy for more recent rural
data within those areas, we are
proposing to use last year’s wage index
value for rural Massachusetts and rural
Puerto Rico.
The second situation has to do with
the urban areas of Hinesville, GA (CBSA
25980) and Mansfield, OH (CBSA
31900). Again, under the proposed new
labor market areas there are no urban
hospitals within those areas. We
propose to use all of the urban areas
within the State to serve as a reasonable
proxy for the urban areas without
specific hospital wage index data in
determining the SNF PPS wage index.
Therefore, in this proposed rule, we
calculated the urban wage index value
for purposes of the wage index for these
areas without urban hospital data as the
average wage index for all urban areas
within the State. We note that we could
not apply a similar averaging in rural
areas, because in the rural areas there
are no State rural hospital wage data
available for averaging on a State-wide
basis. We solicit comments on these
approaches to calculating the wage
index values for areas without hospitals
for FY 2006 and subsequent years.
The proposed wage index values that
would be applicable for SNF PPS
services furnished on or after October 1,
2005 through August 31, 2006 are
shown in Tables 8 and 9 in the
Addendum of this proposed rule.
E. Updates to the Federal Rates
In accordance with section
1888(e)(4)(E) of the Act and section 311
of the BIPA, the proposed payment rates
listed here reflect a proposed update
equal to the full SNF market basket,
estimated at 3.0 percentage points. We
will continue to disseminate the rates,
wage index, and case-mix classification
methodology through the Federal
Register before August 1 preceding the
start of each succeeding fiscal year. We
discuss the Federal rate update factor in
greater detail in section III.C of this
preamble.
F. Relationship of RUG–III Classification
System to Existing Skilled Nursing
Facility Level-of-Care Criteria
As discussed in § 413.345, we include
in each update of the Federal payment
rates in the Federal Register the
designation of those specific RUGs
under the classification system that
represent the required SNF level of care,
as provided in § 409.30. This
designation reflects an administrative
presumption under the current 44-group
RUG–III classification system. Our
presumption is that any beneficiary who
is correctly assigned to one of the upper
26 RUG–III groups in the initial 5-day,
Medicare-required assessment is
automatically classified as meeting the
SNF level of care definition up to the
assessment reference date for that
assessment.
Any beneficiary assigned to any of the
lower 18 groups is not automatically
classified as either meeting or not
meeting the definition, but instead
receives an individual level of care
determination using the existing
administrative criteria. This
presumption recognizes the strong
likelihood that beneficiaries assigned to
one of the upper 26 groups during the
immediate post-hospital period require
a covered level of care, which would be
significantly less likely for those
beneficiaries assigned to one of the
lower 18 groups.
As discussed in section II.B of this
preamble, we propose to refine the
existing 44-group RUG–III classification
system by adding an additional 9
groups, comprising a new Rehabilitation
plus Extensive Services category. In
effect, the groups in this new category
would encompass care that is at least as
intensive as that identified by any of the
upper 26 RUG–III groups under the
original, 44-group RUG–III classification
system. Accordingly, for purposes of the
administrative presumption, we propose
to designate the upper 35 groups of the
proposed 53-group refined case-mix
classification system (including the
upper 26 groups that we have identified
as representing a covered level of care
under the existing 44-group system,
plus the additional 9 groups set forth in
this proposed rule), consisting of the
following RUG classifications: All
groups within the proposed new
Rehabilitation plus Extensive Services
category; all groups within the Ultra
High Rehabilitation category; all groups
within the Very High Rehabilitation
category; all groups within the High
Rehabilitation category; all groups
within the Medium Rehabilitation
category; all groups within the Low
Rehabilitation category; all groups
within the Extensive Services category;
all groups within the Special Care
category; and, all groups within the
Clinically Complex category.
G. Initial 3-Year Transition Period From
Facility Specific to Federal Rates
As noted previously in section I.A
and section I.F.2 of this proposed rule,
the PPS is no longer operating under the
initial 3-year transition period from
facility-specific to Federal rates.
Therefore, payment now equals the
adjusted Federal per diem rate.
H. Example of Computation of Adjusted
PPS Rates and SNF Payment
As explained in section II.B of this
proposed rule, from October 1, 2005,
through December 31, 2005, we propose
to make payment based entirely on the
existing 44-group RUG–III classification
system (including any associated add-on
payments). Using the model SNF (XYZ)
described in Table 10, the following
shows the adjustments made to the
Federal per diem rate to compute the
provider’s actual per diem PPS for the
time period mentioned above using the
existing 44 group RUG-III classification
system.
TABLE 10.—RUG–44, SNF XYZ: LOCATED IN STATE COLLEGE, PA, WAGE INDEX: 0.8364
RUG group
Labor
Wage index
Adjustment
labor
Non-labor
Adjustment
rate
Percent
adjustment
Medicare
days
Payment
RVC ..................................
RHA ..................................
CC2 ..................................
SE3 ..................................
IA2 ....................................
$282.62
218.40
180.87
241.52
123.35
0.8364
0.8364
0.8364
0.8364
0.8364
$236.38
182.67
151.28
202.01
103.17
$88.82
68.64
56.84
75.91
38.77
$325.20
251.31
208.12
277.92
141.94
* $346.99
* 268.15
** 474.51
*** 333.50
141.94
14
16
10
30
30
$4,858
4,290
4,745
10,005
4,258
Total ..........................
....................
....................
....................
....................
....................
....................
100
28,156
* Reflects a 6.7 percent adjustment from section 314 of the BIPA.
** Reflects a 128 percent adjustment from section 511 of the MMA. Section 101(a) of the BBRA no longer applies because of the MMA section
511 adjustment.
*** Reflects a 20 percent adjustment from section 101(a) of the BBRA.
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00028
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
19MYP3
29097
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
Beginning January 1, 2006, we
propose to make payment based on the
proposed new RUG–53 classification
system (and, thus, would not include
the add-on payments). Table 10a shows
an example of the actual per diem PPS
payments under the RUG–53
classification system.
TABLE 10A.—RUG–53, SNF XYZ: LOCATED IN STATE COLLEGE, PA, WAGE INDEX: 0.8364
RUG group
Labor
Wage index
Adjustment
labor
Non-labor
Adjustment
rate
Percent
adjustment
Medicare
days
Payment
RVX ..................................
RHA ..................................
CC2 ..................................
RLX ..................................
IA2 ....................................
$310.03
233.09
184.01
246.32
125.44
0.8364
0.8364
0.8364
0.8364
0.8364
$259.31
194.96
153.91
206.02
104.92
$97.44
73.26
57.83
77.42
39.43
$356.75
268.22
211.74
283.44
144.35
$356.75
268.22
* 482.76
283.44
144.35
14
16
10
30
30
$4,994
4,291
4,828
8,503
4,330
Total ..........................
....................
....................
....................
....................
....................
....................
100
26,946
* Reflects a 128 percent adjustment from section 511 of the MMA.
for an adjustment to account for market
basket forecast error. The initial
adjustment applied to the update of the
Section 1888(e)(5)(A) of the Act
Relative im- Relative im- FY 2003 rate that occurred in FY 2004,
requires us to establish a SNF market
portance,
portance,
and took into account the cumulative
labor-relabor-rebasket index (input price index) that
forecast error for the period from FY
lated,
lated,
reflects changes over time in the prices
2000 through FY 2002. Subsequent
FY 2005
FY 2006
of an appropriate mix of goods and
adjustments in succeeding FYs take into
(97 index)
(97 index)
services included in the SNF PPS. This
account the forecast error from the most
proposed rule incorporates the latest
Labor-intensive
recently available fiscal year for which
services .........
4.125
4.116 there are final data, and are applied
available projections of the SNF market
Capital-related ..
3.094
3.006 whenever the difference between the
basket index. The final rule will
Total ..............
76.222
76.087
incorporate updated projections based
forecasted and actual change in the
on the latest available projections at that
market basket exceeds a 0.25 percentage
time. Accordingly, we have developed a A. Use of the Skilled Nursing Facility
point threshold. As discussed
Market Basket Percentage
SNF market basket index that
previously in section I.G of this
encompasses the most commonly used
Section 1888(e)(5)(B) of the Act
proposed rule, as the difference between
cost categories for SNF routine services, defines the SNF market basket
the estimated and actual amounts of
ancillary services, and capital-related
percentage as the percentage change in
increase in the market basket index for
expenses. In the July 31, 2001 Federal
the SNF market basket index, as
FY 2004 (the most recently available
Register (66 FR 39562), we included a
described in the previous section, from
fiscal year for which there are final data)
complete discussion on the rebasing of
the average index level of the prior
did not exceed the 0.25 percentage point
the SNF market basket to FY 1997.
fiscal year to the average index level of
threshold, the payment rates for FY
There are 21 separate cost categories
the current fiscal year. For the Federal
2006 do not include a forecast error
and respective price proxies. These cost rates established in this proposed rule,
adjustment.
categories were illustrated in Table
this percentage increase in the SNF
C. Federal Rate Update Factor
market basket index would be used to
10.A, Table 10.B, and Appendix A,
Section 1888(e)(4)(E)(ii)(IV) of the Act
compute the update factor occurring
along with other relevant information,
between FY 2005 and FY 2006. We used requires that the update factor used to
in the July 31, 2001 Federal Register.
establish the FY 2006 Federal rates be
the Global Insight, Inc. (formerly DRIEach year, we calculate a revised
at a level equal to the full market basket
WEFA), 1st quarter 2005 forecasted
labor-related share based on the relative
percentage change. Accordingly, to
percentage increase in the FY 1997importance of labor-related cost
establish the update factor, we
based SNF market basket index for
categories in the input price index.
determined the total growth from the
routine, ancillary, and capital-related
Table 11 summarizes the proposed
average market basket level for the
expenses, described in the previous
updated labor-related share for FY 2006.
period of October 1, 2004 through
section, to compute the update factor.
Finally, we no longer compute update
September 30, 2005 to the average
TABLE 11.—FY 2006 LABOR-RELATED
factors to adjust a facility-specific
market basket level for the period of
SHARE
portion of the SNF PPS rates, because
October 1, 2005 through September 30,
the 3-year transition period from
2006. Using this process, the proposed
Relative im- Relative imfacility-specific to full Federal rates that update factor for FY 2006 SNF Federal
portance,
portance,
started with cost reporting periods
rates is 3.0 percentage points. We used
labor-relabor-related,
lated,
beginning in July 1998 has expired.
this revised proposed update factor to
FY 2005
FY 2006
compute the proposed Federal portion
B. Market Basket Forecast Error
(97 index)
(97 index)
of the SNF PPS rate shown in Tables 2
Adjustment
and 3.
Wages and salaAs discussed in the June 10, 2003,
ries ................
54.720
54.572
IV. Consolidated Billing
supplemental proposed rule (68 FR
Employee bene34768) and finalized in the August 4,
As established by section 4432(b) of
fits ..................
11.595
11.691
2003, final rule (68 FR 46067), the
the BBA, the consolidated billing
Nonmedical professional fees
2.688
2.702 regulations at § 413.337(d)(2) provide
requirement places with the SNF the
III. The Skilled Nursing Facility Market
Basket Index
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
TABLE 11.—FY 2006 LABOR-RELATED
SHARE—Continued
PO 00000
Frm 00029
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
19MYP3
29098
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
Medicare billing responsibility for
virtually all of the services that the
SNF’s residents receive, except for a
small number of services that the statute
specifically identifies as being excluded
from this provision. Section 103 of the
BBRA amended this provision by
further excluding a number of high-cost,
low probability services (identified by
Healthcare Common Procedure Coding
System (HCPCS) codes) within several
broader categories that otherwise
remained subject to the provision.
Section 313 of the BIPA further
amended this provision by repealing its
Part B aspect; that is, its applicability to
services furnished to a resident during
a SNF stay that Medicare does not
cover. (However, physical,
occupational, and speech-language
therapy remain subject to consolidated
billing, regardless of whether the
resident who receives these services is
in a covered Part A stay.)
Further, while the services of rural
health clinics (RHCs) and Federally
Qualified Health Centers (FQHCs)
generally are subject to SNF
consolidated billing, section 410 of the
MMA provided that when an RHC or
FQHC furnishes the services of a
physician (or another type of service
that section 1888(e)(2)(A)(ii) of the Act
identifies as being excluded from SNF
consolidated billing), those services do
not become subject to consolidated
billing merely by virtue of being
furnished under the auspices of the RHC
or FQHC. In effect, this provision
(which applies to services furnished on
or after January 1, 2005) enables those
services to retain their separate identity
as excluded ‘‘practitioner’’ services in
this context, rather than being treated as
bundled ‘‘RHC’’ or ‘‘FQHC’’ services. As
such, these services would remain
separately billable to Part B when
furnished to a resident of the SNF
during a covered Part A stay.
To date, the Congress has enacted no
further legislation affecting the
consolidated billing provision.
However, as we noted in the proposed
rule of April 10, 2000 (65 FR 19232),
section 1888(e)(2)(A)(iii) of the Act, as
added by section 103 of the BBRA, not
only identified for exclusion from this
provision a number of particular service
codes within four specified categories
(that is, chemotherapy items,
chemotherapy administration services,
radioisotope services, and customized
prosthetic devices), but ‘‘* * * also
gives the Secretary the authority to
designate additional, individual services
for exclusion within each of the
specified service categories.’’ In that
proposed rule, we also noted that the
BBRA Conference report (H.R. Conf.
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
Rep. No. 106–479 at 854) characterizes
the individual services that this
legislation targets for exclusion as
‘‘* * * high-cost, low probability events
that could have devastating financial
impacts because their costs far exceed
the payment [SNFs] receive under the
prospective payment system * * *’’
According to the conferees, section
103(a) ‘‘is an attempt to exclude from
the PPS certain services and costly
items that are provided infrequently in
SNFs * * *.’’ By contrast, we noted that
the Congress declined to designate for
exclusion any of the remaining services
within those four categories (thus
leaving all of those services subject to
SNF consolidated billing), because they
are relatively inexpensive and are
furnished routinely in SNFs.
As we further explained in the final
rule of July 31, 2000 (65 FR 46790), any
additional service codes that we might
designate for exclusion under our
discretionary authority must meet the
same criteria that the Congress used in
identifying the original codes excluded
from consolidated billing under section
103(a) of the BBRA: They must fall
within one of the four service categories
specified in the BBRA, and they also
must meet the same standards of high
cost and low probability in the SNF
setting. Accordingly, we characterized
this statutory authority to identify
additional service codes for exclusion
‘‘* * * as essentially affording the
flexibility to revise the list of excluded
codes in response to changes of major
significance that may occur over time
(for example, the development of new
medical technologies or other advances
in the state of medical practice)’’ (65 FR
46791). In view of the amount of time
that has elapsed since we last invited
comments on this issue, we believe it is
appropriate at this point once again to
invite public comments that identify
codes in any of these four service
categories representing recent medical
advances that might meet the BBRA
criteria for exclusion from SNF
consolidated billing.
We note that the original BBRA
legislation (as well as the implementing
regulations) identified a set of excluded
services by means of specifying HCPCS
codes that were in effect as of a
particular date (for example July 1,
1999). Identifying the excluded services
in this manner made it possible for us
to utilize a Program Memorandum as
the vehicle for accomplishing routine
updates of the excluded codes, in order
to reflect any minor revisions that might
subsequently occur in the coding system
itself (for example, the assignment of a
different code number to the same
service). Accordingly, for any new
PO 00000
Frm 00030
Fmt 4701
Sfmt 4702
services that would actually represent a
substantive change in the scope of
services that are excluded from the SNF
consolidated billing provision, we
would identify these additional
excluded services by means of the
HCPCS codes that are in effect as of a
specific date (in this case, October 1,
2005). By making any new exclusions in
this manner, we could similarly
accomplish routine future updates of
these additional codes through the
issuance of program instructions.
V. Application of the SNF PPS to SNF
Services Furnished by Swing-Bed
Hospitals
In accordance with section 1888(e)(7)
of the Act (as amended by section 203
of the BIPA), Part A pays critical access
hospitals (CAHs) on a reasonable cost
basis for SNF services furnished under
a swing-bed agreement. However, as
noted previously in section I.A of this
notice, the services furnished by nonCAH rural hospitals are paid under the
SNF PPS. In the July 31, 2001 final rule
(66 FR 39562), we announced the
conversion of swing-bed rural hospitals
to the SNF PPS, effective with the start
of the provider’s first cost reporting
period beginning on or after July 1,
2002. We selected this date consistent
with the statutory provision to integrate
swing-bed rural hospitals into the SNF
PPS by the end of the SNF transition
period, June 30, 2002.
As of June 30, 2003, all swing-bed
rural hospitals have come under the
SNF PPS. Therefore, all rates and wage
indexes outlined in earlier sections of
this notice for SNF PPS also apply to all
swing-bed rural hospitals. A complete
discussion of assessment schedules, the
MDS, and the transmission software
(Raven-SB for Swing Beds) can be found
in the July 31, 2001 final rule (66 FR
39562). The latest changes in the MDS
for swing-bed rural hospitals are listed
on our SNF PPS Web site, https://
www.cms.hhs.gov/providers/snfpps/
default.asp.
VI. Qualifying Three-Day Inpatient
Hospital Stay Requirement
As indicated in section I.A of this
proposed rule, the SNF benefit includes
not only level of care requirements, but
also a set of technical, or ‘‘posthospital’’
eligibility requirements as well. These
requirements date back to the original
Medicare legislation (section 102(a) of
the Social Security Amendments of
1965, Public Law 89–97), when the
Congress defined the intended scope of
this benefit. The SNF benefit was never
intended to cover long-term, relatively
low-level ‘‘custodial’’ care; rather, the
Congress envisioned this benefit more
E:\FR\FM\19MYP3.SGM
19MYP3
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
narrowly, in terms of serving as a less
expensive alternative to what would
otherwise be the final, convalescent
portion of an acute care stay of several
days as an inpatient at a hospital. In
order to target the SNF benefit more
effectively at the limited segment of the
nursing home population that the
benefit was actually designed to cover
(that is, those beneficiaries requiring a
short-term, fairly intensive stay in a SNF
as a continuation of an acute hospital
stay of several days), the Congress
established as a prerequisite for SNF
coverage a requirement that a
beneficiary must first be a hospital
inpatient for ‘‘not less than 3
consecutive days before his discharge
from the hospital’’ (section 1861(i) of
the Act). From the very inception of the
Medicare program, in determining the
three-day inpatient requirement for
purposes of triggering the SNF benefit,
‘‘inpatient’’ status has been determined
as commencing with ‘‘the calendar day
of admission’’ to the hospital (see 20
CFR § 405.120 (1966)). The current
guidelines in the CMS Internet Online
Manual (IOM) at Publication 100–02
(Medicare Benefit Policy Manual),
Chapter 8 (Coverage of Extended Care
(SNF) Services Under Hospital
Insurance), § 20.1 (Three-Day Prior
Hospitalization) reflect this
determination.
More recently, it has been suggested
that because of changes in hospital
admission practices that have occurred
since the Congress enacted this
provision in 1965, some patients who at
that time would have been a hospital
inpatient for at least 3 days are instead
now placed in observation status
initially, before being formally admitted
as a hospital inpatient. Observation
status is a distinct service that is
discussed in the IOM in Publication
100–02 (Medicare Benefit Policy
Manual), Chapter 6 (Hospital Services
Covered Under Part B), § 70.4
(Outpatient Observation Services), in
which a patient who needs more care
than can be provided in an emergency
room is moved from the emergency
room, placed in a hospital bed in the
appropriate hospital unit, and
monitored by the unit nursing and
physician staff. We recognize that
coverage of observation services under
the outpatient prospective payment
system is connected to patients with
three specific diagnoses: chest pain,
asthma, and congestive heart failure.
However, as we noted previously, the
longstanding policy interpretation of the
SNF benefit’s prior hospital stay
requirement does not count hospital
observation time that immediately
precedes an inpatient admission toward
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
meeting the requirement. We have
received occasional inquiries about the
effect of this policy on those
beneficiaries who would be able to
satisfy the SNF benefit’s 3-day hospital
stay requirement only if time spent in
observation status immediately prior to
the formal inpatient admission were
counted. These inquiries assert that in
such situations, the care furnished
during observation may be
indistinguishable from the inpatient
care that follows the formal admission,
so that the beneficiaries themselves
often learn of the difference only after
they were transferred to the SNF and
failed to meet the SNF benefit’s prior
hospital stay requirement. The inquirers
argue that it is unfair to deny SNF
coverage to such a beneficiary based
solely on what they characterize as a
mere recordkeeping convention on the
part of the hospital rather than a
substantive change in the actual care
that the beneficiary receives there.
We note that the current SNF benefit
policy (which counts only time
following the formal inpatient
admission to the hospital toward
meeting the qualifying hospital stay
requirement) is based directly on the
applicable portion of the Medicare law
at section 1861(i) of the Act, which
defines the SNF benefit’s qualifying
hospital stay as one in which the
beneficiary ‘‘* * * was an inpatient for
not less than 3 consecutive days * * *’’
(emphasis added). An inpatient is a
person who has been admitted to a
hospital for bed occupancy for purposes
of receiving inpatient hospital services
as defined in section 1861 of the Act.
Moreover, although at the time that this
provision was enacted, the concept of
observation status itself was not yet
even envisioned, to date, the Congress
has not chosen to amend section 1861(i)
of the Act specifically to reflect use of
observation time as triggering the SNF
benefit. However, we are aware that
over time, practice and treatment of
observation time may have changed;
thus, the effect of not counting this
observation time under the existing
policy ultimately might be to restrict
SNF coverage to a narrower segment of
the beneficiary population than the
Congress originally intended.
Accordingly, with regard to those
beneficiaries whose formal admission to
the hospital as an inpatient is
immediately preceded by time spent in
hospital observation status, we invite
comments on whether we should
consider the possibility of counting the
time spent in observation status toward
meeting the SNF benefit’s qualifying 3day hospital stay requirement. We note
that in evaluating the potential impact
PO 00000
Frm 00031
Fmt 4701
Sfmt 4702
29099
of such a change, it is necessary not
only to consider its effect on those
beneficiaries who might not otherwise
be able to meet the SNF benefit’s prior
qualifying hospital stay requirement,
but also to assess potential negative
consequences. Possible examples could
include altering the nature of the SNF
benefit in a manner that is inconsistent
with Congressional intent in
establishing this requirement, or
creating a ‘‘woodwork effect’’ of
unanticipated consequences, such as
routine placement of patients in
observation status prior to formal
admission, even in situations where
observation is not appropriate.
In soliciting these comments,
moreover, we wish to distinguish the
possible use of observation time from
time spent in the hospital’s emergency
room. Although both observation
services and emergency room services
are directed at patients who are
expected to spend only a short period of
time in that service area, they are in
many other ways dissimilar. Other than
for patients with scheduled admissions,
the emergency room generally serves as
the hospital’s overall point of entry,
irrespective of the degree of severity of
a particular patient’s condition; thus,
many hospital patients typically would
commence their hospital encounter by
spending at least some time initially in
the emergency room. However, the time
in the emergency room is not
considered a substitute for or equivalent
to inpatient hospital care. Clearly, many
visits to the ER are for treatment of
problems requiring no inpatient
hospitalization (for example, most
wounds, broken or sprained limbs, or
minor respiratory illnesses) and often
patients come to the ER because their
regular physician is unavailable.
Situations involving observation status,
however, tend to be relatively
infrequent compared to the care of all
patients that present to the hospital (for
example, excessive bleeding or
complications during surgery
necessitating a longer-than-normal
recovery period, or non-specific
significant abdominal pain). Further, as
emergency room services typically
represent the patient’s initial medical
encounter for new or worsening
symptoms, such services focus on
identifying, managing, and stabilizing
the patient’s acute condition. By
contrast, observation services are
furnished to a patient for whom there is
already at least a working diagnosis, and
involve ongoing assessment and shortterm treatment that is specifically
directed at that condition so that a
subsequent determination about
E:\FR\FM\19MYP3.SGM
19MYP3
29100
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
hospital admission or discharge can be
made. (With respect to continuing
assessment and treatment, observation
services would appear to share some
common elements with inpatient care,
although the latter involves a condition
that is expected to require care for a
significantly longer duration, and that
also may well require medical
intervention at a level of complexity
that does not occur on an outpatient
basis.)
We recognize that, under section
1886(a) of the Act, the statute defines
‘‘operating costs of inpatient hospital
services’’ as including the costs of
certain services furnished prior to a
patient’s admission to the hospital. That
is, the costs of certain services furnished
prior to an individual’s admission as an
inpatient are deemed by statute to be
operating costs of inpatient hospital
services. However, it is worth noting
that section 1886(a) addresses costs, and
neither section 1886(a) nor section
1861(i) provides that a patient be
deemed an inpatient during the time
prior to admission for purposes of the 3day requirement for SNF coverage.
Moreover, the deeming requirement in
section 1886(a) and the 3-day
requirement for SNF coverage in section
1861(i) serve different purposes. The
deeming requirement in section 1886(a)
was intended to prevent hospitals from
‘‘unbundling’’ services from the
inpatient stay and inappropriately
seeking separate payment. See 59 FR
1654, 1656 (Jan. 12, 1994). That
consideration does not apply in the
context of SNF coverage. As discussed
above, the purpose of the 3-day
inpatient stay requirement for SNF
coverage is to target SNF coverage to
individuals requiring a short-term, fairly
intensive stay in a SNF as a
continuation of an acute hospital stay.
The Congress chose to target SNF
coverage to individuals who had been
inpatients for at least 3 consecutive
days; the Congress could have chosen a
shorter time, or it could have specified
that certain time before admission must
be counted for purposes of the 3-day
requirement, but it did not. Given the
differences in statutory language and
statutory purpose, we believe the
requirement in section 1886(a) of the
Act (to treat certain preadmission costs
as inpatient costs) is consistent with not
counting time spent in the hospital prior
to an individual’s inpatient admission
as inpatient time, for purposes of the 3day requirement for SNF coverage under
section 1861(i) of the Act.
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
VII. Provisions of the Proposed Rule
In this proposed rule, we propose to
make the following revision to the
existing text of the regulations:
• We would revise the regulations at
§ 424.20(e)(2), regarding the
performance of SNF certifications and
recertifications by NPs and CNSs, to
clarify the distinction between ‘‘direct’’
and ‘‘indirect’’ employment
relationships. We would also make a
minor technical correction in the
definition of ‘‘HCPCS’’ that appears in
§ 424.3.
VIII. Collection of Information
Requirements
This document does not impose
information collection and
recordkeeping requirements.
Consequently, it need not be reviewed
by the Office of Management and
Budget under the authority of the
Paperwork Reduction Act of 1995.
IX. Regulatory Impact Analysis
A. Overall Impact
We have examined the impacts of this
proposed rule as required by Executive
Order 12866 (September 1993,
Regulatory Planning and Review), the
Regulatory Flexibility Act (RFA,
September 16, 1980, Pub. L. 96–354),
section 1102(b) of the Social Security
Act, the Unfunded Mandates Reform
Act of 1995 (Pub. L. 104–4), and
Executive Order 13132.
Executive Order 12866 (as amended
by Executive Order 13258, which
merely reassigns responsibility of
duties) 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).
This proposed rule is major, as defined
in Title 5, United States Code, section
804(2), because we estimate the impact
to the Medicare program, and the
annual effects to the overall economy,
would be more than $100 million.
The RFA requires agencies to analyze
options for regulatory relief of small
businesses. For purposes of the RFA,
small entities include small businesses,
nonprofit organizations, and
government agencies. Most SNFs and
most other providers and suppliers are
small entities, either by their nonprofit
status or by having revenues of $11.5
million or less in any 1 year. For
PO 00000
Frm 00032
Fmt 4701
Sfmt 4702
purposes of the RFA, approximately 53
percent of SNFs are considered small
businesses according to the Small
Business Administration’s latest size
standards, with total revenues of $11.5
million or less in any 1 year (for further
information, see 65 FR 69432,
November 17, 2000). Individuals and
States are not included in the definition
of a small entity. In addition,
approximately 29 percent of SNFs are
nonprofit organizations.
This proposed rule proposes to
update the SNF PPS rates published in
the FY 2005 update notice on July 30,
2004 (69 FR 45775) and the associated
correction notices published on October
7, 2004 (69 FR 60158), and December
30, 2004 (69 FR 78445).
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 603 of the
RFA. For purposes of section 1102(b) of
the Act, we define a small rural hospital
as a hospital that is located outside of
a Metropolitan Statistical Area and has
fewer than 100 beds. We anticipate that
the impact on swing-bed facilities will
be similar to the impact on rural
hospital-based facilities, which benefit
from the case-mix refinement (see Table
12 below).
Section 202 of the Unfunded
Mandates Reform Act of 1995 also
requires that agencies assess anticipated
costs and benefits before issuing any
rule that may result in expenditure in
any 1 year by State, local, or tribal
governments, in the aggregate, or by the
private sector, of $110 million or more.
This proposed rule would not have a
substantial effect on the governments
mentioned, or on private sector costs.
Executive Order 13132 establishes
certain requirements that an agency
must meet when it promulgates a
proposed rule that impose substantial
direct requirement costs on State and
local governments, preempts State law,
or otherwise has Federalism
implications. As stated above, this
proposed rule would not have a
substantial effect on State and local
governments.
B. Anticipated Effects
This proposed rule sets forth updates
of the SNF PPS rates contained in the
FY 2005 update notice (69 FR 45775),
and the associated correction notices (69
FR 60158 and 69 FR 78445) and
presents a refinement to the RUG–III
case-mix classification system to be
incorporated into the Medicare SNF PPS
effective January 1, 2006. As described
E:\FR\FM\19MYP3.SGM
19MYP3
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
in Section II.B.4, providers would
continue to be paid under the current 44
group RUG–III system from October 1,
2005 through December 31, 2005.
Beginning January 1, 2006, we propose
that providers would be paid the
proposed new RUG–53 payment.
Based on the above, we estimate the
FY 2006 impact to be a net impact of $0
million on payments (this reflects a
$1.02 billion reduction from the
expiration of temporary payment
increases, offset by a $510 million
increase from the proposed refined casemix classification system and a $510
million increase from the update to the
payment rates, as explained in greater
detail later in this section). The impact
analysis in Table 12 of this proposed
rule represents the projected effects of
the proposed policy changes in the SNF
PPS from FY 2005 to FY 2006. We
estimate the effects by estimating
payments while holding all other
payment variables constant. We use the
best data available, but we do not
attempt to predict behavioral responses
to these changes, and we do not make
adjustments for future changes in such
variables as days or case-mix.
We note that certain events may
combine to limit the scope or accuracy
of our impact analysis, because such an
analysis is future-oriented and, thus,
susceptible to forecasting errors due to
other changes in the forecasted impact
time period. Some examples are newlylegislated general Medicare program
funding changes by the Congress, or
changes specifically related to SNFs. In
addition, changes to the Medicare
program may continue to be made as a
result of the BBA, the BBRA, the BIPA,
the MMA, or new statutory provisions.
Although these changes may not be
specific to the SNF PPS, the nature of
the Medicare program is such that the
changes may interact, and the
complexity of the interaction of these
changes could make it difficult to
predict accurately the full scope of the
impact upon SNFs.
In accordance with section
1888(e)(4)(E) of the Act, we are updating
the payment rates for FY 2006. The
BBRA, BIPA, and MMA provided for
several temporary adjustments to the
SNF PPS payment rates that together,
using the most recent data available,
accounted for an estimated $1.4 billion
per year in payments to the nursing
home industry.
We note that in accordance with
section 101(a) of the BBRA and section
314 of the BIPA, the existing, temporary
increase in the per diem adjusted
payment rates of 20 percent for certain
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
specified clinically complex RUGs (and
6.7 percent for other, rehabilitation
RUGs) would expire with the
implementation of the proposed casemix refinements in the SNF PPS. As
explained in section II.B.3 of this
proposed rule, section 511 of the MMA,
which provides for a 128 percent
increase in the PPS per diem payment
for any SNF resident with Acquired
Immune Deficiency Syndrome (AIDS),
remains in effect. However, we have not
provided a separate impact analysis for
the MMA provision. Our latest estimates
indicate that there are less than 2,000
beneficiaries who qualify for this add-on
payment. The impact to Medicare is
included in the ‘‘total’’ column of Table
12.
In proposing to update the rates for
FY 2006, we made a number of standard
annual revisions and clarifications
mentioned elsewhere in this proposed
rule (for example, the update to the
wage and market basket indexes used
for adjusting the Federal rates). These
revisions would increase payments to
SNFs by approximately $510 million.
The aggregate change in payments
associated with this proposed rule is
estimated to be $0 million for FY 2006.
The decrease of $1.02 billion due to the
elimination of the temporary add-ons as
of January 1, 2006, together with the
additional payment due to the proposed
refined case-mix classification system of
$510 million and the market basket
increase of $510 million, results in a net
change in payments of $0 million. There
are two areas of change that produce
this impact on SNFs:
1. The implementation of a refined
case-mix classification system under
section 1888(e)(4)(G)(i) of the Act and,
consequently, the reduction of the
temporary 20 percent/6.7 percent addons to the Federal rates for the specified
RUG groups.
2. The total change in payments from
FY 2005 levels to FY 2006 levels. This
includes all of the previously noted
changes in addition to the effect of the
update to the rates.
The impacts are shown in Table 12.
The breakdown of the various categories
of data in the table follows.
The first column shows the
breakdown of all SNFs by urban or rural
status, hospital-based or freestanding
status, and census region.
The first row of figures in the first
column describes the estimated effects
of the various changes on all facilities.
The next 6 rows show the effects on
facilities split by hospital-based,
freestanding, urban, and rural
categories. The next 20 rows show the
PO 00000
Frm 00033
Fmt 4701
Sfmt 4702
29101
effects on urban versus rural status by
census region.
The second column in the table shows
the number of facilities in the impact
database.
The third column of the table shows
the effect of the annual update to the
wage index. This represents the effect of
using the most recent wage data
available. The total impact of this
change is zero percent; however, there
are distributional effects of the change.
The fourth column of the table shows
the effect of using the new OMB
geographic designations based on
CBSAs.
The fifth column of the table shows
the effect of the elimination of the addon for specified RUG groups. As
expected, this results in a decrease in
payments for all providers.
The sixth column of the table shows
the effect of the proposed refinements to
the case-mix classification system. Table
12 shows that there is a positive three
percent overall impact from the
proposed case-mix refinements.
Distributional effects are noted for
specific providers. For example,
hospital-based facilities are expected to
receive greater than a 5.6 percent
increase in payment, compared with
freestanding facilities that show an
increase in payments of between 2.4 and
2.9 percent. Additionally, rural Census
regions show increases in payments of
3.4 percent.
The seventh column of the table
shows the effect of all of the changes on
the FY 2006 payments. As the market
basket increase of 3.0 percentage points
is constant for all providers, it is not
shown individually; however, we note
that the ‘‘Total FY 2006 change’’ column
does incorporate this increase. It is
projected that aggregate payments
would not change in total, assuming
facilities do not change their care
delivery and billing practices in
response.
As can be seen from this table, the
combined effects of all of the changes
would vary by specific types of
providers and by location. For example,
though facilities in the rural South
Atlantic and rural Mountain region
experience payment decreases of 2.3
and 1.8 percent respectively, some
providers such as the rural Pacific and
rural New England show increases of
4.1 and 2.6 percent respectively.
Payment increases for facilities in the
Rural Pacific area of the country are the
highest for any provider type.
E:\FR\FM\19MYP3.SGM
19MYP3
29102
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE 12.—PROJECTED IMPACT TO THE SNF PPS FOR FY 2006
Number of
facilities
Total .................................................................................
Urban ...............................................................................
Rural .................................................................................
Hospital based urban .......................................................
Freestanding urban ..........................................................
Hospital based rural .........................................................
Freestanding rural ............................................................
Urban by region:
New England ............................................................
Middle Atlantic ..........................................................
South Atlantic ............................................................
East North Central ....................................................
East South Central ...................................................
West North Central ...................................................
West South Central ..................................................
Mountain ...................................................................
Pacific .......................................................................
Rural by region:
New England ............................................................
Middle Atlantic ..........................................................
South Atlantic ............................................................
East North Central ....................................................
East South Central ...................................................
West North Central ...................................................
West South Central ..................................................
Mountain ...................................................................
Pacific .......................................................................
Ownership:
Government ..............................................................
Proprietary ................................................................
Voluntary ...................................................................
C. Accounting Statement
As required by OMB Circular A–4
(available at https://
www.whitehouse.gov/omb/circulars/
a004/a–4.pdf), in Table 13 below, we
have prepared an accounting statement
showing the classification of the
expenditures associated with the
provisions of this proposed rule. This
table provides our best estimate of the
change in Medicare payments under the
SNF PPS as a result of the proposals
presented in this proposed rule based
on the data for 15,675 SNFs in our
database. All expenditures are classified
as transfers to Medicare providers (that
is, SNFs).
TABLE 13.—ACCOUNTING STATEMENT:
CLASSIFICATION OF ESTIMATED EXPENDITURES, FROM THE 2005 SNF
PPS RATE YEAR TO THE 2006 SNF
PPS RATE YEAR (IN MILLIONS)
Category
Annualized Monetized Transfers.
From Whom To Whom? .......
VerDate jul<14>2003
22:47 May 18, 2005
Transfers
$0 million.
No Transfer.
Jkt 205001
Update
wage data
(percent)
MSA to
CBSA
(percent)
Frm 00034
Case-mix
refinements
(percent)
Total FY
2006
change
(percent)
15,675
10,599
5,076
1,097
8,693
1,160
3,372
0.0
0.0
0.1
0.0
0.0
0.0
0.2
0.0
0.2
¥0.8
0.2
0.2
¥0.7
¥1.0
¥6.0
¥6.0
¥6.0
¥6.3
¥5.9
¥6.8
¥5.9
3.0
2.9
3.4
5.6
2.4
5.9
2.9
0.0
0.1
¥0.3
2.5
¥0.3
1.3
¥0.8
917
1,499
1,739
2,009
531
836
1,093
467
1,501
¥0.4
0.2
¥0.3
¥0.3
0.4
¥0.4
¥0.1
¥0.2
1.2
¥0.4
0.3
0.3
0.0
0.7
0.4
0.5
0.5
0.0
¥6.4
¥6.1
¥5.9
¥5.7
¥6.0
¥5.9
¥5.8
¥5.6
¥6.2
3.0
3.4
2.6
2.8
2.7
3.7
2.7
3.0
2.7
¥1.2
0.8
¥0.3
¥0.2
0.8
0.8
0.3
0.7
0.7
139
283
612
947
571
1,219
823
298
182
1.9
0.0
¥0.3
0.2
0.4
¥0.4
0.3
0.8
1.3
¥0.1
¥0.8
¥1.7
¥0.8
¥0.6
¥0.3
¥0.8
¥3.4
0.5
¥5.7
¥6.0
¥6.2
¥5.9
¥6.3
¥6.2
¥6.2
¥5.9
¥4.2
3.5
3.7
2.9
3.5
2.9
4.0
2.9
3.8
3.5
2.6
¥0.1
¥2.3
0.1
¥0.6
0.1
¥0.7
¥1.8
4.1
693
9,317
3,493
0.1
0.0
¥0.1
0.3
0.0
¥0.1
¥6.5
¥5.9
¥6.0
3.2
2.9
3.1
0.0
0.0
¥0.1
D. Alternatives Considered
Section 1888(e) of the Act establishes
the SNF PPS for the payment of
Medicare SNF services for cost reporting
periods beginning on or after July 1,
1998. This section of the statute
prescribes a detailed formula for
calculating payment rates under the
SNF PPS, and does not provide for the
use of any alternative methodology. It
specifies that the base year cost data to
be used for computing the RUG-III
payment rates must be from FY 1995
(October 1, 1994, through September 30,
1995.) In accordance with the statute,
we also incorporated a number of
elements into the SNF PPS, such as
case-mix classification methodology, the
MDS assessment schedule, a market
basket index, a wage index, and the
urban and rural distinction used in the
development or adjustment of the
Federal rates. Further, section
1888(e)(4)(H) of the Act specifically
requires us to disseminate the payment
rates for each new fiscal year through
the Federal Register, and to do so before
the August 1 that precedes the start of
the new fiscal year.
As discussed previously in section
II.B of this proposed rule, we propose to
PO 00000
Eliminate
add-on to
certain
RUGs
(percent)
Fmt 4701
Sfmt 4702
implement refinements to the RUG-III
case-mix classification system under
section 1888(e)(4)(G)(i) of the Act. At
the same time, we continue to evaluate
longer-range, more comprehensive
changes in the case-mix classification
system. One alternative that we
considered was to defer proposing
refinements at this time until our
evaluation of longer-range, more
comprehensive changes is complete.
However, we believe that the
refinements that we are proposing
would serve to improve the distribution
of payments under the PPS, in a manner
that more accurately accounts for the
care needs of the most medically
complex patients. As noted in section II
of this preamble, a number of analyses
have demonstrated an increase in the
explanatory power (R-square) of the
proposed refined case-mix classification
system model, compared to the 44group model that is currently in use.
While our additional research may
identify more comprehensive
modifications, it is not currently known
when the results of this research would
become available. Therefore, we have
decided to propose the refinements
discussed elsewhere in this proposed
E:\FR\FM\19MYP3.SGM
19MYP3
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
rule. In addition, as noted previously,
we specifically solicit comments on the
economic impact of the payment
changes discussed in this proposed rule,
as well as their potential impact on
beneficiaries’ access to quality SNF care.
We considered other options intended
to help ensure more accurate allocation
of payments specifically with regard to
non-therapy ancillaries. One of these
options included moving the nontherapy ancillary costs used in
establishing the nursing case-mix
component of the payment rates to a
separate, newly created ‘‘medically
ancillary’’ component (65 FR 19192,
April 10, 2000). In addition, we looked
at a number of possible models, both
weighted and unweighted, for a new
non-therapy ancillary index (65 FR
19248ff.). Finally, we also researched
the application of models such as
Diagnosis-Related Groups (DRGs) and
All Patient Refined DRGs (APR–DRGs).
However, at this stage in our analysis,
none of these alternatives offered a
significant improvement over the RUG–
53 model in accounting for the
variability of non-therapy ancillary
costs.
In accordance with the provisions of
Executive Order 12866, this regulation
was reviewed by the Office of
Management and Budget.
List of Subjects in 42 CFR Part 424
Emergency medical services, Health
facilities, Health professions, Medicare.
For the reasons set forth in the
preamble, the Centers for Medicare &
Medicaid Services proposes to amend
42 CFR chapter IV as follows:
PART 424—CONDITIONS FOR
MEDICARE PAYMENT
1. The authority citation for part 424
continues to read as follows:
Authority: Secs. 1102 and 1871 of the
Social Security Act (42 U.S.C. 1302 and
1395hh).
Subpart A—General Provisions
§ 424.3
[Amended]
2. In § 424.3, in the definition of
‘‘HCPCS’’ remove the word ‘‘CMS’’ and
add the word ‘‘Healthcare’’ in its place.
Subpart B—Certification and Plan of
Treatment Requirements
3. In § 424.20, paragraph (e)(2) is
revised to read as follows:
§ 424.20 Requirements for posthospital
SNF care.
*
*
*
*
(e) * * *
(2) A nurse practitioner or clinical
nurse specialist, neither of whom has a
direct or indirect employment
relationship with the facility but who is
working in collaboration with a
physician. For purposes of this
section—
(i) Collaboration means a process
whereby a nurse practitioner or clinical
nurse specialist works with a doctor of
medicine or osteopathy to deliver health
care services. The services are delivered
within the scope of the nurse’s
professional expertise, with medical
direction and appropriate supervision as
provided for in guidelines jointly
developed by the nurse and the
physician or other mechanisms defined
by Federal regulations and the law of
the State in which the services are
performed.
(ii) A direct employment relationship
with the facility is one meeting the
common law test specified in 20 CFR
404.1005, 404.1007, and 404.1009.
When this test is not met, the facility is
considered to have an indirect
employment relationship with any
nurse practitioner or clinical nurse
specialist who performs nursing
services for the facility under § 409.21 of
this subchapter (however, the
performance of only delegated
physician tasks under § 483.40(e) of this
chapter does not, in itself, establish the
existence of an indirect employment
relationship).
*
*
*
*
*
TABLE 8.—PROPOSED WAGE INDEX
FOR URBAN AREAS BASED ON
CBSA LABOR MARKET AREAS—
Continued
(Catalog of Federal Domestic Assistance
Program No. 93.773, Medicare-Hospital
Insurance Program; and No. 93.774,
Medicare-Supplementary Medical Insurance
Program)
Dated: March 31, 2005.
Mark B. McClellan,
Administrator, Centers for Medicare &
Medicaid Services.
Dated: May 13, 2005.
Michael O. Leavitt,
Secretary.
10580 .......
VI. Addendum
This section contains the tables
referred to throughout the preamble to
this proposed rule. Tables 8 ‘‘Proposed
Wage Index For Urban Areas Based On
CBSA Labor Market Areas,’’ Table 9
‘‘Proposed Wage Index Based On CBSA
Labor Market Areas For Rural Areas’’
and Table A ‘‘MSA/CBSA Crosswalk’’
are presented below.
22:47 May 18, 2005
Jkt 205001
CBSA
Code
10380 .......
10420 .......
10500 .......
10740 .......
10780 .......
10900 .......
TABLE 8.—PROPOSED WAGE INDEX
FOR URBAN AREAS BASED ON
CBSA LABOR MARKET AREAS
CBSA
Code
Urban Area
(Constituent
Counties)
10180 .......
Abilene, TX .............
*
VerDate jul<14>2003
29103
PO 00000
Frm 00035
Fmt 4701
Sfmt 4702
Wage
Index
11020 .......
11100 .......
0.7904
E:\FR\FM\19MYP3.SGM
19MYP3
Urban Area
(Constituent
Counties)
Callahan County,
TX.
Jones County, TX.
Taylor County, TX.
Aguadilla-IsabelaSan Sebastian,
PR.
Aguada Municipio,
PR.
Aguadilla Municipio,
PR.
˜
Anasco Municipio,
PR.
Isabela Municipio,
PR.
Lares Municipio, PR.
Moca Municipio, PR.
´
Rincon Municipio,
PR.
San Sebastian
Municipio, PR.
Akron, OH ...............
Portage County, OH.
Summit County, OH.
Albany, GA .............
Baker County, GA.
Dougherty County,
GA.
Lee County, GA.
Terrell County, GA.
Worth County, GA.
Albany-Schenectady-Troy, NY.
Albany County, NY.
Rensselaer County,
NY.
Saratoga County,
NY.
Schenectady County, NY.
Schoharie County,
NY.
Albuquerque, NM ....
Bernalillo County,
NM.
Sandoval County,
NM.
Torrance County,
NM.
Valencia County,
NM.
Alexandria, LA ........
Grant Parish, LA.
Rapides Parish, LA.
Allentown-Bethlehem-Easton,
PA-NJ.
Warren County, NJ.
Carbon County, PA.
Lehigh County, PA.
Northampton County, PA.
Altoona, PA .............
Blair County, PA.
Amarillo, TX ............
Armstrong County,
TX.
Wage
Index
0.4743
0.8991
0.8636
0.8545
0.9693
0.8041
0.9828
0.8953
0.9166
29104
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE 8.—PROPOSED WAGE INDEX TABLE 8.—PROPOSED WAGE INDEX TABLE 8.—PROPOSED WAGE INDEX
FOR URBAN AREAS BASED ON
FOR URBAN AREAS BASED ON
FOR URBAN AREAS BASED ON
CBSA LABOR MARKET AREAS—
CBSA LABOR MARKET AREAS—
CBSA LABOR MARKET AREAS—
Continued
Continued
Continued
CBSA
Code
11180 .......
11260 .......
11300 .......
11340 .......
11460 .......
11500 .......
11540 .......
11700 .......
12020 .......
12060 .......
VerDate jul<14>2003
Urban Area
(Constituent
Counties)
Wage
Index
Carson County, TX.
Potter County, TX.
Randall County, TX.
Ames, IA .................
Story County, IA.
Anchorage, AK .......
Anchorage Municipality, AK.
Matanuska-Susitna
Borough, AK.
Anderson, IN ...........
Madison County, IN.
Anderson, SC .........
Anderson County,
SC.
Ann Arbor, MI .........
Washtenaw County,
MI.
Anniston-Oxford, AL
Calhoun County, AL.
Appleton, WI ...........
Calumet County, WI.
Outagamie County,
WI.
Asheville, NC ..........
Buncombe County,
NC.
Haywood County,
NC.
Henderson County,
NC.
Madison County,
NC.
Athens-Clarke
County, GA.
Clarke County, GA.
Madison County,
GA.
Oconee County, GA.
Oglethorpe County,
GA.
Atlanta-Sandy
Springs-Marietta,
GA.
Barrow County, GA.
Bartow County, GA.
Butts County, GA.
Carroll County, GA.
Cherokee County,
GA.
Clayton County, GA.
Cobb County, GA.
Coweta County, GA.
Dawson County, GA.
DeKalb County, GA.
Douglas County, GA.
Fayette County, GA.
Forsyth County, GA.
Fulton County, GA.
Gwinnett County,
GA.
Haralson County,
GA.
Heard County, GA.
Henry County, GA.
Jasper County, GA.
Lamar County, GA.
22:47 May 18, 2005
CBSA
Code
0.9545
1.2110
0.8595
0.8897
12100 .......
12220 .......
1.0870
12260 .......
0.7659
0.9298
0.9294
12420 .......
0.9843
12540 .......
12580 .......
0.9648
Jkt 205001
12620 .......
12700 .......
12940 .......
PO 00000
Frm 00036
Urban Area
(Constituent
Counties)
Wage
Index
Meriwether County,
GA.
Newton County, GA.
Paulding County,
GA.
Pickens County, GA.
Pike County, GA.
Rockdale County,
GA.
Spalding County,
GA.
Walton County, GA.
Atlantic City, NJ ......
Atlantic County, NJ.
Auburn-Opelika, AL
Lee County, AL.
Augusta-Richmond
County, GA-SC.
Burke County, GA.
Columbia County,
GA.
McDuffie County,
GA.
Richmond County,
GA.
Aiken County, SC.
Edgefield County,
SC.
Austin-Round Rock,
TX.
Bastrop County, TX.
Caldwell County, TX.
Hays County, TX.
Travis County, TX.
Williamson County,
TX.
Bakersfield, CA .......
Kern County, CA.
Baltimore-Towson,
MD.
Anne Arundel County, MD.
Baltimore County,
MD.
Carroll County, MD.
Harford County, MD.
Howard County, MD.
Queen Anne’s
County, MD.
Baltimore City, MD.
Bangor, ME .............
Penobscot County,
ME.
Barnstable Town,
MA.
Barnstable County,
MA.
Baton Rouge, LA ....
Ascension Parish,
LA.
East Baton Rouge
Parish, LA.
East Feliciana Parish, LA.
Iberville Parish, LA.
Livingston Parish,
LA.
Fmt 4701
Sfmt 4702
CBSA
Code
12980 .......
13020 .......
1.1633
13140 .......
0.8108
0.9565
13380 .......
13460 .......
13644 .......
0.9450
13740 .......
13780 .......
1.0344
13820 .......
0.9907
13900 .......
1.0003
13980 .......
1.2527
0.8601
14020 .......
14060 .......
14260 .......
E:\FR\FM\19MYP3.SGM
19MYP3
Urban Area
(Constituent
Counties)
Pointe Coupee Parish, LA.
St. Helena Parish,
LA.
West Baton Rouge
Parish, LA.
West Feliciana Parish, LA.
Battle Creek, MI ......
Calhoun County, MI.
Bay City, MI ............
Bay County, MI.
Beaumont-Port Arthur, TX.
Hardin County, TX.
Jefferson County,
TX.
Orange County, TX.
Bellingham, WA ......
Whatcom County,
WA.
Bend, OR ................
Deschutes County,
OR.
Bethesda-FrederickGaithersburg, MD.
Frederick County,
MD.
Montgomery County, MD.
Billings, MT .............
Carbon County, MT.
Yellowstone County,
MT.
Binghamton, NY .....
Broome County, NY.
Tioga County, NY.
Birmingham-Hoover,
AL.
Bibb County, AL.
Blount County, AL.
Chilton County, AL.
Jefferson County,
AL.
St. Clair County, AL.
Shelby County, AL.
Walker County, AL.
Bismarck, ND ..........
Burleigh County, ND.
Morton County, ND.
BlacksburgChristiansburgRadford, VA.
Giles County, VA.
Montgomery County, VA.
Pulaski County, VA.
Radford City, VA.
Bloomington, IN ......
Greene County, IN.
Monroe County, IN.
Owen County, IN.
Bloomington-Normal, IL.
McLean County, IL.
Boise City-Nampa,
ID.
Wage
Index
0.9510
0.9352
0.8421
1.1743
1.0796
1.1495
0.8843
0.8571
0.8979
0.7519
0.7962
0.8456
0.9084
0.9061
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
29105
TABLE 8.—PROPOSED WAGE INDEX TABLE 8.—PROPOSED WAGE INDEX TABLE 8.—PROPOSED WAGE INDEX
FOR URBAN AREAS BASED ON
FOR URBAN AREAS BASED ON
FOR URBAN AREAS BASED ON
CBSA LABOR MARKET AREAS—
CBSA LABOR MARKET AREAS—
CBSA LABOR MARKET AREAS—
Continued
Continued
Continued
CBSA
Code
14484 .......
14500 .......
14540 .......
14740 .......
14860 .......
15180 .......
15260 .......
15380 .......
15500 .......
15540 .......
15764 .......
15804 .......
15940 .......
15980 .......
16180 .......
16220 .......
16300 .......
VerDate jul<14>2003
Urban Area
(Constituent
Counties)
Wage
Index
Ada County, ID.
Boise County, ID.
Canyon County, ID.
Gem County, ID.
Owyhee County, ID.
Boston-Quincy, MA
Norfolk County, MA.
Plymouth County,
MA.
Suffolk County, MA.
Boulder, CO ............
Boulder County, CO.
Bowling Green, KY
Edmonson County,
KY.
Warren County, KY.
BremertonSilverdale, WA.
Kitsap County, WA.
Bridgeport-Stamford-Norwalk, CT.
Fairfield County, CT.
Brownsville-Harlingen, TX.
Cameron County,
TX.
Brunswick, GA ........
Brantley County, GA.
Glynn County, GA.
McIntosh County,
GA.
Buffalo-Niagara
Falls, NY.
Erie County, NY.
Niagara County, NY.
Burlington, NC ........
Alamance County,
NC.
Burlington-South
Burlington, VT.
Chittenden County,
VT.
Franklin County, VT.
Grand Isle County,
VT.
Cambridge-NewtonFramingham, MA.
Middlesex County,
MA.
Camden, NJ ............
Burlington County,
NJ.
Camden County, NJ.
Gloucester County,
NJ.
Canton-Massillon,
OH.
Carroll County, OH.
Stark County, OH.
Cape Coral-Fort
Myers, FL.
Lee County, FL.
Carson City, NV ......
Casper, WY ............
Natrona County, WY.
Cedar Rapids, IA ....
Benton County, IA.
22:47 May 18, 2005
CBSA
Code
16580 .......
1.1543
16620 .......
0.9744
0.8220
16700 .......
1.0686
1.2598
0.9822
16740 .......
0.9320
0.8889
16820 .......
0.8914
0.9446
16860 .......
1.1084
1.0528
16940 .......
0.8944
16974 .......
0.9366
1.0244
0.9035
0.8617
Jkt 205001
17020 .......
PO 00000
Frm 00037
Urban Area
(Constituent
Counties)
Jones County, IA.
Linn County, IA.
Champaign-Urbana,
IL.
Champaign County,
IL.
Ford County, IL.
Piatt County, IL.
Charleston, WV ......
Boone County, WV.
Clay County, WV.
Kanawha County,
WV.
Lincoln County, WV.
Putnam County, WV.
Charleston-North
Charleston, SC.
Berkeley County,
SC.
Charleston County,
SC.
Dorchester County,
SC.
Charlotte-GastoniaConcord, NC-SC.
Anson County, NC.
Cabarrus County,
NC.
Gaston County, NC.
Mecklenburg County, NC.
Union County, NC.
York County, SC.
Charlottesville, VA ..
Albemarle County,
VA.
Fluvanna County,
VA.
Greene County, VA.
Nelson County, VA.
Charlottesville City,
VA.
Chattanooga, TNGA.
Catoosa County, GA.
Dade County, GA.
Walker County, GA.
Hamilton County,
TN.
Marion County, TN.
Sequatchie County,
TN.
Cheyenne, WY .......
Laramie County,
WY.
Chicago-NapervilleJoliet, IL.
Cook County, IL.
DeKalb County, IL.
DuPage County, IL.
Grundy County, IL.
Kane County, IL.
Kendall County, IL.
McHenry County, IL.
Will County, IL.
Chico, CA ...............
Butte County, CA.
Fmt 4701
Sfmt 4702
CBSA
Code
Urban Area
(Constituent
Counties)
17140 .......
Wage
Index
Cincinnati-Middletown, OH-KY-IN.
Dearborn County, IN.
Franklin County, IN.
Ohio County, IN.
Boone County, KY.
Bracken County, KY.
Campbell County,
KY.
Gallatin County, KY.
Grant County, KY.
Kenton County, KY.
Pendleton County,
KY.
Brown County, OH.
Butler County, OH.
Clermont County,
OH.
Hamilton County,
OH.
Warren County, OH.
Clarksville, TN-KY ..
Christian County,
KY.
Trigg County, KY.
Montgomery County, TN.
Stewart County, TN.
Cleveland, TN .........
Bradley County, TN.
Polk County, TN.
Cleveland-ElyriaMentor, OH.
Cuyahoga County,
OH.
Geauga County, OH.
Lake County, OH.
Lorain County, OH.
Medina County, OH.
Coeur d’Alene, ID ...
Kootenai County, ID.
College StationBryan, TX.
Brazos County, TX.
Burleson County,
TX.
Robertson County,
TX.
Colorado Springs,
CO.
El Paso County, CO.
Teller County, CO.
Columbia, MO .........
Boone County, MO.
Howard County, MO.
Columbia, SC .........
Calhoun County, SC.
Fairfield County, SC.
Kershaw County,
SC.
Lexington County,
SC.
Richland County,
SC.
Saluda County, SC.
Columbus, GA-AL ...
Russell County, AL.
0.9604
0.8428
0.9438
17300 .......
0.9760
17420 .......
17460 .......
1.0234
17660 .......
17780 .......
0.9098
17820 .......
0.8784
17860 .......
1.0848
17900 .......
1.0522
17980 .......
E:\FR\FM\19MYP3.SGM
19MYP3
Wage
Index
0.9623
0.8292
0.8141
0.9204
0.9657
0.8909
0.9478
0.8354
0.9047
0.8568
29106
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE 8.—PROPOSED WAGE INDEX TABLE 8.—PROPOSED WAGE INDEX TABLE 8.—PROPOSED WAGE INDEX
FOR URBAN AREAS BASED ON
FOR URBAN AREAS BASED ON
FOR URBAN AREAS BASED ON
CBSA LABOR MARKET AREAS—
CBSA LABOR MARKET AREAS—
CBSA LABOR MARKET AREAS—
Continued
Continued
Continued
CBSA
Code
18020 .......
18140 .......
18580 .......
18700 .......
19060 .......
19124 .......
19140 .......
19180 .......
19260 .......
19340 .......
19380 .......
VerDate jul<14>2003
Urban Area
(Constituent
Counties)
Wage
Index
Chattahoochee
County, GA.
Harris County, GA.
Marion County, GA.
Muscogee County,
GA.
Columbus, IN ..........
Bartholomew County, IN.
Columbus, OH ........
Delaware County,
OH.
Fairfield County, OH.
Franklin County, OH.
Licking County, OH.
Madison County,
OH.
Morrow County, OH.
Pickaway County,
OH.
Union County, OH.
Corpus Christi, TX ..
Aransas County, TX.
Nueces County, TX.
San Patricio County,
TX.
Corvallis, OR ..........
Benton County, OR.
Cumberland, MDWV.
Allegany County,
MD.
Mineral County, WV.
Dallas-Plano-Irving,
TX.
Collin County, TX.
Dallas County, TX.
Delta County, TX.
Denton County, TX.
Ellis County, TX.
Hunt County, TX.
Kaufman County,
TX.
Rockwall County,
TX.
Dalton, GA ..............
Murray County, GA.
Whitfield County,
GA.
Danville, IL ..............
Vermilion County, IL.
Danville, VA ............
Pittsylvania County,
VA.
Danville City, VA.
Davenport-MolineRock Island, IA-IL.
Henry County, IL.
Mercer County, IL.
Rock Island County,
IL.
Scott County, IA.
Dayton, OH .............
Greene County, OH.
Miami County, OH.
Montgomery County, OH.
22:47 May 18, 2005
CBSA
Code
19460 .......
19500 .......
0.9598
19660 .......
0.9850
19740 .......
0.8559
1.0739
19780 .......
0.9326
19804 .......
1.0233
20020 .......
20100 .......
20220 .......
20260 .......
0.9044
20500 .......
0.9037
0.8497
20740 .......
0.8731
20764 .......
0.9073
Jkt 205001
PO 00000
Frm 00038
Urban Area
(Constituent
Counties)
Preble County, OH.
Decatur, AL .............
Lawrence County,
AL.
Morgan County, AL.
Decatur, IL ..............
Macon County, IL.
Deltona-Daytona
Beach-Ormond
Beach, FL.
Volusia County, FL.
Denver-Aurora, CO
Adams County, CO.
Arapahoe County,
CO.
Broomfield County,
CO.
Clear Creek County,
CO.
Denver County, CO.
Douglas County, CO.
Elbert County, CO.
Gilpin County, CO.
Jefferson County,
CO.
Park County, CO.
Des Moines, IA .......
Dallas County, IA.
Guthrie County, IA.
Madison County, IA.
Polk County, IA.
Warren County, IA.
Detroit-Livonia-Dearborn, MI.
Wayne County, MI.
Dothan, AL ..............
Geneva County, AL.
Henry County, AL.
Houston County, AL.
Dover, DE ...............
Kent County, DE.
Dubuque, IA ............
Dubuque County, IA.
Duluth, MN-WI ........
Carlton County, MN.
St. Louis County,
MN.
Douglas County, WI.
Durham, NC ............
Chatham County,
NC.
Durham County, NC.
Orange County, NC.
Person County, NC.
Eau Claire, WI ........
Chippewa County,
WI.
Eau Claire County,
WI.
Edison, NJ ..............
Middlesex County,
NJ.
Monmouth County,
NJ.
Ocean County, NJ.
Somerset County,
NJ.
Fmt 4701
Sfmt 4702
CBSA
Code
Urban Area
(Constituent
Counties)
20940 .......
Wage
Index
El Centro, CA .........
Imperial County, CA.
Elizabethtown, KY ..
Hardin County, KY.
Larue County, KY.
Elkhart-Goshen, IN
Elkhart County, IN.
Elmira, NY ..............
Chemung County,
NY.
El Paso, TX ............
El Paso County, TX.
Erie, PA ..................
Erie County, PA.
Essex County, MA ..
Essex County, MA.
Eugene-Springfield,
OR.
Lane County, OR.
Evansville, IN-KY ....
Gibson County, IN.
Posey County, IN.
Vanderburgh County, IN.
Warrick County, IN.
Henderson County,
KY.
Webster County, KY.
Fairbanks, AK .........
Fairbanks North
Star Borough, AK.
Fajardo, PR ............
Ceiba Municipio, PR.
Fajardo Municipio,
PR.
Luquillo Municipio,
PR.
Fargo, ND-MN ........
Cass County, ND.
Clay County, MN.
Farmington, NM ......
San Juan County,
NM.
Fayetteville, NC ......
Cumberland County,
NC.
Hoke County, NC.
Fayetteville-Springdale-Rogers, ARMO.
Benton County, AR.
Madison County, AR.
Washington County,
AR.
McDonald County,
MO.
Flagstaff, AZ ...........
Coconino County,
AZ.
Flint, MI ...................
Genesee County, MI.
Florence, SC ...........
Darlington County,
SC.
Florence County,
SC.
0.8478
21060 .......
0.8076
21140 .......
0.9308
21300 .......
1.0733
21340 .......
21500 .......
21604 .......
21660 .......
21780 .......
0.9651
21820 .......
1.0441
21940 .......
0.7707
22020 .......
0.9779
0.9135
22140 .......
1.0209
22180 .......
1.0303
22220 .......
0.9210
22380 .......
1.1260
22420 .......
22500 .......
E:\FR\FM\19MYP3.SGM
19MYP3
Wage
Index
0.8915
0.8810
0.9637
0.8259
0.8924
0.8746
1.0533
1.0829
0.8721
1.1419
0.4157
0.8495
0.8518
0.9426
0.8563
1.2105
1.0663
0.8964
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
29107
TABLE 8.—PROPOSED WAGE INDEX TABLE 8.—PROPOSED WAGE INDEX TABLE 8.—PROPOSED WAGE INDEX
FOR URBAN AREAS BASED ON
FOR URBAN AREAS BASED ON
FOR URBAN AREAS BASED ON
CBSA LABOR MARKET AREAS—
CBSA LABOR MARKET AREAS—
CBSA LABOR MARKET AREAS—
Continued
Continued
Continued
CBSA
Code
Urban Area
(Constituent
Counties)
22520 .......
Florence-Muscle
Shoals, AL.
Colbert County, AL.
Lauderdale County,
AL.
Fond du Lac, WI .....
Fond du Lac County, WI.
Fort CollinsLoveland, CO.
Larimer County, CO.
Fort LauderdalePompano BeachDeerfield Beach,
FL.
Broward County, FL.
Fort Smith, AR-OK
Crawford County,
AR.
Franklin County, AR.
Sebastian County,
AR.
Le Flore County, OK.
Sequoyah County,
OK.
Fort Walton BeachCrestview-Destin,
FL.
Okaloosa County,
FL.
Fort Wayne, IN .......
Allen County, IN.
Wells County, IN.
Whitley County, IN.
Fort Worth-Arlington, TX.
Johnson County, TX.
Parker County, TX.
Tarrant County, TX.
Wise County, TX.
Fresno, CA .............
Fresno County, CA.
Gadsden, AL ...........
Etowah County, AL.
Gainesville, FL ........
Alachua County, FL.
Gilchrist County, FL.
Gainesville, GA .......
Hall County, GA.
Gary, IN ..................
Jasper County, IN.
Lake County, IN.
Newton County, IN.
Porter County, IN.
Glens Falls, NY ......
Warren County, NY.
Washington County,
NY.
Goldsboro, NC ........
Wayne County, NC.
Grand Forks, NDMN.
Polk County, MN.
Grand Forks County, ND.
Grand Junction, CO
Mesa County, CO.
22540 .......
22660 .......
22744 .......
22900 .......
23020 .......
23060 .......
23104 .......
23420 .......
23460 .......
23540 .......
23580 .......
23844 .......
24020 .......
24140 .......
24220 .......
24300 .......
VerDate jul<14>2003
22:47 May 18, 2005
CBSA
Code
Urban Area
(Constituent
Counties)
24340 .......
Grand Rapids-Wyoming, MI.
Barry County, MI.
Ionia County, MI.
Kent County, MI.
Newaygo County,
MI.
Great Falls, MT .......
Cascade County,
MT.
Greeley, CO ............
Weld County, CO.
Green Bay, WI ........
Brown County, WI.
Kewaunee County,
WI.
Oconto County, WI.
Greensboro-High
Point, NC.
Guilford County, NC.
Randolph County,
NC.
Rockingham County, NC.
Greenville, NC ........
Greene County, NC.
Pitt County, NC.
Greenville, SC ........
Greenville County,
SC.
Laurens County, SC.
Pickens County, SC.
Guayama, PR .........
Arroyo Municipio,
PR.
Guayama Municipio,
PR.
Patillas Municipio,
PR.
Gulfport-Biloxi, MS ..
Hancock County,
MS.
Harrison County,
MS.
Stone County, MS.
Hagerstown-Martinsburg, MD-WV.
Washington County,
MD.
Berkeley County,
WV.
Morgan County, WV.
Hanford-Corcoran,
CA.
Kings County, CA.
Harrisburg-Carlisle,
PA.
Cumberland County,
PA.
Dauphin County, PA.
Perry County, PA.
Harrisonburg, VA ....
Rockingham County, VA.
Harrisonburg City,
VA.
Wage
Index
0.8280
0.9650
1.0132
1.0442
24500 .......
24540 .......
24580 .......
0.8214
24660 .......
0.8881
24780 .......
24860 .......
0.9803
25020 .......
0.9510
1.0541
25060 .......
0.7946
0.9474
25180 .......
0.8883
0.9369
25260 .......
0.8567
25420 .......
0.8784
1.1516
25500 .......
0.9560
Jkt 205001
PO 00000
Frm 00039
Fmt 4701
Sfmt 4702
Wage
Index
0.9400
CBSA
Code
Urban Area
(Constituent
Counties)
25540 .......
Hartford-West Hartford-East Hartford,
CT.
Hartford County, CT.
Litchfield County,
CT.
Middlesex County,
CT.
Tolland County, CT.
Hattiesburg, MS ......
Forrest County, MS.
Lamar County, MS.
Perry County, MS.
Hickory-Lenoir-Morganton, NC.
Alexander County,
NC.
Burke County, NC.
Caldwell County,
NC.
Catawba County,
NC.
Hinesville-Fort Stewart, GA 1.
Liberty County, GA.
Long County, GA.
Holland-Grand
Haven, MI.
Ottawa County, MI.
Honolulu, HI ............
Honolulu County, HI.
Hot Springs, AR ......
Garland County, AR.
Houma-Bayou
Cane-Thibodaux,
LA.
Lafourche Parish,
LA.
Terrebonne Parish,
LA.
Houston-BaytownSugar Land, TX.
Austin County, TX.
Brazoria County, TX.
Chambers County,
TX.
Fort Bend County,
TX.
Galveston County,
TX.
Harris County, TX.
Liberty County, TX.
Montgomery County, TX.
San Jacinto County,
TX.
Waller County, TX.
Huntington-Ashland,
WV-KY-OH.
Boyd County, KY.
Greenup County,
KY.
Lawrence County,
OH.
Cabell County, WV.
Wayne County, WV.
Huntsville, AL ..........
0.9061
25620 .......
0.9580
0.9452
25860 .......
0.9113
25980 .......
0.9434
26100 .......
1.0165
26180 .......
26300 .......
0.3184
26380 .......
0.8938
26420 .......
0.9499
1.0046
0.9322
26580 .......
0.9098
26620 .......
E:\FR\FM\19MYP3.SGM
19MYP3
Wage
Index
1.1084
0.7609
0.8922
0.9178
0.9064
1.1208
0.9053
0.7902
1.0005
0.9486
0.9149
29108
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE 8.—PROPOSED WAGE INDEX TABLE 8.—PROPOSED WAGE INDEX TABLE 8.—PROPOSED WAGE INDEX
FOR URBAN AREAS BASED ON
FOR URBAN AREAS BASED ON
FOR URBAN AREAS BASED ON
CBSA LABOR MARKET AREAS—
CBSA LABOR MARKET AREAS—
CBSA LABOR MARKET AREAS—
Continued
Continued
Continued
CBSA
Code
26820 .......
26900 .......
26980 .......
27060 .......
27100 .......
27140 .......
27180 .......
27260 .......
27340 .......
27500 .......
27620 .......
27740 .......
27780 .......
27860 .......
VerDate jul<14>2003
Urban Area
(Constituent
Counties)
Wage
Index
Limestone County,
AL.
Madison County, AL.
Idaho Falls, ID ........
Bonneville County,
ID.
Jefferson County, ID.
Indianapolis, IN .......
Boone County, IN.
Brown County, IN.
Hamilton County, IN.
Hancock County, IN.
Hendricks County,
IN.
Johnson County, IN.
Marion County, IN.
Morgan County, IN.
Putnam County, IN.
Shelby County, IN.
Iowa City, IA ...........
Johnson County, IA.
Washington County,
IA.
Ithaca, NY ...............
Tompkins County,
NY.
Jackson, MI ............
Jackson County, MI.
Jackson, MS ...........
Copiah County, MS.
Hinds County, MS.
Madison County,
MS.
Rankin County, MS.
Simpson County,
MS.
Jackson, TN ............
Chester County, TN.
Madison County, TN.
Jacksonville, FL ......
Baker County, FL.
Clay County, FL.
Duval County, FL.
Nassau County, FL.
St. Johns County,
FL.
Jacksonville, NC .....
Onslow County, NC.
Janesville, WI .........
Rock County, WI.
Jefferson City, MO ..
Callaway County,
MO.
Cole County, MO.
Moniteau County,
MO.
Osage County, MO.
Johnson City, TN ....
Carter County, TN.
Unicoi County, TN.
Washington County,
TN.
Johnstown, PA ........
Cambria County, PA.
Jonesboro, AR ........
Craighead County,
AR.
22:47 May 18, 2005
CBSA
Code
27900 .......
0.9429
28020 .......
0.9930
28100 .......
28140 .......
0.9756
0.9803
0.9313
0.8319
0.8973
0.9299
0.8244
28420 .......
28660 .......
28700 .......
0.9547
0.8396
28740 .......
28940 .......
0.7945
0.8362
29020 .......
0.7919
Jkt 205001
29100 .......
PO 00000
Frm 00040
Urban Area
(Constituent
Counties)
Wage
Index
Poinsett County, AR.
Joplin, MO ..............
Jasper County, MO.
Newton County, MO.
Kalamazoo-Portage,
MI.
Kalamazoo County,
MI.
Van Buren County,
MI.
Kankakee-Bradley,
IL.
Kankakee County,
IL.
Kansas City, MO-KS
Franklin County, KS.
Johnson County, KS.
Leavenworth County, KS.
Linn County, KS.
Miami County, KS.
Wyandotte County,
KS.
Bates County, MO.
Caldwell County,
MO.
Cass County, MO.
Clay County, MO.
Clinton County, MO.
Jackson County,
MO.
Lafayette County,
MO.
Platte County, MO.
Ray County, MO.
Kennewick-Richland-Pasco, WA.
Benton County, WA.
Franklin County, WA.
Killeen-Temple-Fort
Hood, TX.
Bell County, TX.
Coryell County, TX.
Lampasas County,
TX.
Kingsport-BristolBristol, TN-VA.
Hawkins County, TN.
Sullivan County, TN.
Bristol City, VA.
Scott County, VA.
Washington County,
VA.
Kingston, NY ...........
Ulster County, NY.
Knoxville, TN ..........
Anderson County,
TN.
Blount County, TN.
Knox County, TN.
Loudon County, TN.
Union County, TN.
Kokomo, IN .............
Howard County, IN.
Tipton County, IN.
La Crosse, WI-MN ..
Fmt 4701
Sfmt 4702
CBSA
Code
0.8590
1.0391
29140 .......
29180 .......
1.0974
29340 .......
0.9467
29404 .......
29460 .......
29540 .......
29620 .......
29700 .......
29740 .......
1.0630
0.8535
29820 .......
29940 .......
30020 .......
30140 .......
0.8062
30300 .......
30340 .......
0.9257
30460 .......
0.8454
0.9517
30620 .......
0.9573
E:\FR\FM\19MYP3.SGM
19MYP3
Urban Area
(Constituent
Counties)
Houston County,
MN.
La Crosse County,
WI.
Lafayette, IN ...........
Benton County, IN.
Carroll County, IN.
Tippecanoe County,
IN.
Lafayette, LA ..........
Lafayette Parish, LA.
St. Martin Parish,
LA.
Lake Charles, LA ....
Calcasieu Parish,
LA.
Cameron Parish, LA.
Lake County-Kenosha County, IL-WI.
Lake County, IL.
Kenosha County, WI.
Lakeland, FL ...........
Polk County, FL.
Lancaster, PA .........
Lancaster County,
PA.
Lansing-East Lansing, MI.
Clinton County, MI.
Eaton County, MI.
Ingham County, MI.
Laredo, TX ..............
Webb County, TX.
Las Cruces, NM ......
Dona Ana County,
NM.
Las Vegas-Paradise, NV.
Clark County, NV.
Lawrence, KS .........
Douglas County, KS.
Lawton, OK .............
Comanche County,
OK.
Lebanon, PA ...........
Lebanon County,
PA.
Lewiston, ID-WA .....
Nez Perce County,
ID.
Asotin County, WA.
Lewiston-Auburn,
ME.
Androscoggin County, ME.
Lexington-Fayette,
KY.
Bourbon County, KY.
Clark County, KY.
Fayette County, KY.
Jessamine County,
KY.
Scott County, KY.
Woodford County,
KY.
Lima, OH ................
Allen County, OH.
Wage
Index
0.8745
0.8436
0.7841
1.0440
0.8921
0.9704
0.9792
0.8076
0.8475
1.1449
0.8546
0.7880
0.8468
0.9896
0.9341
0.9084
0.9234
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
29109
TABLE 8.—PROPOSED WAGE INDEX TABLE 8.—PROPOSED WAGE INDEX TABLE 8.—PROPOSED WAGE INDEX
FOR URBAN AREAS BASED ON
FOR URBAN AREAS BASED ON
FOR URBAN AREAS BASED ON
CBSA LABOR MARKET AREAS—
CBSA LABOR MARKET AREAS—
CBSA LABOR MARKET AREAS—
Continued
Continued
Continued
CBSA
Code
Urban Area
(Constituent
Counties)
30700 .......
Lincoln, NE .............
Lancaster County,
NE.
Seward County, NE.
Little Rock-North Little Rock, AR.
Faulkner County,
AR.
Grant County, AR.
Lonoke County, AR.
Perry County, AR.
Pulaski County, AR.
Saline County, AR.
Logan, UT-ID ..........
Franklin County, ID.
Cache County, UT.
Longview, TX ..........
Gregg County, TX.
Rusk County, TX.
Upshur County, TX.
Longview, WA .........
Cowlitz County, WA.
Los Angeles-Long
Beach-Glendale,
CA.
Los Angeles County, CA.
Louisville, KY-IN .....
Clark County, IN.
Floyd County, IN.
Harrison County, IN.
Washington County,
IN.
Bullitt County, KY.
Henry County, KY.
Jefferson County,
KY.
Meade County, KY.
Nelson County, KY.
Oldham County, KY.
Shelby County, KY.
Spencer County, KY.
Trimble County, KY.
Lubbock, TX ...........
Crosby County, TX.
Lubbock County, TX.
Lynchburg, VA ........
Amherst County, VA.
Appomattox County,
VA.
Bedford County, VA.
Campbell County,
VA.
Bedford City, VA.
Lynchburg City, VA.
Macon, GA ..............
Bibb County, GA.
Crawford County,
GA.
Jones County, GA.
Monroe County, GA.
Twiggs County, GA.
Madera, CA ............
Madera County, CA.
Madison, WI ............
Columbia County,
WI.
30780 .......
30860 .......
30980 .......
31020 .......
31084 .......
31140 .......
31180 .......
31340 .......
31420 .......
31460 .......
31540 .......
VerDate jul<14>2003
22:47 May 18, 2005
Wage
Index
CBSA
Code
1.0225
31700 .......
0.8756
31900 .......
32420 .......
0.9173
0.8739
32580 .......
0.9523
32780 .......
1.1752
32820 .......
0.9261
32900 .......
33124 .......
33140 .......
0.8792
33260 .......
33340 .......
0.8700
0.9453
33460 .......
0.8721
1.0635
Jkt 205001
PO 00000
Frm 00041
Urban Area
(Constituent
Counties)
Wage
Index
Dane County, WI.
Iowa County, WI.
Manchester-Nashua,
NH.
Hillsborough County, NH.
Merrimack County,
NH.
Mansfield, OH 1 .......
Richland County,
OH.
¨
Mayaguez, PR ........
Hormigueros
Municipio, PR.
¨
Mayaguez
Municipio, PR.
McAllen-EdinburgPharr, TX.
Hidalgo County, TX.
Medford, OR ...........
Jackson County, OR.
Memphis, TN-MSAR.
Crittenden County,
AR.
DeSoto County, MS.
Marshall County,
MS.
Tate County, MS.
Tunica County, MS.
Fayette County, TN.
Shelby County, TN.
Tipton County, TN.
Merced, CA .............
Merced County, CA.
Miami-Miami BeachKendall, FL.
Miami-Dade County,
FL.
Michigan City-La
Porte, IN.
LaPorte County, IN.
Midland, TX ............
Midland County, TX.
MilwaukeeWaukesha-West
Allis, WI.
Milwaukee County,
WI.
Ozaukee County,
WI.
Washington County,
WI.
Waukesha County,
WI.
Minneapolis-St.
Paul-Bloomington,
MN-WI.
Anoka County, MN.
Carver County, MN.
Chisago County,
MN.
Dakota County, MN.
Hennepin County,
MN.
Isanti County, MN.
Fmt 4701
Sfmt 4702
CBSA
Code
1.0335
0.8887
33540 .......
0.4017
33660 .......
33700 .......
0.8943
33740 .......
1.0235
0.9341
33780 .......
33860 .......
34060 .......
1.1120
34100 .......
0.9759
0.9409
34580 .......
0.9523
1.0106
34620 .......
34740 .......
34820 .......
1.1078
34900 .......
34940 .......
34980 .......
E:\FR\FM\19MYP3.SGM
19MYP3
Urban Area
(Constituent
Counties)
Ramsey County,
MN.
Scott County, MN.
Sherburne County,
MN.
Washington County,
MN.
Wright County, MN.
Pierce County, WI.
St. Croix County, WI.
Missoula, MT ..........
Missoula County,
MT.
Mobile, AL ...............
Mobile County, AL.
Modesto, CA ...........
Stanislaus County,
CA.
Monroe, LA .............
Ouachita Parish, LA.
Union Parish, LA.
Monroe, MI .............
Monroe County, MI.
Montgomery, AL .....
Autauga County, AL.
Elmore County, AL.
Lowndes County,
AL.
Montgomery County, AL.
Morgantown, WV ....
Monongalia County,
WV.
Preston County, WV.
Morristown, TN .......
Grainger County,
TN.
Hamblen County,
TN.
Jefferson County,
TN.
Mount VernonAnacortes, WA.
Skagit County, WA.
Muncie, IN ..............
Delaware County,
IN.
Muskegon-Norton
Shores, MI.
Muskegon County,
MI.
Myrtle BeachConway-North
Myrtle Beach, SC.
Horry County, SC.
Napa, CA ................
Napa County, CA.
Naples-Marco Island, FL.
Collier County, FL.
Nashville-Davidson—
Murfreesboro, TN.
Cannon County, TN.
Cheatham County,
TN.
Wage
Index
0.9482
0.7895
1.1804
0.8040
0.9478
0.8588
0.8428
0.8753
1.0465
0.8939
0.9673
0.8873
1.2656
1.0140
0.9769
29110
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE 8.—PROPOSED WAGE INDEX TABLE 8.—PROPOSED WAGE INDEX TABLE 8.—PROPOSED WAGE INDEX
FOR URBAN AREAS BASED ON
FOR URBAN AREAS BASED ON
FOR URBAN AREAS BASED ON
CBSA LABOR MARKET AREAS—
CBSA LABOR MARKET AREAS—
CBSA LABOR MARKET AREAS—
Continued
Continued
Continued
CBSA
Code
35004 .......
35084 .......
35300 .......
35380 .......
35644 .......
VerDate jul<14>2003
Urban Area
(Constituent
Counties)
Davidson County,
TN.
Dickson County, TN.
Hickman County,
TN.
Macon County, TN.
Robertson County,
TN.
Rutherford County,
TN.
Smith County, TN.
Sumner County, TN.
Trousdale County,
TN.
Williamson County,
TN.
Wilson County, TN.
Nassau-Suffolk, NY
Nassau County, NY.
Suffolk County, NY.
Newark-Union, NJPA.
Essex County, NJ.
Hunterdon County,
NJ.
Morris County, NJ.
Sussex County, NJ.
Union County, NJ.
Pike County, PA.
New Haven-Milford,
CT.
New Haven County,
CT.
New OrleansMetairie-Kenner,
LA.
Jefferson Parish, LA.
Orleans Parish, LA.
Plaquemines Parish,
LA.
St. Bernard Parish,
LA.
St. Charles Parish,
LA.
St. John the Baptist
Parish, LA.
St. Tammany Parish, LA.
New York-WayneWhite Plains, NYNJ.
Bergen County, NJ.
Hudson County, NJ.
Passaic County, NJ.
Bronx County, NY.
Kings County, NY.
New York County,
NY.
Putnam County, NY.
Queens County, NY.
Richmond County,
NY.
Rockland County,
NY.
Westchester County, NY.
22:47 May 18, 2005
CBSA
Code
Urban Area
(Constituent
Counties)
35660 .......
Niles-Benton Harbor, MI.
Berrien County, MI.
Norwich-New London, CT.
New London County, CT.
Oakland-FremontHayward, CA.
Alameda County,
CA.
Contra Costa County, CA.
Ocala, FL ................
Marion County, FL.
Ocean City, NJ .......
Cape May County,
NJ.
Odessa, TX .............
Ector County, TX.
Ogden-Clearfield,
UT.
Davis County, UT.
Morgan County, UT.
Weber County, UT.
Oklahoma City, OK
Canadian County,
OK.
Cleveland County,
OK.
Grady County, OK.
Lincoln County, OK.
Logan County, OK.
McClain County, OK.
Oklahoma County,
OK.
Olympia, WA ...........
Thurston County,
WA.
Omaha-Council
Bluffs, NE-IA.
Harrison County, IA.
Mills County, IA.
Pottawattamie
County, IA.
Cass County, NE.
Douglas County, NE.
Sarpy County, NE.
Saunders County,
NE.
Washington County,
NE.
Orlando, FL .............
Lake County, FL.
Orange County, FL.
Osceola County, FL.
Seminole County,
FL.
Oshkosh-Neenah,
WI.
Winnebago County,
WI.
Owensboro, KY ......
Daviess County, KY.
Hancock County,
KY.
McLean County, KY.
Wage
Index
35980 .......
36084 .......
36100 .......
36140 .......
1.2760
1.2195
36220 .......
36260 .......
36420 .......
1.1702
0.9005
36500 .......
36540 .......
1.3185
Jkt 205001
36740 .......
36780 .......
36980 .......
PO 00000
Frm 00042
Fmt 4701
Sfmt 4702
CBSA
Code
Urban Area
(Constituent
Counties)
0.8888
37100 .......
1.1356
37340 .......
1.5346
37460 .......
Oxnard-Thousand
Oaks-Ventura, CA.
Ventura County, CA.
Palm Bay-Melbourne-Titusville,
FL.
Brevard County, FL.
Panama City-Lynn
Haven, FL.
Bay County, FL.
Parkersburg-Marietta, WV-OH.
Washington County,
OH.
Pleasants County,
WV.
Wirt County, WV.
Wood County, WV.
Pascagoula, MS .....
George County, MS.
Jackson County, MS.
Pensacola-Ferry
Pass-Brent, FL.
Escambia County,
FL.
Santa Rosa County,
FL.
Peoria, IL ................
Marshall County, IL.
Peoria County, IL.
Stark County, IL.
Tazewell County, IL.
Woodford County, IL.
Philadelphia, PA .....
Bucks County, PA.
Chester County, PA.
Delaware County,
PA.
Montgomery County, PA.
Philadelphia County,
PA.
Phoenix-MesaScottsdale, AZ.
Maricopa County,
AZ.
Pinal County, AZ.
Pine Bluff, AR .........
Cleveland County,
AR.
Jefferson County,
AR.
Lincoln County, AR.
Pittsburgh, PA .........
Allegheny County,
PA.
Armstrong County,
PA.
Beaver County, PA.
Butler County, PA.
Fayette County, PA.
Washington County,
PA.
Westmoreland
County, PA.
Pittsfield, MA ...........
Wage
Index
37620 .......
0.8934
1.1022
0.9894
37700 .......
0.9038
37860 .......
0.9040
37900 .......
37964 .......
1.0938
0.9569
38060 .......
38220 .......
0.9459
38300 .......
0.9192
0.8789
38340 .......
E:\FR\FM\19MYP3.SGM
19MYP3
Wage
Index
1.1613
0.9835
0.7989
0.8278
0.8165
0.8104
0.8868
1.1040
1.0138
0.8689
0.8853
1.0191
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
29111
TABLE 8.—PROPOSED WAGE INDEX TABLE 8.—PROPOSED WAGE INDEX TABLE 8.—PROPOSED WAGE INDEX
FOR URBAN AREAS BASED ON
FOR URBAN AREAS BASED ON
FOR URBAN AREAS BASED ON
CBSA LABOR MARKET AREAS—
CBSA LABOR MARKET AREAS—
CBSA LABOR MARKET AREAS—
Continued
Continued
Continued
CBSA
Code
38540 .......
38660 .......
38860 .......
38900 .......
38940 .......
39100 .......
39140 .......
39300 .......
39340 .......
39380 .......
39460 .......
39540 .......
VerDate jul<14>2003
Urban Area
(Constituent
Counties)
Wage
Index
Berkshire County,
MA.
Pocatello, ID ...........
Bannock County, ID.
Power County, ID.
Ponce, PR ..............
´
Juana Dıaz
Municipio, PR.
Ponce Municipio,
PR.
Villalba Municipio,
PR.
Portland-South Portland-Biddeford,
ME.
Cumberland County,
ME.
Sagadahoc County,
ME.
York County, ME.
Portland-VancouverBeaverton, ORWA.
Clackamas County,
OR.
Columbia County,
OR.
Multnomah County,
OR.
Washington County,
OR.
Yamhill County, OR.
Clark County, WA.
Skamania County,
WA.
Port St. Lucie-Fort
Pierce, FL.
Martin County, FL.
St. Lucie County, FL.
Poughkeepsie-Newburgh-Middletown,
NY.
Dutchess County,
NY.
Orange County, NY.
Prescott, AZ ............
Yavapai County, AZ.
Providence-New
Bedford-Fall
River, RI-MA.
Bristol County, MA.
Bristol County, RI.
Kent County, RI.
Newport County, RI.
Providence County,
RI.
Washington County,
RI.
Provo-Orem, UT .....
Juab County, UT.
Utah County, UT.
Pueblo, CO .............
Pueblo County, CO.
Punta Gorda, FL .....
Charlotte County,
FL.
Racine, WI ..............
22:47 May 18, 2005
CBSA
Code
39580 .......
0.9360
0.5177
39660 .......
39740 .......
1.0392
39820 .......
39900 .......
40060 .......
1.1260
1.0133
1.0766
0.9879
1.0966
40140 .......
40220 .......
0.9510
0.8632
0.9264
40340 .......
0.9006
Jkt 205001
PO 00000
Frm 00043
Urban Area
(Constituent
Counties)
Wage
Index
Racine County, WI.
Raleigh-Cary, NC ...
Franklin County, NC.
Johnston County,
NC.
Wake County, NC.
Rapid City, SD ........
Meade County, SD.
Pennington County,
SD.
Reading, PA ...........
Berks County, PA.
Redding, CA ...........
Shasta County, CA.
Reno-Sparks, NV ....
Storey County, NV.
Washoe County, NV.
Richmond, VA .........
Amelia County, VA.
Caroline County, VA.
Charles City County,
VA.
Chesterfield County,
VA.
Cumberland County,
VA.
Dinwiddie County,
VA.
Goochland County,
VA.
Hanover County, VA.
Henrico County, VA.
King and Queen
County, VA.
King William County, VA.
Louisa County, VA.
New Kent County,
VA.
Powhatan County,
VA.
Prince George
County, VA.
Sussex County, VA.
Colonial Heights
City, VA.
Hopewell City, VA.
Petersburg City, VA.
Richmond City, VA.
Riverside-San
Bernardino-Ontario, CA.
Riverside County,
CA.
San Bernardino
County, CA.
Roanoke, VA ..........
Botetourt County,
VA.
Craig County, VA.
Franklin County, VA.
Roanoke County,
VA.
Roanoke City, VA.
Salem City, VA.
Rochester, MN ........
Dodge County, MN.
Fmt 4701
Sfmt 4702
CBSA
Code
0.9733
40380 .......
0.9021
0.9696
1.2215
40420 .......
1.0993
40484 .......
0.9338
40580 .......
40660 .......
40900 .......
40980 .......
41060 .......
41100 .......
41140 .......
1.1022
41180 .......
0.8383
1.1142
E:\FR\FM\19MYP3.SGM
19MYP3
Urban Area
(Constituent
Counties)
Olmsted County,
MN.
Wabasha County,
MN.
Rochester, NY ........
Livingston County,
NY.
Monroe County, NY.
Ontario County, NY.
Orleans County, NY.
Wayne County, NY.
Rockford, IL ............
Boone County, IL.
Winnebago County,
IL.
Rockingham County-Strafford County, NH.
Rockingham County, NH.
Strafford County,
NH.
Rocky Mount, NC ...
Edgecombe County,
NC.
Nash County, NC.
Rome, GA ...............
Floyd County, GA.
Sacramento—
Arden-Arcade—
Roseville, CA.
El Dorado County,
CA.
Placer County, CA.
Sacramento County,
CA.
Yolo County, CA.
Saginaw-Saginaw
Township North,
MI.
Saginaw County, MI.
St. Cloud, MN .........
Benton County, MN.
Stearns County, MN.
St. George, UT .......
Washington County,
UT.
St. Joseph, MO-KS
Doniphan County,
KS.
Andrew County, MO.
Buchanan County,
MO.
DeKalb County, MO.
St. Louis, MO-IL .....
Bond County, IL.
Calhoun County, IL.
Clinton County, IL.
Jersey County, IL.
Macoupin County, IL.
Madison County, IL.
Monroe County, IL.
St. Clair County, IL.
Crawford County,
MO.
Franklin County, MO.
Wage
Index
0.9115
0.9994
1.0385
0.8924
0.9424
1.2973
0.9420
0.9975
0.9402
0.9529
0.8949
29112
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE 8.—PROPOSED WAGE INDEX TABLE 8.—PROPOSED WAGE INDEX TABLE 8.—PROPOSED WAGE INDEX
FOR URBAN AREAS BASED ON
FOR URBAN AREAS BASED ON
FOR URBAN AREAS BASED ON
CBSA LABOR MARKET AREAS—
CBSA LABOR MARKET AREAS—
CBSA LABOR MARKET AREAS—
Continued
Continued
Continued
CBSA
Code
41420 .......
41500 .......
41540 .......
41620 .......
41660 .......
41700 .......
41740 .......
41780 .......
41884 .......
41900 .......
VerDate jul<14>2003
Urban Area
(Constituent
Counties)
Jefferson County,
MO.
Lincoln County, MO.
St. Charles County,
MO.
St. Louis County,
MO.
Warren County, MO.
Washington County,
MO.
St. Louis City, MO.
Salem, OR ..............
Marion County, OR.
Polk County, OR.
Salinas, CA .............
Monterey County,
CA.
Salisbury, MD .........
Somerset County,
MD.
Wicomico County,
MD.
Salt Lake City, UT ..
Salt Lake County,
UT.
Summit County, UT.
Tooele County, UT.
San Angelo, TX ......
Irion County, TX.
Tom Green County,
TX.
San Antonio, TX .....
Atascosa County,
TX.
Bandera County, TX.
Bexar County, TX.
Comal County, TX.
Guadalupe County,
TX.
Kendall County, TX.
Medina County, TX.
Wilson County, TX.
San Diego-Carlsbad-San Marcos,
CA.
San Diego County,
CA.
Sandusky, OH ........
Erie County, OH.
San Francisco-San
Mateo-Redwood
City, CA.
Marin County, CA.
San Francisco
County, CA.
San Mateo County,
CA.
´
San German-Cabo
Rojo, PR.
Cabo Rojo
Municipio, PR.
Lajas Municipio, PR.
Sabana Grande
Municipio, PR.
´
San German
Municipio, PR.
22:47 May 18, 2005
CBSA
Code
Urban Area
(Constituent
Counties)
41940 .......
San Jose-Sunnyvale-Santa Clara,
CA.
San Benito County,
CA.
Santa Clara County,
CA.
San Juan-CaguasGuaynabo, PR.
Aguas Buenas
Municipio, PR.
Aibonito Municipio,
PR.
Arecibo Municipio,
PR.
Barceloneta
Municipio, PR.
Barranquitas
Municipio, PR.
´
Bayamon Municipio,
PR.
Caguas Municipio,
PR.
Camuy Municipio,
PR.
´
Canovanas
Municipio, PR.
Carolina Municipio,
PR.
˜
Catano Municipio,
PR.
Cayey Municipio,
PR.
Ciales Municipio,
PR.
Cidra Municipio, PR.
´
Comerıo Municipio,
PR.
Corozal Municipio,
PR.
Dorado Municipio,
PR.
Florida Municipio,
PR.
Guaynabo
Municipio, PR.
Gurabo Municipio,
PR.
Hatillo Municipio,
PR.
Humacao Municipio,
PR.
Juncos Municipio,
PR.
Las Piedras
Municipio, PR.
´
Loıza Municipio, PR.
´
Manatı Municipio,
PR.
Maunabo Municipio,
PR.
Morovis Municipio,
PR.
Naguabo Municipio,
PR.
Wage
Index
41980 .......
1.0452
1.4142
0.9073
0.9433
0.8280
0.8989
1.1424
0.9025
1.4990
0.4655
Jkt 205001
PO 00000
Frm 00044
Fmt 4701
Sfmt 4702
Wage
Index
CBSA
Code
1.5125
0.4686
42020 .......
42044 .......
42060 .......
42100 .......
42140 .......
42220 .......
42260 .......
42340 .......
42540 .......
42644 .......
E:\FR\FM\19MYP3.SGM
19MYP3
Urban Area
(Constituent
Counties)
Naranjito Municipio,
PR.
Orocovis Municipio,
PR.
Quebradillas
Municipio, PR.
´
Rıo Grande
Municipio, PR.
San Juan Municipio,
PR.
San Lorenzo
Municipio, PR.
Toa Alta Municipio,
PR.
Toa Baja Municipio,
PR.
Trujillo Alto
Municipio, PR.
Vega Alta Municipio,
PR.
Vega Baja
Municipio, PR.
Yabucoa Municipio,
PR.
San Luis ObispoPaso Robles, CA.
San Luis Obispo
County, CA.
Santa Ana-Anaheim-Irvine, CA.
Orange County, CA.
Santa BarbaraSanta MariaGoleta, CA.
Santa Barbara
County, CA.
Santa CruzWatsonville, CA.
Santa Cruz County,
CA.
Santa Fe, NM .........
Santa Fe County,
NM.
Santa RosaPetaluma, CA.
Sonoma County, CA.
Sarasota-BradentonVenice, FL.
Manatee County, FL.
Sarasota County, FL.
Savannah, GA ........
Bryan County, GA.
Chatham County,
GA.
Effingham County,
GA.
Scranton—WilkesBarre, PA.
Lackawanna County, PA.
Luzerne County, PA.
Wyoming County,
PA.
Seattle-BellevueEverett, WA.
King County, WA.
Wage
Index
1.1360
1.1576
1.1538
1.5182
1.0931
1.3506
0.9555
0.9480
0.8548
1.1589
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
29113
TABLE 8.—PROPOSED WAGE INDEX TABLE 8.—PROPOSED WAGE INDEX TABLE 8.—PROPOSED WAGE INDEX
FOR URBAN AREAS BASED ON
FOR URBAN AREAS BASED ON
FOR URBAN AREAS BASED ON
CBSA LABOR MARKET AREAS—
CBSA LABOR MARKET AREAS—
CBSA LABOR MARKET AREAS—
Continued
Continued
Continued
CBSA
Code
43100 .......
43300 .......
43340 .......
43580 .......
43620 .......
43780 .......
43900 .......
44060 .......
44100 .......
44140 .......
44180 .......
44220 .......
44300 .......
44700 .......
44940 .......
45060 .......
VerDate jul<14>2003
Urban Area
(Constituent
Counties)
Snohomish County,
WA.
Sheboygan, WI .......
Sheboygan County,
WI.
Sherman-Denison,
TX.
Grayson County, TX.
Shreveport-Bossier
City, LA.
Bossier Parish, LA.
Caddo Parish, LA.
De Soto Parish, LA.
Sioux City, IA-NESD.
Woodbury County,
IA.
Dakota County, NE.
Dixon County, NE.
Union County, SD.
Sioux Falls, SD .......
Lincoln County, SD.
McCook County, SD.
Minnehaha County,
SD.
Turner County, SD.
South BendMishawaka, IN-MI.
St. Joseph County,
IN.
Cass County, MI.
Spartanburg, SC .....
Spartanburg County,
SC.
Spokane, WA ..........
Spokane County,
WA.
Springfield, IL ..........
Menard County, IL.
Sangamon County,
IL.
Springfield, MA .......
Franklin County, MA.
Hampden County,
MA.
Hampshire County,
MA.
Springfield, MO .......
Christian County,
MO.
Dallas County, MO.
Greene County, MO.
Polk County, MO.
Webster County,
MO.
Springfield, OH .......
Clark County, OH.
State College, PA ...
Centre County, PA.
Stockton, CA ...........
San Joaquin County, CA.
Sumter, SC .............
Sumter County, SC.
Syracuse, NY ..........
Madison County, NY.
22:47 May 18, 2005
CBSA
Code
Wage
Index
0.8920
45104 .......
0.9516
45220 .......
0.8769
45300 .......
0.9376
0.9645
0.9798
0.9181
45460 .......
45500 .......
45780 .......
1.0916
45820 .......
0.8885
1.0259
45940 .......
46060 .......
0.8246
46140 .......
0.8404
0.8364
46220 .......
1.1311
0.8386
46340 .......
0.9581
Jkt 205001
46540 .......
PO 00000
Frm 00045
Urban Area
(Constituent
Counties)
Wage
Index
Onondaga County,
NY.
Oswego County, NY.
Tacoma, WA ...........
Pierce County, WA.
Tallahassee, FL ......
Gadsden County,
FL.
Jefferson County,
FL.
Leon County, FL.
Wakulla County, FL.
Tampa-St. Petersburg-Clearwater,
FL.
Hernando County,
FL.
Hillsborough County, FL.
Pasco County, FL.
Pinellas County, FL.
Terre Haute, IN .......
Clay County, IN.
Sullivan County, IN.
Vermillion County,
IN.
Vigo County, IN.
Texarkana, TX-Texarkana, AR.
Miller County, AR.
Bowie County, TX.
Toledo, OH .............
Fulton County, OH.
Lucas County, OH.
Ottawa County, OH.
Wood County, OH.
Topeka, KS .............
Jackson County, KS.
Jefferson County,
KS.
Osage County, KS.
Shawnee County,
KS.
Wabaunsee County,
KS.
Trenton-Ewing, NJ ..
Mercer County, NJ.
Tucson, AZ .............
Pima County, AZ.
Tulsa, OK ................
Creek County, OK.
Okmulgee County,
OK.
Osage County, OK.
Pawnee County, OK.
Rogers County, OK.
Tulsa County, OK.
Wagoner County,
OK.
Tuscaloosa, AL .......
Greene County, AL.
Hale County, AL.
Tuscaloosa County,
AL.
Tyler, TX .................
Smith County, TX.
Utica-Rome, NY ......
Fmt 4701
Sfmt 4702
1.0753
CBSA
Code
46660 .......
0.8697
46700 .......
0.9193
46940 .......
47020 .......
47220 .......
0.8313
47260 .......
0.8291
0.9584
0.8929
1.0845
0.8987
0.8286
47300 .......
47380 .......
47580 .......
0.8721
47644 .......
0.9307
0.8293
E:\FR\FM\19MYP3.SGM
19MYP3
Urban Area
(Constituent
Counties)
Herkimer County,
NY.
Oneida County, NY.
Valdosta, GA ..........
Brooks County, GA.
Echols County, GA.
Lanier County, GA.
Lowndes County,
GA.
Vallejo-Fairfield, CA
Solano County, CA.
Vero Beach, FL ......
Indian River County,
FL.
Victoria, TX .............
Calhoun County, TX.
Goliad County, TX.
Victoria County, TX.
Vineland-MillvilleBridgeton, NJ.
Cumberland County,
NJ.
Virginia Beach-Norfolk-Newport
News, VA-NC.
Currituck County,
NC.
Gloucester County,
VA.
Isle of Wight County, VA.
James City County,
VA.
Mathews County,
VA.
Surry County, VA.
York County, VA.
Chesapeake City,
VA.
Hampton City, VA.
Newport News City,
VA.
Norfolk City, VA.
Poquoson City, VA.
Portsmouth City, VA.
Suffolk City, VA.
Virginia Beach City,
VA.
Williamsburg City,
VA.
Visalia-Porterville,
CA.
Tulare County, CA.
Waco, TX ................
McLennan County,
TX.
Warner Robins, GA
Houston County, GA.
Warren-Farmington
Hills-Troy, MI.
Lapeer County, MI.
Livingston County,
MI.
Macomb County, MI.
Oakland County, MI.
St. Clair County, MI.
Wage
Index
0.8875
1.4899
0.9444
0.8168
0.9837
0.8808
1.0074
0.8527
0.8654
0.9861
29114
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE 8.—PROPOSED WAGE INDEX TABLE 8.—PROPOSED WAGE INDEX TABLE 8.—PROPOSED WAGE INDEX
FOR URBAN AREAS BASED ON
FOR URBAN AREAS BASED ON
FOR URBAN AREAS BASED ON
CBSA LABOR MARKET AREAS—
CBSA LABOR MARKET AREAS—
CBSA LABOR MARKET AREAS—
Continued
Continued
Continued
CBSA
Code
Urban Area
(Constituent
Counties)
47894 .......
Washington-Arlington-Alexandria,
DC-VA-MD-WV.
District of Columbia,
DC.
Calvert County, MD.
Charles County, MD.
Prince George’s
County, MD.
Arlington County,
VA.
Clarke County, VA.
Fairfax County, VA.
Fauquier County,
VA.
Loudoun County,
VA.
Prince William
County, VA.
Spotsylvania County, VA.
Stafford County, VA.
Warren County, VA.
Alexandria City, VA.
Fairfax City, VA.
Falls Church City,
VA.
Fredericksburg City,
VA.
Manassas City, VA.
Manassas Park City,
VA.
Jefferson County,
WV.
Waterloo-Cedar
Falls, IA.
Black Hawk County,
IA.
Bremer County, IA.
Grundy County, IA.
Wausau, WI ............
Marathon County,
WI.
Weirton-Steubenville, WV-OH.
Jefferson County,
OH.
Brooke County, WV.
Hancock County,
WV.
Wenatchee, WA ......
Chelan County, WA.
Douglas County,
WA.
West Palm BeachBoca Raton-Boynton Beach, FL.
Palm Beach County,
FL.
Wheeling, WV-OH ..
Belmont County, OH.
Marshall County,
WV.
Ohio County, WV.
Wichita, KS .............
Butler County, KS.
Harvey County, KS.
47940 .......
48140 .......
48260 .......
48300 .......
48424 .......
48540 .......
48620 .......
VerDate jul<14>2003
22:47 May 18, 2005
Wage
Index
CBSA
Code
1.0932
48660 .......
48700 .......
48864 .......
48900 .......
49020 .......
49180 .......
0.8566
49340 .......
49420 .......
0.9600
49500 .......
0.7827
1.0080
49620 .......
49660 .......
1.0077
0.7168
49700 .......
0.9141
Jkt 205001
49740 .......
PO 00000
Frm 00046
Urban Area
(Constituent
Counties)
Sedgwick County,
KS.
Sumner County, KS.
Wichita Falls, TX ....
Archer County, TX.
Clay County, TX.
Wichita County, TX.
Williamsport, PA .....
Lycoming County,
PA.
Wilmington, DE-MDNJ.
New Castle County,
DE.
Cecil County, MD.
Salem County, NJ.
Wilmington, NC .......
Brunswick County,
NC.
New Hanover County, NC.
Pender County, NC.
Winchester, VA-WV
Frederick County,
VA.
Winchester City, VA.
Hampshire County,
WV.
Winston-Salem, NC
Davie County, NC.
Forsyth County, NC.
Stokes County, NC.
Yadkin County, NC.
Worcester, MA ........
Worcester County,
MA.
Yakima, WA ............
Yakima County, WA.
Yauco, PR ..............
´
Guanica Municipio,
PR.
Guayanilla
Municipio, PR.
˜
Penuelas Municipio,
PR.
Yauco Municipio,
PR.
York-Hanover, PA ...
York County, PA.
Youngstown-Warren-Boardman,
OH-PA.
Mahoning County,
OH.
Trumbull County,
OH.
Mercer County, PA.
Yuba City, CA .........
Sutter County, CA.
Yuba County, CA.
Yuma, AZ ................
Fmt 4701
Sfmt 4702
CBSA
Code
Wage
Index
Urban Area
(Constituent
Counties)
Wage
Index
Yuma County, AZ.
1At
0.8294
0.8377
this time, there are no hospitals located
in these urban areas on which to base a wage
index. Therefore, the urban wage index value
is based on the average wage index for all
urban areas within the state.
TABLE 9.—PROPOSED WAGE INDEX
BASED ON CBSA LABOR MARKET
AREAS FOR RURAL AREAS
1.0482
CBSA
Code
0.9592
1.0224
0.8953
1.1039
1.0165
0.4413
0.9420
0.8611
1.0932
0.9135
01
02
03
04
05
06
07
08
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
.............
E:\FR\FM\19MYP3.SGM
19MYP3
Nonurban Area
Wage
Index
Alabama ..................
Alaska .....................
Arizona ....................
Arkansas .................
California .................
Colorado .................
Connecticut .............
Delaware .................
Florida .....................
Georgia ...................
Hawaii .....................
Idaho .......................
Illinois ......................
Indiana ....................
Iowa ........................
Kansas ....................
Kentucky .................
Louisiana ................
Maine ......................
Maryland .................
Massachusetts 2 ......
Michigan .................
Minnesota ...............
Mississippi ..............
Missouri ..................
Montana ..................
Nebraska ................
Nevada ...................
New Hampshire ......
New Jersey 2 ...........
New Mexico ............
New York ................
North Carolina ........
North Dakota ..........
Ohio ........................
Oklahoma ...............
Oregon ....................
Pennsylvania ..........
Puerto Rico 2 ...........
Rhode Island 2 ........
South Carolina ........
South Dakota ..........
Tennessee ..............
Texas ......................
Utah ........................
Vermont ..................
Virgin Islands ..........
Virginia ....................
Washington .............
West Virginia ..........
Wisconsin ...............
Wyoming .................
0.7477
1.1990
0.8777
0.7451
1.0857
0.9389
1.1794
0.9606
0.8598
0.7666
1.0562
0.8045
0.8279
0.8630
0.8502
0.7987
0.7774
0.7418
0.8852
0.9095
1.0216
0.8870
0.9183
0.7671
0.7909
0.8833
0.8665
0.9074
1.0677
................
0.8644
0.8157
0.8567
0.7268
0.8786
0.7589
0.9830
0.8302
0.4047
................
0.8641
0.8484
0.7888
0.8007
0.8126
0.9840
0.7026
0.8012
1.0458
0.7725
0.9480
0.9214
29115
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE 9.—PROPOSED WAGE INDEX
BASED ON CBSA LABOR MARKET
AREAS FOR RURAL AREAS—Continued
CBSA
Code
Nonurban Area
Wage
Index
65 .............
Guam ......................
0.9611
2 All
counties within the State are classified
as urban, with the exception of Massachusetts
and Puerto Rico. Massachusetts and Puerto
Rico have areas designated as rural, however,
no short-term, acute care hospitals are located
in the area(s) for FY 2006. Because more recent data is not available for those areas, we
are using last year’s wage index value.
TABLE A.—MSA/CBSA CROSSWALK
SSA
State/
County
Code
01000
01010
01020
01030
01040
01050
01060
01070
01080
01090
01100
01110
01120
01130
01140
01150
01160
01170
01180
01190
01200
01210
01220
01230
01240
01250
01260
01270
01280
01290
01300
01310
01320
01330
01340
01350
01360
01370
01380
01390
01400
01410
01420
01430
01440
01450
01460
01470
01480
01490
01500
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Autauga County, Alabama ........................................................................................
Baldwin County, Alabama .........................................................................................
Barbour County, Alabama .........................................................................................
Bibb County, Alabama ...............................................................................................
Blount County, Alabama ............................................................................................
Bullock County, Alabama ..........................................................................................
Butler County, Alabama ............................................................................................
Calhoun County, Alabama ........................................................................................
Chambers County, Alabama .....................................................................................
Cherokee County, Alabama ......................................................................................
Chilton County, Alabama ...........................................................................................
Choctaw County, Alabama ........................................................................................
Clarke County, Alabama ...........................................................................................
Clay County, Alabama ...............................................................................................
Cleburne County, Alabama .......................................................................................
Coffee County, Alabama ...........................................................................................
Colbert County, Alabama ..........................................................................................
Conecuh County, Alabama .......................................................................................
Coosa County, Alabama ...........................................................................................
Covington County, Alabama ......................................................................................
Crenshaw County, Alabama ......................................................................................
Cullman County, Alabama .........................................................................................
Dale County, Alabama ..............................................................................................
Dallas County, Alabama ............................................................................................
De Kalb County, Alabama .........................................................................................
Elmore County, Alabama ..........................................................................................
Escambia County, Alabama ......................................................................................
Etowah County, Alabama ..........................................................................................
Fayette County, Alabama ..........................................................................................
Franklin County, Alabama .........................................................................................
Geneva County, Alabama .........................................................................................
Greene County, Alabama ..........................................................................................
Hale County, Alabama ..............................................................................................
Henry County, Alabama ............................................................................................
Houston County, Alabama ........................................................................................
Jackson County, Alabama .........................................................................................
Jefferson County, Alabama .......................................................................................
Lamar County, Alabama ............................................................................................
Lauderdale County, Alabama ....................................................................................
Lawrence County, Alabama ......................................................................................
Lee County, Alabama ................................................................................................
Limestone County, Alabama .....................................................................................
Lowndes County, Alabama .......................................................................................
Macon County, Alabama ...........................................................................................
Madison County, Alabama ........................................................................................
Marengo County, Alabama ........................................................................................
Marion County, Alabama ...........................................................................................
Marshall County, Alabama ........................................................................................
Mobile County, Alabama ...........................................................................................
Monroe County, Alabama ..........................................................................................
Montgomery County, Alabama ..................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00047
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
5240
5160
01
01
1000
01
01
0450
01
01
01
01
01
01
01
01
2650
01
01
01
01
01
2180
01
01
5240
01
2880
01
01
01
01
01
01
2180
01
1000
01
2650
2030
0580
3440
01
01
3440
01
01
01
5160
01
5240
19MYP3
2006
MSAbased
WI
0.8588
0.7866
0.7463
0.7463
0.9021
0.7463
0.7463
0.7659
0.7463
0.7463
0.7463
0.7463
0.7463
0.7463
0.7463
0.7463
0.8280
0.7463
0.7463
0.7463
0.7463
0.7463
0.7687
0.7463
0.7463
0.8588
0.7463
0.7946
0.7463
0.7463
0.7463
0.7463
0.7463
0.7463
0.7687
0.7463
0.9021
0.7463
0.8280
0.8478
0.8108
0.9149
0.7463
0.7463
0.9149
0.7463
0.7463
0.7463
0.7866
0.7463
0.8588
2006
CBSAbased
WI
0.8588
0.7477
0.7477
0.8979
0.8979
0.7477
0.7477
0.7659
0.7477
0.7477
0.8979
0.7477
0.7477
0.7477
0.7477
0.7477
0.8280
0.7477
0.7477
0.7477
0.7477
0.7477
0.7477
0.7477
0.7477
0.8588
0.7477
0.7946
0.7477
0.7477
0.7707
0.8721
0.8721
0.7707
0.7707
0.7477
0.8979
0.7477
0.8280
0.8478
0.8108
0.9149
0.8588
0.7477
0.9149
0.7477
0.7477
0.7477
0.7895
0.7477
0.8588
CBSA
Number
33860
99901
99901
13820
13820
99901
99901
11500
99901
99901
13820
99901
99901
99901
99901
99901
22520
99901
99901
99901
99901
99901
99901
99901
99901
33860
99901
23460
99901
99901
20020
46220
46220
20020
20020
99901
13820
99901
22520
19460
12220
26620
33860
99901
26620
99901
99901
99901
33660
99901
33860
29116
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
01510
01520
01530
01540
01550
01560
01570
01580
01590
01600
01610
01620
01630
01640
01650
01660
02013
02016
02020
02030
02040
02050
02060
02068
02070
02080
02090
02100
02110
02120
02122
02130
02140
02150
02160
02164
02170
02180
02185
02188
02190
02200
02201
02210
02220
02230
02231
02232
02240
02250
02260
02261
02270
02280
02282
02290
03000
03010
03020
03030
03040
03050
03055
03060
03070
03080
03090
03100
03110
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Morgan County, Alabama ..........................................................................................
Perry County, Alabama .............................................................................................
Pickens County, Alabama .........................................................................................
Pike County, Alabama ...............................................................................................
Randolph County, Alabama ......................................................................................
Russell County, Alabama ..........................................................................................
St Clair County, Alabama ..........................................................................................
Shelby County, Alabama ...........................................................................................
Sumter County, Alabama ..........................................................................................
Talladega County, Alabama ......................................................................................
Tallapoosa County, Alabama ....................................................................................
Tuscaloosa County, Alabama ...................................................................................
Walker County, Alabama ...........................................................................................
Washington County, Alabama ...................................................................................
Wilcox County, Alabama ...........................................................................................
Winston County, Alabama .........................................................................................
Aleutians County East, Alaska ..................................................................................
Aleutians County West, Alaska .................................................................................
Anchorage County, Alaska ........................................................................................
Angoon County, Alaska .............................................................................................
Barrow-North Slope County, Alaska .........................................................................
Bethel County, Alaska ...............................................................................................
Bristol Bay Borough County, Alaska .........................................................................
Denali County, Alaska ...............................................................................................
Bristol Bay County, Alaska ........................................................................................
Cordova-Mc Carthy County, Alaska ..........................................................................
Fairbanks County, Alaska .........................................................................................
Haines County, Alaska ..............................................................................................
Juneau County, Alaska .............................................................................................
Kenai-Cook Inlet County, Alaska ..............................................................................
Kenai Peninsula Borough, Alaska .............................................................................
Ketchikan County, Alaska .........................................................................................
Kobuk County, Alaska ...............................................................................................
Kodiak County, Alaska ..............................................................................................
Kuskokwin County, Alaska ........................................................................................
Lake and Peninsula Borough, Alaska .......................................................................
Matanuska County, Alaska ........................................................................................
Nome County, Alaska ................................................................................................
North Slope Borough, Alaska ....................................................................................
Northwest Arctic Borough, Alaska .............................................................................
Outer Ketchikan County, Alaska ...............................................................................
Prince Of Wales County, Alaska ...............................................................................
Prince of Wales-Outer Ketchikan Census Area, Alaska ...........................................
Seward County, Alaska .............................................................................................
Sitka County, Alaska .................................................................................................
Skagway-Yakutat County, Alaska .............................................................................
Skagway-Yakutat-Angoon Census Area, Alaska ......................................................
Skagway-Hoonah-Angoon Census Area, Alaska ......................................................
Southeast Fairbanks County, Alaska ........................................................................
Upper Yukon County, Alaska ....................................................................................
Valdz-Chitna-Whitier County, Alaska ........................................................................
Valdex-Cordove Census Area, Alaska ......................................................................
Wade Hampton County, Alaska ................................................................................
Wrangell-Petersburg County, Alaska ........................................................................
Yakutat Borough, Alaska ...........................................................................................
Yukon-Koyukuk County, Alaska ................................................................................
Apache County, Arizona ............................................................................................
Cochise County, Arizona ...........................................................................................
Coconino County, Arizona .........................................................................................
Gila County, Arizona .................................................................................................
Graham County, Arizona ...........................................................................................
Greenlee County, Arizona .........................................................................................
La Paz County, Arizona ............................................................................................
Maricopa County, Arizona .........................................................................................
Mohave County, Arizona ...........................................................................................
Navajo County, Arizona .............................................................................................
Pima County, Arizona ................................................................................................
Pinal County, Arizona ................................................................................................
Santa Cruz County, Arizona ......................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00048
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
2030
01
01
01
01
1800
1000
1000
01
01
01
8600
01
01
01
01
02
02
0380
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
02
03
03
2620
03
03
03
03
6200
4120
03
8520
6200
03
19MYP3
2006
MSAbased
WI
0.8478
0.7463
0.7463
0.7463
0.7463
0.8568
0.9021
0.9021
0.7463
0.7463
0.7463
0.8842
0.7463
0.7463
0.7463
0.7463
1.1900
1.1900
1.2022
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
1.1900
0.9054
0.9054
1.1857
0.9054
0.9054
0.9054
0.9054
1.0138
1.1166
0.9054
0.8987
1.0138
0.9054
2006
CBSAbased
WI
0.8478
0.7477
0.7477
0.7477
0.7477
0.8568
0.8979
0.8979
0.7477
0.7477
0.7477
0.8721
0.8979
0.7477
0.7477
0.7477
1.1990
1.1990
1.2110
1.1990
1.1990
1.1990
1.1990
1.1990
1.1990
1.1990
1.1419
1.1990
1.1990
1.1990
1.1990
1.1990
1.1990
1.1990
1.1990
1.1990
1.2110
1.1990
1.1990
1.1990
1.1990
1.1990
1.1990
1.1990
1.1990
1.1990
1.1990
1.1990
1.1990
1.1990
1.1990
1.1990
1.1990
1.1990
1.1990
1.1990
0.8777
0.8777
1.2105
0.8777
0.8777
0.8777
0.8777
1.0138
0.8777
0.8777
0.8987
1.0138
0.8777
CBSA
Number
19460
99901
99901
99901
99901
17980
13820
13820
99901
99901
99901
46220
13820
99901
99901
99901
99902
99902
11260
99902
99902
99902
99902
99902
99902
99902
21820
99902
99902
99902
99902
99902
99902
99902
99902
99902
11260
99902
99902
99902
99902
99902
99902
99902
99902
99902
99902
99902
99902
99902
99902
99902
99902
99902
99902
99902
99903
99903
22380
99903
99903
99903
99903
38060
99903
99903
46060
38060
99903
29117
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
03120
03130
04000
04010
04020
04030
04040
04050
04060
04070
04080
04090
04100
04110
04120
04130
04140
04150
04160
04170
04180
04190
04200
04210
04220
04230
04240
04250
04260
04270
04280
04290
04300
04310
04320
04330
04340
04350
04360
04370
04380
04390
04400
04410
04420
04430
04440
04450
04460
04470
04480
04490
04500
04510
04520
04530
04540
04550
04560
04570
04580
04590
04600
04610
04620
04630
04640
04650
04660
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Yavapai County, Arizona ...........................................................................................
Yuma County, Arizona ..............................................................................................
Arkansas County, Arkansas ......................................................................................
Ashley County, Arkansas ..........................................................................................
Baxter County, Arkansas ...........................................................................................
Benton County, Arkansas ..........................................................................................
Boone County, Arkansas ...........................................................................................
Bradley County, Arkansas .........................................................................................
Calhoun County, Arkansas ........................................................................................
Carroll County, Arkansas ..........................................................................................
Chicot County, Arkansas ...........................................................................................
Clark County, Arkansas .............................................................................................
Clay County, Arkansas ..............................................................................................
Cleburne County, Arkansas ......................................................................................
Cleveland County, Arkansas .....................................................................................
Columbia County, Arkansas ......................................................................................
Conway County, Arkansas ........................................................................................
Craighead County, Arkansas ....................................................................................
Crawford County, Arkansas ......................................................................................
Crittenden County, Arkansas ....................................................................................
Cross County, Arkansas ............................................................................................
Dallas County, Arkansas ...........................................................................................
Desha County, Arkansas ...........................................................................................
Drew County, Arkansas .............................................................................................
Faulkner County, Arkansas .......................................................................................
Franklin County, Arkansas ........................................................................................
Fulton County, Arkansas ...........................................................................................
Garland County, Arkansas ........................................................................................
Grant County, Arkansas ............................................................................................
Greene County, Arkansas .........................................................................................
Hempstead County, Arkansas ...................................................................................
Hot Spring County, Arkansas ....................................................................................
Howard County, Arkansas .........................................................................................
Independence County, Arkansas ..............................................................................
Izard County, Arkansas .............................................................................................
Jackson County, Arkansas ........................................................................................
Jefferson County, Arkansas ......................................................................................
Johnson County, Arkansas .......................................................................................
Lafayette County, Arkansas ......................................................................................
Lawrence County, Arkansas .....................................................................................
Lee County, Arkansas ...............................................................................................
Lincoln County, Arkansas ..........................................................................................
Little River County, Arkansas ....................................................................................
Logan County, Arkansas ...........................................................................................
Lonoke County, Arkansas .........................................................................................
Madison County, Arkansas .......................................................................................
Marion County, Arkansas ..........................................................................................
Miller County, Arkansas ............................................................................................
Mississippi County, Arkansas ....................................................................................
Monroe County, Arkansas .........................................................................................
Montgomery County, Arkansas .................................................................................
Nevada County, Arkansas .........................................................................................
Newton County, Arkansas .........................................................................................
Ouachita County, Arkansas .......................................................................................
Perry County, Arkansas ............................................................................................
Phillips County, Arkansas ..........................................................................................
Pike County, Arkansas ..............................................................................................
Poinsett County, Arkansas ........................................................................................
Polk County, Arkansas ..............................................................................................
Pope County, Arkansas .............................................................................................
Prairie County, Arkansas ...........................................................................................
Pulaski County, Arkansas .........................................................................................
Randolph County, Arkansas ......................................................................................
St Francis County, Arkansas .....................................................................................
Saline County, Arkansas ...........................................................................................
Scott County, Arkansas .............................................................................................
Searcy County, Arkansas ..........................................................................................
Sebastian County, Arkansas .....................................................................................
Sevier County, Arkansas ...........................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00049
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
03
9360
04
04
04
2580
04
04
04
04
04
04
04
04
04
04
04
3700
2720
4920
04
04
04
04
4400
04
04
04
04
04
04
04
04
04
04
04
6240
04
04
04
04
04
04
04
4400
04
04
8360
04
04
04
04
04
04
04
04
04
04
04
04
04
4400
04
04
4400
04
04
2720
04
19MYP3
2006
MSAbased
WI
0.9054
0.9135
0.7744
0.7744
0.7744
0.8563
0.7744
0.7744
0.7744
0.7744
0.7744
0.7744
0.7744
0.7744
0.7744
0.7744
0.7744
0.7919
0.8229
0.9360
0.7744
0.7744
0.7744
0.7744
0.8756
0.7744
0.7744
0.7744
0.7744
0.7744
0.7744
0.7744
0.7744
0.7744
0.7744
0.7744
0.8689
0.7744
0.7744
0.7744
0.7744
0.7744
0.7744
0.7744
0.8756
0.7744
0.7744
0.8291
0.7744
0.7744
0.7744
0.7744
0.7744
0.7744
0.7744
0.7744
0.7744
0.7744
0.7744
0.7744
0.7744
0.8756
0.7744
0.7744
0.8756
0.7744
0.7744
0.8229
0.7744
2006
CBSAbased
WI
0.9879
0.9135
0.7451
0.7451
0.7451
0.8563
0.7451
0.7451
0.7451
0.7451
0.7451
0.7451
0.7451
0.7451
0.8689
0.7451
0.7451
0.7919
0.8214
0.9341
0.7451
0.7451
0.7451
0.7451
0.8756
0.8214
0.7451
0.9053
0.8756
0.7451
0.7451
0.7451
0.7451
0.7451
0.7451
0.7451
0.8689
0.7451
0.7451
0.7451
0.7451
0.8689
0.7451
0.7451
0.8756
0.8563
0.7451
0.8291
0.7451
0.7451
0.7451
0.7451
0.7451
0.7451
0.8756
0.7451
0.7451
0.7919
0.7451
0.7451
0.7451
0.8756
0.7451
0.7451
0.8756
0.7451
0.7451
0.8214
0.7451
CBSA
Number
39140
49740
99904
99904
99904
22220
99904
99904
99904
99904
99904
99904
99904
99904
38220
99904
99904
27860
22900
32820
99904
99904
99904
99904
30780
22900
99904
26300
30780
99904
99904
99904
99904
99904
99904
99904
38220
99904
99904
99904
99904
38220
99904
99904
30780
22220
99904
45500
99904
99904
99904
99904
99904
99904
30780
99904
99904
27860
99904
99904
99904
30780
99904
99904
30780
99904
99904
22900
99904
29118
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
04670
04680
04690
04700
04710
04720
04730
04740
05000
05010
05020
05030
05040
05050
05060
05070
05080
05090
05100
05110
05120
05130
05140
05150
05160
05170
05200
05210
05300
05310
05320
05330
05340
05350
05360
05370
05380
05390
05400
05410
05420
05430
05440
05450
05460
05470
05480
05490
05500
05510
05520
05530
05540
05550
05560
05570
05580
05590
05600
05610
05620
05630
05640
05650
05660
05670
05680
06000
06010
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Sharp County, Arkansas ...........................................................................................
Stone County, Arkansas ............................................................................................
Union County, Arkansas ............................................................................................
Van Buren County, Arkansas ....................................................................................
Washington County, Arkansas ..................................................................................
White County, Arkansas ............................................................................................
Woodruff County, Arkansas ......................................................................................
Yell County, Arkansas ...............................................................................................
Alameda County, California .......................................................................................
Alpine County, California ...........................................................................................
Amador County, California ........................................................................................
Butte County, California ............................................................................................
Calaveras County, California .....................................................................................
Colusa County, California ..........................................................................................
Contra Costa County, California ...............................................................................
Del Norte County, California .....................................................................................
Eldorado County, California ......................................................................................
Fresno County, California ..........................................................................................
Glenn County, California ...........................................................................................
Humboldt County, California .....................................................................................
Imperial County, California ........................................................................................
Inyo County, California ..............................................................................................
Kern County, California .............................................................................................
Kings County, California ............................................................................................
Lake County, California .............................................................................................
Lassen County, California .........................................................................................
Los Angeles County, California .................................................................................
Los Angeles County, California .................................................................................
Madera County, California .........................................................................................
Marin County, California ............................................................................................
Mariposa County, California ......................................................................................
Mendocino County, California ...................................................................................
Merced County, California .........................................................................................
Modoc County, California ..........................................................................................
Mono County, California ............................................................................................
Monterey County, California ......................................................................................
Napa County, California ............................................................................................
Nevada County, California ........................................................................................
Orange County, California .........................................................................................
Placer County, California ...........................................................................................
Plumas County, California .........................................................................................
Riverside County, California ......................................................................................
Sacramento County, California .................................................................................
San Benito County, California ...................................................................................
San Bernardino County, California ............................................................................
San Diego County, California ....................................................................................
San Francisco County, California ..............................................................................
San Joaquin County, California .................................................................................
San Luis Obispo County, California ..........................................................................
San Mateo County, California ...................................................................................
Santa Barbara County, California .............................................................................
Santa Clara County, California ..................................................................................
Santa Cruz County, California ...................................................................................
Shasta County, California ..........................................................................................
Sierra County, California ...........................................................................................
Siskiyou County, California .......................................................................................
Solano County, California ..........................................................................................
Sonoma County, California .......................................................................................
Stanislaus County, California ....................................................................................
Sutter County, California ...........................................................................................
Tehama County, California ........................................................................................
Trinity County, California ...........................................................................................
Tulare County, California ...........................................................................................
Tuolumne County, California .....................................................................................
Ventura County, California ........................................................................................
Yolo County, California ..............................................................................................
Yuba County, California ............................................................................................
Adams County, Colorado ..........................................................................................
Alamosa County, Colorado .......................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00050
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
04
04
04
04
2580
04
04
04
5775
05
05
1620
05
05
5775
05
6920
2840
05
05
05
05
0680
05
05
05
4480
4480
2840
7360
05
05
4940
05
05
7120
8720
05
5945
6920
05
6780
6920
05
6780
7320
7360
8120
7460
7360
7480
7400
7485
6690
05
05
8720
7500
5170
9340
05
05
8780
05
8735
9270
9340
2080
06
19MYP3
2006
MSAbased
WI
0.7744
0.7744
0.7744
0.7744
0.8563
0.7744
0.7744
0.7744
1.5346
1.0639
1.0639
1.0522
1.0639
1.0639
1.5346
1.0639
1.3148
1.0432
1.0639
1.0639
1.0639
1.0639
1.0344
1.0639
1.0639
1.0639
1.1752
1.1752
1.0432
1.4990
1.0639
1.0639
1.1120
1.0639
1.0639
1.4142
1.3966
1.0639
1.1576
1.3148
1.0639
1.1022
1.3148
1.0639
1.1022
1.1424
1.4990
1.1311
1.1360
1.4990
1.1538
1.5144
1.5182
1.2215
1.0639
1.0639
1.3966
1.3506
1.1804
1.0932
1.0639
1.0639
1.0074
1.0639
1.1613
0.9949
1.0932
1.0733
0.9389
2006
CBSAbased
WI
0.7451
0.7451
0.7451
0.7451
0.8563
0.7451
0.7451
0.7451
1.5346
1.0857
1.0857
1.0522
1.0857
1.0857
1.5346
1.0857
1.2973
1.0541
1.0857
1.0857
0.8915
1.0857
1.0344
1.0046
1.0857
1.0857
1.1752
1.1752
0.8721
1.4990
1.0857
1.0857
1.1120
1.0857
1.0857
1.4142
1.2656
1.0857
1.1576
1.2973
1.0857
1.1022
1.2973
1.5125
1.1022
1.1424
1.4990
1.1311
1.1360
1.4990
1.1538
1.5125
1.5182
1.2215
1.0857
1.0857
1.4899
1.3506
1.1804
1.0932
1.0857
1.0857
1.0074
1.0857
1.1613
1.2973
1.0932
1.0733
0.9389
CBSA
Number
99904
99904
99904
99904
22220
99904
99904
99904
36084
99905
99905
17020
99905
99905
36084
99905
40900
23420
99905
99905
20940
99905
12540
25260
99905
99905
31084
31084
31460
41884
99905
99905
32900
99905
99905
41500
34900
99905
42044
40900
99905
40140
40900
41940
40140
41740
41884
44700
42020
41884
42060
41940
42100
39820
99905
99905
46700
42220
33700
49700
99905
99905
47300
99905
37100
40900
49700
19740
99906
29119
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
06020
06030
06040
06050
06060
06070
06080
06090
06100
06110
06120
06130
06140
06150
06160
06170
06180
06190
06200
06210
06220
06230
06240
06250
06260
06270
06280
06290
06300
06310
06320
06330
06340
06350
06360
06370
06380
06390
06400
06410
06420
06430
06440
06450
06460
06470
06480
06490
06500
06510
06520
06530
06540
06550
06560
06570
06580
06590
06600
06610
06620
06630
07000
07010
07020
07030
07040
07050
07060
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Arapahoe County, Colorado ......................................................................................
Archuleta County, Colorado ......................................................................................
Baca County, Colorado .............................................................................................
Bent County, Colorado ..............................................................................................
Boulder County, Colorado .........................................................................................
Chaffee County, Colorado .........................................................................................
Cheyenne County, Colorado .....................................................................................
Clear Creek County, Colorado ..................................................................................
Conejos County, Colorado ........................................................................................
Costilla County, Colorado ..........................................................................................
Crowley County, Colorado ........................................................................................
Custer County, Colorado ...........................................................................................
Delta County, Colorado .............................................................................................
Denver County, Colorado ..........................................................................................
Dolores County, Colorado .........................................................................................
Douglas County, Colorado ........................................................................................
Eagle County, Colorado ............................................................................................
Elbert County, Colorado ............................................................................................
El Paso County, Colorado .........................................................................................
Fremont County, Colorado ........................................................................................
Garfield County, Colorado .........................................................................................
Gilpin County, Colorado ............................................................................................
Grand County, Colorado ...........................................................................................
Gunnison County, Colorado ......................................................................................
Hinsdale County, Colorado .......................................................................................
Huerfano County, Colorado .......................................................................................
Jackson County, Colorado ........................................................................................
Jefferson County, Colorado .......................................................................................
Kiowa County, Colorado ............................................................................................
Kit Carson County, Colorado ....................................................................................
Lake County, Colorado ..............................................................................................
La Plata County, Colorado ........................................................................................
Larimer County, Colorado .........................................................................................
Las Animas County, Colorado ..................................................................................
Lincoln County, Colorado ..........................................................................................
Logan County, Colorado ...........................................................................................
Mesa County, Colorado .............................................................................................
Mineral County, Colorado ..........................................................................................
Moffat County, Colorado ...........................................................................................
Montezuma County, Colorado ...................................................................................
Montrose County, Colorado ......................................................................................
Morgan County, Colorado .........................................................................................
Otero County, Colorado ............................................................................................
Ouray County, Colorado ............................................................................................
Park County, Colorado ..............................................................................................
Phillips County, Colorado ..........................................................................................
Pitkin County, Colorado .............................................................................................
Prowers County, Colorado ........................................................................................
Pueblo County, Colorado ..........................................................................................
Rio Blanco County, Colorado ....................................................................................
Rio Grande County, Colorado ...................................................................................
Routt County, Colorado .............................................................................................
Saguache County, Colorado .....................................................................................
San Juan County, Colorado ......................................................................................
San Miguel County, Colorado ...................................................................................
Sedgwick County, Colorado ......................................................................................
Summit County, Colorado .........................................................................................
Teller County, Colorado ............................................................................................
Washington County, Colorado ..................................................................................
Weld County, Colorado .............................................................................................
Yuma County, Colorado ............................................................................................
Broomfield County, Colorado ....................................................................................
Fairfield County, Connecticut ....................................................................................
Hartford County, Connecticut ....................................................................................
Litchfield County, Connecticut ...................................................................................
Middlesex County, Connecticut .................................................................................
New Haven County, Connecticut ..............................................................................
New London County, Connecticut .............................................................................
Tolland County, Connecticut .....................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00051
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
2080
06
06
06
1125
06
06
06
06
06
06
06
06
2080
06
2080
06
06
1720
06
06
06
06
06
06
06
06
2080
06
06
06
06
2670
06
06
06
2995
06
06
06
06
06
06
06
06
06
06
06
6560
06
06
06
06
06
06
06
06
06
06
3060
06
2080
5483
3283
3283
3283
5483
5523
3283
19MYP3
2006
MSAbased
WI
1.0733
0.9389
0.9389
0.9389
0.9744
0.9389
0.9389
0.9389
0.9389
0.9389
0.9389
0.9389
0.9389
1.0733
0.9389
1.0733
0.9389
0.9389
0.9478
0.9389
0.9389
0.9389
0.9389
0.9389
0.9389
0.9389
0.9389
1.0733
0.9389
0.9389
0.9389
0.9389
1.0132
0.9389
0.9389
0.9389
0.9560
0.9389
0.9389
0.9389
0.9389
0.9389
0.9389
0.9389
0.9389
0.9389
0.9389
0.9389
0.8632
0.9389
0.9389
0.9389
0.9389
0.9389
0.9389
0.9389
0.9389
0.9389
0.9389
0.9580
0.9389
1.0733
1.2096
1.1084
1.1084
1.1084
1.2096
1.1356
1.1084
2006
CBSAbased
WI
1.0733
0.9389
0.9389
0.9389
0.9744
0.9389
0.9389
1.0733
0.9389
0.9389
0.9389
0.9389
0.9389
1.0733
0.9389
1.0733
0.9389
1.0733
0.9478
0.9389
0.9389
1.0733
0.9389
0.9389
0.9389
0.9389
0.9389
1.0733
0.9389
0.9389
0.9389
0.9389
1.0132
0.9389
0.9389
0.9389
0.9560
0.9389
0.9389
0.9389
0.9389
0.9389
0.9389
0.9389
1.0733
0.9389
0.9389
0.9389
0.8632
0.9389
0.9389
0.9389
0.9389
0.9389
0.9389
0.9389
0.9389
0.9478
0.9389
0.9580
0.9389
1.0733
1.2598
1.1084
1.1084
1.1084
1.1702
1.1356
1.1084
CBSA
Number
19740
99906
99906
99906
14500
99906
99906
19740
99906
99906
99906
99906
99906
19740
99906
19740
99906
19740
17820
99906
99906
19740
99906
99906
99906
99906
99906
19740
99906
99906
99906
99906
22660
99906
99906
99906
24300
99906
99906
99906
99906
99906
99906
99906
19740
99906
99906
99906
39380
99906
99906
99906
99906
99906
99906
99906
99906
17820
99906
24540
99906
19740
14860
25540
25540
25540
35300
35980
25540
29120
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
07070
08000
08010
08020
09000
10000
10010
10020
10030
10040
10050
10060
10070
10080
10090
10100
10110
10120
10130
10140
10150
10160
10170
10180
10190
10200
10210
10220
10230
10240
10250
10260
10270
10280
10290
10300
10310
10320
10330
10340
10350
10360
10370
10380
10390
10400
10410
10420
10430
10440
10450
10460
10470
10480
10490
10500
10510
10520
10530
10540
10550
10560
10570
10580
10590
10600
10610
10620
10630
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Windham County, Connecticut ..................................................................................
Kent County, Delaware .............................................................................................
New Castle County, Delaware ..................................................................................
Sussex County, Delaware .........................................................................................
Washington Dc County, Dist Of Col ..........................................................................
Alachua County, Florida ............................................................................................
Baker County, Florida ................................................................................................
Bay County, Florida ...................................................................................................
Bradford County, Florida ...........................................................................................
Brevard County, Florida ............................................................................................
Broward County, Florida ............................................................................................
Calhoun County, Florida ............................................................................................
Charlotte County, Florida ..........................................................................................
Citrus County, Florida ................................................................................................
Clay County, Florida ..................................................................................................
Collier County, Florida ...............................................................................................
Columbia County, Florida ..........................................................................................
Dade County, Florida ................................................................................................
De Soto County, Florida ............................................................................................
Dixie County, Florida .................................................................................................
Duval County, Florida ................................................................................................
Escambia County, Florida .........................................................................................
Flagler County, Florida ..............................................................................................
Franklin County, Florida ............................................................................................
Gadsden County, Florida ..........................................................................................
Gilchrist County, Florida ............................................................................................
Glades County, Florida ..............................................................................................
Gulf County, Florida ..................................................................................................
Hamilton County, Florida ...........................................................................................
Hardee County, Florida .............................................................................................
Hendry County, Florida .............................................................................................
Hernando County, Florida .........................................................................................
Highlands County, Florida .........................................................................................
Hillsborough County, Florida .....................................................................................
Holmes County, Florida .............................................................................................
Indian River County, Florida ......................................................................................
Jackson County, Florida ............................................................................................
Jefferson County, Florida ..........................................................................................
Lafayette County, Florida ..........................................................................................
Lake County, Florida .................................................................................................
Lee County, Florida ...................................................................................................
Leon County, Florida .................................................................................................
Levy County, Florida .................................................................................................
Liberty County, Florida ..............................................................................................
Madison County, Florida ...........................................................................................
Manatee County, Florida ...........................................................................................
Marion County, Florida ..............................................................................................
Martin County, Florida ...............................................................................................
Monroe County, Florida .............................................................................................
Nassau County, Florida .............................................................................................
Okaloosa County, Florida ..........................................................................................
Okeechobee County, Florida .....................................................................................
Orange County, Florida .............................................................................................
Osceola County, Florida ............................................................................................
Palm Beach County, Florida .....................................................................................
Pasco County, Florida ...............................................................................................
Pinellas County, Florida ............................................................................................
Polk County, Florida ..................................................................................................
Putnam County, Florida .............................................................................................
Johns County, Florida ...............................................................................................
St Lucie County, Florida ............................................................................................
Santa Rosa County, Florida ......................................................................................
Sarasota County, Florida ...........................................................................................
Seminole County, Florida ..........................................................................................
Sumter County, Florida .............................................................................................
Suwannee County, Florida ........................................................................................
Taylor County, Florida ...............................................................................................
Union County, Florida ................................................................................................
Volusia County, Florida .............................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00052
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
07
2190
9160
08
8840
2900
10
6015
10
4900
2680
10
6580
10
3600
5345
10
5000
10
10
3600
6080
2020
10
8240
10
10
10
10
10
10
8280
10
8280
10
10
10
10
10
5960
2700
8240
10
10
10
7510
5790
2710
10
3600
2750
10
5960
5960
8960
8280
8280
3980
10
3600
2710
6080
7510
5960
10
10
10
10
2020
19MYP3
2006
MSAbased
WI
1.1794
0.9779
1.0537
0.9606
1.0983
0.9474
0.8698
0.7989
0.8698
0.9835
1.0442
0.8698
0.9264
0.8698
0.9308
1.0140
0.8698
0.9759
0.8698
0.8698
0.9308
0.8104
0.9334
0.8698
0.8697
0.8698
0.8698
0.8698
0.8698
0.8698
0.8698
0.9193
0.8698
0.9193
0.8698
0.8698
0.8698
0.8698
0.8698
0.9459
0.9366
0.8697
0.8698
0.8698
0.8698
0.9555
0.8934
1.0133
0.8698
0.9308
0.8881
0.8698
0.9459
0.9459
1.0077
0.9193
0.9193
0.8921
0.8698
0.9308
1.0133
0.8104
0.9555
0.9459
0.8698
0.8698
0.8698
0.8698
0.9334
2006
CBSAbased
WI
1.1794
0.9779
1.0482
0.9606
1.0932
0.9474
0.9299
0.7989
0.8598
0.9835
1.0442
0.8598
0.9264
0.8598
0.9299
1.0140
0.8598
0.9759
0.8598
0.8598
0.9299
0.8104
0.8598
0.8598
0.8697
0.9474
0.8598
0.8598
0.8598
0.8598
0.8598
0.9193
0.8598
0.9193
0.8598
0.9444
0.8598
0.8697
0.8598
0.9459
0.9366
0.8697
0.8598
0.8598
0.8598
0.9555
0.8934
1.0133
0.8598
0.9299
0.8881
0.8598
0.9459
0.9459
1.0077
0.9193
0.9193
0.8921
0.8598
0.9299
1.0133
0.8104
0.9555
0.9459
0.8598
0.8598
0.8598
0.8598
0.9308
CBSA
Number
99907
20100
48864
99908
47894
23540
27260
37460
99910
37340
22744
99910
39460
99910
27260
34940
99910
33124
99910
99910
27260
37860
99910
99910
45220
23540
99910
99910
99910
99910
99910
45300
99910
45300
99910
46940
99910
45220
99910
36740
15980
45220
99910
99910
99910
42260
36100
38940
99910
27260
23020
99910
36740
36740
48424
45300
45300
29460
99910
27260
38940
37860
42260
36740
99910
99910
99910
99910
19660
29121
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
10640
10650
10660
11000
11010
11011
11020
11030
11040
11050
11060
11070
11080
11090
11100
11110
11120
11130
11140
11150
11160
11161
11170
11180
11190
11200
11210
11220
11230
11240
11250
11260
11270
11280
11281
11290
11291
11300
11310
11311
11320
11330
11340
11341
11350
11360
11370
11380
11381
11390
11400
11410
11420
11421
11430
11440
11441
11450
11451
11460
11461
11462
11470
11471
11480
11490
11500
11510
11520
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Wakulla County, Florida ............................................................................................
Walton County, Florida ..............................................................................................
Washington County, Florida ......................................................................................
Appling County, Georgia ...........................................................................................
Atkinson County, Georgia .........................................................................................
Bacon County, Georgia .............................................................................................
Baker County, Georgia ..............................................................................................
Baldwin County, Georgia ...........................................................................................
Banks County, Georgia .............................................................................................
Barrow County, Georgia ............................................................................................
Bartow County, Georgia ............................................................................................
Ben Hill County, Georgia ...........................................................................................
Berrien County, Georgia ............................................................................................
Bibb County, Georgia ................................................................................................
Bleckley County, Georgia ..........................................................................................
Brantley County, Georgia ..........................................................................................
Brooks County, Georgia ............................................................................................
Bryan County, Georgia ..............................................................................................
Bulloch County, Georgia ...........................................................................................
Burke County, Georgia ..............................................................................................
Butts County, Georgia ...............................................................................................
Calhoun County, Georgia ..........................................................................................
Camden County, Georgia ..........................................................................................
Candler County, Georgia ...........................................................................................
Carroll County, Georgia .............................................................................................
Catoosa County, Georgia ..........................................................................................
Charlton County, Georgia ..........................................................................................
Chatham County, Georgia .........................................................................................
Chattahoochee County, Georgia ...............................................................................
Chattooga County, Georgia .......................................................................................
Cherokee County, Georgia ........................................................................................
Clarke County, Georgia .............................................................................................
Clay County, Georgia ................................................................................................
Clayton County, Georgia ...........................................................................................
Clinch County, Georgia .............................................................................................
Cobb County, Georgia ...............................................................................................
Coffee County, Georgia .............................................................................................
Colquitt County, Georgia ...........................................................................................
Columbia County, Georgia ........................................................................................
Cook County, Georgia ...............................................................................................
Coweta County, Georgia ...........................................................................................
Crawford County, Georgia .........................................................................................
Crisp County, Georgia ...............................................................................................
Dade County, Georgia ...............................................................................................
Dawson County, Georgia ..........................................................................................
Decatur County, Georgia ...........................................................................................
De Kalb County, Georgia ..........................................................................................
Dodge County, Georgia .............................................................................................
Dooly County, Georgia ..............................................................................................
Dougherty County, Georgia .......................................................................................
Douglas County, Georgia ..........................................................................................
Early County, Georgia ...............................................................................................
Echols County, Georgia ............................................................................................
Effingham County, Georgia .......................................................................................
Elbert County, Georgia ..............................................................................................
Emanuel County, Georgia .........................................................................................
Evans County, Georgia .............................................................................................
Fannin County, Georgia ............................................................................................
Fayette County, Georgia ...........................................................................................
Floyd County, Georgia ..............................................................................................
Forsyth County, Georgia ...........................................................................................
Franklin County, Georgia ..........................................................................................
Fulton County, Georgia .............................................................................................
Gilmer County, Georgia .............................................................................................
Glascock County, Georgia ........................................................................................
Glynn County, Georgia ..............................................................................................
Gordon County, Georgia ...........................................................................................
Grady County, Georgia .............................................................................................
Greene County, Georgia ...........................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00053
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
10
10
10
11
11
11
11
11
11
0520
0520
11
11
4680
11
11
11
7520
11
11
11
11
11
11
0520
1560
11
7520
1800
11
0520
0500
11
0520
11
0520
11
11
0600
11
0520
11
11
1560
11
11
0520
11
11
0120
0520
11
11
7520
11
11
11
11
0520
11
0520
11
0520
11
11
11
11
11
11
19MYP3
2006
MSAbased
WI
0.8698
0.8698
0.8698
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
0.9648
0.9648
0.8165
0.8165
0.9286
0.8165
0.8165
0.8165
0.9480
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
0.9648
0.9098
0.8165
0.9480
0.8568
0.8165
0.9648
0.9843
0.8165
0.9648
0.8165
0.9648
0.8165
0.8165
0.9619
0.8165
0.9648
0.8165
0.8165
0.9098
0.8165
0.8165
0.9648
0.8165
0.8165
0.8636
0.9648
0.8165
0.8165
0.9480
0.8165
0.8165
0.8165
0.8165
0.9648
0.8165
0.9648
0.8165
0.9648
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
2006
CBSAbased
WI
0.8697
0.8598
0.8598
0.7666
0.7666
0.7666
0.8636
0.7666
0.7666
0.9648
0.9648
0.7666
0.7666
0.9453
0.7666
0.9320
0.8875
0.9480
0.7666
0.9565
0.9648
0.7666
0.7666
0.7666
0.9648
0.9098
0.7666
0.9480
0.8568
0.7666
0.9648
0.9843
0.7666
0.9648
0.7666
0.9648
0.7666
0.7666
0.9565
0.7666
0.9648
0.9453
0.7666
0.9098
0.9648
0.7666
0.9648
0.7666
0.7666
0.8636
0.9648
0.7666
0.8875
0.9480
0.7666
0.7666
0.7666
0.7666
0.9648
0.9424
0.9648
0.7666
0.9648
0.7666
0.7666
0.9320
0.7666
0.7666
0.7666
CBSA
Number
45220
99910
99910
99911
99911
99911
10500
99911
99911
12060
12060
99911
99911
31420
99911
15260
46660
42340
99911
12260
12060
99911
99911
99911
12060
16860
99911
42340
17980
99911
12060
12020
99911
12060
99911
12060
99911
99911
12260
99911
12060
31420
99911
16860
12060
99911
12060
99911
99911
10500
12060
99911
46660
42340
99911
99911
99911
99911
12060
40660
12060
99911
12060
99911
99911
15260
99911
99911
99911
29122
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
11530
11540
11550
11560
11570
11580
11581
11590
11591
11600
11601
11610
11611
11612
11620
11630
11640
11650
11651
11652
11660
11670
11680
11690
11691
11700
11701
11702
11703
11710
11720
11730
11740
11741
11750
11760
11770
11771
11772
11780
11790
11800
11801
11810
11811
11812
11820
11821
11830
11831
11832
11833
11834
11835
11840
11841
11842
11850
11851
11860
11861
11862
11870
11880
11881
11882
11883
11884
11885
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Gwinnett County, Georgia .........................................................................................
Habersham County, Georgia .....................................................................................
Hall County, Georgia .................................................................................................
Hancock County, Georgia .........................................................................................
Haralson County, Georgia .........................................................................................
Harris County, Georgia ..............................................................................................
Hart County, Georgia ................................................................................................
Heard County, Georgia .............................................................................................
Henry County, Georgia ..............................................................................................
Houston County, Georgia ..........................................................................................
Irwin County, Georgia ................................................................................................
Jackson County, Georgia ..........................................................................................
Jasper County, Georgia ............................................................................................
Jeff Davis County, Georgia .......................................................................................
Jefferson County, Georgia ........................................................................................
Jenkins County, Georgia ...........................................................................................
Johnson County, Georgia ..........................................................................................
Jones County, Georgia ..............................................................................................
Lamar County, Georgia .............................................................................................
Lanier County, Georgia .............................................................................................
Laurens County, Georgia ..........................................................................................
Lee County, Georgia .................................................................................................
Liberty County, Georgia ............................................................................................
Lincoln County, Georgia ............................................................................................
Long County, Georgia ...............................................................................................
Lowndes County, Georgia .........................................................................................
Lumpkin County, Georgia ..........................................................................................
Mc Duffie County, Georgia ........................................................................................
Mc Intosh County, Georgia .......................................................................................
Macon County, Georgia ............................................................................................
Madison County, Georgia ..........................................................................................
Marion County, Georgia ............................................................................................
Meriwether County, Georgia .....................................................................................
Miller County, Georgia ...............................................................................................
Mitchell County, Georgia ...........................................................................................
Monroe County, Georgia ...........................................................................................
Montgomery County, Georgia ...................................................................................
Morgan County, Georgia ...........................................................................................
Murray County, Georgia ............................................................................................
Muscogee County, Georgia .......................................................................................
Newton County, Georgia ...........................................................................................
Oconee County, Georgia ...........................................................................................
Oglethorpe County, Georgia .....................................................................................
Paulding County, Georgia .........................................................................................
Peach County, Georgia .............................................................................................
Pickens County, Georgia ...........................................................................................
Pierce County, Georgia .............................................................................................
Pike County, Georgia ................................................................................................
Polk County, Georgia ................................................................................................
Pulaski County, Georgia ............................................................................................
Putnam County, Georgia ...........................................................................................
Quitman County, Georgia ..........................................................................................
Rabun County, Georgia .............................................................................................
Randolph County, Georgia ........................................................................................
Richmond County, Georgia .......................................................................................
Rockdale County, Georgia ........................................................................................
Schley County, Georgia ............................................................................................
Screven County, Georgia ..........................................................................................
Seminole County, Georgia ........................................................................................
Spalding County, Georgia .........................................................................................
Stephens County, Georgia ........................................................................................
Stewart County, Georgia ...........................................................................................
Sumter County, Georgia ............................................................................................
Talbot County, Georgia .............................................................................................
Taliaferro County, Georgia ........................................................................................
Tattnall County, Georgia ...........................................................................................
Taylor County, Georgia .............................................................................................
Telfair County, Georgia .............................................................................................
Terrell County, Georgia .............................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00054
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
0520
11
11
11
11
1800
11
11
0520
4680
11
11
11
11
11
11
11
4680
11
11
11
0120
11
11
11
11
11
0600
11
11
0500
11
11
11
11
11
11
11
11
1800
0520
0500
11
0520
4680
0520
11
11
11
11
11
11
11
11
0600
0520
11
11
11
0520
11
11
11
11
11
11
11
11
11
19MYP3
2006
MSAbased
WI
0.9648
0.8165
0.8165
0.8165
0.8165
0.8568
0.8165
0.8165
0.9648
0.9286
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
0.9286
0.8165
0.8165
0.8165
0.8636
0.8165
0.8165
0.8165
0.8165
0.8165
0.9619
0.8165
0.8165
0.9843
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
0.8568
0.9648
0.9843
0.8165
0.9648
0.9286
0.9648
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
0.9619
0.9648
0.8165
0.8165
0.8165
0.9648
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
2006
CBSAbased
WI
0.9648
0.7666
0.8883
0.7666
0.9648
0.8568
0.7666
0.9648
0.9648
0.8654
0.7666
0.7666
0.9648
0.7666
0.7666
0.7666
0.7666
0.9453
0.9648
0.8875
0.7666
0.8636
0.9178
0.7666
0.9178
0.8875
0.7666
0.9565
0.9320
0.7666
0.9843
0.8568
0.9648
0.7666
0.7666
0.9453
0.7666
0.7666
0.9044
0.8568
0.9648
0.9843
0.9843
0.9648
0.7666
0.9648
0.7666
0.9648
0.7666
0.7666
0.7666
0.7666
0.7666
0.7666
0.9565
0.9648
0.7666
0.7666
0.7666
0.9648
0.7666
0.7666
0.7666
0.7666
0.7666
0.7666
0.7666
0.7666
0.8636
CBSA
Number
12060
99911
23580
99911
12060
17980
99911
12060
12060
47580
99911
99911
12060
99911
99911
99911
99911
31420
12060
46660
99911
10500
25980
99911
25980
46660
99911
12260
15260
99911
12020
17980
12060
99911
99911
31420
99911
99911
19140
17980
12060
12020
12020
12060
99911
12060
99911
12060
99911
99911
99911
99911
99911
99911
12260
12060
99911
99911
99911
12060
99911
99911
99911
99911
99911
99911
99911
99911
10500
29123
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
11890
11900
11901
11902
11903
11910
11911
11912
11913
11920
11921
11930
11940
11941
11950
11960
11961
11962
11963
11970
11971
11972
11973
11980
12005
12010
12020
12040
12050
13000
13010
13020
13030
13040
13050
13060
13070
13080
13090
13100
13110
13120
13130
13140
13150
13160
13170
13180
13190
13200
13210
13220
13230
13240
13250
13260
13270
13280
13290
13300
13310
13320
13330
13340
13350
13360
13370
13380
13390
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Thomas County, Georgia ..........................................................................................
Tift County, Georgia ..................................................................................................
Toombs County, Georgia ..........................................................................................
Towns County, Georgia .............................................................................................
Treutlen County, Georgia ..........................................................................................
Troup County, Georgia ..............................................................................................
Turner County, Georgia .............................................................................................
Twiggs County, Georgia ............................................................................................
Union County, Georgia ..............................................................................................
Upson County, Georgia .............................................................................................
Walker County, Georgia ............................................................................................
Walton County, Georgia ............................................................................................
Ware County, Georgia ...............................................................................................
Warren County, Georgia ...........................................................................................
Washington County, Georgia ....................................................................................
Wayne County, Georgia ............................................................................................
Webster County, Georgia ..........................................................................................
Wheeler County, Georgia ..........................................................................................
White County, Georgia ..............................................................................................
Whitfield County, Georgia .........................................................................................
Wilcox County, Georgia .............................................................................................
Wilkes County, Georgia .............................................................................................
Wilkinson County, Georgia ........................................................................................
Worth County, Georgia ..............................................................................................
Kalawao County, Hawaii ...........................................................................................
Hawaii County, Hawaii ..............................................................................................
Honolulu County, Hawaii ...........................................................................................
Kauai County, Hawaii ................................................................................................
Maui County, Hawaii .................................................................................................
Ada County, Idaho .....................................................................................................
Adams County, Idaho ................................................................................................
Bannock County, Idaho .............................................................................................
Bear Lake County, Idaho ..........................................................................................
Benewah County, Idaho ............................................................................................
Bingham County, Idaho .............................................................................................
Blaine County, Idaho .................................................................................................
Boise County, Idaho ..................................................................................................
Bonner County, Idaho ...............................................................................................
Bonneville County, Idaho ..........................................................................................
Boundary County, Idaho ............................................................................................
Butte County, Idaho ...................................................................................................
Camas County, Idaho ................................................................................................
Canyon County, Idaho ...............................................................................................
Caribou County, Idaho ..............................................................................................
Cassia County, Idaho ................................................................................................
Clark County, Idaho ...................................................................................................
Clearwater County, Idaho ..........................................................................................
Custer County, Idaho ................................................................................................
Elmore County, Idaho ................................................................................................
Franklin County, Idaho ..............................................................................................
Fremont County, Idaho ..............................................................................................
Gem County, Idaho ...................................................................................................
Gooding County, Idaho .............................................................................................
Idaho County, Idaho ..................................................................................................
Jefferson County, Idaho ............................................................................................
Jerome County, Idaho ...............................................................................................
Kootenai County, Idaho .............................................................................................
Latah County, Idaho ..................................................................................................
Lemhi County, Idaho .................................................................................................
Lewis County, Idaho ..................................................................................................
Lincoln County, Idaho ................................................................................................
Madison County, Idaho .............................................................................................
Minidoka County, Idaho .............................................................................................
Nez Perce County, Idaho ..........................................................................................
Oneida County, Idaho ...............................................................................................
Owyhee County, Idaho ..............................................................................................
Payette County, Idaho ...............................................................................................
Power County, Idaho .................................................................................................
Shoshone County, Idaho ...........................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00055
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
11
11
11
11
11
11
11
4680
11
11
1560
0520
11
11
11
11
11
11
11
11
11
11
11
11
12
12
3320
12
12
1080
13
6340
13
13
13
13
13
13
13
13
13
13
1080
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
13
19MYP3
2006
MSAbased
WI
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
0.9286
0.8165
0.8165
0.9098
0.9648
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
0.8165
1.0562
1.0562
1.1208
1.0562
1.0562
0.9061
0.9106
0.9360
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9061
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
0.9106
2006
CBSAbased
WI
0.7666
0.7666
0.7666
0.7666
0.7666
0.7666
0.7666
0.9453
0.7666
0.7666
0.9098
0.9648
0.7666
0.7666
0.7666
0.7666
0.7666
0.7666
0.7666
0.9044
0.7666
0.7666
0.7666
0.8636
1.0562
1.0562
1.1208
1.0562
1.0562
0.9061
0.8045
0.9360
0.8045
0.8045
0.8045
0.8045
0.9061
0.8045
0.9429
0.8045
0.8045
0.8045
0.9061
0.8045
0.8045
0.8045
0.8045
0.8045
0.8045
0.9173
0.8045
0.9061
0.8045
0.8045
0.9429
0.8045
0.9657
0.8045
0.8045
0.8045
0.8045
0.8045
0.8045
0.9896
0.8045
0.9061
0.8045
0.9360
0.8045
CBSA
Number
99911
99911
99911
99911
99911
99911
99911
31420
99911
99911
16860
12060
99911
99911
99911
99911
99911
99911
99911
19140
99911
99911
99911
10500
99912
99912
26180
99912
99912
14260
99913
38540
99913
99913
99913
99913
14260
99913
26820
99913
99913
99913
14260
99913
99913
99913
99913
99913
99913
30860
99913
14260
99913
99913
26820
99913
17660
99913
99913
99913
99913
99913
99913
30300
99913
14260
99913
38540
99913
29124
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
13390
13410
13420
13430
14000
14010
14020
14030
14040
14050
14060
14070
14080
14090
14100
14110
14120
14130
14140
14141
14150
14160
14170
14180
14190
14250
14310
14320
14330
14340
14350
14360
14370
14380
14390
14400
14410
14420
14421
14440
14450
14460
14470
14480
14490
14500
14510
14520
14530
14540
14550
14560
14570
14580
14590
14600
14610
14620
14630
14640
14650
14660
14670
14680
14690
14700
14710
14720
14730
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Teton County, Idaho ..................................................................................................
Twin Falls County, Idaho ...........................................................................................
Valley County, Idaho .................................................................................................
Washington County, Idaho ........................................................................................
Adams County, Illinois ...............................................................................................
Alexander County, Illinois ..........................................................................................
Bond County, Illinois ..................................................................................................
Boone County, Illinois ................................................................................................
Brown County, Illinois ................................................................................................
Bureau County, Illinois ..............................................................................................
Calhoun County, Illinois .............................................................................................
Carroll County, Illinois ...............................................................................................
Cass County, Illinois ..................................................................................................
Champaign County, Illinois ........................................................................................
Christian County, Illinois ............................................................................................
Clark County, Illinois ..................................................................................................
Clay County, Illinois ...................................................................................................
Clinton County, Illinois ...............................................................................................
Coles County, Illinois .................................................................................................
Cook County, Illinois ..................................................................................................
Crawford County, Illinois ...........................................................................................
Cumberland County, Illinois ......................................................................................
De Kalb County, Illinois .............................................................................................
De Witt County, Illinois ..............................................................................................
Douglas County, Illinois .............................................................................................
Du Page County, Illinois ............................................................................................
Edgar County, Illinois ................................................................................................
Edwards County, Illinois ............................................................................................
Effingham County, Illinois ..........................................................................................
Fayette County, Illinois ..............................................................................................
Ford County, Illinois ...................................................................................................
Franklin County, Illinois .............................................................................................
Fulton County, Illinois ................................................................................................
Gallatin County, Illinois ..............................................................................................
Greene County, Illinois ..............................................................................................
Grundy County, Illinois ..............................................................................................
Hamilton County, Illinois ............................................................................................
Hancock County, Illinois ............................................................................................
Hardin County, Illinois ...............................................................................................
Henderson County, Illinois ........................................................................................
Henry County, Illinois ................................................................................................
Iroquois County, Illinois .............................................................................................
Jackson County, Illinois .............................................................................................
Jasper County, Illinois ...............................................................................................
Jefferson County, Illinois ...........................................................................................
Jersey County, Illinois ...............................................................................................
Jo Daviess County, Illinois ........................................................................................
Johnson County, Illinois ............................................................................................
Kane County, Illinois ..................................................................................................
Kankakee County, Illinois ..........................................................................................
Kendall County, Illinois ..............................................................................................
Knox County, Illinois ..................................................................................................
Lake County, Illinois ..................................................................................................
La Salle County, Illinois .............................................................................................
Lawrence County, Illinois ..........................................................................................
Lee County, Illinois ....................................................................................................
Livingston County, Illinois ..........................................................................................
Logan County, Illinois ................................................................................................
Mc Donough County, Illinois .....................................................................................
Mc Henry County, Illinois ..........................................................................................
Mclean County, Illinois ..............................................................................................
Macon County, Illinois ...............................................................................................
Macoupin County, Illinois ..........................................................................................
Madison County, Illinois ............................................................................................
Marion County, Illinois ...............................................................................................
Marshall County, Illinois ............................................................................................
Mason County, Illinois ...............................................................................................
Massac County, Illinois ..............................................................................................
Menard County, Illinois ..............................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00056
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
13
13
13
13
14
14
14
6880
14
14
14
14
14
1400
14
14
14
7040
14
1600
14
14
1600
14
14
1600
14
14
14
14
14
14
14
14
14
1600
14
14
14
14
1960
14
14
14
14
7040
14
14
1600
3740
1600
14
1600
14
14
14
14
14
14
1600
1040
2040
14
7040
14
14
14
14
7880
19MYP3
2006
MSAbased
WI
0.9106
0.9106
0.9106
0.9106
0.8309
0.8309
0.8309
0.9994
0.8309
0.8309
0.8309
0.8309
0.8309
0.9604
0.8309
0.8309
0.8309
0.8957
0.8309
1.0838
0.8309
0.8309
1.0838
0.8309
0.8309
1.0838
0.8309
0.8309
0.8309
0.8309
0.8309
0.8309
0.8309
0.8309
0.8309
1.0838
0.8309
0.8309
0.8309
0.8309
0.8731
0.8309
0.8309
0.8309
0.8309
0.8957
0.8309
0.8309
1.0838
1.0974
1.0838
0.8309
1.0838
0.8309
0.8309
0.8309
0.8309
0.8309
0.8309
1.0838
0.9084
0.8076
0.8309
0.8957
0.8309
0.8309
0.8309
0.8309
0.8885
2006
CBSAbased
WI
0.8045
0.8045
0.8045
0.8045
0.8279
0.8279
0.8949
0.9994
0.8279
0.8279
0.8949
0.8279
0.8279
0.9604
0.8279
0.8279
0.8279
0.8949
0.8279
1.0848
0.8279
0.8279
1.0848
0.8279
0.8279
1.0848
0.8279
0.8279
0.8279
0.8279
0.9604
0.8279
0.8279
0.8279
0.8279
1.0848
0.8279
0.8279
0.8279
0.8279
0.8731
0.8279
0.8279
0.8279
0.8279
0.8949
0.8279
0.8279
1.0848
1.0974
1.0848
0.8279
1.0440
0.8279
0.8279
0.8279
0.8279
0.8279
0.8279
1.0848
0.9084
0.8076
0.8949
0.8949
0.8279
0.8868
0.8279
0.8279
0.8885
CBSA
Number
99913
99913
99913
99913
99914
99914
41180
40420
99914
99914
41180
99914
99914
16580
99914
99914
99914
41180
99914
16974
99914
99914
16974
99914
99914
16974
99914
99914
99914
99914
16580
99914
99914
99914
99914
16974
99914
99914
99914
99914
19340
99914
99914
99914
99914
41180
99914
99914
16974
28100
16974
99914
29404
99914
99914
99914
99914
99914
99914
16974
14060
19500
41180
41180
99914
37900
99914
99914
44100
29125
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
14740
14750
14760
14770
14780
14790
14800
14810
14820
14830
14831
14850
14860
14870
14880
14890
14900
14910
14920
14921
14940
14950
14960
14970
14980
14981
14982
14983
14984
14985
14986
14987
14988
14989
14990
14991
14992
15000
15010
15020
15030
15040
15050
15060
15070
15080
15090
15100
15110
15120
15130
15140
15150
15160
15170
15180
15190
15200
15210
15220
15230
15240
15250
15260
15270
15280
15290
15300
15310
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Mercer County, Illinois ...............................................................................................
Monroe County, Illinois ..............................................................................................
Montgomery County, Illinois ......................................................................................
Morgan County, Illinois ..............................................................................................
Moultrie County, Illinois .............................................................................................
Ogle County, Illinois ..................................................................................................
Peoria County, Illinois ................................................................................................
Perry County, Illinois .................................................................................................
Piatt County, Illinois ...................................................................................................
Pike County, Illinois ...................................................................................................
Pope County, Illinois ..................................................................................................
Pulaski County, Illinois ..............................................................................................
Putnam County, Illinois ..............................................................................................
Randolph County, Illinois ...........................................................................................
Richland County, Illinois ............................................................................................
Rock Island County, Illinois .......................................................................................
St Clair County, Illinois ..............................................................................................
Saline County, Illinois ................................................................................................
Sangamon County, Illinois .........................................................................................
Schuyler County, Illinois ............................................................................................
Scott County, Illinois ..................................................................................................
Shelby County, Illinois ...............................................................................................
Stark County, Illinois ..................................................................................................
Stephenson County, Illinois .......................................................................................
Tazewell County, Illinois ............................................................................................
Union County, Illinois .................................................................................................
Vermilion County, Illinois ...........................................................................................
Wabash County, Illinois .............................................................................................
Warren County, Illinois ..............................................................................................
Washington County, Illinois .......................................................................................
Wayne County, Illinois ...............................................................................................
White County, Illinois .................................................................................................
Whiteside County, Illinois ..........................................................................................
Will County, Illinois ....................................................................................................
Williamson County, Illinois .........................................................................................
Winnebago County, Illinois ........................................................................................
Woodford County, Illinois ..........................................................................................
Adams County, Indiana .............................................................................................
Allen County, Indiana ................................................................................................
Bartholomew County, Indiana ...................................................................................
Benton County, Indiana .............................................................................................
Blackford County, Indiana .........................................................................................
Boone County, Indiana ..............................................................................................
Brown County, Indiana ..............................................................................................
Carroll County, Indiana ..............................................................................................
Cass County, Indiana ................................................................................................
Clark County, Indiana ................................................................................................
Clay County, Indiana .................................................................................................
Clinton County, Indiana .............................................................................................
Crawford County, Indiana ..........................................................................................
Daviess County, Indiana ...........................................................................................
Dearborn County, Indiana .........................................................................................
Decatur County, Indiana ............................................................................................
De Kalb County, Indiana ...........................................................................................
Delaware County, Indiana .........................................................................................
Dubois County, Indiana .............................................................................................
Elkhart County, Indiana .............................................................................................
Fayette County, Indiana ............................................................................................
Floyd County, Indiana ...............................................................................................
Fountain County, Indiana ..........................................................................................
Franklin County, Indiana ...........................................................................................
Fulton County, Indiana ..............................................................................................
Gibson County, Indiana .............................................................................................
Grant County, Indiana ...............................................................................................
Greene County, Indiana ............................................................................................
Hamilton County, Indiana ..........................................................................................
Hancock County, Indiana ..........................................................................................
Harrison County, Indiana ...........................................................................................
Hendricks County, Indiana ........................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00057
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
14
7040
14
14
14
6880
6120
14
14
14
14
14
14
14
14
1960
7040
14
7880
14
14
14
14
14
6120
14
14
14
14
14
14
14
14
1600
14
6880
6120
2760
2760
15
15
15
3480
15
15
15
4520
8320
3920
15
15
1640
15
2760
5280
15
2330
15
4520
15
15
15
15
15
15
3480
3480
4520
3480
19MYP3
2006
MSAbased
WI
0.8309
0.8957
0.8309
0.8309
0.8309
0.9994
0.8868
0.8309
0.8309
0.8309
0.8309
0.8309
0.8309
0.8309
0.8309
0.8731
0.8957
0.8309
0.8885
0.8309
0.8309
0.8309
0.8309
0.8309
0.8868
0.8309
0.8309
0.8309
0.8309
0.8309
0.8309
0.8309
0.8309
1.0838
0.8309
0.9994
0.8868
0.9716
0.9716
0.8727
0.8727
0.8727
0.9875
0.8727
0.8727
0.8727
0.9302
0.8345
0.8745
0.8727
0.8727
0.9742
0.8727
0.9716
0.8939
0.8727
0.9637
0.8727
0.9302
0.8727
0.8727
0.8727
0.8727
0.8727
0.8727
0.9875
0.9875
0.9302
0.9875
2006
CBSAbased
WI
0.8731
0.8949
0.8279
0.8279
0.8279
0.8279
0.8868
0.8279
0.9604
0.8279
0.8279
0.8279
0.8279
0.8279
0.8279
0.8731
0.8949
0.8279
0.8885
0.8279
0.8279
0.8279
0.8868
0.8279
0.8868
0.8279
0.9037
0.8279
0.8279
0.8279
0.8279
0.8279
0.8279
1.0848
0.8279
0.9994
0.8868
0.8630
0.9803
0.9598
0.8745
0.8630
0.9930
0.9930
0.8745
0.8630
0.9261
0.8313
0.8630
0.8630
0.8630
0.9623
0.8630
0.8630
0.8939
0.8630
0.9637
0.8630
0.9261
0.8630
0.9623
0.8630
0.8721
0.8630
0.8456
0.9930
0.9930
0.9261
0.9930
CBSA
Number
19340
41180
99914
99914
99914
99914
37900
99914
16580
99914
99914
99914
99914
99914
99914
19340
41180
99914
44100
99914
99914
99914
37900
99914
37900
99914
19180
99914
99914
99914
99914
99914
99914
16974
99914
40420
37900
99915
23060
18020
29140
99915
26900
26900
29140
99915
31140
45460
99915
99915
99915
17140
99915
99915
34620
99915
21140
99915
31140
99915
17140
99915
21780
99915
14020
26900
26900
31140
26900
29126
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
15320
15330
15340
15350
15360
15370
15380
15390
15400
15410
15420
15430
15440
15450
15460
15470
15480
15490
15500
15510
15520
15530
15540
15550
15560
15570
15580
15590
15600
15610
15620
15630
15640
15650
15660
15670
15680
15690
15700
15710
15720
15730
15740
15750
15760
15770
15780
15790
15800
15810
15820
15830
15840
15840
15860
15870
15880
15890
15900
15910
16000
16010
16020
16030
16040
16050
16060
16070
16080
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Henry County, Indiana ...............................................................................................
Howard County, Indiana ............................................................................................
Huntington County, Indiana .......................................................................................
Jackson County, Indiana ...........................................................................................
Jasper County, Indiana .............................................................................................
Jay County, Indiana ...................................................................................................
Jefferson County, Indiana .........................................................................................
Jennings County, Indiana ..........................................................................................
Johnson County, Indiana ...........................................................................................
Knox County, Indiana ................................................................................................
Kosciusko County, Indiana ........................................................................................
Lagrange County, Indiana .........................................................................................
Lake County, Indiana ................................................................................................
La Porte County, Indiana ..........................................................................................
Lawrence County, Indiana .........................................................................................
Madison County, Indiana ...........................................................................................
Marion County, Indiana .............................................................................................
Marshall County, Indiana ...........................................................................................
Martin County, Indiana ..............................................................................................
Miami County, Indiana ...............................................................................................
Monroe County, Indiana ............................................................................................
Montgomery County, Indiana ....................................................................................
Morgan County, Indiana ............................................................................................
Newton County, Indiana ............................................................................................
Noble County, Indiana ...............................................................................................
Ohio County, Indiana .................................................................................................
Orange County, Indiana ............................................................................................
Owen County, Indiana ...............................................................................................
Parke County, Indiana ...............................................................................................
Perry County, Indiana ................................................................................................
Pike County, Indiana .................................................................................................
Porter County, Indiana ..............................................................................................
Posey County, Indiana ..............................................................................................
Pulaski County, Indiana .............................................................................................
Putnam County, Indiana ............................................................................................
Randolph County, Indiana .........................................................................................
Ripley County, Indiana ..............................................................................................
Rush County, Indiana ................................................................................................
St Joseph County, Indiana ........................................................................................
Scott County, Indiana ................................................................................................
Shelby County, Indiana .............................................................................................
Spencer County, Indiana ...........................................................................................
Starke County, Indiana ..............................................................................................
Steuben County, Indiana ...........................................................................................
Sullivan County, Indiana ............................................................................................
Switzerland County, Indiana ......................................................................................
Tippecanoe County, Indiana .....................................................................................
Tipton County, Indiana ..............................................................................................
Union County, Indiana ...............................................................................................
Vanderburgh County, Indiana ...................................................................................
Vermillion County, Indiana ........................................................................................
Vigo County, Indiana .................................................................................................
Wabash County, Indiana ...........................................................................................
Warren County, Indiana ............................................................................................
Warrick County, Indiana ............................................................................................
Washington County, Indiana .....................................................................................
Wayne County, Indiana .............................................................................................
Wells County, Indiana ...............................................................................................
White County, Indiana ...............................................................................................
Whitley County, Indiana ............................................................................................
Adair County, Iowa ....................................................................................................
Adams County, Iowa .................................................................................................
Allamakee County, Iowa ............................................................................................
Appanoose County, Iowa ..........................................................................................
Audubon County, Iowa ..............................................................................................
Benton County, Iowa .................................................................................................
Black Hawk County, Iowa .........................................................................................
Boone County, Iowa ..................................................................................................
Bremer County, Iowa .................................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00058
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
15
3850
2760
15
15
15
15
15
3480
15
15
15
2960
15
15
3480
3480
15
15
15
1020
15
3480
15
15
1640
15
15
15
15
15
2960
2440
15
15
15
15
15
7800
4520
3480
15
15
15
15
15
3920
3850
15
2440
8320
8320
15
15
2440
15
15
2760
15
2760
16
16
16
16
16
16
8920
16
16
19MYP3
2006
MSAbased
WI
0.8727
0.9517
0.9716
0.8727
0.8727
0.8727
0.8727
0.8727
0.9875
0.8727
0.8727
0.8727
0.9404
0.8727
0.8727
0.9875
0.9875
0.8727
0.8727
0.8727
0.8456
0.8727
0.9875
0.8727
0.8727
0.9742
0.8727
0.8727
0.8727
0.8727
0.8727
0.9404
0.8721
0.8727
0.8727
0.8727
0.8727
0.8727
0.9798
0.9302
0.9875
0.8727
0.8727
0.8727
0.8727
0.8727
0.8745
0.9517
0.8727
0.8721
0.8345
0.8345
0.8727
0.8727
0.8721
0.8727
0.8727
0.9716
0.8727
0.9716
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8566
0.8588
0.8588
2006
CBSAbased
WI
0.8630
0.9517
0.8630
0.8630
0.9369
0.8630
0.8630
0.8630
0.9930
0.8630
0.8630
0.8630
0.9369
0.9409
0.8630
0.8595
0.9930
0.8630
0.8630
0.8630
0.8456
0.8630
0.9930
0.9369
0.8630
0.9623
0.8630
0.8456
0.8630
0.8630
0.8630
0.9369
0.8721
0.8630
0.9930
0.8630
0.8630
0.8630
0.9798
0.8630
0.9930
0.8630
0.8630
0.8630
0.8313
0.8630
0.8745
0.9517
0.8630
0.8721
0.8313
0.8313
0.8630
0.8630
0.8721
0.9261
0.8630
0.9803
0.8630
0.9803
0.8502
0.8502
0.8502
0.8502
0.8502
0.8617
0.8566
0.8502
0.8566
CBSA
Number
99915
29020
99915
99915
23844
99915
99915
99915
26900
99915
99915
99915
23844
33140
99915
11300
26900
99915
99915
99915
14020
99915
26900
23844
99915
17140
99915
14020
99915
99915
99915
23844
21780
99915
26900
99915
99915
99915
43780
99915
26900
99915
99915
99915
45460
99915
29140
29020
99915
21780
45460
45460
99915
99915
21780
31140
99915
23060
99915
23060
99916
99916
99916
99916
99916
16300
47940
99916
47940
29127
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
16090
16100
16110
16120
16130
16140
16150
16160
16170
16180
16190
16200
16210
16220
16230
16240
16250
16260
16270
16280
16290
16300
16310
16320
16330
16340
16350
16360
16370
16380
16390
16400
16410
16420
16430
16440
16450
16460
16470
16480
16490
16500
16510
16520
16530
16540
16550
16560
16570
16580
16590
16600
16610
16620
16630
16640
16650
16660
16670
16680
16690
16700
16710
16720
16730
16740
16750
16760
16770
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Buchanan County, Iowa ............................................................................................
Buena Vista County, Iowa .........................................................................................
Butler County, Iowa ...................................................................................................
Calhoun County, Iowa ...............................................................................................
Carroll County, Iowa ..................................................................................................
Cass County, Iowa ....................................................................................................
Cedar County, Iowa ...................................................................................................
Cerro Gordo County, Iowa ........................................................................................
Cherokee County, Iowa .............................................................................................
Chickasaw County, Iowa ...........................................................................................
Clarke County, Iowa ..................................................................................................
Clay County, Iowa .....................................................................................................
Clayton County, Iowa ................................................................................................
Clinton County, Iowa .................................................................................................
Crawford County, Iowa ..............................................................................................
Dallas County, Iowa ..................................................................................................
Davis County, Iowa ...................................................................................................
Decatur County, Iowa ................................................................................................
Delaware County, Iowa .............................................................................................
Des Moines County, Iowa .........................................................................................
Dickinson County, Iowa .............................................................................................
Dubuque County, Iowa ..............................................................................................
Emmet County, Iowa .................................................................................................
Fayette County, Iowa ................................................................................................
Floyd County, Iowa ....................................................................................................
Franklin County, Iowa ................................................................................................
Fremont County, Iowa ...............................................................................................
Greene County, Iowa ................................................................................................
Grundy County, Iowa .................................................................................................
Guthrie County, Iowa .................................................................................................
Hamilton County, Iowa ..............................................................................................
Hancock County, Iowa ..............................................................................................
Hardin County, Iowa ..................................................................................................
Harrison County, Iowa ...............................................................................................
Henry County, Iowa ...................................................................................................
Howard County, Iowa ................................................................................................
Humboldt County, Iowa .............................................................................................
Ida County, Iowa .......................................................................................................
Iowa County, Iowa .....................................................................................................
Jackson County, Iowa ...............................................................................................
Jasper County, Iowa ..................................................................................................
Jefferson County, Iowa ..............................................................................................
Johnson County, Iowa ...............................................................................................
Jones County, Iowa ...................................................................................................
Keokuk County, Iowa ................................................................................................
Kossuth County, Iowa ...............................................................................................
Lee County, Iowa ......................................................................................................
Linn County, Iowa ......................................................................................................
Louisa County, Iowa ..................................................................................................
Lucas County, Iowa ...................................................................................................
Lyon County, Iowa .....................................................................................................
Madison County, Iowa ...............................................................................................
Mahaska County, Iowa ..............................................................................................
Marion County, Iowa .................................................................................................
Marshall County, Iowa ...............................................................................................
Mills County, Iowa .....................................................................................................
Mitchell County, Iowa ................................................................................................
Monona County, Iowa ...............................................................................................
Monroe County, Iowa ................................................................................................
Montgomery County, Iowa ........................................................................................
Muscatine County, Iowa ............................................................................................
OBrien County, Iowa .................................................................................................
Osceola County, Iowa ...............................................................................................
Page County, Iowa ....................................................................................................
Palo Alto County, Iowa ..............................................................................................
Plymouth County, Iowa .............................................................................................
Pocahontas County, Iowa .........................................................................................
Polk County, Iowa .....................................................................................................
Pottawattamie County, Iowa ......................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00059
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
2120
16
16
16
16
16
2200
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
3500
16
16
16
16
1360
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
2120
5920
19MYP3
2006
MSAbased
WI
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.9651
0.8588
0.8588
0.8588
0.8588
0.8588
0.9135
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.9756
0.8588
0.8588
0.8588
0.8588
0.8617
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.9651
0.9569
2006
CBSAbased
WI
0.8502
0.8502
0.8502
0.8502
0.8502
0.8502
0.8502
0.8502
0.8502
0.8502
0.8502
0.8502
0.8502
0.8502
0.8502
0.9651
0.8502
0.8502
0.8502
0.8502
0.8502
0.9135
0.8502
0.8502
0.8502
0.8502
0.8502
0.8502
0.8566
0.9651
0.8502
0.8502
0.8502
0.9569
0.8502
0.8502
0.8502
0.8502
0.8502
0.8502
0.8502
0.8502
0.9756
0.8617
0.8502
0.8502
0.8502
0.8617
0.8502
0.8502
0.8502
0.9651
0.8502
0.8502
0.8502
0.9569
0.8502
0.8502
0.8502
0.8502
0.8502
0.8502
0.8502
0.8502
0.8502
0.8502
0.8502
0.9651
0.9569
CBSA
Number
99916
99916
99916
99916
99916
99916
99916
99916
99916
99916
99916
99916
99916
99916
99916
19780
99916
99916
99916
99916
99916
20220
99916
99916
99916
99916
99916
99916
47940
19780
99916
99916
99916
36540
99916
99916
99916
99916
99916
99916
99916
99916
26980
16300
99916
99916
99916
16300
99916
99916
99916
19780
99916
99916
99916
36540
99916
99916
99916
99916
99916
99916
99916
99916
99916
99916
99916
19780
36540
29128
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
16780
16790
16800
16810
16820
16830
16840
16850
16860
16870
16880
16890
16900
16910
16920
16930
16940
16950
16960
16970
16980
17000
17010
17020
17030
17040
17050
17060
17070
17080
17090
17100
17110
17120
17130
17140
17150
17160
17170
17180
17190
17200
17210
17220
17230
17240
17250
17260
17270
17280
17290
17300
17310
17320
17330
17340
17350
17360
17370
17380
17390
17391
17410
17420
17430
17440
17450
17451
17470
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Poweshiek County, Iowa ...........................................................................................
Ringgold County, Iowa ..............................................................................................
Sac County, Iowa ......................................................................................................
Scott County, Iowa ....................................................................................................
Shelby County, Iowa .................................................................................................
Sioux County, Iowa ...................................................................................................
Story County, Iowa ....................................................................................................
Tama County, Iowa ...................................................................................................
Taylor County, Iowa ..................................................................................................
Union County, Iowa ...................................................................................................
Van Buren County, Iowa ...........................................................................................
Wapello County, Iowa ...............................................................................................
Warren County, Iowa .................................................................................................
Washington County, Iowa .........................................................................................
Wayne County, Iowa .................................................................................................
Webster County, Iowa ...............................................................................................
Winnebago County, Iowa ..........................................................................................
Winneshiek County, Iowa ..........................................................................................
Woodbury County, Iowa ............................................................................................
Worth County, Iowa ...................................................................................................
Wright County, Iowa ..................................................................................................
Allen County, Kansas ................................................................................................
Anderson County, Kansas .........................................................................................
Atchison County, Kansas ..........................................................................................
Barber County, Kansas .............................................................................................
Barton County, Kansas .............................................................................................
Bourbon County, Kansas ..........................................................................................
Brown County, Kansas ..............................................................................................
Butler County, Kansas ...............................................................................................
Chase County, Kansas ..............................................................................................
Chautauqua County, Kansas ....................................................................................
Cherokee County, Kansas ........................................................................................
Cheyenne County, Kansas ........................................................................................
Clark County, Kansas ................................................................................................
Clay County, Kansas .................................................................................................
Cloud County, Kansas ...............................................................................................
Coffey County, Kansas ..............................................................................................
Comanche County, Kansas .......................................................................................
Cowley County, Kansas ............................................................................................
Crawford County, Kansas .........................................................................................
Decatur County, Kansas ...........................................................................................
Dickinson County, Kansas ........................................................................................
Doniphan County, Kansas .........................................................................................
Douglas County, Kansas ...........................................................................................
Edwards County, Kansas ..........................................................................................
Elk County, Kansas ...................................................................................................
Ellis County, Kansas .................................................................................................
Ellsworth County, Kansas .........................................................................................
Finney County, Kansas .............................................................................................
Ford County, Kansas .................................................................................................
Franklin County, Kansas ...........................................................................................
Geary County, Kansas ..............................................................................................
Gove County, Kansas ...............................................................................................
Graham County, Kansas ...........................................................................................
Grant County, Kansas ...............................................................................................
Gray County, Kansas ................................................................................................
Greeley County, Kansas ...........................................................................................
Greenwood County, Kansas .....................................................................................
Hamilton County, Kansas ..........................................................................................
Harper County, Kansas .............................................................................................
Harvey County, Kansas .............................................................................................
Haskell County, Kansas ............................................................................................
Hodgeman County, Kansas ......................................................................................
Jackson County, Kansas ...........................................................................................
Jefferson County, Kansas .........................................................................................
Jewell County, Kansas ..............................................................................................
Johnson County, Kansas ..........................................................................................
Kearny County, Kansas .............................................................................................
Kingman County, Kansas ..........................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00060
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
16
16
16
1960
16
16
16
16
16
16
16
16
2120
16
16
16
16
16
7720
16
16
17
17
17
17
17
17
17
9040
17
17
17
17
17
17
17
17
17
17
17
17
17
17
4150
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
9040
17
17
17
17
17
3760
17
17
19MYP3
2006
MSAbased
WI
0.8588
0.8588
0.8588
0.8731
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.8588
0.9651
0.8588
0.8588
0.8588
0.8588
0.8588
0.9411
0.8588
0.8588
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.9163
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.8546
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.9163
0.7994
0.7994
0.7994
0.7994
0.7994
0.9481
0.7994
0.7994
2006
CBSAbased
WI
0.8502
0.8502
0.8502
0.8731
0.8502
0.8502
0.9545
0.8502
0.8502
0.8502
0.8502
0.8502
0.9651
0.9756
0.8502
0.8502
0.8502
0.8502
0.9376
0.8502
0.8502
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.9141
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.9529
0.8546
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.9467
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.9141
0.7987
0.7987
0.8929
0.8929
0.7987
0.9467
0.7987
0.7987
CBSA
Number
99916
99916
99916
19340
99916
99916
11180
99916
99916
99916
99916
99916
19780
26980
99916
99916
99916
99916
43580
99916
99916
99917
99917
99917
99917
99917
99917
99917
48620
99917
99917
99917
99917
99917
99917
99917
99917
99917
99917
99917
99917
99917
41140
29940
99917
99917
99917
99917
99917
99917
28140
99917
99917
99917
99917
99917
99917
99917
99917
99917
48620
99917
99917
45820
45820
99917
28140
99917
99917
29129
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
17480
17490
17500
17510
17520
17530
17540
17550
17560
17570
17580
17590
17600
17610
17620
17630
17640
17650
17660
17670
17680
17690
17700
17710
17720
17730
17740
17750
17760
17770
17780
17790
17800
17810
17820
17830
17840
17841
17860
17870
17880
17890
17900
17910
17920
17921
17940
17950
17960
17970
17980
17981
17982
17983
17984
17985
17986
18000
18010
18020
18030
18040
18050
18060
18070
18080
18090
18100
18110
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Kiowa County, Kansas ..............................................................................................
Labette County, Kansas ............................................................................................
Lane County, Kansas ................................................................................................
Leavenworth County, Kansas ...................................................................................
Lincoln County, Kansas .............................................................................................
Linn County, Kansas .................................................................................................
Logan County, Kansas ..............................................................................................
Lyon County, Kansas ................................................................................................
Mc Pherson County, Kansas .....................................................................................
Marion County, Kansas .............................................................................................
Marshall County, Kansas ..........................................................................................
Meade County, Kansas .............................................................................................
Miami County, Kansas ..............................................................................................
Mitchell County, Kansas ............................................................................................
Montgomery County, Kansas ....................................................................................
Morris County, Kansas ..............................................................................................
Morton County, Kansas .............................................................................................
Nemaha County, Kansas ..........................................................................................
Neosho County, Kansas ............................................................................................
Ness County, Kansas ................................................................................................
Norton County, Kansas .............................................................................................
Osage County, Kansas .............................................................................................
Osborne County, Kansas ..........................................................................................
Ottawa County, Kansas .............................................................................................
Pawnee County, Kansas ...........................................................................................
Phillips County, Kansas .............................................................................................
Pottawatomie County, Kansas ..................................................................................
Pratt County, Kansas ................................................................................................
Rawlins County, Kansas ...........................................................................................
Reno County, Kansas ...............................................................................................
Republic County, Kansas ..........................................................................................
Rice County, Kansas .................................................................................................
Riley County, Kansas ................................................................................................
Rooks County, Kansas ..............................................................................................
Rush County, Kansas ................................................................................................
Russell County, Kansas ............................................................................................
Saline County, Kansas ..............................................................................................
Scott County, Kansas ................................................................................................
Sedgwick County, Kansas .........................................................................................
Seward County, Kansas ............................................................................................
Shawnee County, Kansas .........................................................................................
Sheridan County, Kansas ..........................................................................................
Sherman County, Kansas .........................................................................................
Smith County, Kansas ...............................................................................................
Stafford County, Kansas ...........................................................................................
Stanton County, Kansas ............................................................................................
Stevens County, Kansas ...........................................................................................
Sumner County, Kansas ...........................................................................................
Thomas County, Kansas ...........................................................................................
Trego County, Kansas ...............................................................................................
Wabaunsee County, Kansas .....................................................................................
Wallace County, Kansas ...........................................................................................
Washington County, Kansas .....................................................................................
Wichita County, Kansas ............................................................................................
Wilson County, Kansas .............................................................................................
Woodson County, Kansas .........................................................................................
Wyandotte County, Kansas .......................................................................................
Adair County, Kentucky .............................................................................................
Allen County, Kentucky .............................................................................................
Anderson County, Kentucky ......................................................................................
Ballard County, Kentucky ..........................................................................................
Barren County, Kentucky ..........................................................................................
Bath County, Kentucky ..............................................................................................
Bell County, Kentucky ...............................................................................................
Boone County, Kentucky ...........................................................................................
Bourbon County, Kentucky ........................................................................................
Boyd County, Kentucky .............................................................................................
Boyle County, Kentucky ............................................................................................
Bracken County, Kentucky ........................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00061
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
17
17
17
3760
17
17
17
17
17
17
17
17
3760
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
9040
17
8440
17
17
17
17
17
17
17
17
17
17
17
17
17
17
17
3760
18
18
18
18
18
18
18
1640
4280
3400
18
18
19MYP3
2006
MSAbased
WI
0.7994
0.7994
0.7994
0.9481
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.9481
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.9163
0.7994
0.8929
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.7994
0.9481
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.9742
0.8997
0.9486
0.7866
0.7866
2006
CBSAbased
WI
0.7987
0.7987
0.7987
0.9467
0.7987
0.9467
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.9467
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.8929
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.9141
0.7987
0.8929
0.7987
0.7987
0.7987
0.7987
0.7987
0.7987
0.9141
0.7987
0.7987
0.8929
0.7987
0.7987
0.7987
0.7987
0.7987
0.9467
0.7774
0.7774
0.7774
0.7774
0.7774
0.7774
0.7774
0.9623
0.9084
0.9486
0.7774
0.9623
CBSA
Number
99917
99917
99917
28140
99917
28140
99917
99917
99917
99917
99917
99917
28140
99917
99917
99917
99917
99917
99917
99917
99917
45820
99917
99917
99917
99917
99917
99917
99917
99917
99917
99917
99917
99917
99917
99917
99917
99917
48620
99917
45820
99917
99917
99917
99917
99917
99917
48620
99917
99917
45820
99917
99917
99917
99917
99917
28140
99918
99918
99918
99918
99918
99918
99918
17140
30460
26580
99918
17140
29130
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
18120
18130
18140
18150
18160
18170
18180
18190
18191
18210
18220
18230
18240
18250
18260
18270
18271
18290
18291
18310
18320
18330
18340
18350
18360
18361
18362
18390
18400
18410
18420
18421
18440
18450
18460
18470
18480
18490
18500
18510
18511
18530
18540
18550
18560
18570
18580
18590
18600
18610
18620
18630
18640
18650
18660
18670
18680
18690
18700
18710
18720
18730
18740
18750
18760
18770
18780
18790
18800
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Breathitt County, Kentucky ........................................................................................
Breckinridge County, Kentucky .................................................................................
Bullitt County, Kentucky ............................................................................................
Butler County, Kentucky ............................................................................................
Caldwell County, Kentucky ........................................................................................
Calloway County, Kentucky .......................................................................................
Campbell County, Kentucky ......................................................................................
Carlisle County, Kentucky .........................................................................................
Carroll County, Kentucky ...........................................................................................
Carter County, Kentucky ...........................................................................................
Casey County, Kentucky ...........................................................................................
Christian County, Kentucky .......................................................................................
Clark County, Kentucky .............................................................................................
Clay County, Kentucky ..............................................................................................
Clinton County, Kentucky ..........................................................................................
Crittenden County, Kentucky .....................................................................................
Cumberland County, Kentucky ..................................................................................
Daviess County, Kentucky ........................................................................................
Edmonson County, Kentucky ....................................................................................
Elliott County, Kentucky ............................................................................................
Estill County, Kentucky ..............................................................................................
Fayette County, Kentucky .........................................................................................
Fleming County, Kentucky ........................................................................................
Floyd County, Kentucky ............................................................................................
Franklin County, Kentucky ........................................................................................
Fulton County, Kentucky ...........................................................................................
Gallatin County, Kentucky .........................................................................................
Garrard County, Kentucky .........................................................................................
Grant County, Kentucky ............................................................................................
Graves County, Kentucky ..........................................................................................
Grayson County, Kentucky ........................................................................................
Green County, Kentucky ...........................................................................................
Greenup County, Kentucky .......................................................................................
Hancock County, Kentucky .......................................................................................
Hardin County, Kentucky ...........................................................................................
Harlan County, Kentucky ...........................................................................................
Harrison County, Kentucky ........................................................................................
Hart County, Kentucky ..............................................................................................
Henderson County, Kentucky ....................................................................................
Henry County, Kentucky ............................................................................................
Hickman County, Kentucky .......................................................................................
Hopkins County, Kentucky ........................................................................................
Jackson County, Kentucky ........................................................................................
Jefferson County, Kentucky ......................................................................................
Jessamine County, Kentucky ....................................................................................
Johnson County, Kentucky ........................................................................................
Kenton County, Kentucky ..........................................................................................
Knott County, Kentucky .............................................................................................
Knox County, Kentucky .............................................................................................
Larue County, Kentucky ............................................................................................
Laurel County, Kentucky ...........................................................................................
Lawrence County, Kentucky ......................................................................................
Lee County, Kentucky ...............................................................................................
Leslie County, Kentucky ............................................................................................
Letcher County, Kentucky .........................................................................................
Lewis County, Kentucky ............................................................................................
Lincoln County, Kentucky ..........................................................................................
Livingston County, Kentucky .....................................................................................
Logan County, Kentucky ...........................................................................................
Lyon County, Kentucky .............................................................................................
Mc Cracken County, Kentucky ..................................................................................
Mc Creary County, Kentucky ....................................................................................
Mc Lean County, Kentucky .......................................................................................
Madison County, Kentucky ........................................................................................
Magoffin County, Kentucky .......................................................................................
Marion County, Kentucky ..........................................................................................
Marshall County, Kentucky ........................................................................................
Martin County, Kentucky ...........................................................................................
Mason County, Kentucky ..........................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00062
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
18
18
4520
18
18
18
1640
18
18
3400
18
1660
4280
18
18
18
18
5990
18
18
18
4280
18
18
18
18
1640
18
1640
18
18
18
3400
18
18
18
18
18
2440
18
18
18
18
4520
4280
18
1640
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
18
4280
18
18
18
18
18
19MYP3
2006
MSAbased
WI
0.7866
0.7866
0.9302
0.7866
0.7866
0.7866
0.9742
0.7866
0.7866
0.9486
0.7866
0.8292
0.8997
0.7866
0.7866
0.7866
0.7866
0.8789
0.7866
0.7866
0.7866
0.8997
0.7866
0.7866
0.7866
0.7866
0.9742
0.7866
0.9742
0.7866
0.7866
0.7866
0.9486
0.7866
0.7866
0.7866
0.7866
0.7866
0.8721
0.7866
0.7866
0.7866
0.7866
0.9302
0.8997
0.7866
0.9742
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.8997
0.7866
0.7866
0.7866
0.7866
0.7866
2006
CBSAbased
WI
0.7774
0.7774
0.9261
0.7774
0.7774
0.7774
0.9623
0.7774
0.7774
0.7774
0.7774
0.8292
0.9084
0.7774
0.7774
0.7774
0.7774
0.8789
0.8220
0.7774
0.7774
0.9084
0.7774
0.7774
0.7774
0.7774
0.9623
0.7774
0.9623
0.7774
0.7774
0.7774
0.9486
0.8789
0.8810
0.7774
0.7774
0.7774
0.8721
0.9261
0.7774
0.7774
0.7774
0.9261
0.9084
0.7774
0.9623
0.7774
0.7774
0.8810
0.7774
0.7774
0.7774
0.7774
0.7774
0.7774
0.7774
0.7774
0.7774
0.7774
0.7774
0.7774
0.8789
0.7774
0.7774
0.7774
0.7774
0.7774
0.7774
CBSA
Number
99918
99918
31140
99918
99918
99918
17140
99918
99918
99918
99918
17300
30460
99918
99918
99918
99918
36980
14540
99918
99918
30460
99918
99918
99918
99918
17140
99918
17140
99918
99918
99918
26580
36980
21060
99918
99918
99918
21780
31140
99918
99918
99918
31140
30460
99918
17140
99918
99918
21060
99918
99918
99918
99918
99918
99918
99918
99918
99918
99918
99918
99918
36980
99918
99918
99918
99918
99918
99918
29131
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
18801
18802
18830
18831
18850
18860
18861
18880
18890
18900
18910
18920
18930
18931
18932
18960
18970
18971
18972
18973
18974
18975
18976
18977
18978
18979
18980
18981
18982
18983
18984
18985
18986
18987
18988
18989
18990
18991
18992
19000
19010
19020
19030
19040
19050
19060
19070
19080
19090
19100
19110
19120
19130
19140
19150
19160
19170
19180
19190
19200
19210
19220
19230
19240
19250
19260
19270
19280
19290
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Meade County, Kentucky ..........................................................................................
Menifee County, Kentucky ........................................................................................
Mercer County, Kentucky ..........................................................................................
Metcalfe County, Kentucky ........................................................................................
Monroe County, Kentucky .........................................................................................
Montgomery County, Kentucky .................................................................................
Morgan County, Kentucky .........................................................................................
Muhlenberg County, Kentucky ..................................................................................
Nelson County, Kentucky ..........................................................................................
Nicholas County, Kentucky .......................................................................................
Ohio County, Kentucky ..............................................................................................
Oldham County, Kentucky .........................................................................................
Owen County, Kentucky ............................................................................................
Owsley County, Kentucky .........................................................................................
Pendleton County, Kentucky .....................................................................................
Perry County, Kentucky .............................................................................................
Pike County, Kentucky ..............................................................................................
Powell County, Kentucky ...........................................................................................
Pulaski County, Kentucky ..........................................................................................
Robertson County, Kentucky .....................................................................................
Rockcastle County, Kentucky ....................................................................................
Rowan County, Kentucky ..........................................................................................
Russell County, Kentucky .........................................................................................
Scott County, Kentucky .............................................................................................
Shelby County, Kentucky ..........................................................................................
Simpson County, Kentucky .......................................................................................
Spencer County, Kentucky ........................................................................................
Taylor County, Kentucky ...........................................................................................
Todd County, Kentucky .............................................................................................
Trigg County, Kentucky .............................................................................................
Trimble County, Kentucky .........................................................................................
Union County, Kentucky ............................................................................................
Warren County, Kentucky .........................................................................................
Washington County, Kentucky ..................................................................................
Wayne County, Kentucky ..........................................................................................
Webster County, Kentucky ........................................................................................
Whitley County, Kentucky .........................................................................................
Wolfe County, Kentucky ............................................................................................
Woodford County, Kentucky ......................................................................................
Acadia County, Louisiana ..........................................................................................
Allen County, Louisiana .............................................................................................
Ascension County, Louisiana ....................................................................................
Assumption County, Louisiana ..................................................................................
Avoyelles County, Louisiana .....................................................................................
Beauregard County, Louisiana ..................................................................................
Bienville County, Louisiana .......................................................................................
Bossier County, Louisiana .........................................................................................
Caddo County, Louisiana ..........................................................................................
Calcasieu County, Louisiana .....................................................................................
Caldwell County, Louisiana .......................................................................................
Cameron County, Louisiana ......................................................................................
Catahoula County, Louisiana ....................................................................................
Claiborne County, Louisiana .....................................................................................
Concordia County, Louisiana ....................................................................................
De Soto County, Louisiana .......................................................................................
East Baton Rouge County, Louisiana .......................................................................
East Carroll County, Louisiana ..................................................................................
East Feliciana County, Louisiana ..............................................................................
Evangeline County, Louisiana ...................................................................................
Franklin County, Louisiana ........................................................................................
Grant County, Louisiana ............................................................................................
Iberia County, Louisiana ............................................................................................
Iberville County, Louisiana ........................................................................................
Jackson County, Louisiana .......................................................................................
Jefferson County, Louisiana ......................................................................................
Jefferson Davis County, Louisiana ............................................................................
Lafayette County, Louisiana ......................................................................................
Lafourche County, Louisiana .....................................................................................
La Salle County, Louisiana .......................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00063
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
18
18
18
18
18
18
18
18
18
18
18
4520
18
18
1640
18
18
18
18
18
18
18
18
4280
18
18
18
18
18
18
18
18
18
18
18
18
18
18
4280
3880
19
0760
19
19
19
19
7680
7680
3960
19
19
19
19
19
19
0760
19
19
19
19
19
19
19
19
5560
19
3880
3350
19
19MYP3
2006
MSAbased
WI
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.9302
0.7866
0.7866
0.9742
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.8997
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.7866
0.8997
0.8260
0.7348
0.8652
0.7348
0.7348
0.7348
0.7348
0.8746
0.8746
0.7866
0.7348
0.7348
0.7348
0.7348
0.7348
0.7348
0.8652
0.7348
0.7348
0.7348
0.7348
0.7348
0.7348
0.7348
0.7348
0.9005
0.7348
0.8260
0.7902
0.7348
2006
CBSAbased
WI
0.9261
0.7774
0.7774
0.7774
0.7774
0.7774
0.7774
0.7774
0.9261
0.7774
0.7774
0.9261
0.7774
0.7774
0.9623
0.7774
0.7774
0.7774
0.7774
0.7774
0.7774
0.7774
0.7774
0.9084
0.9261
0.7774
0.9261
0.7774
0.7774
0.8292
0.9261
0.7774
0.8220
0.7774
0.7774
0.8721
0.7774
0.7774
0.9084
0.7418
0.7418
0.8601
0.7418
0.7418
0.7418
0.7418
0.8769
0.8769
0.7841
0.7418
0.7841
0.7418
0.7418
0.7418
0.8769
0.8601
0.7418
0.8601
0.7418
0.7418
0.8041
0.7418
0.8601
0.7418
0.9005
0.7418
0.8436
0.7902
0.7418
CBSA
Number
31140
99918
99918
99918
99918
99918
99918
99918
31140
99918
99918
31140
99918
99918
17140
99918
99918
99918
99918
99918
99918
99918
99918
30460
31140
99918
31140
99918
99918
17300
31140
99918
14540
99918
99918
21780
99918
99918
30460
99919
99919
12940
99919
99919
99919
99919
43340
43340
29340
99919
29340
99919
99919
99919
43340
12940
99919
12940
99919
99919
10780
99919
12940
99919
35380
99919
29180
26380
99919
29132
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
19300
19310
19320
19330
19340
19350
19360
19370
19380
19390
19400
19410
19420
19430
19440
19450
19460
19470
19480
19490
19500
19510
19520
19530
19540
19550
19560
19570
19580
19590
19600
19610
19620
19630
20000
20010
20020
20030
20040
20050
20060
20070
20080
20090
20100
20110
20120
20130
20140
20150
21000
21010
21020
21030
21040
21050
21060
21070
21080
21090
21100
21110
21120
21130
21140
21150
21160
21170
21180
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Lincoln County, Louisiana .........................................................................................
Livingston County, Louisiana ....................................................................................
Madison County, Louisiana .......................................................................................
Morehouse County, Louisiana ...................................................................................
Natchitoches County, Louisiana ................................................................................
Orleans County, Louisiana ........................................................................................
Ouachita County, Louisiana ......................................................................................
Plaquemines County, Louisiana ................................................................................
Pointe Coupee County, Louisiana .............................................................................
Rapides County, Louisiana .......................................................................................
Red River County, Louisiana ....................................................................................
Richland County, Louisiana .......................................................................................
Sabine County, Louisiana .........................................................................................
St Bernard County, Louisiana ...................................................................................
St Charles County, Louisiana ....................................................................................
St Helena County, Louisiana .....................................................................................
St James County, Louisiana .....................................................................................
St John Baptist County, Louisiana ............................................................................
St Landry County, Louisiana .....................................................................................
St Martin County, Louisiana ......................................................................................
St Mary County, Louisiana ........................................................................................
St Tammany County, Louisiana ................................................................................
Tangipahoa County, Louisiana ..................................................................................
Tensas County, Louisiana .........................................................................................
Terrebonne County, Louisiana ..................................................................................
Union County, Louisiana ...........................................................................................
Vermilion County, Louisiana ......................................................................................
Vernon County, Louisiana .........................................................................................
Washington County, Louisiana ..................................................................................
Webster County, Louisiana .......................................................................................
West Baton Rouge County, Louisiana ......................................................................
West Carroll County, Louisiana .................................................................................
West Feliciana County, Louisiana .............................................................................
Winn County, Louisiana ............................................................................................
Androscoggin County, Maine ....................................................................................
Aroostook County, Maine ..........................................................................................
Cumberland County, Maine .......................................................................................
Franklin County, Maine .............................................................................................
Hancock County, Maine ............................................................................................
Kennebec County, Maine ..........................................................................................
Knox County, Maine ..................................................................................................
Lincoln County, Maine ...............................................................................................
Oxford County, Maine ...............................................................................................
Penobscot County, Maine .........................................................................................
Piscataquis County, Maine ........................................................................................
Sagadahoc County, Maine ........................................................................................
Somerset County, Maine ...........................................................................................
Waldo County, Maine ................................................................................................
Washington County, Maine .......................................................................................
York County, Maine ...................................................................................................
Allegany County, Maryland .......................................................................................
Anne Arundel County, Maryland ...............................................................................
Baltimore County, Maryland ......................................................................................
Baltimore City County, Maryland ...............................................................................
Calvert County, Maryland ..........................................................................................
Caroline County, Maryland ........................................................................................
Carroll County, Maryland ...........................................................................................
Cecil County, Maryland .............................................................................................
Charles County, Maryland .........................................................................................
Dorchester County, Maryland ....................................................................................
Frederick County, Maryland ......................................................................................
Garrett County, Maryland ..........................................................................................
Harford County, Maryland .........................................................................................
Howard County, Maryland .........................................................................................
Kent County, Maryland ..............................................................................................
Montgomery County, Maryland .................................................................................
Prince Georges County, Maryland ............................................................................
Queen Annes County, Maryland ...............................................................................
St Marys County, Maryland .......................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00064
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
19
0760
19
19
19
5560
5200
5560
19
0220
19
19
19
5560
5560
19
5560
5560
3880
3880
19
5560
19
19
3350
19
19
19
19
7680
0760
19
19
19
4243
20
6403
20
20
20
20
20
20
0733
20
6403
20
20
20
6403
1900
0720
0720
0720
8840
21
0720
9160
8840
21
8840
21
0720
0720
21
8840
8840
0720
21
19MYP3
2006
MSAbased
WI
0.7348
0.8652
0.7348
0.7348
0.7348
0.9005
0.8052
0.9005
0.7348
0.8041
0.7348
0.7348
0.7348
0.9005
0.9005
0.7348
0.9005
0.9005
0.8260
0.8260
0.7348
0.9005
0.7348
0.7348
0.7902
0.7348
0.7348
0.7348
0.7348
0.8746
0.8652
0.7348
0.7348
0.7348
0.9341
0.8852
1.0392
0.8852
0.8852
0.8852
0.8852
0.8852
0.8852
1.0003
0.8852
1.0392
0.8852
0.8852
0.8852
1.0392
0.9326
0.9907
0.9907
0.9907
1.0983
0.9085
0.9907
1.0537
1.0983
0.9085
1.0983
0.9085
0.9907
0.9907
0.9085
1.0983
1.0983
0.9907
0.9085
2006
CBSAbased
WI
0.7418
0.8601
0.7418
0.7418
0.7418
0.9005
0.8040
0.9005
0.8601
0.8041
0.7418
0.7418
0.7418
0.9005
0.9005
0.8601
0.7418
0.9005
0.7418
0.8436
0.7418
0.9005
0.7418
0.7418
0.7902
0.8040
0.7418
0.7418
0.7418
0.7418
0.8601
0.7418
0.8601
0.7418
0.9341
0.8852
1.0392
0.8852
0.8852
0.8852
0.8852
0.8852
0.8852
1.0003
0.8852
1.0392
0.8852
0.8852
0.8852
1.0392
0.9326
0.9907
0.9907
0.9907
1.0932
0.9095
0.9907
1.0482
1.0932
0.9095
1.1495
0.9095
0.9907
0.9907
0.9095
1.1495
1.0932
0.9907
0.9095
CBSA
Number
99919
12940
99919
99919
99919
35380
33740
35380
12940
10780
99919
99919
99919
35380
35380
12940
99919
35380
99919
29180
99919
35380
99919
99919
26380
33740
99919
99919
99919
99919
12940
99919
12940
99919
30340
99920
38860
99920
99920
99920
99920
99920
99920
12620
99920
38860
99920
99920
99920
38860
19060
12580
12580
12580
47894
99921
12580
48864
47894
99921
13644
99921
12580
12580
99921
13644
47894
12580
99921
29133
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
21190
21200
21210
21220
21230
22000
22010
22020
22030
22040
22060
22070
22080
22090
22120
22130
22150
22160
22170
23000
23010
23020
23030
23040
23050
23060
23070
23080
23090
23100
23110
23120
23130
23140
23150
23160
23170
23180
23190
23200
23210
23220
23230
23240
23250
23260
23270
23280
23290
23300
23310
23320
23330
23340
23350
23360
23370
23380
23390
23400
23410
23420
23430
23440
23450
23460
23470
23480
23490
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Somerset County, Maryland ......................................................................................
Talbot County, Maryland ...........................................................................................
Washington County, Maryland ..................................................................................
Wicomico County, Maryland ......................................................................................
Worcester County, Maryland .....................................................................................
Barnstable County, Massachusetts ...........................................................................
Berkshire County, Massachusetts .............................................................................
Bristol County, Massachusetts ..................................................................................
Dukes County, Massachusetts ..................................................................................
Essex County, Massachusetts ..................................................................................
Franklin County, Massachusetts ...............................................................................
Hampden County, Massachusetts ............................................................................
Hampshire County, Massachusetts ...........................................................................
Middlesex County, Massachusetts ............................................................................
Nantucket County, Massachusetts ............................................................................
Norfolk County, Massachusetts .................................................................................
Plymouth County, Massachusetts .............................................................................
Suffolk County, Massachusetts .................................................................................
Worcester County, Massachusetts ............................................................................
Alcona County, Michigan ...........................................................................................
Alger County, Michigan .............................................................................................
Allegan County, Michigan ..........................................................................................
Alpena County, Michigan ..........................................................................................
Antrim County, Michigan ...........................................................................................
Arenac County, Michigan ..........................................................................................
Baraga County, Michigan ..........................................................................................
Barry County, Michigan .............................................................................................
Bay County, Michigan ...............................................................................................
Benzie County, Michigan ...........................................................................................
Berrien County, Michigan ..........................................................................................
Branch County, Michigan ..........................................................................................
Calhoun County, Michigan ........................................................................................
Cass County, Michigan .............................................................................................
Charlevoix County, Michigan .....................................................................................
Cheboygan County, Michigan ...................................................................................
Chippewa County, Michigan ......................................................................................
Clare County, Michigan .............................................................................................
Clinton County, Michigan ..........................................................................................
Crawford County, Michigan .......................................................................................
Delta County, Michigan .............................................................................................
Dickinson County, Michigan ......................................................................................
Eaton County, Michigan ............................................................................................
Emmet County, Michigan ..........................................................................................
Genesee County, Michigan .......................................................................................
Gladwin County, Michigan .........................................................................................
Gogebic County, Michigan ........................................................................................
Grand Traverse County, Michigan ............................................................................
Gratiot County, Michigan ...........................................................................................
Hillsdale County, Michigan ........................................................................................
Houghton County, Michigan ......................................................................................
Huron County, Michigan ............................................................................................
Ingham County, Michigan ..........................................................................................
Ionia County, Michigan ..............................................................................................
Iosco County, Michigan .............................................................................................
Iron County, Michigan ...............................................................................................
Isabella County, Michigan .........................................................................................
Jackson County, Michigan ........................................................................................
Kalamazoo County, Michigan ....................................................................................
Kalkaska County, Michigan .......................................................................................
Kent County, Michigan ..............................................................................................
Keweenaw County, Michigan ....................................................................................
Lake County, Michigan ..............................................................................................
Lapeer County, Michigan ..........................................................................................
Leelanau County, Michigan .......................................................................................
Lenawee County, Michigan .......................................................................................
Livingston County, Michigan .....................................................................................
Luce County, Michigan ..............................................................................................
Mackinac County, Michigan ......................................................................................
Macomb County, Michigan ........................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00065
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
21
21
3180
21
21
0743
6323
1123
22
1123
22
8003
8003
1123
22
1123
1123
1123
1123
23
23
3000
23
23
23
23
23
6960
23
0870
23
3720
23
23
23
23
23
4040
23
23
23
4040
23
2640
23
23
23
23
23
23
23
4040
23
23
23
23
3520
3720
23
3000
23
23
2160
23
0440
0440
23
23
2160
19MYP3
2006
MSAbased
WI
0.9085
0.9085
0.9879
0.9085
0.9085
1.2527
1.0191
1.1152
1.0050
1.1152
1.0050
1.0273
1.0273
1.1152
1.0050
1.1152
1.1152
1.1152
1.1152
0.8813
0.8813
0.9455
0.8813
0.8813
0.8813
0.8813
0.8813
0.9415
0.8813
0.8888
0.8813
1.0151
0.8813
0.8813
0.8813
0.8813
0.8813
0.9792
0.8813
0.8813
0.8813
0.9792
0.8813
1.0663
0.8813
0.8813
0.8813
0.8813
0.8813
0.8813
0.8813
0.9792
0.8813
0.8813
0.8813
0.8813
0.9313
1.0151
0.8813
0.9455
0.8813
0.8813
1.0152
0.8813
1.0718
1.0718
0.8813
0.8813
1.0152
2006
CBSAbased
WI
0.9073
0.9095
0.9499
0.9073
0.9095
1.2527
1.0191
1.0966
1.0216
1.0533
1.0259
1.0259
1.0259
1.1084
1.0216
1.1543
1.1543
1.1543
1.1039
0.8870
0.8870
0.8870
0.8870
0.8870
0.8870
0.8870
0.9400
0.9352
0.8870
0.8888
0.8870
0.9510
0.9798
0.8870
0.8870
0.8870
0.8870
0.9792
0.8870
0.8870
0.8870
0.9792
0.8870
1.0663
0.8870
0.8870
0.8870
0.8870
0.8870
0.8870
0.8870
0.9792
0.9400
0.8870
0.8870
0.8870
0.9313
1.0391
0.8870
0.9400
0.8870
0.8870
0.9861
0.8870
0.8870
0.9861
0.8870
0.8870
0.9861
CBSA
Number
41540
99921
25180
41540
99921
12700
38340
39300
99922
21604
44140
44140
44140
15764
99922
14484
14484
14484
49340
99923
99923
99923
99923
99923
99923
99923
24340
13020
99923
35660
99923
12980
43780
99923
99923
99923
99923
29620
99923
99923
99923
29620
99923
22420
99923
99923
99923
99923
99923
99923
99923
29620
24340
99923
99923
99923
27100
28020
99923
24340
99923
99923
47644
99923
99923
47644
99923
99923
47644
29134
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
23500
23510
23520
23530
23540
23550
23560
23570
23580
23590
23600
23610
23620
23630
23640
23650
23660
23670
23680
23690
23700
23710
23720
23730
23740
23750
23760
23770
23780
23790
23800
23810
23830
24000
24010
24020
24030
24040
24050
24060
24070
24080
24090
24100
24110
24120
24130
24140
24150
24160
24170
24180
24190
24200
24210
24220
24230
24240
24250
24260
24270
24280
24290
24300
24310
24320
24330
24340
24350
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Manistee County, Michigan .......................................................................................
Marquette County, Michigan .....................................................................................
Mason County, Michigan ...........................................................................................
Mecosta County, Michigan ........................................................................................
Menominee County, Michigan ...................................................................................
Midland County, Michigan .........................................................................................
Missaukee County, Michigan ....................................................................................
Monroe County, Michigan .........................................................................................
Montcalm County, Michigan ......................................................................................
Montmorency County, Michigan ................................................................................
Muskegon County, Michigan .....................................................................................
Newaygo County, Michigan .......................................................................................
Oakland County, Michigan ........................................................................................
Oceana County, Michigan .........................................................................................
Ogemaw County, Michigan .......................................................................................
Ontonagon County, Michigan ....................................................................................
Osceola County, Michigan ........................................................................................
Oscoda County, Michigan .........................................................................................
Otsego County, Michigan ..........................................................................................
Ottawa County, Michigan ..........................................................................................
Presque Isle County, Michigan .................................................................................
Roscommon County, Michigan .................................................................................
Saginaw County, Michigan ........................................................................................
St Clair County, Michigan ..........................................................................................
St Joseph County, Michigan .....................................................................................
Sanilac County, Michigan ..........................................................................................
Schoolcraft County, Michigan ....................................................................................
Shiawassee County, Michigan ..................................................................................
Tuscola County, Michigan .........................................................................................
Van Buren County, Michigan ....................................................................................
Washtenaw County, Michigan ...................................................................................
Wayne County, Michigan ..........................................................................................
Wexford County, Michigan ........................................................................................
Aitkin County, Minnesota ...........................................................................................
Anoka County, Minnesota .........................................................................................
Becker County, Minnesota ........................................................................................
Beltrami County, Minnesota ......................................................................................
Benton County, Minnesota ........................................................................................
Big Stone County, Minnesota ....................................................................................
Blue Earth County, Minnesota ..................................................................................
Brown County, Minnesota .........................................................................................
Carlton County, Minnesota ........................................................................................
Carver County, Minnesota .........................................................................................
Cass County, Minnesota ...........................................................................................
Chippewa County, Minnesota ...................................................................................
Chisago County, Minnesota ......................................................................................
Clay County, Minnesota ............................................................................................
Clearwater County, Minnesota ..................................................................................
Cook County, Minnesota ...........................................................................................
Cottonwood County, Minnesota ................................................................................
Crow Wing County, Minnesota ..................................................................................
Dakota County, Minnesota ........................................................................................
Dodge County, Minnesota .........................................................................................
Douglas County, Minnesota ......................................................................................
Faribault County, Minnesota .....................................................................................
Fillmore County, Minnesota .......................................................................................
Freeborn County, Minnesota .....................................................................................
Goodhue County, Minnesota .....................................................................................
Grant County, Minnesota ..........................................................................................
Hennepin County, Minnesota ....................................................................................
Houston County, Minnesota ......................................................................................
Hubbard County, Minnesota ......................................................................................
Isanti County, Minnesota ...........................................................................................
Itasca County, Minnesota ..........................................................................................
Jackson County, Minnesota ......................................................................................
Kanabec County, Minnesota .....................................................................................
Kandiyohi County, Minnesota ....................................................................................
Kittson County, Minnesota ........................................................................................
Koochiching County, Minnesota ................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00066
Fmt 4701
Sfmt 4702
23
23
23
23
23
6960
23
2160
23
23
3000
23
2160
23
23
23
23
23
23
3000
23
23
6960
12160
23
23
23
23
23
3720
0440
2160
23
24
5120
24
24
6980
24
24
24
24
5120
24
24
5120
2520
24
24
24
24
5120
24
24
24
24
24
24
24
5120
3870
24
5120
24
24
24
24
24
24
E:\FR\FM\19MYP3.SGM
19MYP3
2006
MSAbased
WI
0.8813
0.8813
0.8813
0.8813
0.8813
0.9415
0.8813
1.0152
0.8813
0.8813
0.9455
0.8813
1.0152
0.8813
0.8813
0.8813
0.8813
0.8813
0.8813
0.9455
0.8813
0.8813
0.9415
1.0152
0.8813
0.8813
0.8813
0.8813
0.8813
1.0151
1.0718
1.0152
0.8813
0.9193
1.1078
0.9193
0.9193
0.9975
0.9193
0.9193
0.9193
0.9193
1.1078
0.9193
0.9193
1.1078
0.8495
0.9193
0.9193
0.9193
0.9193
1.1078
0.9193
0.9193
0.9193
0.9193
0.9193
0.9193
0.9193
1.1078
0.9573
0.9193
1.1078
0.9193
0.9193
0.9193
0.9193
0.9193
0.9193
2006
CBSAbased
WI
0.8870
0.8870
0.8870
0.8870
0.8870
0.8870
0.8870
0.9478
0.8870
0.8870
0.9673
0.9400
0.9861
0.8870
0.8870
0.8870
0.8870
0.8870
0.8870
0.9064
0.8870
0.8870
0.9420
0.9861
0.8870
0.8870
0.8870
0.8870
0.8870
1.0391
1.0870
1.0441
0.8870
0.9183
1.1078
0.9183
0.9183
0.9975
0.9183
0.9183
0.9183
1.0209
1.1078
0.9183
0.9183
1.1078
0.8495
0.9183
0.9183
0.9183
0.9183
1.1078
1.1142
0.9183
0.9183
0.9183
0.9183
0.9183
0.9183
1.1078
0.9573
0.9183
1.1078
0.9183
0.9183
0.9183
0.9183
0.9183
0.9183
CBSA
Number
99923
99923
99923
99923
99923
99923
99923
33780
99923
99923
34740
24340
47644
99923
99923
99923
99923
99923
99923
26100
99923
99923
40980
47644
99923
99923
99923
99923
99923
28020
11460
19804
99923
99924
33460
99924
99924
41060
99924
99924
99924
20260
33460
99924
99924
33460
22020
99924
99924
99924
99924
33460
40340
99924
99924
99924
99924
99924
99924
33460
29100
99924
33460
99924
99924
99924
99924
99924
99924
29135
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
24360
24370
24380
24390
24400
24410
24420
24430
24440
24450
24460
24470
24480
24490
24500
24510
24520
24530
24540
24550
24560
24570
24580
24590
24600
24610
24620
24630
24640
24650
24660
24670
24680
24690
24700
24710
24720
24730
24740
24750
24760
24770
24780
24790
24800
24810
24820
24830
24840
24850
24860
25000
25010
25020
25030
25040
25050
25060
25070
25080
25090
25100
25110
25120
25130
25140
25150
25160
25170
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Lac Qui Parle County, Minnesota .............................................................................
Lake County, Minnesota ............................................................................................
Lake Of Woods County, Minnesota ..........................................................................
Le Sueur County, Minnesota .....................................................................................
Lincoln County, Minnesota ........................................................................................
Lyon County, Minnesota ............................................................................................
Mc Leod County, Minnesota .....................................................................................
Mahnomen County, Minnesota .................................................................................
Marshall County, Minnesota ......................................................................................
Martin County, Minnesota .........................................................................................
Meeker County, Minnesota .......................................................................................
Mille Lacs County, Minnesota ...................................................................................
Morrison County, Minnesota .....................................................................................
Mower County, Minnesota .........................................................................................
Murray County, Minnesota ........................................................................................
Nicollet County, Minnesota ........................................................................................
Nobles County, Minnesota ........................................................................................
Norman County, Minnesota .......................................................................................
Olmsted County, Minnesota ......................................................................................
Otter Tail County, Minnesota ....................................................................................
Pennington County, Minnesota .................................................................................
Pine County, Minnesota ............................................................................................
Pipestone County, Minnesota ...................................................................................
Polk County, Minnesota ............................................................................................
Pope County, Minnesota ...........................................................................................
Ramsey County, Minnesota ......................................................................................
Red Lake County, Minnesota ....................................................................................
Redwood County, Minnesota ....................................................................................
Renville County, Minnesota .......................................................................................
Rice County, Minnesota ............................................................................................
Rock County, Minnesota ...........................................................................................
Roseau County, Minnesota .......................................................................................
St Louis County, Minnesota ......................................................................................
Scott County, Minnesota ...........................................................................................
Sherburne County, Minnesota ...................................................................................
Sibley County, Minnesota ..........................................................................................
Stearns County, Minnesota .......................................................................................
Steele County, Minnesota .........................................................................................
Stevens County, Minnesota ......................................................................................
Swift County, Minnesota ............................................................................................
Todd County, Minnesota ...........................................................................................
Traverse County, Minnesota .....................................................................................
Wabasha County, Minnesota ....................................................................................
Wadena County, Minnesota ......................................................................................
Waseca County, Minnesota ......................................................................................
Washington County, Minnesota ................................................................................
Watonwan County, Minnesota ..................................................................................
Wilkin County, Minnesota ..........................................................................................
Winona County, Minnesota .......................................................................................
Wright County, Minnesota .........................................................................................
Yellow Medicine County, Minnesota .........................................................................
Adams County, Mississippi .......................................................................................
Alcorn County, Mississippi ........................................................................................
Amite County, Mississippi .........................................................................................
Attala County, Mississippi .........................................................................................
Benton County, Mississippi .......................................................................................
Bolivar County, Mississippi ........................................................................................
Calhoun County, Mississippi .....................................................................................
Carroll County, Mississippi ........................................................................................
Chickasaw County, Mississippi .................................................................................
Choctaw County, Mississippi .....................................................................................
Claiborne County, Mississippi ...................................................................................
Clarke County, Mississippi ........................................................................................
Clay County, Mississippi ...........................................................................................
Coahoma County, Mississippi ...................................................................................
Copiah County, Mississippi .......................................................................................
Covington County, Mississippi ..................................................................................
Desoto County, Mississippi .......................................................................................
Forrest County, Mississippi .......................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00067
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
24
6820
24
24
24
24
2985
24
5120
24
24
24
24
24
24
2240
5120
5120
24
6980
24
24
24
24
24
24
24
24
5120
24
24
24
5120
24
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
4920
3285
19MYP3
2006
MSAbased
WI
0.9193
0.9193
0.9193
0.9193
0.9193
0.9193
0.9193
0.9193
0.9193
0.9193
0.9193
0.9193
0.9193
0.9193
0.9193
0.9193
0.9193
0.9193
1.1142
0.9193
0.9193
0.9193
0.9193
1.1516
0.9193
1.1078
0.9193
0.9193
0.9193
0.9193
0.9193
0.9193
1.0223
1.1078
1.1078
0.9193
0.9975
0.9193
0.9193
0.9193
0.9193
0.9193
0.9193
0.9193
0.9193
1.1078
0.9193
0.9193
0.9193
1.1078
0.9193
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.9360
0.7609
2006
CBSAbased
WI
0.9183
0.9183
0.9183
0.9183
0.9183
0.9183
0.9183
0.9183
0.9183
0.9183
0.9183
0.9183
0.9183
0.9183
0.9183
0.9183
0.9183
0.9183
1.1142
0.9183
0.9183
0.9183
0.9183
1.1516
0.9183
1.1078
0.9183
0.9183
0.9183
0.9183
0.9183
0.9183
1.0209
1.1078
1.1078
0.9183
0.9975
0.9183
0.9183
0.9183
0.9183
0.9183
1.1142
0.9183
0.9183
1.1078
0.9183
0.9183
0.9183
1.1078
0.9183
0.7671
0.7671
0.7671
0.7671
0.7671
0.7671
0.7671
0.7671
0.7671
0.7671
0.7671
0.7671
0.7671
0.7671
0.8319
0.7671
0.9341
0.7609
CBSA
Number
99924
99924
99924
99924
99924
99924
99924
99924
99924
99924
99924
99924
99924
99924
99924
99924
99924
99924
40340
99924
99924
99924
99924
24220
99924
33460
99924
99924
99924
99924
99924
99924
20260
33460
33460
99924
41060
99924
99924
99924
99924
99924
40340
99924
99924
33460
99924
99924
99924
33460
99924
99925
99925
99925
99925
99925
99925
99925
99925
99925
99925
99925
99925
99925
99925
27140
99925
32820
25620
29136
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
25180
25190
25200
25210
25220
25230
25240
25250
25260
25270
25280
25290
25300
25310
25320
25330
25340
25350
25360
25370
25380
25390
25400
25410
25420
25430
25440
25450
25460
25470
25480
25490
25500
25510
25520
25530
25540
25550
25560
25570
25580
25590
25600
25610
25620
25630
25640
25650
25660
25670
25680
25690
25700
25710
25720
25730
25740
25750
25760
25770
25780
25790
25800
25810
26000
26010
26020
26030
26040
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Franklin County, Mississippi ......................................................................................
George County, Mississippi .......................................................................................
Greene County, Mississippi .......................................................................................
Grenada County, Mississippi .....................................................................................
Hancock County, Mississippi .....................................................................................
Harrison County, Mississippi .....................................................................................
Hinds County, Mississippi .........................................................................................
Holmes County, Mississippi ......................................................................................
Humphreys County, Mississippi ................................................................................
Issaquena County, Mississippi ..................................................................................
Itawamba County, Mississippi ...................................................................................
Jackson County, Mississippi .....................................................................................
Jasper County, Mississippi ........................................................................................
Jefferson County, Mississippi ....................................................................................
Jefferson Davis County, Mississippi ..........................................................................
Jones County, Mississippi .........................................................................................
Kemper County, Mississippi ......................................................................................
Lafayette County, Mississippi ....................................................................................
Lamar County, Mississippi ........................................................................................
Lauderdale County, Mississippi .................................................................................
Lawrence County, Mississippi ...................................................................................
Leake County, Mississippi .........................................................................................
Lee County, Mississippi .............................................................................................
Leflore County, Mississippi ........................................................................................
Lincoln County, Mississippi .......................................................................................
Lowndes County, Mississippi ....................................................................................
Madison County, Mississippi .....................................................................................
Marion County, Mississippi ........................................................................................
Marshall County, Mississippi .....................................................................................
Monroe County, Mississippi ......................................................................................
Montgomery County, Mississippi ...............................................................................
Neshoba County, Mississippi ....................................................................................
Newton County, Mississippi ......................................................................................
Noxubee County, Mississippi ....................................................................................
Oktibbeha County, Mississippi ..................................................................................
Panola County, Mississippi .......................................................................................
Pearl River County, Mississippi .................................................................................
Perry County, Mississippi ..........................................................................................
Pike County, Mississippi ............................................................................................
Pontotoc County, Mississippi ....................................................................................
Prentiss County, Mississippi ......................................................................................
Quitman County, Mississippi .....................................................................................
Rankin County, Mississippi .......................................................................................
Scott County, Mississippi ..........................................................................................
Sharkey County, Mississippi .....................................................................................
Simpson County, Mississippi .....................................................................................
Smith County, Mississippi .........................................................................................
Stone County, Mississippi .........................................................................................
Sunflower County, Mississippi ...................................................................................
Tallahatchie County, Mississippi ...............................................................................
Tate County, Mississippi ...........................................................................................
Tippah County, Mississippi ........................................................................................
Tishomingo County, Mississippi ................................................................................
Tunica County, Mississippi ........................................................................................
Union County, Mississippi .........................................................................................
Walthall County, Mississippi ......................................................................................
Warren County, Mississippi .......................................................................................
Washington County, Mississippi ................................................................................
Wayne County, Mississippi .......................................................................................
Webster County, Mississippi .....................................................................................
Wilkinson County, Mississippi ...................................................................................
Winston County, Mississippi ......................................................................................
Yalobusha County, Mississippi ..................................................................................
Yazoo County, Mississippi ........................................................................................
Adair County, Missouri ..............................................................................................
Andrew County, Missouri ..........................................................................................
Atchison County, Missouri .........................................................................................
Audrain County, Missouri ..........................................................................................
Barry County, Missouri ..............................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00068
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
25
25
25
25
0920
0920
3560
25
25
25
25
0920
25
25
25
25
25
25
3285
25
25
25
25
25
25
25
3560
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
3560
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
26
7000
26
26
26
19MYP3
2006
MSAbased
WI
0.7631
0.7631
0.7631
0.7631
0.8715
0.8715
0.8391
0.7631
0.7631
0.7631
0.7631
0.8715
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7609
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.8391
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.8391
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7631
0.7968
0.9529
0.7968
0.7968
0.7968
2006
CBSAbased
WI
0.7671
0.8165
0.7671
0.7671
0.8938
0.8938
0.8319
0.7671
0.7671
0.7671
0.7671
0.8165
0.7671
0.7671
0.7671
0.7671
0.7671
0.7671
0.7609
0.7671
0.7671
0.7671
0.7671
0.7671
0.7671
0.7671
0.8319
0.7671
0.9341
0.7671
0.7671
0.7671
0.7671
0.7671
0.7671
0.7671
0.7671
0.7609
0.7671
0.7671
0.7671
0.7671
0.8319
0.7671
0.7671
0.8319
0.7671
0.8938
0.7671
0.7671
0.9341
0.7671
0.7671
0.9341
0.7671
0.7671
0.7671
0.7671
0.7671
0.7671
0.7671
0.7671
0.7671
0.7671
0.7909
0.9529
0.7909
0.7909
0.7909
CBSA
Number
99925
37700
99925
99925
25060
25060
27140
99925
99925
99925
99925
37700
99925
99925
99925
99925
99925
99925
25620
99925
99925
99925
99925
99925
99925
99925
27140
99925
32820
99925
99925
99925
99925
99925
99925
99925
99925
25620
99925
99925
99925
99925
27140
99925
99925
27140
99925
25060
99925
99925
32820
99925
99925
32820
99925
99925
99925
99925
99925
99925
99925
99925
99925
99925
99926
41140
99926
99926
99926
29137
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
26050
26060
26070
26080
26090
26100
26110
26120
26130
26140
26150
26160
26170
26180
26190
26200
26210
26220
26230
26240
26250
26260
26270
26280
26290
26300
26310
26320
26330
26340
26350
26360
26370
26380
26390
26400
26410
26411
26412
26440
26450
26460
26470
26480
26490
26500
26510
26520
26530
26540
26541
26560
26570
26580
26590
26600
26601
26620
26630
26631
26650
26660
26670
26680
26690
26700
26710
26720
26730
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Barton County, Missouri ............................................................................................
Bates County, Missouri .............................................................................................
Benton County, Missouri ...........................................................................................
Bollinger County, Missouri .........................................................................................
Boone County, Missouri ............................................................................................
Buchanan County, Missouri ......................................................................................
Butler County, Missouri .............................................................................................
Caldwell County, Missouri .........................................................................................
Callaway County, Missouri ........................................................................................
Camden County, Missouri .........................................................................................
Cape Girardeau County, Missouri .............................................................................
Carroll County, Missouri ............................................................................................
Carter County, Missouri .............................................................................................
Cass County, Missouri ..............................................................................................
Cedar County, Missouri .............................................................................................
Chariton County, Missouri .........................................................................................
Christian County, Missouri ........................................................................................
Clark County, Missouri ..............................................................................................
Clay County, Missouri ...............................................................................................
Clinton County, Missouri ...........................................................................................
Cole County, Missouri ...............................................................................................
Cooper County, Missouri ...........................................................................................
Crawford County, Missouri ........................................................................................
Dade County, Missouri ..............................................................................................
Dallas County, Missouri .............................................................................................
Daviess County, Missouri ..........................................................................................
De Kalb County, Missouri ..........................................................................................
Dent County, Missouri ...............................................................................................
Douglas County, Missouri .........................................................................................
Dunklin County, Missouri ...........................................................................................
Franklin County, Missouri ..........................................................................................
Gasconade County, Missouri ....................................................................................
Gentry County, Missouri ............................................................................................
Greene County, Missouri ...........................................................................................
Grundy County, Missouri ...........................................................................................
Harrison County, Missouri .........................................................................................
Henry County, Missouri .............................................................................................
Hickory County, Missouri ...........................................................................................
Holt County, Missouri ................................................................................................
Howard County, Missouri ..........................................................................................
Howell County, Missouri ............................................................................................
Iron County, Missouri ................................................................................................
Jackson County, Missouri .........................................................................................
Jasper County, Missouri ............................................................................................
Jefferson County, Missouri ........................................................................................
Johnson County, Missouri .........................................................................................
Knox County, Missouri ..............................................................................................
Laclede County, Missouri ..........................................................................................
Lafayette County, Missouri ........................................................................................
Lawrence County, Missouri .......................................................................................
Lewis County, Missouri .............................................................................................
Lincoln County, Missouri ...........................................................................................
Linn County, Missouri ................................................................................................
Livingston County, Missouri ......................................................................................
Mc Donald County, Missouri .....................................................................................
Macon County, Missouri ............................................................................................
Madison County, Missouri .........................................................................................
Maries County, Missouri ............................................................................................
Marion County, Missouri ............................................................................................
Mercer County, Missouri ...........................................................................................
Miller County, Missouri ..............................................................................................
Mississippi County, Missouri .....................................................................................
Moniteau County, Missouri ........................................................................................
Monroe County, Missouri ..........................................................................................
Montgomery County, Missouri ...................................................................................
Morgan County, Missouri ..........................................................................................
New Madrid County, Missouri ...................................................................................
Newton County, Missouri ..........................................................................................
Nodaway County, Missouri ........................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00069
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
26
26
26
26
1740
7000
26
26
26
26
26
26
26
3760
26
26
7920
26
3760
3760
26
26
26
26
26
26
26
26
26
26
7040
26
26
7920
26
26
26
26
26
26
26
26
3760
3710
7040
26
26
26
3760
26
26
7040
26
26
26
26
26
26
26
26
26
26
26
26
26
26
26
3710
26
19MYP3
2006
MSAbased
WI
0.7968
0.7968
0.7968
0.7968
0.8354
0.9529
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.9481
0.7968
0.7968
0.8259
0.7968
0.9481
0.9481
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.8957
0.7968
0.7968
0.8259
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.9481
0.8590
0.8957
0.7968
0.7968
0.7968
0.9481
0.7968
0.7968
0.8957
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.8590
0.7968
2006
CBSAbased
WI
0.7909
0.9467
0.7909
0.7909
0.8354
0.9529
0.7909
0.9467
0.8396
0.7909
0.7909
0.7909
0.7909
0.9467
0.7909
0.7909
0.8246
0.7909
0.9467
0.9467
0.8396
0.7909
0.8949
0.7909
0.8246
0.7909
0.9529
0.7909
0.7909
0.7909
0.8949
0.7909
0.7909
0.8246
0.7909
0.7909
0.7909
0.7909
0.7909
0.8354
0.7909
0.7909
0.9467
0.8590
0.8949
0.7909
0.7909
0.7909
0.9467
0.7909
0.7909
0.8949
0.7909
0.7909
0.8563
0.7909
0.7909
0.7909
0.7909
0.7909
0.7909
0.7909
0.8396
0.7909
0.7909
0.7909
0.7909
0.8590
0.7909
CBSA
Number
99926
28140
99926
99926
17860
41140
99926
28140
27620
99926
99926
99926
99926
28140
99926
99926
44180
99926
28140
28140
27620
99926
41180
99926
44180
99926
41140
99926
99926
99926
41180
99926
99926
44180
99926
99926
99926
99926
99926
17860
99926
99926
28140
27900
41180
99926
99926
99926
28140
99926
99926
41180
99926
99926
22220
99926
99926
99926
99926
99926
99926
99926
27620
99926
99926
99926
99926
27900
99926
29138
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
26740
26750
26751
26770
26780
26790
26800
26810
26820
26821
26840
26850
26860
26870
26880
26881
26900
26910
26911
26930
26940
26950
26960
26970
26980
26981
26982
26983
26984
26985
26986
26987
26988
26989
26990
26991
26992
26993
26994
26995
26996
27000
27010
27020
27030
27040
27050
27060
27070
27080
27090
27100
27110
27113
27120
27130
27140
27150
27160
27170
27180
27190
27200
27210
27220
27230
27240
27250
27260
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Oregon County, Missouri ...........................................................................................
Osage County, Missouri ............................................................................................
Ozark County, Missouri .............................................................................................
Pemiscot County, Missouri ........................................................................................
Perry County, Missouri ..............................................................................................
Pettis County, Missouri ..............................................................................................
Phelps County, Missouri ............................................................................................
Pike County, Missouri ................................................................................................
Platte County, Missouri .............................................................................................
Polk County, Missouri ................................................................................................
Pulaski County, Missouri ...........................................................................................
Putnam County, Missouri ..........................................................................................
Ralls County, Missouri ...............................................................................................
Randolph County, Missouri .......................................................................................
Ray County, Missouri ................................................................................................
Reynolds County, Missouri ........................................................................................
Ripley County, Missouri .............................................................................................
St Charles County, Missouri ......................................................................................
St Clair County, Missouri ...........................................................................................
St Francois County, Missouri ....................................................................................
St Louis County, Missouri .........................................................................................
St Louis City County, Missouri ..................................................................................
Ste Genevieve County, Missouri ...............................................................................
Saline County, Missouri .............................................................................................
Schuyler County, Missouri .........................................................................................
Scotland County, Missouri .........................................................................................
Scott County, Missouri ..............................................................................................
Shannon County, Missouri ........................................................................................
Shelby County, Missouri ............................................................................................
Stoddard County, Missouri ........................................................................................
Stone County, Missouri .............................................................................................
Sullivan County, Missouri ..........................................................................................
Taney County, Missouri .............................................................................................
Texas County, Missouri .............................................................................................
Vernon County, Missouri ...........................................................................................
Warren County, Missouri ...........................................................................................
Washington County, Missouri ....................................................................................
Wayne County, Missouri ...........................................................................................
Webster County, Missouri .........................................................................................
Worth County, Missouri .............................................................................................
Wright County, Missouri ............................................................................................
Beaverhead County, Montana ...................................................................................
Big Horn County, Montana ........................................................................................
Blaine County, Montana ............................................................................................
Broadwater County, Montana ....................................................................................
Carbon County, Montana ..........................................................................................
Carter County, Montana ............................................................................................
Cascade County, Montana ........................................................................................
Chouteau County, Montana ......................................................................................
Custer County, Montana ...........................................................................................
Daniels County, Montana ..........................................................................................
Dawson County, Montana .........................................................................................
Deer Lodge County, Montana ...................................................................................
Yellowstone National Park, Montana ........................................................................
Fallon County, Montana ............................................................................................
Fergus County, Montana ...........................................................................................
Flathead County, Montana ........................................................................................
Gallatin County, Montana ..........................................................................................
Garfield County, Montana .........................................................................................
Glacier County, Montana ...........................................................................................
Golden Valley County, Montana ...............................................................................
Granite County, Montana ..........................................................................................
Hill County, Montana .................................................................................................
Jefferson County, Montana .......................................................................................
Judith Basin County, Montana ..................................................................................
Lake County, Montana ..............................................................................................
Lewis And Clark County, Montana ............................................................................
Liberty County, Montana ...........................................................................................
Lincoln County, Montana ...........................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00070
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
26
26
26
26
26
26
26
26
3760
26
26
26
26
26
3760
26
26
7040
26
26
7040
7040
26
26
26
26
26
26
26
26
26
26
26
26
26
7040
26
26
7920
26
26
27
27
27
27
27
27
3040
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
19MYP3
2006
MSAbased
WI
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.9481
0.7968
0.7968
0.7968
0.7968
0.7968
0.9481
0.7968
0.7968
0.8957
0.7968
0.7968
0.8957
0.8957
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.7968
0.8957
0.7968
0.7968
0.8259
0.7968
0.7968
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.9061
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
2006
CBSAbased
WI
0.7909
0.8396
0.7909
0.7909
0.7909
0.7909
0.7909
0.7909
0.9467
0.8246
0.7909
0.7909
0.7909
0.7909
0.9467
0.7909
0.7909
0.8949
0.7909
0.7909
0.8949
0.8949
0.7909
0.7909
0.7909
0.7909
0.7909
0.7909
0.7909
0.7909
0.7909
0.7909
0.7909
0.7909
0.7909
0.8949
0.8949
0.7909
0.8246
0.7909
0.7909
0.8833
0.8833
0.8833
0.8833
0.8843
0.8833
0.9061
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
CBSA
Number
99926
27620
99926
99926
99926
99926
99926
99926
28140
44180
99926
99926
99926
99926
28140
99926
99926
41180
99926
99926
41180
41180
99926
99926
99926
99926
99926
99926
99926
99926
99926
99926
99926
99926
99926
41180
41180
99926
44180
99926
99926
99927
99927
99927
99927
13740
99927
24500
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
29139
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
27270
27280
27290
27300
27310
27320
27330
27340
27350
27360
27370
27380
27390
27400
27410
27420
27430
27440
27450
27460
27470
27480
27490
27500
27510
27520
27530
27540
27550
28000
28010
28020
28030
28040
28050
28060
28070
28080
28090
28100
28110
28120
28130
28140
28150
28160
28170
28180
28190
28200
28210
28220
28230
28240
28250
28260
28270
28280
28290
28300
28310
28320
28330
28340
28350
28360
28370
28380
28390
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Mc Cone County, Montana .......................................................................................
Madison County, Montana ........................................................................................
Meagher County, Montana ........................................................................................
Mineral County, Montana ..........................................................................................
Missoula County, Montana ........................................................................................
Musselshell County, Montana ...................................................................................
Park County, Montana ...............................................................................................
Petroleum County, Montana ......................................................................................
Phillips County, Montana ...........................................................................................
Pondera County, Montana ........................................................................................
Powder River County, Montana ................................................................................
Powell County, Montana ...........................................................................................
Prairie County, Montana ............................................................................................
Ravalli County, Montana ...........................................................................................
Richland County, Montana ........................................................................................
Roosevelt County, Montana ......................................................................................
Rosebud County, Montana ........................................................................................
Sanders County, Montana .........................................................................................
Sheridan County, Montana ........................................................................................
Silver Bow County, Montana .....................................................................................
Stillwater County, Montana .......................................................................................
Sweet Grass County, Montana .................................................................................
Teton County, Montana .............................................................................................
Toole County, Montana .............................................................................................
Treasure County, Montana ........................................................................................
Valley County, Montana ............................................................................................
Wheatland County, Montana .....................................................................................
Wibaux County, Montana ..........................................................................................
Yellowstone County, Montana ...................................................................................
Adams County, Nebraska .........................................................................................
Antelope County, Nebraska ......................................................................................
Arthur County, Nebraska ...........................................................................................
Banner County, Nebraska .........................................................................................
Blaine County, Nebraska ...........................................................................................
Boone County, Nebraska ..........................................................................................
Box Butte County, Nebraska .....................................................................................
Boyd County, Nebraska ............................................................................................
Brown County, Nebraska ..........................................................................................
Buffalo County, Nebraska .........................................................................................
Burt County, Nebraska ..............................................................................................
Butler County, Nebraska ...........................................................................................
Cass County, Nebraska ............................................................................................
Cedar County, Nebraska ...........................................................................................
Chase County, Nebraska ..........................................................................................
Cherry County, Nebraska ..........................................................................................
Cheyenne County, Nebraska ....................................................................................
Clay County, Nebraska .............................................................................................
Colfax County, Nebraska ..........................................................................................
Cuming County, Nebraska ........................................................................................
Custer County, Nebraska ..........................................................................................
Dakota County, Nebraska .........................................................................................
Dawes County, Nebraska ..........................................................................................
Dawson County, Nebraska ........................................................................................
Deuel County, Nebraska ...........................................................................................
Dixon County, Nebraska ...........................................................................................
Dodge County, Nebraska ..........................................................................................
Douglas County, Nebraska .......................................................................................
Dundy County, Nebraska ..........................................................................................
Fillmore County, Nebraska ........................................................................................
Franklin County, Nebraska ........................................................................................
Frontier County, Nebraska ........................................................................................
Furnas County, Nebraska .........................................................................................
Gage County, Nebraska ............................................................................................
Garden County, Nebraska .........................................................................................
Garfield County, Nebraska ........................................................................................
Gosper County, Nebraska .........................................................................................
Grant County, Nebraska ............................................................................................
Greeley County, Nebraska ........................................................................................
Hall County, Nebraska ..............................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00071
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
27
27
27
27
5140
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
27
0880
28
28
28
28
28
28
28
28
28
28
28
28
5920
28
28
28
28
28
28
28
28
7720
28
28
28
28
28
5920
28
28
28
28
28
28
28
28
28
28
28
28
19MYP3
2006
MSAbased
WI
0.8833
0.8833
0.8833
0.8833
0.9482
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8843
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.9569
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.9411
0.8665
0.8665
0.8665
0.8665
0.8665
0.9569
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
2006
CBSAbased
WI
0.8833
0.8833
0.8833
0.8833
0.9482
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8833
0.8843
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.9569
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.9376
0.8665
0.8665
0.8665
0.9376
0.8665
0.9569
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
CBSA
Number
99927
99927
99927
99927
33540
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
99927
13740
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
36540
99928
99928
99928
99928
99928
99928
99928
99928
43580
99928
99928
99928
43580
99928
36540
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
29140
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
28400
28410
28420
28430
28440
28450
28460
28470
28480
28490
28500
28510
28520
28530
28540
28550
28560
28570
28580
28590
28600
28610
28620
28630
28640
28650
28660
28670
28680
28690
28700
28710
28720
28730
28740
28750
28760
28770
28780
28790
28800
28810
28820
28830
28840
28850
28860
28870
28880
28890
28900
28910
28920
29000
29010
29020
29030
29040
29050
29060
29070
29080
29090
29100
29110
29120
29130
29140
29150
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Hamilton County, Nebraska ......................................................................................
Harlan County, Nebraska ..........................................................................................
Hayes County, Nebraska ..........................................................................................
Hitchcock County, Nebraska .....................................................................................
Holt County, Nebraska ..............................................................................................
Hooker County, Nebraska .........................................................................................
Howard County, Nebraska ........................................................................................
Jefferson County, Nebraska ......................................................................................
Johnson County, Nebraska .......................................................................................
Kearney County, Nebraska .......................................................................................
Keith County, Nebraska ............................................................................................
Keya Paha County, Nebraska ...................................................................................
Kimball County, Nebraska .........................................................................................
Knox County, Nebraska ............................................................................................
Lancaster County, Nebraska .....................................................................................
Lincoln County, Nebraska .........................................................................................
Logan County, Nebraska ...........................................................................................
Loup County, Nebraska .............................................................................................
Mc Pherson County, Nebraska .................................................................................
Madison County, Nebraska .......................................................................................
Merrick County, Nebraska .........................................................................................
Morrill County, Nebraska ...........................................................................................
Nance County, Nebraska ..........................................................................................
Nemaha County, Nebraska .......................................................................................
Nuckolls County, Nebraska .......................................................................................
Otoe County, Nebraska .............................................................................................
Pawnee County, Nebraska ........................................................................................
Perkins County, Nebraska .........................................................................................
Phelps County, Nebraska ..........................................................................................
Pierce County, Nebraska ..........................................................................................
Platte County, Nebraska ...........................................................................................
Polk County, Nebraska ..............................................................................................
Redwillow County, Nebraska ....................................................................................
Richardson County, Nebraska ..................................................................................
Rock County, Nebraska ............................................................................................
Saline County, Nebraska ...........................................................................................
Sarpy County, Nebraska ...........................................................................................
Saunders County, Nebraska .....................................................................................
Scotts Bluff County, Nebraska ..................................................................................
Seward County, Nebraska ........................................................................................
Sheridan County, Nebraska ......................................................................................
Sherman County, Nebraska ......................................................................................
Sioux County, Nebraska ............................................................................................
Stanton County, Nebraska ........................................................................................
Thayer County, Nebraska .........................................................................................
Thomas County, Nebraska ........................................................................................
Thurston County, Nebraska ......................................................................................
Valley County, Nebraska ...........................................................................................
Washington County, Nebraska ..................................................................................
Wayne County, Nebraska .........................................................................................
Webster County, Nebraska .......................................................................................
Wheeler County, Nebraska .......................................................................................
York County, Nebraska .............................................................................................
Churchill County, Nevada ..........................................................................................
Clark County, Nevada ...............................................................................................
Douglas County, Nevada ..........................................................................................
Elko County, Nevada .................................................................................................
Esmeralda County, Nevada ......................................................................................
Eureka County, Nevada ............................................................................................
Humboldt County, Nevada ........................................................................................
Lander County, Nevada ............................................................................................
Lincoln County, Nevada ............................................................................................
Lyon County, Nevada ................................................................................................
Mineral County, Nevada ............................................................................................
Nye County, Nevada .................................................................................................
Carson City County, Nevada .....................................................................................
Pershing County, Nevada .........................................................................................
Storey County, Nevada .............................................................................................
Washoe County, Nevada ..........................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00072
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
28
28
28
28
28
28
28
28
28
28
28
28
28
28
4360
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
28
5920
28
28
28
28
28
28
28
28
28
28
28
5920
28
28
28
28
29
4120
29
29
29
29
29
29
29
29
29
4120
29
29
29
6720
19MYP3
2006
MSAbased
WI
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
1.0225
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.9569
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.9569
0.8665
0.8665
0.8665
0.8665
0.9697
1.1166
0.9697
0.9697
0.9697
0.9697
0.9697
0.9697
0.9697
0.9697
0.9697
1.1166
0.9697
0.9697
0.9697
1.0993
2006
CBSAbased
WI
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
1.0225
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.9569
0.9569
0.8665
1.0225
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.8665
0.9569
0.8665
0.8665
0.8665
0.8665
0.9074
1.1449
0.9074
0.9074
0.9074
0.9074
0.9074
0.9074
0.9074
0.9074
0.9074
0.9074
1.0244
0.9074
1.0993
1.0993
CBSA
Number
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
30700
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
99928
36540
36540
99928
30700
99928
99928
99928
99928
99928
99928
99928
99928
36540
99928
99928
99928
99928
99929
29820
99929
99929
99929
99929
99929
99929
99929
99929
99929
99929
16180
99929
39900
39900
29141
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
29160
30000
30010
30020
30030
30040
30050
30060
30070
30080
30090
31000
31100
31150
31160
31180
31190
31200
31220
31230
31250
31260
31270
31290
31300
31310
31320
31340
31350
31360
31370
31390
32000
32010
32020
32025
32030
32040
32050
32060
32070
32080
32090
32100
32110
32120
32130
32131
32140
32150
32160
32170
32180
32190
32200
32210
32220
32230
32240
32250
32260
32270
32280
32290
32300
33000
33010
33020
33030
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
White Pine County, Nevada ......................................................................................
Belknap County, New Hampshire .............................................................................
Carroll County, New Hampshire ................................................................................
Cheshire County, New Hampshire ............................................................................
Coos County, New Hampshire ..................................................................................
Grafton County, New Hampshire ..............................................................................
Hillsboro County, New Hampshire ............................................................................
Merrimack County, New Hampshire .........................................................................
Rockingham County, New Hampshire ......................................................................
Strafford County, New Hampshire ............................................................................
Sullivan County, New Hampshire ..............................................................................
Atlantic County, New Jersey .....................................................................................
Bergen County, New Jersey .....................................................................................
Burlington County, New Jersey .................................................................................
Camden County, New Jersey ...................................................................................
Cape May County, New Jersey ................................................................................
Cumberland County, New Jersey .............................................................................
Essex County, New Jersey .......................................................................................
Gloucester County, New Jersey ................................................................................
Hudson County, New Jersey .....................................................................................
Hunterdon County, New Jersey ................................................................................
Mercer County, New Jersey ......................................................................................
Middlesex County, New Jersey .................................................................................
Monmouth County, New Jersey ................................................................................
Morris County, New Jersey .......................................................................................
Ocean County, New Jersey ......................................................................................
Passaic County, New Jersey ....................................................................................
Salem County, New Jersey .......................................................................................
Somerset County, New Jersey ..................................................................................
Sussex County, New Jersey .....................................................................................
Union County, New Jersey ........................................................................................
Warren County, New Jersey .....................................................................................
Bernalillo County, New Mexico .................................................................................
Catron County, New Mexico .....................................................................................
Chaves County, New Mexico ....................................................................................
Cibola County, New Mexico ......................................................................................
Colfax County, New Mexico ......................................................................................
Curry County, New Mexico .......................................................................................
De Baca County, New Mexico ..................................................................................
Dona Ana County, New Mexico ................................................................................
Eddy County, New Mexico ........................................................................................
Grant County, New Mexico .......................................................................................
Guadalupe County, New Mexico ...............................................................................
Harding County, New Mexico ....................................................................................
Hidalgo County, New Mexico ....................................................................................
Lea County, New Mexico ..........................................................................................
Lincoln County, New Mexico .....................................................................................
Los Alamos County, New Mexico .............................................................................
Luna County, New Mexico ........................................................................................
Mc Kinley County, New Mexico ................................................................................
Mora County, New Mexico ........................................................................................
Otero County, New Mexico .......................................................................................
Quay County, New Mexico ........................................................................................
Rio Arriba County, New Mexico ................................................................................
Roosevelt County, New Mexico ................................................................................
Sandoval County, New Mexico .................................................................................
San Juan County, New Mexico .................................................................................
San Miguel County, New Mexico ..............................................................................
Santa Fe County, New Mexico .................................................................................
Sierra County, New Mexico .......................................................................................
Socorro County, New Mexico ....................................................................................
Taos County, New Mexico ........................................................................................
Torrance County, New Mexico ..................................................................................
Union County, New Mexico .......................................................................................
Valencia County, New Mexico ..................................................................................
Albany County, New York .........................................................................................
Allegany County, New York ......................................................................................
Bronx County, New York ...........................................................................................
Broome County, New York ........................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00073
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
29
30
30
30
30
30
1123
1123
1123
1123
30
0560
0875
6160
6160
0560
8760
5640
6160
3640
5015
8480
5015
5190
5640
5190
0875
6160
5015
5640
5640
5640
0200
32
32
32
32
32
32
4100
32
32
32
32
32
32
32
7490
32
32
32
32
32
32
32
0200
32
32
7490
32
32
32
32
32
0200
0160
33
5600
0960
19MYP3
2006
MSAbased
WI
0.9697
1.0677
1.0677
1.0677
1.0677
1.0677
1.1152
1.1152
1.1152
1.1152
1.0677
1.1513
1.1660
1.0926
1.0926
1.1513
0.9837
1.2141
1.0926
1.1349
1.1178
1.0845
1.1178
1.1271
1.2141
1.1271
1.1660
1.0926
1.1178
1.2141
1.2141
1.2141
0.9693
0.8571
0.8571
0.8571
0.8571
0.8571
0.8571
0.8475
0.8571
0.8571
0.8571
0.8571
0.8571
0.8571
0.8571
1.0759
0.8571
0.8571
0.8571
0.8571
0.8571
0.8571
0.8571
0.9693
0.8571
0.8571
1.0759
0.8571
0.8571
0.8571
0.8571
0.8571
0.9693
0.8518
0.8395
1.3465
0.8571
2006
CBSAbased
WI
0.9074
1.0677
1.0677
1.0677
1.0677
1.0677
1.0335
1.0335
1.0385
1.0385
1.0677
1.1633
1.3185
1.0528
1.0528
1.1022
0.9837
1.2195
1.0528
1.3185
1.2195
1.0845
1.1260
1.1260
1.2195
1.1260
1.3185
1.0482
1.1260
1.2195
1.2195
0.9828
0.9693
0.8644
0.8644
0.8644
0.8644
0.8644
0.8644
0.8475
0.8644
0.8644
0.8644
0.8644
0.8644
0.8644
0.8644
0.8644
0.8644
0.8644
0.8644
0.8644
0.8644
0.8644
0.8644
0.9693
0.8518
0.8644
1.0931
0.8644
0.8644
0.8644
0.9693
0.8644
0.9693
0.8545
0.8157
1.3185
0.8571
CBSA
Number
99929
99930
99930
99930
99930
99930
31700
31700
40484
40484
99930
12100
35644
15804
15804
36140
47220
35084
15804
35644
35084
45940
20764
20764
35084
20764
35644
48864
20764
35084
35084
10900
10740
99932
99932
99932
99932
99932
99932
29740
99932
99932
99932
99932
99932
99932
99932
99932
99932
99932
99932
99932
99932
99932
99932
10740
22140
99932
42140
99932
99932
99932
10740
99932
10740
10580
99933
35644
13780
29142
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
33040
33050
33060
33070
33080
33090
33200
33210
33220
33230
33240
33260
33270
33280
33290
33300
33310
33320
33330
33331
33340
33350
33360
33370
33380
33400
33420
33500
33510
33520
33530
33540
33550
33560
33570
33580
33590
33600
33610
33620
33630
33640
33650
33660
33670
33680
33690
33700
33710
33720
33730
33740
33750
33760
33770
33800
33900
33910
34000
34010
34020
34030
34040
34050
34060
34070
34080
34090
34100
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Cattaraugus County, New York .................................................................................
Cayuga County, New York ........................................................................................
Chautauqua County, New York .................................................................................
Chemung County, New York .....................................................................................
Chenango County, New York ....................................................................................
Clinton County, New York .........................................................................................
Columbia County, New York .....................................................................................
Cortland County, New York .......................................................................................
Delaware County, New York .....................................................................................
Dutchess County, New York .....................................................................................
Erie County, New York ..............................................................................................
Essex County, New York ..........................................................................................
Franklin County, New York .......................................................................................
Fulton County, New York ..........................................................................................
Genesee County, New York ......................................................................................
Greene County, New York ........................................................................................
Hamilton County, New York ......................................................................................
Herkimer County, New York ......................................................................................
Jefferson County, New York .....................................................................................
Kings County, New York ...........................................................................................
Lewis County, New York ...........................................................................................
Livingston County, New York ....................................................................................
Madison County, New York .......................................................................................
Monroe County, New York ........................................................................................
Montgomery County, New York ................................................................................
Nassau County, New York ........................................................................................
New York County, New York ....................................................................................
Niagara County, New York ........................................................................................
Oneida County, New York .........................................................................................
Onondaga County, New York ...................................................................................
Ontario County, New York ........................................................................................
Orange County, New York ........................................................................................
Orleans County, New York ........................................................................................
Oswego County, New York .......................................................................................
Otsego County, New York .........................................................................................
Putnam County, New York ........................................................................................
Queens County, New York ........................................................................................
Rensselaer County, New York ..................................................................................
Richmond County, New York ....................................................................................
Rockland County, New York .....................................................................................
St Lawrence County, New York ................................................................................
Saratoga County, New York ......................................................................................
Schenectady County, New York ...............................................................................
Schoharie County, New York ....................................................................................
Schuyler County, New York ......................................................................................
Seneca County, New York ........................................................................................
Steuben County, New York .......................................................................................
Suffolk County, New York .........................................................................................
Sullivan County, New York ........................................................................................
Tioga County, New York ...........................................................................................
Tompkins County, New York .....................................................................................
Ulster County, New York ...........................................................................................
Warren County, New York ........................................................................................
Washington County, New York .................................................................................
Wayne County, New York .........................................................................................
Westchester County, New York ................................................................................
Wyoming County, New York .....................................................................................
Yates County, New York ...........................................................................................
Alamance County, N Carolina ...................................................................................
Alexander County, N Carolina ...................................................................................
Alleghany County, N Carolina ...................................................................................
Anson County, N Carolina .........................................................................................
Ashe County, N Carolina ...........................................................................................
Avery County, N Carolina ..........................................................................................
Beaufort County, N Carolina .....................................................................................
Bertie County, N Carolina .........................................................................................
Bladen County, N Carolina ........................................................................................
Brunswick County, N Carolina ..................................................................................
Buncombe County, N Carolina ..................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00074
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
33
8160
3610
2335
33
33
33
33
33
2281
1280
33
33
33
6840
33
33
8680
33
5600
33
6840
8160
6840
0160
5380
5600
1280
8680
8160
6840
5660
6840
8160
33
5600
5600
0160
5600
5600
33
0160
0160
0160
33
33
33
5380
33
0960
33
33
2975
2975
6840
5600
33
33
3120
3290
34
34
34
34
34
34
34
9200
0480
19MYP3
2006
MSAbased
WI
0.8395
0.9499
0.7552
0.8259
0.8395
0.8395
0.8395
0.8395
0.8395
1.0183
0.8889
0.8395
0.8395
0.8395
0.9044
0.8395
0.8395
0.8293
0.8395
1.3465
0.8395
0.9044
0.9499
0.9044
0.8518
1.2760
1.3465
0.8889
0.8293
0.9499
0.9044
1.1218
0.9044
0.9499
0.8395
1.3465
1.3465
0.8518
1.3465
1.3465
0.8395
0.8518
0.8518
0.8518
0.8395
0.8395
0.8395
1.2760
0.8395
0.8571
0.8395
0.8395
0.8567
0.8567
0.9044
1.3465
0.8395
0.8395
0.9027
0.8922
0.8490
0.8490
0.8490
0.8490
0.8490
0.8490
0.8490
0.9592
0.9747
2006
CBSAbased
WI
0.8157
0.8157
0.8157
0.8259
0.8157
0.8157
0.8157
0.8157
0.8157
1.0766
0.8889
0.8157
0.8157
0.8157
0.8157
0.8157
0.8157
0.8293
0.8157
1.3185
0.8157
0.9115
0.9581
0.9115
0.8157
1.2760
1.3185
0.8889
0.8293
0.9581
0.9115
1.0766
0.9115
0.9581
0.8157
1.3185
1.3185
0.8545
1.3185
1.3185
0.8157
0.8545
0.8545
0.8545
0.8157
0.8157
0.8157
1.2760
0.8157
0.8571
0.9803
0.9257
0.8567
0.8567
0.9115
1.3185
0.8157
0.8157
0.8914
0.8922
0.8567
0.9760
0.8567
0.8567
0.8567
0.8567
0.8567
0.9592
0.9294
CBSA
Number
99933
99933
99933
21300
99933
99933
99933
99933
99933
39100
15380
99933
99933
99933
99933
99933
99933
46540
99933
35644
99933
40380
45060
40380
99933
35004
35644
15380
46540
45060
40380
39100
40380
45060
99933
35644
35644
10580
35644
35644
99933
10580
10580
10580
99933
99933
99933
35004
99933
13780
27060
28740
24020
24020
40380
35644
99933
99933
15500
25860
99934
16740
99934
99934
99934
99934
99934
48900
11700
29143
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
34110
34120
34130
34140
34150
34160
34170
34180
34190
34200
34210
34220
34230
34240
34250
34251
34270
34280
34290
34300
34310
34320
34330
34340
34350
34360
34370
34380
34390
34400
34410
34420
34430
34440
34450
34460
34470
34480
34490
34500
34510
34520
34530
34540
34550
34560
34570
34580
34590
34600
34610
34620
34630
34640
34650
34660
34670
34680
34690
34700
34710
34720
34730
34740
34750
34760
34770
34780
34790
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Burke County, N Carolina .........................................................................................
Cabarrus County, N Carolina ....................................................................................
Caldwell County, N Carolina .....................................................................................
Camden County, N Carolina .....................................................................................
Carteret County, N Carolina ......................................................................................
Caswell County, N Carolina ......................................................................................
Catawba County, N Carolina .....................................................................................
Chatham County, N Carolina ....................................................................................
Cherokee County, N Carolina ...................................................................................
Chowan County, N Carolina ......................................................................................
Clay County, N Carolina ............................................................................................
Cleveland County, N Carolina ...................................................................................
Columbus County, N Carolina ...................................................................................
Craven County, N Carolina .......................................................................................
Cumberland County, N Carolina ...............................................................................
Currituck County, N Carolina ....................................................................................
Dare County, N Carolina ...........................................................................................
Davidson County, N Carolina ....................................................................................
Davie County, N Carolina ..........................................................................................
Duplin County, N Carolina .........................................................................................
Durham County, N Carolina ......................................................................................
Edgecombe County, N Carolina ................................................................................
Forsyth County, N Carolina .......................................................................................
Franklin County, N Carolina ......................................................................................
Gaston County, N Carolina .......................................................................................
Gates County, N Carolina .........................................................................................
Graham County, N Carolina ......................................................................................
Granville County, N Carolina .....................................................................................
Greene County, N Carolina .......................................................................................
Guilford County, N Carolina ......................................................................................
Halifax County, N Carolina ........................................................................................
Harnett County, N Carolina .......................................................................................
Haywood County, N Carolina ....................................................................................
Henderson County, N Carolina .................................................................................
Hertford County, N Carolina ......................................................................................
Hoke County, N Carolina ..........................................................................................
Hyde County, N Carolina ..........................................................................................
Iredell County, N Carolina .........................................................................................
Jackson County, N Carolina ......................................................................................
Johnston County, N Carolina ....................................................................................
Jones County, N Carolina .........................................................................................
Lee County, N Carolina .............................................................................................
Lenoir County, N Carolina .........................................................................................
Lincoln County, N Carolina .......................................................................................
Mc Dowell County, N Carolina ..................................................................................
Macon County, N Carolina ........................................................................................
Madison County, N Carolina .....................................................................................
Martin County, N Carolina .........................................................................................
Mecklenburg County, N Carolina ..............................................................................
Mitchell County, N Carolina .......................................................................................
Montgomery County, N Carolina ...............................................................................
Moore County, N Carolina .........................................................................................
Nash County, N Carolina ..........................................................................................
New Hanover County, N Carolina .............................................................................
Northampton County, N Carolina ..............................................................................
Onslow County, N Carolina .......................................................................................
Orange County, N Carolina .......................................................................................
Pamlico County, N Carolina ......................................................................................
Pasquotank County, N Carolina ................................................................................
Pender County, N Carolina .......................................................................................
Perquimans County, N Carolina ................................................................................
Person County, N Carolina .......................................................................................
Pitt County, N Carolina ..............................................................................................
Polk County, N Carolina ............................................................................................
Randolph County, N Carolina ...................................................................................
Richmond County, N Carolina ...................................................................................
Robeson County, N Carolina ....................................................................................
Rockingham County, N Carolina ...............................................................................
Rowan County, N Carolina ........................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00075
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
3290
1520
3290
34
34
34
3290
6640
34
34
34
34
34
34
2560
5720
34
3120
3120
34
6640
6895
3120
6640
1520
34
34
34
34
3120
34
34
34
34
34
34
34
34
34
6640
34
34
34
1520
34
34
0480
34
1520
34
34
34
6895
9200
34
3605
6640
34
34
34
34
34
3150
34
3120
34
34
34
1520
19MYP3
2006
MSAbased
WI
0.8922
0.9725
0.8922
0.8490
0.8490
0.8490
0.8922
1.0087
0.8490
0.8490
0.8490
0.8490
0.8490
0.8490
0.9426
0.8808
0.8490
0.9027
0.9027
0.8490
1.0087
0.8924
0.9027
1.0087
0.9725
0.8490
0.8490
0.8490
0.8490
0.9027
0.8490
0.8490
0.8490
0.8490
0.8490
0.8490
0.8490
0.8490
0.8490
1.0087
0.8490
0.8490
0.8490
0.9725
0.8490
0.8490
0.9747
0.8490
0.9725
0.8490
0.8490
0.8490
0.8924
0.9592
0.8490
0.8244
1.0087
0.8490
0.8490
0.8490
0.8490
0.8490
0.9434
0.8490
0.9027
0.8490
0.8490
0.8490
0.9725
2006
CBSAbased
WI
0.8922
0.9760
0.8922
0.8567
0.8567
0.8567
0.8922
1.0303
0.8567
0.8567
0.8567
0.8567
0.8567
0.8567
0.9426
0.8808
0.8567
0.8567
0.8953
0.8567
1.0303
0.8924
0.8953
0.9733
0.9760
0.8567
0.8567
0.8567
0.9434
0.9113
0.8567
0.8567
0.9294
0.9294
0.8567
0.9426
0.8567
0.8567
0.8567
0.9733
0.8567
0.8567
0.8567
0.8567
0.8567
0.8567
0.9294
0.8567
0.9760
0.8567
0.8567
0.8567
0.8924
0.9592
0.8567
0.8244
1.0303
0.8567
0.8567
0.9592
0.8567
1.0303
0.9434
0.8567
0.9113
0.8567
0.8567
0.9113
0.8567
CBSA
Number
25860
16740
25860
99934
99934
99934
25860
20500
99934
99934
99934
99934
99934
99934
22180
47260
99934
99934
49180
99934
20500
40580
49180
39580
16740
99934
99934
99934
24780
24660
99934
99934
11700
11700
99934
22180
99934
99934
99934
39580
99934
99934
99934
99934
99934
99934
11700
99934
16740
99934
99934
99934
40580
48900
99934
27340
20500
99934
99934
48900
99934
20500
24780
99934
24660
99934
99934
24660
99934
29144
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
34800
34810
34820
34830
34840
34850
34860
34870
34880
34890
34900
34910
34920
34930
34940
34950
34960
34970
34980
34981
35000
35010
35020
35030
35040
35050
35060
35070
35080
35090
35100
35110
35120
35130
35140
35150
35160
35170
35180
35190
35200
35210
35220
35230
35240
35250
35260
35270
35280
35290
35300
35310
35320
35330
35340
35350
35360
35370
35380
35390
35400
35410
35420
35430
35440
35450
35460
35470
35480
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Rutherford County, N Carolina ..................................................................................
Sampson County, N Carolina ....................................................................................
Scotland County, N Carolina .....................................................................................
Stanly County, N Carolina .........................................................................................
Stokes County, N Carolina ........................................................................................
Surry County, N Carolina ..........................................................................................
Swain County, N Carolina .........................................................................................
Transylvania County, N Carolina ..............................................................................
Tyrrell County, N Carolina .........................................................................................
Union County, N Carolina .........................................................................................
Vance County, N Carolina .........................................................................................
Wake County, N Carolina ..........................................................................................
Warren County, N Carolina .......................................................................................
Washington County, N Carolina ................................................................................
Watauga County, N Carolina ....................................................................................
Wayne County, N Carolina ........................................................................................
Wilkes County, N Carolina ........................................................................................
Wilson County, N Carolina ........................................................................................
Yadkin County, N Carolina ........................................................................................
Yancey County, N Carolina .......................................................................................
Adams County, N Dakota ..........................................................................................
Barnes County, N Dakota .........................................................................................
Benson County, N Dakota .........................................................................................
Billings County, N Dakota .........................................................................................
Bottineau County, N Dakota ......................................................................................
Bowman County, N Dakota .......................................................................................
Burke County, N Dakota ...........................................................................................
Burleigh County, N Dakota ........................................................................................
Cass County, N Dakota .............................................................................................
Cavalier County, N Dakota ........................................................................................
Dickey County, N Dakota ..........................................................................................
Divide County, N Dakota ...........................................................................................
Dunn County, N Dakota ............................................................................................
Eddy County, N Dakota .............................................................................................
Emmons County, N Dakota .......................................................................................
Foster County, N Dakota ...........................................................................................
Golden Valley County, N Dakota ..............................................................................
Grand Forks County, N Dakota .................................................................................
Grant County, N Dakota ............................................................................................
Griggs County, N Dakota ..........................................................................................
Hettinger County, N Dakota ......................................................................................
Kidder County, N Dakota ..........................................................................................
La Moure County, N Dakota .....................................................................................
Logan County, N Dakota ...........................................................................................
Mc Henry County, N Dakota .....................................................................................
Mc Intosh County, N Dakota .....................................................................................
Mc Kenzie County, N Dakota ....................................................................................
Mc Lean County, N Dakota .......................................................................................
Mercer County, N Dakota ..........................................................................................
Morton County, N Dakota ..........................................................................................
Mountrail County, N Dakota ......................................................................................
Nelson County, N Dakota ..........................................................................................
Oliver County, N Dakota ...........................................................................................
Pembina County, N Dakota .......................................................................................
Pierce County, N Dakota ...........................................................................................
Ramsey County, N Dakota ........................................................................................
Ransom County, N Dakota .......................................................................................
Renville County, N Dakota ........................................................................................
Richland County, N Dakota .......................................................................................
Rolette County, N Dakota .........................................................................................
Sargent County, N Dakota ........................................................................................
Sheridan County, N Dakota ......................................................................................
Sioux County, N Dakota ............................................................................................
Slope County, N Dakota ............................................................................................
Stark County, N Dakota ............................................................................................
Steele County, N Dakota ...........................................................................................
Stutsman County, N Dakota ......................................................................................
Towner County, N Dakota .........................................................................................
Traill County, N Dakota .............................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00076
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
34
34
34
1520
3120
34
34
34
34
1520
34
6640
34
34
34
2980
34
34
3120
34
35
35
35
35
35
35
35
1010
2520
35
35
35
35
35
35
35
35
2985
35
35
35
35
35
35
35
35
35
35
35
1010
35
35
35
35
35
35
35
35
35
35
35
35
35
35
35
35
35
35
35
19MYP3
2006
MSAbased
WI
0.8490
0.8490
0.8490
0.9725
0.9027
0.8490
0.8490
0.8490
0.8490
0.9725
0.8490
1.0087
0.8490
0.8490
0.8490
0.8784
0.8490
0.8490
0.9027
0.8490
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7519
0.8495
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
1.1516
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7519
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
2006
CBSAbased
WI
0.8567
0.8567
0.8567
0.9760
0.8953
0.8567
0.8567
0.8567
0.8567
0.9760
0.8567
0.9733
0.8567
0.8567
0.8567
0.8784
0.8567
0.8567
0.8953
0.8567
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7519
0.8495
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
1.1516
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7519
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
0.7268
CBSA
Number
99934
99934
99934
16740
49180
99934
99934
99934
99934
16740
99934
39580
99934
99934
99934
24140
99934
99934
49180
99934
99935
99935
99935
99935
99935
99935
99935
13900
22020
99935
99935
99935
99935
99935
99935
99935
99935
24220
99935
99935
99935
99935
99935
99935
99935
99935
99935
99935
99935
13900
99935
99935
99935
99935
99935
99935
99935
99935
99935
99935
99935
99935
99935
99935
99935
99935
99935
99935
99935
29145
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
35490
35500
35510
35520
36000
36010
36020
36030
36040
36050
36060
36070
36080
36090
36100
36110
36120
36130
36140
36150
36160
36170
36190
36200
36210
36220
36230
36240
36250
36260
36270
36280
36290
36300
36310
36330
36340
36350
36360
36370
36380
36390
36400
36410
36420
36430
36440
36450
36460
36470
36480
36490
36500
36510
36520
36530
36540
36550
36560
36570
36580
36590
36600
36610
36620
36630
36640
36650
36660
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Walsh County, N Dakota ...........................................................................................
Ward County, N Dakota ............................................................................................
Wells County, N Dakota ............................................................................................
Williams County, N Dakota .......................................................................................
Adams County, Ohio .................................................................................................
Allen County, Ohio ....................................................................................................
Ashland County, Ohio ...............................................................................................
Ashtabula County, Ohio ............................................................................................
Athens County, Ohio .................................................................................................
Auglaize County, Ohio ...............................................................................................
Belmont County, Ohio ...............................................................................................
Brown County, Ohio ..................................................................................................
Butler County, Ohio ...................................................................................................
Carroll County, Ohio ..................................................................................................
Champaign County, Ohio ..........................................................................................
Clark County, Ohio ....................................................................................................
Clermont County, Ohio ..............................................................................................
Clinton County, Ohio .................................................................................................
Columbiana County, Ohio .........................................................................................
Coshocton County, Ohio ...........................................................................................
Crawford County, Ohio ..............................................................................................
Cuyahoga County, Ohio ............................................................................................
Darke County, Ohio ...................................................................................................
Defiance County, Ohio ..............................................................................................
Delaware County, Ohio .............................................................................................
Erie County, Ohio ......................................................................................................
Fairfield County, Ohio ................................................................................................
Fayette County, Ohio ................................................................................................
Franklin County, Ohio ................................................................................................
Fulton County, Ohio ..................................................................................................
Gallia County, Ohio ...................................................................................................
Geauga County, Ohio ................................................................................................
Greene County, Ohio ................................................................................................
Guernsey County, Ohio .............................................................................................
Hamilton County, Ohio ..............................................................................................
Hancock County, Ohio ..............................................................................................
Hardin County, Ohio ..................................................................................................
Harrison County, Ohio ...............................................................................................
Henry County, Ohio ...................................................................................................
Highland County, Ohio ..............................................................................................
Hocking County, Ohio ...............................................................................................
Holmes County, Ohio ................................................................................................
Huron County, Ohio ...................................................................................................
Jackson County, Ohio ...............................................................................................
Jefferson County, Ohio ..............................................................................................
Knox County, Ohio ....................................................................................................
Lake County, Ohio .....................................................................................................
Lawrence County, Ohio .............................................................................................
Licking County, Ohio .................................................................................................
Logan County, Ohio ..................................................................................................
Lorain County, Ohio ..................................................................................................
Lucas County, Ohio ...................................................................................................
Madison County, Ohio ...............................................................................................
Mahoning County, Ohio .............................................................................................
Marion County, Ohio .................................................................................................
Medina County, Ohio .................................................................................................
Meigs County, Ohio ...................................................................................................
Mercer County, Ohio .................................................................................................
Miami County, Ohio ...................................................................................................
Monroe County, Ohio ................................................................................................
Montgomery County, Ohio ........................................................................................
Morgan County, Ohio ................................................................................................
Morrow County, Ohio ................................................................................................
Muskingum County, Ohio ..........................................................................................
Noble County, Ohio ...................................................................................................
Ottawa County, Ohio .................................................................................................
Paulding County, Ohio ..............................................................................................
Perry County, Ohio ....................................................................................................
Pickaway County, Ohio .............................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00077
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
35
35
35
35
36
4320
36
1680
36
4320
9000
1640
3200
1320
36
2000
1640
36
9320
36
4800
1680
36
36
1840
36
1840
36
1840
8400
36
1680
2000
36
1640
36
36
36
36
36
36
36
36
36
8080
36
1680
3400
1840
36
1680
8400
1840
9320
36
1680
36
36
2000
36
2000
36
36
36
36
36
36
36
1840
19MYP3
2006
MSAbased
WI
0.7268
0.7268
0.7268
0.7268
0.8886
0.9128
0.8886
0.9174
0.8886
0.9128
0.7168
0.9742
0.8960
0.8944
0.8886
0.8989
0.9742
0.8886
0.8857
0.8886
0.8886
0.9174
0.8886
0.8886
0.9864
0.8886
0.9864
0.8886
0.9864
0.9584
0.8886
0.9174
0.8989
0.8886
0.9742
0.8886
0.8886
0.8886
0.8886
0.8886
0.8886
0.8886
0.8886
0.8886
0.7827
0.8886
0.9174
0.9486
0.9864
0.8886
0.9174
0.9584
0.9864
0.8857
0.8886
0.9174
0.8886
0.8886
0.8989
0.8886
0.8989
0.8886
0.8886
0.8886
0.8886
0.8886
0.8886
0.8886
0.9864
2006
CBSAbased
WI
0.7268
0.7268
0.7268
0.7268
0.8786
0.9234
0.8786
0.8786
0.8786
0.8786
0.7168
0.9623
0.9623
0.8944
0.8786
0.8404
0.9623
0.8786
0.8786
0.8786
0.8786
0.9204
0.8786
0.8786
0.9850
0.9025
0.9850
0.8786
0.9850
0.9584
0.8786
0.9204
0.9073
0.8786
0.9623
0.8786
0.8786
0.8786
0.8786
0.8786
0.8786
0.8786
0.8786
0.8786
0.7827
0.8786
0.9204
0.9486
0.9850
0.8786
0.9204
0.9584
0.9850
0.8611
0.8786
0.9204
0.8786
0.8786
0.9073
0.8786
0.9073
0.8786
0.9850
0.8786
0.8786
0.9584
0.8786
0.8786
0.9850
CBSA
Number
99935
99935
99935
99935
99936
30620
99936
99936
99936
99936
48540
17140
17140
15940
99936
44220
17140
99936
99936
99936
99936
17460
99936
99936
18140
41780
18140
99936
18140
45780
99936
17460
19380
99936
17140
99936
99936
99936
99936
99936
99936
99936
99936
99936
48260
99936
17460
26580
18140
99936
17460
45780
18140
49660
99936
17460
99936
99936
19380
99936
19380
99936
18140
99936
99936
45780
99936
99936
18140
29146
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
36670
36680
36690
36700
36710
36720
36730
36740
36750
36760
36770
36780
36790
36800
36810
36820
36830
36840
36850
36860
36870
36880
36890
37000
37010
37020
37030
37040
37050
37060
37070
37080
37090
37100
37110
37120
37130
37140
37150
37160
37170
37180
37190
37200
37210
37220
37230
37240
37250
37260
37270
37280
37290
37300
37310
37320
37330
37340
37350
37360
37370
37380
37390
37400
37410
37420
37430
37440
37450
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Pike County, Ohio .....................................................................................................
Portage County, Ohio ................................................................................................
Preble County, Ohio ..................................................................................................
Putnam County, Ohio ................................................................................................
Richland County, Ohio ..............................................................................................
Ross County, Ohio ....................................................................................................
Sandusky County, Ohio .............................................................................................
Scioto County, Ohio ..................................................................................................
Seneca County, Ohio ................................................................................................
Shelby County, Ohio .................................................................................................
Stark County, Ohio ....................................................................................................
Summit County, Ohio ................................................................................................
Trumbull County, Ohio ..............................................................................................
Tuscarawas County, Ohio .........................................................................................
Union County, Ohio ...................................................................................................
Van Wert County, Ohio .............................................................................................
Vinton County, Ohio ..................................................................................................
Warren County, Ohio .................................................................................................
Washington County, Ohio .........................................................................................
Wayne County, Ohio .................................................................................................
Williams County, Ohio ...............................................................................................
Wood County, Ohio ...................................................................................................
Wyandot County, Ohio ..............................................................................................
Adair County, Oklahoma ...........................................................................................
Alfalfa County, Oklahoma ..........................................................................................
Atoka County, Oklahoma ..........................................................................................
Beaver County, Oklahoma ........................................................................................
Beckham County, Oklahoma .....................................................................................
Blaine County, Oklahoma ..........................................................................................
Bryan County, Oklahoma ..........................................................................................
Caddo County, Oklahoma .........................................................................................
Canadian County, Oklahoma ....................................................................................
Carter County, Oklahoma ..........................................................................................
Cherokee County, Oklahoma ....................................................................................
Choctaw County, Oklahoma ......................................................................................
Cimarron County, Oklahoma .....................................................................................
Cleveland County, Oklahoma ....................................................................................
Coal County, Oklahoma ............................................................................................
Comanche County, Oklahoma ..................................................................................
Cotton County, Oklahoma .........................................................................................
Craig County, Oklahoma ...........................................................................................
Creek County, Oklahoma ..........................................................................................
Custer County, Oklahoma .........................................................................................
Delaware County, Oklahoma ....................................................................................
Dewey County, Oklahoma .........................................................................................
Ellis County, Oklahoma .............................................................................................
Garfield County, Oklahoma .......................................................................................
Garvin County, Oklahoma .........................................................................................
Grady County, Oklahoma ..........................................................................................
Grant County, Oklahoma ...........................................................................................
Greer County, Oklahoma ..........................................................................................
Harmon County, Oklahoma .......................................................................................
Harper County, Oklahoma .........................................................................................
Haskell County, Oklahoma ........................................................................................
Hughes County, Oklahoma .......................................................................................
Jackson County, Oklahoma ......................................................................................
Jefferson County, Oklahoma .....................................................................................
Johnston County, Oklahoma .....................................................................................
Kay County, Oklahoma .............................................................................................
Kingfisher County, Oklahoma ....................................................................................
Kiowa County, Oklahoma ..........................................................................................
Latimer County, Oklahoma ........................................................................................
Le Flore County, Oklahoma ......................................................................................
Lincoln County, Oklahoma ........................................................................................
Logan County, Oklahoma ..........................................................................................
Love County, Oklahoma ............................................................................................
Mc Clain County, Oklahoma .....................................................................................
Mc Curtain County, Oklahoma ..................................................................................
Mc Intosh County, Oklahoma ....................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00078
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
36
0080
36
36
4800
36
36
36
36
36
1320
0080
9320
36
36
36
36
1640
6020
36
36
8400
36
37
37
37
37
37
37
37
37
5880
37
37
37
37
5880
37
4200
37
37
8560
37
37
37
37
2340
37
37
37
37
37
37
37
37
37
37
37
37
37
37
37
37
37
5880
37
5880
37
37
19MYP3
2006
MSAbased
WI
0.8886
0.8991
0.8886
0.8886
0.8886
0.8886
0.8886
0.8886
0.8886
0.8886
0.8944
0.8991
0.8857
0.8886
0.8886
0.8886
0.8886
0.9742
0.8278
0.8886
0.8886
0.9584
0.8886
0.7450
0.7450
0.7450
0.7450
0.7450
0.7450
0.7450
0.7450
0.9034
0.7450
0.7450
0.7450
0.7450
0.9034
0.7450
0.7880
0.7450
0.7450
0.8322
0.7450
0.7450
0.7450
0.7450
0.8675
0.7450
0.7450
0.7450
0.7450
0.7450
0.7450
0.7450
0.7450
0.7450
0.7450
0.7450
0.7450
0.7450
0.7450
0.7450
0.7450
0.7450
0.9034
0.7450
0.9034
0.7450
0.7450
2006
CBSAbased
WI
0.8786
0.8991
0.9073
0.8786
0.8887
0.8786
0.8786
0.8786
0.8786
0.8786
0.8944
0.8991
0.8611
0.8786
0.9850
0.8786
0.8786
0.9623
0.8278
0.8786
0.8786
0.9584
0.8786
0.7589
0.7589
0.7589
0.7589
0.7589
0.7589
0.7589
0.7589
0.9040
0.7589
0.7589
0.7589
0.7589
0.9040
0.7589
0.7880
0.7589
0.7589
0.8286
0.7589
0.7589
0.7589
0.7589
0.7589
0.7589
0.9040
0.7589
0.7589
0.7589
0.7589
0.7589
0.7589
0.7589
0.7589
0.7589
0.7589
0.7589
0.7589
0.7589
0.8214
0.9040
0.9040
0.7589
0.9040
0.7589
0.7589
CBSA
Number
99936
10420
19380
99936
31900
99936
99936
99936
99936
99936
15940
10420
49660
99936
18140
99936
99936
17140
37620
99936
99936
45780
99936
99937
99937
99937
99937
99937
99937
99937
99937
36420
99937
99937
99937
99937
36420
99937
30020
99937
99937
46140
99937
99937
99937
99937
99937
99937
36420
99937
99937
99937
99937
99937
99937
99937
99937
99937
99937
99937
99937
99937
22900
36420
36420
99937
36420
99937
99937
29147
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
37460
37470
37480
37490
37500
37510
37520
37530
37540
37550
37560
37570
37580
37590
37600
37610
37620
37630
37640
37650
37660
37670
37680
37690
37700
37710
37720
37730
37740
37750
37760
38000
38010
38020
38030
38040
38050
38060
38070
38080
38090
38100
38110
38120
38130
38140
38150
38160
38170
38180
38190
38200
38210
38220
38230
38240
38250
38260
38270
38280
38290
38300
38310
38320
38330
38340
38350
39000
39010
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Major County, Oklahoma ...........................................................................................
Marshall County, Oklahoma ......................................................................................
Mayes County, Oklahoma .........................................................................................
Murray County, Oklahoma ........................................................................................
Muskogee County, Oklahoma ...................................................................................
Noble County, Oklahoma ..........................................................................................
Nowata County, Oklahoma .......................................................................................
Okfuskee County, Oklahoma ....................................................................................
Oklahoma County, Oklahoma ...................................................................................
Okmulgee County, Oklahoma ...................................................................................
Osage County, Oklahoma .........................................................................................
Ottawa County, Oklahoma ........................................................................................
Pawnee County, Oklahoma .......................................................................................
Payne County, Oklahoma .........................................................................................
Pittsburg County, Oklahoma .....................................................................................
Pontotoc County, Oklahoma .....................................................................................
Pottawatomie County, Oklahoma ..............................................................................
Pushmataha County, Oklahoma ...............................................................................
Roger Mills County, Oklahoma .................................................................................
Rogers County, Oklahoma ........................................................................................
Seminole County, Oklahoma .....................................................................................
Sequoyah County, Oklahoma ...................................................................................
Stephens County, Oklahoma ....................................................................................
Texas County, Oklahoma ..........................................................................................
Tillman County, Oklahoma ........................................................................................
Tulsa County, Oklahoma ...........................................................................................
Wagoner County, Oklahoma .....................................................................................
Washington County, Oklahoma .................................................................................
Washita County, Oklahoma .......................................................................................
Woods County, Oklahoma ........................................................................................
Woodward County, Oklahoma ..................................................................................
Baker County, Oregon ...............................................................................................
Benton County, Oregon .............................................................................................
Clackamas County, Oregon ......................................................................................
Clatsop County, Oregon ............................................................................................
Columbia County, Oregon .........................................................................................
Coos County, Oregon ................................................................................................
Crook County, Oregon ..............................................................................................
Curry County, Oregon ...............................................................................................
Deschutes County, Oregon .......................................................................................
Douglas County, Oregon ...........................................................................................
Gilliam County, Oregon .............................................................................................
Grant County, Oregon ...............................................................................................
Harney County, Oregon ............................................................................................
Hood River County, Oregon ......................................................................................
Jackson County, Oregon ...........................................................................................
Jefferson County, Oregon .........................................................................................
Josephine County, Oregon ........................................................................................
Klamath County, Oregon ...........................................................................................
Lake County, Oregon ................................................................................................
Lane County, Oregon ................................................................................................
Lincoln County, Oregon .............................................................................................
Linn County, Oregon .................................................................................................
Malheur County, Oregon ...........................................................................................
Marion County, Oregon .............................................................................................
Morrow County, Oregon ............................................................................................
Multnomah County, Oregon ......................................................................................
Polk County, Oregon .................................................................................................
Sherman County, Oregon .........................................................................................
Tillamook County, Oregon .........................................................................................
Umatilla County, Oregon ...........................................................................................
Union County, Oregon ...............................................................................................
Wallowa County, Oregon ..........................................................................................
Wasco County, Oregon .............................................................................................
Washington County, Oregon .....................................................................................
Wheeler County, Oregon ...........................................................................................
Yamhill County, Oregon ............................................................................................
Adams County, Pennsylvania ...................................................................................
Allegheny County, Pennsylvania ...............................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00079
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
37
37
37
37
37
37
37
37
5880
37
8560
37
37
37
37
37
5880
37
37
8560
37
2720
37
37
37
8560
8560
37
37
37
37
38
1890
6440
38
6440
38
38
38
38
38
38
38
38
38
4890
38
38
38
38
2400
38
38
38
7080
38
6440
7080
38
38
38
38
38
38
6440
38
6440
39
6280
19MYP3
2006
MSAbased
WI
0.7450
0.7450
0.7450
0.7450
0.7450
0.7450
0.7450
0.7450
0.9034
0.7450
0.8322
0.7450
0.7450
0.7450
0.7450
0.7450
0.9034
0.7450
0.7450
0.8322
0.7450
0.8229
0.7450
0.7450
0.7450
0.8322
0.8322
0.7450
0.7450
0.7450
0.7450
1.0057
1.0739
1.1260
1.0057
1.1260
1.0057
1.0057
1.0057
1.0057
1.0057
1.0057
1.0057
1.0057
1.0057
1.0235
1.0057
1.0057
1.0057
1.0057
1.0829
1.0057
1.0057
1.0057
1.0452
1.0057
1.1260
1.0452
1.0057
1.0057
1.0057
1.0057
1.0057
1.0057
1.1260
1.0057
1.1260
0.8331
0.8868
2006
CBSAbased
WI
0.7589
0.7589
0.7589
0.7589
0.7589
0.7589
0.7589
0.7589
0.9040
0.8286
0.8286
0.7589
0.8286
0.7589
0.7589
0.7589
0.7589
0.7589
0.7589
0.8286
0.7589
0.8214
0.7589
0.7589
0.7589
0.8286
0.8286
0.7589
0.7589
0.7589
0.7589
0.9830
1.0739
1.1260
0.9830
1.1260
0.9830
0.9830
0.9830
1.0796
0.9830
0.9830
0.9830
0.9830
0.9830
1.0235
0.9830
0.9830
0.9830
0.9830
1.0829
0.9830
0.9830
0.9830
1.0452
0.9830
1.1260
1.0452
0.9830
0.9830
0.9830
0.9830
0.9830
0.9830
1.1260
0.9830
1.1260
0.8302
0.8853
CBSA
Number
99937
99937
99937
99937
99937
99937
99937
99937
36420
46140
46140
99937
46140
99937
99937
99937
99937
99937
99937
46140
99937
22900
99937
99937
99937
46140
46140
99937
99937
99937
99937
99938
18700
38900
99938
38900
99938
99938
99938
13460
99938
99938
99938
99938
99938
32780
99938
99938
99938
99938
21660
99938
99938
99938
41420
99938
38900
41420
99938
99938
99938
99938
99938
99938
38900
99938
38900
99939
38300
29148
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
39070
39080
39100
39110
39120
39130
39140
39150
39160
39180
39190
39200
39210
39220
39230
39240
39250
39260
39270
39280
39290
39310
39320
39330
39340
39350
39360
39370
39380
39390
39400
39410
39420
39440
39450
39460
39470
39480
39510
39520
39530
39540
39550
39560
39580
39590
39600
39610
39620
39630
39640
39650
39670
39680
39690
39700
39710
39720
39730
39740
39750
39760
39770
39790
39800
40010
40020
40030
40040
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Armstrong County, Pennsylvania ..............................................................................
Beaver County, Pennsylvania ...................................................................................
Bedford County, Pennsylvania ..................................................................................
Berks County, Pennsylvania .....................................................................................
Blair County, Pennsylvania .......................................................................................
Bradford County, Pennsylvania .................................................................................
Bucks County, Pennsylvania .....................................................................................
Butler County, Pennsylvania .....................................................................................
Cambria County, Pennsylvania .................................................................................
Cameron County, Pennsylvania ................................................................................
Carbon County, Pennsylvania ...................................................................................
Centre County, Pennsylvania ....................................................................................
Chester County, Pennsylvania ..................................................................................
Clarion County, Pennsylvania ...................................................................................
Clearfield County, Pennsylvania ...............................................................................
Clinton County, Pennsylvania ...................................................................................
Columbia County, Pennsylvania ...............................................................................
Crawford County, Pennsylvania ................................................................................
Cumberland County, Pennsylvania ...........................................................................
Dauphin County, Pennsylvania .................................................................................
Delaware County, Pennsylvania ...............................................................................
Elk County, Pennsylvania ..........................................................................................
Erie County, Pennsylvania ........................................................................................
Fayette County, Pennsylvania ...................................................................................
Forest County, Pennsylvania ....................................................................................
Franklin County, Pennsylvania ..................................................................................
Fulton County, Pennsylvania .....................................................................................
Greene County, Pennsylvania ...................................................................................
Huntingdon County, Pennsylvania ............................................................................
Indiana County, Pennsylvania ...................................................................................
Jefferson County, Pennsylvania ................................................................................
Juniata County, Pennsylvania ...................................................................................
Lackawanna County, Pennsylvania ..........................................................................
Lancaster County, Pennsylvania ...............................................................................
Lawrence County, Pennsylvania ...............................................................................
Lebanon County, Pennsylvania .................................................................................
Lehigh County, Pennsylvania ....................................................................................
Luzerne County, Pennsylvania ..................................................................................
Lycoming County, Pennsylvania ...............................................................................
Mc Kean County, Pennsylvania ................................................................................
Mercer County, Pennsylvania ...................................................................................
Mifflin County, Pennsylvania .....................................................................................
Monroe County, Pennsylvania ..................................................................................
Montgomery County, Pennsylvania ...........................................................................
Montour County, Pennsylvania .................................................................................
Northampton County, Pennsylvania ..........................................................................
Northumberland County, Pennsylvania .....................................................................
Perry County, Pennsylvania ......................................................................................
Philadelphia County, Pennsylvania ...........................................................................
Pike County, Pennsylvania ........................................................................................
Potter County, Pennsylvania .....................................................................................
Schuylkill County, Pennsylvania ................................................................................
Snyder County, Pennsylvania ...................................................................................
Somerset County, Pennsylvania ...............................................................................
Sullivan County, Pennsylvania ..................................................................................
Susquehanna County, Pennsylvania ........................................................................
Tioga County, Pennsylvania ......................................................................................
Union County, Pennsylvania .....................................................................................
Venango County, Pennsylvania ................................................................................
Warren County, Pennsylvania ...................................................................................
Washington County, Pennsylvania ............................................................................
Wayne County, Pennsylvania ...................................................................................
Westmoreland County, Pennsylvania .......................................................................
Wyoming County, Pennsylvania ................................................................................
York County, Pennsylvania .......................................................................................
Adjuntas County, Puerto Rico ...................................................................................
Aguada County, Puerto Rico .....................................................................................
Aguadilla County, Puerto Rico ..................................................................................
Aguas Buenas County, Puerto Rico .........................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00080
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
39
6280
39
6680
0280
39
6160
6280
3680
39
0240
8050
6160
39
39
39
7560
39
3240
3240
6160
39
2360
6280
39
39
39
39
39
39
39
39
7560
4000
39
3240
0240
7560
9140
39
7610
39
39
6160
39
0240
39
3240
6160
5660
39
39
39
3680
39
39
39
39
39
39
6280
39
6280
7560
9280
40
0060
0060
7440
19MYP3
2006
MSAbased
WI
0.8331
0.8868
0.8331
0.9696
0.8953
0.8331
1.0926
0.8868
0.8094
0.8331
0.9855
0.8364
1.0926
0.8331
0.8331
0.8331
0.8533
0.8331
0.9242
0.9242
1.0926
0.8331
0.8746
0.8868
0.8331
0.8331
0.8331
0.8331
0.8331
0.8331
0.8331
0.8331
0.8533
0.9704
0.8331
0.9242
0.9855
0.8533
0.8377
0.8331
0.7801
0.8331
0.8331
1.0926
0.8331
0.9855
0.8331
0.9242
1.0926
1.1218
0.8331
0.8331
0.8331
0.8094
0.8331
0.8331
0.8331
0.8331
0.8331
0.8331
0.8868
0.8331
0.8868
0.8533
0.9420
0.3608
0.4881
0.4881
0.4855
2006
CBSAbased
WI
0.8853
0.8853
0.8302
0.9696
0.8953
0.8302
1.1040
0.8853
0.8362
0.8302
0.9828
0.8364
1.1040
0.8302
0.8302
0.8302
0.8302
0.8302
0.9322
0.9322
1.1040
0.8302
0.8746
0.8853
0.8302
0.8302
0.8302
0.8302
0.8302
0.8302
0.8302
0.8302
0.8548
0.9704
0.8302
0.8468
0.9828
0.8548
0.8377
0.8302
0.8611
0.8302
0.8302
1.1040
0.8302
0.9828
0.8302
0.9322
1.1040
1.2195
0.8302
0.8302
0.8302
0.8302
0.8302
0.8302
0.8302
0.8302
0.8302
0.8302
0.8853
0.8302
0.8853
0.8548
0.9420
0.4047
0.4743
0.4743
0.4686
CBSA
Number
38300
38300
99939
39740
11020
99939
37964
38300
27780
99939
10900
44300
37964
99939
99939
99939
99939
99939
25420
25420
37964
99939
21500
38300
99939
99939
99939
99939
99939
99939
99939
99939
42540
29540
99939
30140
10900
42540
48700
99939
49660
99939
99939
37964
99939
10900
99939
25420
37964
35084
99939
99939
99939
99939
99939
99939
99939
99939
99939
99939
38300
99939
38300
42540
49620
99940
10380
10380
41980
29149
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
40050
40060
40070
40080
40090
40100
40110
40120
40130
40140
40145
40150
40160
40170
40180
40190
40200
40210
40220
40230
40240
40250
40260
40265
40270
40280
40290
40300
40310
40320
40330
40340
40350
40360
40370
40380
40390
40400
40410
40420
40430
40440
40450
40460
40470
40480
40490
40500
40510
40520
40530
40540
40550
40560
40570
40580
40590
40610
40620
40630
40640
40650
40660
40670
40680
40690
40700
40710
40720
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Aibonito County, Puerto Rico ....................................................................................
Anasco County, Puerto Rico .....................................................................................
Arecibo County, Puerto Rico .....................................................................................
Arroyo County, Puerto Rico ......................................................................................
Barceloneta County, Puerto Rico ..............................................................................
Barranquitas County, Puerto Rico .............................................................................
Bayamon County, Puerto Rico ..................................................................................
Cabo Rojo County, Puerto Rico ................................................................................
Caguas County, Puerto Rico .....................................................................................
Camuy County, Puerto Rico ......................................................................................
Canovanas County, Puerto Rico ...............................................................................
Carolina County, Puerto Rico ....................................................................................
Catano County, Puerto Rico .....................................................................................
Cayey County, Puerto Rico .......................................................................................
Ceiba County, Puerto Rico ........................................................................................
Ciales County, Puerto Rico .......................................................................................
Cidra County, Puerto Rico ........................................................................................
Coamo County, Puerto Rico .....................................................................................
Comerio County, Puerto Rico ...................................................................................
Corozal County, Puerto Rico .....................................................................................
Culebra County, Puerto Rico ....................................................................................
Dorado County, Puerto Rico .....................................................................................
Fajardo County, Puerto Rico .....................................................................................
Florida County, Puerto Rico ......................................................................................
Guanica County, Puerto Rico ....................................................................................
Guayama County, Puerto Rico .................................................................................
Guayanilla County, Puerto Rico ................................................................................
Guaynabo County, Puerto Rico ................................................................................
Gurabo County, Puerto Rico .....................................................................................
Hatillo County, Puerto Rico .......................................................................................
Hormigueros County, Puerto Rico ............................................................................
Humacao County, Puerto Rico ..................................................................................
Isabela County, Puerto Rico .....................................................................................
Jayuya County, Puerto Rico ......................................................................................
Juana Diaz County, Puerto Rico ...............................................................................
Juncos County, Puerto Rico ......................................................................................
Lajas County, Puerto Rico ........................................................................................
Lares County, Puerto Rico ........................................................................................
Las Marias County, Puerto Rico ...............................................................................
Las Piedras County, Puerto Rico ..............................................................................
Loiza County, Puerto Rico ........................................................................................
Luquillo County, Puerto Rico .....................................................................................
Manati County, Puerto Rico ......................................................................................
Maricao County, Puerto Rico ....................................................................................
Maunabo County, Puerto Rico ..................................................................................
Mayaguez County, Puerto Rico ................................................................................
Moca County, Puerto Rico ........................................................................................
Morovis County, Puerto Rico ....................................................................................
Naguabo County, Puerto Rico ..................................................................................
Naranjito County, Puerto Rico ...................................................................................
Orocovis County, Puerto Rico ...................................................................................
Patillas County, Puerto Rico .....................................................................................
Penuelas County, Puerto Rico ..................................................................................
Ponce County, Puerto Rico .......................................................................................
Quebradillas County, Puerto Rico .............................................................................
Rincon County, Puerto Rico ......................................................................................
Rio Grande County, Puerto Rico ..............................................................................
Sabana Grande County, Puerto Rico .......................................................................
Salinas County, Puerto Rico .....................................................................................
San German County, Puerto Rico ............................................................................
San Juan County, Puerto Rico ..................................................................................
San Lorenzo County, Puerto Rico ............................................................................
San Sebastian County, Puerto Rico .........................................................................
Santa Isabel County, Puerto Rico .............................................................................
Toa Alta County, Puerto Rico ...................................................................................
Toa Baja County, Puerto Rico ..................................................................................
Trujillo Alto County, Puerto Rico ...............................................................................
Utuado County, Puerto Rico .....................................................................................
Vega Alta County, Puerto Rico .................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00081
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
40
4840
0470
40
7440
40
7440
4840
1310
0470
7440
7440
7440
1310
7440
40
1310
40
7440
7440
40
7440
7440
7440
40
40
6360
7440
1310
0470
4840
7440
40
40
6360
7440
40
40
40
7440
7440
7440
7440
40
40
4840
0060
7440
7440
7440
40
40
6360
6360
40
40
7440
4840
40
4840
7440
1310
40
40
7440
7440
7440
40
7440
19MYP3
2006
MSAbased
WI
0.3608
0.4246
0.4116
0.3608
0.4855
0.3608
0.4855
0.4246
0.4020
0.4116
0.4855
0.4855
0.4855
0.4020
0.4855
0.3608
0.4020
0.3608
0.4855
0.4855
0.3608
0.4855
0.4855
0.4855
0.3608
0.3608
0.5091
0.4855
0.4020
0.4116
0.4246
0.4855
0.3608
0.3608
0.5091
0.4855
0.3608
0.3608
0.3608
0.4855
0.4855
0.4855
0.4855
0.3608
0.3608
0.4246
0.4881
0.4855
0.4855
0.4855
0.3608
0.3608
0.5091
0.5091
0.3608
0.3608
0.4855
0.4246
0.3608
0.4246
0.4855
0.4020
0.3608
0.3608
0.4855
0.4855
0.4855
0.3608
0.4855
2006
CBSAbased
WI
0.4686
0.4743
0.4686
0.3184
0.4686
0.4686
0.4686
0.4655
0.4686
0.4686
0.4686
0.4686
0.4686
0.4686
0.4157
0.4686
0.4686
0.4047
0.4686
0.4686
0.4047
0.4686
0.4157
0.4686
0.4413
0.3184
0.4413
0.4686
0.4686
0.4686
0.4017
0.4686
0.4743
0.4047
0.5177
0.4686
0.4655
0.4743
0.4047
0.4686
0.4686
0.4157
0.4686
0.4047
0.4686
0.4017
0.4743
0.4686
0.4686
0.4686
0.4686
0.3184
0.4413
0.5177
0.4686
0.4743
0.4686
0.4655
0.4047
0.4655
0.4686
0.4686
0.4743
0.4047
0.4686
0.4686
0.4686
0.4047
0.4686
CBSA
Number
41980
10380
41980
25020
41980
41980
41980
41900
41980
41980
41980
41980
41980
41980
21940
41980
41980
99940
41980
41980
99940
41980
21940
41980
49500
25020
49500
41980
41980
41980
32420
41980
10380
99940
38660
41980
41900
10380
99940
41980
41980
21940
41980
99940
41980
32420
10380
41980
41980
41980
41980
25020
49500
38660
41980
10380
41980
41900
99940
41900
41980
41980
10380
99940
41980
41980
41980
99940
41980
29150
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
40730
40740
40750
40760
40770
41000
41010
41020
41030
41050
42000
42010
42020
42030
42040
42050
42060
42070
42080
42090
42100
42110
42120
42130
42140
42150
42160
42170
42180
42190
42200
42210
42220
42230
42240
42250
42260
42270
42280
42290
42300
42310
42320
42330
42340
42350
42360
42370
42380
42390
42400
42410
42420
42430
42440
42450
43010
43020
43030
43040
43050
43060
43070
43080
43090
43100
43110
43120
43130
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Vega Baja County, Puerto Rico ................................................................................
Vieques County, Puerto Rico ....................................................................................
Villalba County, Puerto Rico .....................................................................................
Yabucoa County, Puerto Rico ...................................................................................
Yauco County, Puerto Rico .......................................................................................
Bristol County, Rhode Island .....................................................................................
Kent County, Rhode Island .......................................................................................
Newport County, Rhode Island .................................................................................
Providence County, Rhode Island .............................................................................
Washington County, Rhode Island ............................................................................
Abbeville County, S Carolina ....................................................................................
Aiken County, S Carolina ..........................................................................................
Allendale County, S Carolina ....................................................................................
Anderson County, S Carolina ....................................................................................
Bamberg County, S Carolina ....................................................................................
Barnwell County, S Carolina .....................................................................................
Beaufort County, S Carolina .....................................................................................
Berkeley County, S Carolina .....................................................................................
Calhoun County, S Carolina ......................................................................................
Charleston County, S Carolina ..................................................................................
Cherokee County, S Carolina ...................................................................................
Chester County, S Carolina ......................................................................................
Chesterfield County, S Carolina ................................................................................
Clarendon County, S Carolina ..................................................................................
Colleton County, S Carolina ......................................................................................
Darlington County, S Carolina ...................................................................................
Dillon County, S Carolina ..........................................................................................
Dorchester County, S Carolina .................................................................................
Edgefield County, S Carolina ....................................................................................
Fairfield County, S Carolina ......................................................................................
Florence County, S Carolina .....................................................................................
Georgetown County, S Carolina ...............................................................................
Greenville County, S Carolina ...................................................................................
Greenwood County, S Carolina ................................................................................
Hampton County, S Carolina ....................................................................................
Horry County, S Carolina ..........................................................................................
Jasper County, S Carolina ........................................................................................
Kershaw County, S Carolina .....................................................................................
Lancaster County, S Carolina ...................................................................................
Laurens County, S Carolina ......................................................................................
Lee County, S Carolina .............................................................................................
Lexington County, S Carolina ...................................................................................
Mc Cormick County, S Carolina ................................................................................
Marion County, S Carolina ........................................................................................
Marlboro County, S Carolina .....................................................................................
Newberry County, S Carolina ....................................................................................
Oconee County, S Carolina ......................................................................................
Orangeburg County, S Carolina ................................................................................
Pickens County, S Carolina ......................................................................................
Richland County, S Carolina .....................................................................................
Saluda County, S Carolina ........................................................................................
Spartanburg County, S Carolina ...............................................................................
Sumter County, S Carolina .......................................................................................
Union County, S Carolina ..........................................................................................
Williamsburg County, S Carolina ..............................................................................
York County, S Carolina ............................................................................................
Aurora County, S Dakota ..........................................................................................
Beadle County, S Dakota ..........................................................................................
Bennett County, S Dakota .........................................................................................
Bon Homme County, S Dakota .................................................................................
Brookings County, S Dakota .....................................................................................
Brown County, S Dakota ...........................................................................................
Brule County, S Dakota .............................................................................................
Buffalo County, S Dakota ..........................................................................................
Butte County, S Dakota .............................................................................................
Campbell County, S Dakota ......................................................................................
Charles Mix County, S Dakota ..................................................................................
Clark County, S Dakota .............................................................................................
Clay County, S Dakota ..............................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00082
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
7440
40
6360
7440
6360
6483
6483
6483
6483
6483
42
0600
42
3160
42
42
42
1440
42
1440
3160
42
42
42
42
42
42
1440
0600
42
2655
42
3160
42
42
5330
42
42
42
42
42
1760
42
42
42
42
42
42
3160
1760
42
3160
8140
42
42
1520
43
43
43
43
43
43
43
43
43
43
43
43
43
19MYP3
2006
MSAbased
WI
0.4855
0.3608
0.5091
0.4855
0.5091
1.1060
1.1060
1.1060
1.1060
1.1060
0.8634
0.9619
0.8634
0.9677
0.8634
0.8634
0.8634
0.9438
0.8634
0.9438
0.9677
0.8634
0.8634
0.8634
0.8634
0.8634
0.8634
0.9438
0.9619
0.8634
0.9060
0.8634
0.9677
0.8634
0.8634
0.8873
0.8634
0.8634
0.8634
0.8634
0.8634
0.9071
0.8634
0.8634
0.8634
0.8634
0.8634
0.8634
0.9677
0.9071
0.8634
0.9677
0.8386
0.8634
0.8634
0.9725
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
2006
CBSAbased
WI
0.4686
0.4047
0.5177
0.4686
0.4413
1.0966
1.0966
1.0966
1.0966
1.0966
0.8641
0.9565
0.8641
0.8897
0.8641
0.8641
0.8641
0.9438
0.9047
0.9438
0.8641
0.8641
0.8641
0.8641
0.8641
0.8964
0.8641
0.9438
0.9565
0.9047
0.8964
0.8641
1.0165
0.8641
0.8641
0.8873
0.8641
0.9047
0.8641
1.0165
0.8641
0.9047
0.8641
0.8641
0.8641
0.8641
0.8641
0.8641
1.0165
0.9047
0.9047
0.9181
0.8386
0.8641
0.8641
0.9760
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
CBSA
Number
41980
99940
38660
41980
49500
39300
39300
39300
39300
39300
99942
12260
99942
11340
99942
99942
99942
16700
17900
16700
99942
99942
99942
99942
99942
22500
99942
16700
12260
17900
22500
99942
24860
99942
99942
34820
99942
17900
99942
24860
99942
17900
99942
99942
99942
99942
99942
99942
24860
17900
17900
43900
44940
99942
99942
16740
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
29151
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
43140
43150
43160
43170
43180
43190
43200
43210
43220
43230
43240
43250
43260
43270
43280
43290
43300
43310
43320
43330
43340
43350
43360
43370
43380
43390
43400
43410
43420
43430
43440
43450
43460
43470
43480
43490
43500
43510
43520
43530
43540
43550
43560
43570
43580
43590
43600
43610
43620
43630
43640
43650
43670
43680
44000
44010
44020
44030
44040
44050
44060
44070
44080
44090
44100
44110
44120
44130
44140
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Codington County, S Dakota .....................................................................................
Corson County, S Dakota .........................................................................................
Custer County, S Dakota ..........................................................................................
Davison County, S Dakota ........................................................................................
Day County, S Dakota ...............................................................................................
Deuel County, S Dakota ............................................................................................
Dewey County, S Dakota ..........................................................................................
Douglas County, S Dakota ........................................................................................
Edmunds County, S Dakota ......................................................................................
Fall River County, S Dakota ......................................................................................
Faulk County, S Dakota ............................................................................................
Grant County, S Dakota ............................................................................................
Gregory County, S Dakota ........................................................................................
Haakon County, S Dakota .........................................................................................
Hamlin County, S Dakota ..........................................................................................
Hand County, S Dakota ............................................................................................
Hanson County, S Dakota .........................................................................................
Harding County, S Dakota ........................................................................................
Hughes County, S Dakota .........................................................................................
Hutchinson County, S Dakota ...................................................................................
Hyde County, S Dakota .............................................................................................
Jackson County, S Dakota ........................................................................................
Jerauld County, S Dakota .........................................................................................
Jones County, S Dakota ...........................................................................................
Kingsbury County, S Dakota .....................................................................................
Lake County, S Dakota .............................................................................................
Lawrence County, S Dakota .....................................................................................
Lincoln County, S Dakota ..........................................................................................
Lyman County, S Dakota ..........................................................................................
Mc Cook County, S Dakota .......................................................................................
Mc Pherson County, S Dakota ..................................................................................
Marshall County, S Dakota .......................................................................................
Meade County, S Dakota ..........................................................................................
Mellette County, S Dakota ........................................................................................
Miner County, S Dakota ............................................................................................
Minnehaha County, S Dakota ...................................................................................
Moody County, S Dakota ..........................................................................................
Pennington County, S Dakota ...................................................................................
Perkins County, S Dakota .........................................................................................
Potter County, S Dakota ...........................................................................................
Roberts County, S Dakota ........................................................................................
Sanborn County, S Dakota .......................................................................................
Shannon County, S Dakota .......................................................................................
Spink County, S Dakota ............................................................................................
Stanley County, S Dakota .........................................................................................
Sully County, S Dakota .............................................................................................
Todd County, S Dakota .............................................................................................
Tripp County, S Dakota .............................................................................................
Turner County, S Dakota ..........................................................................................
Union County, S Dakota ............................................................................................
Walworth County, S Dakota ......................................................................................
Washabaugh County, S Dakota ................................................................................
Yankton County, S Dakota ........................................................................................
Ziebach County, S Dakota ........................................................................................
Anderson County, Tennessee ...................................................................................
Bedford County, Tennessee ......................................................................................
Benton County, Tennessee .......................................................................................
Bledsoe County, Tennessee .....................................................................................
Blount County, Tennessee ........................................................................................
Bradley County, Tennessee ......................................................................................
Campbell County, Tennessee ...................................................................................
Cannon County, Tennessee ......................................................................................
Carroll County, Tennessee ........................................................................................
Carter County, Tennessee ........................................................................................
Cheatham County, Tennessee ..................................................................................
Chester County, Tennessee ......................................................................................
Claiborne County, Tennessee ...................................................................................
Clay County, Tennessee ...........................................................................................
Cocke County, Tennessee ........................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00083
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
7760
43
43
43
43
43
43
43
7760
43
6660
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
43
3840
44
44
44
3840
44
44
44
44
3660
5360
3580
44
44
44
19MYP3
2006
MSAbased
WI
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.9645
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.9645
0.8476
0.9021
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8476
0.8411
0.7988
0.7988
0.7988
0.8411
0.7988
0.7988
0.7988
0.7988
0.8015
0.9787
0.8973
0.7988
0.7988
0.7988
2006
CBSAbased
WI
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.9645
0.8484
0.9645
0.8484
0.8484
0.9021
0.8484
0.8484
0.9645
0.8484
0.9021
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.8484
0.9645
0.9376
0.8484
0.8484
0.8484
0.8484
0.8454
0.7888
0.7888
0.7888
0.8454
0.8141
0.7888
0.9769
0.7888
0.7945
0.9769
0.8973
0.7888
0.7888
0.7888
CBSA
Number
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
43620
99943
43620
99943
99943
39660
99943
99943
43620
99943
39660
99943
99943
99943
99943
99943
99943
99943
99943
99943
99943
43620
43580
99943
99943
99943
99943
28940
99944
99944
99944
28940
17420
99944
34980
99944
27740
34980
27180
99944
99944
99944
29152
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
44150
44160
44170
44180
44190
44200
44210
44220
44230
44240
44250
44260
44270
44280
44290
44300
44310
44320
44330
44340
44350
44360
44370
44380
44390
44400
44410
44420
44430
44440
44450
44460
44470
44480
44490
44500
44510
44520
44530
44540
44550
44560
44570
44580
44590
44600
44610
44620
44630
44640
44650
44660
44670
44680
44690
44700
44710
44720
44730
44740
44750
44760
44770
44780
44790
44800
44810
44820
44830
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Coffee County, Tennessee ........................................................................................
Crockett County, Tennessee .....................................................................................
Cumberland County, Tennessee ...............................................................................
Davidson County, Tennessee ...................................................................................
Decatur County, Tennessee ......................................................................................
De Kalb County, Tennessee .....................................................................................
Dickson County, Tennessee .....................................................................................
Dyer County, Tennessee ...........................................................................................
Fayette County, Tennessee ......................................................................................
Fentress County, Tennessee ....................................................................................
Franklin County, Tennessee .....................................................................................
Gibson County, Tennessee .......................................................................................
Giles County, Tennessee ..........................................................................................
Grainger County, Tennessee ....................................................................................
Greene County, Tennessee ......................................................................................
Grundy County, Tennessee ......................................................................................
Hamblen County, Tennessee ....................................................................................
Hamilton County, Tennessee ....................................................................................
Hancock County, Tennessee ....................................................................................
Hardeman County, Tennessee .................................................................................
Hardin County, Tennessee ........................................................................................
Hawkins County, Tennessee .....................................................................................
Haywood County, Tennessee ...................................................................................
Henderson County, Tennessee .................................................................................
Henry County, Tennessee .........................................................................................
Hickman County, Tennessee ....................................................................................
Houston County, Tennessee .....................................................................................
Humphreys County, Tennessee ................................................................................
Jackson County, Tennessee .....................................................................................
Jefferson County, Tennessee ...................................................................................
Johnson County, Tennessee .....................................................................................
Knox County, Tennessee ..........................................................................................
Lake County, Tennessee ..........................................................................................
Lauderdale County, Tennessee ................................................................................
Lawrence County, Tennessee ...................................................................................
Lewis County, Tennessee .........................................................................................
Lincoln County, Tennessee .......................................................................................
Loudon County, Tennessee ......................................................................................
Mc Minn County, Tennessee ....................................................................................
Mc Nairy County, Tennessee ....................................................................................
Macon County, Tennessee .......................................................................................
Madison County, Tennessee .....................................................................................
Marion County, Tennessee .......................................................................................
Marshall County, Tennessee .....................................................................................
Maury County, Tennessee ........................................................................................
Meigs County, Tennessee .........................................................................................
Monroe County, Tennessee ......................................................................................
Montgomery County, Tennessee ..............................................................................
Moore County, Tennessee ........................................................................................
Morgan County, Tennessee ......................................................................................
Obion County, Tennessee .........................................................................................
Overton County, Tennessee .....................................................................................
Perry County, Tennessee ..........................................................................................
Pickett County, Tennessee .......................................................................................
Polk County, Tennessee ...........................................................................................
Putnam County, Tennessee ......................................................................................
Rhea County, Tennessee ..........................................................................................
Roane County, Tennessee ........................................................................................
Robertson County, Tennessee ..................................................................................
Rutherford County, Tennessee .................................................................................
Scott County, Tennessee ..........................................................................................
Sequatchie County, Tennessee ................................................................................
Sevier County, Tennessee ........................................................................................
Shelby County, Tennessee .......................................................................................
Smith County, Tennessee .........................................................................................
Stewart County, Tennessee ......................................................................................
Sullivan County, Tennessee ......................................................................................
Sumner County, Tennessee ......................................................................................
Tipton County, Tennessee ........................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00084
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
44
44
44
5360
44
44
5360
44
4920
44
44
44
44
44
44
44
44
1560
44
44
44
3660
44
44
44
44
44
44
44
44
44
3840
44
44
44
44
44
3840
44
44
44
3580
1560
44
44
44
44
1660
44
44
44
44
44
44
44
44
44
44
5360
5360
44
44
3840
4920
44
44
3660
5360
4920
19MYP3
2006
MSAbased
WI
0.7988
0.7988
0.7988
0.9787
0.7988
0.7988
0.9787
0.7988
0.9360
0.7988
0.7988
0.7988
0.7988
0.7988
0.7988
0.7988
0.7988
0.9098
0.7988
0.7988
0.7988
0.8015
0.7988
0.7988
0.7988
0.7988
0.7988
0.7988
0.7988
0.7988
0.7988
0.8411
0.7988
0.7988
0.7988
0.7988
0.7988
0.8411
0.7988
0.7988
0.7988
0.8973
0.9098
0.7988
0.7988
0.7988
0.7988
0.8292
0.7988
0.7988
0.7988
0.7988
0.7988
0.7988
0.7988
0.7988
0.7988
0.7988
0.9787
0.9787
0.7988
0.7988
0.8411
0.9360
0.7988
0.7988
0.8015
0.9787
0.9360
2006
CBSAbased
WI
0.7888
0.7888
0.7888
0.9769
0.7888
0.7888
0.9769
0.7888
0.9341
0.7888
0.7888
0.7888
0.7888
0.8753
0.7888
0.7888
0.8753
0.9098
0.7888
0.7888
0.7888
0.8062
0.7888
0.7888
0.7888
0.9769
0.7888
0.7888
0.7888
0.8753
0.7888
0.8454
0.7888
0.7888
0.7888
0.7888
0.7888
0.8454
0.7888
0.7888
0.9769
0.8973
0.9098
0.7888
0.7888
0.7888
0.7888
0.8292
0.7888
0.7888
0.7888
0.7888
0.7888
0.7888
0.8141
0.7888
0.7888
0.7888
0.9769
0.9769
0.7888
0.9098
0.7888
0.9341
0.9769
0.8292
0.8062
0.9769
0.9341
CBSA
Number
99944
99944
99944
34980
99944
99944
34980
99944
32820
99944
99944
99944
99944
34100
99944
99944
34100
16860
99944
99944
99944
28700
99944
99944
99944
34980
99944
99944
99944
34100
99944
28940
99944
99944
99944
99944
99944
28940
99944
99944
34980
27180
16860
99944
99944
99944
99944
17300
99944
99944
99944
99944
99944
99944
17420
99944
99944
99944
34980
34980
99944
16860
99944
32820
34980
17300
28700
34980
32820
29153
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
44840
44850
44860
44870
44880
44890
44900
44910
44920
44930
44940
45000
45010
45020
45030
45040
45050
45060
45070
45080
45090
45100
45110
45113
45120
45130
45140
45150
45160
45170
45180
45190
45200
45201
45210
45220
45221
45222
45223
45224
45230
45240
45250
45251
45260
45270
45280
45281
45290
45291
45292
45300
45301
45310
45311
45312
45320
45321
45330
45340
45341
45350
45360
45361
45362
45370
45380
45390
45391
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Trousdale County, Tennessee ..................................................................................
Unicoi County, Tennessee ........................................................................................
Union County, Tennessee .........................................................................................
Van Buren County, Tennessee .................................................................................
Warren County, Tennessee ......................................................................................
Washington County, Tennessee ...............................................................................
Wayne County, Tennessee .......................................................................................
Weakley County, Tennessee ....................................................................................
White County, Tennessee .........................................................................................
Williamson County, Tennessee .................................................................................
Wilson County, Tennessee .......................................................................................
Anderson County, Texas ...........................................................................................
Andrews County, Texas ............................................................................................
Angelina County, Texas ............................................................................................
Aransas County, Texas .............................................................................................
Archer County, Texas ................................................................................................
Armstrong County, Texas ..........................................................................................
Atascosa County, Texas ...........................................................................................
Austin County, Texas ................................................................................................
Bailey County, Texas ................................................................................................
Bandera County, Texas .............................................................................................
Bastrop County, Texas ..............................................................................................
Baylor County, Texas ................................................................................................
Bee County, Texas ....................................................................................................
Bell County, Texas ....................................................................................................
Bexar County, Texas .................................................................................................
Blanco County, Texas ...............................................................................................
Borden County, Texas ...............................................................................................
Bosque County, Texas ..............................................................................................
Bowie County, Texas ................................................................................................
Brazoria County, Texas .............................................................................................
Brazos County, Texas ...............................................................................................
Brewster County, Texas ............................................................................................
Briscoe County, Texas ..............................................................................................
Brooks County, Texas ...............................................................................................
Brown County, Texas ................................................................................................
Burleson County, Texas ............................................................................................
Burnet County, Texas ................................................................................................
Caldwell County, Texas .............................................................................................
Calhoun County, Texas .............................................................................................
Callahan County, Texas ............................................................................................
Cameron County, Texas ...........................................................................................
Camp County, Texas .................................................................................................
Carson County, Texas ...............................................................................................
Cass County, Texas ..................................................................................................
Castro County, Texas ................................................................................................
Chambers County, Texas ..........................................................................................
Cherokee County, Texas ...........................................................................................
Childress County, Texas ...........................................................................................
Clay County, Texas ...................................................................................................
Cochran County, Texas .............................................................................................
Coke County, Texas ..................................................................................................
Coleman County, Texas ............................................................................................
Collin County, Texas .................................................................................................
Collingsworth County, Texas .....................................................................................
Colorado County, Texas ............................................................................................
Comal County, Texas ................................................................................................
Comanche County, Texas .........................................................................................
Concho County, Texas ..............................................................................................
Cooke County, Texas ................................................................................................
Coryell County, Texas ...............................................................................................
Cottle County, Texas .................................................................................................
Crane County, Texas ................................................................................................
Crockett County, Texas .............................................................................................
Crosby County, Texas ...............................................................................................
Culberson County, Texas ..........................................................................................
Dallam County, Texas ...............................................................................................
Dallas County, Texas ................................................................................................
Dawson County, Texas .............................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00085
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
44
3660
3840
44
44
3660
44
44
44
5360
5360
45
45
45
45
9080
45
45
45
45
45
0640
45
45
3810
7240
45
45
45
8360
1145
1260
45
45
45
45
45
45
0640
45
45
1240
45
45
45
45
3360
45
45
45
45
45
45
1920
45
45
7240
45
45
45
3810
45
45
45
45
45
45
1920
45
19MYP3
2006
MSAbased
WI
0.7988
0.8015
0.8411
0.7988
0.7988
0.8015
0.7988
0.7988
0.7988
0.9787
0.9787
0.7936
0.7936
0.7936
0.7936
0.8373
0.7936
0.7936
0.7936
0.7936
0.7936
0.9450
0.7936
0.7936
0.8535
0.8993
0.7936
0.7936
0.7936
0.8291
0.8572
0.8909
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.9450
0.7936
0.7936
0.9822
0.7936
0.7936
0.7936
0.7936
1.0101
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
1.0211
0.7936
0.7936
0.8993
0.7936
0.7936
0.7936
0.8535
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
1.0211
0.7936
2006
CBSAbased
WI
0.9769
0.7945
0.8454
0.7888
0.7888
0.7945
0.7888
0.7888
0.7888
0.9769
0.9769
0.8007
0.8007
0.8007
0.8559
0.8294
0.9166
0.8989
1.0005
0.8007
0.8989
0.9450
0.8007
0.8007
0.8535
0.8989
0.8007
0.8007
0.8007
0.8291
1.0005
0.8909
0.8007
0.8007
0.8007
0.8007
0.8909
0.8007
0.9450
0.8168
0.7904
0.9822
0.8007
0.9166
0.8007
0.8007
1.0005
0.8007
0.8007
0.8294
0.8007
0.8007
0.8007
1.0233
0.8007
0.8007
0.8989
0.8007
0.8007
0.8007
0.8535
0.8007
0.8007
0.8007
0.8792
0.8007
0.8007
1.0233
0.8007
CBSA
Number
34980
27740
28940
99944
99944
27740
99944
99944
99944
34980
34980
99945
99945
99945
18580
48660
11100
41700
26420
99945
41700
12420
99945
99945
28660
41700
99945
99945
99945
45500
26420
17780
99945
99945
99945
99945
17780
99945
12420
47020
10180
15180
99945
11100
99945
99945
26420
99945
99945
48660
99945
99945
99945
19124
99945
99945
41700
99945
99945
99945
28660
99945
99945
99945
31180
99945
99945
19124
99945
29154
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
45392
45400
45410
45420
45421
45430
45431
45440
45450
45451
45460
45470
45480
45490
45500
45510
45511
45520
45521
45522
45530
45531
45540
45541
45542
45550
45551
45552
45560
45561
45562
45563
45564
45570
45580
45581
45582
45583
45590
45591
45592
45600
45610
45620
45621
45630
45631
45632
45640
45650
45651
45652
45653
45654
45660
45661
45662
45670
45671
45672
45680
45681
45690
45691
45700
45710
45711
45720
45721
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Deaf Smith County, Texas ........................................................................................
Delta County, Texas ..................................................................................................
Denton County, Texas ...............................................................................................
De Witt County, Texas ..............................................................................................
Dickens County, Texas .............................................................................................
Dimmit County, Texas ...............................................................................................
Donley County, Texas ...............................................................................................
Duval County, Texas .................................................................................................
Eastland County, Texas ............................................................................................
Ector County, Texas ..................................................................................................
Edwards County, Texas ............................................................................................
Ellis County, Texas ....................................................................................................
El Paso County, Texas ..............................................................................................
Erath County, Texas ..................................................................................................
Falls County, Texas ...................................................................................................
Fannin County, Texas ...............................................................................................
Fayette County, Texas ..............................................................................................
Fisher County, Texas ................................................................................................
Floyd County, Texas .................................................................................................
Foard County, Texas .................................................................................................
Fort Bend County, Texas ..........................................................................................
Franklin County, Texas .............................................................................................
Freestone County, Texas ..........................................................................................
Frio County, Texas ....................................................................................................
Gaines County, Texas ...............................................................................................
Galveston County, Texas ..........................................................................................
Garza County, Texas ................................................................................................
Gillespie County, Texas ............................................................................................
Glasscock County, Texas ..........................................................................................
Goliad County, Texas ................................................................................................
Gonzales County, Texas ...........................................................................................
Gray County, Texas ..................................................................................................
Grayson County, Texas .............................................................................................
Gregg County, Texas ................................................................................................
Grimes County, Texas ...............................................................................................
Guadaloupe County, Texas .......................................................................................
Hale County, Texas ...................................................................................................
Hall County, Texas ....................................................................................................
Hamilton County, Texas ............................................................................................
Hansford County, Texas ............................................................................................
Hardeman County, Texas .........................................................................................
Hardin County, Texas ................................................................................................
Harris County, Texas .................................................................................................
Harrison County, Texas .............................................................................................
Hartley County, Texas ...............................................................................................
Haskell County, Texas ..............................................................................................
Hays County, Texas ..................................................................................................
Hemphill County, Texas ............................................................................................
Henderson County, Texas .........................................................................................
Hidalgo County, Texas ..............................................................................................
Hill County, Texas .....................................................................................................
Hockley County, Texas .............................................................................................
Hood County, Texas ..................................................................................................
Hopkins County, Texas .............................................................................................
Houston County, Texas .............................................................................................
Howard County, Texas ..............................................................................................
Hudspeth County, Texas ...........................................................................................
Hunt County, Texas ...................................................................................................
Hutchinson County, Texas ........................................................................................
Irion County, Texas ...................................................................................................
Jack County, Texas ...................................................................................................
Jackson County, Texas .............................................................................................
Jasper County, Texas ...............................................................................................
Jeff Davis County, Texas ..........................................................................................
Jefferson County, Texas ...........................................................................................
Jim Hogg County, Texas ...........................................................................................
Jim Wells County, Texas ...........................................................................................
Johnson County, Texas .............................................................................................
Jones County, Texas .................................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00086
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
45
45
1920
45
45
45
45
45
45
5800
45
1920
2320
45
45
45
45
45
45
45
3360
45
45
45
45
2920
45
45
45
45
45
45
7640
4420
45
7240
45
45
45
45
45
0840
3360
4420
45
45
0640
45
1920
4880
45
45
2800
45
45
45
45
1920
45
45
45
45
45
45
0840
45
45
2800
45
19MYP3
2006
MSAbased
WI
0.7936
0.7936
1.0211
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.9751
0.7936
1.0211
0.8924
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
1.0101
0.7936
0.7936
0.7936
0.7936
0.9645
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.9516
0.8897
0.7936
0.8993
0.7936
0.7936
0.7936
0.7936
0.7936
0.8421
1.0101
0.8897
0.7936
0.7936
0.9450
0.7936
1.0211
0.8943
0.7936
0.7936
0.9545
0.7936
0.7936
0.7936
0.7936
1.0211
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.8421
0.7936
0.7936
0.9545
0.7936
2006
CBSAbased
WI
0.8007
1.0233
1.0233
0.8007
0.8007
0.8007
0.8007
0.8007
0.8007
0.9894
0.8007
1.0233
0.8924
0.8007
0.8007
0.8007
0.8007
0.8007
0.8007
0.8007
1.0005
0.8007
0.8007
0.8007
0.8007
1.0005
0.8007
0.8007
0.8007
0.8168
0.8007
0.8007
0.9516
0.8739
0.8007
0.8989
0.8007
0.8007
0.8007
0.8007
0.8007
0.8421
1.0005
0.8007
0.8007
0.8007
0.9450
0.8007
0.8007
0.8943
0.8007
0.8007
0.8007
0.8007
0.8007
0.8007
0.8007
1.0233
0.8007
0.8280
0.8007
0.8007
0.8007
0.8007
0.8421
0.8007
0.8007
0.9510
0.7904
CBSA
Number
99945
19124
19124
99945
99945
99945
99945
99945
99945
36220
99945
19124
21340
99945
99945
99945
99945
99945
99945
99945
26420
99945
99945
99945
99945
26420
99945
99945
99945
47020
99945
99945
43300
30980
99945
41700
99945
99945
99945
99945
99945
13140
26420
99945
99945
99945
12420
99945
99945
32580
99945
99945
99945
99945
99945
99945
99945
19124
99945
41660
99945
99945
99945
99945
13140
99945
99945
23104
10180
29155
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
45722
45730
45731
45732
45733
45734
45740
45741
45742
45743
45744
45750
45751
45752
45753
45754
45755
45756
45757
45758
45759
45760
45761
45762
45770
45771
45772
45780
45781
45782
45783
45784
45785
45790
45791
45792
45793
45794
45795
45796
45797
45800
45801
45802
45803
45804
45810
45820
45821
45822
45830
45831
45832
45840
45841
45842
45843
45844
45845
45850
45860
45861
45870
45871
45872
45873
45874
45875
45876
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Karnes County, Texas ...............................................................................................
Kaufman County, Texas ............................................................................................
Kendall County, Texas ..............................................................................................
Kenedy County, Texas ..............................................................................................
Kent County, Texas ...................................................................................................
Kerr County, Texas ...................................................................................................
Kimble County, Texas ...............................................................................................
King County, Texas ...................................................................................................
Kinney County, Texas ...............................................................................................
Kleberg County, Texas ..............................................................................................
Knox County, Texas ..................................................................................................
Lamar County, Texas ................................................................................................
Lamb County, Texas .................................................................................................
Lampasas County, Texas ..........................................................................................
La Salle County, Texas .............................................................................................
Lavaca County, Texas ...............................................................................................
Lee County, Texas ....................................................................................................
Leon County, Texas ..................................................................................................
Liberty County, Texas ...............................................................................................
Limestone County, Texas ..........................................................................................
Lipscomb County, Texas ...........................................................................................
Live Oak County, Texas ............................................................................................
Llano County, Texas .................................................................................................
Loving County, Texas ................................................................................................
Lubbock County, Texas .............................................................................................
Lynn County, Texas ..................................................................................................
Mc Culloch County, Texas ........................................................................................
Mc Lennan County, Texas ........................................................................................
Mc Mullen County, Texas ..........................................................................................
Madison County, Texas .............................................................................................
Marion County, Texas ...............................................................................................
Martin County, Texas ................................................................................................
Mason County, Texas ...............................................................................................
Matagorda County, Texas .........................................................................................
Maverick County, Texas ............................................................................................
Medina County, Texas ..............................................................................................
Menard County, Texas ..............................................................................................
Midland County, Texas ..............................................................................................
Milam County, Texas .................................................................................................
Mills County, Texas ...................................................................................................
Mitchell County, Texas ..............................................................................................
Montague County, Texas ..........................................................................................
Montgomery County, Texas ......................................................................................
Moore County, Texas ................................................................................................
Morris County, Texas ................................................................................................
Motley County, Texas ................................................................................................
Nacogdoches County, Texas ....................................................................................
Navarro County, Texas .............................................................................................
Newton County, Texas ..............................................................................................
Nolan County, Texas .................................................................................................
Nueces County, Texas ..............................................................................................
Ochiltree County, Texas ............................................................................................
Oldham County, Texas ..............................................................................................
Orange County, Texas ..............................................................................................
Palo Pinto County, Texas ..........................................................................................
Panola County, Texas ...............................................................................................
Parker County, Texas ................................................................................................
Parmer County, Texas ..............................................................................................
Pecos County, Texas ................................................................................................
Polk County, Texas ...................................................................................................
Potter County, Texas .................................................................................................
Presidio County, Texas .............................................................................................
Rains County, Texas .................................................................................................
Randall County, Texas ..............................................................................................
Reagan County, Texas ..............................................................................................
Real County, Texas ...................................................................................................
Red River County, Texas ..........................................................................................
Reeves County, Texas ..............................................................................................
Refugio County, Texas ..............................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00087
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
45
1920
45
45
45
45
45
45
45
45
45
45
45
45
45
45
45
45
3360
45
45
45
45
45
4600
45
45
8800
45
45
45
45
45
45
45
45
45
5800
45
45
45
45
3360
45
45
45
45
45
45
45
1880
45
45
0840
45
45
2800
45
45
45
0320
45
45
0320
45
45
45
45
45
19MYP3
2006
MSAbased
WI
0.7936
1.0211
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
1.0101
0.7936
0.7936
0.7936
0.7936
0.7936
0.8792
0.7936
0.7936
0.8527
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.9751
0.7936
0.7936
0.7936
0.7936
1.0101
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.8559
0.7936
0.7936
0.8421
0.7936
0.7936
0.9545
0.7936
0.7936
0.7936
0.9166
0.7936
0.7936
0.9166
0.7936
0.7936
0.7936
0.7936
0.7936
2006
CBSAbased
WI
0.8007
1.0233
0.8989
0.8007
0.8007
0.8007
0.8007
0.8007
0.8007
0.8007
0.8007
0.8007
0.8007
0.8535
0.8007
0.8007
0.8007
0.8007
1.0005
0.8007
0.8007
0.8007
0.8007
0.8007
0.8792
0.8007
0.8007
0.8527
0.8007
0.8007
0.8007
0.8007
0.8007
0.8007
0.8007
0.8989
0.8007
0.9523
0.8007
0.8007
0.8007
0.8007
1.0005
0.8007
0.8007
0.8007
0.8007
0.8007
0.8007
0.8007
0.8559
0.8007
0.8007
0.8421
0.8007
0.8007
0.9510
0.8007
0.8007
0.8007
0.9166
0.8007
0.8007
0.9166
0.8007
0.8007
0.8007
0.8007
0.8007
CBSA
Number
99945
19124
41700
99945
99945
99945
99945
99945
99945
99945
99945
99945
99945
28660
99945
99945
99945
99945
26420
99945
99945
99945
99945
99945
31180
99945
99945
47380
99945
99945
99945
99945
99945
99945
99945
41700
99945
33260
99945
99945
99945
99945
26420
99945
99945
99945
99945
99945
99945
99945
18580
99945
99945
13140
99945
99945
23104
99945
99945
99945
11100
99945
99945
11100
99945
99945
99945
99945
99945
29156
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
45877
45878
45879
45880
45881
45882
45883
45884
45885
45886
45887
45888
45889
45890
45891
45892
45893
45900
45901
45902
45903
45904
45905
45910
45911
45912
45913
45920
45921
45930
45940
45941
45942
45943
45944
45945
45946
45947
45948
45949
45950
45951
45952
45953
45954
45955
45960
45961
45962
45970
45971
45972
45973
45974
45980
45981
45982
45983
46000
46010
46020
46030
46040
46050
46060
46070
46080
46090
46100
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Roberts County, Texas ..............................................................................................
Robertson County, Texas ..........................................................................................
Rockwall County, Texas ............................................................................................
Runnels County, Texas .............................................................................................
Rusk County, Texas ..................................................................................................
Sabine County, Texas ...............................................................................................
San Augustine County, Texas ...................................................................................
San Jacinto County, Texas .......................................................................................
San Patricio County, Texas .......................................................................................
San Saba County, Texas ..........................................................................................
Schleicher County, Texas .........................................................................................
Scurry County, Texas ................................................................................................
Shackelford County, Texas .......................................................................................
Shelby County, Texas ...............................................................................................
Sherman County, Texas ............................................................................................
Smith County, Texas .................................................................................................
Somervell County, Texas ..........................................................................................
Starr County, Texas ..................................................................................................
Stephens County, Texas ...........................................................................................
Sterling County, Texas ..............................................................................................
Stonewall County, Texas ...........................................................................................
Sutton County, Texas ................................................................................................
Swisher County, Texas .............................................................................................
Tarrant County, Texas ...............................................................................................
Taylor County, Texas ................................................................................................
Terrell County, Texas ................................................................................................
Terry County, Texas ..................................................................................................
Throckmorton County, Texas ....................................................................................
Titus County, Texas ..................................................................................................
Tom Green County, Texas ........................................................................................
Travis County, Texas ................................................................................................
Trinity County, Texas ................................................................................................
Tyler County, Texas ..................................................................................................
Upshur County, Texas ...............................................................................................
Upton County, Texas .................................................................................................
Uvalde County, Texas ...............................................................................................
Val Verde County, Texas ..........................................................................................
Van Zandt County, Texas .........................................................................................
Victoria County, Texas ..............................................................................................
Walker County, Texas ...............................................................................................
Waller County, Texas ................................................................................................
Ward County, Texas ..................................................................................................
Washington County, Texas .......................................................................................
Webb County, Texas .................................................................................................
Wharton County, Texas .............................................................................................
Wheeler County, Texas .............................................................................................
Wichita County, Texas ..............................................................................................
Wilbarger County, Texas ...........................................................................................
Willacy County, Texas ...............................................................................................
Williamson County, Texas .........................................................................................
Wilson County, Texas ...............................................................................................
Winkler County, Texas ..............................................................................................
Wise County, Texas ..................................................................................................
Wood County, Texas .................................................................................................
Yoakum County, Texas .............................................................................................
Young County, Texas ................................................................................................
Zapata County, Texas ...............................................................................................
Zavala County, Texas ...............................................................................................
Beaver County, Utah .................................................................................................
Box Elder County, Utah .............................................................................................
Cache County, Utah ..................................................................................................
Carbon County, Utah .................................................................................................
Daggett County, Utah ................................................................................................
Davis County, Utah ...................................................................................................
Duchesne County, Utah ............................................................................................
Emery County, Utah ..................................................................................................
Garfield County, Utah ................................................................................................
Grand County, Utah ..................................................................................................
Iron County, Utah ......................................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00088
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
45
45
1920
45
45
45
45
45
1880
45
45
45
45
45
45
8640
45
45
45
45
45
45
45
2800
0040
45
45
45
45
7200
0640
45
45
4420
45
45
45
45
8750
45
3360
45
45
4080
45
45
9080
45
45
0640
7240
45
45
45
45
45
45
45
46
46
46
46
46
7160
46
46
46
46
46
19MYP3
2006
MSAbased
WI
0.7936
0.7936
1.0211
0.7936
0.7936
0.7936
0.7936
0.7936
0.8559
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.9307
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.9545
0.8062
0.7936
0.7936
0.7936
0.7936
0.8280
0.9450
0.7936
0.7936
0.8897
0.7936
0.7936
0.7936
0.7936
0.8168
0.7936
1.0101
0.7936
0.7936
0.8076
0.7936
0.7936
0.8373
0.7936
0.7936
0.9450
0.8993
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.7936
0.8779
0.8779
0.8779
0.8779
0.8779
0.9350
0.8779
0.8779
0.8779
0.8779
0.8779
2006
CBSAbased
WI
0.8007
0.8909
1.0233
0.8007
0.8739
0.8007
0.8007
1.0005
0.8559
0.8007
0.8007
0.8007
0.8007
0.8007
0.8007
0.9307
0.8007
0.8007
0.8007
0.8007
0.8007
0.8007
0.8007
0.9510
0.7904
0.8007
0.8007
0.8007
0.8007
0.8280
0.9450
0.8007
0.8007
0.8739
0.8007
0.8007
0.8007
0.8007
0.8168
0.8007
1.0005
0.8007
0.8007
0.8076
0.8007
0.8007
0.8294
0.8007
0.8007
0.9450
0.8989
0.8007
0.9510
0.8007
0.8007
0.8007
0.8007
0.8007
0.8126
0.8126
0.9173
0.8126
0.8126
0.9038
0.8126
0.8126
0.8126
0.8126
0.8126
CBSA
Number
99945
17780
19124
99945
30980
99945
99945
26420
18580
99945
99945
99945
99945
99945
99945
46340
99945
99945
99945
99945
99945
99945
99945
23104
10180
99945
99945
99945
99945
41660
12420
99945
99945
30980
99945
99945
99945
99945
47020
99945
26420
99945
99945
29700
99945
99945
48660
99945
99945
12420
41700
99945
23104
99945
99945
99945
99945
99945
99946
99946
30860
99946
99946
36260
99946
99946
99946
99946
99946
29157
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
46110
46120
46130
46140
46150
46160
46170
46180
46190
46200
46210
46220
46230
46240
46250
46260
46270
46280
47000
47010
47020
47030
47040
47050
47060
47070
47080
47090
47100
47110
47120
47130
49000
49010
49011
49020
49030
49040
49050
49060
49070
49080
49088
49090
49100
49110
49111
49120
49130
49140
49141
49150
49160
49170
49180
49190
49191
49194
49200
49210
49211
49212
49213
49220
49230
49240
49241
49250
49260
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Juab County, Utah .....................................................................................................
Kane County, Utah ....................................................................................................
Millard County, Utah ..................................................................................................
Morgan County, Utah ................................................................................................
Piute County, Utah ....................................................................................................
Rich County, Utah .....................................................................................................
Salt Lake County, Utah .............................................................................................
San Juan County, Utah .............................................................................................
Sanpete County, Utah ...............................................................................................
Sevier County, Utah ..................................................................................................
Summit County, Utah ................................................................................................
Tooele County, Utah .................................................................................................
Uintah County, Utah ..................................................................................................
Utah County, Utah .....................................................................................................
Wasatch County, Utah ..............................................................................................
Washington County, Utah .........................................................................................
Wayne County, Utah .................................................................................................
Weber County, Utah ..................................................................................................
Addison County, Vermont .........................................................................................
Bennington County, Vermont ....................................................................................
Caledonia County, Vermont ......................................................................................
Chittenden County, Vermont .....................................................................................
Essex County, Vermont .............................................................................................
Franklin County, Vermont ..........................................................................................
Grand Isle County, Vermont ......................................................................................
Lamoille County, Vermont .........................................................................................
Orange County, Vermont ..........................................................................................
Orleans County, Vermont ..........................................................................................
Rutland County, Vermont ..........................................................................................
Washington County, Vermont ...................................................................................
Windham County, Vermont .......................................................................................
Windsor County, Vermont .........................................................................................
Accomack County, Virginia .......................................................................................
Albemarle County, Virginia ........................................................................................
Alexandria City County, Virginia ................................................................................
Alleghany County, Virginia ........................................................................................
Amelia County, Virginia .............................................................................................
Amherst County, Virginia ...........................................................................................
Appomattox County, Virginia .....................................................................................
Arlington County, Virginia ..........................................................................................
Augusta County, Virginia ...........................................................................................
Bath County, Virginia .................................................................................................
Bedford City County, Virginia ....................................................................................
Bedford County, Virginia ...........................................................................................
Bland County, Virginia ...............................................................................................
Botetourt County, Virginia .........................................................................................
Bristol City County, Virginia .......................................................................................
Brunswick County, Virginia ........................................................................................
Buchanan County, Virginia ........................................................................................
Buckingham County, Virginia ....................................................................................
Buena Vista City County, Virginia .............................................................................
Campbell County, Virginia .........................................................................................
Caroline County, Virginia ...........................................................................................
Carroll County, Virginia .............................................................................................
Charles City County, Virginia ....................................................................................
Charlotte County, Virginia .........................................................................................
Charlottesville City County, Virginia ..........................................................................
Chesapeake County, Virginia ....................................................................................
Chesterfield County, Virginia .....................................................................................
Clarke County, Virginia ..............................................................................................
Clifton Forge City County, Virginia ............................................................................
Colonial Heights County, Virginia ..............................................................................
Covington City County, Virginia ................................................................................
Craig County, Virginia ...............................................................................................
Culpeper County, Virginia .........................................................................................
Cumberland County, Virginia ....................................................................................
Danville City County, Virginia ....................................................................................
Dickenson County, Virginia .......................................................................................
Dinniddie County, Virginia .........................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00089
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
46
2620
46
46
46
46
7160
46
46
46
46
46
46
6520
46
46
46
7160
47
47
47
1303
47
1303
1303
47
47
47
47
47
47
47
49
1540
8840
49
49
4640
49
8840
49
49
4640
4640
49
6800
3660
49
49
49
49
4640
49
49
6760
49
1540
5720
6760
8840
49
6760
49
49
8840
49
1950
49
6760
19MYP3
2006
MSAbased
WI
0.8779
1.1857
0.8779
0.8779
0.8779
0.8779
0.9350
0.8779
0.8779
0.8779
0.8779
0.8779
0.8779
0.9510
0.8779
0.8779
0.8779
0.9350
0.9840
0.9840
0.9840
0.9446
0.9840
0.9446
0.9446
0.9840
0.9840
0.9840
0.9840
0.9840
0.9840
0.9840
0.8420
1.0234
1.0983
0.8420
0.8420
0.8700
0.8420
1.0983
0.8420
0.8420
0.8700
0.8700
0.8420
0.8395
0.8015
0.8420
0.8420
0.8420
0.8420
0.8700
0.8420
0.8420
0.9338
0.8420
1.0234
0.8808
0.9338
1.0983
0.8420
0.9338
0.8420
0.8420
1.0983
0.8420
0.8497
0.8420
0.9338
2006
CBSAbased
WI
0.9510
0.8126
0.8126
0.9038
0.8126
0.8126
0.9433
0.8126
0.8126
0.8126
0.9433
0.9433
0.8126
0.9510
0.8126
0.9402
0.8126
0.9038
0.9840
0.9840
0.9840
0.9446
0.9840
0.9446
0.9446
0.9840
0.9840
0.9840
0.9840
0.9840
0.9840
0.9840
0.8012
1.0234
1.0932
0.8012
0.9338
0.8700
0.8700
1.0932
0.8012
0.8012
0.8700
0.8700
0.8012
0.8383
0.8062
0.8012
0.8012
0.8012
0.8012
0.8700
0.9338
0.8012
0.9338
0.8012
1.0234
0.8808
0.9338
1.0932
0.8012
0.9338
0.8012
0.8383
0.8012
0.9338
0.8497
0.8012
0.9338
CBSA
Number
39340
99946
99946
36260
99946
99946
41620
99946
99946
99946
41620
41620
99946
39340
99946
41100
99946
36260
99947
99947
99947
15540
99947
15540
15540
99947
99947
99947
99947
99947
99947
99947
99949
16820
47894
99949
40060
31340
31340
47894
99949
99949
31340
31340
99949
40220
28700
99949
99949
99949
99949
31340
40060
99949
40060
99949
16820
47260
40060
47894
99949
40060
99949
40220
99949
40060
19260
99949
40060
29158
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
49270
49280
49288
49290
49291
49300
49310
49320
49328
49330
49340
49342
49343
49350
49360
49370
49380
49390
49400
49410
49411
49420
49421
49430
49440
49450
49451
49460
49470
49480
49490
49500
49510
49520
49522
49530
49540
49550
49551
49560
49561
49563
49565
49570
49580
49590
49600
49610
49620
49621
49622
49641
49650
49660
49661
49670
49680
49690
49700
49701
49710
49711
49712
49720
49730
49740
49750
49770
49771
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Emporia County, Virginia ...........................................................................................
Essex County, Virginia ..............................................................................................
Fairfax City County, Virginia ......................................................................................
Fairfax County, Virginia .............................................................................................
Falls Church City County, Virginia ............................................................................
Fauquier County, Virginia ..........................................................................................
Floyd County, Virginia ...............................................................................................
Fluvanna County, Virginia .........................................................................................
Franklin City County, Virginia ....................................................................................
Franklin County, Virginia ...........................................................................................
Frederick County, Virginia .........................................................................................
Fredericksburg City County, Virginia .........................................................................
Galax City County, Virginia .......................................................................................
Giles County, Virginia ................................................................................................
Gloucester County, Virginia .......................................................................................
Goochland County, Virginia .......................................................................................
Grayson County, Virginia ..........................................................................................
Greene County, Virginia ............................................................................................
Greensville County, Virginia ......................................................................................
Halifax County, Virginia .............................................................................................
Hampton City County, Virginia ..................................................................................
Hanover County, Virginia ..........................................................................................
Harrisonburg City County, Virginia ............................................................................
Henrico County, Virginia ............................................................................................
Henry County, Virginia ..............................................................................................
Highland County, Virginia ..........................................................................................
Hopewell City County, Virginia ..................................................................................
Isle Of Wight County, Virginia ...................................................................................
James City Co County, Virginia ................................................................................
King And Queen County, Virginia .............................................................................
King George County, Virginia ....................................................................................
King William County, Virginia ....................................................................................
Lancaster County, Virginia ........................................................................................
Lee County, Virginia ..................................................................................................
Lexington County, Virginia ........................................................................................
Loudoun County, Virginia ..........................................................................................
Louisa County, Virginia .............................................................................................
Lunenburg County, Virginia .......................................................................................
Lynchburg City County, Virginia ................................................................................
Madison County, Virginia ..........................................................................................
Martinsville City County, Virginia ...............................................................................
Manassas City County, Virginia ................................................................................
Manassas Park City County, Virginia ........................................................................
Mathews County, Virginia ..........................................................................................
Mecklenburg County, Virginia ...................................................................................
Middlesex County, Virginia ........................................................................................
Montgomery County, Virginia ....................................................................................
Nansemond County, Virginia .....................................................................................
Nelson County, Virginia .............................................................................................
New Kent County, Virginia ........................................................................................
Newport News City County, Virginia .........................................................................
Norfolk City County, Virginia .....................................................................................
Northampton County, Virginia ...................................................................................
Northumberland County, Virginia ..............................................................................
Norton City County, Virginia ......................................................................................
Nottoway County, Virginia .........................................................................................
Orange County, Virginia ............................................................................................
Page County, Virginia ................................................................................................
Patrick County, Virginia .............................................................................................
Petersburg City County, Virginia ...............................................................................
Pittsylvania County, Virginia ......................................................................................
Portsmouth City County, Virginia ..............................................................................
Poquoson City County, Virginia ................................................................................
Powhatan County, Virginia ........................................................................................
Prince Edward County, Virginia ................................................................................
Prince George County, Virginia .................................................................................
Prince William County, Virginia .................................................................................
Pulaski County, Virginia ............................................................................................
Radford City County, Virginia ....................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00090
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
49
49
8840
8840
8840
8840
49
1540
49
49
49
8840
49
49
5720
6760
49
1540
49
49
5720
6760
49
6760
49
49
6760
5720
5720
49
8840
49
49
49
49
8840
49
49
4640
49
49
8840
8840
5720
49
49
49
49
49
6760
5720
5720
49
49
49
49
49
49
49
6760
1950
5720
5720
6760
49
6760
8840
49
49
19MYP3
2006
MSAbased
WI
0.8420
0.8420
1.0983
1.0983
1.0983
1.0983
0.8420
1.0234
0.8420
0.8420
0.8420
1.0983
0.8420
0.8420
0.8808
0.9338
0.8420
1.0234
0.8420
0.8420
0.8808
0.9338
0.8420
0.9338
0.8420
0.8420
0.9338
0.8808
0.8808
0.8420
1.0983
0.8420
0.8420
0.8420
0.8420
1.0983
0.8420
0.8420
0.8700
0.8420
0.8420
1.0983
1.0983
0.8808
0.8420
0.8420
0.8420
0.8420
0.8420
0.9338
0.8808
0.8808
0.8420
0.8420
0.8420
0.8420
0.8420
0.8420
0.8420
0.9338
0.8497
0.8808
0.8808
0.9338
0.8420
0.9338
1.0983
0.8420
0.8420
2006
CBSAbased
WI
0.8012
0.8012
1.0932
1.0932
1.0932
1.0932
0.8012
1.0234
0.8012
0.8383
1.0224
1.0932
0.8012
0.7962
0.8808
0.9338
0.8012
1.0234
0.8012
0.8012
0.8808
0.9338
0.9098
0.9338
0.8012
0.8012
0.9338
0.8808
0.8808
0.9338
0.8012
0.9338
0.8012
0.8012
0.8012
1.0932
0.9338
0.8012
0.8700
0.8012
0.8012
1.0932
1.0932
0.8808
0.8012
0.8012
0.7962
0.8012
1.0234
0.9338
0.8808
0.8808
0.8012
0.8012
0.8012
0.8012
0.8012
0.8012
0.8012
0.9338
0.8497
0.8808
0.8808
0.9338
0.8012
0.9338
1.0932
0.7962
0.7962
CBSA
Number
99949
99949
47894
47894
47894
47894
99949
16820
99949
40220
49020
47894
99949
13980
47260
40060
99949
16820
99949
99949
47260
40060
25500
40060
99949
99949
40060
47260
47260
40060
99949
40060
99949
99949
99949
47894
40060
99949
31340
99949
99949
47894
47894
47260
99949
99949
13980
99949
16820
40060
47260
47260
99949
99949
99949
99949
99949
99949
99949
40060
19260
47260
47260
40060
99949
40060
47894
13980
13980
29159
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
49780
49790
49791
49800
49801
49810
49820
49830
49838
49840
49850
49860
49867
49870
49880
49890
49891
49892
49900
49910
49920
49921
49930
49950
49951
49960
49961
49962
49970
49980
49981
50000
50010
50020
50030
50040
50050
50060
50070
50080
50090
50100
50110
50120
50130
50140
50150
50160
50170
50180
50190
50200
50210
50220
50230
50240
50250
50260
50270
50280
50290
50300
50310
50320
50330
50340
50350
50360
50370
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Rappahannock County, Virginia ................................................................................
Richmond County, Virginia ........................................................................................
Richmond City County, Virginia ................................................................................
Roanoke County, Virginia ..........................................................................................
Roanoke City County, Virginia ..................................................................................
Rockbridge County, Virginia ......................................................................................
Rockingham County, Virginia ....................................................................................
Russell County, Virginia ............................................................................................
Salem County, Virginia ..............................................................................................
Scott County, Virginia ................................................................................................
Shenandoah County, Virginia ....................................................................................
Smyth County, Virginia ..............................................................................................
South Boston City County, Virginia ...........................................................................
Southampton County, Virginia ...................................................................................
Spotsylvania County, Virginia ....................................................................................
Stafford County, Virginia ...........................................................................................
Staunton City County, Virginia ..................................................................................
Suffolk City County, Virginia ......................................................................................
Surry County, Virginia ...............................................................................................
Sussex County, Virginia ............................................................................................
Tazewell County, Virginia ..........................................................................................
Virginia Beach City County, Virginia .........................................................................
Warren County, Virginia ............................................................................................
Washington County, Virginia .....................................................................................
Waynesboro City County, Virginia ............................................................................
Westmoreland County, Virginia .................................................................................
Williamsburg City County, Virginia ............................................................................
Winchester City County, Virginia ...............................................................................
Wise County, Virginia ................................................................................................
Wythe County, Virginia ..............................................................................................
York County, Virginia .................................................................................................
Adams County, Washington ......................................................................................
Asotin County, Washington .......................................................................................
Benton County, Washington ......................................................................................
Chelan County, Washington ......................................................................................
Clallam County, Washington .....................................................................................
Clark County, Washington .........................................................................................
Columbia County, Washington ..................................................................................
Cowlitz County, Washington .....................................................................................
Douglas County, Washington ....................................................................................
Ferry County, Washington .........................................................................................
Franklin County, Washington ....................................................................................
Garfield County, Washington ....................................................................................
Grant County, Washington ........................................................................................
Grays Harbor County, Washington ...........................................................................
Island County, Washington .......................................................................................
Jefferson County, Washington ..................................................................................
King County, Washington ..........................................................................................
Kitsap County, Washington .......................................................................................
Kittitas County, Washington ......................................................................................
Klickitat County, Washington .....................................................................................
Lewis County, Washington ........................................................................................
Lincoln County, Washington ......................................................................................
Mason County, Washington ......................................................................................
Okanogan County, Washington ................................................................................
Pacific County, Washington ......................................................................................
Pend Oreille County, Washington .............................................................................
Pierce County, Washington .......................................................................................
San Juan County, Washington ..................................................................................
Skagit County, Washington .......................................................................................
Skamania County, Washington .................................................................................
Snohomish County, Washington ...............................................................................
Spokane County, Washington ...................................................................................
Stevens County, Washington ....................................................................................
Thurston County, Washington ...................................................................................
Wahkiakum County, Washington ..............................................................................
Walla Walla County, Washington ..............................................................................
Whatcom County, Washington ..................................................................................
Whitman County, Washington ...................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00091
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
49
49
6760
6800
6800
49
49
49
6800
3660
49
49
49
49
8840
8840
49
5720
49
49
49
5720
8840
3660
49
49
5720
49
49
49
5720
50
50
6740
50
50
6440
50
50
50
50
6740
50
50
50
7600
50
7600
1150
50
50
50
50
50
50
50
50
8200
50
50
50
7600
7840
50
5910
50
50
0860
50
19MYP3
2006
MSAbased
WI
0.8420
0.8420
0.9338
0.8395
0.8395
0.8420
0.8420
0.8420
0.8395
0.8015
0.8420
0.8420
0.8420
0.8420
1.0983
1.0983
0.8420
0.8808
0.8420
0.8420
0.8420
0.8808
1.0983
0.8015
0.8420
0.8420
0.8808
0.8420
0.8420
0.8420
0.8808
1.0194
1.0194
1.0630
1.0194
1.0194
1.1260
1.0194
1.0194
1.0194
1.0194
1.0630
1.0194
1.0194
1.0194
1.1579
1.0194
1.1579
1.0686
1.0194
1.0194
1.0194
1.0194
1.0194
1.0194
1.0194
1.0194
1.0753
1.0194
1.0194
1.0194
1.1579
1.0916
1.0194
1.0938
1.0194
1.0194
1.1743
1.0194
2006
CBSAbased
WI
0.8012
0.8012
0.9338
0.8383
0.8383
0.8012
0.9098
0.8012
0.8383
0.8062
0.8012
0.8012
0.8012
0.8012
1.0932
1.0932
0.8012
0.8808
0.8808
0.9338
0.8012
0.8808
1.0932
0.8062
0.8012
0.8012
0.8808
1.0224
0.8012
0.8012
0.8808
1.0458
0.9896
1.0630
1.0080
1.0458
1.1260
1.0458
0.9523
1.0080
1.0458
1.0630
1.0458
1.0458
1.0458
1.0458
1.0458
1.1589
1.0686
1.0458
1.0458
1.0458
1.0458
1.0458
1.0458
1.0458
1.0458
1.0753
1.0458
1.0465
1.1260
1.1589
1.0916
1.0458
1.0938
1.0458
1.0458
1.1743
1.0458
CBSA
Number
99949
99949
40060
40220
40220
99949
25500
99949
40220
28700
99949
99949
99949
99949
47894
47894
99949
47260
47260
40060
99949
47260
47894
28700
99949
99949
47260
49020
99949
99949
47260
99950
30300
28420
48300
99950
38900
99950
31020
48300
99950
28420
99950
99950
99950
99950
99950
42644
14740
99950
99950
99950
99950
99950
99950
99950
99950
45104
99950
34580
38900
42644
44060
99950
36500
99950
99950
13380
99950
29160
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
50380
51000
51010
51020
51030
51040
51050
51060
51070
51080
51090
51100
51110
51120
51130
51140
51150
51160
51170
51180
51190
51200
51210
51220
51230
51240
51250
51260
51270
51280
51290
51300
51310
51320
51330
51340
51350
51360
51370
51380
51390
51400
51410
51420
51430
51440
51450
51460
51470
51480
51490
51500
51510
51520
51530
51540
52000
52010
52020
52030
52040
52050
52060
52070
52080
52090
52100
52110
52120
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Yakima County, Washington .....................................................................................
Barbour County, W Virginia .......................................................................................
Berkeley County, W Virginia .....................................................................................
Boone County, W Virginia .........................................................................................
Braxton County, W Virginia .......................................................................................
Brooke County, W Virginia ........................................................................................
Cabell County, W Virginia .........................................................................................
Calhoun County, W Virginia ......................................................................................
Clay County, W Virginia ............................................................................................
Doddridge County, W Virginia ...................................................................................
Fayette County, W Virginia .......................................................................................
Gilmer County, W Virginia .........................................................................................
Grant County, W Virginia ..........................................................................................
Greenbrier County, W Virginia ..................................................................................
Hampshire County, W Virginia ..................................................................................
Hancock County, W Virginia .....................................................................................
Hardy County, W Virginia ..........................................................................................
Harrison County, W Virginia ......................................................................................
Jackson County, W Virginia ......................................................................................
Jefferson County, W Virginia .....................................................................................
Kanawha County, W Virginia ....................................................................................
Lewis County, W Virginia ..........................................................................................
Lincoln County, W Virginia ........................................................................................
Logan County, W Virginia .........................................................................................
Mc Dowell County, W Virginia ...................................................................................
Marion County, W Virginia ........................................................................................
Marshall County, W Virginia ......................................................................................
Mason County, W Virginia .........................................................................................
Mercer County, W Virginia ........................................................................................
Mineral County, W Virginia ........................................................................................
Mingo County, W Virginia ..........................................................................................
Monongalia County, W Virginia .................................................................................
Monroe County, W Virginia .......................................................................................
Morgan County, W Virginia .......................................................................................
Nicholas County, W Virginia ......................................................................................
Ohio County, W Virginia ............................................................................................
Pendleton County, W Virginia ...................................................................................
Pleasants County, W Virginia ....................................................................................
Pocahontas County, W Virginia ................................................................................
Preston County, W Virginia .......................................................................................
Putnam County, W Virginia .......................................................................................
Raleigh County, W Virginia .......................................................................................
Randolph County, W Virginia ....................................................................................
Ritchie County, W Virginia ........................................................................................
Roane County, W Virginia .........................................................................................
Summers County, W Virginia ....................................................................................
Taylor County, W Virginia .........................................................................................
Tucker County, W Virginia ........................................................................................
Tyler County, W Virginia ...........................................................................................
Upshur County, W Virginia ........................................................................................
Wayne County, W Virginia ........................................................................................
Webster County, W Virginia ......................................................................................
Wetzel County, W Virginia ........................................................................................
Wirt County, W Virginia .............................................................................................
Wood County, W Virginia ..........................................................................................
Wyoming County, W Virginia ....................................................................................
Adams County, Wisconsin ........................................................................................
Ashland County, Wisconsin .......................................................................................
Barron County, Wisconsin .........................................................................................
Bayfield County, Wisconsin .......................................................................................
Brown County, Wisconsin .........................................................................................
Buffalo County, Wisconsin ........................................................................................
Burnett County, Wisconsin ........................................................................................
Calumet County, Wisconsin ......................................................................................
Chippewa County, Wisconsin ....................................................................................
Clark County, Wisconsin ...........................................................................................
Columbia County, Wisconsin ....................................................................................
Crawford County, Wisconsin .....................................................................................
Dane County, Wisconsin ...........................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00092
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
9260
51
8840
51
51
8080
3400
51
51
51
51
51
51
51
51
8080
51
51
51
8840
1480
51
51
51
51
51
9000
51
51
1900
51
51
51
51
51
9000
51
51
51
51
1480
51
51
51
51
51
51
51
51
51
3400
51
51
51
6020
51
52
52
52
52
3080
52
52
0460
2290
52
52
52
4720
19MYP3
2006
MSAbased
WI
1.0165
0.7908
1.0983
0.7908
0.7908
0.7827
0.9486
0.7908
0.7908
0.7908
0.7908
0.7908
0.7908
0.7908
0.7908
0.7827
0.7908
0.7908
0.7908
1.0983
0.8428
0.7908
0.7908
0.7908
0.7908
0.7908
0.7168
0.7908
0.7908
0.9326
0.7908
0.7908
0.7908
0.7908
0.7908
0.7168
0.7908
0.7908
0.7908
0.7908
0.8428
0.7908
0.7908
0.7908
0.7908
0.7908
0.7908
0.7908
0.7908
0.7908
0.9486
0.7908
0.7908
0.7908
0.8278
0.7908
0.9446
0.9446
0.9446
0.9446
0.9452
0.9446
0.9446
0.9248
0.9210
0.9446
0.9446
0.9446
1.0764
2006
CBSAbased
WI
1.0165
0.7725
0.9499
0.8428
0.7725
0.7827
0.9486
0.7725
0.8428
0.7725
0.7725
0.7725
0.7725
0.7725
1.0224
0.7827
0.7725
0.7725
0.7725
1.0932
0.8428
0.7725
0.8428
0.7725
0.7725
0.7725
0.7168
0.7725
0.7725
0.9326
0.7725
0.8428
0.7725
0.9499
0.7725
0.7168
0.7725
0.8278
0.7725
0.8428
0.8428
0.7725
0.7725
0.7725
0.7725
0.7725
0.7725
0.7725
0.7725
0.7725
0.9486
0.7725
0.7725
0.8278
0.8278
0.7725
0.9480
0.9480
0.9480
0.9480
0.9452
0.9480
0.9480
0.9298
0.9210
0.9480
1.0635
0.9480
1.0635
CBSA
Number
49420
99951
25180
16620
99951
48260
26580
99951
16620
99951
99951
99951
99951
99951
49020
48260
99951
99951
99951
47894
16620
99951
16620
99951
99951
99951
48540
99951
99951
19060
99951
34060
99951
25180
99951
48540
99951
37620
99951
34060
16620
99951
99951
99951
99951
99951
99951
99951
99951
99951
26580
99951
99951
37620
37620
99951
99952
99952
99952
99952
24580
99952
99952
11540
20740
99952
31540
99952
31540
29161
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
52130
52140
52150
52160
52170
52180
52190
52200
52210
52220
52230
52240
52250
52260
52270
52280
52290
52300
52310
52320
52330
52340
52350
52360
52370
52380
52381
52390
52400
52410
52420
52430
52440
52450
52460
52470
52480
52490
52500
52510
52520
52530
52540
52550
52560
52570
52580
52590
52600
52610
52620
52630
52640
52650
52660
52670
52680
52690
52700
53000
53010
53020
53030
53040
53050
53060
53070
53080
53090
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
VerDate jul<14>2003
MSA
Number
County and State Name
Dodge County, Wisconsin .........................................................................................
Door County, Wisconsin ............................................................................................
Douglas County, Wisconsin ......................................................................................
Dunn County, Wisconsin ...........................................................................................
Eau Claire County, Wisconsin ...................................................................................
Florence County, Wisconsin ......................................................................................
Fond Du Lac County, Wisconsin ...............................................................................
Forest County, Wisconsin .........................................................................................
Grant County, Wisconsin ...........................................................................................
Green County, Wisconsin ..........................................................................................
Green Lake County, Wisconsin .................................................................................
Iowa County, Wisconsin ............................................................................................
Iron County, Wisconsin .............................................................................................
Jackson County, Wisconsin ......................................................................................
Jefferson County, Wisconsin .....................................................................................
Juneau County, Wisconsin ........................................................................................
Kenosha County, Wisconsin .....................................................................................
Kewaunee County, Wisconsin ...................................................................................
La Crosse County, Wisconsin ...................................................................................
Lafayette County, Wisconsin .....................................................................................
Langlade County, Wisconsin .....................................................................................
Lincoln County, Wisconsin ........................................................................................
Manitowoc County, Wisconsin ..................................................................................
Marathon County, Wisconsin ....................................................................................
Marinette County, Wisconsin .....................................................................................
Marquette County, Wisconsin ...................................................................................
Menominee County, Wisconsin .................................................................................
Milwaukee County, Wisconsin ...................................................................................
Monroe County, Wisconsin .......................................................................................
Oconto County, Wisconsin ........................................................................................
Oneida County, Wisconsin ........................................................................................
Outagamie County, Wisconsin ..................................................................................
Ozaukee County, Wisconsin .....................................................................................
Pepin County, Wisconsin ..........................................................................................
Pierce County, Wisconsin .........................................................................................
Polk County, Wisconsin .............................................................................................
Portage County, Wisconsin .......................................................................................
Price County, Wisconsin ...........................................................................................
Racine County, Wisconsin ........................................................................................
Richland County, Wisconsin ......................................................................................
Rock County, Wisconsin ...........................................................................................
Rusk County, Wisconsin ...........................................................................................
St Croix County, Wisconsin .......................................................................................
Sauk County, Wisconsin ...........................................................................................
Sawyer County, Wisconsin ........................................................................................
Shawano County, Wisconsin .....................................................................................
Sheboygan County, Wisconsin .................................................................................
Taylor County, Wisconsin ..........................................................................................
Trempealeau County, Wisconsin ..............................................................................
Vernon County, Wisconsin ........................................................................................
Vilas County, Wisconsin ............................................................................................
Walworth County, Wisconsin .....................................................................................
Washburn County, Wisconsin ...................................................................................
Washington County, Wisconsin .................................................................................
Waukesha County, Wisconsin ...................................................................................
Waupaca County, Wisconsin ....................................................................................
Waushara County, Wisconsin ...................................................................................
Winnebago County, Wisconsin .................................................................................
Wood County, Wisconsin ..........................................................................................
Albany County, Wyoming ..........................................................................................
Big Horn County, Wyoming .......................................................................................
Campbell County, Wyoming ......................................................................................
Carbon County, Wyoming .........................................................................................
Converse County, Wyoming ......................................................................................
Crook County, Wyoming ...........................................................................................
Fremont County, Wyoming ........................................................................................
Goshen County, Wyoming ........................................................................................
Hot Springs County, Wyoming ..................................................................................
Johnson County, Wyoming .......................................................................................
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00093
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
52
52
2240
52
2290
52
52
52
52
52
52
52
52
52
52
52
3800
52
3870
52
52
52
52
8940
52
52
52
5080
52
52
52
0460
5080
52
5120
52
52
52
6600
52
3620
52
5120
52
52
52
7620
52
52
52
52
52
52
5080
5080
52
52
0460
52
53
53
53
53
53
53
53
53
53
53
19MYP3
2006
MSAbased
WI
0.9446
0.9446
1.0223
0.9446
0.9210
0.9446
0.9446
0.9446
0.9446
0.9446
0.9446
0.9446
0.9446
0.9446
0.9446
0.9446
0.9770
0.9446
0.9573
0.9446
0.9446
0.9446
0.9446
0.9600
0.9446
0.9446
0.9446
1.0106
0.9446
0.9446
0.9446
0.9248
1.0106
0.9446
1.1078
0.9446
0.9446
0.9446
0.9006
0.9446
0.9547
0.9446
1.1078
0.9446
0.9446
0.9446
0.8920
0.9446
0.9446
0.9446
0.9446
0.9446
0.9446
1.0106
1.0106
0.9446
0.9446
0.9248
0.9446
0.9214
0.9214
0.9214
0.9214
0.9214
0.9214
0.9214
0.9214
0.9214
0.9214
2006
CBSAbased
WI
0.9480
0.9480
1.0209
0.9480
0.9210
0.9480
0.9650
0.9480
0.9480
0.9480
0.9480
1.0635
0.9480
0.9480
0.9480
0.9480
1.0440
0.9452
0.9573
0.9480
0.9480
0.9480
0.9480
0.9600
0.9480
0.9480
0.9480
1.0106
0.9480
0.9452
0.9480
0.9298
1.0106
0.9480
1.1078
0.9480
0.9480
0.9480
0.9006
0.9480
0.9547
0.9480
1.1078
0.9480
0.9480
0.9480
0.8920
0.9480
0.9480
0.9480
0.9480
0.9480
0.9480
1.0106
1.0106
0.9480
0.9480
0.9192
0.9480
0.9214
0.9214
0.9214
0.9214
0.9214
0.9214
0.9214
0.9214
0.9214
0.9214
CBSA
Number
99952
99952
20260
99952
20740
99952
22540
99952
99952
99952
99952
31540
99952
99952
99952
99952
29404
24580
29100
99952
99952
99952
99952
48140
99952
99952
99952
33340
99952
24580
99952
11540
33340
99952
33460
99952
99952
99952
39540
99952
27500
99952
33460
99952
99952
99952
43100
99952
99952
99952
99952
99952
99952
33340
33340
99952
99952
36780
99952
99953
99953
99953
99953
99953
99953
99953
99953
99953
99953
29162
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 / Proposed Rules
TABLE A.—MSA/CBSA CROSSWALK—Continued
SSA
State/
County
Code
53100
53110
53120
53130
53140
53150
53160
53170
53180
53190
53200
53210
53220
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
.......
MSA
Number
County and State Name
Laramie County, Wyoming ........................................................................................
Lincoln County, Wyoming ..........................................................................................
Natrona County, Wyoming ........................................................................................
Niobrara County, Wyoming .......................................................................................
Park County, Wyoming ..............................................................................................
Platte County, Wyoming ............................................................................................
Sheridan County, Wyoming .......................................................................................
Sublette County, Wyoming ........................................................................................
Sweetwater County, Wyoming ..................................................................................
Teton County, Wyoming ............................................................................................
Uinta County, Wyoming .............................................................................................
Washakie County, Wyoming .....................................................................................
Weston County, Wyoming .........................................................................................
1580
53
1350
53
53
53
53
53
53
53
53
53
53
[FR Doc. 05–9934 Filed 5–13–05; 4:15 pm]
BILLING CODE 4120–01–P
VerDate jul<14>2003
22:47 May 18, 2005
Jkt 205001
PO 00000
Frm 00094
Fmt 4701
Sfmt 4702
E:\FR\FM\19MYP3.SGM
19MYP3
2006
MSAbased
WI
0.8784
0.9214
0.9035
0.9214
0.9214
0.9214
0.9214
0.9214
0.9214
0.9214
0.9214
0.9214
0.9214
2006
CBSAbased
WI
0.8784
0.9214
0.9035
0.9214
0.9214
0.9214
0.9214
0.9214
0.9214
0.9214
0.9214
0.9214
0.9214
CBSA
Number
16940
99953
16220
99953
99953
99953
99953
99953
99953
99953
99953
99953
99953
]]>Agencies
[Federal Register Volume 70, Number 96 (Thursday, May 19, 2005)]
[Proposed Rules]
[Pages 29070-29162]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-9934]
[[Page 29069]]
-----------------------------------------------------------------------
Part V
Department of Health and Human Services
-----------------------------------------------------------------------
Centers for Medicare & Medicaid Services
-----------------------------------------------------------------------
42 CFR Part 424
Medicare Program; Prospective Payment System and Consolidated Billing
for Skilled Nursing Facilities for FY 2006; Proposed Rule
Federal Register / Vol. 70, No. 96 / Thursday, May 19, 2005 /
Proposed Rules
[[Page 29070]]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Part 424
[CMS-1282-P]
RIN 0938-AN65
Medicare Program; Prospective Payment System and Consolidated
Billing for Skilled Nursing Facilities for FY 2006
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Proposed rule.
-----------------------------------------------------------------------
SUMMARY: This proposed rule would update the payment rates used under
the prospective payment system (PPS) for skilled nursing facilities
(SNFs), for fiscal year (FY) 2006, as required by statute. Annual
updates to the PPS rates are required by section 1888(e) of the Social
Security Act (the Act), as amended by the Medicare, Medicaid, and SCHIP
Balanced Budget Refinement Act of 1999 (BBRA), the Medicare, Medicaid,
and State Children's Health Insurance Program (SCHIP) Benefits
Improvement and Protection Act of 2000 (BIPA), and the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003 (MMA),
relating to Medicare payments and consolidated billing for SNFs. As
part of this year's annual update, we are proposing to introduce
refinements in the Resource Utilization Groups, version III (RUG-III),
the case-mix classification system used under the SNF PPS.
DATES: To be assured consideration, comments must be received at one of
the addresses provided below, no later than 5 p.m. on July 12, 2005.
ADDRESSES: In commenting, please refer to file code CMS-1282-P. Because
of staff and resource limitations, we cannot accept comments by
facsimile (FAX) transmission.
You may submit comments in one of three ways (no duplicates,
please):
1. Electronically. You may submit electronic comments on specific
issues in this regulation to https://www.cms.hhs.gov/regulations/
ecomments. (Attachments should be in Microsoft Word, WordPerfect, or
Excel; however, we prefer Microsoft Word.)
2. By mail. You may mail written comments (one original and two
copies) to the following address ONLY: Centers for Medicare & Medicaid
Services, Department of Health and Human Services, Attention: CMS-1282-
P, P.O. Box 8016, Baltimore, MD 21244-8016.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By hand or courier. If you prefer, you may deliver (by hand or
courier) your written comments (one original and two copies) before the
close of the comment period to one of the following addresses. If you
intend to deliver your comments to the Baltimore, Maryland address,
please call telephone number (410) 786-9994 in advance to schedule your
arrival with one of our staff members. Room 445-G, Hubert H. Humphrey
Building, 200 Independence Avenue, SW., Washington, DC 20201; or 7500
Security Boulevard, Baltimore, MD 21244-1850.
(Because access to the interior of the HHH Building is not readily
available to persons without Federal Government identification,
commenters are encouraged to leave their comments in the CMS drop slots
located in the main lobby of the building. A stamp-in clock is
available for persons wishing to retain a proof of filing by stamping
in and retaining an extra copy of the comments being filed.)
Comments mailed to the addresses indicated as appropriate for hand
or courier delivery may be delayed and received after the comment
period.
Submission of comments on paperwork requirements. You may submit
comments on this document's paperwork requirements by mailing your
comments to the addresses provided at the end of the ``Collection of
Information Requirements'' section in this document.
For information on viewing public comments, see the beginning of
the SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT: Ellen Gay, (410) 786-4528 (for
information related to the case-mix classification methodology, and for
information related to swing-bed providers).
Jeanette Kranacs, (410) 786-9385 (for information related to the
development of the payment rates, and for information related to the
wage index).
Bill Ullman, (410) 786-5667 (for information related to coverage
requirements, level of care determinations, consolidated billing, and
general information).
SUPPLEMENTARY INFORMATION:
Submitting Comments: We welcome comments from the public on all
issues set forth in this rule to assist us in fully considering issues
and developing policies. You can assist us by referencing the file code
CMS-1282-P and the specific ``issue identifier'' that precedes the
section on which you choose to comment.
Inspection of Public Comments: All comments received before the
close of the comment period are available for viewing by the public,
including any personally identifiable or confidential business
information that is included in a comment. CMS posts all electronic
comments received before the close of the comment period on its public
Web site as soon as possible after they have been received. Hard copy
comments received timely will be available for public inspection as
they are received, generally beginning approximately 3 weeks after
publication of a document, at the headquarters of the Centers for
Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore,
Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4
p.m. To schedule an appointment to view public comments, phone 1-800-
743-3951.
To assist readers in referencing sections contained in this
document, we are providing the following Table of Contents.
Table of Contents
I. Background
A. Current System for Payment of Skilled Nursing Facility
Services Under Part A of the Medicare Program
B. Requirements of the Balanced Budget Act of 1997 (the BBA) for
Updating the Prospective Payment System for Skilled Nursing
Facilities
C. The Medicare, Medicaid, and SCHIP Balanced Budget Refinement
Act of 1999 (the BBRA)
D. The Medicare, Medicaid, and SCHIP Benefits Improvement and
Protection Act of 2000 (the BIPA)
E. The Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (the MMA)
F. Skilled Nursing Facility Prospective Payment--General
Overview
1. Payment Provisions--Federal Rates
2. Payment Provisions--Initial Transition Period
G. Use of the Skilled Nursing Facility Market Basket Index
II. Update of Payment Rates Under the Prospective Payment System for
Skilled Nursing Facilities
A. Federal Prospective Payment System
1. Costs and Services Covered by the Federal Rates
2. Methodology Used for the Calculation of the Federal Rates
B. Case-Mix Adjustment and Other Clinical Issues
1. Background
2. Case-Mix Refinement Research
a. Data Sources and Analyses
b. Constructing the New RUG-III Groups
c. Development of the Case-Mix Indexes
3. Proposed Refinements to the Case-Mix Classification System
4. Implementation Issues
[[Page 29071]]
5. Assessment Timeframes
6. SNF Certifications and Recertifications Performed by Nurse
Practitioners and Clinical Nurse Specialists
7. Concurrent Therapy
C. Wage Index Adjustment to Federal Rates
D. Proposed Area Wage Index
1. Proposed Revision of SNF PPS Geographic Classifications
2. Current SNF PPS Labor Market Areas Based on MSAs
3. Core-Based Statistical Areas
4. Proposed Revisions to the SNF PPS Labor Market Areas
a. New England MSAs
b. Metropolitan Divisions
c. Micropolitan Areas
5. Implementation of the Revised Labor Market Areas
6. Wage Index Data
E. Updates to the Federal Rates
F. Relationship of RUG-III Classification System to Existing
Skilled Nursing Facility Level-of-Care Criteria
G. Initial Three-Year Transition Period From Facility Specific
to Federal Rates
H. Example of Computation of Adjusted PPS Rates and SNF Payment
III. The Skilled Nursing Facility Market Basket Index
A. Use of the Skilled Nursing Facility Market Basket Percentage
B. Market Basket Forecast Error Adjustment
C. Federal Rate Update Factor
IV. Consolidated Billing
V. Application of the SNF PPS to SNF Services Furnished by Swing-Bed
Hospitals
VI. Qualifying Three-Day Inpatient Hospital Stay Requirement
VII. Provisions of the Proposed Rule
VIII. Collection of Information Requirements
IX. Regulatory Impact Analysis
A. Overall Impact
B. Anticipated Effects
C. Accounting Statement
D. Alternatives Considered
Regulation Text
Addendum: Table 8 (Proposed Wage Index For Urban Areas Based On
Core-Based Statistical Area (CBSA) Labor Market Areas); Table 9
(Proposed Wage Index For Rural Areas Based On CBSA Labor Market
Areas); and Table A (Metropolitan Statistical Area (MSA)/CBSA
Crosswalk)
In addition, because of the many terms to which we refer by
abbreviation in this proposed rule, we are listing these abbreviations
and their corresponding terms in alphabetical order below:
ADL Activity of Daily Living
AHE Average Hourly Earnings
ARD Assessment Reference Date
BBA Balanced Budget Act of 1997, Pub. L. 105-33
BBRA Medicare, Medicaid and SCHIP Balanced Budget Refinement Act of
1999, Pub. L. 106-113
BEA (U.S. Department of Commerce) Bureau of Economic Analysis
BIPA Medicare, Medicaid, and SCHIP Benefits Improvement and
Protection Act of 2000, Pub. L. 106-554
CAH Critical Access Hospital
CBSA Core-Based Statistical Area
CFR Code of Federal Regulations
CMS Centers for Medicare & Medicaid Services
CMSA Consolidated Metropolitan Statistical Area
CPT (Physicians') Current Procedural Terminology
DRG Diagnosis Related Group
FI Fiscal Intermediary
FR Federal Register
FY Fiscal Year
GAO Government Accountability Office
HCPCS Healthcare Common Procedure Coding System
ICD-9-CM International Classification of Diseases, Ninth Edition,
Clinical Modification
IFC Interim Final Rule with Comment Period
MDS Minimum Data Set
MEDPAR Medicare Provider Analysis and Review File
MIP Medicare Integrity Program
MMA Medicare Prescription Drug, Improvement, and Modernization Act
of 2003, Pub. L. 108-173
MSA Metropolitan Statistical Area
NECMA New England County Metropolitan Area
OIG Office of Inspector General
OMRA Other Medicare Required Assessment
PCE Personal Care Expenditures
PMSA Primary Metropolitan Statistical Area
PPI Producer Price Index
PPS Prospective Payment System
PRM Provider Reimbursement Manual
RAI Resident Assessment Instrument
RAP Resident Assessment Protocol
RAVEN Resident Assessment Validation Entry
RFA Regulatory Flexibility Act, Pub. L. 96-354
RIA Regulatory Impact Analysis
RUG Resource Utilization Groups
SCHIP State Children's Health Insurance Program
SNF Skilled Nursing Facility
STM Staff Time Measure
UMRA Unfunded Mandates Reform Act, Pub. L. 104-4
I. Background
On July 30, 2004, we published a notice in the Federal Register (69
FR 45775) that set forth updates to the payment rates used under the
prospective payment system (PPS) for skilled nursing facilities (SNFs),
for fiscal year (FY) 2005. Annual updates to the PPS rates are required
by section 1888(e) of the Social Security Act (the Act), as amended by
the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of
1999 (the BBRA) and the Medicare, Medicaid, and SCHIP Benefits
Improvement and Protection Act of 2000 (the BIPA), relating to Medicare
payments and consolidated billing for SNFs.
A. Current System for Payment of Skilled Nursing Facility Services
Under Part A of the Medicare Program
Section 4432 of the Balanced Budget Act of 1997 (the BBA) amended
section 1888 of the Act to provide for the implementation of a per diem
PPS for SNFs, covering all costs (routine, ancillary, and capital-
related) of covered SNF services furnished to Medicare beneficiaries
under Part A of the Medicare program, effective for cost reporting
periods beginning on or after July 1, 1998. In this proposed rule, we
propose to update the per diem payment rates for SNFs for FY 2006.
Major elements of the SNF PPS include:
Rates. Per diem Federal rates were established for urban
and rural areas using allowable costs from FY 1995 cost reports. These
rates also included an estimate of the cost of services that, before
July 1, 1998, had been paid under Part B but were furnished to Medicare
beneficiaries in a SNF during a Part A covered stay. The rates were
adjusted annually using a SNF market basket index. Rates were case-mix
adjusted using a classification system (Resource Utilization Groups,
version III (RUG-III)) based on beneficiary assessments (using the
Minimum Data Set (MDS) 2.0). The rates were also adjusted by the
hospital wage index to account for geographic variation in wages. (In
section II.C of this preamble, we discuss the wage index adjustment in
detail.)
Correction notices were published in the Federal Register on
October 7, 2004 (69 FR 60158) and on December 30, 2004 (69 FR 78445),
announcing corrections to several of the wage factors. Additionally, as
noted in sections I.C through I.E of this proposed rule, section 101 of
the BBRA, sections 311, 312, and 314 of the BIPA, and section 511 of
the MMA also affect the payment rate.
Transition. The SNF PPS included an initial 3-year, phased
transition that blended a facility-specific payment rate with the
Federal case-mix adjusted rate. For each cost reporting period after a
facility migrated to the new system, the facility-specific portion of
the blend decreased and the Federal portion increased in 25 percentage
point increments. For most facilities, the facility-specific rate was
based on allowable costs from FY 1995; however, since the last year of
the transition was FY 2001, all facilities were paid at the full
Federal rate by the following fiscal year (FY 2002). Therefore, as
discussed in section I.F.2 of this proposed rule, we are no longer
including adjustment
[[Page 29072]]
factors related to facility-specific rates for the coming fiscal year.
Coverage. The establishment of the SNF PPS did not change
Medicare's fundamental requirements for SNF coverage. However, because
RUG-III classification is based, in part, on the beneficiary's need for
skilled nursing care and therapy, we have attempted, where possible, to
coordinate claims review procedures involving level of care
determinations with the outputs of beneficiary assessment and RUG-III
classifying activities. We discuss this coordination in greater detail
in section II.F of this preamble. Moreover, the Part A SNF benefit has
not only level of care requirements, but also a set of technical, or
``posthospital'' requirements as well. In section VI of this preamble,
we discuss one aspect of the technical requirement for a qualifying
prior inpatient hospital stay of at least 3 consecutive days, on which
we invite comment.
Consolidated Billing. The SNF PPS includes a consolidated
billing provision (described in greater detail in section IV of this
proposed rule) that requires a SNF to submit consolidated Medicare
bills for almost all of the services that its residents receive during
the course of a covered Part A stay. (In addition, this provision
places the Medicare billing responsibility for physical, occupational,
and speech-language therapy that the resident receives during a
noncovered stay with the SNF.) The statute excludes from the
consolidated billing provision a small list of services--primarily
those of physicians and certain other types of practitioners--which
remain separately billable to Part B by the outside entity that
furnishes them.
Application of the SNF PPS to SNF services furnished by
swing-bed hospitals. Section 1883 of the Act permits certain small,
rural hospitals to enter into a Medicare swing-bed agreement, under
which the hospital can use its beds to provide either acute or SNF
care, as needed. For critical access hospitals (CAHs), Part A pays on a
reasonable cost basis for SNF services furnished under a swing-bed
agreement. However, in accordance with section 1888(e)(7) of the Act,
those swing-bed SNF services furnished by non-CAH rural hospitals are
paid under the SNF PPS, effective with cost reporting periods beginning
on or after July 1, 2002. A more detailed discussion of this provision
appears in section V of this proposed rule.
B. Requirements of the Balanced Budget Act of 1997 (the BBA) for
Updating the Prospective Payment System for Skilled Nursing Facilities
Section 1888(e)(4)(H) of the Act requires that we publish in the
Federal Register:
1. The unadjusted Federal per diem rates to be applied to days of
covered SNF services furnished during the FY.
2. The case-mix classification system to be applied with respect to
these services during the FY.
3. The factors to be applied in making the area wage adjustment
with respect to these services.
In the July 30, 1999 final rule (64 FR 41670), we indicated that we
would announce any changes to the guidelines for Medicare level of care
determinations related to modifications in the RUG-III classification
structure (see section II.F of this proposed rule).
Along with a number of other revisions discussed later in this
preamble, this proposed rule provides the annual updates to the Federal
rates as mandated by the Act.
C. The Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of
1999 (the BBRA)
There were several provisions in the BBRA that resulted in
adjustments to the SNF PPS. These provisions were described in detail
in the final rule that we published in the Federal Register on July 31,
2000 (65 FR 46770). In particular, section 101 of the BBRA provided for
a temporary 20 percent increase in the per diem adjusted payment rates
for 15 specified RUG-III groups (SE3, SE2, SE1, SSC, SSB, SSA, CC2,
CC1, CB2, CB1, CA2, CA1, RHC, RMC, and RMB). Under the law, this
temporary increase remains in effect until the later of October 1,
2000, or the implementation of case-mix refinements in the PPS. A
discussion of the case-mix refinements that we are proposing to
implement appears in section II.B of this proposed rule. Section 101
also included a 4 percent across-the-board increase in the adjusted
Federal per diem payment rates each year for FYs 2001 and 2002,
exclusive of the 20 percent increase.
We included further information on all of the provisions of the
BBRA that affect the SNF PPS in Program Memoranda A-99-53 and A-99-61
(December 1999), and Program Memorandum AB-00-18 (March 2000). In
addition, for swing-bed hospitals with more than 49 (but less than 100)
beds, section 408 of the BBRA provided for the repeal of certain
statutory restrictions on length of stay and aggregate payment for
patient days, effective with the end of the SNF PPS transition period
described in section 1888(e)(2)(E) of the Act. In the July 31, 2001
final rule (66 FR 39562), we made conforming changes to the regulations
in 42 CFR section 413.114(d), effective for services furnished in cost
reporting periods beginning on or after July 1, 2002, to reflect
section 408 of the BBRA.
D. The Medicare, Medicaid, and SCHIP Benefits Improvement and
Protection Act of 2000 (the BIPA)
The BIPA also included several provisions that resulted in
adjustments to the PPS for SNFs. These provisions were described in
detail in the final rule that we published in the Federal Register on
July 31, 2001 (66 FR 39562) as follows:
Section 203 of the BIPA exempted critical access hospital
(CAH) swing-beds from the SNF PPS; we included further information on
this provision in Program Memorandum A-01-09 (January 16, 2001).
Section 311 of the BIPA eliminated the 1 percent reduction
in the SNF market basket that the statutory update formula had
previously specified for FY 2001, and changed the 1 percent reduction
specified for FYs 2002 and 2003 to a 0.5 percent reduction. As
discussed in section II.B of this proposed rule, this provision also
required us to conduct a study of alternative case-mix classification
systems for the SNF PPS, and to submit a report to the Congress on the
results of the study.
Section 312 of the BIPA provided for a temporary 16.66
percent increase in the nursing component of the case-mix adjusted
Federal rate for services furnished on or after April 1, 2001, and
before October 1, 2002. This section also required the Government
Accountability Office (GAO) to conduct an audit of SNF nursing staff
ratios and submit a report to the Congress on whether the temporary
increase in the nursing component should be continued. GAO issued this
report (GAO-03-176) in November 2002.
Section 313 of the BIPA repealed the consolidated billing
requirement for services (other than physical, occupational, and
speech-language therapy) furnished to SNF residents during noncovered
stays, effective January 1, 2001.
Section 314 of the BIPA adjusted the payment rates for all
of the 14 rehabilitation RUGs (RUC, RUB, RUA, RVC, RVB, RVA, RHC, RHB,
RHA, RMC, RMB, RMA, RLB, and RLA), in order to correct an anomaly under
which the existing payment rates for three
[[Page 29073]]
particular rehabilitation RUGs--RHC, RMC, and RMB--were higher than the
rates for some other, more intensive rehabilitation RUGs. Under the
BIPA adjustment, the temporary increase that section 101(a) of the BBRA
had applied to the RHC, RMC, and RMB rehabilitation RUGs was revised
from 20 percent to 6.7 percent, and the BIPA adjustment also applied
this temporary 6.7 percent increase to each of the other 11
rehabilitation RUGs.
Section 315 of the BIPA authorized us to establish a
geographic reclassification procedure that is specific to SNFs, but
only after collecting the data necessary to establish a SNF wage index
that is based on wage data from nursing homes.
We included further information on several of these provisions in
Program Memorandum A-01-08 (January 16, 2001).
E. The Medicare Prescription Drug, Improvement, and Modernization Act
of 2003 (the MMA)
A provision of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA) resulted in a further adjustment to the
PPS for SNFs. Specifically, section 511 of the MMA amended paragraph
(12) of section 1888(e) of the Act to provide for a temporary 128
percent increase in the PPS per diem payment for any SNF resident with
Acquired Immune Deficiency Syndrome (AIDS), effective with services
furnished on or after October 1, 2004. As discussed in Transmittal
160 (Change Request 3291, April 30, 2004), this add-
on applies to claims with diagnosis code 042. Like the temporary add-on
payments created by section 101(a) of the BBRA (as amended by section
314 of the BIPA), this special AIDS add-on was not intended to remain
in effect indefinitely. As amended by section 511 of the MMA, section
1888(e)(12)(B) of the Act specifies that this temporary increase for
patients with AIDS is to remain in effect only until ``* * * such date
as the Secretary certifies that there is an appropriate adjustment in
the case mix * * * to compensate for the increased costs associated
with [such] residents * * *.'' As discussed elsewhere in this proposed
rule, we are not proposing at this time to address the issue of such
certification and, accordingly, the temporary add-on payments created
by section 511 of the MMA will remain in effect during FY 2006.
The law further provided that the 128 percent increase in payment
under the AIDS add-on is to be `` * * * determined without regard to
any increase'' under section 101 of the BBRA (as amended by section 314
of the BIPA). As explained in the MMA Conference report, this means
that if a resident qualifies for the temporary 128 percent increase in
payment under the special AIDS add-on, ``the BBRA temporary RUG add-on
does not apply in this case * * *.'' (H.R. Conf. Rep. No. 108-391 at
662). The AIDS add-on was also discussed in Transmittal 160
(Change Request 3291), issued on April 30, 2004, which is
available online at https://www.cms.hhs.gov/manuals/pm_trans/2004/
transmittals/comm_date_dsc.asp.
In addition, section 410 of the MMA contained a provision that
affects the consolidated billing requirement, which we discuss in
section IV of this proposed rule.
F. Skilled Nursing Facility Prospective Payment--General Overview
The Medicare SNF PPS was implemented for cost reporting periods
beginning on or after July 1, 1998. Under the PPS, we pay SNFs through
prospective, case-mix adjusted per diem payment rates applicable to all
covered SNF services. These payment rates cover all the costs of
furnishing covered skilled nursing services (routine, ancillary, and
capital-related costs) other than costs associated with approved
educational activities. Covered SNF services include post-hospital
services for which benefits are provided under Part A and all items and
services that, before July 1, 1998, had been paid under Part B (other
than physician and certain other services specifically excluded under
the BBA) but furnished to Medicare beneficiaries in a SNF during a
covered Part A stay. A complete discussion of these provisions appears
in the May 12, 1998 interim final rule (63 FR 26252).
1. Payment Provisions--Federal Rate
The PPS uses per diem Federal payment rates based on mean SNF costs
in a base year updated for inflation to the first effective period of
the PPS. We developed the Federal payment rates using allowable costs
from hospital-based and freestanding SNF cost reports for reporting
periods beginning in FY 1995. The data used in developing the Federal
rates also incorporated an estimate of the amounts that would be
payable under Part B for covered SNF services furnished to individuals
during the course of a covered Part A stay in a SNF.
In developing the rates for the initial period, we updated costs to
the first effective year of PPS (the 15-month period beginning July 1,
1998) using a SNF market basket, and then standardized for the costs of
facility differences in case-mix and for geographic variations in
wages. Providers that received new provider exemptions from the routine
cost limits were excluded from the database used to compute the Federal
payment rates, as well as costs related to payments for exceptions to
the routine cost limits. In accordance with the formula prescribed in
the BBA, we set the Federal rates at a level equal to the weighted mean
of freestanding costs plus 50 percent of the difference between the
freestanding mean and weighted mean of all SNF costs (hospital-based
and freestanding) combined. We computed and applied separately the
payment rates for facilities located in urban and rural areas. In
addition, we adjusted the portion of the Federal rate attributable to
wage-related costs by a wage index.
The Federal rate also incorporates adjustments to account for
facility case-mix, using a classification system that accounts for the
relative resource utilization of different patient types. This
classification system, Resource Utilization Groups, version III (RUG-
III), uses beneficiary assessment data from the Minimum Data Set (MDS)
completed by SNFs to assign beneficiaries to one of 44 RUG-III groups.
The May 12, 1998 interim final rule (63 FR 26252) included a complete
and detailed description of the RUG-III classification system, and a
further discussion appears in section II.B of this proposed rule.
The Federal rates in this proposed rule reflect an update to the
rates that we published for FY 2005 equal to the full change in the SNF
market basket index. According to section 1888(e)(4)(E)(ii)(IV) of the
Act, for FY 2006, we would update the rate by adjusting the current
rates by the full SNF market basket index.
2. Payment Provisions--Initial Transition Period
The SNF PPS included an initial, phased transition from a facility-
specific rate (which reflected the individual facility's historical
cost experience) to the Federal case-mix adjusted rate. The transition
extended through the facility's first three cost reporting periods
under the PPS, up to and including the one that began in FY 2001.
Accordingly, starting with cost reporting periods beginning in FY 2002,
we base payments entirely on the Federal rates and, as indicated in
section II.G of this proposed rule, we no longer include adjustment
factors related to facility-specific rates for the coming fiscal year.
[[Page 29074]]
G. Use of the Skilled Nursing Facility Market Basket Index
Section 1888(e)(5) of the Act requires us to establish a SNF market
basket index that reflects changes over time in the prices of an
appropriate mix of goods and services included in the covered SNF
services. The SNF market basket index is used to update the Federal
rates on an annual basis. The final rule published on July 31, 2001 (66
FR 39562) revised and rebased the market basket to reflect 1997 total
cost data.
In addition, as explained in the FY 2004 final rule (68 FR 46058,
August 4, 2003) and in section III.B of this proposed rule, the annual
update of the payment rates includes, as appropriate, an adjustment to
account for market basket forecast error. This adjustment takes into
account the forecast error from the most recently available fiscal year
for which there are final data, and is applied whenever the difference
between the forecasted and actual change in the market basket exceeds a
0.25 percentage point threshold. For FY 2004 (the most recently
available fiscal year for which there are final data), the estimated
increase in the market basket index was 3.0 percentage points, while
the actual increase was 3.1 percentage points. Therefore, the payment
rates for FY 2006 do not include a forecast error adjustment, as the
difference between the estimated and actual amounts of change does not
exceed the 0.25 percentage point threshold. Table 1 below shows the
forecasted and actual market basket amounts for FY 2004.
Table 1.--FY 2004 Forecast Error Correction for CMS SNF Market Basket
------------------------------------------------------------------------
FY 2004
Forecasted Actual FY forecast
Index FY 2004 2004 error
increase * increase ** correction
***
------------------------------------------------------------------------
SNF........................... 3.0 3.1 0.0
------------------------------------------------------------------------
* Published in August 4, 2003 Federal Register; based on second quarter
2003 Global Insight/DRI-WEFA forecast.
** Based on the fourth quarter 2004 Global Insight/DRI-WEFA forecast.
*** The FY 2004 forecast error correction will be applied to the FY 2006
PPS update. Any forecast error less than 0.25 percentage points is not
reflected in the update.
II. Update of Payment Rates Under the Prospective Payment System for
Skilled Nursing Facilities
A. Federal Prospective Payment System
This proposed rule sets forth a schedule of Federal prospective
payment rates applicable to Medicare Part A SNF services beginning
October 1, 2005. The schedule incorporates per diem Federal rates that
provide Part A payment for all costs of services furnished to a
beneficiary in a SNF during a Medicare-covered stay.
1. Costs and Services Covered by the Federal Rates
The Federal rates apply to all costs (routine, ancillary, and
capital-related costs) of covered SNF services other than costs
associated with approved educational activities as defined in Sec.
413.85. Under section 1888(e)(2) of the Act, covered SNF services
include post-hospital SNF services for which benefits are provided
under Part A (the hospital insurance program), as well as all items and
services (other than those services excluded by statute) that, before
July 1, 1998, were paid under Part B (the supplementary medical
insurance program) but furnished to Medicare beneficiaries in a SNF
during a Part A covered stay. (These excluded service categories are
discussed in greater detail in section V.B.2 of the May 12, 1998
interim final rule (63 FR 26295 through 63 FR 26297)).
2. Methodology Used for the Calculation of the Federal Rates
The proposed FY 2006 rates would reflect an update using the full
amount of the latest market basket index. The FY 2006 market basket
increase factor is estimated to be 3.0 percent. Consistent with
previous years, this factor may be revised in the final rule when later
forecast data are available. For a complete description of the multi-
step process, see the May 12, 1998 interim final rule (63 FR 26252). We
note that in accordance with section 101(a) of the BBRA and section 314
of the BIPA, the existing, temporary increase in the per diem adjusted
payment rates of 20 percent for certain specified clinically complex
RUGs (and 6.7 percent for rehabilitation RUGs) remains in effect until
the implementation of case-mix refinements. (A discussion of the case-
mix refinements that we now propose to implement appears in section
II.B of this preamble.)
We used the SNF market basket to adjust each per diem component of
the Federal rates forward to reflect cost increases occurring between
the midpoint of the Federal fiscal year beginning October 1, 2004, and
ending September 30, 2005, and the midpoint of the Federal fiscal year
beginning October 1, 2005, and ending September 30, 2006, to which the
payment rates apply. In accordance with section 1888(e)(4)(E)(ii)(IV)
of the Act, the payment rates for FY 2006 are updated by a factor equal
to the full market basket index percentage. The rates would be further
adjusted by a wage index budget neutrality factor, described later in
this section. The unadjusted rates are the same under both the existing
44 group RUG classification system and the proposed RUG-53
classification system. Tables 2 and 3 reflect the updated components of
the unadjusted Federal rates for FY 2006.
Table 2.--FY 2006 Unadjusted Federal Rate Per Diem--Urban
----------------------------------------------------------------------------------------------------------------
Nursing--case- Therapy--case- Therapy--non-
Rate component mix mix case-mix Non-case-mix
----------------------------------------------------------------------------------------------------------------
Per Diem Amount.................................... $137.44 $103.53 $13.63 $70.15
----------------------------------------------------------------------------------------------------------------
[[Page 29075]]
Table 3.--FY 2006 Unadjusted Federal Rate Per Diem--Rural
----------------------------------------------------------------------------------------------------------------
Nursing--case- Therapy--case- Therapy--non-
Rate component mix mix case-mix Non-case-mix
----------------------------------------------------------------------------------------------------------------
Per Diem Amount.................................... $131.30 $119.38 $14.56 $71.45
----------------------------------------------------------------------------------------------------------------
B. Case-Mix Adjustment and Other Clinical Issues
[If you choose to comment on issues in this section, please include the
caption ``Case-Mix Adjustment and Other Clinical Issues'' at the
beginning of your comments.]
Under the BBA, we must publish the SNF PPS case-mix classification
methodology applicable for the next Federal FY before August 1 of each
year. As discussed in the following sections, we propose to begin
utilizing a refinement to the RUG-III case-mix classification system
applicable to the SNF PPS during FY 2006, and we specifically solicit
comments on the proposed refinement.
1. Background
The SNF PPS replaced the cost-based structure that had been in
effect since the inception of the Medicare program. Under the SNF PPS,
providers have more flexibility in the use of Medicare funds but are
responsible not only for furnishing the full range of services to
Medicare beneficiaries, but for the cost effectiveness of their
purchasing decisions. Like the inpatient hospital PPS, reimbursement
for all services, including therapy and other ancillaries such as
diagnostic tests, supplies, and pharmacy, were for the first time
included in the SNF Part A ``bundle of services'' and reimbursed
directly to the SNF rather than to the actual entity furnishing the
service.
In addition, in response to over a decade of rapidly rising
Medicare SNF payments, the SNF PPS instituted controls to adjust for
identified overutilization and inflated charge structures for therapy
and other ancillary services. By restructuring the payment system to
reflect a more appropriate expenditure level, there was an aggregate
decrease in Medicare expenditure levels for the first SNF PPS year.
Providers responded to the SNF PPS by restructuring their operations
and practice patterns in an effort to adapt to the new payment
structure and incentives.
These rapid changes in facility practices and Medicare payment also
generated significant concerns that the transition to a prospective
payment system would impede access for beneficiaries with complex
medical needs and, by decreasing aggregate payments to SNFs, negatively
affect the quality of care in nursing homes across the country. The
research presented in this proposed rule was initiated as part of a
broad-based effort to investigate and respond to access, quality, and
payment concerns raised by industry, advocates, and other stakeholders.
During the course of this effort, CMS developed tools to monitor
and evaluate quality of care that are now integral components of our
program oversight activities, including the use of Quality Indicators,
Quality Measures, and Nursing Home Compare. As discussed later in this
section, the development of these new capabilities has also positioned
us to move forward in new areas. The refinements discussed in this
section are based on research originally conducted by Abt Associates
(and later validated by the Urban Institute) that was initiated
immediately after the introduction of the SNF PPS in 1999.
In the BBRA, the Congress acted to address these access and quality
concerns by enacting a series of temporary payment adjustments. At
present, only one of these payment adjustments is still in effect, a 20
percent increase in the per diem adjusted payment rates for 12 complex
medical RUG-III groups (SE3, SE2, SE1, SSC, SSB, SSA, CC2, CC1, CB2,
CB1, CA2, and CA1,) and a 6.7 percent increase to all 14 rehabilitation
groups. This legislation specified that the payment adjustments would
continue until the later of: (1) October 1, 2000, or (2) implementation
of a refined case-mix classification system under section
1888(e)(4)(G)(i) of the Act that would better account for medically
complex patients.
As we noted in the SNF PPS proposed rule for FY 2001 (65 FR 19190,
April 10, 2000), this mandated rate increase was intended to serve as a
temporary, interim adjustment to the payment rates and RUG-III case-mix
classification system as published in the final rule of July 30, 1999,
until implementation of the case-mix refinements described in the
legislation. In that FY 2001 proposed rule, we included a proposal for
an extensive, comprehensive set of refinements to the existing case-mix
classification system that collectively would have resulted in
expanding the existing 44-group structure to well over 150 groups.
The speed with which we conducted this initial evaluation of the
SNF PPS demonstrated our commitment to ensuring the accuracy and equity
of the new payment system, but the evaluation had important
limitations. Comprehensive SNF PPS data were not yet available, and the
research was conducted using 1995-1997 data housed in a large, cross-
linked research database collected from only six states that had
implemented a RUG-III payment system prior to July 1998 (either through
the Federal case-mix demonstration project or for state Medicaid
payment). These limitations were explained in the proposed rule along
with our plans to validate the data using a national SNF PPS database
(65 FR 19193, April 10, 2000).
In conducting the validation analyses, it became clear that the
introduction of the SNF PPS and SNF consolidated billing had caused
changes in facility practice patterns and billing. Some of these
changes could also have been related to the use of a national database
and to changing industry practices during the early stages of the SNF
PPS implementation. While it was still true that beneficiaries
requiring both rehabilitation and extensive medical services used
greater amounts of ancillary services, the distribution patterns for
those high-cost ancillaries (such as medications and respiratory
therapy) had changed from the patterns in the six-state data. These
results, in conjunction with the high degree of intra-group and inter-
group variability in ancillary utilization identified in both the
initial and validation analyses, raised new questions that needed to be
addressed prior to implementing refinements. For these reasons, we
decided not to implement such refinements at that time. (See the FY
2001 final rule, 65 FR 46773, July 31, 2000.)
Several months later, the Congress enacted the BIPA. Of the various
provisions of this legislation that addressed the SNF PPS, one
directive also addressed the future development of the SNF PPS.
Specifically, section 311(e) of the BIPA directed us to conduct a study
of the different systems for categorizing patients in Medicare SNFs in
a manner that accounts for the
[[Page 29076]]
relative resource utilization of different patient types and to issue a
report with any appropriate recommendations to the Congress.
Based upon the broad language describing the purpose of this study,
and the multi-year timeframe provided for conducting it, we believe
that the Congress clearly intended for this study to address
comprehensive changes, by evaluating a number of different
classification systems and considering the full range of patient types.
In contrast, since the BBRA specifically ties the duration of its
temporary payment increases to the implementation of a case-mix
refinement that would ``better account for medically complex
patients,'' we believe that even case-mix refinements of a more
incremental nature would meet this more targeted mandate to better
account for medically complex patients, and need not await the
completion of the broader changes envisioned in the BIPA provision.
Moreover, ongoing analysis of the SNF PPS showed that providers
have adjusted to it, and that the SNF PPS rates have generally covered
the cost of care to Medicare beneficiaries. For example, in its March
2005 report, MedPAC estimated 2005 profit margins for freestanding SNFs
of 13 percent. In this environment, it is appropriate to reevaluate the
need for maintaining payment adjustments that were always intended to
be temporary.
2. Case-Mix Refinement Research
a. Data Sources and Analyses
In July 2001, we awarded a contract to the Urban Institute (Urban)
for performance of research to aid us in making refinements to the
case-mix classification system under section 1888(e)(4)(G)(i) of the
Act and starting the case-mix study mandated by section 311(e) of the
BIPA. The first phase of the contract focused on developing options for
refining the case-mix classification system under section
1888(e)(4)(G)(i) of the Act to account for medically complex patients.
As part of this research, Urban updated and broadened the database
created for the previous refinement analyses by using 1999 matched MDS
and SNF claims, and applied the latest cost report data (1998 and 1999)
to estimate costs more accurately for non-therapy ancillary and other
services.
We then used this updated and broadened database to replicate and
validate the earlier studies conducted by Abt. The study used Medicare
SNF claims data for calendar year 1999 and MDS data from our National
MDS Repository. We matched the claims to the MDS assessments upon which
they were based, yielding approximately 2.7 million MDS segments,
resulting in every national facility that billed Medicare for a Part A
SNF stay in 1999 being represented in the database. We allocated the
non-therapy ancillary costs to the portion of the stay in which they
were most likely to have been incurred according to a set of decision
rules. We performed comparative analyses of cost and charge data to
other existing administrative data sets in order to establish the
validity of these data. We also performed a further regression analysis
of costs and RUG-III groups.
In addition, we constructed anew the case-mix indexes using our
Staff Time Measurement (STM) study data. The STM data were collected in
1990, 1995, and 1997, and are described in the May 12, 1998 interim
final rule (63 FR 26252) that implemented the SNF PPS.
Urban then analyzed 270,215 records, a 10 percent sample of this
updated and broadened database. As expected, our analyses again
verified that non-therapy ancillary costs are higher for Medicare
beneficiaries who classify into the Extensive Services category than
for those who classify to other categories. In these analyses, Urban
found that the addition of a combined Rehabilitation plus Extensive
group improved the predictive power of the model. These results were
very similar to the preliminary Abt results discussed in our FY 2001
proposed rule, and provided validation for the preliminary Abt analyses
(that is, both studies showed an increase in the R-square (explanation
of variance) for non-therapy ancillaries from approximately 4.1 percent
in the 44-group model to 8 percent in the 58-group model that added
nine Rehabilitation plus Extensive groups).
Urban then replicated its results with 2001 data using the same
analytic protocols. In this study, Urban found that the addition of a
new RUG-III Rehabilitation plus Extensive category was consistent with
the prior research. Urban used a 163,386 record test sample and found
that the R-square for non-therapy ancillaries improved to 9.5 percent
from the previous result of 4.1 percent mentioned above. The analyses
were repeated on a 170,253 record validation sample with a comparable
result; that is, an R-square of 10.3 percent.
While maintaining the general structure of the RUG-III system, we
found that the most viable way to refine the system at the present time
would be to add groups to the top of the hierarchy to capture
beneficiaries who qualify for both the Extensive Services category and
the Rehabilitation Therapy category. In addition, beneficiaries who
qualify for Extensive Services and receive rehabilitation services have
assumed a larger percentage of the Medicare patient population in SNFs
in recent years. Therefore, we believe that the RUG-III case-mix
classification system can provide even more accurate payment for these
beneficiaries if refined to create a new RUG-III category for
beneficiaries who qualify for both the Extensive Services and
Rehabilitation Therapy categories.
b. Constructing the New RUG-III Groups
Our research findings showed little or no correlation between the
groups within the Extensive Services category (that is, SE1, SE2, SE3)
and the level of rehabilitation services used. For this reason, the
structure for this new hierarchy level would closely mirror that of the
existing Rehabilitation Therapy groups. Normally, this methodology
would result in the creation of 14 new groups, the number that was
originally proposed in the FY 2001 proposed rule. However, for the
reasons discussed below, the more recent research (Urban 2003) has
shown that a smaller number of RUG-III groups are sufficient to address
the needs of beneficiaries eligible for a new RUG-III category,
Combined Rehabilitation and Extensive Care.
First, we found that several of the groups had very few
beneficiaries assigned to them. In fact, no beneficiaries at all were
assigned to several of the lowest ADL score rehabilitation groups.
Second, under the present structure, each Rehabilitation group is sub-
divided into three levels based on the activities of daily living (ADL)
score. The lowest level ADL score for the Rehabilitation groups is
either 4-7 or 4-8, and very few beneficiaries currently classify into
those groups. No beneficiaries who would qualify for the proposed newly
created groups would classify into such a low ADL score level, as a
minimum ADL score of seven is required for classification into an
Extensive Care group.
Therefore, it appears that stratification for the lowest level ADL
scores for the proposed new groups would add needless complexity and,
thus, would not be warranted. Instead, we propose to combine that level
with the next higher level, and would no longer use the ADL scores
lower than 7. Thus, the proposed new groups would be stratified only by
two levels of ADL score. For example, the Rehabilitation High plus
Extensive Services group would be subdivided into only two ADL levels,
ADL scores of 7-12 and 13-18. This left us with only
[[Page 29077]]
one level for Rehabilitation Low plus Extensive Services and with only
two levels at each of the other sub-categories in the new category, for
a total of 9 new groups. As a result, we are proposing the addition of
9 new RUG-III groups.
Table 3a.--Crosswalk Between Existing RUG-III Rehabilitation Groups and the Proposed Extensive Plus
Rehabilitation Groups
----------------------------------------------------------------------------------------------------------------
New combined extensive plus
Current rehabilitation groups rehabilitation groups
----------------------------------------------------------------------------------------------------------------
Rehab Ultra......................... RUC-ADL 16-18.............. RUX-ADL 16-18.
RUB-ADL 9-15............... RUL-ADL 7-15.
RUA-ADL 4-8................
Rehab Very High..................... RVC-ADL 16-18.............. RVX-ADL 16-18.
RVB-ADL 9-15............... RVL-ADL 7-15.
RVA-ADL 4-8................
Rehab High.......................... RHC-ADL 13-18.............. RUX-ADL 13-18.
RHB-ADL 8-12 .............. RUL-ADL 7-12.
RHA-ADL 4-7................
Rehab Medium........................ RHC-ADL 15-18.............. RUX-ADL 15-18.
RHB-ADL 8-14............... RUL-ADL 7-14.
RHA-ADL 4-7................
Rehab Low........................... RLB-ADL 14-18.............. RUX-ADL 7-18
RLA-ADL 4-13...............
----------------------------------------------------------------------------------------------------------------
c. Development of the Case-Mix Indexes
We developed the case-mix indexes for the proposed refined RUG-III
system using the same method used for calculating the initial SNF PPS
case-mix indexes. The original staff time studies conducted in 1990,
1995, and 1997 resulted in the assignment of resident-specific and non-
resident specific time (minutes) to individual SNF residents. In the
initial determination of the case-mix indexes, the residents were
classified into the 44-group system and the minutes of staff time,
nursing, and therapy services, where appropriate, remained associated
with those residents. All of the staff time was stratified by type of
staff providing the minutes of time (for example, RN, LPN, etc.), and
the minutes were weighted for salary.
In order to calculate weights for the proposed refined system, we
used the minutes as originally assigned at the individual patient
level. We reclassified the patients into the proposed 53 groups with
their associated wage-weighted minutes of resident-specific and
nonresident-specific staff time. The next step was to apply these wage-
weighted minutes to the entire sample population of 26 million days. We
multiplied the population in each group by the wage-weighted minutes
for each of the staff types. We then derived an average for the group
using the sum of the wage-weighted minutes for all staff (nursing and
therapy staff minutes were calculated separately) xxdivided by the
total population for that group. The relative weight was then
calculated by dividing that average by the average minutes across all
of the RUG-III groups.
The nursing weights changed more than the therapy weights, due to
the redistribution of patients from existing groups to the newly
created proposed groups. Even though many of the beneficiaries who move
into one of the proposed new groups are from an existing therapy group,
the therapy weights are affected only slightly. This is because the
amount of therapy time does not change significantly between the
existing groups and the proposed new groups. The therapy groups were
already narrowly stratified by minutes of therapy provided. The groups'
weights would be affected only to the extent that the individual
beneficiaries who are reclassified into one of the proposed new groups
have unusually high or low minutes of therapy within the specific
limits. The nursing weights are more affected by the reclassifications,
as those are based on a much broader scope of possible minute values.
The therapy weights for the nine proposed Rehabilitation Therapy
plus Extensive Services groups were identical to those for the
comparable existing RUG-III rehabilitation therapy groups. Although we
are capturing increased medical/clinical complexity with the proposed
new groups, the therapy contribution remains the same as for the
existing therapy groups. In this way, the Rehabilitation High therapy
weight is identical to the new Rehabilitation High plus Extensive
Services sub-category.
The effect of the increased number of groups and changes in the
case-mix indexes should be distributional. By this we mean that the
relative weights assigned to each RUG-III group would shift so that the
proposed new Rehabilitation plus Extensive groups would have the
highest relative weights and the weights for other RUG-III groups would
decrease proportionally.
The results of applying these methods to index calculation worked
well and yielded hierarchically sound indexes for all of the groups;
that is, the indexes for the highest groups in the hierarchy are higher
than for those below it, and this pattern holds throughout the proposed
new category.
The nursing indexes in the new category, as well as in the existing
rehabilitation category, are naturally more compressed (that is,
encompass a smaller range) than those in the 44-group RUG-III
rehabilitation groups. The groups within the new Rehabilitation plus
Extensive category are more homogeneous than were the rehabilitation
groups of the 44-group system. By removing the most clinically complex
cases and better accounting for them by putting them in rehabilitation
groups of their own, both the resulting proposed new category and the
remaining rehabilitation category groups would be more homogeneous and,
therefore, the relative weights for each set of groups would exhibit
less variance.
Next, we simulated payments using the existing weights compared to
the new weights to ensure that the refinement did not result in greater
or lesser aggregate payments. The simulation results showed an almost
exact match in payments under both case-mix models. However, the
proposed new 53-group model did yield a slight decrease (less than 1
percent) in aggregate Medicare payments. To
[[Page 29078]]
remove this minor variance, we then applied a factor of +.02 to
calibrate the nursing indexes and re-ran the simulation. Using this
calibration factor of +.02, we are able to ensure absolute parity of
aggregate payment under the 53-group RUG-III system compared to the 44-
group system.
Finally, we propose to provide for an additional adjustment to the
nursing component of the case-mix weights (which includes non-therapy
ancillary services) for all RUG-53 groups. As discussed further in
section II.B.3 of this proposed rule, we have reviewed data that show a
high degree of variability in non-therapy ancillary utilization, not
only within but across RUG groups. Therefore, we believe that it is
appropriate to adjust the case-mix weights for all 53 groups (that is,
the existing 44 RUG-III groups plus the 9 new groups that we are
proposing to create in this proposed rule) to better account for non-
therapy ancillary variability. We would do this under our authority in
section 1888(e)(4)(G)(i) of the Act to establish an ``appropriate
adjustment to account for case mix * * * *''
In determining the size of this adjustment, we considered not only
the high degree of variability in non-therapy ancillary costs, but also
the absence of an outlier policy under the SNF PPS. Accordingly, we
looked at the outlier pool established under another post-acute care
PPS, the one for inpatient rehabilitation facility (IRF) services,
which is set at 3 percent of aggregate expenditures. For the purpose of
this refinement, our calculations employed a comparable funding level
that could be targeted toward payment of non-therapy ancillaries. Based
on this analysis, we are proposing an increase to the nursing component
of the case-mix weights (the component that includes non-therapy
ancillaries) of approximately 8.4 percent, which equates to
approximately 3 percent of aggregate expenditures under the SNF PPS.
The final RUG-53 nursing indexes are presented in Tables 4a and 5a.
Further information regarding this adjustment can be found in section
II.B.3 of this proposed rule.
3. Proposed Refinements to the Case-Mix Classification System
[If you choose to comment on issues in this section, please include the
caption ``Proposed Refinements to the Case-Mix Classification System''
at the beginning of your comments.]
We note that, of the various individual refinements that were
collectively set forth in the FY 2001 proposed rule (65 FR 19194), the
particular refinement that entailed the least amount of added
complexity (yet addressed the medically complex patient) involved the
creation of several additional groups that would comprise a new,
combined Rehabilitation plus Extensive Services category. As we noted
in that proposed rule:
There are * * * a significant number of beneficiaries who would
classify into the Extensive Services category based on clinical
conditions but who, because they are also receiving rehabilitation
services, classify into one of the Rehabilitation groups instead (due
to the hierarchical logic of the RUG-III classification system). These
beneficiaries carry with them the same non-therapy ancillary costs
associated with their complex clinical needs even though they are
classified into a RUG-III Rehabilitation category. The high costs for
beneficiaries in the Extensive Services category suggest that the
payment rate for Extensive Services should be increased. However,
increasing the payment rate without further adjustments could adversely
affect provider incentives to provide therapy to beneficiaries
requiring Extensive Services. Therefore, we expanded the scope of the
proposed refinement to include new categories for beneficiaries who
qualify for both Extensive Services and a RUG-III Rehabilitation
category.
Further, as our subsequent research (discussed in the previous
section) confirmed, the creation of a proposed new Rehabilitation plus
Extensive category would be a means of accounting more accurately for
the costs of certain medically complex patients, with the added benefit
of a minimal degree of added complexity. We note that, in the past,
some support has been expressed for making this particular type of
modification to the existing case-mix classification system.
Therefore, we propose to refine the case-mix classification system
under section 1888(e)(4)(G)(i) of the Act by creating a new, combined
Rehabilitation plus Extensive category, that better accounts for
medically complex patients, as required in section 101 of the BBRA.
Accordingly, the payment rates set forth in this proposed rule reflect
the use of the refined 53-group RUG classification system that we are
proposing. The nine groups that we propose to add to the existing RUG-
III system are as follows:
RUX Rehabilitation Ultra High plus Extensive Services, High
RUL Rehabilitation Ultra High plus Extensive Services, Low
RVX Rehabilitation Very High plus Extensive Services, High
RVL Rehabilitation Very High plus Extensive Services, Low
RHX Rehabilitation High plus Extensive Services, High
RHL Rehabilitation High plus Extensive Services, Low
RMX Rehabilitation Medium plus Extensive Services, High
RML Rehabilitation Medium plus Extensive Services, Low
RLX Rehabilitation Low plus Extensive Services
We note that, like our current proposal, the case-mix refinement
that we considered in our FY 2001 proposed rule would have reconfigured
the RUGs themselves, in a general effort to allocate payments more
accurately under the SNF PPS. However, that earlier proposal also
included an additional element, which was intended to help ensure more
accurate allocation of payments specifically with regard to non-therapy
ancillaries (such as drugs and medications, laboratory services,
supplies and other equipment). For example, it proposed moving the non-
therapy ancillary costs used in establishing the nursing case-mix
component of the payment rates to a separate, newly created ``medical
ancillary'' component (65 FR 19192, April 10, 2000). In addition, it
suggested a number of possible models, both weighted and unweighted,
for a new non-therapy ancillary index (65 FR 19248ff). As noted in the
FY 2001 final rule, these elements ultimately were not adopted when
subsequent research indicated that their added complexity would
outweigh their increased predictive power (65 FR 46774, July 31, 2000).
Following the publication of that final rule, further research in
this area revealed a high degree of variability in non-therapy
ancillary utilization, both within and across the various RUG-III
groups. This finding suggested that using an index model to address
non-therapy ancillary services might require the creation of such a
high number of groups as to be impractical.
In fact, the ability of the SNF PPS to account adequately for non-
therapy ancillary services has been the subject of attention (and a
focus of our research) since the very inception of t
