[Federal Register: May 19, 2005 (Volume 70, Number 96)]
[Proposed Rules]
[Page 29069-29162]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr19my05-37]
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Part V
Department of Health and Human Services
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Centers for Medicare & Medicaid Services
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42 CFR Part 424
Medicare Program; Prospective Payment System and Consolidated Billing
for Skilled Nursing Facilities for FY 2006; Proposed Rule
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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.
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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 http://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 http://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 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 case-mix refinements that better account for
[[Page 29079]]
``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 non-therapy 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 expensive to
treat in terms of non-therapy 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 non-therapy 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 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.
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
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 non-therapy
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,
[[Page 29080]]
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 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 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 http://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
[[Page 29081]]
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 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 post-acute 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-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 case-mix 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
[[Page 29082]]
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 (Sec. 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 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 Sec. 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 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.
[[Page 29083]]
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 non-reimbursed
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 case-mix 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
--------------------------------------------------------------------------------------------------------------------------------------------------------
Non-case Non-case
RUG III category Nursing Therapy Nursing Therapy mix therapy mix Total rate
index index component component component component
--------------------------------------------------------------------------------------------------------------------------------------------------------
RUC.......................................................... 1.30 2.25 178.67 232.94 ........... 70.15 481.76
RUB.......................................................... 0.95 2.25 130.57 232.94 ........... 70.15 433.66
RUA.......................................................... 0.78 2.25 107.20 232.94 ........... 70.15 410.29
RVC.......................................................... 1.13 1.41 155.31 145.98 ........... 70.15 371.44
RVB.......................................................... 1.04 1.41 142.94 145.98 ........... 70.15 359.07
RVA.......................................................... 0.81 1.41 111.33 145.98 ........... 70.15 327.46
RHC.......................................................... 1.26 0.94 173.17 97.32 ........... 70.15 340.64
RHB.......................................................... 1.06 0.94 145.69 97.32 ........... 70.15 313.16
RHA.......................................................... 0.87 0.94 119.57 97.32 ........... 70.15 287.04
RMC.......................................................... 1.35 0.77 185.54 79.72 ........... 70.15 335.41
RMB.......................................................... 1.09 0.77 149.81 79.72 ........... 70.15 299.68
RMA.......................................................... 0.96 0.77 131.94 79.72 ........... 70.15 281.81
RLB.......................................................... 1.11 0.43 152.56 44.52 ........... 70.15 267.23
RLA.......................................................... 0.80 0.43 109.95 44.52 ........... 70.15 224.62
SE3.......................................................... 1.70 ........... 233.65 ........... 13.63 70.15 317.43
SE2.......................................................... 1.39 ........... 191.04 ........... 13.63 70.15 274.82
SE1.......................................................... 1.17 ........... 160.80 ........... 13.63 70.15 244.58
SSC.......................................................... 1.13 ........... 155.31 ........... 13.63 70.15 239.09
SSB.......................................................... 1.05 ........... 144.31 ........... 13.63 70.15 228.09
SSA.......................................................... 1.01 ........... 138.81 ........... 13.63 70.15 222.59
CC2.......................................................... 1.12 ........... 153.93 ........... 13.63 70.15 237.71
CC1.......................................................... 0.99 ........... 136.07 ........... 13.63 70.15 219.85
CB2.......................................................... 0.91 ........... 125.07 ........... 13.63 70.15 208.85
CB1.......................................................... 0.84 ........... 115.45 ........... 13.63 70.15 199.23
CA2.......................................................... 0.83 ........... 114.08 ........... 13.63 70.15 197.86
CA1.......................................................... 0.75 ........... 103.08 ........... 13.63 70.15 186.86
IB2.......................................................... 0.69 ........... 94.83 ........... 13.63 70.15 178.61
IB1.......................................................... 0.67 ........... 92.08 ........... 13.63 70.15 175.86
IA2.......................................................... 0.57 ........... 78.34 ........... 13.63 70.15 162.12
IA1.......................................................... 0.53 ........... 72.84 ........... 13.63 70.15 156.62
BB2.......................................................... 0.68 ........... 93.46 ........... 13.63 70.15 177.24
BB1.......................................................... 0.65 ........... 89.34 ........... 13.63 70.15 173.12
BA2.......................................................... 0.56 ........... 76.97 ........... 13.63 70.15 160.75
BA1.......................................................... 0.48 ........... 65.97 ........... 13.63 70.15 149.75
PE2.......................................................... 0.79 ........... 108.58 ........... 13.63 70.15 192.36
PE1.......................................................... 0.77 ........... 105.83 ........... 13.63 70.15 189.61
PD2.......................................................... 0.72 ........... 98.96 ........... 13.63 70.15 182.74
[[Page 29084]]
PD1.......................................................... 0.70 ........... 96.21 ........... 13.63 70.15 179.99
PC2.......................................................... 0.65 ........... 89.34 ........... 13.63 70.15 173.12
PC1.......................................................... 0.64 ........... 87.96 ........... 13.63 70.15 171.74
PB2.......................................................... 0.51 ........... 70.09 ........... 13.63 70.15 153.87
PB1.......................................................... 0.50 ........... 68.72 ........... 13.63 70.15 152.50
PA2.......................................................... 0.49 ........... 67.35 ........... 13.63 70.15 151.13
PA1.......................................................... 0.46 ........... 63.22 ........... 13.63 70.15 147.00
--------------------------------------------------------------------------------------------------------------------------------------------------------
Table 4a.--RUG-53, Case-Mix Adjusted Federal Rates and Associated Indexes--Urban
--------------------------------------------------------------------------------------------------------------------------------------------------------
Non-case Non-case
RUG-53 category Nursing Therapy Nursing Therapy mix therapy mix Total rate
index index component component component component
--------------------------------------------------------------------------------------------------------------------------------------------------------
RUX.......................................................... 1.80 2.24 247.39 231.91 ........... 70.15 549.45
RUL.......................................................... 1.33 2.24 182.80 231.91 ........... 70.15 484.86
RVX.......................................................... 1.46 1.32 200.66 136.66 ........... 70.15 407.47
RVL.......................................................... 1.26 1.32 173.17 136.66 ........... 70.15 379.98
RHX.......................................................... 1.34 1.10 184.17 113.88 ........... 70.15 368.20
RHL.......................................................... 1.30 1.10 178.67 113.88 ........... 70.15 362.70
RMX.......................................................... 1.83 1.03 251.52 106.64 ........... 70.15 428.31
RML.......................................................... 1.60 1.03 219.90 106.64 ........... 70.15 396.69
RLX.......................................................... 1.25 0.79 171.80 81.79 ........... 70.15 323.74
RUC.......................................................... 1.21 2.24 166.30 231.91 ........... 70.15 468.36
RUB.......................................................... 0.94 2.24 129.19 231.91 ........... 70.15 431.25
RUA.......................................................... 0.79 2.24 108.58 231.91 ........... 70.15 410.64
RVC.......................................................... 1.16 1.32 159.43 136.66 ........... 70.15 366.24
RVB.......................................................... 1.02 1.32 140.19 136.66 ........... 70.15 347.00
RVA.......................................................... 0.79 1.32 108.58 136.66 ........... 70.15 315.39
RHC.......................................................... 1.15 1.10 158.06 113.88 ........... 70.15 342.09
RHB.......................................................... 1.05 1.10 144.31 113.88 ........... 70.15 328.34
RHA.......................................................... 0.89 1.10 122.32 113.88 ........... 70.15 306.35
RMC.......................................................... 1.09 1.03 149.81 106.64 ........... 70.15 326.60
RMB.......................................................... 1.02 1.03 140.19 106.64 ........... 70.15 316.98
RMA.......................................................... 0.99 1.03 136.07 106.64 ........... 70.15 312.86
RLB.......................................................... 1.08 0.79 148.44 81.79 ........... 70.15 300.38
RLA.......................................................... 0.80 0.79 109.95 81.79 ........... 70.15 261.89
SE3.......................................................... 1.76 ........... 241.89 ........... 13.63 70.15 325.67
SE2.......................................................... 1.41 ........... 193.79 ........... 13.63 70.15 277.57
SE1.......................................................... 1.19 ........... 163.55 ........... 13.63 70.15 247.33
SSC.......................................................... 1.16 ........... 159.43 ........... 13.63 70.15 243.21
SSB.......................................................... 1.07 ........... 147.06 ........... 13.63 70.15 230.84
SSA.......................................................... 1.03 ........... 141.56 ........... 13.63 70.15 225.34
CC2.......................................................... 1.15 ........... 158.06 ........... 13.63 70.15 241.84
CC1.......................................................... 1.01 ........... 138.81 ........... 13.63 70.15 222.59
CB2.......................................................... 0.93 ........... 127.82 ........... 13.63 70.15 211.60
CB1.......................................................... 0.86 ........... 118.20 ........... 13.63 70.15 201.98
CA2.......................................................... 0.85 ........... 116.82 ........... 13.63 70.15 200.60
CA1.......................................................... 0.77 ........... 105.83 ........... 13.63 70.15 189.61
IB2.......................................................... 0.70 ........... 96.21 ........... 13.63 70.15 179.99
IB1.......................................................... 0.68 ........... 93.46 ........... 13.63 70.15 177.24
IA2.......................................................... 0.59 ........... 81.09 ........... 13.63 70.15 164.87
IA1.......................................................... 0.54 ........... 74.22 ........... 13.63 70.15 158.00
BB2.......................................................... 0.69 ........... 94.83 ........... 13.63 70.15 178.61
BB1.......................................................... 0.66 ........... 90.71 ........... 13.63 70.15 174.49
BA2.......................................................... 0.57 ........... 78.34 ........... 13.63 70.15 162.12
BA1.......................................................... 0.49 ........... 67.35 ........... 13.63 70.15 151.13
PE2.......................................................... 0.80 ........... 109.95 ........... 13.63 70.15 193.73
PE1.......................................................... 0.78 ........... 107.20 ........... 13.63 70.15 190.98
PD2.......................................................... 0.74 ........... 101.71 ........... 13.63 70.15 185.49
PD1.......................................................... 0.72 ........... 98.96 ........... 13.63 70.15 182.74
PC2.......................................................... 0.67 ........... 92.08 ........... 13.63 70.15 175.86
PC1.......................................................... 0.65 ........... 89.34 ........... 13.63 70.15 173.12
PB2.......................................................... 0.52 ........... 71.47 ........... 13.63 70.15 155.25
PB1.......................................................... 0.51 ........... 70.09 ........... 13.63 70.15 153.87
PA2.......................................................... 0.50 ........... 68.72 ........... 13.63 70.15 152.50
PA1.......................................................... 0.48 ........... 65.97 ........... 13.63 70.15 149.75
--------------------------------------------------------------------------------------------------------------------------------------------------------
[[Page 29085]]
Table 5.--RUG-44, Case-Mix Adjusted Federal Rates and Associated Indexes--Rural
--------------------------------------------------------------------------------------------------------------------------------------------------------
Non-case Non-case
RUG III category Nursing Therapy Nursing Therapy mix therapy mix Total rate
index index component component component component
--------------------------------------------------------------------------------------------------------------------------------------------------------
RUC.......................................................... 1.30 2.25 170.69 268.61 ........... 71.45 510.75
RUB.......................................................... 0.95 2.25 124.74 268.61 ........... 71.45 464.80
RUA.......................................................... 0.78 2.25 102.41 268.61 ........... 71.45 442.47
RVC.......................................................... 1.13 1.41 148.37 168.33 ........... 71.45 388.15
RVB.......................................................... 1.04 1.41 136.55 168.33 ........... 71.45 376.33
RVA.......................................................... 0.81 1.41 106.35 168.33 ........... 71.45 346.13
RHC.......................................................... 1.26 0.94 165.44 112.22 ........... 71.45 349.11
RHB.......................................................... 1.06 0.94 139.18 112.22 ........... 71.45 322.85
RHA.......................................................... 0.87 0.94 114.23 112.22 ........... 71.45 297.90
RMC.......................................................... 1.35 0.77 177.26 91.92 ........... 71.45 340.63
RMB.......................................................... 1.09 0.77 143.12 91.92 ........... 71.45 306.49
RMA.......................................................... 0.96 0.77 126.05 91.92 ........... 71.45 289.42
RLB.......................................................... 1.11 0.43 145.74 51.33 ........... 71.45 268.52
RLA.......................................................... 0.80 0.43 105.04 51.33 ........... 71.45 227.82
SE3.......................................................... 1.70 ........... 223.21 ........... 14.56 71.45 309.22
SE2.......................................................... 1.39 ........... 182.51 ........... 14.56 71.45 268.52
SE1.......................................................... 1.17 ........... 153.62 ........... 14.56 71.45 239.63
SSC.......................................................... 1.13 ........... 148.37 ........... 14.56 71.45 234.38
SSB.......................................................... 1.05 ........... 137.87 ........... 14.56 71.45 223.88
SSA.......................................................... 1.01 ........... 132.61 ........... 14.56 71.45 218.62
CC2.......................................................... 1.12 ........... 147.06 ........... 14.56 71.45 233.07
CC1.......................................................... 0.99 ........... 129.99 ........... 14.56 71.45 216.00
CB2.......................................................... 0.91 ........... 119.48 ........... 14.56 71.45 205.49
CB1.......................................................... 0.84 ........... 110.29 ........... 14.56 71.45 196.30
CA2.......................................................... 0.83 ........... 108.98 ........... 14.56 71.45 194.99
CA1.......................................................... 0.75 ........... 98.48 ........... 14.56 71.45 184.49
IB2.......................................................... 0.69 ........... 90.60 ........... 14.56 71.45 176.61
IB1.......................................................... 0.67 ........... 87.97 ........... 14.56 71.45 173.98
IA2.......................................................... 0.57 ........... 74.84 ........... 14.56 71.45 160.85
IA1.......................................................... 0.53 ........... 69.59 ........... 14.56 71.45 155.60
BB2.......................................................... 0.68 ........... 89.28 ........... 14.56 71.45 175.29
BB1.......................................................... 0.65 ........... 85.35 ........... 14.56 71.45 171.36
BA2.......................................................... 0.56 ........... 73.53 ........... 14.56 71.45 159.54
BA1.......................................................... 0.48 ........... 63.02 ........... 14.56 71.45 149.03
PE2.......................................................... 0.79 ........... 103.73 ........... 14.56 71.45 189.74
PE1.......................................................... 0.77 ........... 101.10 ........... 14.56 71.45 187.11
PD2.......................................................... 0.72 ........... 94.54 ........... 14.56 71.45 180.55
PD1.......................................................... 0.70 ........... 91.91 ........... 14.56 71.45 177.92
PC2.......................................................... 0.65 ........... 85.35 ........... 14.56 71.45 171.36
PC1.......................................................... 0.64 ........... 84.03 ........... 14.56 71.45 170.04
PB2.......................................................... 0.51 ........... 66.96 ........... 14.56 71.45 152.97
PB1.......................................................... 0.50 ........... 65.65 ........... 14.56 71.45 151.66
PA2.......................................................... 0.49 ........... 64.34 ........... 14.56 71.45 150.35
PA1.......................................................... 0.46 ........... 60.40 ........... 14.56 71.45 146.41
--------------------------------------------------------------------------------------------------------------------------------------------------------
Table 5a.--RUG-53, Case-Mix Adjusted Federal Rates and Associated Indexes--Rural
--------------------------------------------------------------------------------------------------------------------------------------------------------
Non-case Non-case
RUG-53 category Nursing Therapy Nursing Therapy mix therapy mix Total rate
index index component component component component
--------------------------------------------------------------------------------------------------------------------------------------------------------
RUX.......................................................... 1.8 2.24 236.34 267.41 ........... 71.45 575.20
RUL.......................................................... 1.33 2.24 174.63 267.41 ........... 71.45 513.49
RVX.......................................................... 1.46 1.32 191.70 157.58 ........... 71.45 420.73
RVL.......................................................... 1.26 1.32 165.44 157.58 ........... 71.45 394.47
RHX.......................................................... 1.34 1.10 175.94 131.32 ........... 71.45 378.71
RHL.......................................................... 1.3 1.10 170.69 131.32 ........... 71.45 373.46
RMX.......................................................... 1.83 1.03 240.28 122.96 ........... 71.45 434.69
RML.......................................................... 1.6 1.03 210.08 122.96 ........... 71.45 404.49
RLX.......................................................... 1.25 0.79 164.13 94.31 ........... 71.45 329.89
RUC.......................................................... 1.21 2.24 158.87 267.41 ........... 71.45 497.73
RUB.......................................................... 0.94 2.24 123.42 267.41 ........... 71.45 462.28
RUA.......................................................... 0.79 2.24 103.73 267.41 ........... 71.45 442.59
RVC.......................................................... 1.16 1.32 152.31 157.58 ........... 71.45 381.34
RVB.......................................................... 1.02 1.32 133.93 157.58 ........... 71.45 362.96
RVA.......................................................... 0.79 1.32 103.73 157.58 ........... 71.45 332.76
RHC.......................................................... 1.15 1.10 151.00 131.32 ........... 71.45 353.77
RHB.......................................................... 1.05 1.10 137.87 131.32 ........... 71.45 340.64
RHA.......................................................... 0.89 1.10 116.86 131.32 ........... 71.45 319.63
RMC.......................................................... 1.09 1.03 143.12 122.96 ........... 71.45 337.53
[[Page 29086]]
RMB.......................................................... 1.02 1.03 133.93 122.96 ........... 71.45 328.34
RMA.......................................................... 0.99 1.03 129.99 122.96 ........... 71.45 324.40
RLB.......................................................... 1.08 0.79 141.80 94.31 ........... 71.45 307.56
RLA.......................................................... 0.80 0.79 105.04 94.31 ........... 71.45 270.80
SE3.......................................................... 1.76 ........... 231.09 ........... 14.56 71.45 317.10
SE2.......................................................... 1.41 ........... 185.13 ........... 14.56 71.45 271.14
SE1.......................................................... 1.19 ........... 156.25 ........... 14.56 71.45 242.26
SSC.......................................................... 1.16 ........... 152.31 ........... 14.56 71.45 238.32
SSB.......................................................... 1.07 ........... 140.49 ........... 14.56 71.45 226.50
SSA.......................................................... 1.03 ........... 135.24 ........... 14.56 71.45 221.25
CC2.......................................................... 1.15 ........... 151.00 ........... 14.56 71.45 237.01
CC1.......................................................... 1.01 ........... 132.61 ........... 14.56 71.45 218.62
CB2.......................................................... 0.93 ........... 122.11 ........... 14.56 71.45 208.12
CB1.......................................................... 0.86 ........... 112.92 ........... 14.56 71.45 198.93
CA2.......................................................... 0.85 ........... 111.61 ........... 14.56 71.45 197.62
CA1.......................................................... 0.77 ........... 101.10 ........... 14.56 71.45 187.11
IB2.......................................................... 0.70 ........... 91.91 ........... 14.56 71.45 177.92
IB1.......................................................... 0.68 ........... 89.28 ........... 14.56 71.45 175.29
IA2.......................................................... 0.59 ........... 77.47 ........... 14.56 71.45 163.48
IA1.......................................................... 0.54 ........... 70.90 ........... 14.56 71.45 156.91
BB2.......................................................... 0.69 ........... 90.60 ........... 14.56 71.45 176.61
BB1.......................................................... 0.66 ........... 86.66 ........... 14.56 71.45 172.67
BA2.......................................................... 0.57 ........... 74.84 ........... 14.56 71.45 160.85
BA1.......................................................... 0.49 ........... 64.34 ........... 14.56 71.45 150.35
PE2.......................................................... 0.80 ........... 105.04 ........... 14.56 71.45 191.05
PE1.......................................................... 0.78 ........... 102.41 ........... 14.56 71.45 188.42
PD2.......................................................... 0.74 ........... 97.16 ........... 14.56 71.45 183.17
PD1.......................................................... 0.72 ........... 94.54 ........... 14.56 71.45 180.55
PC2.......................................................... 0.67 ........... 87.97 ........... 14.56 71.45 173.98
PC1.......................................................... 0.65 ........... 85.35 ........... 14.56 71.45 171.36
PB2.......................................................... 0.52 ........... 68.28 ........... 14.56 71.45 154.29
PB1.......................................................... 0.51 ........... 66.96 ........... 14.56 71.45 152.97
PA2.......................................................... 0.50 ........... 65.65 ........... 14.56 71.45 151.66
PA1.......................................................... 0.48 ........... 63.02 ........... 14.56 71.45 149.03
--------------------------------------------------------------------------------------------------------------------------------------------------------
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 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 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, labor-intensive
services, and capital-related expenses) to produce the FY 2006 labor-
related relative importance. Tables 6 and 7 show the Federal rates by
labor-related and non-labor-related components for the existing 44
group RUG classification system. Tables 6a and 7a show the Federal
rates by labor-related 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
------------------------------------------------------------------------
Labor Non-labor
RUG III category Total rate portion portion
------------------------------------------------------------------------
RUC........................... 481.76 366.56 115.20
RUB........................... 433.66 329.96 103.70
[[Page 29087]]
RUA........................... 410.29 312.18 98.11
RVC........................... 371.44 282.62 88.82
RVB........................... 359.07 273.21 85.86
RVA........................... 327.46 249.15 78.31
RHC........................... 340.64 259.18 81.46
RHB........................... 313.16 238.27 74.89
RHA........................... 287.04 218.40 68.64
RMC........................... 335.41 255.20 80.21
RMB........................... 299.68 228.02 71.66
RMA........................... 281.81 214.42 67.39
RLB........................... 267.23 203.33 63.90
RLA........................... 224.62 170.91 53.71
SE3........................... 317.43 241.52 75.91
SE2........................... 274.82 209.10 65.72
SE1........................... 244.58 186.09 58.49
SSC........................... 239.09 181.92 57.17
SSB........................... 228.09 173.55 54.54
SSA........................... 222.59 169.36 53.23
CC2........................... 237.71 180.87 56.84
CC1........................... 219.85 167.28 52.57
CB2........................... 208.85 158.91 49.94
CB1........................... 199.23 151.59 47.64
CA2........................... 197.86 150.55 47.31
CA1........................... 186.86 142.18 44.68
IB2........................... 178.61 135.90 42.71
IB1........................... 175.86 133.81 42.05
IA2........................... 162.12 123.35 38.77
IA1........................... 156.62 119.17 37.45
BB2........................... 177.24 134.86 42.38
BB1........................... 173.12 131.72 41.40
BA2........................... 160.75 122.31 38.44
BA1........................... 149.75 113.94 35.81
PE2........................... 192.36 146.36 46.00
PE1........................... 189.61 144.27 45.34
PD2........................... 182.74 139.04 43.70
PD1........................... 179.99 136.95 43.04
PC2........................... 173.12 131.72 41.40
PC1........................... 171.74 130.67 41.07
PB2........................... 153.87 117.08 36.79
PB1........................... 152.50 116.03 36.47
PA2........................... 151.13 114.99 36.14
PA1........................... 147.00 111.85 35.15
------------------------------------------------------------------------
Table 6A.--RUG-53, Case-Mix Adjusted Federal Rates for Urban SNFs by
Labor and Non-Labor Component
------------------------------------------------------------------------
Labor Non-labor
RUG 53 category Total rate portion portion
------------------------------------------------------------------------
RUX........................... 549.45 418.06 131.39
RUL........................... 484.86 368.92 115.94
RVX........................... 407.47 310.03 97.44
RVL........................... 379.98 289.12 90.86
RHX........................... 368.20 280.15 88.05
RHL........................... 362.70 275.97 86.73
RMX........................... 428.31 325.89 102.42
RML........................... 396.69 301.83 94.86
RLX........................... 323.74 246.32 77.42
RUC........................... 468.36 356.36 112.00
RUB........................... 431.25 328.13 103.12
RUA........................... 410.64 312.44 98.20
RVC........................... 366.24 278.66 87.58
RVB........................... 347.00 264.02 82.98
RVA........................... 315.39 239.97 75.42
RHC........................... 342.09 260.29 81.80
RHB........................... 328.34 249.82 78.52
RHA........................... 306.35 233.09 73.26
RMC........................... 326.60 248.50 78.10
RMB........................... 316.98 241.18 75.80
RMA........................... 312.86 238.05 74.81
[[Page 29088]]
RLB........................... 300.38 228.55 71.83
RLA........................... 261.89 199.26 62.63
SE3........................... 325.67 247.79 77.88
SE2........................... 277.57 211.19 66.38
SE1........................... 247.33 188.19 59.14
SSC........................... 243.21 185.05 58.16
SSB........................... 230.84 175.64 55.20
SSA........................... 225.34 171.45 53.89
CC2........................... 241.84 184.01 57.83
CC1........................... 222.59 169.36 53.23
CB2........................... 211.60 161.00 50.60
CB1........................... 201.98 153.68 48.30
CA2........................... 200.60 152.63 47.97
CA1........................... 189.61 144.27 45.34
IB2........................... 179.99 136.95 43.04
IB1........................... 177.24 134.86 42.38
IA2........................... 164.87 125.44 39.43
IA1........................... 158.00 120.22 37.78
BB2........................... 178.61 135.90 42.71
BB1........................... 174.49 132.76 41.73
BA2........................... 162.12 123.35 38.77
BA1........................... 151.13 114.99 36.14
PE2........................... 193.73 147.40 46.33
PE1........................... 190.98 145.31 45.67
PD2........................... 185.49 141.13 44.36
PD1........................... 182.74 139.04 43.70
PC2........................... 175.86 133.81 42.05
PC1........................... 173.12 131.72 41.40
PB2........................... 155.25 118.13 37.12
PB1........................... 153.87 117.08 36.79
PA2........................... 152.50 116.03 36.47
PA1........................... 149.75 113.94 35.81
------------------------------------------------------------------------
Table 7.--RUG-44, Case-Mix Adjusted Federal Rates for Rural SNFs by
Labor and Non-Labor Component
------------------------------------------------------------------------
Labor Non-labor
RUG III category Total rate portion portion
------------------------------------------------------------------------
RUC........................... 510.75 388.61 122.14
RUB........................... 464.80 353.65 111.15
RUA........................... 442.47 336.66 105.81
RVC........................... 388.15 295.33 92.82
RVB........................... 376.33 286.34 89.99
RVA........................... 346.13 263.36 82.77
RHC........................... 349.11 265.63 83.48
RHB........................... 322.85 245.65 77.20
RHA........................... 297.90 226.66 71.24
RMC........................... 340.63 259.18 81.45
RMB........................... 306.49 233.20 73.29
RMA........................... 289.42 220.21 69.21
RLB........................... 268.52 204.31 64.21
RLA........................... 227.82 173.34 54.48
SE3........................... 309.22 235.28 73.94
SE2........................... 268.52 204.31 64.21
SE1........................... 239.63 182.33 57.30
SSC........................... 234.38 178.33 56.05
SSB........................... 223.88 170.34 53.54
SSA........................... 218.62 166.34 52.28
CC2........................... 233.07 177.34 55.73
CC1........................... 216.00 164.35 51.65
CB2........................... 205.49 156.35 49.14
CB1........................... 196.30 149.36 46.94
CA2........................... 194.99 148.36 46.63
CA1........................... 184.49 140.37 44.12
IB2........................... 176.61 134.38 42.23
IB1........................... 173.98 132.38 41.60
IA2........................... 160.85 122.39 38.46
IA1........................... 155.60 118.39 37.21
BB2........................... 175.29 133.37 41.92
[[Page 29089]]
BB1........................... 171.36 130.38 40.98
BA2........................... 159.54 121.39 38.15
BA1........................... 149.03 113.39 35.64
PE2........................... 189.74 144.37 45.37
PE1........................... 187.11 142.37 44.74
PD2........................... 180.55 137.38 43.17
PD1........................... 177.92 135.37 42.55
PC2........................... 171.36 130.38 40.98
PC1........................... 170.04 129.38 40.66
PB2........................... 152.97 116.39 36.58
PB1........................... 151.66 115.39 36.27
PA2........................... 150.35 114.40 35.95
PA1........................... 146.41 111.40 35.01
------------------------------------------------------------------------
Table 7a.--RUG-53 Case-Mix Adjusted Federal Rates for Rural SNFs by
Labor and Non-Labor Component
------------------------------------------------------------------------
Labor Non-labor
RUG-53 category Total rate portion portion
------------------------------------------------------------------------
RUX........................... 575.20 437.65 137.55
RUL........................... 513.49 390.70 122.79
RVX........................... 420.73 320.12 100.61
RVL........................... 394.47 300.14 94.33
RHX........................... 378.71 288.15 90.56
RHL........................... 373.46 284.15 89.31
RMX........................... 434.69 330.74 103.95
RML........................... 404.49 307.76 96.73
RLX........................... 329.89 251.00 78.89
RUC........................... 497.73 378.71 119.02
RUB........................... 462.28 351.73 110.55
RUA........................... 442.59 336.75 105.84
RVC........................... 381.34 290.15 91.19
RVB........................... 362.96 276.17 86.79
RVA........................... 332.76 253.19 79.57
RHC........................... 353.77 269.17 84.60
RHB........................... 340.64 259.18 81.46
RHA........................... 319.63 243.20 76.43
RMC........................... 337.53 256.82 80.71
RMB........................... 328.34 249.82 78.52
RMA........................... 324.40 246.83 77.57
RLB........................... 307.56 234.01 73.55
RLA........................... 270.80 206.04 64.76
SE3........................... 317.10 241.27 75.83
SE2........................... 271.14 206.30 64.84
SE1........................... 242.26 184.33 57.93
SSC........................... 238.32 181.33 56.99
SSB........................... 226.50 172.34 54.16
SSA........................... 221.25 168.34 52.91
CC2........................... 237.01 180.33 56.68
CC1........................... 218.62 166.34 52.28
CB2........................... 208.12 158.35 49.77
CB1........................... 198.93 151.36 47.57
CA2........................... 197.62 150.36 47.26
CA1........................... 187.11 142.37 44.74
IB2........................... 177.92 135.37 42.55
IB1........................... 175.29 133.37 41.92
IA2........................... 163.48 124.39 39.09
IA1........................... 156.91 119.39 37.52
BB2........................... 176.61 134.38 42.23
BB1........................... 172.67 131.38 41.29
BA2........................... 160.85 122.39 38.46
BA1........................... 150.35 114.40 35.95
PE2........................... 191.05 145.36 45.69
PE1........................... 188.42 143.36 45.06
PD2........................... 183.17 139.37 43.80
PD1........................... 180.55 137.38 43.17
PC2........................... 173.98 132.38 41.60
PC1........................... 171.36 130.38 40.98
PB2........................... 154.29 117.39 36.90
[[Page 29090]]
PB1........................... 152.97 116.39 36.58
PA2........................... 151.66 115.39 36.27
PA1........................... 149.03 113.39 35.64
------------------------------------------------------------------------
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: http://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 OMB-
revised 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 Sec. 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 Sec. 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 Sec. 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 Sec. 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 Sec. 412.62(f)(1)(ii) and
(f)(1)(iii), respectively, were used under the IPPS from FYs 1985
through 2004 (Sec. 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 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 Sec. 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,
[[Page 29091]]
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 Core-Based 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: http://www.whitehouse.gov/omb/bulletins/fy04/b04-03.html.
)
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 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
[[Page 29092]]
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 Sec.
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
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 Sec.
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 Sec. 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 Sec. 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 county-based. 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 city- and town-based system as an 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 county-based 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
[[Page 29093]]
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 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-Wayne-White 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 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
[[Page 29094]]
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 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 MSA-based 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 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
[[Page 29095]]
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, 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 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 SNF-specific 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
[[Page 29096]]
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 Sec. 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 Sec. 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
--------------------------------------------------------------------------------------------------------------------------------------------------------
Adjustment Adjustment Percent Medicare
RUG group Labor Wage index labor Non-labor rate adjustment days Payment
--------------------------------------------------------------------------------------------------------------------------------------------------------
RVC............................................. $282.62 0.8364 $236.38 $88.82 $325.20 * $346.99 14 $4,858
RHA............................................. 218.40 0.8364 182.67 68.64 251.31 * 268.15 16 4,290
CC2............................................. 180.87 0.8364 151.28 56.84 208.12 ** 474.51 10 4,745
SE3............................................. 241.52 0.8364 202.01 75.91 277.92 *** 333.50 30 10,005
IA2............................................. 123.35 0.8364 103.17 38.77 141.94 141.94 30 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.
[[Page 29097]]
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
--------------------------------------------------------------------------------------------------------------------------------------------------------
Adjustment Adjustment Percent Medicare
RUG group Labor Wage index labor Non-labor rate adjustment days Payment
--------------------------------------------------------------------------------------------------------------------------------------------------------
RVX............................................. $310.03 0.8364 $259.31 $97.44 $356.75 $356.75 14 $4,994
RHA............................................. 233.09 0.8364 194.96 73.26 268.22 268.22 16 4,291
CC2............................................. 184.01 0.8364 153.91 57.83 211.74 * 482.76 10 4,828
RLX............................................. 246.32 0.8364 206.02 77.42 283.44 283.44 30 8,503
IA2............................................. 125.44 0.8364 104.92 39.43 144.35 144.35 30 4,330
--------------
Total....................................... ........... ........... ........... ........... ........... ........... 100 26,946
--------------------------------------------------------------------------------------------------------------------------------------------------------
* Reflects a 128 percent adjustment from section 511 of the MMA.
III. The Skilled Nursing Facility Market Basket Index
Section 1888(e)(5)(A) of the Act requires us to establish a SNF
market basket index (input price index) that reflects changes over time
in the prices of an appropriate mix of goods and services included in
the SNF PPS. This proposed rule incorporates the latest available
projections of the SNF market basket index. The final rule will
incorporate updated projections based on the latest available
projections at that time. Accordingly, we have developed a SNF market
basket index that encompasses the most commonly used cost categories
for SNF routine services, ancillary services, and capital-related
expenses. In the July 31, 2001 Federal Register (66 FR 39562), we
included a complete discussion on the rebasing of the SNF market basket
to FY 1997. There are 21 separate cost categories and respective price
proxies. These cost categories were illustrated in Table 10.A, Table
10.B, and Appendix A, along with other relevant information, in the
July 31, 2001 Federal Register.
Each year, we calculate a revised labor-related share based on the
relative importance of labor-related cost categories in the input price
index. Table 11 summarizes the proposed updated labor-related share for
FY 2006.
Table 11.--FY 2006 Labor-Related Share
------------------------------------------------------------------------
Relative Relative
importance, importance,
labor- labor-
related, related,
FY 2005 FY 2006
(97 index) (97 index)
------------------------------------------------------------------------
Wages and salaries............................ 54.720 54.572
Employee benefits............................. 11.595 11.691
Nonmedical professional fees.................. 2.688 2.702
Labor-intensive services...................... 4.125 4.116
Capital-related............................... 3.094 3.006
Total....................................... 76.222 76.087
------------------------------------------------------------------------
A. Use of the Skilled Nursing Facility Market Basket Percentage
Section 1888(e)(5)(B) of the Act defines the SNF market basket
percentage as the percentage change in the SNF market basket index, as
described in the previous section, from the average index level of the
prior fiscal year to the average index level of the current fiscal
year. For the Federal rates established in this proposed rule, this
percentage increase in the SNF market basket index would be used to
compute the update factor occurring between FY 2005 and FY 2006. We
used the Global Insight, Inc. (formerly DRI-WEFA), 1st quarter 2005
forecasted percentage increase in the FY 1997-based SNF market basket
index for routine, ancillary, and capital-related expenses, described
in the previous section, to compute the update factor. Finally, we no
longer compute update factors to adjust a facility-specific portion of
the SNF PPS rates, because the 3-year transition period from facility-
specific to full Federal rates that started with cost reporting periods
beginning in July 1998 has expired.
B. Market Basket Forecast Error Adjustment
As discussed in the June 10, 2003, supplemental proposed rule (68
FR 34768) and finalized in the August 4, 2003, final rule (68 FR
46067), the regulations at Sec. 413.337(d)(2) provide for an
adjustment to account for market basket forecast error. The initial
adjustment applied to the update of the FY 2003 rate that occurred in
FY 2004, and took into account the cumulative forecast error for the
period from FY 2000 through FY 2002. Subsequent adjustments in
succeeding FYs take into account the forecast error from the most
recently available fiscal year for which there are final data, and are
applied whenever the difference between the forecasted and actual
change in the market basket exceeds a 0.25 percentage point threshold.
As discussed previously in section I.G of this proposed rule, as the
difference between the estimated and actual amounts of increase in the
market basket index for FY 2004 (the most recently available fiscal
year for which there are final data) did not exceed the 0.25 percentage
point threshold, the payment rates for FY 2006 do not include a
forecast error adjustment.
C. Federal Rate Update Factor
Section 1888(e)(4)(E)(ii)(IV) of the Act requires that the update
factor used to establish the FY 2006 Federal rates be at a level equal
to the full market basket percentage change. Accordingly, to establish
the update factor, we determined the total growth from the average
market basket level for the period of October 1, 2004 through September
30, 2005 to the average market basket level for the period of October
1, 2005 through September 30, 2006. Using this process, the proposed
update factor for FY 2006 SNF Federal rates is 3.0 percentage points.
We used this revised proposed update factor to compute the proposed
Federal portion of the SNF PPS rate shown in Tables 2 and 3.
IV. Consolidated Billing
As established by section 4432(b) of the BBA, the consolidated
billing requirement places with the SNF the
[[Page 29098]]
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. 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 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 non-CAH 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,
http://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
[[Page 29099]]
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 Sec. 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), Sec. 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), Sec. 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 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 3-day
hospital stay requirement. We note that in evaluating the potential
impact 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 short-term
treatment that is specifically directed at that condition so that a
subsequent determination about
[[Page 29100]]
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 3-day
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 3-day requirement for SNF
coverage under section 1861(i) of the Act.
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 Sec. 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
Sec. 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 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
[[Page 29101]]
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 case-mix
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 newly-
legislated 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 specified
clinically complex RUGs (and 6.7 percent for other, rehabilitation
RUGs) would expire with the implementation of the proposed case-mix
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 add-ons 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
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 add-on 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.
[[Page 29102]]
Table 12.--Projected Impact to the SNF PPS for FY 2006
----------------------------------------------------------------------------------------------------------------
Eliminate
Update wage add-on to Case-mix Total FY
Number of data MSA to CBSA certain refinements 2006 change
facilities (percent) (percent) RUGs (percent) (percent)
(percent)
----------------------------------------------------------------------------------------------------------------
Total............................. 15,675 0.0 0.0 -6.0 3.0 0.0
Urban............................. 10,599 0.0 0.2 -6.0 2.9 0.1
Rural............................. 5,076 0.1 -0.8 -6.0 3.4 -0.3
Hospital based urban.............. 1,097 0.0 0.2 -6.3 5.6 2.5
Freestanding urban................ 8,693 0.0 0.2 -5.9 2.4 -0.3
Hospital based rural.............. 1,160 0.0 -0.7 -6.8 5.9 1.3
Freestanding rural................ 3,372 0.2 -1.0 -5.9 2.9 -0.8
Urban by region:
New England................... 917 -0.4 -0.4 -6.4 3.0 -1.2
Middle Atlantic............... 1,499 0.2 0.3 -6.1 3.4 0.8
South Atlantic................ 1,739 -0.3 0.3 -5.9 2.6 -0.3
East North Central............ 2,009 -0.3 0.0 -5.7 2.8 -0.2
East South Central............ 531 0.4 0.7 -6.0 2.7 0.8
West North Central............ 836 -0.4 0.4 -5.9 3.7 0.8
West South Central............ 1,093 -0.1 0.5 -5.8 2.7 0.3
Mountain...................... 467 -0.2 0.5 -5.6 3.0 0.7
Pacific....................... 1,501 1.2 0.0 -6.2 2.7 0.7
Rural by region:
New England................... 139 1.9 -0.1 -5.7 3.5 2.6
Middle Atlantic............... 283 0.0 -0.8 -6.0 3.7 -0.1
South Atlantic................ 612 -0.3 -1.7 -6.2 2.9 -2.3
East North Central............ 947 0.2 -0.8 -5.9 3.5 0.1
East South Central............ 571 0.4 -0.6 -6.3 2.9 -0.6
West North Central............ 1,219 -0.4 -0.3 -6.2 4.0 0.1
West South Central............ 823 0.3 -0.8 -6.2 2.9 -0.7
Mountain...................... 298 0.8 -3.4 -5.9 3.8 -1.8
Pacific....................... 182 1.3 0.5 -4.2 3.5 4.1
Ownership:
Government.................... 693 0.1 0.3 -6.5 3.2 0.0
Proprietary................... 9,317 0.0 0.0 -5.9 2.9 0.0
Voluntary..................... 3,493 -0.1 -0.1 -6.0 3.1 -0.1
----------------------------------------------------------------------------------------------------------------
C. Accounting Statement
As required by OMB Circular A-4 (available at http://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 Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers............ $0 million.
From Whom To Whom?........................ No Transfer.
------------------------------------------------------------------------
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 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 44-group 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
[[Page 29103]]
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 non-therapy
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
Sec. 424.3 [Amended]
2. In Sec. 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 Sec. 424.20, paragraph (e)(2) is revised to read as follows:
Sec. 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 Sec. 409.21 of this subchapter (however, the
performance of only delegated physician tasks under Sec. 483.40(e) of
this chapter does not, in itself, establish the existence of an
indirect employment relationship).
* * * * *
(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.
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.
Table 8.--Proposed Wage Index For Urban Areas Based On CBSA Labor Market
Areas
------------------------------------------------------------------------
Urban Area (Constituent Wage
CBSA Code Counties) Index
------------------------------------------------------------------------
10180........................ Abilene, TX................... 0.7904
Callahan County, TX...........
Jones County, TX..............
Taylor County, TX.............
10380........................ Aguadilla-Isabela-San 0.4743
Sebastian, PR.
Aguada Municipio, PR..........
Aguadilla Municipio, PR.......
A[ntilde]asco Municipio, PR...
Isabela Municipio, PR.........
Lares Municipio, PR...........
Moca Municipio, PR............
Rinc[oacute]n Municipio, PR...
San Sebastian Municipio, PR...
10420........................ Akron, OH..................... 0.8991
Portage County, OH............
Summit County, OH.............
10500........................ Albany, GA.................... 0.8636
Baker County, GA..............
Dougherty County, GA..........
Lee County, GA................
Terrell County, GA............
Worth County, GA..............
10580........................ Albany-Schenectady-Troy, NY... 0.8545
Albany County, NY.............
Rensselaer County, NY.........
Saratoga County, NY...........
Schenectady County, NY........
Schoharie County, NY..........
10740........................ Albuquerque, NM............... 0.9693
Bernalillo County, NM.........
Sandoval County, NM...........
Torrance County, NM...........
Valencia County, NM...........
10780........................ Alexandria, LA................ 0.8041
Grant Parish, LA..............
Rapides Parish, LA............
10900........................ Allentown-Bethlehem-Easton, PA- 0.9828
NJ.
Warren County, NJ.............
Carbon County, PA.............
Lehigh County, PA.............
Northampton County, PA........
11020........................ Altoona, PA................... 0.8953
Blair County, PA..............
11100........................ Amarillo, TX.................. 0.9166
Armstrong County, TX..........
[[Page 29104]]
Carson County, TX.............
Potter County, TX.............
Randall County, TX............
11180........................ Ames, IA...................... 0.9545
Story County, IA..............
11260........................ Anchorage, AK................. 1.2110
Anchorage Municipality, AK....
Matanuska-Susitna Borough, AK.
11300........................ Anderson, IN.................. 0.8595
Madison County, IN............
11340........................ Anderson, SC.................. 0.8897
Anderson County, SC...........
11460........................ Ann Arbor, MI................. 1.0870
Washtenaw County, MI..........
11500........................ Anniston-Oxford, AL........... 0.7659
Calhoun County, AL............
11540........................ Appleton, WI.................. 0.9298
Calumet County, WI............
Outagamie County, WI..........
11700........................ Asheville, NC................. 0.9294
Buncombe County, NC...........
Haywood County, NC............
Henderson County, NC..........
Madison County, NC............
12020........................ Athens-Clarke County, GA...... 0.9843
Clarke County, GA.............
Madison County, GA............
Oconee County, GA.............
Oglethorpe County, GA.........
12060........................ Atlanta-Sandy Springs- 0.9648
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..............
Meriwether County, GA.........
Newton County, GA.............
Paulding County, GA...........
Pickens County, GA............
Pike County, GA...............
Rockdale County, GA...........
Spalding County, GA...........
Walton County, GA.............
12100........................ Atlantic City, NJ............. 1.1633
Atlantic County, NJ...........
12220........................ Auburn-Opelika, AL............ 0.8108
Lee County, AL................
12260........................ Augusta-Richmond County, GA-SC 0.9565
Burke County, GA..............
Columbia County, GA...........
McDuffie County, GA...........
Richmond County, GA...........
Aiken County, SC..............
Edgefield County, SC..........
12420........................ Austin-Round Rock, TX......... 0.9450
Bastrop County, TX............
Caldwell County, TX...........
Hays County, TX...............
Travis County, TX.............
Williamson County, TX.........
12540........................ Bakersfield, CA............... 1.0344
Kern County, CA...............
12580........................ Baltimore-Towson, MD.......... 0.9907
Anne Arundel County, MD.......
Baltimore County, MD..........
Carroll County, MD............
Harford County, MD............
Howard County, MD.............
Queen Anne's County, MD.......
Baltimore City, MD............
12620........................ Bangor, ME.................... 1.0003
Penobscot County, ME..........
12700........................ Barnstable Town, MA........... 1.2527
Barnstable County, MA.........
12940........................ Baton Rouge, LA............... 0.8601
Ascension Parish, LA..........
East Baton Rouge Parish, LA...
East Feliciana Parish, LA.....
Iberville Parish, LA..........
Livingston Parish, LA.........
Pointe Coupee Parish, LA......
St. Helena Parish, LA.........
West Baton Rouge Parish, LA...
West Feliciana Parish, LA.....
12980........................ Battle Creek, MI.............. 0.9510
Calhoun County, MI............
13020........................ Bay City, MI.................. 0.9352
Bay County, MI................
13140........................ Beaumont-Port Arthur, TX...... 0.8421
Hardin County, TX.............
Jefferson County, TX..........
Orange County, TX.............
13380........................ Bellingham, WA................ 1.1743
Whatcom County, WA............
13460........................ Bend, OR...................... 1.0796
Deschutes County, OR..........
13644........................ Bethesda-Frederick- 1.1495
Gaithersburg, MD.
Frederick County, MD..........
Montgomery County, MD.........
13740........................ Billings, MT.................. 0.8843
Carbon County, MT.............
Yellowstone County, MT........
13780........................ Binghamton, NY................ 0.8571
Broome County, NY.............
Tioga County, NY..............
13820........................ Birmingham-Hoover, AL......... 0.8979
Bibb County, AL...............
Blount County, AL.............
Chilton County, AL............
Jefferson County, AL..........
St. Clair County, AL..........
Shelby County, AL.............
Walker County, AL.............
13900........................ Bismarck, ND.................. 0.7519
Burleigh County, ND...........
Morton County, ND.............
13980........................ Blacksburg-Christiansburg- 0.7962
Radford, VA.
Giles County, VA..............
Montgomery County, VA.........
Pulaski County, VA............
Radford City, VA..............
14020........................ Bloomington, IN............... 0.8456
Greene County, IN.............
Monroe County, IN.............
Owen County, IN...............
14060........................ Bloomington-Normal, IL........ 0.9084
McLean County, IL.............
14260........................ Boise City-Nampa, ID.......... 0.9061
[[Page 29105]]
Ada County, ID................
Boise County, ID..............
Canyon County, ID.............
Gem County, ID................
Owyhee County, ID.............
14484........................ Boston-Quincy, MA............. 1.1543
Norfolk County, MA............
Plymouth County, MA...........
Suffolk County, MA............
14500........................ Boulder, CO................... 0.9744
Boulder County, CO............
14540........................ Bowling Green, KY............. 0.8220
Edmonson County, KY...........
Warren County, KY.............
14740........................ Bremerton-Silverdale, WA...... 1.0686
Kitsap County, WA.............
14860........................ Bridgeport-Stamford-Norwalk, 1.2598
CT.
Fairfield County, CT..........
15180........................ Brownsville-Harlingen, TX..... 0.9822
Cameron County, TX............
15260........................ Brunswick, GA................. 0.9320
Brantley County, GA...........
Glynn County, GA..............
McIntosh County, GA...........
15380........................ Buffalo-Niagara Falls, NY..... 0.8889
Erie County, NY...............
Niagara County, NY............
15500........................ Burlington, NC................ 0.8914
Alamance County, NC...........
15540........................ Burlington-South Burlington, 0.9446
VT.
Chittenden County, VT.........
Franklin County, VT...........
Grand Isle County, VT.........
15764........................ Cambridge-Newton-Framingham, 1.1084
MA.
Middlesex County, MA..........
15804........................ Camden, NJ.................... 1.0528
Burlington County, NJ.........
Camden County, NJ.............
Gloucester County, NJ.........
15940........................ Canton-Massillon, OH.......... 0.8944
Carroll County, OH............
Stark County, OH..............
15980........................ Cape Coral-Fort Myers, FL..... 0.9366
Lee County, FL................
16180........................ Carson City, NV............... 1.0244
16220........................ Casper, WY.................... 0.9035
Natrona County, WY............
16300........................ Cedar Rapids, IA.............. 0.8617
Benton County, IA.............
Jones County, IA..............
Linn County, IA...............
16580........................ Champaign-Urbana, IL.......... 0.9604
Champaign County, IL..........
Ford County, IL...............
Piatt County, IL..............
16620........................ Charleston, WV................ 0.8428
Boone County, WV..............
Clay County, WV...............
Kanawha County, WV............
Lincoln County, WV............
Putnam County, WV.............
16700........................ Charleston-North Charleston, 0.9438
SC.
Berkeley County, SC...........
Charleston County, SC.........
Dorchester County, SC.........
16740........................ Charlotte-Gastonia-Concord, NC- 0.9760
SC.
Anson County, NC..............
Cabarrus County, NC...........
Gaston County, NC.............
Mecklenburg County, NC........
Union County, NC..............
York County, SC...............
16820........................ Charlottesville, VA........... 1.0234
Albemarle County, VA..........
Fluvanna County, VA...........
Greene County, VA.............
Nelson County, VA.............
Charlottesville City, VA......
16860........................ Chattanooga, TN-GA............ 0.9098
Catoosa County, GA............
Dade County, GA...............
Walker County, GA.............
Hamilton County, TN...........
Marion County, TN.............
Sequatchie County, TN.........
16940........................ Cheyenne, WY.................. 0.8784
Laramie County, WY............
16974........................ Chicago-Naperville-Joliet, IL. 1.0848
Cook County, IL...............
DeKalb County, IL.............
DuPage County, IL.............
Grundy County, IL.............
Kane County, IL...............
Kendall County, IL............
McHenry County, IL............
Will County, IL...............
17020........................ Chico, CA..................... 1.0522
Butte County, CA..............
17140........................ Cincinnati-Middletown, OH-KY- 0.9623
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.............
17300........................ Clarksville, TN-KY............ 0.8292
Christian County, KY..........
Trigg County, KY..............
Montgomery County, TN.........
Stewart County, TN............
17420........................ Cleveland, TN................. 0.8141
Bradley County, TN............
Polk County, TN...............
17460........................ Cleveland-Elyria-Mentor, OH... 0.9204
Cuyahoga County, OH...........
Geauga County, OH.............
Lake County, OH...............
Lorain County, OH.............
Medina County, OH.............
17660........................ Coeur d'Alene, ID............. 0.9657
Kootenai County, ID...........
17780........................ College Station-Bryan, TX..... 0.8909
Brazos County, TX.............
Burleson County, TX...........
Robertson County, TX..........
17820........................ Colorado Springs, CO.......... 0.9478
El Paso County, CO............
Teller County, CO.............
17860........................ Columbia, MO.................. 0.8354
Boone County, MO..............
Howard County, MO.............
17900........................ Columbia, SC.................. 0.9047
Calhoun County, SC............
Fairfield County, SC..........
Kershaw County, SC............
Lexington County, SC..........
Richland County, SC...........
Saluda County, SC.............
17980........................ Columbus, GA-AL............... 0.8568
Russell County, AL............
[[Page 29106]]
Chattahoochee County, GA......
Harris County, GA.............
Marion County, GA.............
Muscogee County, GA...........
18020........................ Columbus, IN.................. 0.9598
Bartholomew County, IN........
18140........................ Columbus, OH.................. 0.9850
Delaware County, OH...........
Fairfield County, OH..........
Franklin County, OH...........
Licking County, OH............
Madison County, OH............
Morrow County, OH.............
Pickaway County, OH...........
Union County, OH..............
18580........................ Corpus Christi, TX............ 0.8559
Aransas County, TX............
Nueces County, TX.............
San Patricio County, TX.......
18700........................ Corvallis, OR................. 1.0739
Benton County, OR.............
19060........................ Cumberland, MD-WV............. 0.9326
Allegany County, MD...........
Mineral County, WV............
19124........................ Dallas-Plano-Irving, TX....... 1.0233
Collin County, TX.............
Dallas County, TX.............
Delta County, TX..............
Denton County, TX.............
Ellis County, TX..............
Hunt County, TX...............
Kaufman County, TX............
Rockwall County, TX...........
19140........................ Dalton, GA.................... 0.9044
Murray County, GA.............
Whitfield County, GA..........
19180........................ Danville, IL.................. 0.9037
Vermilion County, IL..........
19260........................ Danville, VA.................. 0.8497
Pittsylvania County, VA.......
Danville City, VA.............
19340........................ Davenport-Moline-Rock Island, 0.8731
IA-IL.
Henry County, IL..............
Mercer County, IL.............
Rock Island County, IL........
Scott County, IA..............
19380........................ Dayton, OH.................... 0.9073
Greene County, OH.............
Miami County, OH..............
Montgomery County, OH.........
Preble County, OH.............
19460........................ Decatur, AL................... 0.8478
Lawrence County, AL...........
Morgan County, AL.............
19500........................ Decatur, IL................... 0.8076
Macon County, IL..............
19660........................ Deltona-Daytona Beach-Ormond 0.9308
Beach, FL.
Volusia County, FL............
19740........................ Denver-Aurora, CO............. 1.0733
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...............
19780........................ Des Moines, IA................ 0.9651
Dallas County, IA.............
Guthrie County, IA............
Madison County, IA............
Polk County, IA...............
Warren County, IA.............
19804........................ Detroit-Livonia-Dearborn, MI.. 1.0441
Wayne County, MI..............
20020........................ Dothan, AL.................... 0.7707
Geneva County, AL.............
Henry County, AL..............
Houston County, AL............
20100........................ Dover, DE..................... 0.9779
Kent County, DE...............
20220........................ Dubuque, IA................... 0.9135
Dubuque County, IA............
20260........................ Duluth, MN-WI................. 1.0209
Carlton County, MN............
St. Louis County, MN..........
Douglas County, WI............
20500........................ Durham, NC.................... 1.0303
Chatham County, NC............
Durham County, NC.............
Orange County, NC.............
Person County, NC.............
20740........................ Eau Claire, WI................ 0.9210
Chippewa County, WI...........
Eau Claire County, WI.........
20764........................ Edison, NJ.................... 1.1260
Middlesex County, NJ..........
Monmouth County, NJ...........
Ocean County, NJ..............
Somerset County, NJ...........
20940........................ El Centro, CA................. 0.8915
Imperial County, CA...........
21060........................ Elizabethtown, KY............. 0.8810
Hardin County, KY.............
Larue County, KY..............
21140........................ Elkhart-Goshen, IN............ 0.9637
Elkhart County, IN............
21300........................ Elmira, NY.................... 0.8259
Chemung County, NY............
21340........................ El Paso, TX................... 0.8924
El Paso County, TX............
21500........................ Erie, PA...................... 0.8746
Erie County, PA...............
21604........................ Essex County, MA.............. 1.0533
Essex County, MA..............
21660........................ Eugene-Springfield, OR........ 1.0829
Lane County, OR...............
21780........................ Evansville, IN-KY............. 0.8721
Gibson County, IN.............
Posey County, IN..............
Vanderburgh County, IN........
Warrick County, IN............
Henderson County, KY..........
Webster County, KY............
21820........................ Fairbanks, AK................. 1.1419
Fairbanks North Star Borough,
AK.
21940........................ Fajardo, PR................... 0.4157
Ceiba Municipio, PR...........
Fajardo Municipio, PR.........
Luquillo Municipio, PR........
22020........................ Fargo, ND-MN.................. 0.8495
Cass County, ND...............
Clay County, MN...............
22140........................ Farmington, NM................ 0.8518
San Juan County, NM...........
22180........................ Fayetteville, NC.............. 0.9426
Cumberland County, NC.........
Hoke County, NC...............
22220........................ Fayetteville-Springdale- 0.8563
Rogers, AR-MO.
Benton County, AR.............
Madison County, AR............
Washington County, AR.........
McDonald County, MO...........
22380........................ Flagstaff, AZ................. 1.2105
Coconino County, AZ...........
22420........................ Flint, MI..................... 1.0663
Genesee County, MI............
22500........................ Florence, SC.................. 0.8964
Darlington County, SC.........
Florence County, SC...........
[[Page 29107]]
22520........................ Florence-Muscle Shoals, AL.... 0.8280
Colbert County, AL............
Lauderdale County, AL.........
22540........................ Fond du Lac, WI............... 0.9650
Fond du Lac County, WI........
22660........................ Fort Collins-Loveland, CO..... 1.0132
Larimer County, CO............
22744........................ Fort Lauderdale-Pompano Beach- 1.0442
Deerfield Beach, FL.
Broward County, FL............
22900........................ Fort Smith, AR-OK............. 0.8214
Crawford County, AR...........
Franklin County, AR...........
Sebastian County, AR..........
Le Flore County, OK...........
Sequoyah County, OK...........
23020........................ Fort Walton Beach-Crestview- 0.8881
Destin, FL.
Okaloosa County, FL...........
23060........................ Fort Wayne, IN................ 0.9803
Allen County, IN..............
Wells County, IN..............
Whitley County, IN............
23104........................ Fort Worth-Arlington, TX...... 0.9510
Johnson County, TX............
Parker County, TX.............
Tarrant County, TX............
Wise County, TX...............
23420........................ Fresno, CA.................... 1.0541
Fresno County, CA.............
23460........................ Gadsden, AL................... 0.7946
Etowah County, AL.............
23540........................ Gainesville, FL............... 0.9474
Alachua County, FL............
Gilchrist County, FL..........
23580........................ Gainesville, GA............... 0.8883
Hall County, GA...............
23844........................ Gary, IN...................... 0.9369
Jasper County, IN.............
Lake County, IN...............
Newton County, IN.............
Porter County, IN.............
24020........................ Glens Falls, NY............... 0.8567
Warren County, NY.............
Washington County, NY.........
24140........................ Goldsboro, NC................. 0.8784
Wayne County, NC..............
24220........................ Grand Forks, ND-MN............ 1.1516
Polk County, MN...............
Grand Forks County, ND........
24300........................ Grand Junction, CO............ 0.9560
Mesa County, CO...............
24340........................ Grand Rapids-Wyoming, MI...... 0.9400
Barry County, MI..............
Ionia County, MI..............
Kent County, MI...............
Newaygo County, MI............
24500........................ Great Falls, MT............... 0.9061
Cascade County, MT............
24540........................ Greeley, CO................... 0.9580
Weld County, CO...............
24580........................ Green Bay, WI................. 0.9452
Brown County, WI..............
Kewaunee County, WI...........
Oconto County, WI.............
24660........................ Greensboro-High Point, NC..... 0.9113
Guilford County, NC...........
Randolph County, NC...........
Rockingham County, NC.........
24780........................ Greenville, NC................ 0.9434
Greene County, NC.............
Pitt County, NC...............
24860........................ Greenville, SC................ 1.0165
Greenville County, SC.........
Laurens County, SC............
Pickens County, SC............
25020........................ Guayama, PR................... 0.3184
Arroyo Municipio, PR..........
Guayama Municipio, PR.........
Patillas Municipio, PR........
25060........................ Gulfport-Biloxi, MS........... 0.8938
Hancock County, MS............
Harrison County, MS...........
Stone County, MS..............
25180........................ Hagerstown-Martinsburg, MD-WV. 0.9499
Washington County, MD.........
Berkeley County, WV...........
Morgan County, WV.............
25260........................ Hanford-Corcoran, CA.......... 1.0046
Kings County, CA..............
25420........................ Harrisburg-Carlisle, PA....... 0.9322
Cumberland County, PA.........
Dauphin County, PA............
Perry County, PA..............
25500........................ Harrisonburg, VA.............. 0.9098
Rockingham County, VA.........
Harrisonburg City, VA.........
25540........................ Hartford-West Hartford-East 1.1084
Hartford, CT.
Hartford County, CT...........
Litchfield County, CT.........
Middlesex County, CT..........
Tolland County, CT............
25620........................ Hattiesburg, MS............... 0.7609
Forrest County, MS............
Lamar County, MS..............
Perry County, MS..............
25860........................ Hickory-Lenoir-Morganton, NC.. 0.8922
Alexander County, NC..........
Burke County, NC..............
Caldwell County, NC...........
Catawba County, NC............
25980........................ Hinesville-Fort Stewart, GA 0.9178
\1\.
Liberty County, GA............
Long County, GA...............
26100........................ Holland-Grand Haven, MI....... 0.9064
Ottawa County, MI.............
26180........................ Honolulu, HI.................. 1.1208
Honolulu County, HI...........
26300........................ Hot Springs, AR............... 0.9053
Garland County, AR............
26380........................ Houma-Bayou Cane-Thibodaux, LA 0.7902
Lafourche Parish, LA..........
Terrebonne Parish, LA.........
26420........................ Houston-Baytown-Sugar Land, TX 1.0005
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.............
26580........................ Huntington-Ashland, WV-KY-OH.. 0.9486
Boyd County, KY...............
Greenup County, KY............
Lawrence County, OH...........
Cabell County, WV.............
Wayne County, WV..............
26620........................ Huntsville, AL................ 0.9149
[[Page 29108]]
Limestone County, AL..........
Madison County, AL............
26820........................ Idaho Falls, ID............... 0.9429
Bonneville County, ID.........
Jefferson County, ID..........
26900........................ Indianapolis, IN.............. 0.9930
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.............
26980........................ Iowa City, IA................. 0.9756
Johnson County, IA............
Washington County, IA.........
27060........................ Ithaca, NY.................... 0.9803
Tompkins County, NY...........
27100........................ Jackson, MI................... 0.9313
Jackson County, MI............
27140........................ Jackson, MS................... 0.8319
Copiah County, MS.............
Hinds County, MS..............
Madison County, MS............
Rankin County, MS.............
Simpson County, MS............
27180........................ Jackson, TN................... 0.8973
Chester County, TN............
Madison County, TN............
27260........................ Jacksonville, FL.............. 0.9299
Baker County, FL..............
Clay County, FL...............
Duval County, FL..............
Nassau County, FL.............
St. Johns County, FL..........
27340........................ Jacksonville, NC.............. 0.8244
Onslow County, NC.............
27500........................ Janesville, WI................ 0.9547
Rock County, WI...............
27620........................ Jefferson City, MO............ 0.8396
Callaway County, MO...........
Cole County, MO...............
Moniteau County, MO...........
Osage County, MO..............
27740........................ Johnson City, TN.............. 0.7945
Carter County, TN.............
Unicoi County, TN.............
Washington County, TN.........
27780........................ Johnstown, PA................. 0.8362
Cambria County, PA............
27860........................ Jonesboro, AR................. 0.7919
Craighead County, AR..........
Poinsett County, AR...........
27900........................ Joplin, MO.................... 0.8590
Jasper County, MO.............
Newton County, MO.............
28020........................ Kalamazoo-Portage, MI......... 1.0391
Kalamazoo County, MI..........
Van Buren County, MI..........
28100........................ Kankakee-Bradley, IL.......... 1.0974
Kankakee County, IL...........
28140........................ Kansas City, MO-KS............ 0.9467
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................
28420........................ Kennewick-Richland-Pasco, WA.. 1.0630
Benton County, WA.............
Franklin County, WA...........
28660........................ Killeen-Temple-Fort Hood, TX.. 0.8535
Bell County, TX...............
Coryell County, TX............
Lampasas County, TX...........
28700........................ Kingsport-Bristol-Bristol, TN- 0.8062
VA.
Hawkins County, TN............
Sullivan County, TN...........
Bristol City, VA..............
Scott County, VA..............
Washington County, VA.........
28740........................ Kingston, NY.................. 0.9257
Ulster County, NY.............
28940........................ Knoxville, TN................. 0.8454
Anderson County, TN...........
Blount County, TN.............
Knox County, TN...............
Loudon County, TN.............
Union County, TN..............
29020........................ Kokomo, IN.................... 0.9517
Howard County, IN.............
Tipton County, IN.............
29100........................ La Crosse, WI-MN.............. 0.9573
Houston County, MN............
La Crosse County, WI..........
29140........................ Lafayette, IN................. 0.8745
Benton County, IN.............
Carroll County, IN............
Tippecanoe County, IN.........
29180........................ Lafayette, LA................. 0.8436
Lafayette Parish, LA..........
St. Martin Parish, LA.........
29340........................ Lake Charles, LA.............. 0.7841
Calcasieu Parish, LA..........
Cameron Parish, LA............
29404........................ Lake County-Kenosha County, IL- 1.0440
WI.
Lake County, IL...............
Kenosha County, WI............
29460........................ Lakeland, FL.................. 0.8921
Polk County, FL...............
29540........................ Lancaster, PA................. 0.9704
Lancaster County, PA..........
29620........................ Lansing-East Lansing, MI...... 0.9792
Clinton County, MI............
Eaton County, MI..............
Ingham County, MI.............
29700........................ Laredo, TX.................... 0.8076
Webb County, TX...............
29740........................ Las Cruces, NM................ 0.8475
Dona Ana County, NM...........
29820........................ Las Vegas-Paradise, NV........ 1.1449
Clark County, NV..............
29940........................ Lawrence, KS.................. 0.8546
Douglas County, KS............
30020........................ Lawton, OK.................... 0.7880
Comanche County, OK...........
30140........................ Lebanon, PA................... 0.8468
Lebanon County, PA............
30300........................ Lewiston, ID-WA............... 0.9896
Nez Perce County, ID..........
Asotin County, WA.............
30340........................ Lewiston-Auburn, ME........... 0.9341
Androscoggin County, ME.......
30460........................ Lexington-Fayette, KY......... 0.9084
Bourbon County, KY............
Clark County, KY..............
Fayette County, KY............
Jessamine County, KY..........
Scott County, KY..............
Woodford County, KY...........
30620........................ Lima, OH...................... 0.9234
Allen County, OH..............
[[Page 29109]]
30700........................ Lincoln, NE................... 1.0225
Lancaster County, NE..........
Seward County, NE.............
30780........................ Little Rock-North Little Rock, 0.8756
AR.
Faulkner County, AR...........
Grant County, AR..............
Lonoke County, AR.............
Perry County, AR..............
Pulaski County, AR............
Saline County, AR.............
30860........................ Logan, UT-ID.................. 0.9173
Franklin County, ID...........
Cache County, UT..............
30980........................ Longview, TX.................. 0.8739
Gregg County, TX..............
Rusk County, TX...............
Upshur County, TX.............
31020........................ Longview, WA.................. 0.9523
Cowlitz County, WA............
31084........................ Los Angeles-Long Beach- 1.1752
Glendale, CA.
Los Angeles County, CA........
31140........................ Louisville, KY-IN............. 0.9261
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............
31180........................ Lubbock, TX................... 0.8792
Crosby County, TX.............
Lubbock County, TX............
31340........................ Lynchburg, VA................. 0.8700
Amherst County, VA............
Appomattox County, VA.........
Bedford County, VA............
Campbell County, VA...........
Bedford City, VA..............
Lynchburg City, VA............
31420........................ Macon, GA..................... 0.9453
Bibb County, GA...............
Crawford County, GA...........
Jones County, GA..............
Monroe County, GA.............
Twiggs County, GA.............
31460........................ Madera, CA.................... 0.8721
Madera County, CA.............
31540........................ Madison, WI................... 1.0635
Columbia County, WI...........
Dane County, WI...............
Iowa County, WI...............
31700........................ Manchester-Nashua, NH......... 1.0335
Hillsborough County, NH.......
Merrimack County, NH..........
31900........................ Mansfield, OH \1\............. 0.8887
Richland County, OH...........
32420........................ Mayag[uuml]ez, PR............. 0.4017
Hormigueros Municipio, PR.....
Mayag[uuml]ez Municipio, PR...
32580........................ McAllen-Edinburg-Pharr, TX.... 0.8943
Hidalgo County, TX............
32780........................ Medford, OR................... 1.0235
Jackson County, OR............
32820........................ Memphis, TN-MS-AR............. 0.9341
Crittenden County, AR.........
DeSoto County, MS.............
Marshall County, MS...........
Tate County, MS...............
Tunica County, MS.............
Fayette County, TN............
Shelby County, TN.............
Tipton County, TN.............
32900........................ Merced, CA.................... 1.1120
Merced County, CA.............
33124........................ Miami-Miami Beach-Kendall, FL. 0.9759
Miami-Dade County, FL.........
33140........................ Michigan City-La Porte, IN.... 0.9409
LaPorte County, IN............
33260........................ Midland, TX................... 0.9523
Midland County, TX............
33340........................ Milwaukee-Waukesha-West Allis, 1.0106
WI.
Milwaukee County, WI..........
Ozaukee County, WI............
Washington County, WI.........
Waukesha County, WI...........
33460........................ Minneapolis-St. Paul- 1.1078
Bloomington, MN-WI.
Anoka County, MN..............
Carver County, MN.............
Chisago County, MN............
Dakota County, MN.............
Hennepin County, MN...........
Isanti County, MN.............
Ramsey County, MN.............
Scott County, MN..............
Sherburne County, MN..........
Washington County, MN.........
Wright County, MN.............
Pierce County, WI.............
St. Croix County, WI..........
33540........................ Missoula, MT.................. 0.9482
Missoula County, MT...........
33660........................ Mobile, AL.................... 0.7895
Mobile County, AL.............
33700........................ Modesto, CA................... 1.1804
Stanislaus County, CA.........
33740........................ Monroe, LA.................... 0.8040
Ouachita Parish, LA...........
Union Parish, LA..............
33780........................ Monroe, MI.................... 0.9478
Monroe County, MI.............
33860........................ Montgomery, AL................ 0.8588
Autauga County, AL............
Elmore County, AL.............
Lowndes County, AL............
Montgomery County, AL.........
34060........................ Morgantown, WV................ 0.8428
Monongalia County, WV.........
Preston County, WV............
34100........................ Morristown, TN................ 0.8753
Grainger County, TN...........
Hamblen County, TN............
Jefferson County, TN..........
34580........................ Mount Vernon-Anacortes, WA.... 1.0465
Skagit County, WA.............
34620........................ Muncie, IN.................... 0.8939
Delaware County, IN...........
34740........................ Muskegon-Norton Shores, MI.... 0.9673
Muskegon County, MI...........
34820........................ Myrtle Beach-Conway-North 0.8873
Myrtle Beach, SC.
Horry County, SC..............
34900........................ Napa, CA...................... 1.2656
Napa County, CA...............
34940........................ Naples-Marco Island, FL....... 1.0140
Collier County, FL............
34980........................ Nashville-Davidson-- 0.9769
Murfreesboro, TN.
Cannon County, TN.............
Cheatham County, TN...........
[[Page 29110]]
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.............
35004........................ Nassau-Suffolk, NY............ 1.2760
Nassau County, NY.............
Suffolk County, NY............
35084........................ Newark-Union, NJ-PA........... 1.2195
Essex County, NJ..............
Hunterdon County, NJ..........
Morris County, NJ.............
Sussex County, NJ.............
Union County, NJ..............
Pike County, PA...............
35300........................ New Haven-Milford, CT......... 1.1702
New Haven County, CT..........
35380........................ New Orleans-Metairie-Kenner, 0.9005
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........
35644........................ New York-Wayne-White Plains, 1.3185
NY-NJ.
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........
35660........................ Niles-Benton Harbor, MI....... 0.8888
Berrien County, MI............
35980........................ Norwich-New London, CT........ 1.1356
New London County, CT.........
36084........................ Oakland-Fremont-Hayward, CA... 1.5346
Alameda County, CA............
Contra Costa County, CA.......
36100........................ Ocala, FL..................... 0.8934
Marion County, FL.............
36140........................ Ocean City, NJ................ 1.1022
Cape May County, NJ...........
36220........................ Odessa, TX.................... 0.9894
Ector County, TX..............
36260........................ Ogden-Clearfield, UT.......... 0.9038
Davis County, UT..............
Morgan County, UT.............
Weber County, UT..............
36420........................ Oklahoma City, OK............. 0.9040
Canadian County, OK...........
Cleveland County, OK..........
Grady County, OK..............
Lincoln County, OK............
Logan County, OK..............
McClain County, OK............
Oklahoma County, OK...........
36500........................ Olympia, WA................... 1.0938
Thurston County, WA...........
36540........................ Omaha-Council Bluffs, NE-IA... 0.9569
Harrison County, IA...........
Mills County, IA..............
Pottawattamie County, IA......
Cass County, NE...............
Douglas County, NE............
Sarpy County, NE..............
Saunders County, NE...........
Washington County, NE.........
36740........................ Orlando, FL................... 0.9459
Lake County, FL...............
Orange County, FL.............
Osceola County, FL............
Seminole County, FL...........
36780........................ Oshkosh-Neenah, WI............ 0.9192
Winnebago County, WI..........
36980........................ Owensboro, KY................. 0.8789
Daviess County, KY............
Hancock County, KY............
McLean County, KY.............
37100........................ Oxnard-Thousand Oaks-Ventura, 1.1613
CA.
Ventura County, CA............
37340........................ Palm Bay-Melbourne-Titusville, 0.9835
FL.
Brevard County, FL............
37460........................ Panama City-Lynn Haven, FL.... 0.7989
Bay County, FL................
37620........................ Parkersburg-Marietta, WV-OH... 0.8278
Washington County, OH.........
Pleasants County, WV..........
Wirt County, WV...............
Wood County, WV...............
37700........................ Pascagoula, MS................ 0.8165
George County, MS.............
Jackson County, MS............
37860........................ Pensacola-Ferry Pass-Brent, FL 0.8104
Escambia County, FL...........
Santa Rosa County, FL.........
37900........................ Peoria, IL.................... 0.8868
Marshall County, IL...........
Peoria County, IL.............
Stark County, IL..............
Tazewell County, IL...........
Woodford County, IL...........
37964........................ Philadelphia, PA.............. 1.1040
Bucks County, PA..............
Chester County, PA............
Delaware County, PA...........
Montgomery County, PA.........
Philadelphia County, PA.......
38060........................ Phoenix-Mesa-Scottsdale, AZ... 1.0138
Maricopa County, AZ...........
Pinal County, AZ..............
38220........................ Pine Bluff, AR................ 0.8689
Cleveland County, AR..........
Jefferson County, AR..........
Lincoln County, AR............
38300........................ Pittsburgh, PA................ 0.8853
Allegheny County, PA..........
Armstrong County, PA..........
Beaver County, PA.............
Butler County, PA.............
Fayette County, PA............
Washington County, PA.........
Westmoreland County, PA.......
38340........................ Pittsfield, MA................ 1.0191
[[Page 29111]]
Berkshire County, MA..........
38540........................ Pocatello, ID................. 0.9360
Bannock County, ID............
Power County, ID..............
38660........................ Ponce, PR..................... 0.5177
Juana D[iacute]az Municipio,
PR.
Ponce Municipio, PR...........
Villalba Municipio, PR........
38860........................ Portland-South Portland- 1.0392
Biddeford, ME.
Cumberland County, ME.........
Sagadahoc County, ME..........
York County, ME...............
38900........................ Portland-Vancouver-Beaverton, 1.1260
OR-WA.
Clackamas County, OR..........
Columbia County, OR...........
Multnomah County, OR..........
Washington County, OR.........
Yamhill County, OR............
Clark County, WA..............
Skamania County, WA...........
38940........................ Port St. Lucie-Fort Pierce, FL 1.0133
Martin County, FL.............
St. Lucie County, FL..........
39100........................ Poughkeepsie-Newburgh- 1.0766
Middletown, NY.
Dutchess County, NY...........
Orange County, NY.............
39140........................ Prescott, AZ.................. 0.9879
Yavapai County, AZ............
39300........................ Providence-New Bedford-Fall 1.0966
River, RI-MA.
Bristol County, MA............
Bristol County, RI............
Kent County, RI...............
Newport County, RI............
Providence County, RI.........
Washington County, RI.........
39340........................ Provo-Orem, UT................ 0.9510
Juab County, UT...............
Utah County, UT...............
39380........................ Pueblo, CO.................... 0.8632
Pueblo County, CO.............
39460........................ Punta Gorda, FL............... 0.9264
Charlotte County, FL..........
39540........................ Racine, WI.................... 0.9006
Racine County, WI.............
39580........................ Raleigh-Cary, NC.............. 0.9733
Franklin County, NC...........
Johnston County, NC...........
Wake County, NC...............
39660........................ Rapid City, SD................ 0.9021
Meade County, SD..............
Pennington County, SD.........
39740........................ Reading, PA................... 0.9696
Berks County, PA..............
39820........................ Redding, CA................... 1.2215
Shasta County, CA.............
39900........................ Reno-Sparks, NV............... 1.0993
Storey County, NV.............
Washoe County, NV.............
40060........................ Richmond, VA.................. 0.9338
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.............
40140........................ Riverside-San Bernardino- 1.1022
Ontario, CA.
Riverside County, CA..........
San Bernardino County, CA.....
40220........................ Roanoke, VA................... 0.8383
Botetourt County, VA..........
Craig County, VA..............
Franklin County, VA...........
Roanoke County, VA............
Roanoke City, VA..............
Salem City, VA................
40340........................ Rochester, MN................. 1.1142
Dodge County, MN..............
Olmsted County, MN............
Wabasha County, MN............
40380........................ Rochester, NY................. 0.9115
Livingston County, NY.........
Monroe County, NY.............
Ontario County, NY............
Orleans County, NY............
Wayne County, NY..............
40420........................ Rockford, IL.................. 0.9994
Boone County, IL..............
Winnebago County, IL..........
40484........................ Rockingham County-Strafford 1.0385
County, NH.
Rockingham County, NH.........
Strafford County, NH..........
40580........................ Rocky Mount, NC............... 0.8924
Edgecombe County, NC..........
Nash County, NC...............
40660........................ Rome, GA...................... 0.9424
Floyd County, GA..............
40900........................ Sacramento--Arden-Arcade-- 1.2973
Roseville, CA.
El Dorado County, CA..........
Placer County, CA.............
Sacramento County, CA.........
Yolo County, CA...............
40980........................ Saginaw-Saginaw Township 0.9420
North, MI.
Saginaw County, MI............
41060........................ St. Cloud, MN................. 0.9975
Benton County, MN.............
Stearns County, MN............
41100........................ St. George, UT................ 0.9402
Washington County, UT.........
41140........................ St. Joseph, MO-KS............. 0.9529
Doniphan County, KS...........
Andrew County, MO.............
Buchanan County, MO...........
DeKalb County, MO.............
41180........................ St. Louis, MO-IL.............. 0.8949
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...........
[[Page 29112]]
Jefferson County, MO..........
Lincoln County, MO............
St. Charles County, MO........
St. Louis County, MO..........
Warren County, MO.............
Washington County, MO.........
St. Louis City, MO............
41420........................ Salem, OR..................... 1.0452
Marion County, OR.............
Polk County, OR...............
41500........................ Salinas, CA................... 1.4142
Monterey County, CA...........
41540........................ Salisbury, MD................. 0.9073
Somerset County, MD...........
Wicomico County, MD...........
41620........................ Salt Lake City, UT............ 0.9433
Salt Lake County, UT..........
Summit County, UT.............
Tooele County, UT.............
41660........................ San Angelo, TX................ 0.8280
Irion County, TX..............
Tom Green County, TX..........
41700........................ San Antonio, TX............... 0.8989
Atascosa County, TX...........
Bandera County, TX............
Bexar County, TX..............
Comal County, TX..............
Guadalupe County, TX..........
Kendall County, TX............
Medina County, TX.............
Wilson County, TX.............
41740........................ San Diego-Carlsbad-San Marcos, 1.1424
CA.
San Diego County, CA..........
41780........................ Sandusky, OH.................. 0.9025
Erie County, OH...............
41884........................ San Francisco-San Mateo- 1.4990
Redwood City, CA.
Marin County, CA..............
San Francisco County, CA......
San Mateo County, CA..........
41900........................ San Germ[aacute]n-Cabo Rojo, 0.4655
PR.
Cabo Rojo Municipio, PR.......
Lajas Municipio, PR...........
Sabana Grande Municipio, PR...
San Germ[aacute]n Municipio,
PR.
41940........................ San Jose-Sunnyvale-Santa 1.5125
Clara, CA.
San Benito County, CA.........
Santa Clara County, CA........
41980........................ San Juan-Caguas-Guaynabo, PR.. 0.4686
Aguas Buenas Municipio, PR....
Aibonito Municipio, PR........
Arecibo Municipio, PR.........
Barceloneta Municipio, PR.....
Barranquitas Municipio, PR....
Bayam[oacute]n Municipio, PR..
Caguas Municipio, PR..........
Camuy Municipio, PR...........
Can[oacute]vanas Municipio, PR
Carolina Municipio, PR........
Cata[ntilde]o Municipio, PR...
Cayey Municipio, PR...........
Ciales Municipio, PR..........
Cidra Municipio, PR...........
Comer[iacute]o 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.....
Lo[iacute]za Municipio, PR....
Manat[iacute] Municipio, PR...
Maunabo Municipio, PR.........
Morovis Municipio, PR.........
Naguabo Municipio, PR.........
Naranjito Municipio, PR.......
Orocovis Municipio, PR........
Quebradillas Municipio, PR....
R[iacute]o 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.........
42020........................ San Luis Obispo-Paso Robles, 1.1360
CA.
San Luis Obispo County, CA....
42044........................ Santa Ana-Anaheim-Irvine, CA.. 1.1576
Orange County, CA.............
42060........................ Santa Barbara-Santa Maria- 1.1538
Goleta, CA.
Santa Barbara County, CA......
42100........................ Santa Cruz-Watsonville, CA.... 1.5182
Santa Cruz County, CA.........
42140........................ Santa Fe, NM.................. 1.0931
Santa Fe County, NM...........
42220........................ Santa Rosa-Petaluma, CA....... 1.3506
Sonoma County, CA.............
42260........................ Sarasota-Bradenton-Venice, FL. 0.9555
Manatee County, FL............
Sarasota County, FL...........
42340........................ Savannah, GA.................. 0.9480
Bryan County, GA..............
Chatham County, GA............
Effingham County, GA..........
42540........................ Scranton--Wilkes-Barre, PA.... 0.8548
Lackawanna County, PA.........
Luzerne County, PA............
Wyoming County, PA............
42644........................ Seattle-Bellevue-Everett, WA.. 1.1589
King County, WA...............
[[Page 29113]]
Snohomish County, WA..........
43100........................ Sheboygan, WI................. 0.8920
Sheboygan County, WI..........
43300........................ Sherman-Denison, TX........... 0.9516
Grayson County, TX............
43340........................ Shreveport-Bossier City, LA... 0.8769
Bossier Parish, LA............
Caddo Parish, LA..............
De Soto Parish, LA............
43580........................ Sioux City, IA-NE-SD.......... 0.9376
Woodbury County, IA...........
Dakota County, NE.............
Dixon County, NE..............
Union County, SD..............
43620........................ Sioux Falls, SD............... 0.9645
Lincoln County, SD............
McCook County, SD.............
Minnehaha County, SD..........
Turner County, SD.............
43780........................ South Bend-Mishawaka, IN-MI... 0.9798
St. Joseph County, IN.........
Cass County, MI...............
43900........................ Spartanburg, SC............... 0.9181
Spartanburg County, SC........
44060........................ Spokane, WA................... 1.0916
Spokane County, WA............
44100........................ Springfield, IL............... 0.8885
Menard County, IL.............
Sangamon County, IL...........
44140........................ Springfield, MA............... 1.0259
Franklin County, MA...........
Hampden County, MA............
Hampshire County, MA..........
44180........................ Springfield, MO............... 0.8246
Christian County, MO..........
Dallas County, MO.............
Greene County, MO.............
Polk County, MO...............
Webster County, MO............
44220........................ Springfield, OH............... 0.8404
Clark County, OH..............
44300........................ State College, PA............. 0.8364
Centre County, PA.............
44700........................ Stockton, CA.................. 1.1311
San Joaquin County, CA........
44940........................ Sumter, SC.................... 0.8386
Sumter County, SC.............
45060........................ Syracuse, NY.................. 0.9581
Madison County, NY............
Onondaga County, NY...........
Oswego County, NY.............
45104........................ Tacoma, WA.................... 1.0753
Pierce County, WA.............
45220........................ Tallahassee, FL............... 0.8697
Gadsden County, FL............
Jefferson County, FL..........
Leon County, FL...............
Wakulla County, FL............
45300........................ Tampa-St. Petersburg- 0.9193
Clearwater, FL.
Hernando County, FL...........
Hillsborough County, FL.......
Pasco County, FL..............
Pinellas County, FL...........
45460........................ Terre Haute, IN............... 0.8313
Clay County, IN...............
Sullivan County, IN...........
Vermillion County, IN.........
Vigo County, IN...............
45500........................ Texarkana, TX-Texarkana, AR... 0.8291
Miller County, AR.............
Bowie County, TX..............
45780........................ Toledo, OH.................... 0.9584
Fulton County, OH.............
Lucas County, OH..............
Ottawa County, OH.............
Wood County, OH...............
45820........................ Topeka, KS.................... 0.8929
Jackson County, KS............
Jefferson County, KS..........
Osage County, KS..............
Shawnee County, KS............
Wabaunsee County, KS..........
45940........................ Trenton-Ewing, NJ............. 1.0845
Mercer County, NJ.............
46060........................ Tucson, AZ.................... 0.8987
Pima County, AZ...............
46140........................ Tulsa, OK..................... 0.8286
Creek County, OK..............
Okmulgee County, OK...........
Osage County, OK..............
Pawnee County, OK.............
Rogers County, OK.............
Tulsa County, OK..............
Wagoner County, OK............
46220........................ Tuscaloosa, AL................ 0.8721
Greene County, AL.............
Hale County, AL...............
Tuscaloosa County, AL.........
46340........................ Tyler, TX..................... 0.9307
Smith County, TX..............
46540........................ Utica-Rome, NY................ 0.8293
Herkimer County, NY...........
Oneida County, NY.............
46660........................ Valdosta, GA.................. 0.8875
Brooks County, GA.............
Echols County, GA.............
Lanier County, GA.............
Lowndes County, GA............
46700........................ Vallejo-Fairfield, CA......... 1.4899
Solano County, CA.............
46940........................ Vero Beach, FL................ 0.9444
Indian River County, FL.......
47020........................ Victoria, TX.................. 0.8168
Calhoun County, TX............
Goliad County, TX.............
Victoria County, TX...........
47220........................ Vineland-Millville-Bridgeton, 0.9837
NJ.
Cumberland County, NJ.........
47260........................ Virginia Beach-Norfolk-Newport 0.8808
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.........
47300........................ Visalia-Porterville, CA....... 1.0074
Tulare County, CA.............
47380........................ Waco, TX...................... 0.8527
McLennan County, TX...........
47580........................ Warner Robins, GA............. 0.8654
Houston County, GA............
47644........................ Warren-Farmington Hills-Troy, 0.9861
MI.
Lapeer County, MI.............
Livingston County, MI.........
Macomb County, MI.............
Oakland County, MI............
St. Clair County, MI..........
[[Page 29114]]
47894........................ Washington-Arlington- 1.0932
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..........
47940........................ Waterloo-Cedar Falls, IA...... 0.8566
Black Hawk County, IA.........
Bremer County, IA.............
Grundy County, IA.............
48140........................ Wausau, WI.................... 0.9600
Marathon County, WI...........
48260........................ Weirton-Steubenville, WV-OH... 0.7827
Jefferson County, OH..........
Brooke County, WV.............
Hancock County, WV............
48300........................ Wenatchee, WA................. 1.0080
Chelan County, WA.............
Douglas County, WA............
48424........................ West Palm Beach-Boca Raton- 1.0077
Boynton Beach, FL.
Palm Beach County, FL.........
48540........................ Wheeling, WV-OH............... 0.7168
Belmont County, OH............
Marshall County, WV...........
Ohio County, WV...............
48620........................ Wichita, KS................... 0.9141
Butler County, KS.............
Harvey County, KS.............
Sedgwick County, KS...........
Sumner County, KS.............
48660........................ Wichita Falls, TX............. 0.8294
Archer County, TX.............
Clay County, TX...............
Wichita County, TX............
48700........................ Williamsport, PA.............. 0.8377
Lycoming County, PA...........
48864........................ Wilmington, DE-MD-NJ.......... 1.0482
New Castle County, DE.........
Cecil County, MD..............
Salem County, NJ..............
48900........................ Wilmington, NC................ 0.9592
Brunswick County, NC..........
New Hanover County, NC........
Pender County, NC.............
49020........................ Winchester, VA-WV............. 1.0224
Frederick County, VA..........
Winchester City, VA...........
Hampshire County, WV..........
49180........................ Winston-Salem, NC............. 0.8953
Davie County, NC..............
Forsyth County, NC............
Stokes County, NC.............
Yadkin County, NC.............
49340........................ Worcester, MA................. 1.1039
Worcester County, MA..........
49420........................ Yakima, WA.................... 1.0165
Yakima County, WA.............
49500........................ Yauco, PR..................... 0.4413
Gu[aacute]nica Municipio, PR..
Guayanilla Municipio, PR......
Pe[ntilde]uelas Municipio, PR.
Yauco Municipio, PR...........
49620........................ York-Hanover, PA.............. 0.9420
York County, PA...............
49660........................ Youngstown-Warren-Boardman, OH- 0.8611
PA.
Mahoning County, OH...........
Trumbull County, OH...........
Mercer County, PA.............
49700........................ Yuba City, CA................. 1.0932
Sutter County, CA.............
Yuba County, CA...............
49740........................ Yuma, AZ...................... 0.9135
Yuma County, AZ ..............
------------------------------------------------------------------------
\1\At 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
------------------------------------------------------------------------
Wage
CBSA Code Nonurban Area Index
------------------------------------------------------------------------
01........................... Alabama....................... 0.7477
02........................... Alaska........................ 1.1990
03........................... Arizona....................... 0.8777
04........................... Arkansas...................... 0.7451
05........................... California.................... 1.0857
06........................... Colorado...................... 0.9389
07........................... Connecticut................... 1.1794
08........................... Delaware...................... 0.9606
10........................... Florida....................... 0.8598
11........................... Georgia....................... 0.7666
12........................... Hawaii........................ 1.0562
13........................... Idaho......................... 0.8045
14........................... Illinois...................... 0.8279
15........................... Indiana....................... 0.8630
16........................... Iowa.......................... 0.8502
17........................... Kansas........................ 0.7987
18........................... Kentucky...................... 0.7774
19........................... Louisiana..................... 0.7418
20........................... Maine......................... 0.8852
21........................... Maryland...................... 0.9095
22........................... Massachusetts \2\............. 1.0216
23........................... Michigan...................... 0.8870
24........................... Minnesota..................... 0.9183
25........................... Mississippi................... 0.7671
26........................... Missouri...................... 0.7909
27........................... Montana....................... 0.8833
28........................... Nebraska...................... 0.8665
29........................... Nevada........................ 0.9074
30........................... New Hampshire................. 1.0677
31........................... New Jersey \2\................ .........
32........................... New Mexico.................... 0.8644
33........................... New York...................... 0.8157
34........................... North Carolina................ 0.8567
35........................... North Dakota.................. 0.7268
36........................... Ohio.......................... 0.8786
37........................... Oklahoma...................... 0.7589
38........................... Oregon........................ 0.9830
39........................... Pennsylvania.................. 0.8302
40........................... Puerto Rico \2\............... 0.4047
41........................... Rhode Island \2\.............. .........
42........................... South Carolina................ 0.8641
43........................... South Dakota.................. 0.8484
44........................... Tennessee..................... 0.7888
45........................... Texas......................... 0.8007
46........................... Utah.......................... 0.8126
47........................... Vermont....................... 0.9840
48........................... Virgin Islands................ 0.7026
49........................... Virginia...................... 0.8012
50........................... Washington.................... 1.0458
51........................... West Virginia................. 0.7725
52........................... Wisconsin..................... 0.9480
53........................... Wyoming....................... 0.9214
[[Page 29115]]
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
----------------------------------------------------------------------------------------------------------------
2006 MSA- 2006
SSA State/County Code County and State Name MSA based CBSA- CBSA
Number WI based WI Number
----------------------------------------------------------------------------------------------------------------
01000........................... Autauga County, Alabama........... 5240 0.8588 0.8588 33860
01010........................... Baldwin County, Alabama........... 5160 0.7866 0.7477 99901
01020........................... Barbour County, Alabama........... 01 0.7463 0.7477 99901
01030........................... Bibb County, Alabama.............. 01 0.7463 0.8979 13820
01040........................... Blount County, Alabama............ 1000 0.9021 0.8979 13820
01050........................... Bullock County, Alabama........... 01 0.7463 0.7477 99901
01060........................... Butler County, Alabama............ 01 0.7463 0.7477 99901
01070........................... Calhoun County, Alabama........... 0450 0.7659 0.7659 11500
01080........................... Chambers County, Alabama.......... 01 0.7463 0.7477 99901
01090........................... Cherokee County, Alabama.......... 01 0.7463 0.7477 99901
01100........................... Chilton County, Alabama........... 01 0.7463 0.8979 13820
01110........................... Choctaw County, Alabama........... 01 0.7463 0.7477 99901
01120........................... Clarke County, Alabama............ 01 0.7463 0.7477 99901
01130........................... Clay County, Alabama.............. 01 0.7463 0.7477 99901
01140........................... Cleburne County, Alabama.......... 01 0.7463 0.7477 99901
01150........................... Coffee County, Alabama............ 01 0.7463 0.7477 99901
01160........................... Colbert County, Alabama........... 2650 0.8280 0.8280 22520
01170........................... Conecuh County, Alabama........... 01 0.7463 0.7477 99901
01180........................... Coosa County, Alabama............. 01 0.7463 0.7477 99901
01190........................... Covington County, Alabama......... 01 0.7463 0.7477 99901
01200........................... Crenshaw County, Alabama.......... 01 0.7463 0.7477 99901
01210........................... Cullman County, Alabama........... 01 0.7463 0.7477 99901
01220........................... Dale County, Alabama.............. 2180 0.7687 0.7477 99901
01230........................... Dallas County, Alabama............ 01 0.7463 0.7477 99901
01240........................... De Kalb County, Alabama........... 01 0.7463 0.7477 99901
01250........................... Elmore County, Alabama............ 5240 0.8588 0.8588 33860
01260........................... Escambia County, Alabama.......... 01 0.7463 0.7477 99901
01270........................... Etowah County, Alabama............ 2880 0.7946 0.7946 23460
01280........................... Fayette County, Alabama........... 01 0.7463 0.7477 99901
01290........................... Franklin County, Alabama.......... 01 0.7463 0.7477 99901
01300........................... Geneva County, Alabama............ 01 0.7463 0.7707 20020
01310........................... Greene County, Alabama............ 01 0.7463 0.8721 46220
01320........................... Hale County, Alabama.............. 01 0.7463 0.8721 46220
01330........................... Henry County, Alabama............. 01 0.7463 0.7707 20020
01340........................... Houston County, Alabama........... 2180 0.7687 0.7707 20020
01350........................... Jackson County, Alabama........... 01 0.7463 0.7477 99901
01360........................... Jefferson County, Alabama......... 1000 0.9021 0.8979 13820
01370........................... Lamar County, Alabama............. 01 0.7463 0.7477 99901
01380........................... Lauderdale County, Alabama........ 2650 0.8280 0.8280 22520
01390........................... Lawrence County, Alabama.......... 2030 0.8478 0.8478 19460
01400........................... Lee County, Alabama............... 0580 0.8108 0.8108 12220
01410........................... Limestone County, Alabama......... 3440 0.9149 0.9149 26620
01420........................... Lowndes County, Alabama........... 01 0.7463 0.8588 33860
01430........................... Macon County, Alabama............. 01 0.7463 0.7477 99901
01440........................... Madison County, Alabama........... 3440 0.9149 0.9149 26620
01450........................... Marengo County, Alabama........... 01 0.7463 0.7477 99901
01460........................... Marion County, Alabama............ 01 0.7463 0.7477 99901
01470........................... Marshall County, Alabama.......... 01 0.7463 0.7477 99901
01480........................... Mobile County, Alabama............ 5160 0.7866 0.7895 33660
01490........................... Monroe County, Alabama............ 01 0.7463 0.7477 99901
01500........................... Montgomery County, Alabama........ 5240 0.8588 0.8588 33860
[[Page 29116]]
01510........................... Morgan County, Alabama............ 2030 0.8478 0.8478 19460
01520........................... Perry County, Alabama............. 01 0.7463 0.7477 99901
01530........................... Pickens County, Alabama........... 01 0.7463 0.7477 99901
01540........................... Pike County, Alabama.............. 01 0.7463 0.7477 99901
01550........................... Randolph County, Alabama.......... 01 0.7463 0.7477 99901
01560........................... Russell County, Alabama........... 1800 0.8568 0.8568 17980
01570........................... St Clair County, Alabama.......... 1000 0.9021 0.8979 13820
01580........................... Shelby County, Alabama............ 1000 0.9021 0.8979 13820
01590........................... Sumter County, Alabama............ 01 0.7463 0.7477 99901
01600........................... Talladega County, Alabama......... 01 0.7463 0.7477 99901
01610........................... Tallapoosa County, Alabama........ 01 0.7463 0.7477 99901
01620........................... Tuscaloosa County, Alabama........ 8600 0.8842 0.8721 46220
01630........................... Walker County, Alabama............ 01 0.7463 0.8979 13820
01640........................... Washington County, Alabama........ 01 0.7463 0.7477 99901
01650........................... Wilcox County, Alabama............ 01 0.7463 0.7477 99901
01660........................... Winston County, Alabama........... 01 0.7463 0.7477 99901
02013........................... Aleutians County East, Alaska..... 02 1.1900 1.1990 99902
02016........................... Aleutians County West, Alaska..... 02 1.1900 1.1990 99902
02020........................... Anchorage County, Alaska.......... 0380 1.2022 1.2110 11260
02030........................... Angoon County, Alaska............. 02 1.1900 1.1990 99902
02040........................... Barrow-North Slope County, Alaska. 02 1.1900 1.1990 99902
02050........................... Bethel County, Alaska............. 02 1.1900 1.1990 99902
02060........................... Bristol Bay Borough County, Alaska 02 1.1900 1.1990 99902
02068........................... Denali County, Alaska............. 02 1.1900 1.1990 99902
02070........................... Bristol Bay County, Alaska........ 02 1.1900 1.1990 99902
02080........................... Cordova-Mc Carthy County, Alaska.. 02 1.1900 1.1990 99902
02090........................... Fairbanks County, Alaska.......... 02 1.1900 1.1419 21820
02100........................... Haines County, Alaska............. 02 1.1900 1.1990 99902
02110........................... Juneau County, Alaska............. 02 1.1900 1.1990 99902
02120........................... Kenai-Cook Inlet County, Alaska... 02 1.1900 1.1990 99902
02122........................... Kenai Peninsula Borough, Alaska... 02 1.1900 1.1990 99902
02130........................... Ketchikan County, Alaska.......... 02 1.1900 1.1990 99902
02140........................... Kobuk County, Alaska.............. 02 1.1900 1.1990 99902
02150........................... Kodiak County, Alaska............. 02 1.1900 1.1990 99902
02160........................... Kuskokwin County, Alaska.......... 02 1.1900 1.1990 99902
02164........................... Lake and Peninsula Borough, Alaska 02 1.1900 1.1990 99902
02170........................... Matanuska County, Alaska.......... 02 1.1900 1.2110 11260
02180........................... Nome County, Alaska............... 02 1.1900 1.1990 99902
02185........................... North Slope Borough, Alaska....... 02 1.1900 1.1990 99902
02188........................... Northwest Arctic Borough, Alaska.. 02 1.1900 1.1990 99902
02190........................... Outer Ketchikan County, Alaska.... 02 1.1900 1.1990 99902
02200........................... Prince Of Wales County, Alaska.... 02 1.1900 1.1990 99902
02201........................... Prince of Wales-Outer Ketchikan 02 1.1900 1.1990 99902
Census Area, Alaska.
02210........................... Seward County, Alaska............. 02 1.1900 1.1990 99902
02220........................... Sitka County, Alaska.............. 02 1.1900 1.1990 99902
02230........................... Skagway-Yakutat County, Alaska.... 02 1.1900 1.1990 99902
02231........................... Skagway-Yakutat-Angoon Census 02 1.1900 1.1990 99902
Area, Alaska.
02232........................... Skagway-Hoonah-Angoon Census Area, 02 1.1900 1.1990 99902
Alaska.
02240........................... Southeast Fairbanks County, Alaska 02 1.1900 1.1990 99902
02250........................... Upper Yukon County, Alaska........ 02 1.1900 1.1990 99902
02260........................... Valdz-Chitna-Whitier County, 02 1.1900 1.1990 99902
Alaska.
02261........................... Valdex-Cordove Census Area, Alaska 02 1.1900 1.1990 99902
02270........................... Wade Hampton County, Alaska....... 02 1.1900 1.1990 99902
02280........................... Wrangell-Petersburg County, Alaska 02 1.1900 1.1990 99902
02282........................... Yakutat Borough, Alaska........... 02 1.1900 1.1990 99902
02290........................... Yukon-Koyukuk County, Alaska...... 02 1.1900 1.1990 99902
03000........................... Apache County, Arizona............ 03 0.9054 0.8777 99903
03010........................... Cochise County, Arizona........... 03 0.9054 0.8777 99903
03020........................... Coconino County, Arizona.......... 2620 1.1857 1.2105 22380
03030........................... Gila County, Arizona.............. 03 0.9054 0.8777 99903
03040........................... Graham County, Arizona............ 03 0.9054 0.8777 99903
03050........................... Greenlee County, Arizona.......... 03 0.9054 0.8777 99903
03055........................... La Paz County, Arizona............ 03 0.9054 0.8777 99903
03060........................... Maricopa County, Arizona.......... 6200 1.0138 1.0138 38060
03070........................... Mohave County, Arizona............ 4120 1.1166 0.8777 99903
03080........................... Navajo County, Arizona............ 03 0.9054 0.8777 99903
03090........................... Pima County, Arizona.............. 8520 0.8987 0.8987 46060
03100........................... Pinal County, Arizona............. 6200 1.0138 1.0138 38060
03110........................... Santa Cruz County, Arizona........ 03 0.9054 0.8777 99903
[[Page 29117]]
03120........................... Yavapai County, Arizona........... 03 0.9054 0.9879 39140
03130........................... Yuma County, Arizona.............. 9360 0.9135 0.9135 49740
04000........................... Arkansas County, Arkansas......... 04 0.7744 0.7451 99904
04010........................... Ashley County, Arkansas........... 04 0.7744 0.7451 99904
04020........................... Baxter County, Arkansas........... 04 0.7744 0.7451 99904
04030........................... Benton County, Arkansas........... 2580 0.8563 0.8563 22220
04040........................... Boone County, Arkansas............ 04 0.7744 0.7451 99904
04050........................... Bradley County, Arkansas.......... 04 0.7744 0.7451 99904
04060........................... Calhoun County, Arkansas.......... 04 0.7744 0.7451 99904
04070........................... Carroll County, Arkansas.......... 04 0.7744 0.7451 99904
04080........................... Chicot County, Arkansas........... 04 0.7744 0.7451 99904
04090........................... Clark County, Arkansas............ 04 0.7744 0.7451 99904
04100........................... Clay County, Arkansas............. 04 0.7744 0.7451 99904
04110........................... Cleburne County, Arkansas......... 04 0.7744 0.7451 99904
04120........................... Cleveland County, Arkansas........ 04 0.7744 0.8689 38220
04130........................... Columbia County, Arkansas......... 04 0.7744 0.7451 99904
04140........................... Conway County, Arkansas........... 04 0.7744 0.7451 99904
04150........................... Craighead County, Arkansas........ 3700 0.7919 0.7919 27860
04160........................... Crawford County, Arkansas......... 2720 0.8229 0.8214 22900
04170........................... Crittenden County, Arkansas....... 4920 0.9360 0.9341 32820
04180........................... Cross County, Arkansas............ 04 0.7744 0.7451 99904
04190........................... Dallas County, Arkansas........... 04 0.7744 0.7451 99904
04200........................... Desha County, Arkansas............ 04 0.7744 0.7451 99904
04210........................... Drew County, Arkansas............. 04 0.7744 0.7451 99904
04220........................... Faulkner County, Arkansas......... 4400 0.8756 0.8756 30780
04230........................... Franklin County, Arkansas......... 04 0.7744 0.8214 22900
04240........................... Fulton County, Arkansas........... 04 0.7744 0.7451 99904
04250........................... Garland County, Arkansas.......... 04 0.7744 0.9053 26300
04260........................... Grant County, Arkansas............ 04 0.7744 0.8756 30780
04270........................... Greene County, Arkansas........... 04 0.7744 0.7451 99904
04280........................... Hempstead County, Arkansas........ 04 0.7744 0.7451 99904
04290........................... Hot Spring County, Arkansas....... 04 0.7744 0.7451 99904
04300........................... Howard County, Arkansas........... 04 0.7744 0.7451 99904
04310........................... Independence County, Arkansas..... 04 0.7744 0.7451 99904
04320........................... Izard County, Arkansas............ 04 0.7744 0.7451 99904
04330........................... Jackson County, Arkansas.......... 04 0.7744 0.7451 99904
04340........................... Jefferson County, Arkansas........ 6240 0.8689 0.8689 38220
04350........................... Johnson County, Arkansas.......... 04 0.7744 0.7451 99904
04360........................... Lafayette County, Arkansas........ 04 0.7744 0.7451 99904
04370........................... Lawrence County, Arkansas......... 04 0.7744 0.7451 99904
04380........................... Lee County, Arkansas.............. 04 0.7744 0.7451 99904
04390........................... Lincoln County, Arkansas.......... 04 0.7744 0.8689 38220
04400........................... Little River County, Arkansas..... 04 0.7744 0.7451 99904
04410........................... Logan County, Arkansas............ 04 0.7744 0.7451 99904
04420........................... Lonoke County, Arkansas........... 4400 0.8756 0.8756 30780
04430........................... Madison County, Arkansas.......... 04 0.7744 0.8563 22220
04440........................... Marion County, Arkansas........... 04 0.7744 0.7451 99904
04450........................... Miller County, Arkansas........... 8360 0.8291 0.8291 45500
04460........................... Mississippi County, Arkansas...... 04 0.7744 0.7451 99904
04470........................... Monroe County, Arkansas........... 04 0.7744 0.7451 99904
04480........................... Montgomery County, Arkansas....... 04 0.7744 0.7451 99904
04490........................... Nevada County, Arkansas........... 04 0.7744 0.7451 99904
04500........................... Newton County, Arkansas........... 04 0.7744 0.7451 99904
04510........................... Ouachita County, Arkansas......... 04 0.7744 0.7451 99904
04520........................... Perry County, Arkansas............ 04 0.7744 0.8756 30780
04530........................... Phillips County, Arkansas......... 04 0.7744 0.7451 99904
04540........................... Pike County, Arkansas............. 04 0.7744 0.7451 99904
04550........................... Poinsett County, Arkansas......... 04 0.7744 0.7919 27860
04560........................... Polk County, Arkansas............. 04 0.7744 0.7451 99904
04570........................... Pope County, Arkansas............. 04 0.7744 0.7451 99904
04580........................... Prairie County, Arkansas.......... 04 0.7744 0.7451 99904
04590........................... Pulaski County, Arkansas.......... 4400 0.8756 0.8756 30780
04600........................... Randolph County, Arkansas......... 04 0.7744 0.7451 99904
04610........................... St Francis County, Arkansas....... 04 0.7744 0.7451 99904
04620........................... Saline County, Arkansas........... 4400 0.8756 0.8756 30780
04630........................... Scott County, Arkansas............ 04 0.7744 0.7451 99904
04640........................... Searcy County, Arkansas........... 04 0.7744 0.7451 99904
04650........................... Sebastian County, Arkansas........ 2720 0.8229 0.8214 22900
04660........................... Sevier County, Arkansas........... 04 0.7744 0.7451 99904
[[Page 29118]]
04670........................... Sharp County, Arkansas............ 04 0.7744 0.7451 99904
04680........................... Stone County, Arkansas............ 04 0.7744 0.7451 99904
04690........................... Union County, Arkansas............ 04 0.7744 0.7451 99904
04700........................... Van Buren County, Arkansas........ 04 0.7744 0.7451 99904
04710........................... Washington County, Arkansas....... 2580 0.8563 0.8563 22220
04720........................... White County, Arkansas............ 04 0.7744 0.7451 99904
04730........................... Woodruff County, Arkansas......... 04 0.7744 0.7451 99904
04740........................... Yell County, Arkansas............. 04 0.7744 0.7451 99904
05000........................... Alameda County, California........ 5775 1.5346 1.5346 36084
05010........................... Alpine County, California......... 05 1.0639 1.0857 99905
05020........................... Amador County, California......... 05 1.0639 1.0857 99905
05030........................... Butte County, California.......... 1620 1.0522 1.0522 17020
05040........................... Calaveras County, California...... 05 1.0639 1.0857 99905
05050........................... Colusa County, California......... 05 1.0639 1.0857 99905
05060........................... Contra Costa County, California... 5775 1.5346 1.5346 36084
05070........................... Del Norte County, California...... 05 1.0639 1.0857 99905
05080........................... Eldorado County, California....... 6920 1.3148 1.2973 40900
05090........................... Fresno County, California......... 2840 1.0432 1.0541 23420
05100........................... Glenn County, California.......... 05 1.0639 1.0857 99905
05110........................... Humboldt County, California....... 05 1.0639 1.0857 99905
05120........................... Imperial County, California....... 05 1.0639 0.8915 20940
05130........................... Inyo County, California........... 05 1.0639 1.0857 99905
05140........................... Kern County, California........... 0680 1.0344 1.0344 12540
05150........................... Kings County, California.......... 05 1.0639 1.0046 25260
05160........................... Lake County, California........... 05 1.0639 1.0857 99905
05170........................... Lassen County, California......... 05 1.0639 1.0857 99905
05200........................... Los Angeles County, California.... 4480 1.1752 1.1752 31084
05210........................... Los Angeles County, California.... 4480 1.1752 1.1752 31084
05300........................... Madera County, California......... 2840 1.0432 0.8721 31460
05310........................... Marin County, California.......... 7360 1.4990 1.4990 41884
05320........................... Mariposa County, California....... 05 1.0639 1.0857 99905
05330........................... Mendocino County, California...... 05 1.0639 1.0857 99905
05340........................... Merced County, California......... 4940 1.1120 1.1120 32900
05350........................... Modoc County, California.......... 05 1.0639 1.0857 99905
05360........................... Mono County, California........... 05 1.0639 1.0857 99905
05370........................... Monterey County, California....... 7120 1.4142 1.4142 41500
05380........................... Napa County, California........... 8720 1.3966 1.2656 34900
05390........................... Nevada County, California......... 05 1.0639 1.0857 99905
05400........................... Orange County, California......... 5945 1.1576 1.1576 42044
05410........................... Placer County, California......... 6920 1.3148 1.2973 40900
05420........................... Plumas County, California......... 05 1.0639 1.0857 99905
05430........................... Riverside County, California...... 6780 1.1022 1.1022 40140
05440........................... Sacramento County, California..... 6920 1.3148 1.2973 40900
05450........................... San Benito County, California..... 05 1.0639 1.5125 41940
05460........................... San Bernardino County, California. 6780 1.1022 1.1022 40140
05470........................... San Diego County, California...... 7320 1.1424 1.1424 41740
05480........................... San Francisco County, California.. 7360 1.4990 1.4990 41884
05490........................... San Joaquin County, California.... 8120 1.1311 1.1311 44700
05500........................... San Luis Obispo County, California 7460 1.1360 1.1360 42020
05510........................... San Mateo County, California...... 7360 1.4990 1.4990 41884
05520........................... Santa Barbara County, California.. 7480 1.1538 1.1538 42060
05530........................... Santa Clara County, California.... 7400 1.5144 1.5125 41940
05540........................... Santa Cruz County, California..... 7485 1.5182 1.5182 42100
05550........................... Shasta County, California......... 6690 1.2215 1.2215 39820
05560........................... Sierra County, California......... 05 1.0639 1.0857 99905
05570........................... Siskiyou County, California....... 05 1.0639 1.0857 99905
05580........................... Solano County, California......... 8720 1.3966 1.4899 46700
05590........................... Sonoma County, California......... 7500 1.3506 1.3506 42220
05600........................... Stanislaus County, California..... 5170 1.1804 1.1804 33700
05610........................... Sutter County, California......... 9340 1.0932 1.0932 49700
05620........................... Tehama County, California......... 05 1.0639 1.0857 99905
05630........................... Trinity County, California........ 05 1.0639 1.0857 99905
05640........................... Tulare County, California......... 8780 1.0074 1.0074 47300
05650........................... Tuolumne County, California....... 05 1.0639 1.0857 99905
05660........................... Ventura County, California........ 8735 1.1613 1.1613 37100
05670........................... Yolo County, California........... 9270 0.9949 1.2973 40900
05680........................... Yuba County, California........... 9340 1.0932 1.0932 49700
06000........................... Adams County, Colorado............ 2080 1.0733 1.0733 19740
06010........................... Alamosa County, Colorado.......... 06 0.9389 0.9389 99906
[[Page 29119]]
06020........................... Arapahoe County, Colorado......... 2080 1.0733 1.0733 19740
06030........................... Archuleta County, Colorado........ 06 0.9389 0.9389 99906
06040........................... Baca County, Colorado............. 06 0.9389 0.9389 99906
06050........................... Bent County, Colorado............. 06 0.9389 0.9389 99906
06060........................... Boulder County, Colorado.......... 1125 0.9744 0.9744 14500
06070........................... Chaffee County, Colorado.......... 06 0.9389 0.9389 99906
06080........................... Cheyenne County, Colorado......... 06 0.9389 0.9389 99906
06090........................... Clear Creek County, Colorado...... 06 0.9389 1.0733 19740
06100........................... Conejos County, Colorado.......... 06 0.9389 0.9389 99906
06110........................... Costilla County, Colorado......... 06 0.9389 0.9389 99906
06120........................... Crowley County, Colorado.......... 06 0.9389 0.9389 99906
06130........................... Custer County, Colorado........... 06 0.9389 0.9389 99906
06140........................... Delta County, Colorado............ 06 0.9389 0.9389 99906
06150........................... Denver County, Colorado........... 2080 1.0733 1.0733 19740
06160........................... Dolores County, Colorado.......... 06 0.9389 0.9389 99906
06170........................... Douglas County, Colorado.......... 2080 1.0733 1.0733 19740
06180........................... Eagle County, Colorado............ 06 0.9389 0.9389 99906
06190........................... Elbert County, Colorado........... 06 0.9389 1.0733 19740
06200........................... El Paso County, Colorado.......... 1720 0.9478 0.9478 17820
06210........................... Fremont County, Colorado.......... 06 0.9389 0.9389 99906
06220........................... Garfield County, Colorado......... 06 0.9389 0.9389 99906
06230........................... Gilpin County, Colorado........... 06 0.9389 1.0733 19740
06240........................... Grand County, Colorado............ 06 0.9389 0.9389 99906
06250........................... Gunnison County, Colorado......... 06 0.9389 0.9389 99906
06260........................... Hinsdale County, Colorado......... 06 0.9389 0.9389 99906
06270........................... Huerfano County, Colorado......... 06 0.9389 0.9389 99906
06280........................... Jackson County, Colorado.......... 06 0.9389 0.9389 99906
06290........................... Jefferson County, Colorado........ 2080 1.0733 1.0733 19740
06300........................... Kiowa County, Colorado............ 06 0.9389 0.9389 99906
06310........................... Kit Carson County, Colorado....... 06 0.9389 0.9389 99906
06320........................... Lake County, Colorado............. 06 0.9389 0.9389 99906
06330........................... La Plata County, Colorado......... 06 0.9389 0.9389 99906
06340........................... Larimer County, Colorado.......... 2670 1.0132 1.0132 22660
06350........................... Las Animas County, Colorado....... 06 0.9389 0.9389 99906
06360........................... Lincoln County, Colorado.......... 06 0.9389 0.9389 99906
06370........................... Logan County, Colorado............ 06 0.9389 0.9389 99906
06380........................... Mesa County, Colorado............. 2995 0.9560 0.9560 24300
06390........................... Mineral County, Colorado.......... 06 0.9389 0.9389 99906
06400........................... Moffat County, Colorado........... 06 0.9389 0.9389 99906
06410........................... Montezuma County, Colorado........ 06 0.9389 0.9389 99906
06420........................... Montrose County, Colorado......... 06 0.9389 0.9389 99906
06430........................... Morgan County, Colorado........... 06 0.9389 0.9389 99906
06440........................... Otero County, Colorado............ 06 0.9389 0.9389 99906
06450........................... Ouray County, Colorado............ 06 0.9389 0.9389 99906
06460........................... Park County, Colorado............. 06 0.9389 1.0733 19740
06470........................... Phillips County, Colorado......... 06 0.9389 0.9389 99906
06480........................... Pitkin County, Colorado........... 06 0.9389 0.9389 99906
06490........................... Prowers County, Colorado.......... 06 0.9389 0.9389 99906
06500........................... Pueblo County, Colorado........... 6560 0.8632 0.8632 39380
06510........................... Rio Blanco County, Colorado....... 06 0.9389 0.9389 99906
06520........................... Rio Grande County, Colorado....... 06 0.9389 0.9389 99906
06530........................... Routt County, Colorado............ 06 0.9389 0.9389 99906
06540........................... Saguache County, Colorado......... 06 0.9389 0.9389 99906
06550........................... San Juan County, Colorado......... 06 0.9389 0.9389 99906
06560........................... San Miguel County, Colorado....... 06 0.9389 0.9389 99906
06570........................... Sedgwick County, Colorado......... 06 0.9389 0.9389 99906
06580........................... Summit County, Colorado........... 06 0.9389 0.9389 99906
06590........................... Teller County, Colorado........... 06 0.9389 0.9478 17820
06600........................... Washington County, Colorado....... 06 0.9389 0.9389 99906
06610........................... Weld County, Colorado............. 3060 0.9580 0.9580 24540
06620........................... Yuma County, Colorado............. 06 0.9389 0.9389 99906
06630........................... Broomfield County, Colorado....... 2080 1.0733 1.0733 19740
07000........................... Fairfield County, Connecticut..... 5483 1.2096 1.2598 14860
07010........................... Hartford County, Connecticut...... 3283 1.1084 1.1084 25540
07020........................... Litchfield County, Connecticut.... 3283 1.1084 1.1084 25540
07030........................... Middlesex County, Connecticut..... 3283 1.1084 1.1084 25540
07040........................... New Haven County, Connecticut..... 5483 1.2096 1.1702 35300
07050........................... New London County, Connecticut.... 5523 1.1356 1.1356 35980
07060........................... Tolland County, Connecticut....... 3283 1.1084 1.1084 25540
[[Page 29120]]
07070........................... Windham County, Connecticut....... 07 1.1794 1.1794 99907
08000........................... Kent County, Delaware............. 2190 0.9779 0.9779 20100
08010........................... New Castle County, Delaware....... 9160 1.0537 1.0482 48864
08020........................... Sussex County, Delaware........... 08 0.9606 0.9606 99908
09000........................... Washington Dc County, Dist Of Col. 8840 1.0983 1.0932 47894
10000........................... Alachua County, Florida........... 2900 0.9474 0.9474 23540
10010........................... Baker County, Florida............. 10 0.8698 0.9299 27260
10020........................... Bay County, Florida............... 6015 0.7989 0.7989 37460
10030........................... Bradford County, Florida.......... 10 0.8698 0.8598 99910
10040........................... Brevard County, Florida........... 4900 0.9835 0.9835 37340
10050........................... Broward County, Florida........... 2680 1.0442 1.0442 22744
10060........................... Calhoun County, Florida........... 10 0.8698 0.8598 99910
10070........................... Charlotte County, Florida......... 6580 0.9264 0.9264 39460
10080........................... Citrus County, Florida............ 10 0.8698 0.8598 99910
10090........................... Clay County, Florida.............. 3600 0.9308 0.9299 27260
10100........................... Collier County, Florida........... 5345 1.0140 1.0140 34940
10110........................... Columbia County, Florida.......... 10 0.8698 0.8598 99910
10120........................... Dade County, Florida.............. 5000 0.9759 0.9759 33124
10130........................... De Soto County, Florida........... 10 0.8698 0.8598 99910
10140........................... Dixie County, Florida............. 10 0.8698 0.8598 99910
10150........................... Duval County, Florida............. 3600 0.9308 0.9299 27260
10160........................... Escambia County, Florida.......... 6080 0.8104 0.8104 37860
10170........................... Flagler County, Florida........... 2020 0.9334 0.8598 99910
10180........................... Franklin County, Florida.......... 10 0.8698 0.8598 99910
10190........................... Gadsden County, Florida........... 8240 0.8697 0.8697 45220
10200........................... Gilchrist County, Florida......... 10 0.8698 0.9474 23540
10210........................... Glades County, Florida............ 10 0.8698 0.8598 99910
10220........................... Gulf County, Florida.............. 10 0.8698 0.8598 99910
10230........................... Hamilton County, Florida.......... 10 0.8698 0.8598 99910
10240........................... Hardee County, Florida............ 10 0.8698 0.8598 99910
10250........................... Hendry County, Florida............ 10 0.8698 0.8598 99910
10260........................... Hernando County, Florida.......... 8280 0.9193 0.9193 45300
10270........................... Highlands County, Florida......... 10 0.8698 0.8598 99910
10280........................... Hillsborough County, Florida...... 8280 0.9193 0.9193 45300
10290........................... Holmes County, Florida............ 10 0.8698 0.8598 99910
10300........................... Indian River County, Florida...... 10 0.8698 0.9444 46940
10310........................... Jackson County, Florida........... 10 0.8698 0.8598 99910
10320........................... Jefferson County, Florida......... 10 0.8698 0.8697 45220
10330........................... Lafayette County, Florida......... 10 0.8698 0.8598 99910
10340........................... Lake County, Florida.............. 5960 0.9459 0.9459 36740
10350........................... Lee County, Florida............... 2700 0.9366 0.9366 15980
10360........................... Leon County, Florida.............. 8240 0.8697 0.8697 45220
10370........................... Levy County, Florida.............. 10 0.8698 0.8598 99910
10380........................... Liberty County, Florida........... 10 0.8698 0.8598 99910
10390........................... Madison County, Florida........... 10 0.8698 0.8598 99910
10400........................... Manatee County, Florida........... 7510 0.9555 0.9555 42260
10410........................... Marion County, Florida............ 5790 0.8934 0.8934 36100
10420........................... Martin County, Florida............ 2710 1.0133 1.0133 38940
10430........................... Monroe County, Florida............ 10 0.8698 0.8598 99910
10440........................... Nassau County, Florida............ 3600 0.9308 0.9299 27260
10450........................... Okaloosa County, Florida.......... 2750 0.8881 0.8881 23020
10460........................... Okeechobee County, Florida........ 10 0.8698 0.8598 99910
10470........................... Orange County, Florida............ 5960 0.9459 0.9459 36740
10480........................... Osceola County, Florida........... 5960 0.9459 0.9459 36740
10490........................... Palm Beach County, Florida........ 8960 1.0077 1.0077 48424
10500........................... Pasco County, Florida............. 8280 0.9193 0.9193 45300
10510........................... Pinellas County, Florida.......... 8280 0.9193 0.9193 45300
10520........................... Polk County, Florida.............. 3980 0.8921 0.8921 29460
10530........................... Putnam County, Florida............ 10 0.8698 0.8598 99910
10540........................... Johns County, Florida............. 3600 0.9308 0.9299 27260
10550........................... St Lucie County, Florida.......... 2710 1.0133 1.0133 38940
10560........................... Santa Rosa County, Florida........ 6080 0.8104 0.8104 37860
10570........................... Sarasota County, Florida.......... 7510 0.9555 0.9555 42260
10580........................... Seminole County, Florida.......... 5960 0.9459 0.9459 36740
10590........................... Sumter County, Florida............ 10 0.8698 0.8598 99910
10600........................... Suwannee County, Florida.......... 10 0.8698 0.8598 99910
10610........................... Taylor County, Florida............ 10 0.8698 0.8598 99910
10620........................... Union County, Florida............. 10 0.8698 0.8598 99910
10630........................... Volusia County, Florida........... 2020 0.9334 0.9308 19660
[[Page 29121]]
10640........................... Wakulla County, Florida........... 10 0.8698 0.8697 45220
10650........................... Walton County, Florida............ 10 0.8698 0.8598 99910
10660........................... Washington County, Florida........ 10 0.8698 0.8598 99910
11000........................... Appling County, Georgia........... 11 0.8165 0.7666 99911
11010........................... Atkinson County, Georgia.......... 11 0.8165 0.7666 99911
11011........................... Bacon County, Georgia............. 11 0.8165 0.7666 99911
11020........................... Baker County, Georgia............. 11 0.8165 0.8636 10500
11030........................... Baldwin County, Georgia........... 11 0.8165 0.7666 99911
11040........................... Banks County, Georgia............. 11 0.8165 0.7666 99911
11050........................... Barrow County, Georgia............ 0520 0.9648 0.9648 12060
11060........................... Bartow County, Georgia............ 0520 0.9648 0.9648 12060
11070........................... Ben Hill County, Georgia.......... 11 0.8165 0.7666 99911
11080........................... Berrien County, Georgia........... 11 0.8165 0.7666 99911
11090........................... Bibb County, Georgia.............. 4680 0.9286 0.9453 31420
11100........................... Bleckley County, Georgia.......... 11 0.8165 0.7666 99911
11110........................... Brantley County, Georgia.......... 11 0.8165 0.9320 15260
11120........................... Brooks County, Georgia............ 11 0.8165 0.8875 46660
11130........................... Bryan County, Georgia............. 7520 0.9480 0.9480 42340
11140........................... Bulloch County, Georgia........... 11 0.8165 0.7666 99911
11150........................... Burke County, Georgia............. 11 0.8165 0.9565 12260
11160........................... Butts County, Georgia............. 11 0.8165 0.9648 12060
11161........................... Calhoun County, Georgia........... 11 0.8165 0.7666 99911
11170........................... Camden County, Georgia............ 11 0.8165 0.7666 99911
11180........................... Candler County, Georgia........... 11 0.8165 0.7666 99911
11190........................... Carroll County, Georgia........... 0520 0.9648 0.9648 12060
11200........................... Catoosa County, Georgia........... 1560 0.9098 0.9098 16860
11210........................... Charlton County, Georgia.......... 11 0.8165 0.7666 99911
11220........................... Chatham County, Georgia........... 7520 0.9480 0.9480 42340
11230........................... Chattahoochee County, Georgia..... 1800 0.8568 0.8568 17980
11240........................... Chattooga County, Georgia......... 11 0.8165 0.7666 99911
11250........................... Cherokee County, Georgia.......... 0520 0.9648 0.9648 12060
11260........................... Clarke County, Georgia............ 0500 0.9843 0.9843 12020
11270........................... Clay County, Georgia.............. 11 0.8165 0.7666 99911
11280........................... Clayton County, Georgia........... 0520 0.9648 0.9648 12060
11281........................... Clinch County, Georgia............ 11 0.8165 0.7666 99911
11290........................... Cobb County, Georgia.............. 0520 0.9648 0.9648 12060
11291........................... Coffee County, Georgia............ 11 0.8165 0.7666 99911
11300........................... Colquitt County, Georgia.......... 11 0.8165 0.7666 99911
11310........................... Columbia County, Georgia.......... 0600 0.9619 0.9565 12260
11311........................... Cook County, Georgia.............. 11 0.8165 0.7666 99911
11320........................... Coweta County, Georgia............ 0520 0.9648 0.9648 12060
11330........................... Crawford County, Georgia.......... 11 0.8165 0.9453 31420
11340........................... Crisp County, Georgia............. 11 0.8165 0.7666 99911
11341........................... Dade County, Georgia.............. 1560 0.9098 0.9098 16860
11350........................... Dawson County, Georgia............ 11 0.8165 0.9648 12060
11360........................... Decatur County, Georgia........... 11 0.8165 0.7666 99911
11370........................... De Kalb County, Georgia........... 0520 0.9648 0.9648 12060
11380........................... Dodge County, Georgia............. 11 0.8165 0.7666 99911
11381........................... Dooly County, Georgia............. 11 0.8165 0.7666 99911
11390........................... Dougherty County, Georgia......... 0120 0.8636 0.8636 10500
11400........................... Douglas County, Georgia........... 0520 0.9648 0.9648 12060
11410........................... Early County, Georgia............. 11 0.8165 0.7666 99911
11420........................... Echols County, Georgia............ 11 0.8165 0.8875 46660
11421........................... Effingham County, Georgia......... 7520 0.9480 0.9480 42340
11430........................... Elbert County, Georgia............ 11 0.8165 0.7666 99911
11440........................... Emanuel County, Georgia........... 11 0.8165 0.7666 99911
11441........................... Evans County, Georgia............. 11 0.8165 0.7666 99911
11450........................... Fannin County, Georgia............ 11 0.8165 0.7666 99911
11451........................... Fayette County, Georgia........... 0520 0.9648 0.9648 12060
11460........................... Floyd County, Georgia............. 11 0.8165 0.9424 40660
11461........................... Forsyth County, Georgia........... 0520 0.9648 0.9648 12060
11462........................... Franklin County, Georgia.......... 11 0.8165 0.7666 99911
11470........................... Fulton County, Georgia............ 0520 0.9648 0.9648 12060
11471........................... Gilmer County, Georgia............ 11 0.8165 0.7666 99911
11480........................... Glascock County, Georgia.......... 11 0.8165 0.7666 99911
11490........................... Glynn County, Georgia............. 11 0.8165 0.9320 15260
11500........................... Gordon County, Georgia............ 11 0.8165 0.7666 99911
11510........................... Grady County, Georgia............. 11 0.8165 0.7666 99911
11520........................... Greene County, Georgia............ 11 0.8165 0.7666 99911
[[Page 29122]]
11530........................... Gwinnett County, Georgia.......... 0520 0.9648 0.9648 12060
11540........................... Habersham County, Georgia......... 11 0.8165 0.7666 99911
11550........................... Hall County, Georgia.............. 11 0.8165 0.8883 23580
11560........................... Hancock County, Georgia........... 11 0.8165 0.7666 99911
11570........................... Haralson County, Georgia.......... 11 0.8165 0.9648 12060
11580........................... Harris County, Georgia............ 1800 0.8568 0.8568 17980
11581........................... Hart County, Georgia.............. 11 0.8165 0.7666 99911
11590........................... Heard County, Georgia............. 11 0.8165 0.9648 12060
11591........................... Henry County, Georgia............. 0520 0.9648 0.9648 12060
11600........................... Houston County, Georgia........... 4680 0.9286 0.8654 47580
11601........................... Irwin County, Georgia............. 11 0.8165 0.7666 99911
11610........................... Jackson County, Georgia........... 11 0.8165 0.7666 99911
11611........................... Jasper County, Georgia............ 11 0.8165 0.9648 12060
11612........................... Jeff Davis County, Georgia........ 11 0.8165 0.7666 99911
11620........................... Jefferson County, Georgia......... 11 0.8165 0.7666 99911
11630........................... Jenkins County, Georgia........... 11 0.8165 0.7666 99911
11640........................... Johnson County, Georgia........... 11 0.8165 0.7666 99911
11650........................... Jones County, Georgia............. 4680 0.9286 0.9453 31420
11651........................... Lamar County, Georgia............. 11 0.8165 0.9648 12060
11652........................... Lanier County, Georgia............ 11 0.8165 0.8875 46660
11660........................... Laurens County, Georgia........... 11 0.8165 0.7666 99911
11670........................... Lee County, Georgia............... 0120 0.8636 0.8636 10500
11680........................... Liberty County, Georgia........... 11 0.8165 0.9178 25980
11690........................... Lincoln County, Georgia........... 11 0.8165 0.7666 99911
11691........................... Long County, Georgia.............. 11 0.8165 0.9178 25980
11700........................... Lowndes County, Georgia........... 11 0.8165 0.8875 46660
11701........................... Lumpkin County, Georgia........... 11 0.8165 0.7666 99911
11702........................... Mc Duffie County, Georgia......... 0600 0.9619 0.9565 12260
11703........................... Mc Intosh County, Georgia......... 11 0.8165 0.9320 15260
11710........................... Macon County, Georgia............. 11 0.8165 0.7666 99911
11720........................... Madison County, Georgia........... 0500 0.9843 0.9843 12020
11730........................... Marion County, Georgia............ 11 0.8165 0.8568 17980
11740........................... Meriwether County, Georgia........ 11 0.8165 0.9648 12060
11741........................... Miller County, Georgia............ 11 0.8165 0.7666 99911
11750........................... Mitchell County, Georgia.......... 11 0.8165 0.7666 99911
11760........................... Monroe County, Georgia............ 11 0.8165 0.9453 31420
11770........................... Montgomery County, Georgia........ 11 0.8165 0.7666 99911
11771........................... Morgan County, Georgia............ 11 0.8165 0.7666 99911
11772........................... Murray County, Georgia............ 11 0.8165 0.9044 19140
11780........................... Muscogee County, Georgia.......... 1800 0.8568 0.8568 17980
11790........................... Newton County, Georgia............ 0520 0.9648 0.9648 12060
11800........................... Oconee County, Georgia............ 0500 0.9843 0.9843 12020
11801........................... Oglethorpe County, Georgia........ 11 0.8165 0.9843 12020
11810........................... Paulding County, Georgia.......... 0520 0.9648 0.9648 12060
11811........................... Peach County, Georgia............. 4680 0.9286 0.7666 99911
11812........................... Pickens County, Georgia........... 0520 0.9648 0.9648 12060
11820........................... Pierce County, Georgia............ 11 0.8165 0.7666 99911
11821........................... Pike County, Georgia.............. 11 0.8165 0.9648 12060
11830........................... Polk County, Georgia.............. 11 0.8165 0.7666 99911
11831........................... Pulaski County, Georgia........... 11 0.8165 0.7666 99911
11832........................... Putnam County, Georgia............ 11 0.8165 0.7666 99911
11833........................... Quitman County, Georgia........... 11 0.8165 0.7666 99911
11834........................... Rabun County, Georgia............. 11 0.8165 0.7666 99911
11835........................... Randolph County, Georgia.......... 11 0.8165 0.7666 99911
11840........................... Richmond County, Georgia.......... 0600 0.9619 0.9565 12260
11841........................... Rockdale County, Georgia.......... 0520 0.9648 0.9648 12060
11842........................... Schley County, Georgia............ 11 0.8165 0.7666 99911
11850........................... Screven County, Georgia........... 11 0.8165 0.7666 99911
11851........................... Seminole County, Georgia.......... 11 0.8165 0.7666 99911
11860........................... Spalding County, Georgia.......... 0520 0.9648 0.9648 12060
11861........................... Stephens County, Georgia.......... 11 0.8165 0.7666 99911
11862........................... Stewart County, Georgia........... 11 0.8165 0.7666 99911
11870........................... Sumter County, Georgia............ 11 0.8165 0.7666 99911
11880........................... Talbot County, Georgia............ 11 0.8165 0.7666 99911
11881........................... Taliaferro County, Georgia........ 11 0.8165 0.7666 99911
11882........................... Tattnall County, Georgia.......... 11 0.8165 0.7666 99911
11883........................... Taylor County, Georgia............ 11 0.8165 0.7666 99911
11884........................... Telfair County, Georgia........... 11 0.8165 0.7666 99911
11885........................... Terrell County, Georgia........... 11 0.8165 0.8636 10500
[[Page 29123]]
11890........................... Thomas County, Georgia............ 11 0.8165 0.7666 99911
11900........................... Tift County, Georgia.............. 11 0.8165 0.7666 99911
11901........................... Toombs County, Georgia............ 11 0.8165 0.7666 99911
11902........................... Towns County, Georgia............. 11 0.8165 0.7666 99911
11903........................... Treutlen County, Georgia.......... 11 0.8165 0.7666 99911
11910........................... Troup County, Georgia............. 11 0.8165 0.7666 99911
11911........................... Turner County, Georgia............ 11 0.8165 0.7666 99911
11912........................... Twiggs County, Georgia............ 4680 0.9286 0.9453 31420
11913........................... Union County, Georgia............. 11 0.8165 0.7666 99911
11920........................... Upson County, Georgia............. 11 0.8165 0.7666 99911
11921........................... Walker County, Georgia............ 1560 0.9098 0.9098 16860
11930........................... Walton County, Georgia............ 0520 0.9648 0.9648 12060
11940........................... Ware County, Georgia.............. 11 0.8165 0.7666 99911
11941........................... Warren County, Georgia............ 11 0.8165 0.7666 99911
11950........................... Washington County, Georgia........ 11 0.8165 0.7666 99911
11960........................... Wayne County, Georgia............. 11 0.8165 0.7666 99911
11961........................... Webster County, Georgia........... 11 0.8165 0.7666 99911
11962........................... Wheeler County, Georgia........... 11 0.8165 0.7666 99911
11963........................... White County, Georgia............. 11 0.8165 0.7666 99911
11970........................... Whitfield County, Georgia......... 11 0.8165 0.9044 19140
11971........................... Wilcox County, Georgia............ 11 0.8165 0.7666 99911
11972........................... Wilkes County, Georgia............ 11 0.8165 0.7666 99911
11973........................... Wilkinson County, Georgia......... 11 0.8165 0.7666 99911
11980........................... Worth County, Georgia............. 11 0.8165 0.8636 10500
12005........................... Kalawao County, Hawaii............ 12 1.0562 1.0562 99912
12010........................... Hawaii County, Hawaii............. 12 1.0562 1.0562 99912
12020........................... Honolulu County, Hawaii........... 3320 1.1208 1.1208 26180
12040........................... Kauai County, Hawaii.............. 12 1.0562 1.0562 99912
12050........................... Maui County, Hawaii............... 12 1.0562 1.0562 99912
13000........................... Ada County, Idaho................. 1080 0.9061 0.9061 14260
13010........................... Adams County, Idaho............... 13 0.9106 0.8045 99913
13020........................... Bannock County, Idaho............. 6340 0.9360 0.9360 38540
13030........................... Bear Lake County, Idaho........... 13 0.9106 0.8045 99913
13040........................... Benewah County, Idaho............. 13 0.9106 0.8045 99913
13050........................... Bingham County, Idaho............. 13 0.9106 0.8045 99913
13060........................... Blaine County, Idaho.............. 13 0.9106 0.8045 99913
13070........................... Boise County, Idaho............... 13 0.9106 0.9061 14260
13080........................... Bonner County, Idaho.............. 13 0.9106 0.8045 99913
13090........................... Bonneville County, Idaho.......... 13 0.9106 0.9429 26820
13100........................... Boundary County, Idaho............ 13 0.9106 0.8045 99913
13110........................... Butte County, Idaho............... 13 0.9106 0.8045 99913
13120........................... Camas County, Idaho............... 13 0.9106 0.8045 99913
13130........................... Canyon County, Idaho.............. 1080 0.9061 0.9061 14260
13140........................... Caribou County, Idaho............. 13 0.9106 0.8045 99913
13150........................... Cassia County, Idaho.............. 13 0.9106 0.8045 99913
13160........................... Clark County, Idaho............... 13 0.9106 0.8045 99913
13170........................... Clearwater County, Idaho.......... 13 0.9106 0.8045 99913
13180........................... Custer County, Idaho.............. 13 0.9106 0.8045 99913
13190........................... Elmore County, Idaho.............. 13 0.9106 0.8045 99913
13200........................... Franklin County, Idaho............ 13 0.9106 0.9173 30860
13210........................... Fremont County, Idaho............. 13 0.9106 0.8045 99913
13220........................... Gem County, Idaho................. 13 0.9106 0.9061 14260
13230........................... Gooding County, Idaho............. 13 0.9106 0.8045 99913
13240........................... Idaho County, Idaho............... 13 0.9106 0.8045 99913
13250........................... Jefferson County, Idaho........... 13 0.9106 0.9429 26820
13260........................... Jerome County, Idaho.............. 13 0.9106 0.8045 99913
13270........................... Kootenai County, Idaho............ 13 0.9106 0.9657 17660
13280........................... Latah County, Idaho............... 13 0.9106 0.8045 99913
13290........................... Lemhi County, Idaho............... 13 0.9106 0.8045 99913
13300........................... Lewis County, Idaho............... 13 0.9106 0.8045 99913
13310........................... Lincoln County, Idaho............. 13 0.9106 0.8045 99913
13320........................... Madison County, Idaho............. 13 0.9106 0.8045 99913
13330........................... Minidoka County, Idaho............ 13 0.9106 0.8045 99913
13340........................... Nez Perce County, Idaho........... 13 0.9106 0.9896 30300
13350........................... Oneida County, Idaho.............. 13 0.9106 0.8045 99913
13360........................... Owyhee County, Idaho.............. 13 0.9106 0.9061 14260
13370........................... Payette County, Idaho............. 13 0.9106 0.8045 99913
13380........................... Power County, Idaho............... 13 0.9106 0.9360 38540
13390........................... Shoshone County, Idaho............ 13 0.9106 0.8045 99913
[[Page 29124]]
13390........................... Teton County, Idaho............... 13 0.9106 0.8045 99913
13410........................... Twin Falls County, Idaho.......... 13 0.9106 0.8045 99913
13420........................... Valley County, Idaho.............. 13 0.9106 0.8045 99913
13430........................... Washington County, Idaho.......... 13 0.9106 0.8045 99913
14000........................... Adams County, Illinois............ 14 0.8309 0.8279 99914
14010........................... Alexander County, Illinois........ 14 0.8309 0.8279 99914
14020........................... Bond County, Illinois............. 14 0.8309 0.8949 41180
14030........................... Boone County, Illinois............ 6880 0.9994 0.9994 40420
14040........................... Brown County, Illinois............ 14 0.8309 0.8279 99914
14050........................... Bureau County, Illinois........... 14 0.8309 0.8279 99914
14060........................... Calhoun County, Illinois.......... 14 0.8309 0.8949 41180
14070........................... Carroll County, Illinois.......... 14 0.8309 0.8279 99914
14080........................... Cass County, Illinois............. 14 0.8309 0.8279 99914
14090........................... Champaign County, Illinois........ 1400 0.9604 0.9604 16580
14100........................... Christian County, Illinois........ 14 0.8309 0.8279 99914
14110........................... Clark County, Illinois............ 14 0.8309 0.8279 99914
14120........................... Clay County, Illinois............. 14 0.8309 0.8279 99914
14130........................... Clinton County, Illinois.......... 7040 0.8957 0.8949 41180
14140........................... Coles County, Illinois............ 14 0.8309 0.8279 99914
14141........................... Cook County, Illinois............. 1600 1.0838 1.0848 16974
14150........................... Crawford County, Illinois......... 14 0.8309 0.8279 99914
14160........................... Cumberland County, Illinois....... 14 0.8309 0.8279 99914
14170........................... De Kalb County, Illinois.......... 1600 1.0838 1.0848 16974
14180........................... De Witt County, Illinois.......... 14 0.8309 0.8279 99914
14190........................... Douglas County, Illinois.......... 14 0.8309 0.8279 99914
14250........................... Du Page County, Illinois.......... 1600 1.0838 1.0848 16974
14310........................... Edgar County, Illinois............ 14 0.8309 0.8279 99914
14320........................... Edwards County, Illinois.......... 14 0.8309 0.8279 99914
14330........................... Effingham County, Illinois........ 14 0.8309 0.8279 99914
14340........................... Fayette County, Illinois.......... 14 0.8309 0.8279 99914
14350........................... Ford County, Illinois............. 14 0.8309 0.9604 16580
14360........................... Franklin County, Illinois......... 14 0.8309 0.8279 99914
14370........................... Fulton County, Illinois........... 14 0.8309 0.8279 99914
14380........................... Gallatin County, Illinois......... 14 0.8309 0.8279 99914
14390........................... Greene County, Illinois........... 14 0.8309 0.8279 99914
14400........................... Grundy County, Illinois........... 1600 1.0838 1.0848 16974
14410........................... Hamilton County, Illinois......... 14 0.8309 0.8279 99914
14420........................... Hancock County, Illinois.......... 14 0.8309 0.8279 99914
14421........................... Hardin County, Illinois........... 14 0.8309 0.8279 99914
14440........................... Henderson County, Illinois........ 14 0.8309 0.8279 99914
14450........................... Henry County, Illinois............ 1960 0.8731 0.8731 19340
14460........................... Iroquois County, Illinois......... 14 0.8309 0.8279 99914
14470........................... Jackson County, Illinois.......... 14 0.8309 0.8279 99914
14480........................... Jasper County, Illinois........... 14 0.8309 0.8279 99914
14490........................... Jefferson County, Illinois........ 14 0.8309 0.8279 99914
14500........................... Jersey County, Illinois........... 7040 0.8957 0.8949 41180
14510........................... Jo Daviess County, Illinois....... 14 0.8309 0.8279 99914
14520........................... Johnson County, Illinois.......... 14 0.8309 0.8279 99914
14530........................... Kane County, Illinois............. 1600 1.0838 1.0848 16974
14540........................... Kankakee County, Illinois......... 3740 1.0974 1.0974 28100
14550........................... Kendall County, Illinois.......... 1600 1.0838 1.0848 16974
14560........................... Knox County, Illinois............. 14 0.8309 0.8279 99914
14570........................... Lake County, Illinois............. 1600 1.0838 1.0440 29404
14580........................... La Salle County, Illinois......... 14 0.8309 0.8279 99914
14590........................... Lawrence County, Illinois......... 14 0.8309 0.8279 99914
14600........................... Lee County, Illinois.............. 14 0.8309 0.8279 99914
14610........................... Livingston County, Illinois....... 14 0.8309 0.8279 99914
14620........................... Logan County, Illinois............ 14 0.8309 0.8279 99914
14630........................... Mc Donough County, Illinois....... 14 0.8309 0.8279 99914
14640........................... Mc Henry County, Illinois......... 1600 1.0838 1.0848 16974
14650........................... Mclean County, Illinois........... 1040 0.9084 0.9084 14060
14660........................... Macon County, Illinois............ 2040 0.8076 0.8076 19500
14670........................... Macoupin County, Illinois......... 14 0.8309 0.8949 41180
14680........................... Madison County, Illinois.......... 7040 0.8957 0.8949 41180
14690........................... Marion County, Illinois........... 14 0.8309 0.8279 99914
14700........................... Marshall County, Illinois......... 14 0.8309 0.8868 37900
14710........................... Mason County, Illinois............ 14 0.8309 0.8279 99914
14720........................... Massac County, Illinois........... 14 0.8309 0.8279 99914
14730........................... Menard County, Illinois........... 7880 0.8885 0.8885 44100
[[Page 29125]]
14740........................... Mercer County, Illinois........... 14 0.8309 0.8731 19340
14750........................... Monroe County, Illinois........... 7040 0.8957 0.8949 41180
14760........................... Montgomery County, Illinois....... 14 0.8309 0.8279 99914
14770........................... Morgan County, Illinois........... 14 0.8309 0.8279 99914
14780........................... Moultrie County, Illinois......... 14 0.8309 0.8279 99914
14790........................... Ogle County, Illinois............. 6880 0.9994 0.8279 99914
14800........................... Peoria County, Illinois........... 6120 0.8868 0.8868 37900
14810........................... Perry County, Illinois............ 14 0.8309 0.8279 99914
14820........................... Piatt County, Illinois............ 14 0.8309 0.9604 16580
14830........................... Pike County, Illinois............. 14 0.8309 0.8279 99914
14831........................... Pope County, Illinois............. 14 0.8309 0.8279 99914
14850........................... Pulaski County, Illinois.......... 14 0.8309 0.8279 99914
14860........................... Putnam County, Illinois........... 14 0.8309 0.8279 99914
14870........................... Randolph County, Illinois......... 14 0.8309 0.8279 99914
14880........................... Richland County, Illinois......... 14 0.8309 0.8279 99914
14890........................... Rock Island County, Illinois...... 1960 0.8731 0.8731 19340
14900........................... St Clair County, Illinois......... 7040 0.8957 0.8949 41180
14910........................... Saline County, Illinois........... 14 0.8309 0.8279 99914
14920........................... Sangamon County, Illinois......... 7880 0.8885 0.8885 44100
14921........................... Schuyler County, Illinois......... 14 0.8309 0.8279 99914
14940........................... Scott County, Illinois............ 14 0.8309 0.8279 99914
14950........................... Shelby County, Illinois........... 14 0.8309 0.8279 99914
14960........................... Stark County, Illinois............ 14 0.8309 0.8868 37900
14970........................... Stephenson County, Illinois....... 14 0.8309 0.8279 99914
14980........................... Tazewell County, Illinois......... 6120 0.8868 0.8868 37900
14981........................... Union County, Illinois............ 14 0.8309 0.8279 99914
14982........................... Vermilion County, Illinois........ 14 0.8309 0.9037 19180
14983........................... Wabash County, Illinois........... 14 0.8309 0.8279 99914
14984........................... Warren County, Illinois........... 14 0.8309 0.8279 99914
14985........................... Washington County, Illinois....... 14 0.8309 0.8279 99914
14986........................... Wayne County, Illinois............ 14 0.8309 0.8279 99914
14987........................... White County, Illinois............ 14 0.8309 0.8279 99914
14988........................... Whiteside County, Illinois........ 14 0.8309 0.8279 99914
14989........................... Will County, Illinois............. 1600 1.0838 1.0848 16974
14990........................... Williamson County, Illinois....... 14 0.8309 0.8279 99914
14991........................... Winnebago County, Illinois........ 6880 0.9994 0.9994 40420
14992........................... Woodford County, Illinois......... 6120 0.8868 0.8868 37900
15000........................... Adams County, Indiana............. 2760 0.9716 0.8630 99915
15010........................... Allen County, Indiana............. 2760 0.9716 0.9803 23060
15020........................... Bartholomew County, Indiana....... 15 0.8727 0.9598 18020
15030........................... Benton County, Indiana............ 15 0.8727 0.8745 29140
15040........................... Blackford County, Indiana......... 15 0.8727 0.8630 99915
15050........................... Boone County, Indiana............. 3480 0.9875 0.9930 26900
15060........................... Brown County, Indiana............. 15 0.8727 0.9930 26900
15070........................... Carroll County, Indiana........... 15 0.8727 0.8745 29140
15080........................... Cass County, Indiana.............. 15 0.8727 0.8630 99915
15090........................... Clark County, Indiana............. 4520 0.9302 0.9261 31140
15100........................... Clay County, Indiana.............. 8320 0.8345 0.8313 45460
15110........................... Clinton County, Indiana........... 3920 0.8745 0.8630 99915
15120........................... Crawford County, Indiana.......... 15 0.8727 0.8630 99915
15130........................... Daviess County, Indiana........... 15 0.8727 0.8630 99915
15140........................... Dearborn County, Indiana.......... 1640 0.9742 0.9623 17140
15150........................... Decatur County, Indiana........... 15 0.8727 0.8630 99915
15160........................... De Kalb County, Indiana........... 2760 0.9716 0.8630 99915
15170........................... Delaware County, Indiana.......... 5280 0.8939 0.8939 34620
15180........................... Dubois County, Indiana............ 15 0.8727 0.8630 99915
15190........................... Elkhart County, Indiana........... 2330 0.9637 0.9637 21140
15200........................... Fayette County, Indiana........... 15 0.8727 0.8630 99915
15210........................... Floyd County, Indiana............. 4520 0.9302 0.9261 31140
15220........................... Fountain County, Indiana.......... 15 0.8727 0.8630 99915
15230........................... Franklin County, Indiana.......... 15 0.8727 0.9623 17140
15240........................... Fulton County, Indiana............ 15 0.8727 0.8630 99915
15250........................... Gibson County, Indiana............ 15 0.8727 0.8721 21780
15260........................... Grant County, Indiana............. 15 0.8727 0.8630 99915
15270........................... Greene County, Indiana............ 15 0.8727 0.8456 14020
15280........................... Hamilton County, Indiana.......... 3480 0.9875 0.9930 26900
15290........................... Hancock County, Indiana........... 3480 0.9875 0.9930 26900
15300........................... Harrison County, Indiana.......... 4520 0.9302 0.9261 31140
15310........................... Hendricks County, Indiana......... 3480 0.9875 0.9930 26900
[[Page 29126]]
15320........................... Henry County, Indiana............. 15 0.8727 0.8630 99915
15330........................... Howard County, Indiana............ 3850 0.9517 0.9517 29020
15340........................... Huntington County, Indiana........ 2760 0.9716 0.8630 99915
15350........................... Jackson County, Indiana........... 15 0.8727 0.8630 99915
15360........................... Jasper County, Indiana............ 15 0.8727 0.9369 23844
15370........................... Jay County, Indiana............... 15 0.8727 0.8630 99915
15380........................... Jefferson County, Indiana......... 15 0.8727 0.8630 99915
15390........................... Jennings County, Indiana.......... 15 0.8727 0.8630 99915
15400........................... Johnson County, Indiana........... 3480 0.9875 0.9930 26900
15410........................... Knox County, Indiana.............. 15 0.8727 0.8630 99915
15420........................... Kosciusko County, Indiana......... 15 0.8727 0.8630 99915
15430........................... Lagrange County, Indiana.......... 15 0.8727 0.8630 99915
15440........................... Lake County, Indiana.............. 2960 0.9404 0.9369 23844
15450........................... La Porte County, Indiana.......... 15 0.8727 0.9409 33140
15460........................... Lawrence County, Indiana.......... 15 0.8727 0.8630 99915
15470........................... Madison County, Indiana........... 3480 0.9875 0.8595 11300
15480........................... Marion County, Indiana............ 3480 0.9875 0.9930 26900
15490........................... Marshall County, Indiana.......... 15 0.8727 0.8630 99915
15500........................... Martin County, Indiana............ 15 0.8727 0.8630 99915
15510........................... Miami County, Indiana............. 15 0.8727 0.8630 99915
15520........................... Monroe County, Indiana............ 1020 0.8456 0.8456 14020
15530........................... Montgomery County, Indiana........ 15 0.8727 0.8630 99915
15540........................... Morgan County, Indiana............ 3480 0.9875 0.9930 26900
15550........................... Newton County, Indiana............ 15 0.8727 0.9369 23844
15560........................... Noble County, Indiana............. 15 0.8727 0.8630 99915
15570........................... Ohio County, Indiana.............. 1640 0.9742 0.9623 17140
15580........................... Orange County, Indiana............ 15 0.8727 0.8630 99915
15590........................... Owen County, Indiana.............. 15 0.8727 0.8456 14020
15600........................... Parke County, Indiana............. 15 0.8727 0.8630 99915
15610........................... Perry County, Indiana............. 15 0.8727 0.8630 99915
15620........................... Pike County, Indiana.............. 15 0.8727 0.8630 99915
15630........................... Porter County, Indiana............ 2960 0.9404 0.9369 23844
15640........................... Posey County, Indiana............. 2440 0.8721 0.8721 21780
15650........................... Pulaski County, Indiana........... 15 0.8727 0.8630 99915
15660........................... Putnam County, Indiana............ 15 0.8727 0.9930 26900
15670........................... Randolph County, Indiana.......... 15 0.8727 0.8630 99915
15680........................... Ripley County, Indiana............ 15 0.8727 0.8630 99915
15690........................... Rush County, Indiana.............. 15 0.8727 0.8630 99915
15700........................... St Joseph County, Indiana......... 7800 0.9798 0.9798 43780
15710........................... Scott County, Indiana............. 4520 0.9302 0.8630 99915
15720........................... Shelby County, Indiana............ 3480 0.9875 0.9930 26900
15730........................... Spencer County, Indiana........... 15 0.8727 0.8630 99915
15740........................... Starke County, Indiana............ 15 0.8727 0.8630 99915
15750........................... Steuben County, Indiana........... 15 0.8727 0.8630 99915
15760........................... Sullivan County, Indiana.......... 15 0.8727 0.8313 45460
15770........................... Switzerland County, Indiana....... 15 0.8727 0.8630 99915
15780........................... Tippecanoe County, Indiana........ 3920 0.8745 0.8745 29140
15790........................... Tipton County, Indiana............ 3850 0.9517 0.9517 29020
15800........................... Union County, Indiana............. 15 0.8727 0.8630 99915
15810........................... Vanderburgh County, Indiana....... 2440 0.8721 0.8721 21780
15820........................... Vermillion County, Indiana........ 8320 0.8345 0.8313 45460
15830........................... Vigo County, Indiana.............. 8320 0.8345 0.8313 45460
15840........................... Wabash County, Indiana............ 15 0.8727 0.8630 99915
15840........................... Warren County, Indiana............ 15 0.8727 0.8630 99915
15860........................... Warrick County, Indiana........... 2440 0.8721 0.8721 21780
15870........................... Washington County, Indiana........ 15 0.8727 0.9261 31140
15880........................... Wayne County, Indiana............. 15 0.8727 0.8630 99915
15890........................... Wells County, Indiana............. 2760 0.9716 0.9803 23060
15900........................... White County, Indiana............. 15 0.8727 0.8630 99915
15910........................... Whitley County, Indiana........... 2760 0.9716 0.9803 23060
16000........................... Adair County, Iowa................ 16 0.8588 0.8502 99916
16010........................... Adams County, Iowa................ 16 0.8588 0.8502 99916
16020........................... Allamakee County, Iowa............ 16 0.8588 0.8502 99916
16030........................... Appanoose County, Iowa............ 16 0.8588 0.8502 99916
16040........................... Audubon County, Iowa.............. 16 0.8588 0.8502 99916
16050........................... Benton County, Iowa............... 16 0.8588 0.8617 16300
16060........................... Black Hawk County, Iowa........... 8920 0.8566 0.8566 47940
16070........................... Boone County, Iowa................ 16 0.8588 0.8502 99916
16080........................... Bremer County, Iowa............... 16 0.8588 0.8566 47940
[[Page 29127]]
16090........................... Buchanan County, Iowa............. 16 0.8588 0.8502 99916
16100........................... Buena Vista County, Iowa.......... 16 0.8588 0.8502 99916
16110........................... Butler County, Iowa............... 16 0.8588 0.8502 99916
16120........................... Calhoun County, Iowa.............. 16 0.8588 0.8502 99916
16130........................... Carroll County, Iowa.............. 16 0.8588 0.8502 99916
16140........................... Cass County, Iowa................. 16 0.8588 0.8502 99916
16150........................... Cedar County, Iowa................ 16 0.8588 0.8502 99916
16160........................... Cerro Gordo County, Iowa.......... 16 0.8588 0.8502 99916
16170........................... Cherokee County, Iowa............. 16 0.8588 0.8502 99916
16180........................... Chickasaw County, Iowa............ 16 0.8588 0.8502 99916
16190........................... Clarke County, Iowa............... 16 0.8588 0.8502 99916
16200........................... Clay County, Iowa................. 16 0.8588 0.8502 99916
16210........................... Clayton County, Iowa.............. 16 0.8588 0.8502 99916
16220........................... Clinton County, Iowa.............. 16 0.8588 0.8502 99916
16230........................... Crawford County, Iowa............. 16 0.8588 0.8502 99916
16240........................... Dallas County, Iowa............... 2120 0.9651 0.9651 19780
16250........................... Davis County, Iowa................ 16 0.8588 0.8502 99916
16260........................... Decatur County, Iowa.............. 16 0.8588 0.8502 99916
16270........................... Delaware County, Iowa............. 16 0.8588 0.8502 99916
16280........................... Des Moines County, Iowa........... 16 0.8588 0.8502 99916
16290........................... Dickinson County, Iowa............ 16 0.8588 0.8502 99916
16300........................... Dubuque County, Iowa.............. 2200 0.9135 0.9135 20220
16310........................... Emmet County, Iowa................ 16 0.8588 0.8502 99916
16320........................... Fayette County, Iowa.............. 16 0.8588 0.8502 99916
16330........................... Floyd County, Iowa................ 16 0.8588 0.8502 99916
16340........................... Franklin County, Iowa............. 16 0.8588 0.8502 99916
16350........................... Fremont County, Iowa.............. 16 0.8588 0.8502 99916
16360........................... Greene County, Iowa............... 16 0.8588 0.8502 99916
16370........................... Grundy County, Iowa............... 16 0.8588 0.8566 47940
16380........................... Guthrie County, Iowa.............. 16 0.8588 0.9651 19780
16390........................... Hamilton County, Iowa............. 16 0.8588 0.8502 99916
16400........................... Hancock County, Iowa.............. 16 0.8588 0.8502 99916
16410........................... Hardin County, Iowa............... 16 0.8588 0.8502 99916
16420........................... Harrison County, Iowa............. 16 0.8588 0.9569 36540
16430........................... Henry County, Iowa................ 16 0.8588 0.8502 99916
16440........................... Howard County, Iowa............... 16 0.8588 0.8502 99916
16450........................... Humboldt County, Iowa............. 16 0.8588 0.8502 99916
16460........................... Ida County, Iowa.................. 16 0.8588 0.8502 99916
16470........................... Iowa County, Iowa................. 16 0.8588 0.8502 99916
16480........................... Jackson County, Iowa.............. 16 0.8588 0.8502 99916
16490........................... Jasper County, Iowa............... 16 0.8588 0.8502 99916
16500........................... Jefferson County, Iowa............ 16 0.8588 0.8502 99916
16510........................... Johnson County, Iowa.............. 3500 0.9756 0.9756 26980
16520........................... Jones County, Iowa................ 16 0.8588 0.8617 16300
16530........................... Keokuk County, Iowa............... 16 0.8588 0.8502 99916
16540........................... Kossuth County, Iowa.............. 16 0.8588 0.8502 99916
16550........................... Lee County, Iowa.................. 16 0.8588 0.8502 99916
16560........................... Linn County, Iowa................. 1360 0.8617 0.8617 16300
16570........................... Louisa County, Iowa............... 16 0.8588 0.8502 99916
16580........................... Lucas County, Iowa................ 16 0.8588 0.8502 99916
16590........................... Lyon County, Iowa................. 16 0.8588 0.8502 99916
16600........................... Madison County, Iowa.............. 16 0.8588 0.9651 19780
16610........................... Mahaska County, Iowa.............. 16 0.8588 0.8502 99916
16620........................... Marion County, Iowa............... 16 0.8588 0.8502 99916
16630........................... Marshall County, Iowa............. 16 0.8588 0.8502 99916
16640........................... Mills County, Iowa................ 16 0.8588 0.9569 36540
16650........................... Mitchell County, Iowa............. 16 0.8588 0.8502 99916
16660........................... Monona County, Iowa............... 16 0.8588 0.8502 99916
16670........................... Monroe County, Iowa............... 16 0.8588 0.8502 99916
16680........................... Montgomery County, Iowa........... 16 0.8588 0.8502 99916
16690........................... Muscatine County, Iowa............ 16 0.8588 0.8502 99916
16700........................... OBrien County, Iowa............... 16 0.8588 0.8502 99916
16710........................... Osceola County, Iowa.............. 16 0.8588 0.8502 99916
16720........................... Page County, Iowa................. 16 0.8588 0.8502 99916
16730........................... Palo Alto County, Iowa............ 16 0.8588 0.8502 99916
16740........................... Plymouth County, Iowa............. 16 0.8588 0.8502 99916
16750........................... Pocahontas County, Iowa........... 16 0.8588 0.8502 99916
16760........................... Polk County, Iowa................. 2120 0.9651 0.9651 19780
16770........................... Pottawattamie County, Iowa........ 5920 0.9569 0.9569 36540
[[Page 29128]]
16780........................... Poweshiek County, Iowa............ 16 0.8588 0.8502 99916
16790........................... Ringgold County, Iowa............. 16 0.8588 0.8502 99916
16800........................... Sac County, Iowa.................. 16 0.8588 0.8502 99916
16810........................... Scott County, Iowa................ 1960 0.8731 0.8731 19340
16820........................... Shelby County, Iowa............... 16 0.8588 0.8502 99916
16830........................... Sioux County, Iowa................ 16 0.8588 0.8502 99916
16840........................... Story County, Iowa................ 16 0.8588 0.9545 11180
16850........................... Tama County, Iowa................. 16 0.8588 0.8502 99916
16860........................... Taylor County, Iowa............... 16 0.8588 0.8502 99916
16870........................... Union County, Iowa................ 16 0.8588 0.8502 99916
16880........................... Van Buren County, Iowa............ 16 0.8588 0.8502 99916
16890........................... Wapello County, Iowa.............. 16 0.8588 0.8502 99916
16900........................... Warren County, Iowa............... 2120 0.9651 0.9651 19780
16910........................... Washington County, Iowa........... 16 0.8588 0.9756 26980
16920........................... Wayne County, Iowa................ 16 0.8588 0.8502 99916
16930........................... Webster County, Iowa.............. 16 0.8588 0.8502 99916
16940........................... Winnebago County, Iowa............ 16 0.8588 0.8502 99916
16950........................... Winneshiek County, Iowa........... 16 0.8588 0.8502 99916
16960........................... Woodbury County, Iowa............. 7720 0.9411 0.9376 43580
16970........................... Worth County, Iowa................ 16 0.8588 0.8502 99916
16980........................... Wright County, Iowa............... 16 0.8588 0.8502 99916
17000........................... Allen County, Kansas.............. 17 0.7994 0.7987 99917
17010........................... Anderson County, Kansas........... 17 0.7994 0.7987 99917
17020........................... Atchison County, Kansas........... 17 0.7994 0.7987 99917
17030........................... Barber County, Kansas............. 17 0.7994 0.7987 99917
17040........................... Barton County, Kansas............. 17 0.7994 0.7987 99917
17050........................... Bourbon County, Kansas............ 17 0.7994 0.7987 99917
17060........................... Brown County, Kansas.............. 17 0.7994 0.7987 99917
17070........................... Butler County, Kansas............. 9040 0.9163 0.9141 48620
17080........................... Chase County, Kansas.............. 17 0.7994 0.7987 99917
17090........................... Chautauqua County, Kansas......... 17 0.7994 0.7987 99917
17100........................... Cherokee County, Kansas........... 17 0.7994 0.7987 99917
17110........................... Cheyenne County, Kansas........... 17 0.7994 0.7987 99917
17120........................... Clark County, Kansas.............. 17 0.7994 0.7987 99917
17130........................... Clay County, Kansas............... 17 0.7994 0.7987 99917
17140........................... Cloud County, Kansas.............. 17 0.7994 0.7987 99917
17150........................... Coffey County, Kansas............. 17 0.7994 0.7987 99917
17160........................... Comanche County, Kansas........... 17 0.7994 0.7987 99917
17170........................... Cowley County, Kansas............. 17 0.7994 0.7987 99917
17180........................... Crawford County, Kansas........... 17 0.7994 0.7987 99917
17190........................... Decatur County, Kansas............ 17 0.7994 0.7987 99917
17200........................... Dickinson County, Kansas.......... 17 0.7994 0.7987 99917
17210........................... Doniphan County, Kansas........... 17 0.7994 0.9529 41140
17220........................... Douglas County, Kansas............ 4150 0.8546 0.8546 29940
17230........................... Edwards County, Kansas............ 17 0.7994 0.7987 99917
17240........................... Elk County, Kansas................ 17 0.7994 0.7987 99917
17250........................... Ellis County, Kansas.............. 17 0.7994 0.7987 99917
17260........................... Ellsworth County, Kansas.......... 17 0.7994 0.7987 99917
17270........................... Finney County, Kansas............. 17 0.7994 0.7987 99917
17280........................... Ford County, Kansas............... 17 0.7994 0.7987 99917
17290........................... Franklin County, Kansas........... 17 0.7994 0.9467 28140
17300........................... Geary County, Kansas.............. 17 0.7994 0.7987 99917
17310........................... Gove County, Kansas............... 17 0.7994 0.7987 99917
17320........................... Graham County, Kansas............. 17 0.7994 0.7987 99917
17330........................... Grant County, Kansas.............. 17 0.7994 0.7987 99917
17340........................... Gray County, Kansas............... 17 0.7994 0.7987 99917
17350........................... Greeley County, Kansas............ 17 0.7994 0.7987 99917
17360........................... Greenwood County, Kansas.......... 17 0.7994 0.7987 99917
17370........................... Hamilton County, Kansas........... 17 0.7994 0.7987 99917
17380........................... Harper County, Kansas............. 17 0.7994 0.7987 99917
17390........................... Harvey County, Kansas............. 9040 0.9163 0.9141 48620
17391........................... Haskell County, Kansas............ 17 0.7994 0.7987 99917
17410........................... Hodgeman County, Kansas........... 17 0.7994 0.7987 99917
17420........................... Jackson County, Kansas............ 17 0.7994 0.8929 45820
17430........................... Jefferson County, Kansas.......... 17 0.7994 0.8929 45820
17440........................... Jewell County, Kansas............. 17 0.7994 0.7987 99917
17450........................... Johnson County, Kansas............ 3760 0.9481 0.9467 28140
17451........................... Kearny County, Kansas............. 17 0.7994 0.7987 99917
17470........................... Kingman County, Kansas............ 17 0.7994 0.7987 99917
[[Page 29129]]
17480........................... Kiowa County, Kansas.............. 17 0.7994 0.7987 99917
17490........................... Labette County, Kansas............ 17 0.7994 0.7987 99917
17500........................... Lane County, Kansas............... 17 0.7994 0.7987 99917
17510........................... Leavenworth County, Kansas........ 3760 0.9481 0.9467 28140
17520........................... Lincoln County, Kansas............ 17 0.7994 0.7987 99917
17530........................... Linn County, Kansas............... 17 0.7994 0.9467 28140
17540........................... Logan County, Kansas.............. 17 0.7994 0.7987 99917
17550........................... Lyon County, Kansas............... 17 0.7994 0.7987 99917
17560........................... Mc Pherson County, Kansas......... 17 0.7994 0.7987 99917
17570........................... Marion County, Kansas............. 17 0.7994 0.7987 99917
17580........................... Marshall County, Kansas........... 17 0.7994 0.7987 99917
17590........................... Meade County, Kansas.............. 17 0.7994 0.7987 99917
17600........................... Miami County, Kansas.............. 3760 0.9481 0.9467 28140
17610........................... Mitchell County, Kansas........... 17 0.7994 0.7987 99917
17620........................... Montgomery County, Kansas......... 17 0.7994 0.7987 99917
17630........................... Morris County, Kansas............. 17 0.7994 0.7987 99917
17640........................... Morton County, Kansas............. 17 0.7994 0.7987 99917
17650........................... Nemaha County, Kansas............. 17 0.7994 0.7987 99917
17660........................... Neosho County, Kansas............. 17 0.7994 0.7987 99917
17670........................... Ness County, Kansas............... 17 0.7994 0.7987 99917
17680........................... Norton County, Kansas............. 17 0.7994 0.7987 99917
17690........................... Osage County, Kansas.............. 17 0.7994 0.8929 45820
17700........................... Osborne County, Kansas............ 17 0.7994 0.7987 99917
17710........................... Ottawa County, Kansas............. 17 0.7994 0.7987 99917
17720........................... Pawnee County, Kansas............. 17 0.7994 0.7987 99917
17730........................... Phillips County, Kansas........... 17 0.7994 0.7987 99917
17740........................... Pottawatomie County, Kansas....... 17 0.7994 0.7987 99917
17750........................... Pratt County, Kansas.............. 17 0.7994 0.7987 99917
17760........................... Rawlins County, Kansas............ 17 0.7994 0.7987 99917
17770........................... Reno County, Kansas............... 17 0.7994 0.7987 99917
17780........................... Republic County, Kansas........... 17 0.7994 0.7987 99917
17790........................... Rice County, Kansas............... 17 0.7994 0.7987 99917
17800........................... Riley County, Kansas.............. 17 0.7994 0.7987 99917
17810........................... Rooks County, Kansas.............. 17 0.7994 0.7987 99917
17820........................... Rush County, Kansas............... 17 0.7994 0.7987 99917
17830........................... Russell County, Kansas............ 17 0.7994 0.7987 99917
17840........................... Saline County, Kansas............. 17 0.7994 0.7987 99917
17841........................... Scott County, Kansas.............. 17 0.7994 0.7987 99917
17860........................... Sedgwick County, Kansas........... 9040 0.9163 0.9141 48620
17870........................... Seward County, Kansas............. 17 0.7994 0.7987 99917
17880........................... Shawnee County, Kansas............ 8440 0.8929 0.8929 45820
17890........................... Sheridan County, Kansas........... 17 0.7994 0.7987 99917
17900........................... Sherman County, Kansas............ 17 0.7994 0.7987 99917
17910........................... Smith County, Kansas.............. 17 0.7994 0.7987 99917
17920........................... Stafford County, Kansas........... 17 0.7994 0.7987 99917
17921........................... Stanton County, Kansas............ 17 0.7994 0.7987 99917
17940........................... Stevens County, Kansas............ 17 0.7994 0.7987 99917
17950........................... Sumner County, Kansas............. 17 0.7994 0.9141 48620
17960........................... Thomas County, Kansas............. 17 0.7994 0.7987 99917
17970........................... Trego County, Kansas.............. 17 0.7994 0.7987 99917
17980........................... Wabaunsee County, Kansas.......... 17 0.7994 0.8929 45820
17981........................... Wallace County, Kansas............ 17 0.7994 0.7987 99917
17982........................... Washington County, Kansas......... 17 0.7994 0.7987 99917
17983........................... Wichita County, Kansas............ 17 0.7994 0.7987 99917
17984........................... Wilson County, Kansas............. 17 0.7994 0.7987 99917
17985........................... Woodson County, Kansas............ 17 0.7994 0.7987 99917
17986........................... Wyandotte County, Kansas.......... 3760 0.9481 0.9467 28140
18000........................... Adair County, Kentucky............ 18 0.7866 0.7774 99918
18010........................... Allen County, Kentucky............ 18 0.7866 0.7774 99918
18020........................... Anderson County, Kentucky......... 18 0.7866 0.7774 99918
18030........................... Ballard County, Kentucky.......... 18 0.7866 0.7774 99918
18040........................... Barren County, Kentucky........... 18 0.7866 0.7774 99918
18050........................... Bath County, Kentucky............. 18 0.7866 0.7774 99918
18060........................... Bell County, Kentucky............. 18 0.7866 0.7774 99918
18070........................... Boone County, Kentucky............ 1640 0.9742 0.9623 17140
18080........................... Bourbon County, Kentucky.......... 4280 0.8997 0.9084 30460
18090........................... Boyd County, Kentucky............. 3400 0.9486 0.9486 26580
18100........................... Boyle County, Kentucky............ 18 0.7866 0.7774 99918
18110........................... Bracken County, Kentucky.......... 18 0.7866 0.9623 17140
[[Page 29130]]
18120........................... Breathitt County, Kentucky........ 18 0.7866 0.7774 99918
18130........................... Breckinridge County, Kentucky..... 18 0.7866 0.7774 99918
18140........................... Bullitt County, Kentucky.......... 4520 0.9302 0.9261 31140
18150........................... Butler County, Kentucky........... 18 0.7866 0.7774 99918
18160........................... Caldwell County, Kentucky......... 18 0.7866 0.7774 99918
18170........................... Calloway County, Kentucky......... 18 0.7866 0.7774 99918
18180........................... Campbell County, Kentucky......... 1640 0.9742 0.9623 17140
18190........................... Carlisle County, Kentucky......... 18 0.7866 0.7774 99918
18191........................... Carroll County, Kentucky.......... 18 0.7866 0.7774 99918
18210........................... Carter County, Kentucky........... 3400 0.9486 0.7774 99918
18220........................... Casey County, Kentucky............ 18 0.7866 0.7774 99918
18230........................... Christian County, Kentucky........ 1660 0.8292 0.8292 17300
18240........................... Clark County, Kentucky............ 4280 0.8997 0.9084 30460
18250........................... Clay County, Kentucky............. 18 0.7866 0.7774 99918
18260........................... Clinton County, Kentucky.......... 18 0.7866 0.7774 99918
18270........................... Crittenden County, Kentucky....... 18 0.7866 0.7774 99918
18271........................... Cumberland County, Kentucky....... 18 0.7866 0.7774 99918
18290........................... Daviess County, Kentucky.......... 5990 0.8789 0.8789 36980
18291........................... Edmonson County, Kentucky......... 18 0.7866 0.8220 14540
18310........................... Elliott County, Kentucky.......... 18 0.7866 0.7774 99918
18320........................... Estill County, Kentucky........... 18 0.7866 0.7774 99918
18330........................... Fayette County, Kentucky.......... 4280 0.8997 0.9084 30460
18340........................... Fleming County, Kentucky.......... 18 0.7866 0.7774 99918
18350........................... Floyd County, Kentucky............ 18 0.7866 0.7774 99918
18360........................... Franklin County, Kentucky......... 18 0.7866 0.7774 99918
18361........................... Fulton County, Kentucky........... 18 0.7866 0.7774 99918
18362........................... Gallatin County, Kentucky......... 1640 0.9742 0.9623 17140
18390........................... Garrard County, Kentucky.......... 18 0.7866 0.7774 99918
18400........................... Grant County, Kentucky............ 1640 0.9742 0.9623 17140
18410........................... Graves County, Kentucky........... 18 0.7866 0.7774 99918
18420........................... Grayson County, Kentucky.......... 18 0.7866 0.7774 99918
18421........................... Green County, Kentucky............ 18 0.7866 0.7774 99918
18440........................... Greenup County, Kentucky.......... 3400 0.9486 0.9486 26580
18450........................... Hancock County, Kentucky.......... 18 0.7866 0.8789 36980
18460........................... Hardin County, Kentucky........... 18 0.7866 0.8810 21060
18470........................... Harlan County, Kentucky........... 18 0.7866 0.7774 99918
18480........................... Harrison County, Kentucky......... 18 0.7866 0.7774 99918
18490........................... Hart County, Kentucky............. 18 0.7866 0.7774 99918
18500........................... Henderson County, Kentucky........ 2440 0.8721 0.8721 21780
18510........................... Henry County, Kentucky............ 18 0.7866 0.9261 31140
18511........................... Hickman County, Kentucky.......... 18 0.7866 0.7774 99918
18530........................... Hopkins County, Kentucky.......... 18 0.7866 0.7774 99918
18540........................... Jackson County, Kentucky.......... 18 0.7866 0.7774 99918
18550........................... Jefferson County, Kentucky........ 4520 0.9302 0.9261 31140
18560........................... Jessamine County, Kentucky........ 4280 0.8997 0.9084 30460
18570........................... Johnson County, Kentucky.......... 18 0.7866 0.7774 99918
18580........................... Kenton County, Kentucky........... 1640 0.9742 0.9623 17140
18590........................... Knott County, Kentucky............ 18 0.7866 0.7774 99918
18600........................... Knox County, Kentucky............. 18 0.7866 0.7774 99918
18610........................... Larue County, Kentucky............ 18 0.7866 0.8810 21060
18620........................... Laurel County, Kentucky........... 18 0.7866 0.7774 99918
18630........................... Lawrence County, Kentucky......... 18 0.7866 0.7774 99918
18640........................... Lee County, Kentucky.............. 18 0.7866 0.7774 99918
18650........................... Leslie County, Kentucky........... 18 0.7866 0.7774 99918
18660........................... Letcher County, Kentucky.......... 18 0.7866 0.7774 99918
18670........................... Lewis County, Kentucky............ 18 0.7866 0.7774 99918
18680........................... Lincoln County, Kentucky.......... 18 0.7866 0.7774 99918
18690........................... Livingston County, Kentucky....... 18 0.7866 0.7774 99918
18700........................... Logan County, Kentucky............ 18 0.7866 0.7774 99918
18710........................... Lyon County, Kentucky............. 18 0.7866 0.7774 99918
18720........................... Mc Cracken County, Kentucky....... 18 0.7866 0.7774 99918
18730........................... Mc Creary County, Kentucky........ 18 0.7866 0.7774 99918
18740........................... Mc Lean County, Kentucky.......... 18 0.7866 0.8789 36980
18750........................... Madison County, Kentucky.......... 4280 0.8997 0.7774 99918
18760........................... Magoffin County, Kentucky......... 18 0.7866 0.7774 99918
18770........................... Marion County, Kentucky........... 18 0.7866 0.7774 99918
18780........................... Marshall County, Kentucky......... 18 0.7866 0.7774 99918
18790........................... Martin County, Kentucky........... 18 0.7866 0.7774 99918
18800........................... Mason County, Kentucky............ 18 0.7866 0.7774 99918
[[Page 29131]]
18801........................... Meade County, Kentucky............ 18 0.7866 0.9261 31140
18802........................... Menifee County, Kentucky.......... 18 0.7866 0.7774 99918
18830........................... Mercer County, Kentucky........... 18 0.7866 0.7774 99918
18831........................... Metcalfe County, Kentucky......... 18 0.7866 0.7774 99918
18850........................... Monroe County, Kentucky........... 18 0.7866 0.7774 99918
18860........................... Montgomery County, Kentucky....... 18 0.7866 0.7774 99918
18861........................... Morgan County, Kentucky........... 18 0.7866 0.7774 99918
18880........................... Muhlenberg County, Kentucky....... 18 0.7866 0.7774 99918
18890........................... Nelson County, Kentucky........... 18 0.7866 0.9261 31140
18900........................... Nicholas County, Kentucky......... 18 0.7866 0.7774 99918
18910........................... Ohio County, Kentucky............. 18 0.7866 0.7774 99918
18920........................... Oldham County, Kentucky........... 4520 0.9302 0.9261 31140
18930........................... Owen County, Kentucky............. 18 0.7866 0.7774 99918
18931........................... Owsley County, Kentucky........... 18 0.7866 0.7774 99918
18932........................... Pendleton County, Kentucky........ 1640 0.9742 0.9623 17140
18960........................... Perry County, Kentucky............ 18 0.7866 0.7774 99918
18970........................... Pike County, Kentucky............. 18 0.7866 0.7774 99918
18971........................... Powell County, Kentucky........... 18 0.7866 0.7774 99918
18972........................... Pulaski County, Kentucky.......... 18 0.7866 0.7774 99918
18973........................... Robertson County, Kentucky........ 18 0.7866 0.7774 99918
18974........................... Rockcastle County, Kentucky....... 18 0.7866 0.7774 99918
18975........................... Rowan County, Kentucky............ 18 0.7866 0.7774 99918
18976........................... Russell County, Kentucky.......... 18 0.7866 0.7774 99918
18977........................... Scott County, Kentucky............ 4280 0.8997 0.9084 30460
18978........................... Shelby County, Kentucky........... 18 0.7866 0.9261 31140
18979........................... Simpson County, Kentucky.......... 18 0.7866 0.7774 99918
18980........................... Spencer County, Kentucky.......... 18 0.7866 0.9261 31140
18981........................... Taylor County, Kentucky........... 18 0.7866 0.7774 99918
18982........................... Todd County, Kentucky............. 18 0.7866 0.7774 99918
18983........................... Trigg County, Kentucky............ 18 0.7866 0.8292 17300
18984........................... Trimble County, Kentucky.......... 18 0.7866 0.9261 31140
18985........................... Union County, Kentucky............ 18 0.7866 0.7774 99918
18986........................... Warren County, Kentucky........... 18 0.7866 0.8220 14540
18987........................... Washington County, Kentucky....... 18 0.7866 0.7774 99918
18988........................... Wayne County, Kentucky............ 18 0.7866 0.7774 99918
18989........................... Webster County, Kentucky.......... 18 0.7866 0.8721 21780
18990........................... Whitley County, Kentucky.......... 18 0.7866 0.7774 99918
18991........................... Wolfe County, Kentucky............ 18 0.7866 0.7774 99918
18992........................... Woodford County, Kentucky......... 4280 0.8997 0.9084 30460
19000........................... Acadia County, Louisiana.......... 3880 0.8260 0.7418 99919
19010........................... Allen County, Louisiana........... 19 0.7348 0.7418 99919
19020........................... Ascension County, Louisiana....... 0760 0.8652 0.8601 12940
19030........................... Assumption County, Louisiana...... 19 0.7348 0.7418 99919
19040........................... Avoyelles County, Louisiana....... 19 0.7348 0.7418 99919
19050........................... Beauregard County, Louisiana...... 19 0.7348 0.7418 99919
19060........................... Bienville County, Louisiana....... 19 0.7348 0.7418 99919
19070........................... Bossier County, Louisiana......... 7680 0.8746 0.8769 43340
19080........................... Caddo County, Louisiana........... 7680 0.8746 0.8769 43340
19090........................... Calcasieu County, Louisiana....... 3960 0.7866 0.7841 29340
19100........................... Caldwell County, Louisiana........ 19 0.7348 0.7418 99919
19110........................... Cameron County, Louisiana......... 19 0.7348 0.7841 29340
19120........................... Catahoula County, Louisiana....... 19 0.7348 0.7418 99919
19130........................... Claiborne County, Louisiana....... 19 0.7348 0.7418 99919
19140........................... Concordia County, Louisiana....... 19 0.7348 0.7418 99919
19150........................... De Soto County, Louisiana......... 19 0.7348 0.8769 43340
19160........................... East Baton Rouge County, Louisiana 0760 0.8652 0.8601 12940
19170........................... East Carroll County, Louisiana.... 19 0.7348 0.7418 99919
19180........................... East Feliciana County, Louisiana.. 19 0.7348 0.8601 12940
19190........................... Evangeline County, Louisiana...... 19 0.7348 0.7418 99919
19200........................... Franklin County, Louisiana........ 19 0.7348 0.7418 99919
19210........................... Grant County, Louisiana........... 19 0.7348 0.8041 10780
19220........................... Iberia County, Louisiana.......... 19 0.7348 0.7418 99919
19230........................... Iberville County, Louisiana....... 19 0.7348 0.8601 12940
19240........................... Jackson County, Louisiana......... 19 0.7348 0.7418 99919
19250........................... Jefferson County, Louisiana....... 5560 0.9005 0.9005 35380
19260........................... Jefferson Davis County, Louisiana. 19 0.7348 0.7418 99919
19270........................... Lafayette County, Louisiana....... 3880 0.8260 0.8436 29180
19280........................... Lafourche County, Louisiana....... 3350 0.7902 0.7902 26380
19290........................... La Salle County, Louisiana........ 19 0.7348 0.7418 99919
[[Page 29132]]
19300........................... Lincoln County, Louisiana......... 19 0.7348 0.7418 99919
19310........................... Livingston County, Louisiana...... 0760 0.8652 0.8601 12940
19320........................... Madison County, Louisiana......... 19 0.7348 0.7418 99919
19330........................... Morehouse County, Louisiana....... 19 0.7348 0.7418 99919
19340........................... Natchitoches County, Louisiana.... 19 0.7348 0.7418 99919
19350........................... Orleans County, Louisiana......... 5560 0.9005 0.9005 35380
19360........................... Ouachita County, Louisiana........ 5200 0.8052 0.8040 33740
19370........................... Plaquemines County, Louisiana..... 5560 0.9005 0.9005 35380
19380........................... Pointe Coupee County, Louisiana... 19 0.7348 0.8601 12940
19390........................... Rapides County, Louisiana......... 0220 0.8041 0.8041 10780
19400........................... Red River County, Louisiana....... 19 0.7348 0.7418 99919
19410........................... Richland County, Louisiana........ 19 0.7348 0.7418 99919
19420........................... Sabine County, Louisiana.......... 19 0.7348 0.7418 99919
19430........................... St Bernard County, Louisiana...... 5560 0.9005 0.9005 35380
19440........................... St Charles County, Louisiana...... 5560 0.9005 0.9005 35380
19450........................... St Helena County, Louisiana....... 19 0.7348 0.8601 12940
19460........................... St James County, Louisiana........ 5560 0.9005 0.7418 99919
19470........................... St John Baptist County, Louisiana. 5560 0.9005 0.9005 35380
19480........................... St Landry County, Louisiana....... 3880 0.8260 0.7418 99919
19490........................... St Martin County, Louisiana....... 3880 0.8260 0.8436 29180
19500........................... St Mary County, Louisiana......... 19 0.7348 0.7418 99919
19510........................... St Tammany County, Louisiana...... 5560 0.9005 0.9005 35380
19520........................... Tangipahoa County, Louisiana...... 19 0.7348 0.7418 99919
19530........................... Tensas County, Louisiana.......... 19 0.7348 0.7418 99919
19540........................... Terrebonne County, Louisiana...... 3350 0.7902 0.7902 26380
19550........................... Union County, Louisiana........... 19 0.7348 0.8040 33740
19560........................... Vermilion County, Louisiana....... 19 0.7348 0.7418 99919
19570........................... Vernon County, Louisiana.......... 19 0.7348 0.7418 99919
19580........................... Washington County, Louisiana...... 19 0.7348 0.7418 99919
19590........................... Webster County, Louisiana......... 7680 0.8746 0.7418 99919
19600........................... West Baton Rouge County, Louisiana 0760 0.8652 0.8601 12940
19610........................... West Carroll County, Louisiana.... 19 0.7348 0.7418 99919
19620........................... West Feliciana County, Louisiana.. 19 0.7348 0.8601 12940
19630........................... Winn County, Louisiana............ 19 0.7348 0.7418 99919
20000........................... Androscoggin County, Maine........ 4243 0.9341 0.9341 30340
20010........................... Aroostook County, Maine........... 20 0.8852 0.8852 99920
20020........................... Cumberland County, Maine.......... 6403 1.0392 1.0392 38860
20030........................... Franklin County, Maine............ 20 0.8852 0.8852 99920
20040........................... Hancock County, Maine............. 20 0.8852 0.8852 99920
20050........................... Kennebec County, Maine............ 20 0.8852 0.8852 99920
20060........................... Knox County, Maine................ 20 0.8852 0.8852 99920
20070........................... Lincoln County, Maine............. 20 0.8852 0.8852 99920
20080........................... Oxford County, Maine.............. 20 0.8852 0.8852 99920
20090........................... Penobscot County, Maine........... 0733 1.0003 1.0003 12620
20100........................... Piscataquis County, Maine......... 20 0.8852 0.8852 99920
20110........................... Sagadahoc County, Maine........... 6403 1.0392 1.0392 38860
20120........................... Somerset County, Maine............ 20 0.8852 0.8852 99920
20130........................... Waldo County, Maine............... 20 0.8852 0.8852 99920
20140........................... Washington County, Maine.......... 20 0.8852 0.8852 99920
20150........................... York County, Maine................ 6403 1.0392 1.0392 38860
21000........................... Allegany County, Maryland......... 1900 0.9326 0.9326 19060
21010........................... Anne Arundel County, Maryland..... 0720 0.9907 0.9907 12580
21020........................... Baltimore County, Maryland........ 0720 0.9907 0.9907 12580
21030........................... Baltimore City County, Maryland... 0720 0.9907 0.9907 12580
21040........................... Calvert County, Maryland.......... 8840 1.0983 1.0932 47894
21050........................... Caroline County, Maryland......... 21 0.9085 0.9095 99921
21060........................... Carroll County, Maryland.......... 0720 0.9907 0.9907 12580
21070........................... Cecil County, Maryland............ 9160 1.0537 1.0482 48864
21080........................... Charles County, Maryland.......... 8840 1.0983 1.0932 47894
21090........................... Dorchester County, Maryland....... 21 0.9085 0.9095 99921
21100........................... Frederick County, Maryland........ 8840 1.0983 1.1495 13644
21110........................... Garrett County, Maryland.......... 21 0.9085 0.9095 99921
21120........................... Harford County, Maryland.......... 0720 0.9907 0.9907 12580
21130........................... Howard County, Maryland........... 0720 0.9907 0.9907 12580
21140........................... Kent County, Maryland............. 21 0.9085 0.9095 99921
21150........................... Montgomery County, Maryland....... 8840 1.0983 1.1495 13644
21160........................... Prince Georges County, Maryland... 8840 1.0983 1.0932 47894
21170........................... Queen Annes County, Maryland...... 0720 0.9907 0.9907 12580
21180........................... St Marys County, Maryland......... 21 0.9085 0.9095 99921
[[Page 29133]]
21190........................... Somerset County, Maryland......... 21 0.9085 0.9073 41540
21200........................... Talbot County, Maryland........... 21 0.9085 0.9095 99921
21210........................... Washington County, Maryland....... 3180 0.9879 0.9499 25180
21220........................... Wicomico County, Maryland......... 21 0.9085 0.9073 41540
21230........................... Worcester County, Maryland........ 21 0.9085 0.9095 99921
22000........................... Barnstable County, Massachusetts.. 0743 1.2527 1.2527 12700
22010........................... Berkshire County, Massachusetts... 6323 1.0191 1.0191 38340
22020........................... Bristol County, Massachusetts..... 1123 1.1152 1.0966 39300
22030........................... Dukes County, Massachusetts....... 22 1.0050 1.0216 99922
22040........................... Essex County, Massachusetts....... 1123 1.1152 1.0533 21604
22060........................... Franklin County, Massachusetts.... 22 1.0050 1.0259 44140
22070........................... Hampden County, Massachusetts..... 8003 1.0273 1.0259 44140
22080........................... Hampshire County, Massachusetts... 8003 1.0273 1.0259 44140
22090........................... Middlesex County, Massachusetts... 1123 1.1152 1.1084 15764
22120........................... Nantucket County, Massachusetts... 22 1.0050 1.0216 99922
22130........................... Norfolk County, Massachusetts..... 1123 1.1152 1.1543 14484
22150........................... Plymouth County, Massachusetts.... 1123 1.1152 1.1543 14484
22160........................... Suffolk County, Massachusetts..... 1123 1.1152 1.1543 14484
22170........................... Worcester County, Massachusetts... 1123 1.1152 1.1039 49340
23000........................... Alcona County, Michigan........... 23 0.8813 0.8870 99923
23010........................... Alger County, Michigan............ 23 0.8813 0.8870 99923
23020........................... Allegan County, Michigan.......... 3000 0.9455 0.8870 99923
23030........................... Alpena County, Michigan........... 23 0.8813 0.8870 99923
23040........................... Antrim County, Michigan........... 23 0.8813 0.8870 99923
23050........................... Arenac County, Michigan........... 23 0.8813 0.8870 99923
23060........................... Baraga County, Michigan........... 23 0.8813 0.8870 99923
23070........................... Barry County, Michigan............ 23 0.8813 0.9400 24340
23080........................... Bay County, Michigan.............. 6960 0.9415 0.9352 13020
23090........................... Benzie County, Michigan........... 23 0.8813 0.8870 99923
23100........................... Berrien County, Michigan.......... 0870 0.8888 0.8888 35660
23110........................... Branch County, Michigan........... 23 0.8813 0.8870 99923
23120........................... Calhoun County, Michigan.......... 3720 1.0151 0.9510 12980
23130........................... Cass County, Michigan............. 23 0.8813 0.9798 43780
23140........................... Charlevoix County, Michigan....... 23 0.8813 0.8870 99923
23150........................... Cheboygan County, Michigan........ 23 0.8813 0.8870 99923
23160........................... Chippewa County, Michigan......... 23 0.8813 0.8870 99923
23170........................... Clare County, Michigan............ 23 0.8813 0.8870 99923
23180........................... Clinton County, Michigan.......... 4040 0.9792 0.9792 29620
23190........................... Crawford County, Michigan......... 23 0.8813 0.8870 99923
23200........................... Delta County, Michigan............ 23 0.8813 0.8870 99923
23210........................... Dickinson County, Michigan........ 23 0.8813 0.8870 99923
23220........................... Eaton County, Michigan............ 4040 0.9792 0.9792 29620
23230........................... Emmet County, Michigan............ 23 0.8813 0.8870 99923
23240........................... Genesee County, Michigan.......... 2640 1.0663 1.0663 22420
23250........................... Gladwin County, Michigan.......... 23 0.8813 0.8870 99923
23260........................... Gogebic County, Michigan.......... 23 0.8813 0.8870 99923
23270........................... Grand Traverse County, Michigan... 23 0.8813 0.8870 99923
23280........................... Gratiot County, Michigan.......... 23 0.8813 0.8870 99923
23290........................... Hillsdale County, Michigan........ 23 0.8813 0.8870 99923
23300........................... Houghton County, Michigan......... 23 0.8813 0.8870 99923
23310........................... Huron County, Michigan............ 23 0.8813 0.8870 99923
23320........................... Ingham County, Michigan........... 4040 0.9792 0.9792 29620
23330........................... Ionia County, Michigan............ 23 0.8813 0.9400 24340
23340........................... Iosco County, Michigan............ 23 0.8813 0.8870 99923
23350........................... Iron County, Michigan............. 23 0.8813 0.8870 99923
23360........................... Isabella County, Michigan......... 23 0.8813 0.8870 99923
23370........................... Jackson County, Michigan.......... 3520 0.9313 0.9313 27100
23380........................... Kalamazoo County, Michigan........ 3720 1.0151 1.0391 28020
23390........................... Kalkaska County, Michigan......... 23 0.8813 0.8870 99923
23400........................... Kent County, Michigan............. 3000 0.9455 0.9400 24340
23410........................... Keweenaw County, Michigan......... 23 0.8813 0.8870 99923
23420........................... Lake County, Michigan............. 23 0.8813 0.8870 99923
23430........................... Lapeer County, Michigan........... 2160 1.0152 0.9861 47644
23440........................... Leelanau County, Michigan......... 23 0.8813 0.8870 99923
23450........................... Lenawee County, Michigan.......... 0440 1.0718 0.8870 99923
23460........................... Livingston County, Michigan....... 0440 1.0718 0.9861 47644
23470........................... Luce County, Michigan............. 23 0.8813 0.8870 99923
23480........................... Mackinac County, Michigan......... 23 0.8813 0.8870 99923
23490........................... Macomb County, Michigan........... 2160 1.0152 0.9861 47644
[[Page 29134]]
23500........................... Manistee County, Michigan......... 23 0.8813 0.8870 99923
23510........................... Marquette County, Michigan........ 23 0.8813 0.8870 99923
23520........................... Mason County, Michigan............ 23 0.8813 0.8870 99923
23530........................... Mecosta County, Michigan.......... 23 0.8813 0.8870 99923
23540........................... Menominee County, Michigan........ 23 0.8813 0.8870 99923
23550........................... Midland County, Michigan.......... 6960 0.9415 0.8870 99923
23560........................... Missaukee County, Michigan........ 23 0.8813 0.8870 99923
23570........................... Monroe County, Michigan........... 2160 1.0152 0.9478 33780
23580........................... Montcalm County, Michigan......... 23 0.8813 0.8870 99923
23590........................... Montmorency County, Michigan...... 23 0.8813 0.8870 99923
23600........................... Muskegon County, Michigan......... 3000 0.9455 0.9673 34740
23610........................... Newaygo County, Michigan.......... 23 0.8813 0.9400 24340
23620........................... Oakland County, Michigan.......... 2160 1.0152 0.9861 47644
23630........................... Oceana County, Michigan........... 23 0.8813 0.8870 99923
23640........................... Ogemaw County, Michigan........... 23 0.8813 0.8870 99923
23650........................... Ontonagon County, Michigan........ 23 0.8813 0.8870 99923
23660........................... Osceola County, Michigan.......... 23 0.8813 0.8870 99923
23670........................... Oscoda County, Michigan........... 23 0.8813 0.8870 99923
23680........................... Otsego County, Michigan........... 23 0.8813 0.8870 99923
23690........................... Ottawa County, Michigan........... 3000 0.9455 0.9064 26100
23700........................... Presque Isle County, Michigan..... 23 0.8813 0.8870 99923
23710........................... Roscommon County, Michigan........ 23 0.8813 0.8870 99923
23720........................... Saginaw County, Michigan.......... 6960 0.9415 0.9420 40980
23730........................... St Clair County, Michigan......... 12160 1.0152 0.9861 47644
23740........................... St Joseph County, Michigan........ 23 0.8813 0.8870 99923
23750........................... Sanilac County, Michigan.......... 23 0.8813 0.8870 99923
23760........................... Schoolcraft County, Michigan...... 23 0.8813 0.8870 99923
23770........................... Shiawassee County, Michigan....... 23 0.8813 0.8870 99923
23780........................... Tuscola County, Michigan.......... 23 0.8813 0.8870 99923
23790........................... Van Buren County, Michigan........ 3720 1.0151 1.0391 28020
23800........................... Washtenaw County, Michigan........ 0440 1.0718 1.0870 11460
23810........................... Wayne County, Michigan............ 2160 1.0152 1.0441 19804
23830........................... Wexford County, Michigan.......... 23 0.8813 0.8870 99923
24000........................... Aitkin County, Minnesota.......... 24 0.9193 0.9183 99924
24010........................... Anoka County, Minnesota........... 5120 1.1078 1.1078 33460
24020........................... Becker County, Minnesota.......... 24 0.9193 0.9183 99924
24030........................... Beltrami County, Minnesota........ 24 0.9193 0.9183 99924
24040........................... Benton County, Minnesota.......... 6980 0.9975 0.9975 41060
24050........................... Big Stone County, Minnesota....... 24 0.9193 0.9183 99924
24060........................... Blue Earth County, Minnesota...... 24 0.9193 0.9183 99924
24070........................... Brown County, Minnesota........... 24 0.9193 0.9183 99924
24080........................... Carlton County, Minnesota......... 24 0.9193 1.0209 20260
24090........................... Carver County, Minnesota.......... 5120 1.1078 1.1078 33460
24100........................... Cass County, Minnesota............ 24 0.9193 0.9183 99924
24110........................... Chippewa County, Minnesota........ 24 0.9193 0.9183 99924
24120........................... Chisago County, Minnesota......... 5120 1.1078 1.1078 33460
24130........................... Clay County, Minnesota............ 2520 0.8495 0.8495 22020
24140........................... Clearwater County, Minnesota...... 24 0.9193 0.9183 99924
24150........................... Cook County, Minnesota............ 24 0.9193 0.9183 99924
24160........................... Cottonwood County, Minnesota...... 24 0.9193 0.9183 99924
24170........................... Crow Wing County, Minnesota....... 24 0.9193 0.9183 99924
24180........................... Dakota County, Minnesota.......... 5120 1.1078 1.1078 33460
24190........................... Dodge County, Minnesota........... 24 0.9193 1.1142 40340
24200........................... Douglas County, Minnesota......... 24 0.9193 0.9183 99924
24210........................... Faribault County, Minnesota....... 24 0.9193 0.9183 99924
24220........................... Fillmore County, Minnesota........ 24 0.9193 0.9183 99924
24230........................... Freeborn County, Minnesota........ 24 0.9193 0.9183 99924
24240........................... Goodhue County, Minnesota......... 24 0.9193 0.9183 99924
24250........................... Grant County, Minnesota........... 24 0.9193 0.9183 99924
24260........................... Hennepin County, Minnesota........ 5120 1.1078 1.1078 33460
24270........................... Houston County, Minnesota......... 3870 0.9573 0.9573 29100
24280........................... Hubbard County, Minnesota......... 24 0.9193 0.9183 99924
24290........................... Isanti County, Minnesota.......... 5120 1.1078 1.1078 33460
24300........................... Itasca County, Minnesota.......... 24 0.9193 0.9183 99924
24310........................... Jackson County, Minnesota......... 24 0.9193 0.9183 99924
24320........................... Kanabec County, Minnesota......... 24 0.9193 0.9183 99924
24330........................... Kandiyohi County, Minnesota....... 24 0.9193 0.9183 99924
24340........................... Kittson County, Minnesota......... 24 0.9193 0.9183 99924
24350........................... Koochiching County, Minnesota..... 24 0.9193 0.9183 99924
[[Page 29135]]
24360........................... Lac Qui Parle County, Minnesota... 24 0.9193 0.9183 99924
24370........................... Lake County, Minnesota............ 24 0.9193 0.9183 99924
24380........................... Lake Of Woods County, Minnesota... 24 0.9193 0.9183 99924
24390........................... Le Sueur County, Minnesota........ 24 0.9193 0.9183 99924
24400........................... Lincoln County, Minnesota......... 24 0.9193 0.9183 99924
24410........................... Lyon County, Minnesota............ 24 0.9193 0.9183 99924
24420........................... Mc Leod County, Minnesota......... 24 0.9193 0.9183 99924
24430........................... Mahnomen County, Minnesota........ 24 0.9193 0.9183 99924
24440........................... Marshall County, Minnesota........ 24 0.9193 0.9183 99924
24450........................... Martin County, Minnesota.......... 24 0.9193 0.9183 99924
24460........................... Meeker County, Minnesota.......... 24 0.9193 0.9183 99924
24470........................... Mille Lacs County, Minnesota...... 24 0.9193 0.9183 99924
24480........................... Morrison County, Minnesota........ 24 0.9193 0.9183 99924
24490........................... Mower County, Minnesota........... 24 0.9193 0.9183 99924
24500........................... Murray County, Minnesota.......... 24 0.9193 0.9183 99924
24510........................... Nicollet County, Minnesota........ 24 0.9193 0.9183 99924
24520........................... Nobles County, Minnesota.......... 24 0.9193 0.9183 99924
24530........................... Norman County, Minnesota.......... 24 0.9193 0.9183 99924
24540........................... Olmsted County, Minnesota......... 6820 1.1142 1.1142 40340
24550........................... Otter Tail County, Minnesota...... 24 0.9193 0.9183 99924
24560........................... Pennington County, Minnesota...... 24 0.9193 0.9183 99924
24570........................... Pine County, Minnesota............ 24 0.9193 0.9183 99924
24580........................... Pipestone County, Minnesota....... 24 0.9193 0.9183 99924
24590........................... Polk County, Minnesota............ 2985 1.1516 1.1516 24220
24600........................... Pope County, Minnesota............ 24 0.9193 0.9183 99924
24610........................... Ramsey County, Minnesota.......... 5120 1.1078 1.1078 33460
24620........................... Red Lake County, Minnesota........ 24 0.9193 0.9183 99924
24630........................... Redwood County, Minnesota......... 24 0.9193 0.9183 99924
24640........................... Renville County, Minnesota........ 24 0.9193 0.9183 99924
24650........................... Rice County, Minnesota............ 24 0.9193 0.9183 99924
24660........................... Rock County, Minnesota............ 24 0.9193 0.9183 99924
24670........................... Roseau County, Minnesota.......... 24 0.9193 0.9183 99924
24680........................... St Louis County, Minnesota........ 2240 1.0223 1.0209 20260
24690........................... Scott County, Minnesota........... 5120 1.1078 1.1078 33460
24700........................... Sherburne County, Minnesota....... 5120 1.1078 1.1078 33460
24710........................... Sibley County, Minnesota.......... 24 0.9193 0.9183 99924
24720........................... Stearns County, Minnesota......... 6980 0.9975 0.9975 41060
24730........................... Steele County, Minnesota.......... 24 0.9193 0.9183 99924
24740........................... Stevens County, Minnesota......... 24 0.9193 0.9183 99924
24750........................... Swift County, Minnesota........... 24 0.9193 0.9183 99924
24760........................... Todd County, Minnesota............ 24 0.9193 0.9183 99924
24770........................... Traverse County, Minnesota........ 24 0.9193 0.9183 99924
24780........................... Wabasha County, Minnesota......... 24 0.9193 1.1142 40340
24790........................... Wadena County, Minnesota.......... 24 0.9193 0.9183 99924
24800........................... Waseca County, Minnesota.......... 24 0.9193 0.9183 99924
24810........................... Washington County, Minnesota...... 5120 1.1078 1.1078 33460
24820........................... Watonwan County, Minnesota........ 24 0.9193 0.9183 99924
24830........................... Wilkin County, Minnesota.......... 24 0.9193 0.9183 99924
24840........................... Winona County, Minnesota.......... 24 0.9193 0.9183 99924
24850........................... Wright County, Minnesota.......... 5120 1.1078 1.1078 33460
24860........................... Yellow Medicine County, Minnesota. 24 0.9193 0.9183 99924
25000........................... Adams County, Mississippi......... 25 0.7631 0.7671 99925
25010........................... Alcorn County, Mississippi........ 25 0.7631 0.7671 99925
25020........................... Amite County, Mississippi......... 25 0.7631 0.7671 99925
25030........................... Attala County, Mississippi........ 25 0.7631 0.7671 99925
25040........................... Benton County, Mississippi........ 25 0.7631 0.7671 99925
25050........................... Bolivar County, Mississippi....... 25 0.7631 0.7671 99925
25060........................... Calhoun County, Mississippi....... 25 0.7631 0.7671 99925
25070........................... Carroll County, Mississippi....... 25 0.7631 0.7671 99925
25080........................... Chickasaw County, Mississippi..... 25 0.7631 0.7671 99925
25090........................... Choctaw County, Mississippi....... 25 0.7631 0.7671 99925
25100........................... Claiborne County, Mississippi..... 25 0.7631 0.7671 99925
25110........................... Clarke County, Mississippi........ 25 0.7631 0.7671 99925
25120........................... Clay County, Mississippi.......... 25 0.7631 0.7671 99925
25130........................... Coahoma County, Mississippi....... 25 0.7631 0.7671 99925
25140........................... Copiah County, Mississippi........ 25 0.7631 0.8319 27140
25150........................... Covington County, Mississippi..... 25 0.7631 0.7671 99925
25160........................... Desoto County, Mississippi........ 4920 0.9360 0.9341 32820
25170........................... Forrest County, Mississippi....... 3285 0.7609 0.7609 25620
[[Page 29136]]
25180........................... Franklin County, Mississippi...... 25 0.7631 0.7671 99925
25190........................... George County, Mississippi........ 25 0.7631 0.8165 37700
25200........................... Greene County, Mississippi........ 25 0.7631 0.7671 99925
25210........................... Grenada County, Mississippi....... 25 0.7631 0.7671 99925
25220........................... Hancock County, Mississippi....... 0920 0.8715 0.8938 25060
25230........................... Harrison County, Mississippi...... 0920 0.8715 0.8938 25060
25240........................... Hinds County, Mississippi......... 3560 0.8391 0.8319 27140
25250........................... Holmes County, Mississippi........ 25 0.7631 0.7671 99925
25260........................... Humphreys County, Mississippi..... 25 0.7631 0.7671 99925
25270........................... Issaquena County, Mississippi..... 25 0.7631 0.7671 99925
25280........................... Itawamba County, Mississippi...... 25 0.7631 0.7671 99925
25290........................... Jackson County, Mississippi....... 0920 0.8715 0.8165 37700
25300........................... Jasper County, Mississippi........ 25 0.7631 0.7671 99925
25310........................... Jefferson County, Mississippi..... 25 0.7631 0.7671 99925
25320........................... Jefferson Davis County, 25 0.7631 0.7671 99925
Mississippi.
25330........................... Jones County, Mississippi......... 25 0.7631 0.7671 99925
25340........................... Kemper County, Mississippi........ 25 0.7631 0.7671 99925
25350........................... Lafayette County, Mississippi..... 25 0.7631 0.7671 99925
25360........................... Lamar County, Mississippi......... 3285 0.7609 0.7609 25620
25370........................... Lauderdale County, Mississippi.... 25 0.7631 0.7671 99925
25380........................... Lawrence County, Mississippi...... 25 0.7631 0.7671 99925
25390........................... Leake County, Mississippi......... 25 0.7631 0.7671 99925
25400........................... Lee County, Mississippi........... 25 0.7631 0.7671 99925
25410........................... Leflore County, Mississippi....... 25 0.7631 0.7671 99925
25420........................... Lincoln County, Mississippi....... 25 0.7631 0.7671 99925
25430........................... Lowndes County, Mississippi....... 25 0.7631 0.7671 99925
25440........................... Madison County, Mississippi....... 3560 0.8391 0.8319 27140
25450........................... Marion County, Mississippi........ 25 0.7631 0.7671 99925
25460........................... Marshall County, Mississippi...... 25 0.7631 0.9341 32820
25470........................... Monroe County, Mississippi........ 25 0.7631 0.7671 99925
25480........................... Montgomery County, Mississippi.... 25 0.7631 0.7671 99925
25490........................... Neshoba County, Mississippi....... 25 0.7631 0.7671 99925
25500........................... Newton County, Mississippi........ 25 0.7631 0.7671 99925
25510........................... Noxubee County, Mississippi....... 25 0.7631 0.7671 99925
25520........................... Oktibbeha County, Mississippi..... 25 0.7631 0.7671 99925
25530........................... Panola County, Mississippi........ 25 0.7631 0.7671 99925
25540........................... Pearl River County, Mississippi... 25 0.7631 0.7671 99925
25550........................... Perry County, Mississippi......... 25 0.7631 0.7609 25620
25560........................... Pike County, Mississippi.......... 25 0.7631 0.7671 99925
25570........................... Pontotoc County, Mississippi...... 25 0.7631 0.7671 99925
25580........................... Prentiss County, Mississippi...... 25 0.7631 0.7671 99925
25590........................... Quitman County, Mississippi....... 25 0.7631 0.7671 99925
25600........................... Rankin County, Mississippi........ 3560 0.8391 0.8319 27140
25610........................... Scott County, Mississippi......... 25 0.7631 0.7671 99925
25620........................... Sharkey County, Mississippi....... 25 0.7631 0.7671 99925
25630........................... Simpson County, Mississippi....... 25 0.7631 0.8319 27140
25640........................... Smith County, Mississippi......... 25 0.7631 0.7671 99925
25650........................... Stone County, Mississippi......... 25 0.7631 0.8938 25060
25660........................... Sunflower County, Mississippi..... 25 0.7631 0.7671 99925
25670........................... Tallahatchie County, Mississippi.. 25 0.7631 0.7671 99925
25680........................... Tate County, Mississippi.......... 25 0.7631 0.9341 32820
25690........................... Tippah County, Mississippi........ 25 0.7631 0.7671 99925
25700........................... Tishomingo County, Mississippi.... 25 0.7631 0.7671 99925
25710........................... Tunica County, Mississippi........ 25 0.7631 0.9341 32820
25720........................... Union County, Mississippi......... 25 0.7631 0.7671 99925
25730........................... Walthall County, Mississippi...... 25 0.7631 0.7671 99925
25740........................... Warren County, Mississippi........ 25 0.7631 0.7671 99925
25750........................... Washington County, Mississippi.... 25 0.7631 0.7671 99925
25760........................... Wayne County, Mississippi......... 25 0.7631 0.7671 99925
25770........................... Webster County, Mississippi....... 25 0.7631 0.7671 99925
25780........................... Wilkinson County, Mississippi..... 25 0.7631 0.7671 99925
25790........................... Winston County, Mississippi....... 25 0.7631 0.7671 99925
25800........................... Yalobusha County, Mississippi..... 25 0.7631 0.7671 99925
25810........................... Yazoo County, Mississippi......... 25 0.7631 0.7671 99925
26000........................... Adair County, Missouri............ 26 0.7968 0.7909 99926
26010........................... Andrew County, Missouri........... 7000 0.9529 0.9529 41140
26020........................... Atchison County, Missouri......... 26 0.7968 0.7909 99926
26030........................... Audrain County, Missouri.......... 26 0.7968 0.7909 99926
26040........................... Barry County, Missouri............ 26 0.7968 0.7909 99926
[[Page 29137]]
26050........................... Barton County, Missouri........... 26 0.7968 0.7909 99926
26060........................... Bates County, Missouri............ 26 0.7968 0.9467 28140
26070........................... Benton County, Missouri........... 26 0.7968 0.7909 99926
26080........................... Bollinger County, Missouri........ 26 0.7968 0.7909 99926
26090........................... Boone County, Missouri............ 1740 0.8354 0.8354 17860
26100........................... Buchanan County, Missouri......... 7000 0.9529 0.9529 41140
26110........................... Butler County, Missouri........... 26 0.7968 0.7909 99926
26120........................... Caldwell County, Missouri......... 26 0.7968 0.9467 28140
26130........................... Callaway County, Missouri......... 26 0.7968 0.8396 27620
26140........................... Camden County, Missouri........... 26 0.7968 0.7909 99926
26150........................... Cape Girardeau County, Missouri... 26 0.7968 0.7909 99926
26160........................... Carroll County, Missouri.......... 26 0.7968 0.7909 99926
26170........................... Carter County, Missouri........... 26 0.7968 0.7909 99926
26180........................... Cass County, Missouri............. 3760 0.9481 0.9467 28140
26190........................... Cedar County, Missouri............ 26 0.7968 0.7909 99926
26200........................... Chariton County, Missouri......... 26 0.7968 0.7909 99926
26210........................... Christian County, Missouri........ 7920 0.8259 0.8246 44180
26220........................... Clark County, Missouri............ 26 0.7968 0.7909 99926
26230........................... Clay County, Missouri............. 3760 0.9481 0.9467 28140
26240........................... Clinton County, Missouri.......... 3760 0.9481 0.9467 28140
26250........................... Cole County, Missouri............. 26 0.7968 0.8396 27620
26260........................... Cooper County, Missouri........... 26 0.7968 0.7909 99926
26270........................... Crawford County, Missouri......... 26 0.7968 0.8949 41180
26280........................... Dade County, Missouri............. 26 0.7968 0.7909 99926
26290........................... Dallas County, Missouri........... 26 0.7968 0.8246 44180
26300........................... Daviess County, Missouri.......... 26 0.7968 0.7909 99926
26310........................... De Kalb County, Missouri.......... 26 0.7968 0.9529 41140
26320........................... Dent County, Missouri............. 26 0.7968 0.7909 99926
26330........................... Douglas County, Missouri.......... 26 0.7968 0.7909 99926
26340........................... Dunklin County, Missouri.......... 26 0.7968 0.7909 99926
26350........................... Franklin County, Missouri......... 7040 0.8957 0.8949 41180
26360........................... Gasconade County, Missouri........ 26 0.7968 0.7909 99926
26370........................... Gentry County, Missouri........... 26 0.7968 0.7909 99926
26380........................... Greene County, Missouri........... 7920 0.8259 0.8246 44180
26390........................... Grundy County, Missouri........... 26 0.7968 0.7909 99926
26400........................... Harrison County, Missouri......... 26 0.7968 0.7909 99926
26410........................... Henry County, Missouri............ 26 0.7968 0.7909 99926
26411........................... Hickory County, Missouri.......... 26 0.7968 0.7909 99926
26412........................... Holt County, Missouri............. 26 0.7968 0.7909 99926
26440........................... Howard County, Missouri........... 26 0.7968 0.8354 17860
26450........................... Howell County, Missouri........... 26 0.7968 0.7909 99926
26460........................... Iron County, Missouri............. 26 0.7968 0.7909 99926
26470........................... Jackson County, Missouri.......... 3760 0.9481 0.9467 28140
26480........................... Jasper County, Missouri........... 3710 0.8590 0.8590 27900
26490........................... Jefferson County, Missouri........ 7040 0.8957 0.8949 41180
26500........................... Johnson County, Missouri.......... 26 0.7968 0.7909 99926
26510........................... Knox County, Missouri............. 26 0.7968 0.7909 99926
26520........................... Laclede County, Missouri.......... 26 0.7968 0.7909 99926
26530........................... Lafayette County, Missouri........ 3760 0.9481 0.9467 28140
26540........................... Lawrence County, Missouri......... 26 0.7968 0.7909 99926
26541........................... Lewis County, Missouri............ 26 0.7968 0.7909 99926
26560........................... Lincoln County, Missouri.......... 7040 0.8957 0.8949 41180
26570........................... Linn County, Missouri............. 26 0.7968 0.7909 99926
26580........................... Livingston County, Missouri....... 26 0.7968 0.7909 99926
26590........................... Mc Donald County, Missouri........ 26 0.7968 0.8563 22220
26600........................... Macon County, Missouri............ 26 0.7968 0.7909 99926
26601........................... Madison County, Missouri.......... 26 0.7968 0.7909 99926
26620........................... Maries County, Missouri........... 26 0.7968 0.7909 99926
26630........................... Marion County, Missouri........... 26 0.7968 0.7909 99926
26631........................... Mercer County, Missouri........... 26 0.7968 0.7909 99926
26650........................... Miller County, Missouri........... 26 0.7968 0.7909 99926
26660........................... Mississippi County, Missouri...... 26 0.7968 0.7909 99926
26670........................... Moniteau County, Missouri......... 26 0.7968 0.8396 27620
26680........................... Monroe County, Missouri........... 26 0.7968 0.7909 99926
26690........................... Montgomery County, Missouri....... 26 0.7968 0.7909 99926
26700........................... Morgan County, Missouri........... 26 0.7968 0.7909 99926
26710........................... New Madrid County, Missouri....... 26 0.7968 0.7909 99926
26720........................... Newton County, Missouri........... 3710 0.8590 0.8590 27900
26730........................... Nodaway County, Missouri.......... 26 0.7968 0.7909 99926
[[Page 29138]]
26740........................... Oregon County, Missouri........... 26 0.7968 0.7909 99926
26750........................... Osage County, Missouri............ 26 0.7968 0.8396 27620
26751........................... Ozark County, Missouri............ 26 0.7968 0.7909 99926
26770........................... Pemiscot County, Missouri......... 26 0.7968 0.7909 99926
26780........................... Perry County, Missouri............ 26 0.7968 0.7909 99926
26790........................... Pettis County, Missouri........... 26 0.7968 0.7909 99926
26800........................... Phelps County, Missouri........... 26 0.7968 0.7909 99926
26810........................... Pike County, Missouri............. 26 0.7968 0.7909 99926
26820........................... Platte County, Missouri........... 3760 0.9481 0.9467 28140
26821........................... Polk County, Missouri............. 26 0.7968 0.8246 44180
26840........................... Pulaski County, Missouri.......... 26 0.7968 0.7909 99926
26850........................... Putnam County, Missouri........... 26 0.7968 0.7909 99926
26860........................... Ralls County, Missouri............ 26 0.7968 0.7909 99926
26870........................... Randolph County, Missouri......... 26 0.7968 0.7909 99926
26880........................... Ray County, Missouri.............. 3760 0.9481 0.9467 28140
26881........................... Reynolds County, Missouri......... 26 0.7968 0.7909 99926
26900........................... Ripley County, Missouri........... 26 0.7968 0.7909 99926
26910........................... St Charles County, Missouri....... 7040 0.8957 0.8949 41180
26911........................... St Clair County, Missouri......... 26 0.7968 0.7909 99926
26930........................... St Francois County, Missouri...... 26 0.7968 0.7909 99926
26940........................... St Louis County, Missouri......... 7040 0.8957 0.8949 41180
26950........................... St Louis City County, Missouri.... 7040 0.8957 0.8949 41180
26960........................... Ste Genevieve County, Missouri.... 26 0.7968 0.7909 99926
26970........................... Saline County, Missouri........... 26 0.7968 0.7909 99926
26980........................... Schuyler County, Missouri......... 26 0.7968 0.7909 99926
26981........................... Scotland County, Missouri......... 26 0.7968 0.7909 99926
26982........................... Scott County, Missouri............ 26 0.7968 0.7909 99926
26983........................... Shannon County, Missouri.......... 26 0.7968 0.7909 99926
26984........................... Shelby County, Missouri........... 26 0.7968 0.7909 99926
26985........................... Stoddard County, Missouri......... 26 0.7968 0.7909 99926
26986........................... Stone County, Missouri............ 26 0.7968 0.7909 99926
26987........................... Sullivan County, Missouri......... 26 0.7968 0.7909 99926
26988........................... Taney County, Missouri............ 26 0.7968 0.7909 99926
26989........................... Texas County, Missouri............ 26 0.7968 0.7909 99926
26990........................... Vernon County, Missouri........... 26 0.7968 0.7909 99926
26991........................... Warren County, Missouri........... 7040 0.8957 0.8949 41180
26992........................... Washington County, Missouri....... 26 0.7968 0.8949 41180
26993........................... Wayne County, Missouri............ 26 0.7968 0.7909 99926
26994........................... Webster County, Missouri.......... 7920 0.8259 0.8246 44180
26995........................... Worth County, Missouri............ 26 0.7968 0.7909 99926
26996........................... Wright County, Missouri........... 26 0.7968 0.7909 99926
27000........................... Beaverhead County, Montana........ 27 0.8833 0.8833 99927
27010........................... Big Horn County, Montana.......... 27 0.8833 0.8833 99927
27020........................... Blaine County, Montana............ 27 0.8833 0.8833 99927
27030........................... Broadwater County, Montana........ 27 0.8833 0.8833 99927
27040........................... Carbon County, Montana............ 27 0.8833 0.8843 13740
27050........................... Carter County, Montana............ 27 0.8833 0.8833 99927
27060........................... Cascade County, Montana........... 3040 0.9061 0.9061 24500
27070........................... Chouteau County, Montana.......... 27 0.8833 0.8833 99927
27080........................... Custer County, Montana............ 27 0.8833 0.8833 99927
27090........................... Daniels County, Montana........... 27 0.8833 0.8833 99927
27100........................... Dawson County, Montana............ 27 0.8833 0.8833 99927
27110........................... Deer Lodge County, Montana........ 27 0.8833 0.8833 99927
27113........................... Yellowstone National Park, Montana 27 0.8833 0.8833 99927
27120........................... Fallon County, Montana............ 27 0.8833 0.8833 99927
27130........................... Fergus County, Montana............ 27 0.8833 0.8833 99927
27140........................... Flathead County, Montana.......... 27 0.8833 0.8833 99927
27150........................... Gallatin County, Montana.......... 27 0.8833 0.8833 99927
27160........................... Garfield County, Montana.......... 27 0.8833 0.8833 99927
27170........................... Glacier County, Montana........... 27 0.8833 0.8833 99927
27180........................... Golden Valley County, Montana..... 27 0.8833 0.8833 99927
27190........................... Granite County, Montana........... 27 0.8833 0.8833 99927
27200........................... Hill County, Montana.............. 27 0.8833 0.8833 99927
27210........................... Jefferson County, Montana......... 27 0.8833 0.8833 99927
27220........................... Judith Basin County, Montana...... 27 0.8833 0.8833 99927
27230........................... Lake County, Montana.............. 27 0.8833 0.8833 99927
27240........................... Lewis And Clark County, Montana... 27 0.8833 0.8833 99927
27250........................... Liberty County, Montana........... 27 0.8833 0.8833 99927
27260........................... Lincoln County, Montana........... 27 0.8833 0.8833 99927
[[Page 29139]]
27270........................... Mc Cone County, Montana........... 27 0.8833 0.8833 99927
27280........................... Madison County, Montana........... 27 0.8833 0.8833 99927
27290........................... Meagher County, Montana........... 27 0.8833 0.8833 99927
27300........................... Mineral County, Montana........... 27 0.8833 0.8833 99927
27310........................... Missoula County, Montana.......... 5140 0.9482 0.9482 33540
27320........................... Musselshell County, Montana....... 27 0.8833 0.8833 99927
27330........................... Park County, Montana.............. 27 0.8833 0.8833 99927
27340........................... Petroleum County, Montana......... 27 0.8833 0.8833 99927
27350........................... Phillips County, Montana.......... 27 0.8833 0.8833 99927
27360........................... Pondera County, Montana........... 27 0.8833 0.8833 99927
27370........................... Powder River County, Montana...... 27 0.8833 0.8833 99927
27380........................... Powell County, Montana............ 27 0.8833 0.8833 99927
27390........................... Prairie County, Montana........... 27 0.8833 0.8833 99927
27400........................... Ravalli County, Montana........... 27 0.8833 0.8833 99927
27410........................... Richland County, Montana.......... 27 0.8833 0.8833 99927
27420........................... Roosevelt County, Montana......... 27 0.8833 0.8833 99927
27430........................... Rosebud County, Montana........... 27 0.8833 0.8833 99927
27440........................... Sanders County, Montana........... 27 0.8833 0.8833 99927
27450........................... Sheridan County, Montana.......... 27 0.8833 0.8833 99927
27460........................... Silver Bow County, Montana........ 27 0.8833 0.8833 99927
27470........................... Stillwater County, Montana........ 27 0.8833 0.8833 99927
27480........................... Sweet Grass County, Montana....... 27 0.8833 0.8833 99927
27490........................... Teton County, Montana............. 27 0.8833 0.8833 99927
27500........................... Toole County, Montana............. 27 0.8833 0.8833 99927
27510........................... Treasure County, Montana.......... 27 0.8833 0.8833 99927
27520........................... Valley County, Montana............ 27 0.8833 0.8833 99927
27530........................... Wheatland County, Montana......... 27 0.8833 0.8833 99927
27540........................... Wibaux County, Montana............ 27 0.8833 0.8833 99927
27550........................... Yellowstone County, Montana....... 0880 0.8843 0.8843 13740
28000........................... Adams County, Nebraska............ 28 0.8665 0.8665 99928
28010........................... Antelope County, Nebraska......... 28 0.8665 0.8665 99928
28020........................... Arthur County, Nebraska........... 28 0.8665 0.8665 99928
28030........................... Banner County, Nebraska........... 28 0.8665 0.8665 99928
28040........................... Blaine County, Nebraska........... 28 0.8665 0.8665 99928
28050........................... Boone County, Nebraska............ 28 0.8665 0.8665 99928
28060........................... Box Butte County, Nebraska........ 28 0.8665 0.8665 99928
28070........................... Boyd County, Nebraska............. 28 0.8665 0.8665 99928
28080........................... Brown County, Nebraska............ 28 0.8665 0.8665 99928
28090........................... Buffalo County, Nebraska.......... 28 0.8665 0.8665 99928
28100........................... Burt County, Nebraska............. 28 0.8665 0.8665 99928
28110........................... Butler County, Nebraska........... 28 0.8665 0.8665 99928
28120........................... Cass County, Nebraska............. 5920 0.9569 0.9569 36540
28130........................... Cedar County, Nebraska............ 28 0.8665 0.8665 99928
28140........................... Chase County, Nebraska............ 28 0.8665 0.8665 99928
28150........................... Cherry County, Nebraska........... 28 0.8665 0.8665 99928
28160........................... Cheyenne County, Nebraska......... 28 0.8665 0.8665 99928
28170........................... Clay County, Nebraska............. 28 0.8665 0.8665 99928
28180........................... Colfax County, Nebraska........... 28 0.8665 0.8665 99928
28190........................... Cuming County, Nebraska........... 28 0.8665 0.8665 99928
28200........................... Custer County, Nebraska........... 28 0.8665 0.8665 99928
28210........................... Dakota County, Nebraska........... 7720 0.9411 0.9376 43580
28220........................... Dawes County, Nebraska............ 28 0.8665 0.8665 99928
28230........................... Dawson County, Nebraska........... 28 0.8665 0.8665 99928
28240........................... Deuel County, Nebraska............ 28 0.8665 0.8665 99928
28250........................... Dixon County, Nebraska............ 28 0.8665 0.9376 43580
28260........................... Dodge County, Nebraska............ 28 0.8665 0.8665 99928
28270........................... Douglas County, Nebraska.......... 5920 0.9569 0.9569 36540
28280........................... Dundy County, Nebraska............ 28 0.8665 0.8665 99928
28290........................... Fillmore County, Nebraska......... 28 0.8665 0.8665 99928
28300........................... Franklin County, Nebraska......... 28 0.8665 0.8665 99928
28310........................... Frontier County, Nebraska......... 28 0.8665 0.8665 99928
28320........................... Furnas County, Nebraska........... 28 0.8665 0.8665 99928
28330........................... Gage County, Nebraska............. 28 0.8665 0.8665 99928
28340........................... Garden County, Nebraska........... 28 0.8665 0.8665 99928
28350........................... Garfield County, Nebraska......... 28 0.8665 0.8665 99928
28360........................... Gosper County, Nebraska........... 28 0.8665 0.8665 99928
28370........................... Grant County, Nebraska............ 28 0.8665 0.8665 99928
28380........................... Greeley County, Nebraska.......... 28 0.8665 0.8665 99928
28390........................... Hall County, Nebraska............. 28 0.8665 0.8665 99928
[[Page 29140]]
28400........................... Hamilton County, Nebraska......... 28 0.8665 0.8665 99928
28410........................... Harlan County, Nebraska........... 28 0.8665 0.8665 99928
28420........................... Hayes County, Nebraska............ 28 0.8665 0.8665 99928
28430........................... Hitchcock County, Nebraska........ 28 0.8665 0.8665 99928
28440........................... Holt County, Nebraska............. 28 0.8665 0.8665 99928
28450........................... Hooker County, Nebraska........... 28 0.8665 0.8665 99928
28460........................... Howard County, Nebraska........... 28 0.8665 0.8665 99928
28470........................... Jefferson County, Nebraska........ 28 0.8665 0.8665 99928
28480........................... Johnson County, Nebraska.......... 28 0.8665 0.8665 99928
28490........................... Kearney County, Nebraska.......... 28 0.8665 0.8665 99928
28500........................... Keith County, Nebraska............ 28 0.8665 0.8665 99928
28510........................... Keya Paha County, Nebraska........ 28 0.8665 0.8665 99928
28520........................... Kimball County, Nebraska.......... 28 0.8665 0.8665 99928
28530........................... Knox County, Nebraska............. 28 0.8665 0.8665 99928
28540........................... Lancaster County, Nebraska........ 4360 1.0225 1.0225 30700
28550........................... Lincoln County, Nebraska.......... 28 0.8665 0.8665 99928
28560........................... Logan County, Nebraska............ 28 0.8665 0.8665 99928
28570........................... Loup County, Nebraska............. 28 0.8665 0.8665 99928
28580........................... Mc Pherson County, Nebraska....... 28 0.8665 0.8665 99928
28590........................... Madison County, Nebraska.......... 28 0.8665 0.8665 99928
28600........................... Merrick County, Nebraska.......... 28 0.8665 0.8665 99928
28610........................... Morrill County, Nebraska.......... 28 0.8665 0.8665 99928
28620........................... Nance County, Nebraska............ 28 0.8665 0.8665 99928
28630........................... Nemaha County, Nebraska........... 28 0.8665 0.8665 99928
28640........................... Nuckolls County, Nebraska......... 28 0.8665 0.8665 99928
28650........................... Otoe County, Nebraska............. 28 0.8665 0.8665 99928
28660........................... Pawnee County, Nebraska........... 28 0.8665 0.8665 99928
28670........................... Perkins County, Nebraska.......... 28 0.8665 0.8665 99928
28680........................... Phelps County, Nebraska........... 28 0.8665 0.8665 99928
28690........................... Pierce County, Nebraska........... 28 0.8665 0.8665 99928
28700........................... Platte County, Nebraska........... 28 0.8665 0.8665 99928
28710........................... Polk County, Nebraska............. 28 0.8665 0.8665 99928
28720........................... Redwillow County, Nebraska........ 28 0.8665 0.8665 99928
28730........................... Richardson County, Nebraska....... 28 0.8665 0.8665 99928
28740........................... Rock County, Nebraska............. 28 0.8665 0.8665 99928
28750........................... Saline County, Nebraska........... 28 0.8665 0.8665 99928
28760........................... Sarpy County, Nebraska............ 5920 0.9569 0.9569 36540
28770........................... Saunders County, Nebraska......... 28 0.8665 0.9569 36540
28780........................... Scotts Bluff County, Nebraska..... 28 0.8665 0.8665 99928
28790........................... Seward County, Nebraska........... 28 0.8665 1.0225 30700
28800........................... Sheridan County, Nebraska......... 28 0.8665 0.8665 99928
28810........................... Sherman County, Nebraska.......... 28 0.8665 0.8665 99928
28820........................... Sioux County, Nebraska............ 28 0.8665 0.8665 99928
28830........................... Stanton County, Nebraska.......... 28 0.8665 0.8665 99928
28840........................... Thayer County, Nebraska........... 28 0.8665 0.8665 99928
28850........................... Thomas County, Nebraska........... 28 0.8665 0.8665 99928
28860........................... Thurston County, Nebraska......... 28 0.8665 0.8665 99928
28870........................... Valley County, Nebraska........... 28 0.8665 0.8665 99928
28880........................... Washington County, Nebraska....... 5920 0.9569 0.9569 36540
28890........................... Wayne County, Nebraska............ 28 0.8665 0.8665 99928
28900........................... Webster County, Nebraska.......... 28 0.8665 0.8665 99928
28910........................... Wheeler County, Nebraska.......... 28 0.8665 0.8665 99928
28920........................... York County, Nebraska............. 28 0.8665 0.8665 99928
29000........................... Churchill County, Nevada.......... 29 0.9697 0.9074 99929
29010........................... Clark County, Nevada.............. 4120 1.1166 1.1449 29820
29020........................... Douglas County, Nevada............ 29 0.9697 0.9074 99929
29030........................... Elko County, Nevada............... 29 0.9697 0.9074 99929
29040........................... Esmeralda County, Nevada.......... 29 0.9697 0.9074 99929
29050........................... Eureka County, Nevada............. 29 0.9697 0.9074 99929
29060........................... Humboldt County, Nevada........... 29 0.9697 0.9074 99929
29070........................... Lander County, Nevada............. 29 0.9697 0.9074 99929
29080........................... Lincoln County, Nevada............ 29 0.9697 0.9074 99929
29090........................... Lyon County, Nevada............... 29 0.9697 0.9074 99929
29100........................... Mineral County, Nevada............ 29 0.9697 0.9074 99929
29110........................... Nye County, Nevada................ 4120 1.1166 0.9074 99929
29120........................... Carson City County, Nevada........ 29 0.9697 1.0244 16180
29130........................... Pershing County, Nevada........... 29 0.9697 0.9074 99929
29140........................... Storey County, Nevada............. 29 0.9697 1.0993 39900
29150........................... Washoe County, Nevada............. 6720 1.0993 1.0993 39900
[[Page 29141]]
29160........................... White Pine County, Nevada......... 29 0.9697 0.9074 99929
30000........................... Belknap County, New Hampshire..... 30 1.0677 1.0677 99930
30010........................... Carroll County, New Hampshire..... 30 1.0677 1.0677 99930
30020........................... Cheshire County, New Hampshire.... 30 1.0677 1.0677 99930
30030........................... Coos County, New Hampshire........ 30 1.0677 1.0677 99930
30040........................... Grafton County, New Hampshire..... 30 1.0677 1.0677 99930
30050........................... Hillsboro County, New Hampshire... 1123 1.1152 1.0335 31700
30060........................... Merrimack County, New Hampshire... 1123 1.1152 1.0335 31700
30070........................... Rockingham County, New Hampshire.. 1123 1.1152 1.0385 40484
30080........................... Strafford County, New Hampshire... 1123 1.1152 1.0385 40484
30090........................... Sullivan County, New Hampshire.... 30 1.0677 1.0677 99930
31000........................... Atlantic County, New Jersey....... 0560 1.1513 1.1633 12100
31100........................... Bergen County, New Jersey......... 0875 1.1660 1.3185 35644
31150........................... Burlington County, New Jersey..... 6160 1.0926 1.0528 15804
31160........................... Camden County, New Jersey......... 6160 1.0926 1.0528 15804
31180........................... Cape May County, New Jersey....... 0560 1.1513 1.1022 36140
31190........................... Cumberland County, New Jersey..... 8760 0.9837 0.9837 47220
31200........................... Essex County, New Jersey.......... 5640 1.2141 1.2195 35084
31220........................... Gloucester County, New Jersey..... 6160 1.0926 1.0528 15804
31230........................... Hudson County, New Jersey......... 3640 1.1349 1.3185 35644
31250........................... Hunterdon County, New Jersey...... 5015 1.1178 1.2195 35084
31260........................... Mercer County, New Jersey......... 8480 1.0845 1.0845 45940
31270........................... Middlesex County, New Jersey...... 5015 1.1178 1.1260 20764
31290........................... Monmouth County, New Jersey....... 5190 1.1271 1.1260 20764
31300........................... Morris County, New Jersey......... 5640 1.2141 1.2195 35084
31310........................... Ocean County, New Jersey.......... 5190 1.1271 1.1260 20764
31320........................... Passaic County, New Jersey........ 0875 1.1660 1.3185 35644
31340........................... Salem County, New Jersey.......... 6160 1.0926 1.0482 48864
31350........................... Somerset County, New Jersey....... 5015 1.1178 1.1260 20764
31360........................... Sussex County, New Jersey......... 5640 1.2141 1.2195 35084
31370........................... Union County, New Jersey.......... 5640 1.2141 1.2195 35084
31390........................... Warren County, New Jersey......... 5640 1.2141 0.9828 10900
32000........................... Bernalillo County, New Mexico..... 0200 0.9693 0.9693 10740
32010........................... Catron County, New Mexico......... 32 0.8571 0.8644 99932
32020........................... Chaves County, New Mexico......... 32 0.8571 0.8644 99932
32025........................... Cibola County, New Mexico......... 32 0.8571 0.8644 99932
32030........................... Colfax County, New Mexico......... 32 0.8571 0.8644 99932
32040........................... Curry County, New Mexico.......... 32 0.8571 0.8644 99932
32050........................... De Baca County, New Mexico........ 32 0.8571 0.8644 99932
32060........................... Dona Ana County, New Mexico....... 4100 0.8475 0.8475 29740
32070........................... Eddy County, New Mexico........... 32 0.8571 0.8644 99932
32080........................... Grant County, New Mexico.......... 32 0.8571 0.8644 99932
32090........................... Guadalupe County, New Mexico...... 32 0.8571 0.8644 99932
32100........................... Harding County, New Mexico........ 32 0.8571 0.8644 99932
32110........................... Hidalgo County, New Mexico........ 32 0.8571 0.8644 99932
32120........................... Lea County, New Mexico............ 32 0.8571 0.8644 99932
32130........................... Lincoln County, New Mexico........ 32 0.8571 0.8644 99932
32131........................... Los Alamos County, New Mexico..... 7490 1.0759 0.8644 99932
32140........................... Luna County, New Mexico........... 32 0.8571 0.8644 99932
32150........................... Mc Kinley County, New Mexico...... 32 0.8571 0.8644 99932
32160........................... Mora County, New Mexico........... 32 0.8571 0.8644 99932
32170........................... Otero County, New Mexico.......... 32 0.8571 0.8644 99932
32180........................... Quay County, New Mexico........... 32 0.8571 0.8644 99932
32190........................... Rio Arriba County, New Mexico..... 32 0.8571 0.8644 99932
32200........................... Roosevelt County, New Mexico...... 32 0.8571 0.8644 99932
32210........................... Sandoval County, New Mexico....... 0200 0.9693 0.9693 10740
32220........................... San Juan County, New Mexico....... 32 0.8571 0.8518 22140
32230........................... San Miguel County, New Mexico..... 32 0.8571 0.8644 99932
32240........................... Santa Fe County, New Mexico....... 7490 1.0759 1.0931 42140
32250........................... Sierra County, New Mexico......... 32 0.8571 0.8644 99932
32260........................... Socorro County, New Mexico........ 32 0.8571 0.8644 99932
32270........................... Taos County, New Mexico........... 32 0.8571 0.8644 99932
32280........................... Torrance County, New Mexico....... 32 0.8571 0.9693 10740
32290........................... Union County, New Mexico.......... 32 0.8571 0.8644 99932
32300........................... Valencia County, New Mexico....... 0200 0.9693 0.9693 10740
33000........................... Albany County, New York........... 0160 0.8518 0.8545 10580
33010........................... Allegany County, New York......... 33 0.8395 0.8157 99933
33020........................... Bronx County, New York............ 5600 1.3465 1.3185 35644
33030........................... Broome County, New York........... 0960 0.8571 0.8571 13780
[[Page 29142]]
33040........................... Cattaraugus County, New York...... 33 0.8395 0.8157 99933
33050........................... Cayuga County, New York........... 8160 0.9499 0.8157 99933
33060........................... Chautauqua County, New York....... 3610 0.7552 0.8157 99933
33070........................... Chemung County, New York.......... 2335 0.8259 0.8259 21300
33080........................... Chenango County, New York......... 33 0.8395 0.8157 99933
33090........................... Clinton County, New York.......... 33 0.8395 0.8157 99933
33200........................... Columbia County, New York......... 33 0.8395 0.8157 99933
33210........................... Cortland County, New York......... 33 0.8395 0.8157 99933
33220........................... Delaware County, New York......... 33 0.8395 0.8157 99933
33230........................... Dutchess County, New York......... 2281 1.0183 1.0766 39100
33240........................... Erie County, New York............. 1280 0.8889 0.8889 15380
33260........................... Essex County, New York............ 33 0.8395 0.8157 99933
33270........................... Franklin County, New York......... 33 0.8395 0.8157 99933
33280........................... Fulton County, New York........... 33 0.8395 0.8157 99933
33290........................... Genesee County, New York.......... 6840 0.9044 0.8157 99933
33300........................... Greene County, New York........... 33 0.8395 0.8157 99933
33310........................... Hamilton County, New York......... 33 0.8395 0.8157 99933
33320........................... Herkimer County, New York......... 8680 0.8293 0.8293 46540
33330........................... Jefferson County, New York........ 33 0.8395 0.8157 99933
33331........................... Kings County, New York............ 5600 1.3465 1.3185 35644
33340........................... Lewis County, New York............ 33 0.8395 0.8157 99933
33350........................... Livingston County, New York....... 6840 0.9044 0.9115 40380
33360........................... Madison County, New York.......... 8160 0.9499 0.9581 45060
33370........................... Monroe County, New York........... 6840 0.9044 0.9115 40380
33380........................... Montgomery County, New York....... 0160 0.8518 0.8157 99933
33400........................... Nassau County, New York........... 5380 1.2760 1.2760 35004
33420........................... New York County, New York......... 5600 1.3465 1.3185 35644
33500........................... Niagara County, New York.......... 1280 0.8889 0.8889 15380
33510........................... Oneida County, New York........... 8680 0.8293 0.8293 46540
33520........................... Onondaga County, New York......... 8160 0.9499 0.9581 45060
33530........................... Ontario County, New York.......... 6840 0.9044 0.9115 40380
33540........................... Orange County, New York........... 5660 1.1218 1.0766 39100
33550........................... Orleans County, New York.......... 6840 0.9044 0.9115 40380
33560........................... Oswego County, New York........... 8160 0.9499 0.9581 45060
33570........................... Otsego County, New York........... 33 0.8395 0.8157 99933
33580........................... Putnam County, New York........... 5600 1.3465 1.3185 35644
33590........................... Queens County, New York........... 5600 1.3465 1.3185 35644
33600........................... Rensselaer County, New York....... 0160 0.8518 0.8545 10580
33610........................... Richmond County, New York......... 5600 1.3465 1.3185 35644
33620........................... Rockland County, New York......... 5600 1.3465 1.3185 35644
33630........................... St Lawrence County, New York...... 33 0.8395 0.8157 99933
33640........................... Saratoga County, New York......... 0160 0.8518 0.8545 10580
33650........................... Schenectady County, New York...... 0160 0.8518 0.8545 10580
33660........................... Schoharie County, New York........ 0160 0.8518 0.8545 10580
33670........................... Schuyler County, New York......... 33 0.8395 0.8157 99933
33680........................... Seneca County, New York........... 33 0.8395 0.8157 99933
33690........................... Steuben County, New York.......... 33 0.8395 0.8157 99933
33700........................... Suffolk County, New York.......... 5380 1.2760 1.2760 35004
33710........................... Sullivan County, New York......... 33 0.8395 0.8157 99933
33720........................... Tioga County, New York............ 0960 0.8571 0.8571 13780
33730........................... Tompkins County, New York......... 33 0.8395 0.9803 27060
33740........................... Ulster County, New York........... 33 0.8395 0.9257 28740
33750........................... Warren County, New York........... 2975 0.8567 0.8567 24020
33760........................... Washington County, New York....... 2975 0.8567 0.8567 24020
33770........................... Wayne County, New York............ 6840 0.9044 0.9115 40380
33800........................... Westchester County, New York...... 5600 1.3465 1.3185 35644
33900........................... Wyoming County, New York.......... 33 0.8395 0.8157 99933
33910........................... Yates County, New York............ 33 0.8395 0.8157 99933
34000........................... Alamance County, N Carolina....... 3120 0.9027 0.8914 15500
34010........................... Alexander County, N Carolina...... 3290 0.8922 0.8922 25860
34020........................... Alleghany County, N Carolina...... 34 0.8490 0.8567 99934
34030........................... Anson County, N Carolina.......... 34 0.8490 0.9760 16740
34040........................... Ashe County, N Carolina........... 34 0.8490 0.8567 99934
34050........................... Avery County, N Carolina.......... 34 0.8490 0.8567 99934
34060........................... Beaufort County, N Carolina....... 34 0.8490 0.8567 99934
34070........................... Bertie County, N Carolina......... 34 0.8490 0.8567 99934
34080........................... Bladen County, N Carolina......... 34 0.8490 0.8567 99934
34090........................... Brunswick County, N Carolina...... 9200 0.9592 0.9592 48900
34100........................... Buncombe County, N Carolina....... 0480 0.9747 0.9294 11700
[[Page 29143]]
34110........................... Burke County, N Carolina.......... 3290 0.8922 0.8922 25860
34120........................... Cabarrus County, N Carolina....... 1520 0.9725 0.9760 16740
34130........................... Caldwell County, N Carolina....... 3290 0.8922 0.8922 25860
34140........................... Camden County, N Carolina......... 34 0.8490 0.8567 99934
34150........................... Carteret County, N Carolina....... 34 0.8490 0.8567 99934
34160........................... Caswell County, N Carolina........ 34 0.8490 0.8567 99934
34170........................... Catawba County, N Carolina........ 3290 0.8922 0.8922 25860
34180........................... Chatham County, N Carolina........ 6640 1.0087 1.0303 20500
34190........................... Cherokee County, N Carolina....... 34 0.8490 0.8567 99934
34200........................... Chowan County, N Carolina......... 34 0.8490 0.8567 99934
34210........................... Clay County, N Carolina........... 34 0.8490 0.8567 99934
34220........................... Cleveland County, N Carolina...... 34 0.8490 0.8567 99934
34230........................... Columbus County, N Carolina....... 34 0.8490 0.8567 99934
34240........................... Craven County, N Carolina......... 34 0.8490 0.8567 99934
34250........................... Cumberland County, N Carolina..... 2560 0.9426 0.9426 22180
34251........................... Currituck County, N Carolina...... 5720 0.8808 0.8808 47260
34270........................... Dare County, N Carolina........... 34 0.8490 0.8567 99934
34280........................... Davidson County, N Carolina....... 3120 0.9027 0.8567 99934
34290........................... Davie County, N Carolina.......... 3120 0.9027 0.8953 49180
34300........................... Duplin County, N Carolina......... 34 0.8490 0.8567 99934
34310........................... Durham County, N Carolina......... 6640 1.0087 1.0303 20500
34320........................... Edgecombe County, N Carolina...... 6895 0.8924 0.8924 40580
34330........................... Forsyth County, N Carolina........ 3120 0.9027 0.8953 49180
34340........................... Franklin County, N Carolina....... 6640 1.0087 0.9733 39580
34350........................... Gaston County, N Carolina......... 1520 0.9725 0.9760 16740
34360........................... Gates County, N Carolina.......... 34 0.8490 0.8567 99934
34370........................... Graham County, N Carolina......... 34 0.8490 0.8567 99934
34380........................... Granville County, N Carolina...... 34 0.8490 0.8567 99934
34390........................... Greene County, N Carolina......... 34 0.8490 0.9434 24780
34400........................... Guilford County, N Carolina....... 3120 0.9027 0.9113 24660
34410........................... Halifax County, N Carolina........ 34 0.8490 0.8567 99934
34420........................... Harnett County, N Carolina........ 34 0.8490 0.8567 99934
34430........................... Haywood County, N Carolina........ 34 0.8490 0.9294 11700
34440........................... Henderson County, N Carolina...... 34 0.8490 0.9294 11700
34450........................... Hertford County, N Carolina....... 34 0.8490 0.8567 99934
34460........................... Hoke County, N Carolina........... 34 0.8490 0.9426 22180
34470........................... Hyde County, N Carolina........... 34 0.8490 0.8567 99934
34480........................... Iredell County, N Carolina........ 34 0.8490 0.8567 99934
34490........................... Jackson County, N Carolina........ 34 0.8490 0.8567 99934
34500........................... Johnston County, N Carolina....... 6640 1.0087 0.9733 39580
34510........................... Jones County, N Carolina.......... 34 0.8490 0.8567 99934
34520........................... Lee County, N Carolina............ 34 0.8490 0.8567 99934
34530........................... Lenoir County, N Carolina......... 34 0.8490 0.8567 99934
34540........................... Lincoln County, N Carolina........ 1520 0.9725 0.8567 99934
34550........................... Mc Dowell County, N Carolina...... 34 0.8490 0.8567 99934
34560........................... Macon County, N Carolina.......... 34 0.8490 0.8567 99934
34570........................... Madison County, N Carolina........ 0480 0.9747 0.9294 11700
34580........................... Martin County, N Carolina......... 34 0.8490 0.8567 99934
34590........................... Mecklenburg County, N Carolina.... 1520 0.9725 0.9760 16740
34600........................... Mitchell County, N Carolina....... 34 0.8490 0.8567 99934
34610........................... Montgomery County, N Carolina..... 34 0.8490 0.8567 99934
34620........................... Moore County, N Carolina.......... 34 0.8490 0.8567 99934
34630........................... Nash County, N Carolina........... 6895 0.8924 0.8924 40580
34640........................... New Hanover County, N Carolina.... 9200 0.9592 0.9592 48900
34650........................... Northampton County, N Carolina.... 34 0.8490 0.8567 99934
34660........................... Onslow County, N Carolina......... 3605 0.8244 0.8244 27340
34670........................... Orange County, N Carolina......... 6640 1.0087 1.0303 20500
34680........................... Pamlico County, N Carolina........ 34 0.8490 0.8567 99934
34690........................... Pasquotank County, N Carolina..... 34 0.8490 0.8567 99934
34700........................... Pender County, N Carolina......... 34 0.8490 0.9592 48900
34710........................... Perquimans County, N Carolina..... 34 0.8490 0.8567 99934
34720........................... Person County, N Carolina......... 34 0.8490 1.0303 20500
34730........................... Pitt County, N Carolina........... 3150 0.9434 0.9434 24780
34740........................... Polk County, N Carolina........... 34 0.8490 0.8567 99934
34750........................... Randolph County, N Carolina....... 3120 0.9027 0.9113 24660
34760........................... Richmond County, N Carolina....... 34 0.8490 0.8567 99934
34770........................... Robeson County, N Carolina........ 34 0.8490 0.8567 99934
34780........................... Rockingham County, N Carolina..... 34 0.8490 0.9113 24660
34790........................... Rowan County, N Carolina.......... 1520 0.9725 0.8567 99934
[[Page 29144]]
34800........................... Rutherford County, N Carolina..... 34 0.8490 0.8567 99934
34810........................... Sampson County, N Carolina........ 34 0.8490 0.8567 99934
34820........................... Scotland County, N Carolina....... 34 0.8490 0.8567 99934
34830........................... Stanly County, N Carolina......... 1520 0.9725 0.9760 16740
34840........................... Stokes County, N Carolina......... 3120 0.9027 0.8953 49180
34850........................... Surry County, N Carolina.......... 34 0.8490 0.8567 99934
34860........................... Swain County, N Carolina.......... 34 0.8490 0.8567 99934
34870........................... Transylvania County, N Carolina... 34 0.8490 0.8567 99934
34880........................... Tyrrell County, N Carolina........ 34 0.8490 0.8567 99934
34890........................... Union County, N Carolina.......... 1520 0.9725 0.9760 16740
34900........................... Vance County, N Carolina.......... 34 0.8490 0.8567 99934
34910........................... Wake County, N Carolina........... 6640 1.0087 0.9733 39580
34920........................... Warren County, N Carolina......... 34 0.8490 0.8567 99934
34930........................... Washington County, N Carolina..... 34 0.8490 0.8567 99934
34940........................... Watauga County, N Carolina........ 34 0.8490 0.8567 99934
34950........................... Wayne County, N Carolina.......... 2980 0.8784 0.8784 24140
34960........................... Wilkes County, N Carolina......... 34 0.8490 0.8567 99934
34970........................... Wilson County, N Carolina......... 34 0.8490 0.8567 99934
34980........................... Yadkin County, N Carolina......... 3120 0.9027 0.8953 49180
34981........................... Yancey County, N Carolina......... 34 0.8490 0.8567 99934
35000........................... Adams County, N Dakota............ 35 0.7268 0.7268 99935
35010........................... Barnes County, N Dakota........... 35 0.7268 0.7268 99935
35020........................... Benson County, N Dakota........... 35 0.7268 0.7268 99935
35030........................... Billings County, N Dakota......... 35 0.7268 0.7268 99935
35040........................... Bottineau County, N Dakota........ 35 0.7268 0.7268 99935
35050........................... Bowman County, N Dakota........... 35 0.7268 0.7268 99935
35060........................... Burke County, N Dakota............ 35 0.7268 0.7268 99935
35070........................... Burleigh County, N Dakota......... 1010 0.7519 0.7519 13900
35080........................... Cass County, N Dakota............. 2520 0.8495 0.8495 22020
35090........................... Cavalier County, N Dakota......... 35 0.7268 0.7268 99935
35100........................... Dickey County, N Dakota........... 35 0.7268 0.7268 99935
35110........................... Divide County, N Dakota........... 35 0.7268 0.7268 99935
35120........................... Dunn County, N Dakota............. 35 0.7268 0.7268 99935
35130........................... Eddy County, N Dakota............. 35 0.7268 0.7268 99935
35140........................... Emmons County, N Dakota........... 35 0.7268 0.7268 99935
35150........................... Foster County, N Dakota........... 35 0.7268 0.7268 99935
35160........................... Golden Valley County, N Dakota.... 35 0.7268 0.7268 99935
35170........................... Grand Forks County, N Dakota...... 2985 1.1516 1.1516 24220
35180........................... Grant County, N Dakota............ 35 0.7268 0.7268 99935
35190........................... Griggs County, N Dakota........... 35 0.7268 0.7268 99935
35200........................... Hettinger County, N Dakota........ 35 0.7268 0.7268 99935
35210........................... Kidder County, N Dakota........... 35 0.7268 0.7268 99935
35220........................... La Moure County, N Dakota......... 35 0.7268 0.7268 99935
35230........................... Logan County, N Dakota............ 35 0.7268 0.7268 99935
35240........................... Mc Henry County, N Dakota......... 35 0.7268 0.7268 99935
35250........................... Mc Intosh County, N Dakota........ 35 0.7268 0.7268 99935
35260........................... Mc Kenzie County, N Dakota........ 35 0.7268 0.7268 99935
35270........................... Mc Lean County, N Dakota.......... 35 0.7268 0.7268 99935
35280........................... Mercer County, N Dakota........... 35 0.7268 0.7268 99935
35290........................... Morton County, N Dakota........... 1010 0.7519 0.7519 13900
35300........................... Mountrail County, N Dakota........ 35 0.7268 0.7268 99935
35310........................... Nelson County, N Dakota........... 35 0.7268 0.7268 99935
35320........................... Oliver County, N Dakota........... 35 0.7268 0.7268 99935
35330........................... Pembina County, N Dakota.......... 35 0.7268 0.7268 99935
35340........................... Pierce County, N Dakota........... 35 0.7268 0.7268 99935
35350........................... Ramsey County, N Dakota........... 35 0.7268 0.7268 99935
35360........................... Ransom County, N Dakota........... 35 0.7268 0.7268 99935
35370........................... Renville County, N Dakota......... 35 0.7268 0.7268 99935
35380........................... Richland County, N Dakota......... 35 0.7268 0.7268 99935
35390........................... Rolette County, N Dakota.......... 35 0.7268 0.7268 99935
35400........................... Sargent County, N Dakota.......... 35 0.7268 0.7268 99935
35410........................... Sheridan County, N Dakota......... 35 0.7268 0.7268 99935
35420........................... Sioux County, N Dakota............ 35 0.7268 0.7268 99935
35430........................... Slope County, N Dakota............ 35 0.7268 0.7268 99935
35440........................... Stark County, N Dakota............ 35 0.7268 0.7268 99935
35450........................... Steele County, N Dakota........... 35 0.7268 0.7268 99935
35460........................... Stutsman County, N Dakota......... 35 0.7268 0.7268 99935
35470........................... Towner County, N Dakota........... 35 0.7268 0.7268 99935
35480........................... Traill County, N Dakota........... 35 0.7268 0.7268 99935
[[Page 29145]]
35490........................... Walsh County, N Dakota............ 35 0.7268 0.7268 99935
35500........................... Ward County, N Dakota............. 35 0.7268 0.7268 99935
35510........................... Wells County, N Dakota............ 35 0.7268 0.7268 99935
35520........................... Williams County, N Dakota......... 35 0.7268 0.7268 99935
36000........................... Adams County, Ohio................ 36 0.8886 0.8786 99936
36010........................... Allen County, Ohio................ 4320 0.9128 0.9234 30620
36020........................... Ashland County, Ohio.............. 36 0.8886 0.8786 99936
36030........................... Ashtabula County, Ohio............ 1680 0.9174 0.8786 99936
36040........................... Athens County, Ohio............... 36 0.8886 0.8786 99936
36050........................... Auglaize County, Ohio............. 4320 0.9128 0.8786 99936
36060........................... Belmont County, Ohio.............. 9000 0.7168 0.7168 48540
36070........................... Brown County, Ohio................ 1640 0.9742 0.9623 17140
36080........................... Butler County, Ohio............... 3200 0.8960 0.9623 17140
36090........................... Carroll County, Ohio.............. 1320 0.8944 0.8944 15940
36100........................... Champaign County, Ohio............ 36 0.8886 0.8786 99936
36110........................... Clark County, Ohio................ 2000 0.8989 0.8404 44220
36120........................... Clermont County, Ohio............. 1640 0.9742 0.9623 17140
36130........................... Clinton County, Ohio.............. 36 0.8886 0.8786 99936
36140........................... Columbiana County, Ohio........... 9320 0.8857 0.8786 99936
36150........................... Coshocton County, Ohio............ 36 0.8886 0.8786 99936
36160........................... Crawford County, Ohio............. 4800 0.8886 0.8786 99936
36170........................... Cuyahoga County, Ohio............. 1680 0.9174 0.9204 17460
36190........................... Darke County, Ohio................ 36 0.8886 0.8786 99936
36200........................... Defiance County, Ohio............. 36 0.8886 0.8786 99936
36210........................... Delaware County, Ohio............. 1840 0.9864 0.9850 18140
36220........................... Erie County, Ohio................. 36 0.8886 0.9025 41780
36230........................... Fairfield County, Ohio............ 1840 0.9864 0.9850 18140
36240........................... Fayette County, Ohio.............. 36 0.8886 0.8786 99936
36250........................... Franklin County, Ohio............. 1840 0.9864 0.9850 18140
36260........................... Fulton County, Ohio............... 8400 0.9584 0.9584 45780
36270........................... Gallia County, Ohio............... 36 0.8886 0.8786 99936
36280........................... Geauga County, Ohio............... 1680 0.9174 0.9204 17460
36290........................... Greene County, Ohio............... 2000 0.8989 0.9073 19380
36300........................... Guernsey County, Ohio............. 36 0.8886 0.8786 99936
36310........................... Hamilton County, Ohio............. 1640 0.9742 0.9623 17140
36330........................... Hancock County, Ohio.............. 36 0.8886 0.8786 99936
36340........................... Hardin County, Ohio............... 36 0.8886 0.8786 99936
36350........................... Harrison County, Ohio............. 36 0.8886 0.8786 99936
36360........................... Henry County, Ohio................ 36 0.8886 0.8786 99936
36370........................... Highland County, Ohio............. 36 0.8886 0.8786 99936
36380........................... Hocking County, Ohio.............. 36 0.8886 0.8786 99936
36390........................... Holmes County, Ohio............... 36 0.8886 0.8786 99936
36400........................... Huron County, Ohio................ 36 0.8886 0.8786 99936
36410........................... Jackson County, Ohio.............. 36 0.8886 0.8786 99936
36420........................... Jefferson County, Ohio............ 8080 0.7827 0.7827 48260
36430........................... Knox County, Ohio................. 36 0.8886 0.8786 99936
36440........................... Lake County, Ohio................. 1680 0.9174 0.9204 17460
36450........................... Lawrence County, Ohio............. 3400 0.9486 0.9486 26580
36460........................... Licking County, Ohio.............. 1840 0.9864 0.9850 18140
36470........................... Logan County, Ohio................ 36 0.8886 0.8786 99936
36480........................... Lorain County, Ohio............... 1680 0.9174 0.9204 17460
36490........................... Lucas County, Ohio................ 8400 0.9584 0.9584 45780
36500........................... Madison County, Ohio.............. 1840 0.9864 0.9850 18140
36510........................... Mahoning County, Ohio............. 9320 0.8857 0.8611 49660
36520........................... Marion County, Ohio............... 36 0.8886 0.8786 99936
36530........................... Medina County, Ohio............... 1680 0.9174 0.9204 17460
36540........................... Meigs County, Ohio................ 36 0.8886 0.8786 99936
36550........................... Mercer County, Ohio............... 36 0.8886 0.8786 99936
36560........................... Miami County, Ohio................ 2000 0.8989 0.9073 19380
36570........................... Monroe County, Ohio............... 36 0.8886 0.8786 99936
36580........................... Montgomery County, Ohio........... 2000 0.8989 0.9073 19380
36590........................... Morgan County, Ohio............... 36 0.8886 0.8786 99936
36600........................... Morrow County, Ohio............... 36 0.8886 0.9850 18140
36610........................... Muskingum County, Ohio............ 36 0.8886 0.8786 99936
36620........................... Noble County, Ohio................ 36 0.8886 0.8786 99936
36630........................... Ottawa County, Ohio............... 36 0.8886 0.9584 45780
36640........................... Paulding County, Ohio............. 36 0.8886 0.8786 99936
36650........................... Perry County, Ohio................ 36 0.8886 0.8786 99936
36660........................... Pickaway County, Ohio............. 1840 0.9864 0.9850 18140
[[Page 29146]]
36670........................... Pike County, Ohio................. 36 0.8886 0.8786 99936
36680........................... Portage County, Ohio.............. 0080 0.8991 0.8991 10420
36690........................... Preble County, Ohio............... 36 0.8886 0.9073 19380
36700........................... Putnam County, Ohio............... 36 0.8886 0.8786 99936
36710........................... Richland County, Ohio............. 4800 0.8886 0.8887 31900
36720........................... Ross County, Ohio................. 36 0.8886 0.8786 99936
36730........................... Sandusky County, Ohio............. 36 0.8886 0.8786 99936
36740........................... Scioto County, Ohio............... 36 0.8886 0.8786 99936
36750........................... Seneca County, Ohio............... 36 0.8886 0.8786 99936
36760........................... Shelby County, Ohio............... 36 0.8886 0.8786 99936
36770........................... Stark County, Ohio................ 1320 0.8944 0.8944 15940
36780........................... Summit County, Ohio............... 0080 0.8991 0.8991 10420
36790........................... Trumbull County, Ohio............. 9320 0.8857 0.8611 49660
36800........................... Tuscarawas County, Ohio........... 36 0.8886 0.8786 99936
36810........................... Union County, Ohio................ 36 0.8886 0.9850 18140
36820........................... Van Wert County, Ohio............. 36 0.8886 0.8786 99936
36830........................... Vinton County, Ohio............... 36 0.8886 0.8786 99936
36840........................... Warren County, Ohio............... 1640 0.9742 0.9623 17140
36850........................... Washington County, Ohio........... 6020 0.8278 0.8278 37620
36860........................... Wayne County, Ohio................ 36 0.8886 0.8786 99936
36870........................... Williams County, Ohio............. 36 0.8886 0.8786 99936
36880........................... Wood County, Ohio................. 8400 0.9584 0.9584 45780
36890........................... Wyandot County, Ohio.............. 36 0.8886 0.8786 99936
37000........................... Adair County, Oklahoma............ 37 0.7450 0.7589 99937
37010........................... Alfalfa County, Oklahoma.......... 37 0.7450 0.7589 99937
37020........................... Atoka County, Oklahoma............ 37 0.7450 0.7589 99937
37030........................... Beaver County, Oklahoma........... 37 0.7450 0.7589 99937
37040........................... Beckham County, Oklahoma.......... 37 0.7450 0.7589 99937
37050........................... Blaine County, Oklahoma........... 37 0.7450 0.7589 99937
37060........................... Bryan County, Oklahoma............ 37 0.7450 0.7589 99937
37070........................... Caddo County, Oklahoma............ 37 0.7450 0.7589 99937
37080........................... Canadian County, Oklahoma......... 5880 0.9034 0.9040 36420
37090........................... Carter County, Oklahoma........... 37 0.7450 0.7589 99937
37100........................... Cherokee County, Oklahoma......... 37 0.7450 0.7589 99937
37110........................... Choctaw County, Oklahoma.......... 37 0.7450 0.7589 99937
37120........................... Cimarron County, Oklahoma......... 37 0.7450 0.7589 99937
37130........................... Cleveland County, Oklahoma........ 5880 0.9034 0.9040 36420
37140........................... Coal County, Oklahoma............. 37 0.7450 0.7589 99937
37150........................... Comanche County, Oklahoma......... 4200 0.7880 0.7880 30020
37160........................... Cotton County, Oklahoma........... 37 0.7450 0.7589 99937
37170........................... Craig County, Oklahoma............ 37 0.7450 0.7589 99937
37180........................... Creek County, Oklahoma............ 8560 0.8322 0.8286 46140
37190........................... Custer County, Oklahoma........... 37 0.7450 0.7589 99937
37200........................... Delaware County, Oklahoma......... 37 0.7450 0.7589 99937
37210........................... Dewey County, Oklahoma............ 37 0.7450 0.7589 99937
37220........................... Ellis County, Oklahoma............ 37 0.7450 0.7589 99937
37230........................... Garfield County, Oklahoma......... 2340 0.8675 0.7589 99937
37240........................... Garvin County, Oklahoma........... 37 0.7450 0.7589 99937
37250........................... Grady County, Oklahoma............ 37 0.7450 0.9040 36420
37260........................... Grant County, Oklahoma............ 37 0.7450 0.7589 99937
37270........................... Greer County, Oklahoma............ 37 0.7450 0.7589 99937
37280........................... Harmon County, Oklahoma........... 37 0.7450 0.7589 99937
37290........................... Harper County, Oklahoma........... 37 0.7450 0.7589 99937
37300........................... Haskell County, Oklahoma.......... 37 0.7450 0.7589 99937
37310........................... Hughes County, Oklahoma........... 37 0.7450 0.7589 99937
37320........................... Jackson County, Oklahoma.......... 37 0.7450 0.7589 99937
37330........................... Jefferson County, Oklahoma........ 37 0.7450 0.7589 99937
37340........................... Johnston County, Oklahoma......... 37 0.7450 0.7589 99937
37350........................... Kay County, Oklahoma.............. 37 0.7450 0.7589 99937
37360........................... Kingfisher County, Oklahoma....... 37 0.7450 0.7589 99937
37370........................... Kiowa County, Oklahoma............ 37 0.7450 0.7589 99937
37380........................... Latimer County, Oklahoma.......... 37 0.7450 0.7589 99937
37390........................... Le Flore County, Oklahoma......... 37 0.7450 0.8214 22900
37400........................... Lincoln County, Oklahoma.......... 37 0.7450 0.9040 36420
37410........................... Logan County, Oklahoma............ 5880 0.9034 0.9040 36420
37420........................... Love County, Oklahoma............. 37 0.7450 0.7589 99937
37430........................... Mc Clain County, Oklahoma......... 5880 0.9034 0.9040 36420
37440........................... Mc Curtain County, Oklahoma....... 37 0.7450 0.7589 99937
37450........................... Mc Intosh County, Oklahoma........ 37 0.7450 0.7589 99937
[[Page 29147]]
37460........................... Major County, Oklahoma............ 37 0.7450 0.7589 99937
37470........................... Marshall County, Oklahoma......... 37 0.7450 0.7589 99937
37480........................... Mayes County, Oklahoma............ 37 0.7450 0.7589 99937
37490........................... Murray County, Oklahoma........... 37 0.7450 0.7589 99937
37500........................... Muskogee County, Oklahoma......... 37 0.7450 0.7589 99937
37510........................... Noble County, Oklahoma............ 37 0.7450 0.7589 99937
37520........................... Nowata County, Oklahoma........... 37 0.7450 0.7589 99937
37530........................... Okfuskee County, Oklahoma......... 37 0.7450 0.7589 99937
37540........................... Oklahoma County, Oklahoma......... 5880 0.9034 0.9040 36420
37550........................... Okmulgee County, Oklahoma......... 37 0.7450 0.8286 46140
37560........................... Osage County, Oklahoma............ 8560 0.8322 0.8286 46140
37570........................... Ottawa County, Oklahoma........... 37 0.7450 0.7589 99937
37580........................... Pawnee County, Oklahoma........... 37 0.7450 0.8286 46140
37590........................... Payne County, Oklahoma............ 37 0.7450 0.7589 99937
37600........................... Pittsburg County, Oklahoma........ 37 0.7450 0.7589 99937
37610........................... Pontotoc County, Oklahoma......... 37 0.7450 0.7589 99937
37620........................... Pottawatomie County, Oklahoma..... 5880 0.9034 0.7589 99937
37630........................... Pushmataha County, Oklahoma....... 37 0.7450 0.7589 99937
37640........................... Roger Mills County, Oklahoma...... 37 0.7450 0.7589 99937
37650........................... Rogers County, Oklahoma........... 8560 0.8322 0.8286 46140
37660........................... Seminole County, Oklahoma......... 37 0.7450 0.7589 99937
37670........................... Sequoyah County, Oklahoma......... 2720 0.8229 0.8214 22900
37680........................... Stephens County, Oklahoma......... 37 0.7450 0.7589 99937
37690........................... Texas County, Oklahoma............ 37 0.7450 0.7589 99937
37700........................... Tillman County, Oklahoma.......... 37 0.7450 0.7589 99937
37710........................... Tulsa County, Oklahoma............ 8560 0.8322 0.8286 46140
37720........................... Wagoner County, Oklahoma.......... 8560 0.8322 0.8286 46140
37730........................... Washington County, Oklahoma....... 37 0.7450 0.7589 99937
37740........................... Washita County, Oklahoma.......... 37 0.7450 0.7589 99937
37750........................... Woods County, Oklahoma............ 37 0.7450 0.7589 99937
37760........................... Woodward County, Oklahoma......... 37 0.7450 0.7589 99937
38000........................... Baker County, Oregon.............. 38 1.0057 0.9830 99938
38010........................... Benton County, Oregon............. 1890 1.0739 1.0739 18700
38020........................... Clackamas County, Oregon.......... 6440 1.1260 1.1260 38900
38030........................... Clatsop County, Oregon............ 38 1.0057 0.9830 99938
38040........................... Columbia County, Oregon........... 6440 1.1260 1.1260 38900
38050........................... Coos County, Oregon............... 38 1.0057 0.9830 99938
38060........................... Crook County, Oregon.............. 38 1.0057 0.9830 99938
38070........................... Curry County, Oregon.............. 38 1.0057 0.9830 99938
38080........................... Deschutes County, Oregon.......... 38 1.0057 1.0796 13460
38090........................... Douglas County, Oregon............ 38 1.0057 0.9830 99938
38100........................... Gilliam County, Oregon............ 38 1.0057 0.9830 99938
38110........................... Grant County, Oregon.............. 38 1.0057 0.9830 99938
38120........................... Harney County, Oregon............. 38 1.0057 0.9830 99938
38130........................... Hood River County, Oregon......... 38 1.0057 0.9830 99938
38140........................... Jackson County, Oregon............ 4890 1.0235 1.0235 32780
38150........................... Jefferson County, Oregon.......... 38 1.0057 0.9830 99938
38160........................... Josephine County, Oregon.......... 38 1.0057 0.9830 99938
38170........................... Klamath County, Oregon............ 38 1.0057 0.9830 99938
38180........................... Lake County, Oregon............... 38 1.0057 0.9830 99938
38190........................... Lane County, Oregon............... 2400 1.0829 1.0829 21660
38200........................... Lincoln County, Oregon............ 38 1.0057 0.9830 99938
38210........................... Linn County, Oregon............... 38 1.0057 0.9830 99938
38220........................... Malheur County, Oregon............ 38 1.0057 0.9830 99938
38230........................... Marion County, Oregon............. 7080 1.0452 1.0452 41420
38240........................... Morrow County, Oregon............. 38 1.0057 0.9830 99938
38250........................... Multnomah County, Oregon.......... 6440 1.1260 1.1260 38900
38260........................... Polk County, Oregon............... 7080 1.0452 1.0452 41420
38270........................... Sherman County, Oregon............ 38 1.0057 0.9830 99938
38280........................... Tillamook County, Oregon.......... 38 1.0057 0.9830 99938
38290........................... Umatilla County, Oregon........... 38 1.0057 0.9830 99938
38300........................... Union County, Oregon.............. 38 1.0057 0.9830 99938
38310........................... Wallowa County, Oregon............ 38 1.0057 0.9830 99938
38320........................... Wasco County, Oregon.............. 38 1.0057 0.9830 99938
38330........................... Washington County, Oregon......... 6440 1.1260 1.1260 38900
38340........................... Wheeler County, Oregon............ 38 1.0057 0.9830 99938
38350........................... Yamhill County, Oregon............ 6440 1.1260 1.1260 38900
39000........................... Adams County, Pennsylvania........ 39 0.8331 0.8302 99939
39010........................... Allegheny County, Pennsylvania.... 6280 0.8868 0.8853 38300
[[Page 29148]]
39070........................... Armstrong County, Pennsylvania.... 39 0.8331 0.8853 38300
39080........................... Beaver County, Pennsylvania....... 6280 0.8868 0.8853 38300
39100........................... Bedford County, Pennsylvania...... 39 0.8331 0.8302 99939
39110........................... Berks County, Pennsylvania........ 6680 0.9696 0.9696 39740
39120........................... Blair County, Pennsylvania........ 0280 0.8953 0.8953 11020
39130........................... Bradford County, Pennsylvania..... 39 0.8331 0.8302 99939
39140........................... Bucks County, Pennsylvania........ 6160 1.0926 1.1040 37964
39150........................... Butler County, Pennsylvania....... 6280 0.8868 0.8853 38300
39160........................... Cambria County, Pennsylvania...... 3680 0.8094 0.8362 27780
39180........................... Cameron County, Pennsylvania...... 39 0.8331 0.8302 99939
39190........................... Carbon County, Pennsylvania....... 0240 0.9855 0.9828 10900
39200........................... Centre County, Pennsylvania....... 8050 0.8364 0.8364 44300
39210........................... Chester County, Pennsylvania...... 6160 1.0926 1.1040 37964
39220........................... Clarion County, Pennsylvania...... 39 0.8331 0.8302 99939
39230........................... Clearfield County, Pennsylvania... 39 0.8331 0.8302 99939
39240........................... Clinton County, Pennsylvania...... 39 0.8331 0.8302 99939
39250........................... Columbia County, Pennsylvania..... 7560 0.8533 0.8302 99939
39260........................... Crawford County, Pennsylvania..... 39 0.8331 0.8302 99939
39270........................... Cumberland County, Pennsylvania... 3240 0.9242 0.9322 25420
39280........................... Dauphin County, Pennsylvania...... 3240 0.9242 0.9322 25420
39290........................... Delaware County, Pennsylvania..... 6160 1.0926 1.1040 37964
39310........................... Elk County, Pennsylvania.......... 39 0.8331 0.8302 99939
39320........................... Erie County, Pennsylvania......... 2360 0.8746 0.8746 21500
39330........................... Fayette County, Pennsylvania...... 6280 0.8868 0.8853 38300
39340........................... Forest County, Pennsylvania....... 39 0.8331 0.8302 99939
39350........................... Franklin County, Pennsylvania..... 39 0.8331 0.8302 99939
39360........................... Fulton County, Pennsylvania....... 39 0.8331 0.8302 99939
39370........................... Greene County, Pennsylvania....... 39 0.8331 0.8302 99939
39380........................... Huntingdon County, Pennsylvania... 39 0.8331 0.8302 99939
39390........................... Indiana County, Pennsylvania...... 39 0.8331 0.8302 99939
39400........................... Jefferson County, Pennsylvania.... 39 0.8331 0.8302 99939
39410........................... Juniata County, Pennsylvania...... 39 0.8331 0.8302 99939
39420........................... Lackawanna County, Pennsylvania... 7560 0.8533 0.8548 42540
39440........................... Lancaster County, Pennsylvania.... 4000 0.9704 0.9704 29540
39450........................... Lawrence County, Pennsylvania..... 39 0.8331 0.8302 99939
39460........................... Lebanon County, Pennsylvania...... 3240 0.9242 0.8468 30140
39470........................... Lehigh County, Pennsylvania....... 0240 0.9855 0.9828 10900
39480........................... Luzerne County, Pennsylvania...... 7560 0.8533 0.8548 42540
39510........................... Lycoming County, Pennsylvania..... 9140 0.8377 0.8377 48700
39520........................... Mc Kean County, Pennsylvania...... 39 0.8331 0.8302 99939
39530........................... Mercer County, Pennsylvania....... 7610 0.7801 0.8611 49660
39540........................... Mifflin County, Pennsylvania...... 39 0.8331 0.8302 99939
39550........................... Monroe County, Pennsylvania....... 39 0.8331 0.8302 99939
39560........................... Montgomery County, Pennsylvania... 6160 1.0926 1.1040 37964
39580........................... Montour County, Pennsylvania...... 39 0.8331 0.8302 99939
39590........................... Northampton County, Pennsylvania.. 0240 0.9855 0.9828 10900
39600........................... Northumberland County, 39 0.8331 0.8302 99939
Pennsylvania.
39610........................... Perry County, Pennsylvania........ 3240 0.9242 0.9322 25420
39620........................... Philadelphia County, Pennsylvania. 6160 1.0926 1.1040 37964
39630........................... Pike County, Pennsylvania......... 5660 1.1218 1.2195 35084
39640........................... Potter County, Pennsylvania....... 39 0.8331 0.8302 99939
39650........................... Schuylkill County, Pennsylvania... 39 0.8331 0.8302 99939
39670........................... Snyder County, Pennsylvania....... 39 0.8331 0.8302 99939
39680........................... Somerset County, Pennsylvania..... 3680 0.8094 0.8302 99939
39690........................... Sullivan County, Pennsylvania..... 39 0.8331 0.8302 99939
39700........................... Susquehanna County, Pennsylvania.. 39 0.8331 0.8302 99939
39710........................... Tioga County, Pennsylvania........ 39 0.8331 0.8302 99939
39720........................... Union County, Pennsylvania........ 39 0.8331 0.8302 99939
39730........................... Venango County, Pennsylvania...... 39 0.8331 0.8302 99939
39740........................... Warren County, Pennsylvania....... 39 0.8331 0.8302 99939
39750........................... Washington County, Pennsylvania... 6280 0.8868 0.8853 38300
39760........................... Wayne County, Pennsylvania........ 39 0.8331 0.8302 99939
39770........................... Westmoreland County, Pennsylvania. 6280 0.8868 0.8853 38300
39790........................... Wyoming County, Pennsylvania...... 7560 0.8533 0.8548 42540
39800........................... York County, Pennsylvania......... 9280 0.9420 0.9420 49620
40010........................... Adjuntas County, Puerto Rico...... 40 0.3608 0.4047 99940
40020........................... Aguada County, Puerto Rico........ 0060 0.4881 0.4743 10380
40030........................... Aguadilla County, Puerto Rico..... 0060 0.4881 0.4743 10380
40040........................... Aguas Buenas County, Puerto Rico.. 7440 0.4855 0.4686 41980
[[Page 29149]]
40050........................... Aibonito County, Puerto Rico...... 40 0.3608 0.4686 41980
40060........................... Anasco County, Puerto Rico........ 4840 0.4246 0.4743 10380
40070........................... Arecibo County, Puerto Rico....... 0470 0.4116 0.4686 41980
40080........................... Arroyo County, Puerto Rico........ 40 0.3608 0.3184 25020
40090........................... Barceloneta County, Puerto Rico... 7440 0.4855 0.4686 41980
40100........................... Barranquitas County, Puerto Rico.. 40 0.3608 0.4686 41980
40110........................... Bayamon County, Puerto Rico....... 7440 0.4855 0.4686 41980
40120........................... Cabo Rojo County, Puerto Rico..... 4840 0.4246 0.4655 41900
40130........................... Caguas County, Puerto Rico........ 1310 0.4020 0.4686 41980
40140........................... Camuy County, Puerto Rico......... 0470 0.4116 0.4686 41980
40145........................... Canovanas County, Puerto Rico..... 7440 0.4855 0.4686 41980
40150........................... Carolina County, Puerto Rico...... 7440 0.4855 0.4686 41980
40160........................... Catano County, Puerto Rico........ 7440 0.4855 0.4686 41980
40170........................... Cayey County, Puerto Rico......... 1310 0.4020 0.4686 41980
40180........................... Ceiba County, Puerto Rico......... 7440 0.4855 0.4157 21940
40190........................... Ciales County, Puerto Rico........ 40 0.3608 0.4686 41980
40200........................... Cidra County, Puerto Rico......... 1310 0.4020 0.4686 41980
40210........................... Coamo County, Puerto Rico......... 40 0.3608 0.4047 99940
40220........................... Comerio County, Puerto Rico....... 7440 0.4855 0.4686 41980
40230........................... Corozal County, Puerto Rico....... 7440 0.4855 0.4686 41980
40240........................... Culebra County, Puerto Rico....... 40 0.3608 0.4047 99940
40250........................... Dorado County, Puerto Rico........ 7440 0.4855 0.4686 41980
40260........................... Fajardo County, Puerto Rico....... 7440 0.4855 0.4157 21940
40265........................... Florida County, Puerto Rico....... 7440 0.4855 0.4686 41980
40270........................... Guanica County, Puerto Rico....... 40 0.3608 0.4413 49500
40280........................... Guayama County, Puerto Rico....... 40 0.3608 0.3184 25020
40290........................... Guayanilla County, Puerto Rico.... 6360 0.5091 0.4413 49500
40300........................... Guaynabo County, Puerto Rico...... 7440 0.4855 0.4686 41980
40310........................... Gurabo County, Puerto Rico........ 1310 0.4020 0.4686 41980
40320........................... Hatillo County, Puerto Rico....... 0470 0.4116 0.4686 41980
40330........................... Hormigueros County, Puerto Rico... 4840 0.4246 0.4017 32420
40340........................... Humacao County, Puerto Rico....... 7440 0.4855 0.4686 41980
40350........................... Isabela County, Puerto Rico....... 40 0.3608 0.4743 10380
40360........................... Jayuya County, Puerto Rico........ 40 0.3608 0.4047 99940
40370........................... Juana Diaz County, Puerto Rico.... 6360 0.5091 0.5177 38660
40380........................... Juncos County, Puerto Rico........ 7440 0.4855 0.4686 41980
40390........................... Lajas County, Puerto Rico......... 40 0.3608 0.4655 41900
40400........................... Lares County, Puerto Rico......... 40 0.3608 0.4743 10380
40410........................... Las Marias County, Puerto Rico.... 40 0.3608 0.4047 99940
40420........................... Las Piedras County, Puerto Rico... 7440 0.4855 0.4686 41980
40430........................... Loiza County, Puerto Rico......... 7440 0.4855 0.4686 41980
40440........................... Luquillo County, Puerto Rico...... 7440 0.4855 0.4157 21940
40450........................... Manati County, Puerto Rico........ 7440 0.4855 0.4686 41980
40460........................... Maricao County, Puerto Rico....... 40 0.3608 0.4047 99940
40470........................... Maunabo County, Puerto Rico....... 40 0.3608 0.4686 41980
40480........................... Mayaguez County, Puerto Rico...... 4840 0.4246 0.4017 32420
40490........................... Moca County, Puerto Rico.......... 0060 0.4881 0.4743 10380
40500........................... Morovis County, Puerto Rico....... 7440 0.4855 0.4686 41980
40510........................... Naguabo County, Puerto Rico....... 7440 0.4855 0.4686 41980
40520........................... Naranjito County, Puerto Rico..... 7440 0.4855 0.4686 41980
40530........................... Orocovis County, Puerto Rico...... 40 0.3608 0.4686 41980
40540........................... Patillas County, Puerto Rico...... 40 0.3608 0.3184 25020
40550........................... Penuelas County, Puerto Rico...... 6360 0.5091 0.4413 49500
40560........................... Ponce County, Puerto Rico......... 6360 0.5091 0.5177 38660
40570........................... Quebradillas County, Puerto Rico.. 40 0.3608 0.4686 41980
40580........................... Rincon County, Puerto Rico........ 40 0.3608 0.4743 10380
40590........................... Rio Grande County, Puerto Rico.... 7440 0.4855 0.4686 41980
40610........................... Sabana Grande County, Puerto Rico. 4840 0.4246 0.4655 41900
40620........................... Salinas County, Puerto Rico....... 40 0.3608 0.4047 99940
40630........................... San German County, Puerto Rico.... 4840 0.4246 0.4655 41900
40640........................... San Juan County, Puerto Rico...... 7440 0.4855 0.4686 41980
40650........................... San Lorenzo County, Puerto Rico... 1310 0.4020 0.4686 41980
40660........................... San Sebastian County, Puerto Rico. 40 0.3608 0.4743 10380
40670........................... Santa Isabel County, Puerto Rico.. 40 0.3608 0.4047 99940
40680........................... Toa Alta County, Puerto Rico...... 7440 0.4855 0.4686 41980
40690........................... Toa Baja County, Puerto Rico...... 7440 0.4855 0.4686 41980
40700........................... Trujillo Alto County, Puerto Rico. 7440 0.4855 0.4686 41980
40710........................... Utuado County, Puerto Rico........ 40 0.3608 0.4047 99940
40720........................... Vega Alta County, Puerto Rico..... 7440 0.4855 0.4686 41980
[[Page 29150]]
40730........................... Vega Baja County, Puerto Rico..... 7440 0.4855 0.4686 41980
40740........................... Vieques County, Puerto Rico....... 40 0.3608 0.4047 99940
40750........................... Villalba County, Puerto Rico...... 6360 0.5091 0.5177 38660
40760........................... Yabucoa County, Puerto Rico....... 7440 0.4855 0.4686 41980
40770........................... Yauco County, Puerto Rico......... 6360 0.5091 0.4413 49500
41000........................... Bristol County, Rhode Island...... 6483 1.1060 1.0966 39300
41010........................... Kent County, Rhode Island......... 6483 1.1060 1.0966 39300
41020........................... Newport County, Rhode Island...... 6483 1.1060 1.0966 39300
41030........................... Providence County, Rhode Island... 6483 1.1060 1.0966 39300
41050........................... Washington County, Rhode Island... 6483 1.1060 1.0966 39300
42000........................... Abbeville County, S Carolina...... 42 0.8634 0.8641 99942
42010........................... Aiken County, S Carolina.......... 0600 0.9619 0.9565 12260
42020........................... Allendale County, S Carolina...... 42 0.8634 0.8641 99942
42030........................... Anderson County, S Carolina....... 3160 0.9677 0.8897 11340
42040........................... Bamberg County, S Carolina........ 42 0.8634 0.8641 99942
42050........................... Barnwell County, S Carolina....... 42 0.8634 0.8641 99942
42060........................... Beaufort County, S Carolina....... 42 0.8634 0.8641 99942
42070........................... Berkeley County, S Carolina....... 1440 0.9438 0.9438 16700
42080........................... Calhoun County, S Carolina........ 42 0.8634 0.9047 17900
42090........................... Charleston County, S Carolina..... 1440 0.9438 0.9438 16700
42100........................... Cherokee County, S Carolina....... 3160 0.9677 0.8641 99942
42110........................... Chester County, S Carolina........ 42 0.8634 0.8641 99942
42120........................... Chesterfield County, S Carolina... 42 0.8634 0.8641 99942
42130........................... Clarendon County, S Carolina...... 42 0.8634 0.8641 99942
42140........................... Colleton County, S Carolina....... 42 0.8634 0.8641 99942
42150........................... Darlington County, S Carolina..... 42 0.8634 0.8964 22500
42160........................... Dillon County, S Carolina......... 42 0.8634 0.8641 99942
42170........................... Dorchester County, S Carolina..... 1440 0.9438 0.9438 16700
42180........................... Edgefield County, S Carolina...... 0600 0.9619 0.9565 12260
42190........................... Fairfield County, S Carolina...... 42 0.8634 0.9047 17900
42200........................... Florence County, S Carolina....... 2655 0.9060 0.8964 22500
42210........................... Georgetown County, S Carolina..... 42 0.8634 0.8641 99942
42220........................... Greenville County, S Carolina..... 3160 0.9677 1.0165 24860
42230........................... Greenwood County, S Carolina...... 42 0.8634 0.8641 99942
42240........................... Hampton County, S Carolina........ 42 0.8634 0.8641 99942
42250........................... Horry County, S Carolina.......... 5330 0.8873 0.8873 34820
42260........................... Jasper County, S Carolina......... 42 0.8634 0.8641 99942
42270........................... Kershaw County, S Carolina........ 42 0.8634 0.9047 17900
42280........................... Lancaster County, S Carolina...... 42 0.8634 0.8641 99942
42290........................... Laurens County, S Carolina........ 42 0.8634 1.0165 24860
42300........................... Lee County, S Carolina............ 42 0.8634 0.8641 99942
42310........................... Lexington County, S Carolina...... 1760 0.9071 0.9047 17900
42320........................... Mc Cormick County, S Carolina..... 42 0.8634 0.8641 99942
42330........................... Marion County, S Carolina......... 42 0.8634 0.8641 99942
42340........................... Marlboro County, S Carolina....... 42 0.8634 0.8641 99942
42350........................... Newberry County, S Carolina....... 42 0.8634 0.8641 99942
42360........................... Oconee County, S Carolina......... 42 0.8634 0.8641 99942
42370........................... Orangeburg County, S Carolina..... 42 0.8634 0.8641 99942
42380........................... Pickens County, S Carolina........ 3160 0.9677 1.0165 24860
42390........................... Richland County, S Carolina....... 1760 0.9071 0.9047 17900
42400........................... Saluda County, S Carolina......... 42 0.8634 0.9047 17900
42410........................... Spartanburg County, S Carolina.... 3160 0.9677 0.9181 43900
42420........................... Sumter County, S Carolina......... 8140 0.8386 0.8386 44940
42430........................... Union County, S Carolina.......... 42 0.8634 0.8641 99942
42440........................... Williamsburg County, S Carolina... 42 0.8634 0.8641 99942
42450........................... York County, S Carolina........... 1520 0.9725 0.9760 16740
43010........................... Aurora County, S Dakota........... 43 0.8476 0.8484 99943
43020........................... Beadle County, S Dakota........... 43 0.8476 0.8484 99943
43030........................... Bennett County, S Dakota.......... 43 0.8476 0.8484 99943
43040........................... Bon Homme County, S Dakota........ 43 0.8476 0.8484 99943
43050........................... Brookings County, S Dakota........ 43 0.8476 0.8484 99943
43060........................... Brown County, S Dakota............ 43 0.8476 0.8484 99943
43070........................... Brule County, S Dakota............ 43 0.8476 0.8484 99943
43080........................... Buffalo County, S Dakota.......... 43 0.8476 0.8484 99943
43090........................... Butte County, S Dakota............ 43 0.8476 0.8484 99943
43100........................... Campbell County, S Dakota......... 43 0.8476 0.8484 99943
43110........................... Charles Mix County, S Dakota...... 43 0.8476 0.8484 99943
43120........................... Clark County, S Dakota............ 43 0.8476 0.8484 99943
43130........................... Clay County, S Dakota............. 43 0.8476 0.8484 99943
[[Page 29151]]
43140........................... Codington County, S Dakota........ 43 0.8476 0.8484 99943
43150........................... Corson County, S Dakota........... 43 0.8476 0.8484 99943
43160........................... Custer County, S Dakota........... 43 0.8476 0.8484 99943
43170........................... Davison County, S Dakota.......... 43 0.8476 0.8484 99943
43180........................... Day County, S Dakota.............. 43 0.8476 0.8484 99943
43190........................... Deuel County, S Dakota............ 43 0.8476 0.8484 99943
43200........................... Dewey County, S Dakota............ 43 0.8476 0.8484 99943
43210........................... Douglas County, S Dakota.......... 43 0.8476 0.8484 99943
43220........................... Edmunds County, S Dakota.......... 43 0.8476 0.8484 99943
43230........................... Fall River County, S Dakota....... 43 0.8476 0.8484 99943
43240........................... Faulk County, S Dakota............ 43 0.8476 0.8484 99943
43250........................... Grant County, S Dakota............ 43 0.8476 0.8484 99943
43260........................... Gregory County, S Dakota.......... 43 0.8476 0.8484 99943
43270........................... Haakon County, S Dakota........... 43 0.8476 0.8484 99943
43280........................... Hamlin County, S Dakota........... 43 0.8476 0.8484 99943
43290........................... Hand County, S Dakota............. 43 0.8476 0.8484 99943
43300........................... Hanson County, S Dakota........... 43 0.8476 0.8484 99943
43310........................... Harding County, S Dakota.......... 43 0.8476 0.8484 99943
43320........................... Hughes County, S Dakota........... 43 0.8476 0.8484 99943
43330........................... Hutchinson County, S Dakota....... 43 0.8476 0.8484 99943
43340........................... Hyde County, S Dakota............. 43 0.8476 0.8484 99943
43350........................... Jackson County, S Dakota.......... 43 0.8476 0.8484 99943
43360........................... Jerauld County, S Dakota.......... 43 0.8476 0.8484 99943
43370........................... Jones County, S Dakota............ 43 0.8476 0.8484 99943
43380........................... Kingsbury County, S Dakota........ 43 0.8476 0.8484 99943
43390........................... Lake County, S Dakota............. 43 0.8476 0.8484 99943
43400........................... Lawrence County, S Dakota......... 43 0.8476 0.8484 99943
43410........................... Lincoln County, S Dakota.......... 7760 0.9645 0.9645 43620
43420........................... Lyman County, S Dakota............ 43 0.8476 0.8484 99943
43430........................... Mc Cook County, S Dakota.......... 43 0.8476 0.9645 43620
43440........................... Mc Pherson County, S Dakota....... 43 0.8476 0.8484 99943
43450........................... Marshall County, S Dakota......... 43 0.8476 0.8484 99943
43460........................... Meade County, S Dakota............ 43 0.8476 0.9021 39660
43470........................... Mellette County, S Dakota......... 43 0.8476 0.8484 99943
43480........................... Miner County, S Dakota............ 43 0.8476 0.8484 99943
43490........................... Minnehaha County, S Dakota........ 7760 0.9645 0.9645 43620
43500........................... Moody County, S Dakota............ 43 0.8476 0.8484 99943
43510........................... Pennington County, S Dakota....... 6660 0.9021 0.9021 39660
43520........................... Perkins County, S Dakota.......... 43 0.8476 0.8484 99943
43530........................... Potter County, S Dakota........... 43 0.8476 0.8484 99943
43540........................... Roberts County, S Dakota.......... 43 0.8476 0.8484 99943
43550........................... Sanborn County, S Dakota.......... 43 0.8476 0.8484 99943
43560........................... Shannon County, S Dakota.......... 43 0.8476 0.8484 99943
43570........................... Spink County, S Dakota............ 43 0.8476 0.8484 99943
43580........................... Stanley County, S Dakota.......... 43 0.8476 0.8484 99943
43590........................... Sully County, S Dakota............ 43 0.8476 0.8484 99943
43600........................... Todd County, S Dakota............. 43 0.8476 0.8484 99943
43610........................... Tripp County, S Dakota............ 43 0.8476 0.8484 99943
43620........................... Turner County, S Dakota........... 43 0.8476 0.9645 43620
43630........................... Union County, S Dakota............ 43 0.8476 0.9376 43580
43640........................... Walworth County, S Dakota......... 43 0.8476 0.8484 99943
43650........................... Washabaugh County, S Dakota....... 43 0.8476 0.8484 99943
43670........................... Yankton County, S Dakota.......... 43 0.8476 0.8484 99943
43680........................... Ziebach County, S Dakota.......... 43 0.8476 0.8484 99943
44000........................... Anderson County, Tennessee........ 3840 0.8411 0.8454 28940
44010........................... Bedford County, Tennessee......... 44 0.7988 0.7888 99944
44020........................... Benton County, Tennessee.......... 44 0.7988 0.7888 99944
44030........................... Bledsoe County, Tennessee......... 44 0.7988 0.7888 99944
44040........................... Blount County, Tennessee.......... 3840 0.8411 0.8454 28940
44050........................... Bradley County, Tennessee......... 44 0.7988 0.8141 17420
44060........................... Campbell County, Tennessee........ 44 0.7988 0.7888 99944
44070........................... Cannon County, Tennessee.......... 44 0.7988 0.9769 34980
44080........................... Carroll County, Tennessee......... 44 0.7988 0.7888 99944
44090........................... Carter County, Tennessee.......... 3660 0.8015 0.7945 27740
44100........................... Cheatham County, Tennessee........ 5360 0.9787 0.9769 34980
44110........................... Chester County, Tennessee......... 3580 0.8973 0.8973 27180
44120........................... Claiborne County, Tennessee....... 44 0.7988 0.7888 99944
44130........................... Clay County, Tennessee............ 44 0.7988 0.7888 99944
44140........................... Cocke County, Tennessee........... 44 0.7988 0.7888 99944
[[Page 29152]]
44150........................... Coffee County, Tennessee.......... 44 0.7988 0.7888 99944
44160........................... Crockett County, Tennessee........ 44 0.7988 0.7888 99944
44170........................... Cumberland County, Tennessee...... 44 0.7988 0.7888 99944
44180........................... Davidson County, Tennessee........ 5360 0.9787 0.9769 34980
44190........................... Decatur County, Tennessee......... 44 0.7988 0.7888 99944
44200........................... De Kalb County, Tennessee......... 44 0.7988 0.7888 99944
44210........................... Dickson County, Tennessee......... 5360 0.9787 0.9769 34980
44220........................... Dyer County, Tennessee............ 44 0.7988 0.7888 99944
44230........................... Fayette County, Tennessee......... 4920 0.9360 0.9341 32820
44240........................... Fentress County, Tennessee........ 44 0.7988 0.7888 99944
44250........................... Franklin County, Tennessee........ 44 0.7988 0.7888 99944
44260........................... Gibson County, Tennessee.......... 44 0.7988 0.7888 99944
44270........................... Giles County, Tennessee........... 44 0.7988 0.7888 99944
44280........................... Grainger County, Tennessee........ 44 0.7988 0.8753 34100
44290........................... Greene County, Tennessee.......... 44 0.7988 0.7888 99944
44300........................... Grundy County, Tennessee.......... 44 0.7988 0.7888 99944
44310........................... Hamblen County, Tennessee......... 44 0.7988 0.8753 34100
44320........................... Hamilton County, Tennessee........ 1560 0.9098 0.9098 16860
44330........................... Hancock County, Tennessee......... 44 0.7988 0.7888 99944
44340........................... Hardeman County, Tennessee........ 44 0.7988 0.7888 99944
44350........................... Hardin County, Tennessee.......... 44 0.7988 0.7888 99944
44360........................... Hawkins County, Tennessee......... 3660 0.8015 0.8062 28700
44370........................... Haywood County, Tennessee......... 44 0.7988 0.7888 99944
44380........................... Henderson County, Tennessee....... 44 0.7988 0.7888 99944
44390........................... Henry County, Tennessee........... 44 0.7988 0.7888 99944
44400........................... Hickman County, Tennessee......... 44 0.7988 0.9769 34980
44410........................... Houston County, Tennessee......... 44 0.7988 0.7888 99944
44420........................... Humphreys County, Tennessee....... 44 0.7988 0.7888 99944
44430........................... Jackson County, Tennessee......... 44 0.7988 0.7888 99944
44440........................... Jefferson County, Tennessee....... 44 0.7988 0.8753 34100
44450........................... Johnson County, Tennessee......... 44 0.7988 0.7888 99944
44460........................... Knox County, Tennessee............ 3840 0.8411 0.8454 28940
44470........................... Lake County, Tennessee............ 44 0.7988 0.7888 99944
44480........................... Lauderdale County, Tennessee...... 44 0.7988 0.7888 99944
44490........................... Lawrence County, Tennessee........ 44 0.7988 0.7888 99944
44500........................... Lewis County, Tennessee........... 44 0.7988 0.7888 99944
44510........................... Lincoln County, Tennessee......... 44 0.7988 0.7888 99944
44520........................... Loudon County, Tennessee.......... 3840 0.8411 0.8454 28940
44530........................... Mc Minn County, Tennessee......... 44 0.7988 0.7888 99944
44540........................... Mc Nairy County, Tennessee........ 44 0.7988 0.7888 99944
44550........................... Macon County, Tennessee........... 44 0.7988 0.9769 34980
44560........................... Madison County, Tennessee......... 3580 0.8973 0.8973 27180
44570........................... Marion County, Tennessee.......... 1560 0.9098 0.9098 16860
44580........................... Marshall County, Tennessee........ 44 0.7988 0.7888 99944
44590........................... Maury County, Tennessee........... 44 0.7988 0.7888 99944
44600........................... Meigs County, Tennessee........... 44 0.7988 0.7888 99944
44610........................... Monroe County, Tennessee.......... 44 0.7988 0.7888 99944
44620........................... Montgomery County, Tennessee...... 1660 0.8292 0.8292 17300
44630........................... Moore County, Tennessee........... 44 0.7988 0.7888 99944
44640........................... Morgan County, Tennessee.......... 44 0.7988 0.7888 99944
44650........................... Obion County, Tennessee........... 44 0.7988 0.7888 99944
44660........................... Overton County, Tennessee......... 44 0.7988 0.7888 99944
44670........................... Perry County, Tennessee........... 44 0.7988 0.7888 99944
44680........................... Pickett County, Tennessee......... 44 0.7988 0.7888 99944
44690........................... Polk County, Tennessee............ 44 0.7988 0.8141 17420
44700........................... Putnam County, Tennessee.......... 44 0.7988 0.7888 99944
44710........................... Rhea County, Tennessee............ 44 0.7988 0.7888 99944
44720........................... Roane County, Tennessee........... 44 0.7988 0.7888 99944
44730........................... Robertson County, Tennessee....... 5360 0.9787 0.9769 34980
44740........................... Rutherford County, Tennessee...... 5360 0.9787 0.9769 34980
44750........................... Scott County, Tennessee........... 44 0.7988 0.7888 99944
44760........................... Sequatchie County, Tennessee...... 44 0.7988 0.9098 16860
44770........................... Sevier County, Tennessee.......... 3840 0.8411 0.7888 99944
44780........................... Shelby County, Tennessee.......... 4920 0.9360 0.9341 32820
44790........................... Smith County, Tennessee........... 44 0.7988 0.9769 34980
44800........................... Stewart County, Tennessee......... 44 0.7988 0.8292 17300
44810........................... Sullivan County, Tennessee........ 3660 0.8015 0.8062 28700
44820........................... Sumner County, Tennessee.......... 5360 0.9787 0.9769 34980
44830........................... Tipton County, Tennessee.......... 4920 0.9360 0.9341 32820
[[Page 29153]]
44840........................... Trousdale County, Tennessee....... 44 0.7988 0.9769 34980
44850........................... Unicoi County, Tennessee.......... 3660 0.8015 0.7945 27740
44860........................... Union County, Tennessee........... 3840 0.8411 0.8454 28940
44870........................... Van Buren County, Tennessee....... 44 0.7988 0.7888 99944
44880........................... Warren County, Tennessee.......... 44 0.7988 0.7888 99944
44890........................... Washington County, Tennessee...... 3660 0.8015 0.7945 27740
44900........................... Wayne County, Tennessee........... 44 0.7988 0.7888 99944
44910........................... Weakley County, Tennessee......... 44 0.7988 0.7888 99944
44920........................... White County, Tennessee........... 44 0.7988 0.7888 99944
44930........................... Williamson County, Tennessee...... 5360 0.9787 0.9769 34980
44940........................... Wilson County, Tennessee.......... 5360 0.9787 0.9769 34980
45000........................... Anderson County, Texas............ 45 0.7936 0.8007 99945
45010........................... Andrews County, Texas............. 45 0.7936 0.8007 99945
45020........................... Angelina County, Texas............ 45 0.7936 0.8007 99945
45030........................... Aransas County, Texas............. 45 0.7936 0.8559 18580
45040........................... Archer County, Texas.............. 9080 0.8373 0.8294 48660
45050........................... Armstrong County, Texas........... 45 0.7936 0.9166 11100
45060........................... Atascosa County, Texas............ 45 0.7936 0.8989 41700
45070........................... Austin County, Texas.............. 45 0.7936 1.0005 26420
45080........................... Bailey County, Texas.............. 45 0.7936 0.8007 99945
45090........................... Bandera County, Texas............. 45 0.7936 0.8989 41700
45100........................... Bastrop County, Texas............. 0640 0.9450 0.9450 12420
45110........................... Baylor County, Texas.............. 45 0.7936 0.8007 99945
45113........................... Bee County, Texas................. 45 0.7936 0.8007 99945
45120........................... Bell County, Texas................ 3810 0.8535 0.8535 28660
45130........................... Bexar County, Texas............... 7240 0.8993 0.8989 41700
45140........................... Blanco County, Texas.............. 45 0.7936 0.8007 99945
45150........................... Borden County, Texas.............. 45 0.7936 0.8007 99945
45160........................... Bosque County, Texas.............. 45 0.7936 0.8007 99945
45170........................... Bowie County, Texas............... 8360 0.8291 0.8291 45500
45180........................... Brazoria County, Texas............ 1145 0.8572 1.0005 26420
45190........................... Brazos County, Texas.............. 1260 0.8909 0.8909 17780
45200........................... Brewster County, Texas............ 45 0.7936 0.8007 99945
45201........................... Briscoe County, Texas............. 45 0.7936 0.8007 99945
45210........................... Brooks County, Texas.............. 45 0.7936 0.8007 99945
45220........................... Brown County, Texas............... 45 0.7936 0.8007 99945
45221........................... Burleson County, Texas............ 45 0.7936 0.8909 17780
45222........................... Burnet County, Texas.............. 45 0.7936 0.8007 99945
45223........................... Caldwell County, Texas............ 0640 0.9450 0.9450 12420
45224........................... Calhoun County, Texas............. 45 0.7936 0.8168 47020
45230........................... Callahan County, Texas............ 45 0.7936 0.7904 10180
45240........................... Cameron County, Texas............. 1240 0.9822 0.9822 15180
45250........................... Camp County, Texas................ 45 0.7936 0.8007 99945
45251........................... Carson County, Texas.............. 45 0.7936 0.9166 11100
45260........................... Cass County, Texas................ 45 0.7936 0.8007 99945
45270........................... Castro County, Texas.............. 45 0.7936 0.8007 99945
45280........................... Chambers County, Texas............ 3360 1.0101 1.0005 26420
45281........................... Cherokee County, Texas............ 45 0.7936 0.8007 99945
45290........................... Childress County, Texas........... 45 0.7936 0.8007 99945
45291........................... Clay County, Texas................ 45 0.7936 0.8294 48660
45292........................... Cochran County, Texas............. 45 0.7936 0.8007 99945
45300........................... Coke County, Texas................ 45 0.7936 0.8007 99945
45301........................... Coleman County, Texas............. 45 0.7936 0.8007 99945
45310........................... Collin County, Texas.............. 1920 1.0211 1.0233 19124
45311........................... Collingsworth County, Texas....... 45 0.7936 0.8007 99945
45312........................... Colorado County, Texas............ 45 0.7936 0.8007 99945
45320........................... Comal County, Texas............... 7240 0.8993 0.8989 41700
45321........................... Comanche County, Texas............ 45 0.7936 0.8007 99945
45330........................... Concho County, Texas.............. 45 0.7936 0.8007 99945
45340........................... Cooke County, Texas............... 45 0.7936 0.8007 99945
45341........................... Coryell County, Texas............. 3810 0.8535 0.8535 28660
45350........................... Cottle County, Texas.............. 45 0.7936 0.8007 99945
45360........................... Crane County, Texas............... 45 0.7936 0.8007 99945
45361........................... Crockett County, Texas............ 45 0.7936 0.8007 99945
45362........................... Crosby County, Texas.............. 45 0.7936 0.8792 31180
45370........................... Culberson County, Texas........... 45 0.7936 0.8007 99945
45380........................... Dallam County, Texas.............. 45 0.7936 0.8007 99945
45390........................... Dallas County, Texas.............. 1920 1.0211 1.0233 19124
45391........................... Dawson County, Texas.............. 45 0.7936 0.8007 99945
[[Page 29154]]
45392........................... Deaf Smith County, Texas.......... 45 0.7936 0.8007 99945
45400........................... Delta County, Texas............... 45 0.7936 1.0233 19124
45410........................... Denton County, Texas.............. 1920 1.0211 1.0233 19124
45420........................... De Witt County, Texas............. 45 0.7936 0.8007 99945
45421........................... Dickens County, Texas............. 45 0.7936 0.8007 99945
45430........................... Dimmit County, Texas.............. 45 0.7936 0.8007 99945
45431........................... Donley County, Texas.............. 45 0.7936 0.8007 99945
45440........................... Duval County, Texas............... 45 0.7936 0.8007 99945
45450........................... Eastland County, Texas............ 45 0.7936 0.8007 99945
45451........................... Ector County, Texas............... 5800 0.9751 0.9894 36220
45460........................... Edwards County, Texas............. 45 0.7936 0.8007 99945
45470........................... Ellis County, Texas............... 1920 1.0211 1.0233 19124
45480........................... El Paso County, Texas............. 2320 0.8924 0.8924 21340
45490........................... Erath County, Texas............... 45 0.7936 0.8007 99945
45500........................... Falls County, Texas............... 45 0.7936 0.8007 99945
45510........................... Fannin County, Texas.............. 45 0.7936 0.8007 99945
45511........................... Fayette County, Texas............. 45 0.7936 0.8007 99945
45520........................... Fisher County, Texas.............. 45 0.7936 0.8007 99945
45521........................... Floyd County, Texas............... 45 0.7936 0.8007 99945
45522........................... Foard County, Texas............... 45 0.7936 0.8007 99945
45530........................... Fort Bend County, Texas........... 3360 1.0101 1.0005 26420
45531........................... Franklin County, Texas............ 45 0.7936 0.8007 99945
45540........................... Freestone County, Texas........... 45 0.7936 0.8007 99945
45541........................... Frio County, Texas................ 45 0.7936 0.8007 99945
45542........................... Gaines County, Texas.............. 45 0.7936 0.8007 99945
45550........................... Galveston County, Texas........... 2920 0.9645 1.0005 26420
45551........................... Garza County, Texas............... 45 0.7936 0.8007 99945
45552........................... Gillespie County, Texas........... 45 0.7936 0.8007 99945
45560........................... Glasscock County, Texas........... 45 0.7936 0.8007 99945
45561........................... Goliad County, Texas.............. 45 0.7936 0.8168 47020
45562........................... Gonzales County, Texas............ 45 0.7936 0.8007 99945
45563........................... Gray County, Texas................ 45 0.7936 0.8007 99945
45564........................... Grayson County, Texas............. 7640 0.9516 0.9516 43300
45570........................... Gregg County, Texas............... 4420 0.8897 0.8739 30980
45580........................... Grimes County, Texas.............. 45 0.7936 0.8007 99945
45581........................... Guadaloupe County, Texas.......... 7240 0.8993 0.8989 41700
45582........................... Hale County, Texas................ 45 0.7936 0.8007 99945
45583........................... Hall County, Texas................ 45 0.7936 0.8007 99945
45590........................... Hamilton County, Texas............ 45 0.7936 0.8007 99945
45591........................... Hansford County, Texas............ 45 0.7936 0.8007 99945
45592........................... Hardeman County, Texas............ 45 0.7936 0.8007 99945
45600........................... Hardin County, Texas.............. 0840 0.8421 0.8421 13140
45610........................... Harris County, Texas.............. 3360 1.0101 1.0005 26420
45620........................... Harrison County, Texas............ 4420 0.8897 0.8007 99945
45621........................... Hartley County, Texas............. 45 0.7936 0.8007 99945
45630........................... Haskell County, Texas............. 45 0.7936 0.8007 99945
45631........................... Hays County, Texas................ 0640 0.9450 0.9450 12420
45632........................... Hemphill County, Texas............ 45 0.7936 0.8007 99945
45640........................... Henderson County, Texas........... 1920 1.0211 0.8007 99945
45650........................... Hidalgo County, Texas............. 4880 0.8943 0.8943 32580
45651........................... Hill County, Texas................ 45 0.7936 0.8007 99945
45652........................... Hockley County, Texas............. 45 0.7936 0.8007 99945
45653........................... Hood County, Texas................ 2800 0.9545 0.8007 99945
45654........................... Hopkins County, Texas............. 45 0.7936 0.8007 99945
45660........................... Houston County, Texas............. 45 0.7936 0.8007 99945
45661........................... Howard County, Texas.............. 45 0.7936 0.8007 99945
45662........................... Hudspeth County, Texas............ 45 0.7936 0.8007 99945
45670........................... Hunt County, Texas................ 1920 1.0211 1.0233 19124
45671........................... Hutchinson County, Texas.......... 45 0.7936 0.8007 99945
45672........................... Irion County, Texas............... 45 0.7936 0.8280 41660
45680........................... Jack County, Texas................ 45 0.7936 0.8007 99945
45681........................... Jackson County, Texas............. 45 0.7936 0.8007 99945
45690........................... Jasper County, Texas.............. 45 0.7936 0.8007 99945
45691........................... Jeff Davis County, Texas.......... 45 0.7936 0.8007 99945
45700........................... Jefferson County, Texas........... 0840 0.8421 0.8421 13140
45710........................... Jim Hogg County, Texas............ 45 0.7936 0.8007 99945
45711........................... Jim Wells County, Texas........... 45 0.7936 0.8007 99945
45720........................... Johnson County, Texas............. 2800 0.9545 0.9510 23104
45721........................... Jones County, Texas............... 45 0.7936 0.7904 10180
[[Page 29155]]
45722........................... Karnes County, Texas.............. 45 0.7936 0.8007 99945
45730........................... Kaufman County, Texas............. 1920 1.0211 1.0233 19124
45731........................... Kendall County, Texas............. 45 0.7936 0.8989 41700
45732........................... Kenedy County, Texas.............. 45 0.7936 0.8007 99945
45733........................... Kent County, Texas................ 45 0.7936 0.8007 99945
45734........................... Kerr County, Texas................ 45 0.7936 0.8007 99945
45740........................... Kimble County, Texas.............. 45 0.7936 0.8007 99945
45741........................... King County, Texas................ 45 0.7936 0.8007 99945
45742........................... Kinney County, Texas.............. 45 0.7936 0.8007 99945
45743........................... Kleberg County, Texas............. 45 0.7936 0.8007 99945
45744........................... Knox County, Texas................ 45 0.7936 0.8007 99945
45750........................... Lamar County, Texas............... 45 0.7936 0.8007 99945
45751........................... Lamb County, Texas................ 45 0.7936 0.8007 99945
45752........................... Lampasas County, Texas............ 45 0.7936 0.8535 28660
45753........................... La Salle County, Texas............ 45 0.7936 0.8007 99945
45754........................... Lavaca County, Texas.............. 45 0.7936 0.8007 99945
45755........................... Lee County, Texas................. 45 0.7936 0.8007 99945
45756........................... Leon County, Texas................ 45 0.7936 0.8007 99945
45757........................... Liberty County, Texas............. 3360 1.0101 1.0005 26420
45758........................... Limestone County, Texas........... 45 0.7936 0.8007 99945
45759........................... Lipscomb County, Texas............ 45 0.7936 0.8007 99945
45760........................... Live Oak County, Texas............ 45 0.7936 0.8007 99945
45761........................... Llano County, Texas............... 45 0.7936 0.8007 99945
45762........................... Loving County, Texas.............. 45 0.7936 0.8007 99945
45770........................... Lubbock County, Texas............. 4600 0.8792 0.8792 31180
45771........................... Lynn County, Texas................ 45 0.7936 0.8007 99945
45772........................... Mc Culloch County, Texas.......... 45 0.7936 0.8007 99945
45780........................... Mc Lennan County, Texas........... 8800 0.8527 0.8527 47380
45781........................... Mc Mullen County, Texas........... 45 0.7936 0.8007 99945
45782........................... Madison County, Texas............. 45 0.7936 0.8007 99945
45783........................... Marion County, Texas.............. 45 0.7936 0.8007 99945
45784........................... Martin County, Texas.............. 45 0.7936 0.8007 99945
45785........................... Mason County, Texas............... 45 0.7936 0.8007 99945
45790........................... Matagorda County, Texas........... 45 0.7936 0.8007 99945
45791........................... Maverick County, Texas............ 45 0.7936 0.8007 99945
45792........................... Medina County, Texas.............. 45 0.7936 0.8989 41700
45793........................... Menard County, Texas.............. 45 0.7936 0.8007 99945
45794........................... Midland County, Texas............. 5800 0.9751 0.9523 33260
45795........................... Milam County, Texas............... 45 0.7936 0.8007 99945
45796........................... Mills County, Texas............... 45 0.7936 0.8007 99945
45797........................... Mitchell County, Texas............ 45 0.7936 0.8007 99945
45800........................... Montague County, Texas............ 45 0.7936 0.8007 99945
45801........................... Montgomery County, Texas.......... 3360 1.0101 1.0005 26420
45802........................... Moore County, Texas............... 45 0.7936 0.8007 99945
45803........................... Morris County, Texas.............. 45 0.7936 0.8007 99945
45804........................... Motley County, Texas.............. 45 0.7936 0.8007 99945
45810........................... Nacogdoches County, Texas......... 45 0.7936 0.8007 99945
45820........................... Navarro County, Texas............. 45 0.7936 0.8007 99945
45821........................... Newton County, Texas.............. 45 0.7936 0.8007 99945
45822........................... Nolan County, Texas............... 45 0.7936 0.8007 99945
45830........................... Nueces County, Texas.............. 1880 0.8559 0.8559 18580
45831........................... Ochiltree County, Texas........... 45 0.7936 0.8007 99945
45832........................... Oldham County, Texas.............. 45 0.7936 0.8007 99945
45840........................... Orange County, Texas.............. 0840 0.8421 0.8421 13140
45841........................... Palo Pinto County, Texas.......... 45 0.7936 0.8007 99945
45842........................... Panola County, Texas.............. 45 0.7936 0.8007 99945
45843........................... Parker County, Texas.............. 2800 0.9545 0.9510 23104
45844........................... Parmer County, Texas.............. 45 0.7936 0.8007 99945
45845........................... Pecos County, Texas............... 45 0.7936 0.8007 99945
45850........................... Polk County, Texas................ 45 0.7936 0.8007 99945
45860........................... Potter County, Texas.............. 0320 0.9166 0.9166 11100
45861........................... Presidio County, Texas............ 45 0.7936 0.8007 99945
45870........................... Rains County, Texas............... 45 0.7936 0.8007 99945
45871........................... Randall County, Texas............. 0320 0.9166 0.9166 11100
45872........................... Reagan County, Texas.............. 45 0.7936 0.8007 99945
45873........................... Real County, Texas................ 45 0.7936 0.8007 99945
45874........................... Red River County, Texas........... 45 0.7936 0.8007 99945
45875........................... Reeves County, Texas.............. 45 0.7936 0.8007 99945
45876........................... Refugio County, Texas............. 45 0.7936 0.8007 99945
[[Page 29156]]
45877........................... Roberts County, Texas............. 45 0.7936 0.8007 99945
45878........................... Robertson County, Texas........... 45 0.7936 0.8909 17780
45879........................... Rockwall County, Texas............ 1920 1.0211 1.0233 19124
45880........................... Runnels County, Texas............. 45 0.7936 0.8007 99945
45881........................... Rusk County, Texas................ 45 0.7936 0.8739 30980
45882........................... Sabine County, Texas.............. 45 0.7936 0.8007 99945
45883........................... San Augustine County, Texas....... 45 0.7936 0.8007 99945
45884........................... San Jacinto County, Texas......... 45 0.7936 1.0005 26420
45885........................... San Patricio County, Texas........ 1880 0.8559 0.8559 18580
45886........................... San Saba County, Texas............ 45 0.7936 0.8007 99945
45887........................... Schleicher County, Texas.......... 45 0.7936 0.8007 99945
45888........................... Scurry County, Texas.............. 45 0.7936 0.8007 99945
45889........................... Shackelford County, Texas......... 45 0.7936 0.8007 99945
45890........................... Shelby County, Texas.............. 45 0.7936 0.8007 99945
45891........................... Sherman County, Texas............. 45 0.7936 0.8007 99945
45892........................... Smith County, Texas............... 8640 0.9307 0.9307 46340
45893........................... Somervell County, Texas........... 45 0.7936 0.8007 99945
45900........................... Starr County, Texas............... 45 0.7936 0.8007 99945
45901........................... Stephens County, Texas............ 45 0.7936 0.8007 99945
45902........................... Sterling County, Texas............ 45 0.7936 0.8007 99945
45903........................... Stonewall County, Texas........... 45 0.7936 0.8007 99945
45904........................... Sutton County, Texas.............. 45 0.7936 0.8007 99945
45905........................... Swisher County, Texas............. 45 0.7936 0.8007 99945
45910........................... Tarrant County, Texas............. 2800 0.9545 0.9510 23104
45911........................... Taylor County, Texas.............. 0040 0.8062 0.7904 10180
45912........................... Terrell County, Texas............. 45 0.7936 0.8007 99945
45913........................... Terry County, Texas............... 45 0.7936 0.8007 99945
45920........................... Throckmorton County, Texas........ 45 0.7936 0.8007 99945
45921........................... Titus County, Texas............... 45 0.7936 0.8007 99945
45930........................... Tom Green County, Texas........... 7200 0.8280 0.8280 41660
45940........................... Travis County, Texas.............. 0640 0.9450 0.9450 12420
45941........................... Trinity County, Texas............. 45 0.7936 0.8007 99945
45942........................... Tyler County, Texas............... 45 0.7936 0.8007 99945
45943........................... Upshur County, Texas.............. 4420 0.8897 0.8739 30980
45944........................... Upton County, Texas............... 45 0.7936 0.8007 99945
45945........................... Uvalde County, Texas.............. 45 0.7936 0.8007 99945
45946........................... Val Verde County, Texas........... 45 0.7936 0.8007 99945
45947........................... Van Zandt County, Texas........... 45 0.7936 0.8007 99945
45948........................... Victoria County, Texas............ 8750 0.8168 0.8168 47020
45949........................... Walker County, Texas.............. 45 0.7936 0.8007 99945
45950........................... Waller County, Texas.............. 3360 1.0101 1.0005 26420
45951........................... Ward County, Texas................ 45 0.7936 0.8007 99945
45952........................... Washington County, Texas.......... 45 0.7936 0.8007 99945
45953........................... Webb County, Texas................ 4080 0.8076 0.8076 29700
45954........................... Wharton County, Texas............. 45 0.7936 0.8007 99945
45955........................... Wheeler County, Texas............. 45 0.7936 0.8007 99945
45960........................... Wichita County, Texas............. 9080 0.8373 0.8294 48660
45961........................... Wilbarger County, Texas........... 45 0.7936 0.8007 99945
45962........................... Willacy County, Texas............. 45 0.7936 0.8007 99945
45970........................... Williamson County, Texas.......... 0640 0.9450 0.9450 12420
45971........................... Wilson County, Texas.............. 7240 0.8993 0.8989 41700
45972........................... Winkler County, Texas............. 45 0.7936 0.8007 99945
45973........................... Wise County, Texas................ 45 0.7936 0.9510 23104
45974........................... Wood County, Texas................ 45 0.7936 0.8007 99945
45980........................... Yoakum County, Texas.............. 45 0.7936 0.8007 99945
45981........................... Young County, Texas............... 45 0.7936 0.8007 99945
45982........................... Zapata County, Texas.............. 45 0.7936 0.8007 99945
45983........................... Zavala County, Texas.............. 45 0.7936 0.8007 99945
46000........................... Beaver County, Utah............... 46 0.8779 0.8126 99946
46010........................... Box Elder County, Utah............ 46 0.8779 0.8126 99946
46020........................... Cache County, Utah................ 46 0.8779 0.9173 30860
46030........................... Carbon County, Utah............... 46 0.8779 0.8126 99946
46040........................... Daggett County, Utah.............. 46 0.8779 0.8126 99946
46050........................... Davis County, Utah................ 7160 0.9350 0.9038 36260
46060........................... Duchesne County, Utah............. 46 0.8779 0.8126 99946
46070........................... Emery County, Utah................ 46 0.8779 0.8126 99946
46080........................... Garfield County, Utah............. 46 0.8779 0.8126 99946
46090........................... Grand County, Utah................ 46 0.8779 0.8126 99946
46100........................... Iron County, Utah................. 46 0.8779 0.8126 99946
[[Page 29157]]
46110........................... Juab County, Utah................. 46 0.8779 0.9510 39340
46120........................... Kane County, Utah................. 2620 1.1857 0.8126 99946
46130........................... Millard County, Utah.............. 46 0.8779 0.8126 99946
46140........................... Morgan County, Utah............... 46 0.8779 0.9038 36260
46150........................... Piute County, Utah................ 46 0.8779 0.8126 99946
46160........................... Rich County, Utah................. 46 0.8779 0.8126 99946
46170........................... Salt Lake County, Utah............ 7160 0.9350 0.9433 41620
46180........................... San Juan County, Utah............. 46 0.8779 0.8126 99946
46190........................... Sanpete County, Utah.............. 46 0.8779 0.8126 99946
46200........................... Sevier County, Utah............... 46 0.8779 0.8126 99946
46210........................... Summit County, Utah............... 46 0.8779 0.9433 41620
46220........................... Tooele County, Utah............... 46 0.8779 0.9433 41620
46230........................... Uintah County, Utah............... 46 0.8779 0.8126 99946
46240........................... Utah County, Utah................. 6520 0.9510 0.9510 39340
46250........................... Wasatch County, Utah.............. 46 0.8779 0.8126 99946
46260........................... Washington County, Utah........... 46 0.8779 0.9402 41100
46270........................... Wayne County, Utah................ 46 0.8779 0.8126 99946
46280........................... Weber County, Utah................ 7160 0.9350 0.9038 36260
47000........................... Addison County, Vermont........... 47 0.9840 0.9840 99947
47010........................... Bennington County, Vermont........ 47 0.9840 0.9840 99947
47020........................... Caledonia County, Vermont......... 47 0.9840 0.9840 99947
47030........................... Chittenden County, Vermont........ 1303 0.9446 0.9446 15540
47040........................... Essex County, Vermont............. 47 0.9840 0.9840 99947
47050........................... Franklin County, Vermont.......... 1303 0.9446 0.9446 15540
47060........................... Grand Isle County, Vermont........ 1303 0.9446 0.9446 15540
47070........................... Lamoille County, Vermont.......... 47 0.9840 0.9840 99947
47080........................... Orange County, Vermont............ 47 0.9840 0.9840 99947
47090........................... Orleans County, Vermont........... 47 0.9840 0.9840 99947
47100........................... Rutland County, Vermont........... 47 0.9840 0.9840 99947
47110........................... Washington County, Vermont........ 47 0.9840 0.9840 99947
47120........................... Windham County, Vermont........... 47 0.9840 0.9840 99947
47130........................... Windsor County, Vermont........... 47 0.9840 0.9840 99947
49000........................... Accomack County, Virginia......... 49 0.8420 0.8012 99949
49010........................... Albemarle County, Virginia........ 1540 1.0234 1.0234 16820
49011........................... Alexandria City County, Virginia.. 8840 1.0983 1.0932 47894
49020........................... Alleghany County, Virginia........ 49 0.8420 0.8012 99949
49030........................... Amelia County, Virginia........... 49 0.8420 0.9338 40060
49040........................... Amherst County, Virginia.......... 4640 0.8700 0.8700 31340
49050........................... Appomattox County, Virginia....... 49 0.8420 0.8700 31340
49060........................... Arlington County, Virginia........ 8840 1.0983 1.0932 47894
49070........................... Augusta County, Virginia.......... 49 0.8420 0.8012 99949
49080........................... Bath County, Virginia............. 49 0.8420 0.8012 99949
49088........................... Bedford City County, Virginia..... 4640 0.8700 0.8700 31340
49090........................... Bedford County, Virginia.......... 4640 0.8700 0.8700 31340
49100........................... Bland County, Virginia............ 49 0.8420 0.8012 99949
49110........................... Botetourt County, Virginia........ 6800 0.8395 0.8383 40220
49111........................... Bristol City County, Virginia..... 3660 0.8015 0.8062 28700
49120........................... Brunswick County, Virginia........ 49 0.8420 0.8012 99949
49130........................... Buchanan County, Virginia......... 49 0.8420 0.8012 99949
49140........................... Buckingham County, Virginia....... 49 0.8420 0.8012 99949
49141........................... Buena Vista City County, Virginia. 49 0.8420 0.8012 99949
49150........................... Campbell County, Virginia......... 4640 0.8700 0.8700 31340
49160........................... Caroline County, Virginia......... 49 0.8420 0.9338 40060
49170........................... Carroll County, Virginia.......... 49 0.8420 0.8012 99949
49180........................... Charles City County, Virginia..... 6760 0.9338 0.9338 40060
49190........................... Charlotte County, Virginia........ 49 0.8420 0.8012 99949
49191........................... Charlottesville City County, 1540 1.0234 1.0234 16820
Virginia.
49194........................... Chesapeake County, Virginia....... 5720 0.8808 0.8808 47260
49200........................... Chesterfield County, Virginia..... 6760 0.9338 0.9338 40060
49210........................... Clarke County, Virginia........... 8840 1.0983 1.0932 47894
49211........................... Clifton Forge City County, 49 0.8420 0.8012 99949
Virginia.
49212........................... Colonial Heights County, Virginia. 6760 0.9338 0.9338 40060
49213........................... Covington City County, Virginia... 49 0.8420 0.8012 99949
49220........................... Craig County, Virginia............ 49 0.8420 0.8383 40220
49230........................... Culpeper County, Virginia......... 8840 1.0983 0.8012 99949
49240........................... Cumberland County, Virginia....... 49 0.8420 0.9338 40060
49241........................... Danville City County, Virginia.... 1950 0.8497 0.8497 19260
49250........................... Dickenson County, Virginia........ 49 0.8420 0.8012 99949
49260........................... Dinniddie County, Virginia........ 6760 0.9338 0.9338 40060
[[Page 29158]]
49270........................... Emporia County, Virginia.......... 49 0.8420 0.8012 99949
49280........................... Essex County, Virginia............ 49 0.8420 0.8012 99949
49288........................... Fairfax City County, Virginia..... 8840 1.0983 1.0932 47894
49290........................... Fairfax County, Virginia.......... 8840 1.0983 1.0932 47894
49291........................... Falls Church City County, Virginia 8840 1.0983 1.0932 47894
49300........................... Fauquier County, Virginia......... 8840 1.0983 1.0932 47894
49310........................... Floyd County, Virginia............ 49 0.8420 0.8012 99949
49320........................... Fluvanna County, Virginia......... 1540 1.0234 1.0234 16820
49328........................... Franklin City County, Virginia.... 49 0.8420 0.8012 99949
49330........................... Franklin County, Virginia......... 49 0.8420 0.8383 40220
49340........................... Frederick County, Virginia........ 49 0.8420 1.0224 49020
49342........................... Fredericksburg City County, 8840 1.0983 1.0932 47894
Virginia.
49343........................... Galax City County, Virginia....... 49 0.8420 0.8012 99949
49350........................... Giles County, Virginia............ 49 0.8420 0.7962 13980
49360........................... Gloucester County, Virginia....... 5720 0.8808 0.8808 47260
49370........................... Goochland County, Virginia........ 6760 0.9338 0.9338 40060
49380........................... Grayson County, Virginia.......... 49 0.8420 0.8012 99949
49390........................... Greene County, Virginia........... 1540 1.0234 1.0234 16820
49400........................... Greensville County, Virginia...... 49 0.8420 0.8012 99949
49410........................... Halifax County, Virginia.......... 49 0.8420 0.8012 99949
49411........................... Hampton City County, Virginia..... 5720 0.8808 0.8808 47260
49420........................... Hanover County, Virginia.......... 6760 0.9338 0.9338 40060
49421........................... Harrisonburg City County, Virginia 49 0.8420 0.9098 25500
49430........................... Henrico County, Virginia.......... 6760 0.9338 0.9338 40060
49440........................... Henry County, Virginia............ 49 0.8420 0.8012 99949
49450........................... Highland County, Virginia......... 49 0.8420 0.8012 99949
49451........................... Hopewell City County, Virginia.... 6760 0.9338 0.9338 40060
49460........................... Isle Of Wight County, Virginia.... 5720 0.8808 0.8808 47260
49470........................... James City Co County, Virginia.... 5720 0.8808 0.8808 47260
49480........................... King And Queen County, Virginia... 49 0.8420 0.9338 40060
49490........................... King George County, Virginia...... 8840 1.0983 0.8012 99949
49500........................... King William County, Virginia..... 49 0.8420 0.9338 40060
49510........................... Lancaster County, Virginia........ 49 0.8420 0.8012 99949
49520........................... Lee County, Virginia.............. 49 0.8420 0.8012 99949
49522........................... Lexington County, Virginia........ 49 0.8420 0.8012 99949
49530........................... Loudoun County, Virginia.......... 8840 1.0983 1.0932 47894
49540........................... Louisa County, Virginia........... 49 0.8420 0.9338 40060
49550........................... Lunenburg County, Virginia........ 49 0.8420 0.8012 99949
49551........................... Lynchburg City County, Virginia... 4640 0.8700 0.8700 31340
49560........................... Madison County, Virginia.......... 49 0.8420 0.8012 99949
49561........................... Martinsville City County, Virginia 49 0.8420 0.8012 99949
49563........................... Manassas City County, Virginia.... 8840 1.0983 1.0932 47894
49565........................... Manassas Park City County, 8840 1.0983 1.0932 47894
Virginia.
49570........................... Mathews County, Virginia.......... 5720 0.8808 0.8808 47260
49580........................... Mecklenburg County, Virginia...... 49 0.8420 0.8012 99949
49590........................... Middlesex County, Virginia........ 49 0.8420 0.8012 99949
49600........................... Montgomery County, Virginia....... 49 0.8420 0.7962 13980
49610........................... Nansemond County, Virginia........ 49 0.8420 0.8012 99949
49620........................... Nelson County, Virginia........... 49 0.8420 1.0234 16820
49621........................... New Kent County, Virginia......... 6760 0.9338 0.9338 40060
49622........................... Newport News City County, Virginia 5720 0.8808 0.8808 47260
49641........................... Norfolk City County, Virginia..... 5720 0.8808 0.8808 47260
49650........................... Northampton County, Virginia...... 49 0.8420 0.8012 99949
49660........................... Northumberland County, Virginia... 49 0.8420 0.8012 99949
49661........................... Norton City County, Virginia...... 49 0.8420 0.8012 99949
49670........................... Nottoway County, Virginia......... 49 0.8420 0.8012 99949
49680........................... Orange County, Virginia........... 49 0.8420 0.8012 99949
49690........................... Page County, Virginia............. 49 0.8420 0.8012 99949
49700........................... Patrick County, Virginia.......... 49 0.8420 0.8012 99949
49701........................... Petersburg City County, Virginia.. 6760 0.9338 0.9338 40060
49710........................... Pittsylvania County, Virginia..... 1950 0.8497 0.8497 19260
49711........................... Portsmouth City County, Virginia.. 5720 0.8808 0.8808 47260
49712........................... Poquoson City County, Virginia.... 5720 0.8808 0.8808 47260
49720........................... Powhatan County, Virginia......... 6760 0.9338 0.9338 40060
49730........................... Prince Edward County, Virginia.... 49 0.8420 0.8012 99949
49740........................... Prince George County, Virginia.... 6760 0.9338 0.9338 40060
49750........................... Prince William County, Virginia... 8840 1.0983 1.0932 47894
49770........................... Pulaski County, Virginia.......... 49 0.8420 0.7962 13980
49771........................... Radford City County, Virginia..... 49 0.8420 0.7962 13980
[[Page 29159]]
49780........................... Rappahannock County, Virginia..... 49 0.8420 0.8012 99949
49790........................... Richmond County, Virginia......... 49 0.8420 0.8012 99949
49791........................... Richmond City County, Virginia.... 6760 0.9338 0.9338 40060
49800........................... Roanoke County, Virginia.......... 6800 0.8395 0.8383 40220
49801........................... Roanoke City County, Virginia..... 6800 0.8395 0.8383 40220
49810........................... Rockbridge County, Virginia....... 49 0.8420 0.8012 99949
49820........................... Rockingham County, Virginia....... 49 0.8420 0.9098 25500
49830........................... Russell County, Virginia.......... 49 0.8420 0.8012 99949
49838........................... Salem County, Virginia............ 6800 0.8395 0.8383 40220
49840........................... Scott County, Virginia............ 3660 0.8015 0.8062 28700
49850........................... Shenandoah County, Virginia....... 49 0.8420 0.8012 99949
49860........................... Smyth County, Virginia............ 49 0.8420 0.8012 99949
49867........................... South Boston City County, Virginia 49 0.8420 0.8012 99949
49870........................... Southampton County, Virginia...... 49 0.8420 0.8012 99949
49880........................... Spotsylvania County, Virginia..... 8840 1.0983 1.0932 47894
49890........................... Stafford County, Virginia......... 8840 1.0983 1.0932 47894
49891........................... Staunton City County, Virginia.... 49 0.8420 0.8012 99949
49892........................... Suffolk City County, Virginia..... 5720 0.8808 0.8808 47260
49900........................... Surry County, Virginia............ 49 0.8420 0.8808 47260
49910........................... Sussex County, Virginia........... 49 0.8420 0.9338 40060
49920........................... Tazewell County, Virginia......... 49 0.8420 0.8012 99949
49921........................... Virginia Beach City County, 5720 0.8808 0.8808 47260
Virginia.
49930........................... Warren County, Virginia........... 8840 1.0983 1.0932 47894
49950........................... Washington County, Virginia....... 3660 0.8015 0.8062 28700
49951........................... Waynesboro City County, Virginia.. 49 0.8420 0.8012 99949
49960........................... Westmoreland County, Virginia..... 49 0.8420 0.8012 99949
49961........................... Williamsburg City County, Virginia 5720 0.8808 0.8808 47260
49962........................... Winchester City County, Virginia.. 49 0.8420 1.0224 49020
49970........................... Wise County, Virginia............. 49 0.8420 0.8012 99949
49980........................... Wythe County, Virginia............ 49 0.8420 0.8012 99949
49981........................... York County, Virginia............. 5720 0.8808 0.8808 47260
50000........................... Adams County, Washington.......... 50 1.0194 1.0458 99950
50010........................... Asotin County, Washington......... 50 1.0194 0.9896 30300
50020........................... Benton County, Washington......... 6740 1.0630 1.0630 28420
50030........................... Chelan County, Washington......... 50 1.0194 1.0080 48300
50040........................... Clallam County, Washington........ 50 1.0194 1.0458 99950
50050........................... Clark County, Washington.......... 6440 1.1260 1.1260 38900
50060........................... Columbia County, Washington....... 50 1.0194 1.0458 99950
50070........................... Cowlitz County, Washington........ 50 1.0194 0.9523 31020
50080........................... Douglas County, Washington........ 50 1.0194 1.0080 48300
50090........................... Ferry County, Washington.......... 50 1.0194 1.0458 99950
50100........................... Franklin County, Washington....... 6740 1.0630 1.0630 28420
50110........................... Garfield County, Washington....... 50 1.0194 1.0458 99950
50120........................... Grant County, Washington.......... 50 1.0194 1.0458 99950
50130........................... Grays Harbor County, Washington... 50 1.0194 1.0458 99950
50140........................... Island County, Washington......... 7600 1.1579 1.0458 99950
50150........................... Jefferson County, Washington...... 50 1.0194 1.0458 99950
50160........................... King County, Washington........... 7600 1.1579 1.1589 42644
50170........................... Kitsap County, Washington......... 1150 1.0686 1.0686 14740
50180........................... Kittitas County, Washington....... 50 1.0194 1.0458 99950
50190........................... Klickitat County, Washington...... 50 1.0194 1.0458 99950
50200........................... Lewis County, Washington.......... 50 1.0194 1.0458 99950
50210........................... Lincoln County, Washington........ 50 1.0194 1.0458 99950
50220........................... Mason County, Washington.......... 50 1.0194 1.0458 99950
50230........................... Okanogan County, Washington....... 50 1.0194 1.0458 99950
50240........................... Pacific County, Washington........ 50 1.0194 1.0458 99950
50250........................... Pend Oreille County, Washington... 50 1.0194 1.0458 99950
50260........................... Pierce County, Washington......... 8200 1.0753 1.0753 45104
50270........................... San Juan County, Washington....... 50 1.0194 1.0458 99950
50280........................... Skagit County, Washington......... 50 1.0194 1.0465 34580
50290........................... Skamania County, Washington....... 50 1.0194 1.1260 38900
50300........................... Snohomish County, Washington...... 7600 1.1579 1.1589 42644
50310........................... Spokane County, Washington........ 7840 1.0916 1.0916 44060
50320........................... Stevens County, Washington........ 50 1.0194 1.0458 99950
50330........................... Thurston County, Washington....... 5910 1.0938 1.0938 36500
50340........................... Wahkiakum County, Washington...... 50 1.0194 1.0458 99950
50350........................... Walla Walla County, Washington.... 50 1.0194 1.0458 99950
50360........................... Whatcom County, Washington........ 0860 1.1743 1.1743 13380
50370........................... Whitman County, Washington........ 50 1.0194 1.0458 99950
[[Page 29160]]
50380........................... Yakima County, Washington......... 9260 1.0165 1.0165 49420
51000........................... Barbour County, W Virginia........ 51 0.7908 0.7725 99951
51010........................... Berkeley County, W Virginia....... 8840 1.0983 0.9499 25180
51020........................... Boone County, W Virginia.......... 51 0.7908 0.8428 16620
51030........................... Braxton County, W Virginia........ 51 0.7908 0.7725 99951
51040........................... Brooke County, W Virginia......... 8080 0.7827 0.7827 48260
51050........................... Cabell County, W Virginia......... 3400 0.9486 0.9486 26580
51060........................... Calhoun County, W Virginia........ 51 0.7908 0.7725 99951
51070........................... Clay County, W Virginia........... 51 0.7908 0.8428 16620
51080........................... Doddridge County, W Virginia...... 51 0.7908 0.7725 99951
51090........................... Fayette County, W Virginia........ 51 0.7908 0.7725 99951
51100........................... Gilmer County, W Virginia......... 51 0.7908 0.7725 99951
51110........................... Grant County, W Virginia.......... 51 0.7908 0.7725 99951
51120........................... Greenbrier County, W Virginia..... 51 0.7908 0.7725 99951
51130........................... Hampshire County, W Virginia...... 51 0.7908 1.0224 49020
51140........................... Hancock County, W Virginia........ 8080 0.7827 0.7827 48260
51150........................... Hardy County, W Virginia.......... 51 0.7908 0.7725 99951
51160........................... Harrison County, W Virginia....... 51 0.7908 0.7725 99951
51170........................... Jackson County, W Virginia........ 51 0.7908 0.7725 99951
51180........................... Jefferson County, W Virginia...... 8840 1.0983 1.0932 47894
51190........................... Kanawha County, W Virginia........ 1480 0.8428 0.8428 16620
51200........................... Lewis County, W Virginia.......... 51 0.7908 0.7725 99951
51210........................... Lincoln County, W Virginia........ 51 0.7908 0.8428 16620
51220........................... Logan County, W Virginia.......... 51 0.7908 0.7725 99951
51230........................... Mc Dowell County, W Virginia...... 51 0.7908 0.7725 99951
51240........................... Marion County, W Virginia......... 51 0.7908 0.7725 99951
51250........................... Marshall County, W Virginia....... 9000 0.7168 0.7168 48540
51260........................... Mason County, W Virginia.......... 51 0.7908 0.7725 99951
51270........................... Mercer County, W Virginia......... 51 0.7908 0.7725 99951
51280........................... Mineral County, W Virginia........ 1900 0.9326 0.9326 19060
51290........................... Mingo County, W Virginia.......... 51 0.7908 0.7725 99951
51300........................... Monongalia County, W Virginia..... 51 0.7908 0.8428 34060
51310........................... Monroe County, W Virginia......... 51 0.7908 0.7725 99951
51320........................... Morgan County, W Virginia......... 51 0.7908 0.9499 25180
51330........................... Nicholas County, W Virginia....... 51 0.7908 0.7725 99951
51340........................... Ohio County, W Virginia........... 9000 0.7168 0.7168 48540
51350........................... Pendleton County, W Virginia...... 51 0.7908 0.7725 99951
51360........................... Pleasants County, W Virginia...... 51 0.7908 0.8278 37620
51370........................... Pocahontas County, W Virginia..... 51 0.7908 0.7725 99951
51380........................... Preston County, W Virginia........ 51 0.7908 0.8428 34060
51390........................... Putnam County, W Virginia......... 1480 0.8428 0.8428 16620
51400........................... Raleigh County, W Virginia........ 51 0.7908 0.7725 99951
51410........................... Randolph County, W Virginia....... 51 0.7908 0.7725 99951
51420........................... Ritchie County, W Virginia........ 51 0.7908 0.7725 99951
51430........................... Roane County, W Virginia.......... 51 0.7908 0.7725 99951
51440........................... Summers County, W Virginia........ 51 0.7908 0.7725 99951
51450........................... Taylor County, W Virginia......... 51 0.7908 0.7725 99951
51460........................... Tucker County, W Virginia......... 51 0.7908 0.7725 99951
51470........................... Tyler County, W Virginia.......... 51 0.7908 0.7725 99951
51480........................... Upshur County, W Virginia......... 51 0.7908 0.7725 99951
51490........................... Wayne County, W Virginia.......... 3400 0.9486 0.9486 26580
51500........................... Webster County, W Virginia........ 51 0.7908 0.7725 99951
51510........................... Wetzel County, W Virginia......... 51 0.7908 0.7725 99951
51520........................... Wirt County, W Virginia........... 51 0.7908 0.8278 37620
51530........................... Wood County, W Virginia........... 6020 0.8278 0.8278 37620
51540........................... Wyoming County, W Virginia........ 51 0.7908 0.7725 99951
52000........................... Adams County, Wisconsin........... 52 0.9446 0.9480 99952
52010........................... Ashland County, Wisconsin......... 52 0.9446 0.9480 99952
52020........................... Barron County, Wisconsin.......... 52 0.9446 0.9480 99952
52030........................... Bayfield County, Wisconsin........ 52 0.9446 0.9480 99952
52040........................... Brown County, Wisconsin........... 3080 0.9452 0.9452 24580
52050........................... Buffalo County, Wisconsin......... 52 0.9446 0.9480 99952
52060........................... Burnett County, Wisconsin......... 52 0.9446 0.9480 99952
52070........................... Calumet County, Wisconsin......... 0460 0.9248 0.9298 11540
52080........................... Chippewa County, Wisconsin........ 2290 0.9210 0.9210 20740
52090........................... Clark County, Wisconsin........... 52 0.9446 0.9480 99952
52100........................... Columbia County, Wisconsin........ 52 0.9446 1.0635 31540
52110........................... Crawford County, Wisconsin........ 52 0.9446 0.9480 99952
52120........................... Dane County, Wisconsin............ 4720 1.0764 1.0635 31540
[[Page 29161]]
52130........................... Dodge County, Wisconsin........... 52 0.9446 0.9480 99952
52140........................... Door County, Wisconsin............ 52 0.9446 0.9480 99952
52150........................... Douglas County, Wisconsin......... 2240 1.0223 1.0209 20260
52160........................... Dunn County, Wisconsin............ 52 0.9446 0.9480 99952
52170........................... Eau Claire County, Wisconsin...... 2290 0.9210 0.9210 20740
52180........................... Florence County, Wisconsin........ 52 0.9446 0.9480 99952
52190........................... Fond Du Lac County, Wisconsin..... 52 0.9446 0.9650 22540
52200........................... Forest County, Wisconsin.......... 52 0.9446 0.9480 99952
52210........................... Grant County, Wisconsin........... 52 0.9446 0.9480 99952
52220........................... Green County, Wisconsin........... 52 0.9446 0.9480 99952
52230........................... Green Lake County, Wisconsin...... 52 0.9446 0.9480 99952
52240........................... Iowa County, Wisconsin............ 52 0.9446 1.0635 31540
52250........................... Iron County, Wisconsin............ 52 0.9446 0.9480 99952
52260........................... Jackson County, Wisconsin......... 52 0.9446 0.9480 99952
52270........................... Jefferson County, Wisconsin....... 52 0.9446 0.9480 99952
52280........................... Juneau County, Wisconsin.......... 52 0.9446 0.9480 99952
52290........................... Kenosha County, Wisconsin......... 3800 0.9770 1.0440 29404
52300........................... Kewaunee County, Wisconsin........ 52 0.9446 0.9452 24580
52310........................... La Crosse County, Wisconsin....... 3870 0.9573 0.9573 29100
52320........................... Lafayette County, Wisconsin....... 52 0.9446 0.9480 99952
52330........................... Langlade County, Wisconsin........ 52 0.9446 0.9480 99952
52340........................... Lincoln County, Wisconsin......... 52 0.9446 0.9480 99952
52350........................... Manitowoc County, Wisconsin....... 52 0.9446 0.9480 99952
52360........................... Marathon County, Wisconsin........ 8940 0.9600 0.9600 48140
52370........................... Marinette County, Wisconsin....... 52 0.9446 0.9480 99952
52380........................... Marquette County, Wisconsin....... 52 0.9446 0.9480 99952
52381........................... Menominee County, Wisconsin....... 52 0.9446 0.9480 99952
52390........................... Milwaukee County, Wisconsin....... 5080 1.0106 1.0106 33340
52400........................... Monroe County, Wisconsin.......... 52 0.9446 0.9480 99952
52410........................... Oconto County, Wisconsin.......... 52 0.9446 0.9452 24580
52420........................... Oneida County, Wisconsin.......... 52 0.9446 0.9480 99952
52430........................... Outagamie County, Wisconsin....... 0460 0.9248 0.9298 11540
52440........................... Ozaukee County, Wisconsin......... 5080 1.0106 1.0106 33340
52450........................... Pepin County, Wisconsin........... 52 0.9446 0.9480 99952
52460........................... Pierce County, Wisconsin.......... 5120 1.1078 1.1078 33460
52470........................... Polk County, Wisconsin............ 52 0.9446 0.9480 99952
52480........................... Portage County, Wisconsin......... 52 0.9446 0.9480 99952
52490........................... Price County, Wisconsin........... 52 0.9446 0.9480 99952
52500........................... Racine County, Wisconsin.......... 6600 0.9006 0.9006 39540
52510........................... Richland County, Wisconsin........ 52 0.9446 0.9480 99952
52520........................... Rock County, Wisconsin............ 3620 0.9547 0.9547 27500
52530........................... Rusk County, Wisconsin............ 52 0.9446 0.9480 99952
52540........................... St Croix County, Wisconsin........ 5120 1.1078 1.1078 33460
52550........................... Sauk County, Wisconsin............ 52 0.9446 0.9480 99952
52560........................... Sawyer County, Wisconsin.......... 52 0.9446 0.9480 99952
52570........................... Shawano County, Wisconsin......... 52 0.9446 0.9480 99952
52580........................... Sheboygan County, Wisconsin....... 7620 0.8920 0.8920 43100
52590........................... Taylor County, Wisconsin.......... 52 0.9446 0.9480 99952
52600........................... Trempealeau County, Wisconsin..... 52 0.9446 0.9480 99952
52610........................... Vernon County, Wisconsin.......... 52 0.9446 0.9480 99952
52620........................... Vilas County, Wisconsin........... 52 0.9446 0.9480 99952
52630........................... Walworth County, Wisconsin........ 52 0.9446 0.9480 99952
52640........................... Washburn County, Wisconsin........ 52 0.9446 0.9480 99952
52650........................... Washington County, Wisconsin...... 5080 1.0106 1.0106 33340
52660........................... Waukesha County, Wisconsin........ 5080 1.0106 1.0106 33340
52670........................... Waupaca County, Wisconsin......... 52 0.9446 0.9480 99952
52680........................... Waushara County, Wisconsin........ 52 0.9446 0.9480 99952
52690........................... Winnebago County, Wisconsin....... 0460 0.9248 0.9192 36780
52700........................... Wood County, Wisconsin............ 52 0.9446 0.9480 99952
53000........................... Albany County, Wyoming............ 53 0.9214 0.9214 99953
53010........................... Big Horn County, Wyoming.......... 53 0.9214 0.9214 99953
53020........................... Campbell County, Wyoming.......... 53 0.9214 0.9214 99953
53030........................... Carbon County, Wyoming............ 53 0.9214 0.9214 99953
53040........................... Converse County, Wyoming.......... 53 0.9214 0.9214 99953
53050........................... Crook County, Wyoming............. 53 0.9214 0.9214 99953
53060........................... Fremont County, Wyoming........... 53 0.9214 0.9214 99953
53070........................... Goshen County, Wyoming............ 53 0.9214 0.9214 99953
53080........................... Hot Springs County, Wyoming....... 53 0.9214 0.9214 99953
53090........................... Johnson County, Wyoming........... 53 0.9214 0.9214 99953
[[Page 29162]]
53100........................... Laramie County, Wyoming........... 1580 0.8784 0.8784 16940
53110........................... Lincoln County, Wyoming........... 53 0.9214 0.9214 99953
53120........................... Natrona County, Wyoming........... 1350 0.9035 0.9035 16220
53130........................... Niobrara County, Wyoming.......... 53 0.9214 0.9214 99953
53140........................... Park County, Wyoming.............. 53 0.9214 0.9214 99953
53150........................... Platte County, Wyoming............ 53 0.9214 0.9214 99953
53160........................... Sheridan County, Wyoming.......... 53 0.9214 0.9214 99953
53170........................... Sublette County, Wyoming.......... 53 0.9214 0.9214 99953
53180........................... Sweetwater County, Wyoming........ 53 0.9214 0.9214 99953
53190........................... Teton County, Wyoming............. 53 0.9214 0.9214 99953
53200........................... Uinta County, Wyoming............. 53 0.9214 0.9214 99953
53210........................... Washakie County, Wyoming.......... 53 0.9214 0.9214 99953
53220........................... Weston County, Wyoming............ 53 0.9214 0.9214 99953
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[FR Doc. 05-9934 Filed 5-13-05; 4:15 pm]
BILLING CODE 4120-01-P