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Code · REGISTER · 2006-01-23 · SECURITIES AND EXCHANGE COMMISSION · Notices

Notices. Notice of petitions for exemption received

122,933 words·~559 min read·/register/2006/01/23/06-488

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BILLING CODE 8010-01-P SECURITIES AND EXCHANGE COMMISSION [Release No. 34-53123; File No. SR-Amex-2005-110] Self-Regulatory Organizations; American Stock Exchange LLC; Notice of Filing of Proposed Rule Change Relating to Specialist Clerks January 13, 2006. Pursuant to Section 19(b)(1) of the Securities Exchange Act of 1934 (the “Act”), 1 and Rule 19b-4 thereunder, 2 notice is hereby given that on October 31, 2005, the American Stock Exchange LLC (“Amex” or “Exchange”) filed with the Securities and Exchange Commission (“Commission” or “SEC”) the proposed rule change as described in Items I, II, and III below, which Items have been prepared by Amex.
The Commission is publishing this notice to solicit comments on the proposed rule change from interested persons. 1 15 U.S.C. 78s(b)(1). 2 17 CFR 240.19b-4. I. Self-Regulatory Organization's Statement of the Terms of Substance of the Proposed Rule Change The Exchange proposes amendments to Amex Rule 184 to require specialists to employ an adequate number of clerks to enable the specialist unit to efficiently handle trading volume in the unit's registered securities and meet its regulatory responsibilities.
The text of the proposed rule change is below. Proposed new language is in *italics* ; proposed deletions are in [brackets]. Rule 184. Specialist Clerks
(a)A specialist or specialist unit *shall* [may] regularly employ, subject to such rules and regulations as the Board of Governors may adopt[,] *an adequate number of* [one or more] clerks[,] to aid such specialist or specialist unit on the floor of the Exchange *and to enable the unit to efficiently handle actual and reasonably anticipated volume in the unit's registered securities* , provided each such clerk receives the approval of the Exchange. A yearly fee, as imposed by the Exchange and payable as directed by the Exchange, shall be charged the specialist or specialist unit for each clerk. No rebate shall be given with respect to the fee in the event that a specialist or specialist unit discontinues the services of such a clerk during any period.
(b)A specialist or specialist unit may, for the purpose of obtaining assistance on a temporary basis, utilize the services on the floor of the Exchange of a clerk regularly employed by another specialist or specialist unit, provided that:
(1)Such use shall be subject to the approval of the Exchange and the consent of the specialist or specialist unit regularly employing the clerk and shall be subject to such conditions as the Exchange may impose; and
(2)such clerk shall not disclose to one specialist or specialist unit any information with respect to orders entrusted to the other specialist or specialist unit. [Commentary .01 Each specialist unit will be allowed by the Exchange to employ a number of clerks which the Exchange approves as reasonable from time to time to enable the unit to efficiently handle actual and reasonably anticipated volume in the unit's registered securities.] II. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change In its filing with the Commission, the Exchange included statements concerning the purpose of, and basis for, the proposed rule change and discussed any comments it received on the proposal. The text of these statements may be examined at the places specified in Item IV below. The Exchange has prepared summaries, set forth in Sections A, B, and C below, of the most significant aspects of such statements. A. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change 1. Purpose Amex Rule 184 governs the employment of clerks on the trading floor by specialists, and provides that each specialist unit may regularly employ a number of clerks to aid the specialist unit on the trading floor provided that such clerk(s) receive Exchange approval. Commentary .01 to Amex Rule 184 further provides that each specialist unit will be allowed by the Exchange to employ a number of clerks which the Exchange approves as reasonable to enable the specialist unit to efficiently handle actual and reasonably anticipated volume in the unit's registered securities. A number of Amex Rules, most notably Amex Rule 170, require specialists to comply with a variety of affirmative and negative obligations. Additionally, specialists are subject to certain Commission order handling rules. In order to comply with SEC and Amex Rules applicable to specialist activities as well as the Exchange Guidelines, it is essential that each specialist unit employ an adequate number of clerks on the trading floor. To clarify this requirement, the Exchange is proposing that Amex Rule 184 be amended to specifically provide that specialists must maintain adequate staffing levels on the trading floor, as necessary to fulfill their regulatory obligations. The New York Stock Exchange, Inc. (“NYSE”) imposes substantially similar staffing obligations on its specialist units. 3 3 *See* NYSE Rule 35, Supplementary Material .40. 2. Statutory Basis Amex believes that the proposed rule change is consistent with Section 6(b) of the Act, 4 in general, and furthers the objectives of Section 6(b)(5), 5 in particular, in that it is designed to prevent fraudulent and manipulative acts and practices, to promote just and equitable principles of trade, and, in general, to protect investors and the public interest. 4 15 U.S.C. 78f(b). 5 15 U.S.C. 78f(b)(5). B. Self-Regulatory Organization's Statement on Burden on Competition The Exchange believes that the proposed rule change will impose no burden on competition not necessary or appropriate in furtherance of the purposes of the Act. C. Self-Regulatory Organization's Statement on Comments on the Proposed Rule Change Received From Members, Participants or Others No written comments were solicited or received in response to the proposed rule change. III. Date of Effectiveness of the Proposed Rule Change and Timing for Commission Action Within 35 days of the date of publication of this notice in the **Federal Register** or within such longer period
(i)as the Commission may designate up to 90 days of such date if it finds such longer period to be appropriate and publishes its reasons for so finding or
(ii)as to which the Exchange consents, the Commission shall:
(A)By order approve such proposed rule change, or
(B)Institute proceedings to determine whether the proposed rule change should be disapproved. IV. Solicitation of Comments Interested persons are invited to submit written data, views, and arguments concerning the foregoing, including whether the proposed rule change is consistent with the Act. Comments may be submitted by any of the following methods: Electronic Comments • Use the Commission's Internet comment form ( *http://www.sec.gov/rules/sro.shtml* ); or • Send an e-mail to *rule-comments@sec.gov.* Please include File No. SR-Amex-2005-110 on the subject line. Paper Comments • Send paper comments in triplicate to Nancy M. Morris, Secretary, Securities and Exchange Commission, Station Place, 100 F Street, NE., Washington, DC 20549-9303. All submissions should refer to File Number SR-Amex-2005-110. This file number should be included on the subject line if e-mail is used. To help the Commission process and review your comments more efficiently, please use only one method. The Commission will post all comments on the Commissions Internet Web site ( *http://www.sec.gov/rules/sro.shtml* ). Copies of the submission, all subsequent amendments, all written statements with respect to the proposed rule change that are filed with the Commission, and all written communications relating to the proposed rule change between the Commission and any person, other than those that may be withheld from the public in accordance with the provisions of 5 U.S.C. 552, will be available for inspection and copying in the Commission's Public Reference Room. Copies of such filing also will be available for inspection and copying at the principal office of Amex. All comments received will be posted without change; the Commission does not edit personal identifying information from submissions. You should submit only information that you wish to make available publicly. All submissions should refer to File Number SR-Amex-2005-110 and should be submitted on or before February 13, 2006. For the Commission, by the Division of Market Regulation, pursuant to delegated authority. 6 6 17 CFR 200.30-3(a)(12). Nancy M. Morris, Secretary. [FR Doc. E6-676 Filed 1-20-06; 8:45 am] BILLING CODE 8010-01-P SECURITIES AND EXCHANGE COMMISSION [Release No. 34-53116; File No. SR-Amex-2006-002] Self-Regulatory Organizations; American Stock Exchange LLC; Notice of Filing and Immediate Effectiveness of Proposed Rule Change Relating to Odd-Lots in Nasdaq Securities January 13, 2006. Pursuant to Section 19(b)(1) of the Securities Exchange Act of 1934 (the “Act”), 1 and Rule 19b-4 thereunder, 2 notice is hereby given that on January 4, 2006, the American Stock Exchange LLC (“Amex” or “Exchange”) filed with the Securities and Exchange Commission (“Commission”) the proposed rule change as described in Items I and II below, which Items have been prepared by Amex. The Exchange filed the proposal as a “non-controversial” rule change pursuant to Section 19(b)(3)(A) of the Act 3 and Rule 19b-4(f)(6) thereunder, 4 which renders the proposed rule change effective upon filing with the Commission. The Commission is publishing this notice to solicit comments on the proposed rule change from interested persons. 1 15 U.S.C. 78s(b)(1). 2 17 CFR 240.19b-4. 3 15 U.S.C. 78s(b)(3)(A). 4 17 CFR 240.19b-4(f)(6). I. Self-Regulatory Organization's Statement of the Terms of Substance of the Proposed Rule Change Amex proposes to extend for an additional six-month period through June 30, 2006, the Exchange's pilot program for odd-lot execution procedures for Nasdaq securities traded on the Exchange pursuant to unlisted trading privileges. There is no proposed rule text. Amex is making no changes to the pilot program as it currently operates, other than extending it through June 30, 2006. II. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change In its filing with the Commission, Amex included statements concerning the purpose of and basis for the proposed rule change and discussed any comments it received on the proposed rule change. The text of these statements may be examined at the places specified in Item IV below. Amex has prepared summaries, set forth in Sections A, B, and C below, of the most significant aspects of such statements. A. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change 1. Purpose The Commission approved, and the Exchange implemented, a pilot program for odd-lot order 5 executions in Nasdaq securities transacted on the Exchange pursuant to unlisted trading privileges. Paragraph
(j)of Amex Rule 118 (“Trading in Nasdaq National Market Securities”) describes the Exchange's odd-lot execution procedures for Nasdaq securities, and Commentary .05 of Amex Rule 205 (“Manner of Executing Odd-Lot Orders”) references Amex Rule 118(j) odd-lot procedures. The pilot program was originally approved on August 2, 2002 for a six-month period, was most recently extended on June 30, 2005, and is due to expire on December 30, 2005. 6 5 An odd-lot order is an order for less than 100 shares. 6 The pilot program originally approved on August 2, 2002 was subsequently extended on July 14, 2003; December 24, 2003; June 14, 2004; December 27, 2004; and July 6, 2005. *See* Securities Exchange Act Release Nos. 46304 (August 2, 2002), 67 FR 51903 (August 9, 2002) (SR-Amex-2002-56); 48174 (July 14, 2003), 68 FR 43409 (July 22, 2003) (SR-Amex-2003-56); 48995 (December 24, 2003), 68 FR 75670 (December 31, 2003) (SR-Amex-2003-102); 49855 (June 14, 2004), 69 FR 35399 (June 24, 2004) (SR-Amex-2004-30); 50934 (December 27, 2004), 70 FR 412 (January 4, 2005) (SR-Amex-2004-108); 51975 (July 6, 2005); and 70 FR 40409 (July 13, 2005) (SR-Amex-2005-065). Under the Exchange's current pilot program, after the opening of trading in Nasdaq securities, odd-lot market orders and executable odd-lot limit orders are executed at the qualified national best bid or offer 7 at the time the order is received at the trading post or through Amex Order File. Odd-lot market orders and executable odd-lot limit orders entered before the opening of trading in Nasdaq securities are executed at the price of the first round-lot or part of round-lot transaction on the Exchange. Non-executable limit orders, stop orders, stop limit orders, orders filled after the close and non-regular way trades are executed in accordance with Amex Rule 205 A(2), A(3), A(4), C(1), and C(2), respectively. Orders to buy or sell “at the close” are filled at the price of the closing round-lot sale on the Exchange. In a locked market condition, odd-lot market orders and executable odd-lot limit orders are executed at the locked market price. In a crossed market condition, odd-lot market orders are executed at the mean of the bid and offer prices when the displayed national best bid is higher than the displayed national best offer by $.05 or less. When the displayed national best bid is higher than the displayed national best offer by more than $.05, odd-lot market orders are executed when the crossed market condition no longer exists. In addition, in a crossed market condition, executable odd-lot limit orders are executed at the crossed market bid price (in the case of an order to sell) or at the crossed market offer price (in the case of an order to buy). For example, if the bid and offer are 20.10 and 20.00, respectively, an executable odd-lot sell limit order priced at 20.10 or less will be executed at 20.10 and an executable odd-lot buy limit order priced at 20.00 or higher will be executed at 20.00. 7 In Amex Rule 118(j), the qualified national best bid and offer are defined as the highest bid and lowest offer, respectively, disseminated
(A)by the Exchange or
(B)by another market center participating in the Joint Self-Regulatory Organization Plan Governing the Collection, Consolidation and Dissemination of Quotation and Transaction Information for Nasdaq Listed Securities Traded on Exchanges on an Unlisted Trading Privileges Basis (“Plan”); provided, however, that the bid and offer in another such market center will be considered in determining the qualified national best bid or offer in a stock only if
(i)the quotation conforms to the requirements of Amex Rule 127 (“Minimum Price Variations”),
(ii)the quotation does not result in a locked or crossed market,
(iii)the market center is not experiencing operational or system problems with respect to the dissemination of quotation information, and
(iv)the bid or offer is “firm,” that is, members of the market center disseminating the bid or offer are not relieved of their obligations with respect to such bid or offer under paragraph (b)(2) of Rule 602 pursuant to the “unusual market” exception of paragraph (a)(3)(i) of Rule 602 under the Act. 17 CFR 242.602. The Exchange believes that the existing odd-lot execution procedures have operated efficiently. Furthermore, the Exchange has received no complaints from members or the public regarding odd-lot executions. Therefore, the Exchange seeks an extension to the pilot program for an additional six-month period through June 30, 2006, providing the Exchange time to assess further enhancements to the odd-lot execution procedures. 2. Statutory Basis The Exchange believes that the proposed rule change is consistent with Section 6(b) of the Act 8 in general and furthers the objectives of Section 6(b)(5) 9 in particular in that it is designed to prevent fraudulent and manipulative acts and practices, to promote just and equitable principles of trade, to foster cooperation and coordination with persons engaged in facilitating transactions in securities, to remove impediments to and perfect the mechanism of a free and open market and a national market system, to protect investors and the public interest and is not designed to permit unfair discrimination between customers, issuers, brokers, or dealers. 8 15 U.S.C. 78f(b). 9 15 U.S.C. 78f(b)(5). B. Self-Regulatory Organization's Statement on Burden on Competition The Exchange does not believe that the proposed rule change will impose any burden on competition. C. Self-Regulatory Organization's Statement on Comments on the Proposed Rule Change Received from Members, Participants or Others No written comments were solicited or received with respect to the proposed rule change. III. Date of Effectiveness of the Proposed Rule Change and Timing for Commission Action Because the foregoing proposed rule change:
(1)Does not significantly affect the protection of investors or the public interest;
(2)does not impose any significant burden on competition; and
(3)by its terms does not become operative for 30 days after the date of this filing, or such shorter time as the Commission may designate if consistent with the protection of investors and the public interest, the proposed rule change has become effective pursuant to Section 19(b)(3)(A) 10 of the Act and Rule 19b-4(f)(6) thereunder. 11 10 15 U.S.C. 78s(b)(3)(A). 11 17 CFR 240.19b-4(f)(6). Rule 19b-4(f)(6)(iii) under the Act requires the self-regulatory organization to provide the Commission written notice of its intent to file the proposed rule change at least five business days (or such shorter time as designated by the Commission) before doing so. Amex has requested that the Commission waive the five-day pre-filing notice requirement. The Commission granted Amex's request. Amex requests that the Commission waive the 30-day operative delay, as specified in Rule 19b-4(f)(6)(iii), 12 and designate the proposed rule change to become operative immediately. The Commission believes that waiving the 30-day operative delay is consistent with the protection of investors and the public interest because such waiver would allow the pilot program to continue operating through June 30, 2006 without interruption. 13 12 17 CFR 240.19b-4(f)(6)(iii). 13 For purposes only of waiving the operative delay for this proposal, the Commission has considered the proposed rule's impact on efficiency, competition, and capital formation. *See* 15 U.S.C. 78c(f). At any time within 60 days of the filing of the proposed rule change, the Commission may summarily abrogate such rule change if it appears to the Commission that such action is necessary or appropriate in the public interest, for the protection of investors, or otherwise in furtherance of the purposes of the Act. IV. Solicitation of Comments Interested persons are invited to submit written data, views, and arguments concerning the foregoing, including whether the proposed rule change is consistent with the Act. Comments may be submitted by any of the following methods: Electronic Comments • Use the Commission's Internet comment form ( *http://www.sec.gov/rules/sro.shtml* ); or • Send an e-mail to *rule-comments@sec.gov* . Please include File No. SR-Amex-2006-002 on the subject line. Paper Comments • Send paper comments in triplicate to Nancy M. Morris, Secretary, Securities and Exchange Commission, Station Place, 100 F Street, NE., Washington, DC 20549-9303. All submissions should refer to File Number SR-Amex-2006-002. This file number should be included on the subject line if e-mail is used. To help the Commission process and review your comments more efficiently, please use only one method. The Commission will post all comments on the Commission's Internet Web site ( *http://www.sec.gov/rules/sro.shtml* ). Copies of the submission, all subsequent amendments, all written statements with respect to the proposed rule change that are filed with the Commission, and all written communications relating to the proposed rule change between the Commission and any person, other than those that may be withheld from the public in accordance with the provisions of 5 U.S.C. 552, will be available for inspection and copying in the Commission's Public Reference Room. Copies of such filing also will be available for inspection and copying at the principal office of Amex. All comments received will be posted without change; the Commission does not edit personal identifying information from submissions. You should submit only information that you wish to make available publicly. All submissions should refer to File Number SR-Amex-2006-002 and should be submitted on or before February 13, 2006. 14 17 CFR 200.30-3(a)(12). For the Commission, by the Division of Market Regulation, pursuant to delegated authority. 14 Nancy M. Morris, Secretary. [FR Doc. E6-698 Filed 1-20-06; 8:45 am] BILLING CODE 8010-01-P SECURITIES AND EXCHANGE COMMISSION [Release No. 34-53130; File No. SR-Amex-2005-072] Self-Regulatory Organizations; American Stock Exchange LLC; Notice of Filing of Proposed Rule Change and Amendment No. 1 Thereto Relating to the Listing and Trading of Shares of the iShares® Silver Trust January 17, 2006. Pursuant to section 19(b)(1) of the Securities Exchange Act of 1934 (“Act”) 1 and Rule 19b-4 thereunder, 2 notice is hereby given that on June 30, 2005, the American Stock Exchange LLC (“Amex” or “Exchange”) filed with the Securities and Exchange Commission (“Commission”) the proposed rule change as described in Items I, II, and III below, which Items have been prepared by the Amex. On September 15, 2005, the Exchange submitted Amendment No. 1 to the proposed rule change. 3 The Commission is publishing this notice to solicit comments on the proposed rule change, as amended, from interested persons. 1 15 U.S.C. 78s(b)(1). 2 17 CFR 240.19b-4. 3 Amendment No. 1 to the proposed rule change clarifies the valuation procedure that would be used by the Bank of New York to determine the daily value of the silver contained in the iShares® Silver Trust. I. Self-Regulatory Organization's Statement of the Terms of Substance of the Proposed Rule Change The Exchange proposes to list and trade under Amex Rules 1200A *et seq.,* the iShares® Silver Trust shares (the “Silver Shares” or “Shares”). 4 4 iShares® is a registered trademark of Barclays Global Investors, N.A. II. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change In its filing with the Commission, the Amex included statements concerning the purpose of, and basis for, the proposed rule change, as amended, and discussed any comments it received on the proposed rule change. The text of these statements may be examined at the places specified in Item IV below. The Exchange has prepared summaries, set forth in sections A, B, and C below, of the most significant aspects of such statements. A. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change 1. Purpose The Exchange proposes to list and trade the iShares Silver Trust (the “Silver Trust” or “Trust”) shares that represent beneficial ownership interests in the net assets of the Trust consisting primarily of silver bullion (“silver”). The Exchange states that the Trust will not be actively managed, and therefore, a holder of Silver Shares will not be hedged to protect against the price volatility of the underlying silver. Under Amex Rule 1201A, the Exchange may approve for listing and trading Commodity-Based Trust Shares on an underlying commodity. 5 Accordingly, the Amex proposes to list for trading Silver Shares under Exchange Rule 1200A et. seq. 6 5 Amex Rule 1200A(b)(2) defines “commodity” as set forth in Section 1(a)(4) of the Commodity Exchange Act (“CEA”). 6 *See* applicable Amex Rules 1200A, 1201A, 1202A, 1203A, 1204A, and 1205A. *Introduction.* In January 2005, the Exchange adopted rules for the listing and trading of “Commodity-Based Trust Shares.” 7 Commodity-Based Trust Shares (the “Commodity Shares”) are securities issued by a trust that represent investors” discrete identifiable and undivided beneficial ownership interest in the commodities deposited into the trust. Commodity Shares are a form of trust issued receipt (“TIR”) 8 that instead of holding one or more discrete securities will hold one or more physical commodities. The Exchange has listed the iShares COMEX Gold Trust 9 and trades pursuant to unlisted trading privileges (“UTP”), the streetTRACKS Gold Trust, 10 as Commodity-Based Trust Shares pursuant to Exchange Rules 1200A *et seq.* 7 *See* Securities Exchange Act Release No. 51058 (January 19, 2005), 70 FR 3749 (January 26, 2005) (approving the listing and trading of the iShares COMEX Gold Trust). 8 A Trust Issued Receipt or “TIR” is defined in Exchange Rule 1200(b) as a security
(a)that is issued by a trust that holds specified securities deposited with the trust;
(b)that, when aggregated in some specified minimum number, may be surrendered to the trust by the beneficial owner to receive the securities; and
(c)that pays beneficial owners dividends and other distributions on the deposited securities, if any are declared and paid to the trustee by an issuer of the deposited securities. Under Amex Rule 1201, the Exchange may approve for listing and trading TIRs based on one or more securities. The Exchange defines a “security” or “securities” to include stocks, bonds, options, and other interests or instruments commonly known as securities. *See* Article I, Section 3(j) of the Amex Constitution. 9 *See supra* note 7. 10 *See* Securities Exchange Act Release No. 51446 (March 29, 2005), 70 FR 17272 (April 5, 2005) (approving the UTP trading of the streetTRACKS Gold Shares). The Exchange may list and trade the Silver Shares pursuant to Amex Rules 1200A *et seq.* subject to Commission review and approval. The Silver Shares will conform to the initial and continued listing criteria under Amex Rule 1202A. 11 The Silver Trust will be formed under a depositary trust agreement, among Bank of New York, as Trustee; Barclays Global Investors International, Inc. (“Barclays” or “Sponsor”), the Sponsor; all depositors, if any; and the holders of Silver Shares. 12 11 The initial listing standards set forth in Amex Rule 1202A(a) provide that the Exchange establish a minimum number of TIRs required to be outstanding at the time of the commencement of trading on the Exchange. As set forth in the section “Criteria for Initial and Continued Listing,” the Exchange expects the minimum number of Silver Shares required to be outstanding at the time of trading to be 150,000. This section, *infra,* specifically details the initial and continued listing standards for the Silver Trust. 12 The trust is not an investment company as defined in Section 3(a) of the Investment Company Act of 1940 (the “1940 Act”). The Exchange notes that the Commission has permitted the listing and trading of products linked to the performance of an underlying commodity or commodities. 13 13 *See* Securities Exchange Act Release Nos. 51058 (January 19, 2005), 70 FR 3749 (January 26, 2005) (approving the listing and trading of the iShares COMEX Gold Trust); 50603 (October 28, 2004), 69 FR 64614 (November 5, 2004) (approving the listing and trading of streetTRACKS Gold Shares); 43427 (October 10, 2000), 65 FR 62783 (October 19, 2000) (approving the listing and trading of inflation indexed securities); 39402 (December 4, 1997), 62 FR 65459 (December 12, 1997) (approving the listing and trading of commodity index preferred or debt securities (ComPS) on various agricultural futures contracts and commodities indexes); 36885 (February 26, 1996), 61 FR 8315 (March 4, 1996) (approving the listing and trading of ComPS linked to the value of single commodity); and 35518 (March 21, 1995), 60 FR 15804 (March 27, 1995) (approving the listing and trading of commodity indexed notes or COINS). *See also* Central Fund of Canada (Registration No. 033-15180) (closed-end fund listed and traded on the Amex that invests in silver) and Salmon Phibro Oil Trust (Registration No. 033-33823) (trust units listed and traded on the Amex that held the right to a forward contract for the delivery of crude oil). *Description of the Silver Market.* The silver market is a global marketplace consisting of both over-the-counter (“OTC”) transactions and exchange-traded products. The OTC market generally consists of transactions in spot, forwards, options and other derivatives, while exchange-traded transactions consist of futures and options. Set forth below, the Exchange has provided a description of each of the OTC and exchange-traded markets for silver as well as a summary of their respective regulatory structures. *The OTC Market.* The OTC market trades on a 24-hour continuous basis and accounts for the substantial portion of global silver trading. Specifically, the London OTC market is the largest silver clearing market. Liquidity in the OTC market can vary from time to time during the course of the 24-hour trading day. Fluctuations in liquidity are reflected in adjustments to dealing spreads—the differential between a dealer's buy and sell prices. The Exchange believes the period of greatest liquidity in the silver market is typically that time of day when trading in the European time zone overlaps with trading in the United States. This occurs when the OTC market trading in New York, London, Zurich and other centers coincides with futures and options trading on the Commodity Exchange, Inc. (“COMEX”). 14 This period lasts for approximately five
(5)hours 15 each New York business day, from 8:25 a.m.-1:25 p.m. Eastern Time (“ET”). 16 14 COMEX is a division of the New York Mercantile Exchange, Inc. (“NYMEX”) where silver futures contracts and related options are traded. 15 Telephone conference between Jeffrey Burns, Associate General Counsel, Amex, and Florence Harmon, Senior Special Counsel, Division of Market Regulation, Commission, on January 13, 2006. 16 The Exchange submits that Silver Shares may be used as a price discovery mechanism for silver from 1:25 p.m. to 4:15 p.m. ET. The open outcry trading hours of the COMEX silver futures contract is from 8:25 a.m. to 1:25 p.m. ET Monday through Friday. NYMEX ACCESS(r), an electronic trading system, is open for price discovery on COMEX silver futures contracts from 2 p.m. Monday afternoon until 8 a.m. Friday morning ET; and from 7 p.m. Sunday night until Monday morning at 8 a.m. ET. Market makers, as well as others in the OTC market, trade with each other and with their clients on a principal-to-principal basis. All risks and issues of credit are between the parties directly involved in the transaction. Market makers include the market-making members of the London Bullion Market Association (“LBMA”), the trade association that acts as the coordinator for activities conducted on behalf of its members and other participants in the London bullion market. 17 The current market-making members of the LBMA are: Bank of Nova Scotia-ScotiaMocatta, Barclays Bank Plc, Deutsche Bank AG, HSBC Bank USA (London branch), Goldman Sachs International, JPMorganChase Bank, Royal Bank of Canada Ltd., Societe Generale, and UBS AG. JPMorganChase Bank NA (London branch) is an affiliate of the custodian for the Trust. Barclays Bank Plc is an affiliate of the Sponsor and the Initial Purchaser, Barclays Capital, Inc. The OTC market provides a relatively flexible market in terms of quotes, price, size, destinations for delivery, and other factors. Bullion dealers customize transactions to meet clients' requirements. The OTC market has no formal structure and no open-outcry meeting place. The main centers of the OTC market are London (the largest market), New York, and Zurich. Bullion dealers have offices around the world, and most of the world's major bullion dealers are either members or associate members of the LBMA. 17 Further information about the LBMA may be found at *http://www.lbma.org.uk.* There are currently nine
(9)market-making members of the LBMA, five of which offer clearing services, and 51 full members. The Exchange indicates that there are no authoritative published figures for overall worldwide volume in silver trading. There are published sources that do suggest the significant size of the overall market. The LBMA publishes statistics compiled from the five
(5)members offering clearing services. 18 The Exchange notes that the monthly average daily volume figures published by the LBMA for 2004 range from, a high of 143.4 million to a low of 75.5 million troy ounces per day. Through May 2005, the monthly average daily volume has ranged from a high of 152.1 million to a low of 76.9 million. The COMEX also publishes price and volume statistics for exchange-traded transactions in contracts for the future delivery of silver (and related options). 19 18 Information regarding clearing volume estimates by the LBMA can be found at *http://www.lbma.org.uk/clearing_table.htm.* The three measures published by the LBMA are: volume, the amount of metal transferred on average each day measured in millions of troy ounces; value, measured in U.S. dollars, using the monthly average London PM fixing price; and the number of transfers, which is the average number recorded each day. The statistics exclude allocated and unallocated balance transfers where the sole purpose is for overnight credit and physical movements arranged by clearing members in locations other than London. 19 Information regarding price and average daily volume on the COMEX can be found at *http://www.nymex.com/jsp/markets.md_annual_volume.jsp.* *The London Bullion Market and the London “Fix” Process.* Although the market for physical silver is distributed globally, most OTC market trades are cleared through London. In addition to coordinating market activities, the Exchange notes that the LBMA acts as the principal point of contact between the market and its regulators. A primary function of the LBMA is its involvement in the promotion of refining standards by maintenance of the “London Good Delivery Lists,” which are the lists of LBMA accredited melters and assayers of silver. The LBMA also coordinates market clearing and vaulting, promotes good trading practices, and develops standard documentation for such clearing and warehousing activities. The LBMA also publishes “The Good Delivery Rules for Gold and Silver Bars,” the specifications for gold and silver bars acceptable for delivery in settlement of a transaction on the London market. Silver bars meeting these requirements are referred to herein as “London Good Delivery Bars.” The silver spot price always refers to that of a London Good Delivery Bar, unless otherwise specified. In the OTC market, business is generally conducted over the phone and through a widely used electronic dealing system. A London silver “fix” is conducted each trading day at 12 p.m. London time (7 a.m. ET) providing reference silver prices for that day's trading. 20 The Exchange notes that many long-term contracts are priced on the basis of the London silver fix and market participants will usually refer to the London silver fix when looking for a basis for valuation. The Exchange believes that the London fix is the most widely used benchmark for daily silver prices and is quoted by various financial information sources. 20 Formal participation in the London silver fix is limited to three
(3)LBMA members, each of which is a bullion dealer. The chairmanship of the London silver fix committee is The Bank of Nova Scotia—ScotiaMocatta. The fix takes place by telephone at 12:00 p.m. London time and also has a web-based commentary. The other members of the London silver fix are currently Deutsche Bank AG and HSBC Bank USA, NA. Any other market participant wishing to participate in trading on the fix is required to do so through one of these three
(3)dealers. Clients place orders either with one of the three
(3)fixing members or with another bullion dealer who will then be in contact with a fixing member during the fixing. The fixing members net-off all orders when communicating their net interest at the fixing. The fix begins with the fixing chairman suggesting a “trying price,” reflecting the market price prevailing at the opening of the fix. This is relayed by the fixing members to their dealing rooms that have direct communication with all interested parties. Any market participant may enter the fixing process at any time, or adjust or withdraw his order. The silver price is adjusted up or down until all the buy and sell orders are matched, at which time the price is declared fixed. All fixing orders are transacted on the basis of this fixed price, which is instantly relayed to the market through various media. Barclays and the Exchange believe that the London fix is widely viewed as a full and fair representation of all market interest at the time of the fix. *Futures Exchanges.* The Exchange states that the most significant silver futures exchanges are the COMEX and the Tokyo Commodity Exchange (“TOCOM”). 21 Trading on these exchanges is based on fixed delivery dates and transaction sizes for the futures and options contracts traded. Trading costs on these exchanges are negotiable. The Exchange represents that as a matter of practice, only a small percentage of the future market turnover ever comes to physical delivery of the silver represented by the contracts traded. Both COMEX and TOCUM permit trading on margin. COMEX operates through a central clearance system. TOCOM has a similar clearance system. In each case, the exchange acts as a counterparty for each member for clearing purposes. 21 There are other silver exchange markets, such as the London Metals Exchange, the Istanbul Gold Exchange, the Shanghai Gold Exchange, and the Hong Kong Chinese Gold & Silver Exchange Society. *Silver Market Regulation.* There is no direct regulation of the global OTC market in silver. However, indirect regulation of some of the overseas participants does occur. In the United Kingdom, responsibility for the regulation of financial market participants, including the major participating members of the LBMA, falls under the authority of the Financial Services Authority (“FSA”) as provided by the Financial Services and Market Act of 2000 (“FSM Act”). The Exchange states that under the FSM Act, all UK-based banks, together with other investment firms, are subject to a range of requirements, including fitness and properness, capital adequacy, liquidity, and systems and controls. The FSA is responsible for regulating investment products, including derivatives, and those who deal in investment products. Regulation of spot, commercial forwards and deposits of silver not covered by the FSM Act is provided for by The London Code of Conduct for Non-Investment Products, which was established by market participants in conjunction with the Bank of England, and is a voluntary code of conduct among market participants. The Exchange states that participants in the U.S. OTC market for silver are generally regulated by their institutional supervisors, which regulate their activities in the other markets in which they operate. For example, participating banks are regulated by the banking authorities. In the U.S., the Commodities Futures Trading Commission (“CFTC”), an independent governmental agency with the mandate to regulate commodity futures and options markets in the U.S., regulates market participants and has established rules designed to prevent market manipulation, abusive trade practices and fraud. The Exchange states that TOCOM has authority to perform financial and operational surveillance on its members' trading activities, scrutinize positions held by members and large-scale customers, and monitor price movements of futures markets by comparing them with cash and other derivative markets' prices. *Product Description.* *1. Creation and Redemption Process.* Issuances of Silver Shares will be made only in baskets of 50,000 shares or multiples thereof (the “Basket Aggregations” or “Baskets”). 22 The Trust will issue and redeem Basket Aggregations on a continuous basis, by or through registered broker-dealers that have entered into participant agreements (each, an “Authorized Participant”) 23 with the Sponsor and the Trustee, Bank of New York (“BNY”). 24 Following issuance, the Shares will be traded on the Exchange similar to other equity securities, such as shares of the iShares COMEX Gold Trust and the streetTRACKS Gold Trust. 25 22 Initially, each Share represents 10 ounces of silver. Telephone conference between Jeffrey Burns, Associate General Counsel, Amex, and Florence Harmon, Senior Special Counsel, Division of Market Regulation, Commission, on January 13, 2006. 23 An “Authorized Participant” is a person, who at the time of submitting to the Trustee an order to create or redeem one or more Baskets,
(i)is a registered broker-dealer,
(ii)is a Depository Trust Company (“DTC”) Participant or an Indirect Participant and
(iii)has in effect a valid Authorized Participant Agreement. 24 BNY will charge a transaction fee in connection with the redemption and/or creation of Baskets. In addition, Barclays Capital, Inc., the Initial Purchaser, will purchase 150,000 shares of the Trust that compose the initial Baskets. 25 *See supra* notes 7 and 10. Basket Aggregations of Shares will be issued as an in-kind exchange for a corresponding amount of silver. The basket amount of silver, measured in ounces (the “Basket Silver Amount”) will be determined on each business day by the Trustee, BNY. 26 Authorized Participants that wish to purchase a Basket must transfer the Basket Silver Amount to the Trust in exchange for a Basket of Shares. Authorized Participants that wish to redeem a Basket of Shares will receive the Basket Silver Amount in exchange for each Basket surrendered. JP Morgan Chase Bank, N.A., London Branch (“JP Morgan Chase” or “Custodian”) will be the custodian for the Trust and responsible for safekeeping the silver. 27 Silver deposited with JP Morgan Chase must meet the specifications for weight, dimensions, fineness (or purity), identifying marks and appearance of silver bars as set forth in “The Good Delivery Rules for Silver and Silver Bars” published by the LBMA. 26 A troy ounce, equal to 1.0971428 ounces avoirdupois, with a minimum fineness of 0.999. “Avoirdupois” is the system of weights used in the U.S. and U.K. for goods other than precious metals, gems and drugs. In that system, a pound is 16 ounces and an ounce is 16 drams. 27 If the total value of the Trust's silver held by the Custodian exceeds $1 billion, then the Custodian will be under no obligation to accept additional silver deliveries. In such a case, the trustee will retain an additional custodian. On each business day, BNY will make available immediately prior to the opening of trading on the Amex, the Indicative Basket Silver Amount for the creation of a Basket. 28 BNY will adjust the quantity of silver included in the Basket Silver Amount (determined shortly after 4 p.m.) to reflect sales of silver to cover expenses and any loss of deposited silver that may occur since the previous calculation. The Amex will disseminate at least every 15 seconds throughout the trading day, via the facilities of the CTA, an amount representing on a per share basis, the current value of the Basket Silver Amount, known as the “Indicative Trust Amount.” It is anticipated that the deposit of silver in exchange for Silver Shares will be made primarily by institutional investors, arbitrageurs, and the Exchange specialist. Baskets are then separable upon issuance into identical shares that will be listed and traded on the Amex. 29 Silver Shares are expected to be traded on the Exchange by professionals, as well as institutional and retail investors. Silver Shares may be acquired in two
(2)ways:
(1)Through a deposit of the Basket Silver Amount with BNY during normal business hours by Authorized Participants, or
(2)through a purchase on the Exchange by investors. 28 The Sponsor will also make the next day's Indicative Basket Silver Amount available on the Trust Web site ( *http://www.iShares.com* ) shortly after 4 p.m. ET each business day. The Basket Silver Amount, Indicative Basket Silver Amount, and net asset value (“NAV”) will be publicly available simultaneously to all market participants (to avoid any informational advantage) on either the Trust Web site or Amex Web site. These items will also be communicated to Authorized Participants via facsimile or electronic mail message. Telephone conference between Jeffrey Burns, Associate General Counsel, Amex, and Florence Harmon, Senior Special Counsel, Division of Market Regulation, Commission, on January 13, 2006. 29 Silver Shares are separate and distinct from the underlying silver comprising the portfolio of the Silver Trust. The Exchange expects that the number of outstanding Silver Shares will increase and decrease as a result of in-kind deposits and withdrawals of the underlying silver. The Shares will not be individually redeemable but will only be redeemable in Basket Aggregations. To redeem, an Authorized Participant will be required to accumulate enough Silver Shares to constitute a Basket Aggregation ( *i.e.* , 50,000 shares). An Authorized Participant redeeming a Basket Aggregation will receive the silver amount of the Basket Silver Amount announced by the Trustee. Upon the surrender of the Shares and payment of applicable Trustee's fee and any expenses, taxes or charges, BNY will deliver to the redeeming Authorized Participant the amount of silver corresponding to the redeemed Baskets. Unless otherwise requested by the Authorized Participants, silver will then be delivered to the redeeming Authorized Participants in the form of physical bars only. Silver Shares will be registered in book entry form through DTC. The Exchange states that the Basket Silver Amount necessary for the creation of a Basket will slightly diminish each day depending on the Trust's daily expense accrual. The initial Basket Silver Amount is 500,000 ounces of silver (with each Share initially representing 10 ounces of Silver). On each day that the Amex is open for regular trading, BNY will adjust the quantity of silver constituting the Basket Silver Amount as appropriate to reflect sales of silver needed for payment of the Sponsor's fee (which is similar to an expense ratio) 30 and any extraordinary expenses or liabilities not assumed by the Sponsor. BNY will determine the Basket Silver Amount for a given business day by subtracting the daily expense accrual from the previous day's total ounces of silver in the Trust and then dividing by the number of Baskets outstanding. Fractions of an ounce of silver smaller than .001 will be disregarded. 30 The Sponsor has agreed to assume the following administrative and marketing expenses incurred by the Trust: The Trustee's fee, the Custodian's fee, Amex listing fees, SEC registration fees, printing and mailing costs, audit fees and expenses and up to $100,000 per annum in legal fees and expenses. The Sponsor will also pay the costs of the Trust's organization and the initial sale of the iShares, including applicable SEC registration fees. Telephone conference between Jeffrey Burns, Associate General Counsel, Amex, and Florence Harmon, Senior Special Counsel, Division of Market Regulation, Commission, on January 13, 2006. The creation/redemption process in connection with the Silver Shares is an in-kind exchange of silver for Shares, rather than an exchange of silver for cash. Except for the accrual of the Sponsor's fee or extraordinary expenses or liabilities, the process is based entirely on the delivery of silver in exchange for Shares. Thus, throughout each business day, the Exchange states that the actual number of ounces required for the Basket Silver Amount usually will not change even though the value of the Basket Silver Amount may change based on the market price of silver. *2. Determination of NAV, Basket Silver Amount, and Indicative Basket Amount.* Shortly after 4 p.m.
(ET)each business day, the BNY will determine the NAV of the Trust, utilizing that day's announced London silver fix price (unless the Sponsor, in consultation with the Trustee, determines that an alternative publicly available pricing benchmark more fairly represents the commercial value of the silver held by the Trust). 31 Once the value of the silver is determined, BNY will then determine an “adjusted NAV” by subtracting all accrued fees (other than the fees to be computed by reference to the value of the Trust or its assets ( *i.e.* , the Sponsor's fee)), expenses, and other liabilities of the Trust from the total value of silver and all other assets of the Trust. This adjusted NAV is then used to compute the Sponsor's fees that are calculated from the value of Trust assets. Then to determine the final NAV, BNY will subtract from the adjusted NAV the amount of accrued fees from the value of Trust assets. BNY will calculate the NAV per share by dividing the NAV by the number of Silver Shares outstanding. 31 In Amendment No. 1, Amex clarified that if there is no London silver fix price on that day, the BNY will use the most recently announced London silver fix price unless the BNY, in consultation, with Barclays Global Investors International, Inc. (“Barclays”), determines such London silver fix price to be inappropriate. Barclays, in consultation with the BNY, may determine that an alternative publicly available pricing benchmark more fairly represents the commercial value of silver held by the Trust. In the case of a temporary disruption of the London silver fix price, the Exchange believes that it is unnecessary for a filing pursuant to Section 19(b) under the Act to be submitted to the Commission. The Exchange submits that for a temporary disruption of the London silver fix, a determination by Barclays, in consultation with the BNY, to use an alternative pricing source for silver, is appropriate. However, the Exchange represents that if the use of an alternative pricing source for the London silver fix price is more than of a temporary nature, a rule filing will be submitted pursuant to Section 19(b) of the Act. After the NAV is determined, at or about 4 p.m. each business day, BNY will then determine the Basket Silver Amount for orders placed by Authorized Participants received before 4 p.m. that day. BNY will also at the same time determine an “Indicative Basket Silver Amount” that Authorized Participants can use as an indicative amount of silver to be deposited for issuance of the Silver Shares on the next business day. Thus, although Authorized Participants place orders to purchase Silver Shares throughout the trading day, the actual Basket Silver Amount is determined at 4 p.m. or shortly thereafter. Shortly after 4 p.m. each business day, BNY and the Sponsor will disseminate the NAV for the Silver Shares, the Basket Silver Amount (for orders properly placed by 4 p.m. during the day), and the next day's Indicative Basket Silver Amount. The Basket Silver Amount, the Indicative Basket Silver Amount, and the NAV are communicated by BNY to all Authorized Participants via facsimile or electronic mail message and on the Trust's Web site at *http://www.ishares.com.* The Amex will also disclose the NAV, Basket Silver Amount, and Indicative Basket Silver Amount on its Web site. The Sponsor fee, in the absence of any extraordinary expenses and liabilities, is established at 0.50% of the net assets of the Trust. As a result, assuming there is no extraordinary movement in the intra-day market price of silver, the amount of silver by which the Basket Silver Amount will decrease each day will be predictable ( *i.e.* , 1/365 of the net asset value of the Trust multiplied by 0.50%). Given the anticipated predictability of the daily decline in the Basket Silver Amount, as stated, BNY will disclose and disseminate the Indicative Basket Silver Amount for the next business day shortly after 4 p.m. Authorized Participants may use the Indicative Basket Silver Amount as guidance regarding the amount of silver expected to be deposited with the custodian, JP Morgan Chase, in connection with the issuance of Silver Shares on the next business day. As a result, the amount of silver required for the Basket Silver Amount is not disseminated during the trading day to correspond to changes in the value of silver as measured by spot silver prices. 32 Before 4 p.m., the Authorized Participants may use the Indicative Basket Silver Amount published by the Sponsor and BNY the day before as guidance in respect of the amount of silver that they may expect to be required to deposit. But if the Indicative Basket Silver Amount published by the Sponsor and BNY turns out to be incorrect (for example, because the Trust incurred an extraordinary expense such as legal fees in excess of the amount assumed by the Sponsor), the amount actually determined by BNY will control. 32 The Amex will disseminate an “Indicative Trust Value” at least every 15 seconds during the trading day that represents an indicative value for the Silver Shares based on the silver spot price. 3. Liquidity. The Exchange states that the amount of the discount or premium in the trading price relative to the NAV per Share may be influenced by the non-concurrent trading hours between the major silver markets and the Amex. While the Silver Shares will trade on the Exchange until 4:15 p.m. ET, liquidity in the OTC market for silver will be reduced after the close of the major world silver markets, including London, Zurich, and the COMEX. As a result, trading spreads and the resulting premium or discount on the Silver Shares may widen as a result of reduced liquidity. 33 33 As noted above in the section titled ”Description of the Silver Market,” the period of greatest liquidity in the silver market is typically that time of the day when trading in the European time zones overlaps with trading in the United States, which is when OTC market trading in New York, London, Zurich and other centers coincides with futures and options trading on the COMEX division of the NYMEX. This period lasts for approximately four hours each New York business day morning. The Exchange believes that Silver Shares will not trade at a material discount or premium to the underlying silver held by the Trust based on potential arbitrage opportunities. Due to the fact that the Shares can be created and redeemed only in Basket Aggregations, the Exchange submits that arbitrage opportunities should provide a mechanism to mitigate the effect of any premiums or discounts that may exist from time to time. If the price of the Shares deviates enough from the price of silver to create a material discount or premium, an arbitrage opportunity is created. If the Shares are inexpensive compared to the silver that underlies them, an arbitrageur may buy the Shares at a discount, immediately redeem them in exchange for silver, and sell the silver in the cash market at a profit. If the Shares are expensive compared to the silver that underlies them, an arbitrageur may sell the Shares short, buy enough silver to acquire the number of Shares sold short, acquire the Shares through the creation process, and deliver the Shares to close out the short position. In both instances, the arbitrageur serves efficiently to correct price discrepancies between the Shares and the underlying silver. *Availability of Information Regarding Silver Prices.* Although the spot price of silver will not be disseminated over the facilities of CTA, the last sale price for the Shares, as is the case for all equity securities traded on the Exchange will be disseminated over the CTA's Network B. In addition, there is a considerable amount of silver price and market information available on public Web sites and through professional and subscription services. Investors may obtain on a 24-hour basis silver pricing information based on the spot price of an ounce of silver from various financial information service providers, such as Reuters and Bloomberg. In addition, the daily London silver fix is also disseminated by various market data vendors and is available from the LBMA's Web site. Reuters and Bloomberg provide at no charge on their Web sites delayed information regarding the spot price of silver and last sale prices of silver futures contracts and related options, as well as information about news and developments in the silver market. Reuters and Bloomberg also offer a professional service to subscribers for a fee that provides information on silver prices directly from market participants. 34 Complete real-time data for silver futures contracts and options prices traded on the COMEX (a division of the NYMEX) is available by subscription from Reuters and Bloomberg and also on a delayed basis free of charge on the NYMEX Web site at *http://www.nymex.com.* The Exchange also notes that there are a variety of other public Web sites providing information on silver, ranging from those specializing in precious metals to sites maintained by major newspapers, such as *The Wall Street Journal.* Current silver spot prices are also generally available with bid/ask spreads from silver bullion dealers. 34 In addition, EBS also provides an electronic trading platform to institutions such as bullion banks and dealers for the trading of spot silver, as well as a feed of live streaming prices to Reuters and Moneyline Telerate subscribers. EBS was launched in September 1993 by a group of the world's largest foreign exchange market making banks. The Exchange states that EBS is the pre-eminent provider of precious metals and foreign exchange trading solutions to the precious metals and interbank spot foreign exchange community. Approximately 500,000 ounces in gold, 4 million ounces in silver and $110 billion a day in spot foreign exchange transactions is traded each day over the EBS trading platform. The shareholders of EBS include the subsidiaries of the following organizations: ABN AMRO, Bank of America, Barclays, Citibank, Commerzbank, Credit Suisse First Boston, Lehman Brothers, HSBC, JPMorgan Chase, The Royal Bank of Scotland, S-E-Banken, UBS AG and the Minex Corporation of Japan. *See http://www.ebs.com.* The Amex, via a link to the Trust's Web site, will provide at no charge continuously updated bids and offers indicative of the spot price ( *i.e.* , real time information) of silver on its own public Web site at *http://www.amex.com.* 35 35 The Trust Web site's silver spot price will be provided by The Bullion Desk at *http://www.thebulliondesk.com.* The Amex will provide a link to the Trust Web site. The Bullion Desk is not affiliated with the Trust, Sponsor, Custodian or the Exchange. The silver spot price is indicative only, constructed using a variety of sources to compile a spot price that is intended to represent a theoretical quote that might be obtained from a market maker from time to time. The Trust Web site will indicate, as noted above in the discussion titled “Availability of Information Regarding Silver Prices,” that there are other sources for obtaining the silver spot price. In the event that the Trust Web site should cease to provide this indicative spot price from an unaffiliated source and the intraday indicative value of the Shares, the Exchange will delist the shares. *See* “Criteria for Initial and Continued Listing,” below. *Availability of Information Regarding Silver Shares.* The Web site for the Trust, which will be publicly accessible at no charge, will contain the following information:
(a)The prior business day's NAV and the reported closing price;
(b)the mid-point of the bid-ask price 36 in relation to the NAV as of the time the NAV is calculated (the “Bid-Asked Price”);
(c)calculation of the premium or discount of such price against such NAV;
(d)data in chart form displaying the frequency distribution of discounts and premiums of the Bid-Ask Price against the NAV, within appropriate ranges for each of the four
(4)previous calendar quarters;
(e)the Basket Silver Amount;
(f)the Indicative Basket Silver Amount;
(g)the Prospectus; and
(h)other applicable quantitative information. 36 The bid-ask price of Shares is determined using the highest bid and lowest offer as of the time of calculation of the NAV. As described above, the NAV for the Trust will be calculated and disseminated daily. The Amex also intends to disseminate for the Trust on a daily basis by means of CTA/CQ High Speed Lines information with respect to the Indicative Trust Value (as discussed below), recent NAV, and shares outstanding. As stated, the Trust Web site will also provide a real time indicative silver spot price through The Bullion Desk at *http://www.thebulliondesk.com,* which will be used to calculate the Indicative Trust Value. 37 Notwithstanding that they will be provided free of charge, the indicative spot price from BullionDesk.com and the Indicative Trust Value per Share will be provided essentially on a real-time basis. 38 The Exchange will also make available on its Web site daily trading volume, closing prices, NAV, and the Basket Silver Amount. The London silver fix price is readily available from the LBMA at *http://www.lbma.org.uk,* automated quotation systems, published or other public sources, or on-line information services such as Bloomberg or Reuters. In addition, the Exchange will provide a hyperlink on its Web site at *http://www.amex.com* to the Trust's Web site at *http://www.ishares.com.* 37 Telephone conference between Jeffrey Burns, Associate General Counsel, Amex, and Florence Harmon, Senior Special Counsel, Division of Market Regulation, Commission, on January 13, 2006. 38 The Trust Web site is expected to indicate that these values are subject to an average delay of 5 to 10 seconds. *Dissemination of Indicative Trust Value.* As noted above, BNY calculates the NAV of the Silver Trust once each trading day. In addition, BNY causes to be made available on a daily basis the required amount of silver to be deposited in connection with the issuance of Silver Shares in Basket Aggregations. In addition, other investors can request such information directly from the BNY. In order to provide updated information relating to the Trust for use by investors, professionals, and Authorized Persons wishing to create or redeem Silver Shares, the Exchange will disseminate through the facilities of CTA an updated Indicative Trust Value (the “Indicative Trust Value”). The Indicative Trust Value will be disseminated on a per Silver Share basis at least every 15 seconds during regular Amex trading hours of 9:30 a.m. to 4:15 p.m. ET. The Indicative Trust Value will be calculated based on the amount of silver required for creations and redemptions and a price of silver derived from updated bids and offers indicative of the spot price of silver. 39 The Indicative Trust Value on a per Silver Share basis disseminated during Amex trading hours should not be viewed as a real time update of the NAV, which is calculated only once a day. 39 *See supra* note 29. The Exchange believes that dissemination of the Indicative Trust Value based on the amount of silver required for a Basket Aggregation provides additional information that is not otherwise available to the public and is useful to professionals and investors in connection with Silver Shares trading on the Exchange or the creation or redemption of Silver Shares. In addition, the Trust's Web site at *http://www.ishares.com* will also provide from The Bullion Desk continuously updated bids and offers indicative of the spot price of silver in the OTC market for the purpose of disclosing to investors on a real-time basis the underlying or spot price of silver. *Termination Events.* The Trust will be terminated if any of the following circumstances occur:
(1)The Silver Shares are delisted from the Amex and are not listed for trading on another national securities exchange within five business days from the date the Silver Shares are delisted;
(2)holders of at least 75% of the outstanding Silver Shares notify the Trustee that they elect to terminate the trust;
(3)the Trustee resigns and no successor trustee is appointed within 60 days from the date the trustee provides notice to the Sponsor of its intent to resign;
(4)the Commission finds that the Trust should be registered as an investment company under the Investment Company Act of 1940, and the Trustee has actual knowledge of the Commission finding;
(5)the aggregate market capitalization of the Trust, based upon the closing price for the Silver Trust, was less than $350 million on each of five
(5)consecutive trading days and the Trustee receives, within six
(6)months from the last of those trading days, notice that the Sponsor has decided to terminate the Trust;
(6)the CFTC determines that the Trust is a commodity pool under the Commodity Exchange Act and the Trustee has actual knowledge of that determination; or
(7)the Trust fails to qualify for treatment, or ceases to be treated, as a grantor trust for U.S. federal income tax purposes and the Trustee receives notice that the Sponsor has determined that the termination of the Trust is advisable. If not terminated earlier by the trustee, the Trust will terminate in 2045 on a date to be determined once the Trust is established. Upon termination of the Trust, holders of the Silver Shares will surrender their shares and receive from the Trustee their portion of the underlying silver. *Criteria for Initial and Continued Listing.* The Trust will be subject to the criteria in Amex Rules 1201A and 1202A for initial and continued listing of Silver Shares. The continued listing criteria provides for the delisting or removal from listing of the Silver Shares under any of the following circumstances: • Following the initial twelve month period from the date of commencement of trading of the Silver Shares:
(i)If the Trust has more than 60 days remaining until termination and there are fewer than 50 record and/or beneficial holders of the Silver Shares for 30 or more consecutive trading days;
(ii)if the Trust has fewer than 50,000 Silver Shares issued and outstanding; or
(iii)if the market value of all Silver Shares is less than $1,000,000. • If the value of the underlying silver is no longer calculated or available on at least a 15-second delayed basis from a source unaffiliated with the sponsor, Trust, custodian or the Exchange or the Exchange stops providing a hyperlink on its Web site to any such unaffiliated silver value. • The Indicative Trust Value is no longer made available on at least a 15-second delayed basis. • If such other event shall occur or condition exists which in the opinion of the Exchange makes further dealings on the Exchange inadvisable. It is anticipated that a minimum of 150,000 Silver Shares will be required to be outstanding at the start of trading. The minimum number of shares required to be outstanding at the start of trading is comparable to requirements that have been applied to previously listed series of the iShares COMEX Gold Trust, the streetTRACKS Gold Trust, trust issues receipts and exchange-traded funds (“ETFs”). It is anticipated that the initial price of a Silver Share will be approximately $91. 40 The Exchange believes that the anticipated minimum number of Silver Shares outstanding at the start of trading is sufficient to provide adequate market liquidity and to further the Trust's objective to seek to provide a simple and cost effective means of making an investment similar to an investment in silver. 40 Telephone conference between Jeffrey Burns, Associate General Counsel, Amex, and Florence Harmon, Senior Special Counsel, Division of Market Regulation, Commission, on January 13, 2006 (updating initial price of a Silver Share that initially will represent 10 ounces of silver). The Exchange represents that it prohibits the initial and/or continued listing of any security that is not in compliance with Rule 10A-3 under the Securities Exchange Act of 1934 (the “1934 Act”). 41 41 *See* Rule 10A-3(c)(7) under the 1934 Act. *Original and Annual Listing Fees.* The Amex original listing fee applicable to the listing of the Silver Trust is $5,000. In addition, the annual listing fee applicable under section 141 of the Amex Company Guide (“Company Guide”) will be based upon the year-end aggregate number of shares in all series of Silver Trusts outstanding at the end of each calendar year. *Trading Rules.* Silver Shares are equity securities subject to Amex Rules governing the trading of equity securities, including, among others, rules governing priority, parity and precedence of orders, specialist responsibilities and account opening and customer suitability (Amex Rule 411). Initial equity margin requirements of 50% will apply to transactions in Silver Shares. Silver Shares will trade on the Amex until 4:15 p.m. ET each business day and will trade in a minimum price variation of $0.01 pursuant to Amex Rule 127. Trading rules pertaining to odd-lot trading in Amex equities (Amex Rule 205) will also apply. Amex Rule 154, Commentary .04(c) provides that stop and stop limit orders to buy or sell a security (other than an option, which is covered by Amex Rule 950(f) and Commentary thereto), the price of which is derivatively priced based upon another security or index of securities, may with the prior approval of a Floor Official, be elected by a quotation, as set forth in Commentary .04(c)(i-v). The Exchange has designated Silver Shares as eligible for this treatment. 42 42 *See* Securities Exchange Act Release No. 29063 (April 10, 1991), 56 FR 15652 (April 17, 1991) at note 9, regarding the Exchange's designation of equity derivative securities as eligible for such treatment under Amex Rule 154, Commentary .04(c). Silver Shares will be deemed “Eligible Securities”, as defined in Amex Rule 230, for purposes of the Intermarket Trading System Plan and therefore will be subject to the trade through provisions of Amex Rule 236, which require that Amex members avoid initiating trade-throughs for ITS securities. Specialist transactions of Silver Shares made in connection with the creation and redemption of Silver Shares will not be subject to the prohibitions of Amex Rule 190. 43 Unless exemptive or no-action relief is available, Silver Shares will be subject to the short sale rule, Rule 10a-1 and Regulation SHO under the Act. 44 If exemptive or no-action relief is provided, the Exchange will issue a notice detailing the terms of the exemption or relief. The Silver Shares will generally be subject to the Exchange's stabilization rule, Amex Rule 170, except that specialists may buy on “plus ticks” and sell on “minus ticks,” in order to bring the Silver Shares into parity with the underlying silver and/or futures price. Commentary .01 to Amex Rule 1203A sets forth this limited exception to Amex Rule 170. 43 *See* Commentary .05 to Amex Rule 190. 44 The Silver Trust has requested relief in connection with the trading of Silver Shares from the operation of the short sale rule, Rule 10a-1 and Regulation SHO under the Act. Amex Rule 1203A relating to certain specialist prohibitions addresses potential conflicts of interest in connection with acting as a specialist in the Silver Shares. Specifically, Amex Rule 1203A provides that the prohibitions in Amex Rule 175(c) apply to a specialist in the Silver Shares so that the specialist or affiliated person may not act or function as a market maker in the underlying silver, related silver futures contract or option or any other related silver derivative. An affiliated person of the specialist consistent with Amex Rule 193 may be afforded an exemption to act in a market making capacity, other than as a specialist in the Silver Shares on another market center, in the underlying silver, related silver futures or options, or any other related silver derivative. In particular, Amex Rule 1203A provides that an approved person of an equity specialist that has established and obtained Exchange approval for procedures restricting the flow of material, non-public market information between itself and the specialist member organization, and any member, officer, or employee associated therewith, may act in a market making capacity, other than as a specialist in the Silver Shares on another market center, in the underlying commodity, related commodity futures or options on commodity futures, or any other related commodity derivatives. Amex Rule 1204A(a) provides that the member organization acting as specialist in Commodity-Based Trust Shares is obligated to conduct all trading in the Shares in its specialist account, subject only to the ability to have one or more investment accounts, all of which must be reported to the Exchange (see Rule 170). In addition, the member organization acting as specialist in Commodity-Based Trust Shares must file, with the Exchange, in a manner prescribed by the Exchange, and keep current a list identifying all accounts for trading the underlying physical commodity, related commodity futures or options on commodity futures, or any other related commodity derivatives, which the member organization acting as specialist may have or over which it may exercise investment discretion. No member organization acting as specialist in Commodity-Based Trust Shares shall trade in the underlying physical commodity, related commodity futures or options on commodity futures, or any other related commodity derivatives, in an account in which a member organization acting as specialist, directly or indirectly, controls trading activities, or has a direct interest in the profits or losses thereof, which has not been reported to the Exchange as required by this Rule. 45 45 Telephone conference between Jeffrey Burns, Associate General Counsel, Amex, and Florence Harmon, Senior Special Counsel, Division of Market Regulation, Commission, on January 13, 2006 (inserting discussion of Amex Rule 1204A(a)). Amex Rule 1204A(b) also ensures that specialists handling the Silver Shares provide the Exchange with all the necessary information relating to their trading in physical silver, related silver futures contracts and options thereon or any other silver derivative. As a general matter, the Exchange has regulatory jurisdiction over its members, member organizations, and approved persons of a member organization. The Exchange also has regulatory jurisdiction over any person or entity controlling a member organization, as well as a subsidiary or affiliate of a member organization that is in the securities business. A subsidiary or affiliate of a member organization that does business only in commodities would not be subject to Exchange jurisdiction, but the Exchange could obtain information regarding the activities of such subsidiary or affiliate through surveillance sharing agreements with regulatory organizations of which such subsidiary or affiliate is a member. Amex Rule 1204A(c) also prohibits the specialist in the Silver Shares from using any material nonpublic information received from any person associated with a member or employee of such person regarding trading by such person or employee in physical silver, silver futures contracts, options on silver futures, or any other silver derivative (including the Silver Shares). 46 46 Telephone conference between Jeffrey Burns, Associate General Counsel, Amex, and Florence Harmon, Senior Special Counsel, Division of Market Regulation, Commission, on January 13, 2006 (inserting discussion of Amex Rule 1204A(c)). Prior to the commencement of trading, the Exchange will issue an Information Circular (described below) to members informing them of, among other things, Exchange policies regarding trading halts in Silver Shares. First, the Circular will advise that trading will be halted in the event the market volatility trading halt parameters set forth in Amex Rule 117 have been reached. Second, the Circular will advise that, in addition to the parameters set forth in Amex Rule 117, the Exchange may halt trading in Silver Shares if conditions in the underlying silver market have caused disruptions and/or lack of trading. Third, with respect to a halt in trading that is not specified above, the Exchange may also consider other relevant factors and the existence of unusual conditions or circumstances that may be detrimental to the maintenance of a fair and orderly market. The Exchange will halt trading in the Shares if the Trust Web site (to which Amex will link) ceases to provide:
(1)The value of the silver updated at least every 15 seconds from a source not affiliated with the Sponsor, Trust, or the Exchange, or
(2)the Indicative Trust Value per Share updated at least every 15 seconds. 47 47 In the event such spot price of silver or Indicative Trust Value is no longer calculated or disseminated, the Exchange would immediately contact the Commission to discuss measures that may be appropriate under the circumstances. Telephone conversation between Jeffrey Burns, Associate General Counsel, Amex, and Florence Harmon, Senior Special Counsel, Division of Market Regulation, Commission, on January 13, 2006. *Information Circular.* The Amex will distribute an Information Circular (the “Circular”) to its members in connection with the trading of Silver Shares. The Circular, will discuss the special characteristics and risks of trading this type of security. Specifically, the Circular, among other things, will discuss what the Silver Shares are, notify members and member organization about the procedures for creation and redemption of Silver Shares in a basket, the requirement, as described below, that members and member firms deliver a prospectus to investors purchasing the Silver Shares prior to or concurrently with the confirmation of a transaction, applicable Amex rules, dissemination of information regarding the per share Indicative Trust Value, NAV, and other information pertaining to the Shares, including trading information, trading halt procedures, and applicable suitability rules. For example, in the Information Circular, members and member organizations will be informed that procedures for purchases and redemptions of Silver Shares in Basket Aggregations are described in the Prospectus and that Silver Shares are not individually redeemable but are redeemable only in Basket Aggregations or multiples thereof. Similarly, the Information Circular will advise members and member organizations, prior to commencement of trading, of the prospectus delivery requirements applicable to the Trust. The Exchange notes that investors purchasing Silver Shares directly from the Trust (by delivery of the Basket Silver Amount) will receive a prospectus. Amex members purchasing Silver Shares from the Trust for resale to investors will deliver a prospectus to such investors. The Circular will also explain that the Silver Trust is subject to various fees and expenses described in the Registration Statement and that the number of ounces of silver required to create a basket or to be delivered upon a redemption of a basket will gradually decrease over time because the Silver Shares comprising a basket will represent a decreasing amount of silver due to the sale of the Silver Trust's silver to pay Trust expenses. The Circular will also reference the fact that there is no regulated source of last sale information regarding physical silver, that the Commission has no jurisdiction over the trading of silver as a physical commodity, and that the CFTC has regulatory jurisdiction over the trading of silver futures contracts and options on silver futures contracts. The Circular will advise members of their suitability obligations with respect to recommended transactions to customers in the Silver Shares. The Exchange notes that pursuant to Amex Rule 411 (Duty to Know and Approve Customers), members and member organizations are required in connection with recommending transactions in the Silver Shares to have a reasonable basis to believe that a customer is suitable for the particular investment given reasonable inquiry concerning the customer's investment objectives, financial situation, needs, and any other information known by such member. The Circular will also discuss any relief, if granted, by the Commission or the staff from any rules under the Act. *Surveillance.* The Exchange represents that its surveillance procedures applicable to trading in the proposed Silver Shares will be similar to those applicable to the iShares COMEX Gold Trust, the streetTRACKS Gold Trust, trust issued receipts, Portfolio Depository Receipts and Index Fund Shares currently trading on the Exchange. For intermarket surveillance purposes, the Exchange currently has in place an Information Sharing Agreement with the NYMEX for the purpose of providing information in connection with trading in or related to COMEX silver futures contracts. The Exchange submits that its surveillance procedures are adequate to properly monitor the trading of the Shares. Also, as noted above, the Exchange states that Amex Rule 1204A(b), which requires that the specialist handling the Silver Shares provide the Exchange with information relating to its trading in physical silver, silver futures contracts, options on silver futures, or any other silver derivative, will facilitate surveillance of specialist handling Silver Shares. 2. Statutory Basis The Exchange believes that the proposed rule change, as amended, is consistent with section 6(b) of the Act 48 in general, and furthers the objectives of section 6(b)(5) 49 in particular, in that it is designed to prevent fraudulent and manipulative acts and practices, to promote just and equitable principles of trade, to foster cooperation and coordination with persons engaged in facilitating transactions in securities, and to remove impediments to and perfect the mechanism of a free and open market and a national market system. 48 15 U.S.C. 78f(b). 49 15 U.S.C. 78f(b)(5). B. Self-Regulatory Organization's Statement on Burden on Competition The Exchange does not believe that the proposed rule change, as amended, would impose any burden on competition that is not necessary or appropriate in furtherance of the purposes of the Act. C. Self-Regulatory Organization's Statement on Comments on the Proposed Rule Change Received From Members, Participants, or Others Written comments were neither solicited nor received. III. Date of Effectiveness of the Proposed Rule Change and Timing for Commission Action Within 35 days of the date of publication of this notice in the **Federal Register** or within such longer period
(i)as the Commission may designate up to 90 days of such date if it finds such longer period to be appropriate and publishes its reasons for so finding, or
(ii)as to which the Amex consents, the Commission will:
(A)By order approve such proposed rule change, as amended; or
(B)Institute proceedings to determine whether the proposed rule change, as amended, should be disapproved. IV. Solicitation of Comments Interested persons are invited to submit written data, views, and arguments concerning the foregoing, including whether the proposed rule change, as amended, is consistent with the Act. Comments may be submitted by any of the following methods: Electronic Comments • Use the Commission's Internet comment form ( *http://www.sec.gov/rules/sro.shtml* ); or • Send an e-mail to *rule-comments@sec.gov* . Please include File Number SR-Amex-2005-072 on the subject line. Paper Comments • Send paper comments in triplicate to Nancy M. Morris, Secretary, Securities and Exchange Commission, Station Place, 100 F Street, NE., Washington, DC 20549-9303. All submissions should refer to File Number SR-Amex-2005-072. This file number should be included on the subject line if e-mail is used. To help the Commission process and review your comments more efficiently, please use only one method. The Commission will post all comments on the Commission's Internet Web site ( *http://www.sec.gov/rules/sro.shtml* ). Copies of the submission, all subsequent amendments, all written statements with respect to the proposed rule change that are filed with the Commission, and all written communications relating to the proposed rule change between the Commission and any person, other than those that may be withheld from the public in accordance with the provisions of 5 U.S.C. 552, will be available for inspection and copying in the Commission's Public Reference Room. Copies of such filing also will be available for inspection and copying at the principal office of the Exchange. All comments received will be posted without change; the Commission does not edit personal identifying information from submissions. You should submit only information that you wish to make publicly available. All submissions should refer to File Number SR-Amex-2005-072 and should be submitted on or before February 13, 2006. For the Commission, by the Division of Market Regulation, pursuant to delegated authority. 50 Nancy M. Morris, Secretary. 50 17 CFR 200.30-3(a)(12). [FR Doc. E6-700 Filed 1-20-06; 8:45 am] BILLING CODE 8010-01-P SECURITIES AND EXCHANGE COMMISSION [Release No. 34-53112; File No. SR-CBOE-2004-21] Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing of Proposed Rule Change To Establish Rules for a Screen-Based Trading System for Non-option Securities January 12, 2006. Pursuant to Section 19(b)(1) of the Securities Exchange Act of 1934 (“Act”) 1 and Rule 19b-4 thereunder, 2 notice is hereby given that on April 14, 2004, the Chicago Board Options Exchange, Incorporated (“CBOE” or “Exchange”) filed with the Securities and Exchange Commission (“Commission” or “SEC”) the proposed rule change as described in Items I, II, and III below, which Items have been substantially prepared by the Exchange. On January 11, 2006, CBOE submitted Amendment No. 1 to the proposed rule change. 3 The Commission is publishing this notice to solicit comments on the proposed rule change, as amended, from interested persons. 1 15 U.S.C. 78s(b)(1). 2 17 CFR 240.19b-4. 3 Amendment No. 1 replaced the original rule filing in its entirety. I. Self-Regulatory Organization's Statement of the Terms of Substance of the Proposed Rule Change CBOE proposes to adopt rules governing the trading of non-option securities on CBOE *direct* , the Exchange's screen-based trading platform. The proposed new system would be called the Stock Trading on CBOE *direct* System (“STOC System” or “System”). The text of the proposed rule change is available at CBOE's Web site ( *http://www.cboe.org/legal/default.aspx* ), at CBOE's principal office, and at the Commission's Public Reference Room. II. Self-Regulatory Organization's Statement of the Purpose of and Statutory Basis for, the Proposed Rule Change In its filing with the Commission, CBOE included statements concerning the purpose of and basis for the proposed rule change and discussed any comments it received on the proposed rule change. The text of these statements may be examined at the places specified in Item IV below. CBOE has prepared summaries, set forth in sections A, B, and C below, of the most significant aspects of such statements. A. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change 1. Purpose As an Intermarket Trading System (“ITS”) participant, CBOE trades a small number of non-option securities. 4 These products are not traded on CBOE's options trading platform. Instead, they trade on CBOE's stand-alone stock platform in an open-outcry environment pursuant to Chapter XXX
(30)of CBOE's rules. In 2003, the Commission approved Chapters XL
(40)through XLVI
(46)of CBOE's rules, 5 which established a purely screen-based trading platform for the trading of options on CBOE. 6 That screen-based platform is commonly referred to as CBOE *direct* , and components of that system have been successfully used to create CBOE's Hybrid Trading System (currently in use for options trading), to facilitate the trading of single-stock futures by OneChicago, and to trade security futures products on the newly-created CBOE Futures Exchange. 7 CBOE now proposes to adopt a new set of rules as Chapters L
(50)through LV
(55)of CBOE's rules to allow for the trading of non-option securities in a purely screen-based environment. CBOE *direct* would be the foundation for this platform. CBOE intends that all products currently traded under Chapter 30 would migrate to the new platform and trade pursuant to Chapters 50-55. The proposed new platform is called the Stock Trading on CBOE *direct* System, or STOC System. The STOC System would be substantially similar to CBOE's screen-based platform for options in that it
(1)would be entirely screen-based;
(2)would utilize a DPM/LMM-driven model with optional supplemental liquidity provided by STOC Market-Makers;
(3)would utilize a configurable matching algorithm based on either price-time or pro-rata priority with optional priority overlays; and
(4)would integrate all quotes and orders entered into the system into the STOC book. 4 Currently, CBOE trades four such products. 5 *See* Securities Exchange Act Release No. 47628 (April 3, 2003), 68 FR 17697 (April 10, 2003) (approving SR-CBOE-00-55); *see also* Securities Exchange Act Release No. 45829 (April 25, 2002), 67 FR 31002 (May 8, 2002) (notice of filing of SR-CBOE-00-55). 6 At this time, CBOE does not trade options pursuant to Chapters 40-46. 7 CBOE represents that these different uses of the CBOE *direct* platform have not had, and will not have, an adverse affect on trading or the stability of the platform. CBOE believes the STOC System would greatly enhance the trading of stock products on the Exchange. Unlike CBOE's current non-option security trading system, the STOC System would be fully integrated with ITS to facilitate the sending and receipt of ITS Commitments. It would automatically execute marketable orders against CBOE's quote up to the size of the quote (assuming such executions would not cause an impermissible trade-through of another exchange's quote). STOC Market-Maker quotes and all orders (customer or otherwise) would be integrated into the STOC Book. Further, the audit trail process would be greatly simplified for regulatory purposes. Almost all of the rules contained in proposed Chapters 50-55 are substantially identical to previously approved rules contained in Chapters 30 and 40-46 of CBOE's rules. Of course, not all the rules from those chapters are proposed to be adopted for the STOC System rules—only ones that would be appropriate for screen-based stock trading. Any new rules or material modifications to the rules proposed to be adopted from Chapters 30 and 40-46 are explained below. Chapter 50 This chapter provides an introduction to the STOC System by setting forth definitions (including definitions of the various market participant types), explaining the application of other CBOE rules, setting forth the registration process for members, 8 stating communication access guidelines, and establishing a limitation on liability with respect to certain reporting authorities. All of the rules in this chapter come from Chapters 40 and 41 of CBOE's rules, except for proposed CBOE Rule 50.7, Limitation on Reporting Authorities' Liability, which is based on CBOE Rule 30.55. 8 With respect to the registration process for members, any Exchange member who chooses to participate on the STOC System must apply with the Exchange to act as a STOC Market-Maker, STOC Broker, or Proprietary Trader in accordance with proposed CBOE Rule 50.4. Such applications must be submitted to the Exchange Membership Committee for approval pursuant to CBOE Rule 3.9. CBOE Rule 3.9 provides that an applicant must submit an application in a form and manner prescribed by the Exchange and describes the application procedures and process for approval or disapproval. Chapter 51 This chapter contains rules concerning operational matters—for example, business hours, units of trading, minimum increments for bids and offers, and types or orders handled. Proposed CBOE Rules 51.1, 51.2, 51.4, 51.5, 51.7, and 51.8 through 51.11 are rules that can also be found in Chapter 30. CBOE Rule 51.3 is based on current CBOE Rule 42.2. Chapter 52 This chapter contains proposed trading and order processing rules for the STOC System. Proposed CBOE Rule 52.1 describes the System's matching algorithm and governs priority on the System. It is similar to CBOE Rule 43.1, which governs priority for options orders. As proposed, the appropriate STOC Trading Committee would apply one of two priority schemes, on a security-by-security basis. Trades would be allocated by the System pursuant to either price-time priority or pro-rata priority. Once one of those two priority schemes is in place, the appropriate STOC Trading Committee could implement additional optional priority overlays. Namely, an additional priority could be provided to public customer orders, the market turner, or to the STOC DPM/LMM (CBOE's specialist equivalent) 9 as part of a participation entitlement. 10 Thus, if pro-rata priority were in place for a particular security, and the market turner, public customer, and trade participation right overlays were in place (in that order of priority), incoming marketable orders would be allocated by the System to all participants in pro-rata fashion after the participant that first established that price (the market turner), any public customers resting at the best price, and the STOC DPM/LMM for the product (assuming its order and/or quote is at the best price) have been satisfied (in that order). As part of the participation right, the STOC DPM/LMM could never receive a quantity larger than the size of its quote. The participation right percentage would be established pursuant to proposed CBOE Rule 53.56 by the STOC DPM Committee and could not exceed 40%. Any participant (including a public customer) could be a market turner. 9 Throughout the proposed rules, references to STOC DPMs are also applicable to STOC LMMs (which are essentially rotating STOC DPMs). A product cannot have both a STOC DPM and a STOC LMM appointed to it. *See* proposed CBOE Rule 53.51 (defining STOC LMM). 10 Proposed CBOE Rule 52.1(b)(3)(C) provides that the participation entitlement may not be in effect unless the public customer priority is in effect and ahead of the participation entitlement in the priority sequence. Proposed CBOE Rule 52.2 would govern the System's opening procedures. The opening would occur in one of two ways, depending on whether CBOE was the primary market for a security. If CBOE were the primary market, the System would calculate a price point at which the most pre-opening buy and sell orders could be matched (based on share volume) and then execute those orders to establish an opening price and open trading. If CBOE were not the primary market, the STOC DPM/LMM would open the security at a single price that matches the primary market or at a price that does not trade-through another exchange's quotes. This would allow the STOC DPM to assess the quantity and balance of pre-opening orders and to interact with the primary market as necessary via ITS. Proposed CBOE Rule 52.4 would govern “clearly erroneous” transactions executed on the Exchange. The proposed rule sets forth the procedure for requesting Exchange review, the review procedures, and the steps taken in the event of system disruption or malfunction. The Exchange notes that this proposed rule is based on PCX Equities (“PCXE”) Rule 7.10, which governs clearly erroneous executions. Proposed CBOE Rule 52.6 would govern market order processing. It provides that market orders would automatically execute against the STOC Book (including against orders behind the best price at varying price points) until the order is fully executed or until such execution would result in an impermissible trade-through. 11 To the extent a market order is not automatically executed against the STOC book because CBOE is not the NBBO, the System would “flash” the order at the NBBO price to STOC Market-Makers on the System (to see if they would match or improve the NBBO) for a period of time not to exceed three seconds. After such time, if the order has not been traded, the System will route it to the STOC DPM/LMM for manual handling (which would allow the DPM/LMM to transmit an ITS commitment on behalf of the order). 11 In most cases any trade-through would be impermissible, but the Commission has provided a temporary 3-tick exemption for certain products. *See* Securities Exchange Act Release No. 46428 (August 28, 2002), 67 FR 56607 (September 4, 2002) (order implementing the exemption as a pilot program); Securities Exchange Act Release No. 52382 (September 6, 2005), 70 FR 53695 (September 9, 2005) (order extending pilot program through June 28, 2006). Any such exemption would be factored into what can automatically execute on the STOC System. Proposed CBOE Rule 52.7, which would govern limit order processing, provides that limit orders would be booked by the System and that they would not automatically execute at prices inferior to the NBBO. When a limit order is received that is marketable against the quote of another exchange but not marketable on CBOE, the System would “flash” the order at its limit price to STOC Traders on the System (to see if they would match or improve the NBBO) for a period of time not to exceed three seconds. After such time, if the limit order has not been traded, the System would route it to the STOC DPM/LMM for manual handling (which would allow the DPM/LMM to transmit an ITS Commitment on behalf of the limit order). Proposed CBOE Rule 52.8 provides that market odd-lot orders would be executed against STOC Market-Maker interest on the STOC Book provided such interest equals the NBBO. If no STOC Market-Makers are quoting at the NBBO, odd-lot orders would route to the STOC DPM/LMM for execution. Limit odd lot orders would execute against the STOC DPM/LMM if
(i)the limit price is marketable against the STOC DPM/LMM quote, or
(ii)a trade occurs at the limit price on another exchange. Pre-opening odd lot orders that are marketable against the opening price would receive the opening price. Proposed CBOE Rule 52.10 would provide that the System would automatically execute inbound ITS Commitments against the best prices available in the STOC Book to the extent such commitments are marketable. When an ITS Commitment is not marketable against the STOC Book, the System would “flash” the commitment at its limit price to STOC Traders on the System (to see if they would match or improve the NBBO) for a period of time not to exceed 3 seconds. After such time, any unexecuted portion would be cancelled by the System. Inbound market ITS Commitments would be executed at the NBBO or cancelled. Proposed CBOE Rule 52.11(a) governs the facilitation of the non-option security portion of option-related complex orders. This rule defines a complex order as an order involving one or more option order components and one or more non-option security order components. Such facilitation transactions would be entered into the STOC System at a price at or within the prevailing quotation for the non-option security at the time the options portion of the complex orders are executed. The non-option security portion of the order would have priority at that price irrespective of pre-existing bids and offers and any priority designations in place pursuant to proposed CBOE Rule 52.1, provided that the option order component(s) bettered the corresponding bid (offer) in the options market on which they were executed. Proposed CBOE Rule 52.11(b), regarding crossing transactions on the STOC System, provides that a STOC Trader that wishes to cross two original orders or to facilitate an original order must first send a Request for Quote
(RFQ)with size. Within 10-30 seconds, as determined by the appropriate STOC Trading Committee, from the conclusion of the RFQ response period, the orders may, at the STOC Trader's discretion, be crossed
(i)between the bid-offer if the transaction would be less than 25,000 shares; or
(ii)at or between the bid-offer if the transaction would be greater than 25,000 shares and in which case the cross transaction will have priority. The cross transaction information would be received and effected by the Exchange's Help Desk. The remaining rules in proposed Chapter 52 are taken from existing CBOE rules. CBOE Rule 52.3 (Unusual Market Conditions) is based on existing CBOE Rule 30.5, and CBOE Rules 52.5 (Order Entry and Maintenance), 52.13 (Firm Quotations), and 52.14 (Quote and Trading Information) are based on rules contained in Chapter 30. CBOE Rule 52.9 (Processing of Requests for Quotes) is based on existing CBOE Rule 43.11. Chapter 53 The chapter relates to requirements and obligations of members, both generally and by participant type ( *e.g.* , STOC DPM, STOC Broker, etc.). Proposed Section A carries over Chapter 30 rules that currently apply to all members trading non-option securities on CBOE. They relate to matters such as trading in member accounts, members acting as brokers, short sale requirements, and doing business with the public. Proposed Section B contains provisions that are applicable to all STOC Market-Makers (including STOC DPMs/LMMs). These provisions are based on similar provisions that apply to SBT Market-Makers trading options under Chapters 40-46. Accordingly, the registration and appointment process for STOC Market-Makers is identical to the process in place for SBT Market-Makers. Further, STOC Market-Maker obligations, as set forth in proposed CBOE Rule 53.23, are centered on RFQ response requirements. STOC Market-Makers that are not providing a two-sided quote at the time of an RFQ would have to respond to the RFQs with a two-sided market that must last in duration for at least 30 seconds (unless traded) and for a minimum size designated by the appropriate STOC Market Performance Committee. As part of their obligations, STOC Market-Makers would be required to respond to at least 75% of all RFQs in their appointed securities. Proposed Section C sets forth additional considerations and requirements applicable to STOC DPMs and LMMs. As previously stated, a STOC LMM essentially would be a rotating STOC DPM. There would never be a STOC DPM and STOC LMM for the same security. As with the STOC Market-Maker provisions, these provisions are patterned after rules in Chapter 44. STOC DPMs/LMMs would be required to provide continuous two-sided markets in assigned securities and to handle customer orders received by the STOC System that are not automatically executed or booked. Thus, STOC DPMs/LMMs would have dealer and agent functions and obligations. Proposed Sections D and E relate to definitions and requirements applicable to STOC Brokers and Clearing Firm Brokers. These provisions are identical to provisions in Chapter 45. Chapters 54 and 55 Proposed Chapter 54 sets forth additional provisions that would be applicable to certain product types that could trade on the STOC System. These product types, which include index portfolio receipts
(IPRs)12 and Index Portfolio Shares (IPSs), 13 are currently available for trading on CBOE under Chapter 30. All of the proposed rules in this Chapter are identical to rules contained in Chapter 30. Proposed Chapter 55 contains CBOE's ITS-related rules, which are modeled on PCXE's ITS rules. CBOE deemed those an appropriate model because, like the proposed STOC system, PCXE is an all-electronic trading platform. Lastly, CBOE is attaching an index to Chapters 50-55 to set forth the applicability of other CBOE rules to trading under Chapters 50-55. 12 *See* CBOE Rule 1.1, Interpretations and Policies .02. 13 *See* CBOE Rule 1.1, Interpretations and Policies .03. Conclusion CBOE believes that the proposed migration of trading of non-option securities to the STOC System would significantly enhance the trading of these products on the Exchange. CBOE proposes that Chapters 50-55 be approved on a pilot basis for a period commencing on the approval date of this filing and ending on the final compliance date for the Order Protection Rule of Regulation NMS. 14 CBOE acknowledges that it will need to file additional rule changes to comply with Regulation NMS, 15 and the Exchange commits to submitting such filings in a timely manner. 14 17 CFR 242.611. 15 *See generally* Securities Exchange Act Release 51808 (June 9, 2005), 70 FR 37496 (June 29, 2005) (order adopting rules under Regulation NMS). 2. Statutory Basis The Exchange believes the proposed rule change is consistent with Section 6(b) of the Exchange Act in general and furthers the objectives of Section 6(b)(5) in particular in that it would enhance the trading of non-option securities on CBOE and it should promote just and equitable principles of trade, serve to remove impediments to and perfect the mechanism of a free and open market and a national market system, and protect investors and the public interest. B. Self-Regulatory Organization's Statement on Burden on Competition The Exchange believes that the proposed rule change would not impose any burden on competition that is not necessary or appropriate in furtherance of the purposes of the Act. C. Self-Regulatory Organization's Statement on Comments on the Proposed Rule Change Received From Members, Participants or Others The Exchange neither solicited nor received comments with respect to the proposed rule change. III. Date of Effectiveness of the Proposed Rule Change and Timing for Commission Action Within 35 days of the date of publication of this notice in the **Federal Register** or within such longer period
(i)as the Commission may designate up to 90 days of such date if it finds such longer period to be appropriate and publishes its reasons for so finding or
(ii)as to which the self-regulatory organization consents, the Commission will:
(A)By order approve such proposed rule change, as amended, or
(B)institute proceedings to determine whether the proposed rule change, as amended, should be disapproved. IV. Solicitation of Comments Interested persons are invited to submit written data, views and arguments concerning the foregoing, including whether the proposed rule change, as amended, is consistent with the Act. Comments may be submitted by any of the following methods: Electronic Comments • Use the Commission's Internet comment form ( *http://www.sec.gov/rules/sro.shtml* ); or • Send an e-mail to *rule-comments@sec.gov.* Please include File Number SR-CBOE-2004-21 on the subject line. Paper Comments • Send paper comments in triplicate to Nancy M. Morris, Secretary, Securities and Exchange Commission, Station Place, 100 F Street, NE., Washington, DC 20549-9303. All submissions should refer to File Number SR-CBOE-2004-21. This file number should be included on the subject line if e-mail is used. To help the Commission process and review your comments more efficiently, please use only one method. The Commission will post all comments on the Commission's Internet Web site ( *http://www.sec.gov/rules/sro.shtml* ). Copies of the submission, all subsequent amendments, all written statements with respect to the proposed rule change that are filed with the Commission, and all written communications relating to the proposed rule change between the Commission and any person, other than those that may be withheld from the public in accordance with the provisions of 5 U.S.C. 552, will be available for inspection and copying in the Commission's Public Reference Section. Copies of such filings also will be available for inspection and copying at the principal office of the Exchange. All comments received will be posted without change; the Commission does not edit personal identifying information from submissions. You should only submit information you wish to make available publicly. All submissions should refer to File Number SR-CBOE-2004-21 and should be submitted on or before February 13, 2006. For the Commission, by the Division of Market Regulation, pursuant to delegated authority. 16 16 17 CFR 200.30-3(a)(12). Nancy M. Morris, Secretary. [FR Doc. E6-662 Filed 1-20-06; 8:45 am] BILLING CODE 8010-01-P SECURITIES AND EXCHANGE COMMISSION [Release No. 34-53127; File No. SR-ISE-2005-57] Self-Regulatory Organizations; International Securities Exchange, Inc.; Notice of Filing and Immediate Effectiveness of a Proposed Rule Change and Amendment No. 1 Thereto Relating to Payment for Order Flow Fee Changes January 13, 2006. Pursuant to Section 19(b)(1) of the Securities Exchange Act of 1934 (“Act”) 1 and Rule 19b-4 thereunder, 2 notice is hereby given that on December 1, 2005, the International Securities Exchange, Inc. (“ISE” or “Exchange”) filed with the Securities and Exchange Commission (“Commission”) the proposed rule change as described in Items I, II, and III below, which Items have been prepared by the Exchange. On December 23, 2005, the ISE submitted Amendment No. 1 to the proposed rule change. 3 The ISE has designated this proposal as one changing a fee imposed by the ISE under Section 19(b)(3)(A)(ii) of the Act 4 and Rule 19b-4(f)(2) thereunder, 5 which renders the proposal, as amended, effective upon filing with the Commission. The Commission is publishing this notice to solicit comments on the proposed rule change, as amended, from interested persons. 1 15 U.S.C. 78s(b)(1). 2 17 CFR 240.19b-4. 3 In Amendment No. 1 (“Amendment No. 1”), the ISE:
(1)Eliminates the proposed $450,000 per firm cap and keeps the current cap of $450,000 per group of option classes;
(2)states the procedures that Competitive Market Makers must follow in order to opt out of the payment for order flow program;
(3)clarifies that the payment for order flow portion of the fee schedule will expire when the preferenced market maker program pilot program expires;
(4)makes minor clarifications to the purpose section;
(5)amends the rule text to conform it to the amended purpose section; and
(6)makes technical corrections to the rule text. 4 15 U.S.C. 78s(b)(3)(A)(ii). 5 17 CFR 240.19b-4(f)(2). I. Self-Regulatory Organization's Statement of the Terms of Substance of the Proposed Rule Change The ISE proposes to amend its payment for order flow program to allow preferenced Competitive Market Makers to administer payment for order flow fees collected by the Exchange. 6 6 *See* Amendment No. 1, *supra* note 3. Below is the text of the proposed rule change, as amended. Proposed new language is in italics; proposed deletions are in [brackets]. 7 7 *Id.* ISE Schedule of Fees Electronic market place Amount Billable unit Frequency Notes Execution Fees * * * * * * * • Payment for Order Flow $0.55 Contract Transaction Applies to market makers only for each public customer contract executed; does not apply to Complex Orders; does not apply to the execution of a Public Customer Order by a Primary Market Maker if the Primary Market Maker executes a corresponding P/A trade on another exchange; does not apply to a market maker executing a Public Customer Order in the Price Improvement Mechanism; does not apply to transactions in HSX, OOG, BYT, HVY, RUF, JLO, SIN, RND, IXZ, IXX and IXK. The Payment for Order Flow Fee will be *rebated proportionately to the members that paid the fee* [suspended for a Group of options established under Rule 802(b) when] *such that on a quarterly basis* the Payment for Order Flow fund balance *administered by a Primary Market Maker* for [such Group reaches] *a Group of options established under Rule 802(b) does not exceed* $450,000 *and the Payment for Order Flow fund balance administered by a preferenced Competitive Market Maker for such a Group does not exceed $50,000* [, and shall be reinstated when any such fund balance falls below $450,000]. *With respect to orders preferenced to a Competitive Marker Maker under Rule 713, a preferenced Competitive Market Maker that elects not to administer a fund will not be charged the Payment for Order Flow fee. The Payment for Order Flow fee administered by preferenced Competitive Market Makers, as described above, will be in effect until June 10, 2006, the date on which the Preferenced Orders pilot program expires.* * * * * * * * II. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change In its filing with the Commission, the ISE included statements concerning the purpose of and basis for the proposed rule change, as amended, and discussed any comments it received on the proposed rule change, as amended. The text of these statements may be examined at the places specified in Item IV below. The ISE has prepared summaries, set forth in Sections A, B, and C below, of the most significant aspects of such statements. A. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change 1. Purpose The ISE proposes to amend its payment for order flow program to allow preferenced Competitive Market Makers to administer payment for order flow fees collected by the Exchange. The Commission recently approved the Exchange's proposed rule change to permit Electronic Access Members
(EAMs)to “preference” their order flow to specified market makers. 8 The Exchange states that, under this rule, if a preferenced market maker, which could be either a Primary Market Maker
(PMM)or a Competitive Market Maker (CMM), is quoting at the national best bid or offer when ISE receives a preferenced order, that market maker receives an enhanced allocation of the order. The Exchange also operates a payment for order flow (“PFOF”) program as approved by the Commission. 9 The Exchange states that this program is funded through a fee paid by Exchange market makers for each customer contract they execute. The Exchange represents that, currently, all funds collected by the Exchange are administered by the PMM for their group (or “bin”) of options classes. 8 *See* Exchange Act Release No. 51818 (June 10, 2005), 70 FR 35146 (June 16, 2005) (SR-ISE-2005-18). 9 *See* Exchange Act Release No. 43833 (January 10, 2001), 66 FR 7822 (January 25, 2001) (SR-ISE-2000-10). The Exchange proposes to amend its PFOF program to allow a CMM to administer the PFOF funds collected by the Exchange with respect to orders preferenced to it in a group of options classes. 10 Each CMM pool would have a ceiling of $50,000. 11 Preferenced CMMs would be able to choose not to administer PFOF pools, in which case the PFOF fee collected by the Exchange would go into the PFOF fund administered by the PMM in the group of options as it would have had the order not been preferenced to the CMM. 12 A CMM will not be charged the PFOF fee for orders preferenced to it if it determines not to administer PFOF pools. 13 10 As is the case with the PFOF funds administered by the PMM, the PFOF fee collected on a preferenced order would be administered by the preferenced CMM whether or not the CMM was a party on a particular trade. 11 In order to accommodate the introduction of the preferenced CMM PFOF pools each having a $50,000 ceiling in addition to the existing PMM PFOF fund that has a $450,000 ceiling, the Exchange will rebate back to members any balance of a fund that exceeds the applicable ceiling for a particular PFOF fund on a quarterly basis. 12 CMMs must notify the Exchange if they elect to opt-out of the proposed payment for order flow fee program in writing no later than five business days prior to the end of the month for which the payment for order flow fee is to be assessed. Once an election not to participate has been made by a CMM, no notice to the Exchange is required in subsequent months unless there is a change in participation status. 13 The Exchange states that the proposed rule change would be in effect until June 10, 2006, the date on which the Preferenced Orders pilot program expires. *See* Exchange Act Release No. 52066 (July 20, 2005), 70 FR 43479 (July 27, 2005) (SR-ISE-2005-35). The Exchange notes that allowing a preferenced CMM to administer the PFOF fees collected by the Exchange with respect to preferenced orders is similar to the Philadelphia Stock Exchange's PFOF program. *See* Exchange Act Release No. 52568 (October 6, 2005), 70 FR 60120 (October 14, 2005) (SR-Phlx-2005-58). 2. Statutory Basis The Exchange believes that its proposal, as amended, is consistent with Section 6(b) of the Act 14 in general, and furthers the objectives of Section 6(b)(4) of the Act 15 in particular, in that it is an equitable allocation of reasonable dues, fees, and other charges among ISE members and other persons using its facilities. 14 15 U.S.C. 78f(b). 15 15 U.S.C. 78f(b)(4). B. Self-Regulatory Organization's Statement on Burden on Competition The Exchange does not believe that the proposed rule change, as amended, will impose any burden on competition that is not necessary or appropriate in furtherance of the purposes of the Act. C. Self-Regulatory Organization's Statement on Comments on the Proposed Rule Change Received From Members, Participants, or Others The Exchange has not solicited, and does not intend to solicit, comments on this proposed rule change. The Exchange has not received any unsolicited written comments from members or other interested parties. III. Date of Effectiveness of the Proposed Rule Change and Timing for Commission Action The foregoing proposed rule change, as amended, has been designated as a fee change pursuant to Section 19(b)(3)(A)(ii) of the Act 16 and Rule 19b-4(f)(2) 17 thereunder, because it establishes or changes a due, fee, or other charge imposed by the Exchange. Accordingly, the proposal will take effect upon filing with the Commission. At any time within 60 days of the filing of such proposed rule change, as amended, the Commission may summarily abrogate such rule change if it appears to the Commission that such action is necessary or appropriate in the public interest, for the protection of investors, or otherwise in furtherance of the purposes of the Act. 18 16 15 U.S.C. 78s(b)(3)(A)(ii). 17 17 CFR 240.19b-4(f)(2). 18 The effective date of the original proposed rule change is December 1, 2005, and the effective date of Amendment No. 1 is December 23, 2005. For purposes of calculating the 60-day period within which the Commission may summarily abrogate the proposal, the Commission considers the period to commence on December 23, 2005, the date on which the Exchange submitted Amendment No. 1. IV. Solicitation of Comments Interested persons are invited to submit written data, views, and arguments concerning the foregoing, including whether the proposed rule change, as amended, is consistent with the Act. Comments may be submitted by any of the following methods: Electronic Comments • Use the Commission's Internet comment form ( *http://www.sec.gov/rules/sro.shtml* ); or • Send an e-mail to *rule-comments@sec.gov.* Please include File Number SR-ISE-2005-57 on the subject line. Paper Comments • Send paper comments in triplicate to Nancy M. Morris, Secretary, Securities and Exchange Commission, 100 F Street, NE,, Washington, DC 20549-9303. All submissions should refer to File Number SR-ISE-2005-57. This file number should be included on the subject line if e-mail is used. To help the Commission process and review your comments more efficiently, please use only one method. The Commission will post all comments on the Commission's Internet Web site ( *http://www.sec.gov/rules/sro.shtml* ). Copies of the submission, all subsequent amendments, all written statements with respect to the proposed rule change that are filed with the Commission, and all written communications relating to the proposed rule change, as amended, between the Commission and any person, other than those that may be withheld from the public in accordance with the provisions of 5 U.S.C. 552, will be available for inspection and copying in the Commission's Public Reference Room. Copies of such filing also will be available for inspection and copying at the principal office of the ISE. All comments received will be posted without change; the Commission does not edit personal identifying information from submissions. You should submit only information that you wish to make available publicly. All submissions should refer to File Number SR-ISE-2005-57 and should be submitted on or before February 13, 2006. For the Commission, by the Division of Market Regulation, pursuant to delegated authority. 19 19 17 CFR 200.30-3(a)(12). Nancy M. Morris, Secretary. [FR Doc. E6-666 Filed 1-20-06; 8:45 am] BILLING CODE 8010-01-P SECURITIES AND EXCHANGE COMMISSION [Release No. 34-53132; File No. SR-NASD-2005-144] Self-Regulatory Organizations; National Association of Securities Dealers, Inc.; Notice of Filing of Proposed Rule Change Relating to Order Entry and Execution Practices January 17, 2006. Pursuant to Section 19(b)(1) of the Securities Exchange Act of 1934 (“Act”) 1 and Rule 19b-4 thereunder, 2 notice is hereby given that on December 8, 2005, the National Association of Securities Dealers, Inc. (“NASD”) filed with the Securities and Exchange Commission (“Commission”) the proposed rule change as described in Items I, II, and III below, which Items have been prepared by NASD. The Commission is publishing this notice to solicit comments on the proposed rule change from interested persons. 1 15 U.S.C. 78s(b)(1). 2 17 CFR 240. 19b-4. I. Self-Regulatory Organization's Statement of the Terms of Substance of the Proposed Rule Change NASD is proposing to add Rule 3380 to prohibit members and associated persons from splitting any order into multiple smaller orders for execution or any execution into multiple smaller executions for transaction reporting for the primary purpose of maximizing a monetary or in-kind payment to the member or associated persons as a result of the execution of such orders or the transaction reporting of such executions. The text of the proposed rule change appears below. Additions are in *italics.* 3380. Order Entry and Execution Practices * No member or associated person may engage in conduct that has the intent or effect of splitting any order into multiple smaller orders for execution or any execution into multiple smaller executions for transaction reporting for the primary purpose of maximizing a monetary or in-kind amount to be received by the member or associated person as a result of the execution of such orders or the transaction reporting of such executions. For purposes of this rule, “monetary or in-kind amount” shall be defined to include, but not be limited to, any credits, commissions, gratuities, payments for or rebates of fees, or any other payments of value to the member or associated person. * II. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change In its filing with the Commission, NASD included statements concerning the purpose of, and basis for, the proposed rule change and discussed any comments it received on the proposed rule change. The text of these statements may be examined at the places specified in Item IV below. NASD has prepared summaries, set forth in Sections A, B, and C below, of the most significant aspects of such statements. A. Self-Regulatory Organization's Statement of the Purpose of, and the Statutory Basis for, the Proposed Rule Change 1. Purpose “Trade shredding” is a term used to describe the practice of splitting customer orders for securities into multiple smaller orders ( *e.g.* , a 1,000 share order is split into 10 100 share orders) for the primary purpose of maximizing payments or rebates to the member. Among other things, concerns have been raised about market participants increasingly engaging in the practice of trade shredding as a means to increase their share of market data revenues under the joint industry plans (“Plans”), 3 where the Plan participant has adopted a practice of sharing its Plan revenues with market participants who send it orders. Specifically, because the current allocation formulas for distributing Plan income heavily emphasize the number of trades, no matter how small the size of the trade, an incentive can exist for market participants to engage in distortive behavior, such as trade shredding, as a means to increase their share of market data revenues. 3 The three joint-industry plans are
(1)the CTA Plan, which is operated by the Consolidated Tape Association and disseminates transaction information for exchange-listed securities,
(2)the CQ Plan, which disseminates consolidated quotation information for exchange-listed securities, and
(3)the Nasdaq UTP Plan, which disseminates consolidated transaction and quotation information for Nasdaq-listed securities. To address these concerns, among others, the Commission adopted Regulation NMS, which contains amendments to the current Plan formulas used to allocate Plan income. 4 These modifications incorporate a more broad-based measure of a self-regulatory organization's (“SRO”) contribution to the consolidated trade stream, including both an SRO's quotes and trades, intended to reduce the incentives for trade shredding. 4 *See* Securities Exchange Act Release No. 51808 (June 9, 2005), 70 FR 37496 (June 29, 2005). Although these modifications in Plan formulas should reduce the incentives for trade shredding, the Commission continues to believe that SRO rules prohibiting trade shredding are necessary and appropriate and has requested that all SROs implement rule changes to inhibit the practice of trade shredding. In response to the Commission's request, NASD is proposing to adopt new Rule 3380, which would prohibit such practices. Specifically, new Rule 3380 would prohibit members and associated persons from splitting any order into multiple smaller orders for execution or any execution into multiple smaller executions for transaction reporting for the primary purpose of maximizing a monetary or in-kind payment to the member or associated persons as a result of the execution of such orders or the transaction reporting of such executions. For purposes of the proposed new rule, “monetary or in-kind amount” shall be defined to include, but not be limited to credits, commissions, gratuities, payments for or rebates of fees, or any other payments of value to the member or associated person. 2. Statutory Basis NASD believes that the proposed rule change is consistent with Section 15A(b)(6) of the Act, 5 which requires, among other things, that NASD rules must be designed to prevent fraudulent and manipulative acts and practices, to promote just and equitable principles of trade, and, in general, to protect investors and the public interest. NASD believes that the proposed rule change will further the goal of preventing manipulative acts and practices by prohibiting this potentially distortive practice. 5 15 U.S.C. 78o-3(b)(6). B. Self-Regulatory Organization's Statement on Burden on Competition NASD believes that the proposed rule change will impose no burden on competition that is not necessary or appropriate in furtherance of the purposes of the Act. C. Self-Regulatory Organization's Statement on Comments on the Proposed Rule Change Received From Members, Participants or Others NASD has neither solicited nor received comments on this proposal. III. Date of Effectiveness of the Proposed Rule Change and Timing for Commission Action Within 35 days of the date of publication of this notice in the **Federal Register** or within such longer period
(i)as the Commission may designate up to 90 days of such date if it finds such longer period to be appropriate and publishes its reasons for so finding or
(ii)as to which the self-regulatory organization consents, the Commission will:
(A)By order approve such proposed rule change, or
(B)Institute proceedings to determine whether the proposed rule change should be disapproved. IV. Solicitation of Comments Interested persons are invited to submit written data, views, and arguments concerning the foregoing, including whether the proposed rule change is consistent with the Act. Comments may be submitted by any of the following methods: Electronic Comments • Use the Commission's Internet comment form ( *http://www.sec.gov/rules/sro.shtml* ); or • Send an e-mail to *rule-comments@sec.gov.* Please include File Number SR-NASD-2005-144 on the subject line. Paper Comments • Send paper comments in triplicate to Nancy M. Morris, Secretary, Securities and Exchange Commission, Station Place, 100 F Street, NE., Washington, DC 20549-9303. All submissions should refer to File Number SR-NASD-2005-144. This file number should be included on the subject line if e-mail is used. To help the Commission process and review your comments more efficiently, please use only one method. The Commission will post all comments on the Commission's Internet Web site ( *http://www.sec.gov/rules/sro.shtml* ). Copies of the submission, all subsequent amendments, all written statements with respect to the proposed rule change that are filed with the Commission, and all written communications relating to the proposed rule change between the Commission and any person, other than those that may be withheld from the public in accordance with the provisions of 5 U.S.C. 552, will be available for inspection and copying in the Commission's Public Reference Room. Copies of such filing also will be available for inspection and copying at the principal offices of NASD. All comments received will be posted without change; the Commission does not edit personal identifying information from submissions. You should submit only information that you wish to make available publicly. All submissions should refer to File Number SR-NASD-2005-144 and should be submitted on or before February 13, 2006. For the Commission, by the Division of Market Regulation, pursuant to delegated authority. 6 6 17 CFR 200.30-3(a)(12). Nancy M. Morris, Secretary. [FR Doc. E6-663 Filed 1-20-06; 8:45 am] BILLING CODE 8010-01-P SECURITIES AND EXCHANGE COMMISSION [Release No. 34-53126; File No. SR-NYSE-2005-93] Self-Regulatory Organizations; New York Stock Exchange, Inc; Notice of Filing of Proposed Rule Change to Rule 431 (“Margin Requirements”) and Rule 726 (“Delivery of Options Disclosure Document and Prospectus”) To Expand the Products Eligible for Customer Portfolio Margining and Cross-Margining January 13, 2006. Pursuant to Section 19(b)(1) of the Securities Exchange Act of 1934 (the “Exchange Act”), 1 and Rule 19b-4 thereunder, 2 notice is hereby given that on December 29, 2005, the New York Stock Exchange, Inc. (“NYSE” or the “Exchange”) filed with the Securities and Exchange Commission (the “Commission”) the proposed rule change as described in Items I, II, and III below, which Items have been prepared by the Exchange. The Commission is publishing this notice to solicit comments on the proposed rule change from interested persons. 1 15 U.S.C. 78s(b)(1). 2 17 CFR 240.19b-4. I. Self-Regulatory Organization's Statement of the Terms of Substance of the Proposed Rule Change The NYSE is filing with the Commission proposed amendments to NYSE Rule 431 (“Margin Requirements”) that would expand the scope of products that are eligible for treatment as part of the Commission's approved Portfolio Margin Pilot Program (the “Pilot”). 3 Amendments to Rule 726 (“Options Disclosure Document”) also are proposed to include the Commission approved products on the disclosure document required to be furnished to customers pursuant to this rule. The text of the proposed rule change is below. Additions are in italics. Deletions are in brackets. 3 *See* Securities Exchange Act Release No. 52031 (July 14, 2005), 70 FR 42130 (July 21, 2005), (SR-NYSE-2002-19). On July 14, 2005, the Commission approved on a Pilot Basis expiring July 31, 2007, amendments to Exchange Rule 431 to permit the use of a prescribed risk-based margin requirement (“portfolio margin”) for certain specified products as an alternative to the strategy based margin requirements currently required in section
(a)through
(f)of the Rule. Amendments to Rule 726 were also approved to require disclosure to, and written acknowledgement from, customers in connection with the use of portfolio margin. *See* NYSE Information Memo 05-56, dated August 18, 2005 for additional information. Margin Requirements Rule 431.
(a)through
(f)unchanged. Portfolio Margin and Cross-Margin [for Index Options]
(g)As an alternative to the [ *“strategy” based* ] “ *strategy-based* ” margin requirements set forth in *sections* [paragraphs]
(a)through
(f)of this Rule, member organizations may elect *to apply the portfolio margin requirements set forth in this section (g)* to [margin for] *(1)* listed, broad-based U.S. index options, index warrants and underlying instruments and *
(2)listed security futures contracts 4 and listed single stock options, (See section (g)(6)(C)(1)). * [(as defined below) in accordance with the portfolio margin requirements set forth in this Rule.] 4 For purposes of this section of the Rule, the term “security future” utilizes the definition at section 3(a)(55) of the Exchange Act, excluding narrow-based security indices. In addition, member organizations, provided they are a Futures Commission Merchant (“FCM”) and are either a clearing member of a futures clearing organization or have an affiliate that is a clearing member of a futures clearing organization, are permitted under this section *(g)* to combine an *eligible participant's* [a customer's] related instruments [(] as defined *in section (g)(2)(C),* [below) and] *with* listed, broad-based U.S. index options, index warrants and underlying instruments and compute a margin requirement *for such combined products* [(“cross margin”)] on a portfolio margin basis[.] *(“cross-margin”).* Member organizations must confine cross-margin positions to a portfolio margin account dedicated exclusively to cross-margining. The portfolio margin and cross-margining provisions of this Rule shall not apply to Individual Retirement Accounts (“IRAs”).
(1)Member organizations *must* [will be expected to] monitor the risk of portfolio margin accounts and maintain a written risk analysis methodology for assessing the potential risk to the member organization's capital over a specified range of possible market movements of positions maintained in such accounts. The risk analysis methodology shall specify the computations to be made, the frequency of computations, the records to be reviewed and maintained, and the *person(s)* [position(s)] within the organization responsible for the risk function. This risk analysis methodology shall be made available to the Exchange upon request. In performing the risk analysis of portfolio margin accounts required by this Rule, each member organization shall include the following in the written risk analysis methodology:
(A)Procedures and guidelines for the determination, review and approval of credit limits to each *eligible participant,* [customer,] and across all *eligible participants,* [customers,] utilizing a portfolio margin account.
(B)Procedures and guidelines for monitoring credit risk exposure to the member organization, including intra-day credit risk, related to portfolio margin accounts.
(C)Procedures and guidelines for the use of stress testing of portfolio margin accounts in order to monitor market risk exposure from individual accounts and in the aggregate.
(D)Procedures providing for the regular review and testing of these risk analysis procedures by an independent unit such as internal audit or other comparable group.
(2)Definitions.—For purposes of this *section* [paragraph] (g), the following terms shall have the meanings specified below:
(A)The term “listed option” [shall] mean *s* any option traded on a registered national securities exchange or automated facility of a registered national securities association. *(B)* [(F)] The term “underlying instrument” means long and short positions in an exchange traded fund or other fund product registered under the Investment Company Act of 1940, that holds the same securities, and in the same proportion, as contained in a broad-based index on which options are listed. The term *“* underlying instrument *”* shall not be deemed to include[,] futures contracts, options on futures contracts, underlying stock baskets, or unlisted instruments. *(C)* [(E]) The term “related instrument” within an option class or product group means futures contracts and options on futures contracts covering the same underlying instrument. *(D)* [(B)] The term “options class” refers to all options contracts covering the same underlying instrument. *(E)* [(C)] The term “portfolio” means *any eligible product, as defined in section (g)(6)(C)(1),* [options of the same options class] grouped with their underlying instruments and related instruments. *(F)* [(D)] The term “option series” relates to listed options and means all option contracts of the same type (either a call or a put) and exercise style, covering the same underlying instrument with the same exercise price, expiration date, and number of underlying units.
(G)The term “product group” means two or more portfolios of the same type (see *table in section* [sub-paragraph] (g)(2) [(H)] *(I)* below) for which it has been determined by Rule 15c3-1a under the Securities Exchange Act of 1934 that a percentage of offsetting profits may be applied to losses at the same valuation point. *(H) For purposes of portfolio margin and cross-margin the term “equity”, as defined in section (a)(4) of this Rule, includes the market value of any long or short option positions held in an eligible participant's account.* *(I)* [(H)] The term “theoretical gains and losses” means the gain and loss in the value of individual *eligible products* [option series] and related instruments at 10 equidistant intervals (valuation points) ranging from an assumed movement (both up and down) in the current market value of the underlying instrument. The magnitude of the valuation point range shall be as follows: 5 6 5 In accordance with *section* [sub-paragraph] (b)(1)(i)(B) of Rule 15c3-1a (Appendix A to Rule 15c3-1) under the Securities Exchange Act of 1934, 17 CFR 240.15c3-1a(b)(1)(i)(B). 6 See footnote above. *Portfolio type* *Up/down market move (high & low valuation points)* *Listed Security Futures Contract and Listed Single Stock Option* *+/−15%* *Non-High Capitalization, Broad-based U.S. Market Index Option* *+/−10%* *High Capitalization, Broad-based U.S. Market Index Option* *+6%/−8%*
(3)Approved Theoretical Pricing Models.—Theoretical pricing models must be approved by a Designated Examining Authority and reviewed by the Securities and Exchange Commission (“The Commission”) in order to qualify. Currently, the theoretical model utilized by [The] *the* Options Clearing Corporation (“[The] OCC”)[,] is the only model qualified pursuant to [The] *the* Commission's Net Capital Rule. All member organizations [participating in the pilot program] shall obtain their theoretical values from [The] *the* OCC.
(4)Eligible Participants.—The application of the portfolio margin provisions of this *section* [paragraph] (g), including cross-margining, is limited to the following:
(A)any broker or dealer registered pursuant to Section 15 of the Securities Exchange Act of 1934;
(B)any member of a national futures exchange to the extent that listed index options hedge the member's index futures; and
(C)any other person or entity not included in *sections (g)* (4)(A) *and* [through] ( *g* )(4)(B) above that has or establishes, and maintains, equity of at least *five* [5] million dollars. For purposes of this equity requirement, all securities and futures accounts carried by the member organization for the same *eligible participant* [customer] may be combined provided ownership across the accounts is identical. A guarantee pursuant to *section* [paragraph] (f)(4) of this Rule is not permitted for purposes of the minimum equity requirement. *For those accounts that are solely limited to listed security futures contracts and listed single stock options, the five million dollar equity requirement shall be waived.*
(5)Opening of Accounts. *(A) Member organizations must notify and receive approval from the Exchange prior to establishing a portfolio margin or cross-margin methodology for eligible participants.* *(B)* [(A)] Only *eligible participants* [customers] that have been approved for options transactions and approved to engage in uncovered short option contracts pursuant to Exchange Rule 721, are permitted to utilize a portfolio margin account. *(C)* [(B)] On or before the date of the initial transaction in a portfolio margin account, a member organization shall: *(1)* [(i)] furnish the *eligible participant* [customer] with a special written disclosure statement describing the nature and risks of portfolio margining and cross-margining which includes an acknowledgement for all portfolio margin account owners to sign, and an additional acknowledgement for owners that also engage in cross-margining to sign, attesting that they have read and understood the disclosure statement, and agree to the terms under which a portfolio margin account and the cross-margin account respectively, are provided (see Exchange Rule 726 (d)), and *(2)* [(ii)] obtain the signed acknowledgement(s) noted above from the *eligible participant* [customer] (both of which are required for cross-margining *eligible participants* [customers]) and record the date of receipt.
(6)Establishing Account and Eligible Positions. *(A)* [(1)] Portfolio Margin Account. For purposes of applying the portfolio margin requirements [provided] *prescribed* in this [paragraph] *section* (g), member organizations are to establish and utilize a specific securities margin account, or sub-account of a margin account, clearly identified as a portfolio margin account that is separate from any other securities account carried for an *eligible participant* [a customer]. *(B)* [(2)] Cross-Margin Account. For purposes of combining related instruments [and] *with* listed, broad-based U.S. index options, index warrants, and underlying instruments, and applying the portfolio margin requirements, member[s] *organizations* are to establish [and utilize a portfolio margin account, clearly identified as] a cross-margin account[,] that is separate from any other securities account or portfolio margin account carried for an *eligible participant.* [a customer.] A margin deficit in either the portfolio margin account or the cross-margin account of an *eligible participant* [a customer] may not be considered as satisfied by excess equity in the other account. Funds and/or securities must be transferred to the deficient account and a written record created and maintained. *(C)* [(A)] Portfolio Margin Account—Eligible [Positions] Products *(1) For eligible participants as described in sections (g)(4)(A) through (g)(4)(C),* [(i) A] *a* transaction in, or transfer of, [a listed, broad-based U.S. index option or index warrant] *an eligible product* may be effected in the portfolio margin account. *Eligible products under this section consist of:* *(i)* *a listed, broad-based U.S. index option or index warrant and underlying instrument.* *(ii)* *a listed security futures contract or listed single stock option.* *(2)* [(ii)] A transaction in, or transfer of, an underlying instrument may be effected in the portfolio margin account provided a position in an offsetting listed, broad-based U.S. index option or index warrant is in the account or is established in the account on the same day. *(3) A transaction in, or transfer of, a listed security futures contract or listed single stock option may also be effected in the portfolio margin account.* *(4) Any long position or any short position in any eligible product that is no longer part of a hedge strategy must be transferred from the portfolio margin account to the appropriate securities account within ten business days, subject to any applicable margin requirement, unless the position becomes part of a hedge strategy again. Member organizations must monitor portfolio margin accounts for possible abuse of this provision.* [(iii) If, in the portfolio margin account, the listed, broad-based U.S. index option or index warrant position offsetting an underlying instrument position ceases to exist and is not replaced within ten business days, the underlying instrument position must be transferred to a regular margin account, subject to initial Regulation T and margined according to the other provisions of this Rule. Member organizations will be expected to monitor portfolio margin accounts for possible abuse of this provision.
(iv)In the event that fully paid for long options and/or index warrants are the only positions contained within a portfolio margin account, such long positions must be transferred to a securities account other than a portfolio margin account or cross-margin account within 10 business days, subject to the margin required, unless the status of the account changes such that it is no longer composed solely of fully paid for long options and/or index warrants.] *(D)* [(B)] Cross-Margin Account—Eligible [Positions] *Products* *(1) For eligible participants, as described in sections (g)(4)(A) through (g)(4)(C), a transaction in, or transfer of, an eligible product may be effected in the cross-margin account.* *(2)* [(i)] A transaction in, or transfer of, a related instrument may be effected in the cross-margin account provided a position in an offsetting *eligible product* [listed, U.S. broad-based index option, index warrant or underlying instrument] is in the account or is established in the account on the same day. *(3) Any long position or any short position in any eligible product that is no longer part of a hedge strategy must be transferred from the cross-margin account to the appropriate securities account or futures account within ten business days, subject to any applicable margin requirement, unless the position becomes part of a hedge strategy again. Member organizations must monitor cross-margin accounts for possible abuse of this provision.* [(ii) If the listed, U.S. broad-based index option, index warrant or underlying instrument position offsetting a related instrument ceases to exist and is not replaced within ten business days, the related instrument position must be transferred to a futures account and margined accordingly. Member organizations will be expected to monitor cross-margin accounts for possible abuse of this provision.
(iii)In the event that fully paid for long options and/or index warrants (securities) are the only positions contained within a cross-margin account, such long positions must be transferred to a securities account other than a portfolio margin account or cross margin account within 10 business days, subject to the margin required, unless the status of the account changes such that it is no longer composed solely of fully paid for long options and/or index warrants.]
(7)Initial and Maintenance Margin Required.—The amount of margin required under this *section* [paragraph]
(g)for each portfolio shall be the greater of:
(A)the amount for any of the 10 equidistant valuation points representing the largest theoretical loss as calculated pursuant to *section* [paragraph] (g)(8) below, or
(B)$.375 for each *contract* [listed index option] and related instrument multiplied by the contract's or instrument's multiplier, not to exceed the market value in the case of long positions in *eligible products.* [listed options and options on futures contracts.]
(C)Account guarantees pursuant to *section* [paragraph] (f)(4) of this Rule are not permitted for purposes of meeting initial and maintenance margin requirements.
(8)Method of Calculation.
(A)Long and short *contracts,* [positions in listed options,] *including* underlying instruments and related instruments *,* are to be grouped [by option class; each option class group being] *as* a “portfolio *.* ”[.] Each portfolio is categorized as one of the portfolio types specified in *section* [sub-paragraph] (g)(2) *(I)* [(H)] above.
(B)For each portfolio, theoretical gains and losses are calculated for each position as specified in *section* [sub-paragraph] (g)(2) *(I)* [(H)] above. For purposes of determining the theoretical gains and losses at each valuation point, member organizations shall obtain and utilize the theoretical value *s* of *eligible products as described in this section* [a listed index option, underlying instrument or related instrument] rendered by *an approved* [a] theoretical pricing model *.* [that, in accordance with sub-paragraph (b)(1)(i)(B) of Rule 15c3-1a under the Securities Exchange Act of 1934, qualifies for purposes of determining the amount to be deducted in computing net capital under a portfolio based methodology.]
(C)Offsets. Within each portfolio, theoretical gains and losses may be netted fully at each valuation point. Offsets between portfolios within *eligible product groups, as described in section (g)(2)(I),* [the High Capitalization, Broad-based Index Option product group and the Non-High Capitalization, Broad-based Index Option product group] may then be applied as permitted by Rule 15c3-1a under the Securities Exchange Act of 1934.
(D)After applying the [Offsets] *offsets* above, the sum of the greatest loss from each portfolio is computed to arrive at the total margin required for the account (subject to the per contract minimum).
(9)*Portfolio Margin Minimum Equity Call* [Equity Deficiency .—] *(A)* If, at any time, *the* equity *in the portfolio margin or cross-margin account of an eligible participant, as described in section (g)(4)(C),* declines below the [5] *five* million dollar minimum *equity* required *,* [under sub-paragraph (4)(D) of this paragraph (g)] and is not restored to at least [5] *five* million dollars within three [(3)] business days (T+3) by a deposit of funds and/or securities *,* [;] member organizations are prohibited from accepting opening orders starting on T+4, except that opening orders entered for the purpose of hedging existing positions may be accepted if the result would be to lower margin requirements. This prohibition shall remain in effect until equity of *five* [5] million dollars is established. *For those accounts that are solely limited to security futures contracts and single stock options, the five million dollar equity requirement shall be waived.* *(B) Member organizations will not be permitted to deduct any portfolio margin minimum equity call amount from Net Capital in lieu of collecting the minimum equity required.* *(10)* [(11)] *Portfolio Margin Maintenance Call* [Additional Margin. —] *(A)* If at any time, the equity in *the* [any] portfolio margin *or cross-margin* account *of an eligible participant, as described in sections (g)(4)(A) through (g)(4)(C),* is less than the margin required, the eligible *participant* [customer] may deposit additional margin or establish a hedge to meet the margin requirement within [one] *three* business day *s* [(T+1)] *(T+3). During the three business day period, member organizations are prohibited from accepting opening orders, except that opening orders entered for the purpose of hedging existing positions may be accepted if the result would be to lower margin requirements.* In the event *an eligible participant* [a customer] fails to hedge existing positions or deposit additional margin within [one] *three* business days *,* the member organization must liquidate positions in an amount sufficient to, at a minimum, lower the total margin required to an amount less than or equal to *the* account equity. [Paragraph (f)(7) of this Rule—Practice of Meeting Regulation T Margin Calls by Liquidation Prohibited shall not apply to portfolio margin accounts. However, member organizations will be expected to monitor portfolio margin and cross-margin accounts for possible abuse of this provision.] *(B) If the portfolio margin maintenance call is not met by the close of business T+1, member organizations will be required to deduct from Net Capital the amount of the call until such time the call is satisfied.* *(C) Member organizations will not be permitted to deduct any portfolio margin maintenance call amount from Net Capital in lieu of collecting the margin required.* *(11)* [(10)] Determination of Value for Margin Purposes.—For the purposes of this *section* [paragraph] (g), all *eligible products* [listed index options] and related instrument positions shall be valued at current market prices. Account equity for the purposes of this *section* [paragraph]
(g)shall be calculated separately for each portfolio margin or *cross-margin* account *.* [by adding the current market value of all long positions, subtracting the current market value of all short positions, and adding the credit (or subtracting the debit) balance in the account.]
(12)Net Capital Treatment of Portfolio Margin and Cross *-* Margin Accounts.
(A)No member organization that requires margin in any *eligible participant* [customer] account pursuant to *section* [paragraph]
(g)of this Rule shall permit [gross] *the aggregate eligible participant* [customer] portfolio margin *and cross-margin initial and maintenance* requirements to exceed [1,000 percent] *ten times* [of] its net capital for any period exceeding three business days. The member organization shall, beginning on the fourth business day, cease opening new portfolio margin *and cross-margin* accounts until compliance is achieved.
(B)If, at any time, a member organization's [gross] *aggregate eligible participant* [customer] portfolio margin *and cross-margin* requirements exceed [1,000 percent] *ten times* [of] its net capital, the member organization shall immediately transmit telegraphic or facsimile notice of such deficiency to the *principal office of the* Securities and Exchange Commission *in Washington, DC,* [450 Fifth Street, NW., Washington, DC 20549; to] the district or regional office of the Securities and Exchange Commission for the district or region in which the member organization maintains its principal place of business; and to *the New York Stock Exchange.* [its Designated Examining Authority.]
(13)Day Trading Requirements.—The requirements of *section* [sub-paragraph] (f)(8)(B) of this Rule—Day-Trading shall not apply to portfolio margin accounts *or* [including] cross *-* margin accounts.
(14)Cross *-* Margin Accounts—Requirements to Liquidate
(A)A member is required immediately either to liquidate, or transfer to another broker-dealer eligible to carry cross-margin accounts, all *eligible participant* [customer] cross-margin accounts that contain positions *eligible for cross-margining* [in futures and/or options on futures] if the member is: *(1)* [(i)] insolvent as defined in section 101 of title 11 of the United States Code, or is unable to meet its obligations as they mature; *(2)* [(ii)] the subject of a proceeding pending in any court or before any agency of the United States or any State in which a receiver, trustee, or liquidator for such debtor has been appointed; *(3)* [(iii)] not in compliance with applicable requirements under the Securities Exchange Act of 1934 or rules of the Securities and Exchange Commission or any self-regulatory organization with respect to financial responsibility or hypothecation of *eligible participant's* [customer's] securities; or *(4)* [(iv)] unable to make such computations as may be necessary to establish compliance with such financial responsibility or hypothecation rules.
(B)Nothing in this *section* [paragraph]
(14)shall be construed as limiting or restricting in any way the exercise of any right of a registered clearing agency to liquidate or cause the liquidation of positions in accordance with its by-laws and rules. Delivery of Options Disclosure Document and Prospectus Rule 726
(a)through
(c)unchanged. Portfolio Margining and Cross-Margining Disclosure Statement and Acknowledgement
(d)The special written disclosure statement describing the nature and risks of portfolio margining and cross-margining, and acknowledgement for an eligible participant [customer] signature, required by Rule 431(g)(5)(B) shall be in a format prescribed by the Exchange or in a format developed by the member organization, provided it contains substantially similar information as in the prescribed Exchange format and has received the prior written approval of the Exchange. Sample Portfolio Margining and Cross-Margining Risk Disclosure Statement To Satisfy Requirements of Exchange Rule 431(g) Overview of Portfolio Margining 1. Portfolio margining is a margin methodology that sets margin requirements for an account based on the greatest projected net loss of all positions in a “product class” or “product group” as determined by an options pricing model using multiple pricing scenarios. These pricing scenarios are designed to measure the theoretical loss of the positions given changes in both the underlying price and implied volatility inputs to the model. Portfolio margining is currently limited to product classes and groups of index products relating to *listed,* broad-based market indexes *, listed security futures contracts and listed single stock options.* 2. The goal of portfolio margining is to set levels of margin that more precisely reflects actual net risk. The *eligible participant* [customer] benefits from portfolio margining in that margin requirements calculated on net risk are generally lower than alternative “position” or “strategy” based methodologies for determining margin requirements. Lower margin requirements allow the customer more leverage in an account. Customers Eligible for Portfolio Margining 3. To be eligible for portfolio margining, customers (other than broker-dealers) must meet the basic standards for having an options account that is approved for uncovered writing and must have and maintain at all times account net equity of not less than [$5] *five* million *dollars,* aggregated across all accounts under identical ownership at the clearing broker. [The] *This* identical ownership requirement excludes accounts held by the same customer in different capacities (e.g., as a trustee and as an individual) and accounts where ownership is overlapping but not identical (e.g., individual accounts and joint accounts). *For those accounts that are solely limited to listed security futures contracts and listed single stock options, the five million dollar equity requirement shall be waived.* Positions Eligible for a Portfolio Margin Account 4. All positions in *listed security futures contracts, listed single stock options, listed,* broad-based U.S. market index options [and] *or* index warrants, [listed on a national securities exchange, and] exchange traded funds and other products registered under the Investment Company Act of 1940 that are managed to track the same index that underlies permitted index options, are eligible for a portfolio margin account. Special Rules for Portfolio Margin Accounts 5. A portfolio margin account may be either a separate account or a sub-account of a customer's *standard* [regular] margin account. In the case of a sub-account, equity in the *standard* [regular] account will be available to satisfy any margin requirement in the portfolio margin sub-account without transfer to the sub-account. 6. A portfolio margin account or sub-account will be subject to a minimum margin requirement of $.375 multiplied by the *contract's* [index] multiplier for every *contract* [option contract or index warrant] carried long or short in the account. No minimum margin is required in the case of eligible exchange traded funds or other eligible fund products. 7. Margin calls in the portfolio margin account or sub-account, regardless of whether due to new commitments or the effect of adverse market [moves] *movements* on existing positions, must be met within [one] *three* business day *s* . Any shortfall in aggregate net equity across accounts must be met within three business days. Failure to meet a *portfolio* margin *maintenance* call when due will result in immediate liquidation of positions to the extent necessary to reduce the margin requirement. Failure to meet [an] *a minimum* equity call prior to the end of the third business day will result in a prohibition on entering any opening orders, with the exception of opening orders that hedge existing positions, beginning on the fourth business day and continuing until such time as the minimum equity requirement is satisfied. 8. A position in an exchange traded index fund or other eligible fund product may not be established in a portfolio margin account unless there exists, or there is established on the same day, an offsetting position in securities options, or other eligible securities. *The position(s)* [Exchange traded index funds and/or other eligible funds] will be transferred out of the portfolio margin account and into a *standard* [regular] securities account subject to *any applicable margin requirement* [initial Regulation T and NYSE Rule 431 margin] if the offsetting securities options, other eligible securities and/or related instruments no longer remain in the account for ten business days. 9. When a broker-dealer carries a *standard* [regular] cash account or margin account for a customer, the broker-dealer is limited by rules of the Securities and Exchange Commission and of The Options Clearing Corporation (“OCC”) to the extent to which the broker-dealer may permit OCC to have a lien against long option positions in those accounts. In contrast, OCC will have a lien against all long option positions that are carried by a broker-dealer in a portfolio margin account, and this could, under certain circumstances, result in greater losses to a customer having long option positions in such an account in the event of the insolvency of the customer's broker. Accordingly, to the extent that a customer does not borrow against long option positions in a portfolio margin account or have margin requirements in the account against which the long option can be credited, there is no advantage to carrying the long options in a portfolio margin account and the customer should consider carrying them in an account other than a portfolio margin account. Special Risks of Portfolio Margin Accounts 10. Portfolio margining generally permits greater leverage in an account, and greater leverage creates greater losses in the event of adverse market movements. 11. Because the time limit for meeting margin calls is shorter than in a *standard* [regular] margin account, there is increased risk that a customer's portfolio margin account will be liquidated involuntarily, possibly causing losses to the customer. 12. Because portfolio margin requirements are determined using sophisticated mathematical calculations and theoretical values that must be calculated from market data, it may be more difficult for customers to predict the size of future margin calls in a portfolio margin account. This is particularly true in the case of customers who do not have access to specialized software necessary to make such calculations or who do not receive theoretical values calculated and distributed periodically by The Options Clearing Corporation. 13. For the reasons noted above, a customer that carries long options positions in a portfolio margin account could, under certain circumstances, be less likely to recover the full value of those positions in the event of the insolvency of the carrying broker. 14. Trading of securities index products in a portfolio margin account is generally subject to all the risks of trading those same products in a *standard* [regular] securities margin account. Customers should be thoroughly familiar with the risk disclosure materials applicable to those products, including the booklet entitled “Characteristics and Risks of Standardized Options”. 15. Customers should consult with their tax advisers to be certain that they are familiar with the tax treatment of transactions in securities *options* [index] *and futures* products. 16. The descriptions in this disclosure statement relating to eligibility requirements for portfolio margin accounts, and minimum equity and margin requirements for those accounts, are minimums imposed under Exchange rules. Time frames within which margin and equity calls must be met are maximums imposed under Exchange rules. Broker-dealers may impose their own more stringent requirements. Overview Of Cross-Margining 17. *In a cross-margin account* , [With cross-margining,] index futures, [and] options on index futures are combined with offsetting positions in securities index options and underlying instruments, for the purpose of computing a margin requirement based on the net risk. This generally produces lower margin requirements than if the related instruments 7 and securities products are viewed separately, thus providing more leverage in the account. 7 For purposes of this Rule, the term “related instruments,” within an option class or product means futures contracts and options on futures contracts covering the same underlying instrument. 18. Cross-margining must be *effected* [done] in a portfolio margin account type. A separate portfolio margin account must be established exclusively for cross-margining. 19. *Cross-margining is achieved when* [When] index futures and options on futures are combined with offsetting positions in index options and underlying instruments in a dedicated account, and a portfolio margining methodology is applied to them. [, cross-margining is achieved.] Customers Eligible for Cross-Margining 20. The eligibility requirements for cross-margining are generally the same as for portfolio margining. [,] *Accordingly* , [and] any customer eligible for portfolio margining is eligible for cross-margining. 21. Members of futures exchanges on which cross-margining eligible index contracts are traded are also permitted to carry positions in cross-margin accounts without regard to the minimum aggregate account equity. Positions Eligible for Cross-Margining 22. All securities products eligible for portfolio margining are also eligible for cross-margining. 23. All broad-based U.S. listed market index futures and options on index futures traded on a designated contract market subject to the jurisdiction of the Commodity Futures Trading Commission (“CFTC”) are eligible for cross-margining. Special Rules for Cross-Margining 24. Cross-margining must be conducted in a portfolio margin account type. A separate portfolio margin account must be established exclusively for cross-margining. A cross-margin account is a securities account, and must be maintained separate *ly* from all other securities account. 25. Cross-margining is automatically accomplished with the portfolio margining methodology. Cross-margin positions are subject to the same minimum margin requirement for every contract, including futures contracts. 26. Margin calls arising in *a* cross-margin account, and any shortfall in aggregate net equity across accounts, must be satisfied within the same timeframe, and subject to the same consequences, as in a portfolio margin account. 27. A position in a futures product may not be established in a cross-margin account unless there exists, or there is established on the same day, an offsetting position in securities options and/or other eligible securities. Related instruments will be transferred out of the cross-margin account and into a futures account if, for more than ten business days and for any reason, the offsetting securities options and/or other eligible securities no longer remain in the account. If the transfer of related instruments to a futures account causes the futures account to be undermargined, a margin call will be issued or positions will be liquidated to the extent necessary to eliminate the deficit. 28. Customers participating in cross-margining will be required to sign an agreement acknowledging that their positions and property in the cross-margin account will be subject to the customer protection provisions of Rule 15c3-3 under the Securities Exchange Act of 1934 and the Securities Investor Protection Act, and will not be subject to the provisions of the Commodity Exchange Act, including segregation of funds. 29. According to the rules of the exchanges, a broker-dealer is required to immediately liquidate[,] or, if feasible, transfer to another broker-dealer eligible to carry cross-margin accounts, all customer cross-margin accounts that contain positions in futures and/or options on futures in the event that the carrying broker-dealer becomes insolvent. 30. In signing the agreement referred to in paragraph 28 above, a customer also acknowledges that a cross-margin account that contains positions in futures and/or options on futures will be immediately liquidated, or, if feasible, transferred to another broker-dealer eligible to carry cross-margin accounts, in the event that the carrying broker-dealer becomes insolvent. Special Risks of Cross-Margining 31. Cross-margining must be conducted in a portfolio margin account type. Generally, cross-margining and the portfolio margining methodology both contribute to provide greater leverage than a *standard* [regular] margin account, and greater leverage creates greater losses in the event of adverse market movements. 32. Since cross-margining must be conducted in a portfolio margin account type, the time required for meeting margin calls is shorter than in a *standard* [regular] securities margin account and may be shorter than the time ordinarily required by a futures commission merchant for meeting margin calls in a futures account. Consequently, there is increased risk that a customer's cross-margin positions will be liquidated involuntarily, causing possible loss to the customer. 33. As noted above, cross-margin accounts are securities accounts and are subject to the customer protections set-forth in Rule 15c3-3 under the Securities Exchange Act of 1934 and the Securities Investor Protection Act. Cross-margin positions are not subject to the customer protection rules under the segregation provisions of the Commodity Exchange Act and the rules of the CFTC adopted pursuant to the Commodity Exchange Act. 34. Trading of index options and futures contracts in a cross-margin account is generally subject to all the risks of trading those same products in a futures account or a standard [regular] securities margin account. Customers should be thoroughly familiar with the risk disclosure materials applicable to those products, including the booklet entitled Characteristics and Risks of Standardized Options and the risk disclosure document required by the CFTC to be delivered to futures customers. Because this disclosure statement does not disclose the risks and other significant aspects of trading in futures and options, customers should review those materials carefully before trading in a cross-margin account. 35. Customers should bear in mind that the discrepancies in the cash flow characteristics of futures and certain options are still present even when those products are carried together in a cross-margin account. Both futures and options contracts are generally marked to the market at least once each business day, but the marks may take place with different frequency and at different times within the day. When a futures contract is marked to the market, the gain or loss is immediately credited to or debited from[, respectively,] the customer's account in cash. While an increase in the value of a long option contract may increase the equity in the account, the gain is not realized until the option is sold or exercised. Accordingly, a customer may be required to deposit cash in the account in order to meet a variation payment on a futures contract even though the customer is in a hedged position and has experienced a corresponding (but yet unrealized) gain on a long option. Alternatively, a customer who is in a hedged position and would otherwise be entitled to receive a variation payment on a futures contract may find that the cash is required to be held in the account as margin collateral on an offsetting option position. 36. Customers should consult with their tax advisers to be certain that they are familiar with the tax treatment of transactions in index products, including tax consequences of trading strategies involving both futures and option contracts. 37. The descriptions in this disclosure statement relating to eligibility requirements for cross-margining, and minimum equity and margin requirements for cross margin accounts, are minimums imposed under Exchange rules. Time frames within which margin and equity calls must be met are maximums imposed under Exchange rules. The broker-dealer carrying a customer's portfolio margin account, including any cross-margin account, may impose [its own] more stringent requirements. Sample Portfolio Margining and Cross-Margining Acknowledgements Acknowledgement for Customers Utilizing a Portfolio Margin Account—Cross-Margining And Non-Cross-Margining— Rule 15c3-3 under the Securities Exchange Act of 1934 requires that a broker or dealer promptly obtain and maintain physical possession or control of all fully-paid securities and excess margin securities of a customer. Fully-paid securities are securities carried in a cash account and margin equity securities carried in a margin or special account (other than a cash account) that have been fully paid for. Excess margin securities are a customer's margin securities having a market value in excess of 140% of the total of the debit balances in the customer's non-cash accounts. For the purposes of Rule 15c3-3, securities held subject to a lien to secure obligations of the broker-dealer are not within the broker-dealer's physical possession or control. The Commission staff has taken the position that all long option positions in a customer's portfolio[-]margining account (including any cross-margin account) may be subject to such a lien by OCC and will not be deemed fully-paid or excess margin securities under Rule 15c3-3. The hypothecation rules under the Securities Exchange Act of 1934 (Rules 8c-1 and 15c2-1)[,] prohibit broker-dealers from permitting the hypothecation of customer securities in a manner that allows those securities to be subject to any lien or liens in an amount that exceeds the customer's aggregate indebtedness. However, all long option positions in a portfolio[-]margining account (including any cross-margining account) will be subject to OCC's lien, including any positions that exceed the customer's aggregate indebtedness. The Commission staff has taken a position that would [to] allow customers to carry positions in portfolio[-]margining accounts[,] (including any cross-margining account) even when those positions exceed the customer's aggregate indebtedness. Accordingly, within a portfolio margin account or cross-margin account, to the extent that you have long option positions that do not operate to offset your aggregate indebtedness and thereby reduce your margin requirement, you receive no benefit from carrying those positions in your portfolio[-]margin account or cross-margin account and incur the additional risk of OCC's lien on your long option position(s). By signing below the customer affirms that the customer has read and understood the foregoing disclosure statement and acknowledges and agrees that long option positions in portfolio[-]margining accounts, and cross-margining accounts, will be exempted from certain customer protection rules of the Securities and Exchange Commission as described above and will be subject to a lien by the options clearing corporation without regard to such rules. Customer Name: By: Date: (Signature/title) Acknowledgement for Customers Engaged in Cross-Margining As disclosed above, futures contracts and other property carried in customer accounts with Futures Commission Merchants (“FCM”) are normally subject to special protection afforded under the customer segregation provisions of the Commodity Exchange Act (“CEA”) and the rules of the Commodity Futures Trading Commission adopted pursuant to the CEA. These rules require that customer funds be segregated from the accounts of financial intermediaries and be accounted for separately. However, they do not provide for, and *standard* [regular] futures accounts do not enjoy the benefit of, insurance protecting customer accounts against loss in the event of the insolvency of the intermediary carrying the accounts. As discussed above, cross-margining must be conducted in a portfolio margin account, dedicated exclusively to cross-margining and cross-margin accounts are not treated as a futures account with an FCM. Instead, cross-margin accounts are treated as securities accounts carried with broker-dealers. As such, cross-margin accounts are covered by Rule 15c3-3 under the Securities Exchange Act of 1934, which protects customer accounts. Rule 15c3-3, among other things, requires a broker-dealer to maintain physical possession or control of all fully-paid and excess margin securities and maintain a special reserve account for the benefit of their customers. However, with regard to cross-margin accounts, there is an exception to the possession or control requirement of Rule 15c3-3 that permits The Options Clearing Corporation to have a lien on long positions. This exception is outlined in a separate acknowledgement form that must be signed prior to or concurrent with this form. Additionally, the Securities Investor Protection Corporation (“SIPC”) insures customer accounts against the financial insolvency of a broker-dealer in the amount of up to $500,000 to protect against the loss of registered securities and cash maintained in the account for purchasing securities or as proceeds from selling securities (although the limit on cash claims is $100,000). According to the rules of the exchanges, a broker-dealer is required to immediately liquidate[,] or, if feasible, transfer to another broker-dealer eligible to carry cross-margin accounts, all customer cross-margin accounts that contain positions in futures and/or options on futures in the event that the carrying broker-dealer becomes insolvent. By signing below the customer affirms that the customer has read and understood the foregoing disclosure statement and acknowledges and agrees that:
(1)Positions and property in cross-margining accounts, will not be subject to the customer protection rules under the customer segregation provisions of the Commodity Exchange Act and the rules of the Commodity Futures Trading Commission adopted pursuant to the CEA and
(2)cross-margining accounts that contain positions in futures and/or options on futures will be immediately liquidated, or if feasible, transferred to another broker-dealer eligible to carry cross-margin accounts in the event that the carrying broker-dealer becomes insolvent. Customer Name: By: Date: (Signature/title) II. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change In its filing with the Commission, the Exchange included statements concerning the purpose of, and basis for, the proposed rule change and discussed any comments it received on the proposed rule change. The text of these statements may be examined at the places specified in Item IV below. The Exchange has prepared summaries, set forth in Sections A, B, and C below, of the most significant aspects of such statements. A. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change 1. Purpose Amendments to NYSE Rule 431 (“Margin Requirements”) are proposed that would include security futures 8 and single stock options as products eligible for treatment under portfolio margin requirements as part of the Portfolio Margin Pilot Program recently approved by the Commission. Amendments to Rule 726 (“Delivery of Options Disclosure Document and Prospectus”) also are proposed to include the SEC approved products on the disclosure document required to be furnished to customers pursuant to this rule. 8 For purposes of this filing term “security futures” utilizes the definition at Section 3(a)(55) of the Exchange Act, excluding narrow-based security indices. a. Background Section 7(a) 9 of the Exchange Act of 1934 10 empowers the Board of Governors of the Federal Reserve System to prescribe the rules and regulations regarding credit that may be extended by broker-dealers on securities (Regulation T) to their customers. NYSE Rule 431 prescribes specific margin requirements that must be maintained in all customer accounts, based on the type of securities products held in such accounts. 9 15 U.S.C. 78g. 10 15 U.S.C. 78a et seq. In April 1996, the Exchange established a Rule 431 Committee (the “Committee”) to assess the adequacy of Rule 431 on an ongoing basis, review margin requirements, and make recommendations for change. A number of proposed amendments resulting from the Committee's recommendations have been approved by the Exchange's Board of Directors since the Committee was established. Similarly, the Committee has endorsed the proposed amendments discussed below. 11 11 The Committee is composed of several member organizations, including Goldman, Sachs & Co., Morgan Stanley & Co., Inc., Merrill Lynch, Pierce, Fenner and Smith, Inc., Bear Stearns Corp. and Credit Suisse First Boston Corp. and several self-regulatory organizations, including: the NYSE, the Chicago Board Options Exchange, the Options, Clearing Corporation, the American Stock Exchange, the Chicago Board of Trade, the Chicago Mercantile Exchange, and the National Association of Securities Dealers. b. The Pilot The Board of Governors of the Federal Reserve System in its amendments to Regulation T in 1998 permitted SROs to implement portfolio margin rules, subject to SEC approval. 12 As noted above, on July 14, 2005 the Commission approved amendments to Exchange Rules 431 and 726 to permit, on a two year pilot basis, the use of a prescribed risk-based methodology (“Portfolio Margin”) 13 for certain products as an alternative to the strategy or position based margin requirements currently required in Rule 431(a) through (f). Exchange member organizations may utilize portfolio margin for listed, broad-based U.S. index options and index warrants, along with any underlying instruments. 14 These positions are to be margined (either for initial or maintenance) in a separate portfolio margin account dedicated exclusively for such margin computation. 12 *See* Federal Reserve System, “Securities Credit Transactions; Borrowing by Broker and Dealers;” Regulations G, T, U and X; Docket Nos. R-0905, R-0923 and R-0944, 63 FR 2806 (January 16, 1998). 13 As a pre-condition to permitting portfolio margining, member organization are required to establish procedures and guidelines to monitor credit risk to the member organization's capital, including intra-day credit risk and stress testing of portfolio margin accounts. Further, member organizations must establish procedures for regular review and testing of these required risk analysis procedures (see Rule 431(g)(1)). 14 For purposes of these amendments, the term “underlying instrument,” means long and short positions in an exchange traded fund of other fund product registered under the Investment Company Act of 1940, that holds the same securities, and in the same proportion, as contained in a broad-based index on which options are listed. The term “underlying instrument” shall not be deemed to include futures contracts, options on futures contracts, underlying stock baskets, or unlisted instruments. c. Strategy or Positioned-Based Margin Requirements Prior to the Pilot, member organizations were subject, pursuant to NYSE Rule 431, to strategy or positioned-based margin requirements. This methodology applied specific margin percentage requirements as prescribed in Rule 431 to each security position and/or strategy, either long or short, held in a customer's account, irrespective of the fact that all security (e.g., options) prices do not change equally (in percentage terms) with a change in the price of the underlying security. As discussed in more detail below, when utilizing a portfolio margin methodology, offsets are fully realized, whereas under strategy or position-based methodology, positions and or groups of positions comprising a single strategy are margined independently of each other and offsets between them do not efficiently impact the total margin requirement. d. Portfolio Margin Requirements Portfolio margining is a margin methodology that sets margin requirements for an account based on the greatest projected net loss of all positions in a product class or group. The Pilot utilizes a Commission approved theoretical options pricing model using multiple pricing scenarios to set or determine the risk level. 15 These scenarios are designed to measure the theoretical loss of the positions given changes in both the underlying price and implied volatility inputs to the model. Accordingly, the margin required is based on the greatest loss that would be incurred in a portfolio if the value of its components move up or down by a predetermined amount. 15 The theoretical options pricing model is used to derive position values at each valuation point for the purpose of determining the gain or loss. The amount of initial and maintenance margin required with respect to a portfolio would be the larger of:
(1)The greatest loss amount among the valuation calculations; or
(2)the sum of $.375 for each option and security future in the portfolio multiplied by the contract's (e.g. 100 shares per contract) or instrument's multiplier. This computation establishes a minimum margin requirement to ensure that a certain level of margin is required from a customer. Generally, the purpose and benefit of portfolio margining is to efficiently set levels of margin that reflect historical moves that more precisely reflects actual net risk of all positions in the account. A customer benefits from portfolio margining in that margin requirements calculated on net position risk are generally lower than strategy-based margin methodologies currently in place. In permitting margin computation based on actual net risk, member organizations are no longer required to compute a margin requirement for each individual position or strategy in a customer's account (see NYSE Rule 431). As discussed in more detail below, utilizing portfolio margin for options portfolios and any related instruments enables the portfolio to be subjected to certain preset market volatility parameters that reflect historical moves in the underlying security thereby assessing potential loss in the portfolio in the aggregate. Accordingly, such a methodology provides an accurate and realistic assessment of reasonable margin requirements. e. Proposed Amendments The Exchange and CBOE received letters in late September 2005 from Commission Chairman Christopher Cox asking the SROs to consider expanding portfolio margining to a broader universe of products. The Commission encouraged the Exchanges to file a rule proposal before year-end. 16 Accordingly, the Exchange is proposing the amendments discussed below. 16 Chairman of the Commission, Christopher Cox, in a letter dated September 27, 2005, to William J. Brodsky and John A. Thain, the Chief Executive Offices of CBOE and NYSE, respectively, encouraged each SRO to file a rule proposal to make portfolio margin available to equity options and security futures with the Commission by year-end 2005. f. Eligible Products/Minimum Equity Requirements The proposed amendments to Rule 431 seek to expand the eligible products previously approved, provided all products can be priced within a prescribed risk-based theoretical pricing methodology. Specifically, the proposed amendments will expand the eligible products to include security futures as well as listed single stock options. The proposed amendments will also permit customers effecting transactions in security futures and listed single stock options to do so without maintaining the $5 million equity requirement, which is currently required under the Pilot for all other eligible products. g. Valuation Points Further, the proposed amendments will establish theoretical prices at 10 equidistant valuation points within a range consisting of an increase or a decrease of +/−15% 17 (i.e., +/−3%, 6%, 9%, 12%, and 15%) in the current market value of the underlying instrument. As proposed, the price range for computing a portfolio margin requirement is the same parameter required under Appendix A of Rule 15c3-1a 18 under the Exchange Act for computing deductions to a firm's net capital for proprietary positions. Currently the only theoretical model qualified pursuant to Rule 15c3-1a under the Exchange Act is the Theoretical Intermarket Margin System (“TIMS”) administered by The Options Clearing Corporation. 17 The Pilot established valuation points for the following eligible products: Non-High Capitalization/Broad-based U.S. Market Index Options (+/−10%) and High Capitalization/Broad-based U.S. Market Index Options (+6%/−8%). 18 17 CFR 240.15c3-1a(b)(1)(i)(B). The requirements of this rule include, among other things, that any model be non-proprietary, approved by a Designated Examining Authority (“DEA”) and available on the same terms to all broker-dealers. Referencing to the SEC's net capital coupled with DEA approval and SEC review assures uniformity across pricing models and that portfolio and cross-margin requirements will not vary significantly from firm to firm. h. Margin Deficiency In addition, the proposed amendments will require a member organization to deduct from its net capital the amount of any portfolio margin maintenance call which is not met by the close of business of trade date plus one (T+1). 19 Member organizations will not be permitted to deduct any portfolio margin maintenance call amount from net capital in lieu of collecting the required margin. 19 Several paragraphs in the proposed rule amendments use the term “portfolio margin maintenance call” rather than the term “portfolio margin maintenance deficiency.” The proposed rule text was intended to measure the time period for a customer to meet a margin call or a member to make a deduction in calculating net capital from the time of the margin deficiency, not the time of the margin call. The Exchange has represented that it will amend the proposed rule changes to clarify this technical non-substantive change prior to any Commission approval of the proposed rule change. Telephone conversation between William Jannace, Director, Rule and Interpretive Standards, Member Firm Regulation, NYSE and Randall Roy, Branch Chief, and Sheila Swartz, Special Counsel, Division of Market Regulation, Commission, on January 13, 2006. i. Definitions The proposed amendments expand upon the core definition of the term “equity” as defined in section (a)(4) of Rule 431 (see proposed Rule 431(g)(2)(H) for purposes of portfolio margin and cross-margin to include the market value of any long or short option positions held in an eligible participant's account. In addition, other non-substantive changes and/or modification to other definitions in Rule 431 were made in light of the proposed amendments. j. Disclosure Document and Customer Attestation Exchange Rule 726 prescribes requirements for the delivery of options disclosure documents concerning the opening of customer accounts. As part of the Pilot amendments, members and member organizations are required to provide every portfolio margin customer with a written risk disclosure statement at or prior to the initial opening of a portfolio margin account. The disclosure statement is divided into two sections, one dealing with portfolio margining and the other with cross-margining. The statement discloses the special risk and operation of portfolio margin accounts, including cross-margining, and the differences between portfolio margin and strategy-based margin requirements. The disclosure statement also addresses who is eligible to open a portfolio margin account, the instruments that are allowed, and when deposits to meet margin and minimum equity are required. In addition, at or prior to the time a portfolio margin account is initially opened, members and member organizations are required to obtain a signed acknowledgement regarding certain implications of portfolio margining ( *e.g.* treatment under Exchange Act Rules 8c-1, 15c2-1 and 15c3-3) from the customer. Further, prior to providing cross-margining, members and member organizations are required to obtain a second signed customer acknowledgement relative to the segregation treatment for futures contracts and Securities Investor Protection Corporation coverage. As proposed, the disclosure document required by Rule 726 is being amended to incorporate the approved Commission products. Finally, the filing includes several minor technical amendments to the rules for purposes of clarity and consistency. 2. Statutory Basis The statutory basis for this proposed rule change is Section 6(b)(5) 20 of the Exchange Act which requires, among other things, that the rules of the Exchange are designed to prevent fraudulent and manipulative acts and practices, to promote just and equitable principles of trade, to foster cooperation and coordination with persons engaged in regulating, clearing, settling, processing information with respect to, and facilitating transactions in securities, to remove impediments to perfect the mechanism of a free and open market and national market system, and in general to protect investors and the public interest. The proposed amendments are consistent with this section in that they will better align margin requirements with the actual risk of hedged products, will also potentially alleviate excess margin calls and potentially reduce the risk of forced liquidations of positions in customer accounts. 20 15 U.S.C. 78f(b)(5). B. Self-Regulatory Organization's Statement on Burden on Competition The Exchange does not believe that the proposed rule change will impose any burden on competition not necessary or appropriate in furtherance of the purposes of the Exchange Act. C. Self-Regulatory Organization's Statement on Comments on the Proposed Rule Change Received From Members, Participants or Others The Exchange has neither solicited nor received written comments on the proposed rule change. III. Date of Effectiveness of the Proposed Rule Change and Timing for Commission Action Within 35 days of the date of publication of this notice in the **Federal Register** or within such longer period
(i)as the Commission may designate up to 90 days of such date if it finds such longer period to be appropriate and publishes its reasons for so finding, or
(ii)as to which the Exchange consents, the Commission will:
(A)By order approve such proposed rule change, as amended; or
(B)Institute proceedings to determine whether the proposed rule change should be disapproved. IV. Solicitation of Comments Interested persons are invited to submit written data, views, and arguments concerning the foregoing, including whether the proposed rule change is consistent with the Exchange Act. Comments may be submitted by any of the following methods: Electronic Comments • Use the Commission's Internet comment form ( *http://www.sec.gov/rules/sro.shtml* ); or • Send e-mail to *rule-comments@sec.gov.* Please include File Number SR-NYSE-2005-93 on the subject line. Paper Comments • Send paper comments in triplicate to Nancy M. Morris, Secretary, Securities and Exchange Commission, 100 F Street, NE., Washington, DC 20549-9303. All submissions should refer to File Number SR-NYSE-2005-93. This file number should be included on the subject line if e-mail is used. To help the Commission process and review your comments more efficiently, please use only one method. The Commission will post all comments on the Commission's Internet Web site ( *http://www.sec.gov/rules/sro/shtml* ). Copies of the submission, all subsequent amendments, all written statements with respect to the proposed rule change that are filed with the Commission, and all written communications relating to the proposed rule change between the Commission and any person, other than those that may be withheld from the public in accordance with the provisions of 5 U.S.C. 552, will be available for inspection and copying in the Commission's Public Reference Room. Copies of such filing also will be available for inspection and copying at the principal office of the NYSE. All comments received will be posted without change; the Commission does not edit personal identifying information from submissions. You should submit only information that you wish to make available publicly. All submission should refer to File Number SR-NYSE-2005-93 and should be submitted on or before February 13, 2006. For the Commission, by the Division of Market Regulation, pursuant to delegated authority. 21 21 17 CFR 200.30-3(a)(12). Nancy M. Morris, Secretary. [FR Doc. E6-668 Filed 1-20-06; 8:45 am] BILLING CODE 8010-01-P SECURITIES AND EXCHANGE COMMISSION [Release No. 34-53124; File No. SR-NYSE-2005-37] Self-Regulatory Organizations; New York Stock Exchange, Inc.; Order Approving a Proposed Rule Change and Amendments No. 1 and 2 Thereto and Notice of Filing and Order Granting Accelerated Approval to Amendment No. 3 Thereto Relating to Amendments to Certain Sections of the Exchange Constitution Concerning the Exchange's Hearing Board and Related Amendments to Exchange Rule 475 and Rule 476 January 13, 2006. I. Introduction On May 23, 2005, the New York Stock Exchange, Inc. (“NYSE” or “Exchange”) filed with the Securities and Exchange Commission (“Commission”), pursuant to Section 19(b)(1) of the Securities Exchange Act of 1934 (“Act”) 1 and Rule 19b-4 thereunder, 2 a proposed rule change to amend Article IX of the Exchange's Constitution and Exchange Rules 475 and 476 to modify certain aspects of the Exchange's disciplinary procedures and to provide a structure for a summary suspension hearing and a “call up” procedure for review by members of the Board of Directors (“Board”), certain members of the Board of Executives listed in NYSE Rule 476(f), any member of the Regulation, Enforcement and Listing Standards Committee, and either the Division of the Exchange that initiated the proceedings or the respondent. On September 9, 2005, the NYSE filed Amendment No. 1 to the proposed rule change. The proposed rule change, as amended by Amendment No. 1, was published for comment in the **Federal Register** on October 26, 2005. 3 The Commission received no comments regarding the proposal, as amended. On November 28, 2005 and December 2, 2005, the NYSE filed Amendments No. 2 4 and 3, 5 respectively, to the proposed rule change. This order approves the proposed rule change, as amended by Amendments No. 1 and 2, grants accelerated approval to Amendment No. 3, and solicits comments from interested persons on Amendment No. 3 to the proposed rule change. 1 15 U.S.C. 78s(b)(1). 2 17 CFR 240.19b-4. 3 *See* Securities Exchange Act Release No. 52638 (October 19, 2005), 70 FR 61866. 4 In Amendment No. 2, the Exchange makes minor, non-substantive changes to the rule text contained in Exhibit 5 of the proposed rule change. This was a technical amendment and is not subject to notice and comment. 5 In Amendment No. 3, the Exchange proposes that the proposed rule change, as amended, be implemented on or about April 1, 2006 and attaches a revised Exhibit 5 to reflect changes made to the rule text in Amendments No. 1 and 2. II. Description of the Proposal The Exchange proposes to amend Article IX of the Exchange's Constitution and NYSE Rules 475 and 476 to modify certain aspects of the Exchange's disciplinary procedures and to provide a structure for a summary suspension hearing and a “call-up” procedure for review by members of the Board, certain members of the Board of Executives listed in NYSE Rule 476(f), any member of the Regulation, Enforcement and Listing Standards Committee, and either the Division of the Exchange that initiated the proceedings or the respondent. Amendment to NYSE Rule 475 NYSE Rule 475 currently provides a process for the Exchange:
(i)To prohibit or limit a person with respect to access of services offered by the Exchange, or
(ii)to summarily suspend an Exchange member or member organization facing certain circumstances, such as financial or operating difficulties, or expulsion or suspension by another self-regulatory organization. The proposed rule change would provide a structure for such a hearing and for a “call-up” procedure for review by members of the Board and certain members of the Board of Executives, 6 any member of the Regulation, Enforcement and Listing Standards Committee, and either the Division of the Exchange that initiated the proceedings or the respondent. 6 These are members of the Board of Executives representing the groups referenced in clauses
(ii)and
(iii)of Article V, Section 2(b) of the Exchange's Constitution, namely, members who spend a substantial part of their time on the trading floor. Amendments to Article IX of the Constitution and NYSE Rule 476 Composition of the Hearing Panel The Exchange currently requires that disciplinary hearings be conducted before a Hearing Panel consisting of a Hearing Officer (an Exchange staff member) and two peer panelists. The Exchange believes that this “trial by peers” requirement raises a concern about bias and perception of bias, especially in cases involving charges against individuals on the trading floor because of the relatively small floor community. Accordingly, the Exchange proposes that a Hearing Panel consist of at least one member who is engaged in securities activities differing from that of the respondent. In any disciplinary proceeding involving activities on the floor of the Exchange, the Exchange also proposes that no more than one of the persons serving on the Hearing Panel be, or if retired, has been, active on the floor. For example, with respect to cases involving the trading floor, the intent of the proposal is such that charges against a specialist or floor broker would be heard before a panel consisting of no more than one individual employed on the trading floor. In addition, the Exchange proposes that a Hearing Panel could include only one retired person. Composition of the Hearing Board and Hearing Officers The Exchange also proposes to eliminate the requirement that Exchange Hearing Officers be employees or officers of the Exchange, thereby enabling the Exchange to retain outside professionals to serve as Hearing Officers, if needed. However, under the amendments to the Exchange's Constitution and NYSE Rule 476, an individual who is, or was within the last three years, a member, allied member, or registered or non-registered employee of a member or member organization would not be eligible to serve as a Hearing Officer. The proposed rule change also would allow former members, allied members, and registered and non-registered employees of members and member organizations to be appointed to the Hearing Board within five years of their retirement. 7 7 The Exchange also proposes to amend NYSE Rule 476 to conform this rule with language in Article IX, Section 3 of the Exchange's Constitution prohibiting members of the Board or the Board of Executives from serving on the Hearing Board. Members of the Hearing Panel, other than the Hearing Officer, are selected from members of the Hearing Board. *See* Article 14, Secs. 2-4 of the Exchange's Constitution. Hearing Officer's Authority The Exchange also proposes to permit Hearing Officers to handle stipulations and uncontested cases without the full Hearing Panel. At present, all disciplinary hearings (including settled cases, in which a respondent consents to a penalty, and uncontested cases, in which a respondent does not file an answer to the charges) must be heard before a full Hearing Panel. The Exchange proposes to confer authority on an Exchange Hearing Officer to act alone in considering such uncontested and settled cases and impose penalties, without a hearing, in order to expedite resolution of such matters. Under the proposal, the Hearing Officer would convene a panel and hold a hearing if either the Enforcement Division or the respondent requests a hearing before a full panel, or if the Hearing Officer, on his or her own initiative, calls for a hearing. Moreover, the Hearing Officer could not reject a stipulated penalty without convening a Hearing Panel. Furthermore, the proposed rule change would permit the Hearing Officer to resolve substantive legal motions, such as motions to dismiss and motions for summary judgment, by no longer requiring that a Hearing Panel resolve such motions. The proposed rule change also would clarify the Hearing Officer's authority to order pre-hearing discovery of documents from the Division of Enforcement and from the respondent. Finally, the proposal would clarify the Hearing Officer's authority to penalize contemptuous participants and permit the Hearing Officer to impose fines on a party for inappropriate behavior of either the party or the party's representative. This authority would not be limited to dealing with such behavior during a hearing, but would allow for sanctions to be imposed at any time during the course of proceedings. The Hearing Officer could also exclude, in extreme situations, any such persons from further participation in the proceeding. Conferring Jurisdiction on the Hearing Board Upon Filing of the Charge Memorandum Under current procedures, the hearing in a disciplinary matter is scheduled only upon request of the Division of Enforcement, after a respondent's answer is received or the time to file an answer has expired. The Hearing Board has no jurisdiction to resolve any issues that arise until the Division of Enforcement requests a hearing, and a respondent has no avenue of recourse if the respondent believes there has been an unreasonable or prejudicial delay. The proposed rule change would require the filing of charges with the Hearing Board at the time they are served on the respondent. The Hearing Board would assume jurisdiction of the matter at that juncture and be able to schedule expeditiously hearings, as well as rule on pre-hearing motions. “Call Up” Authority Reallocated At present, all members of the Board of Executives (as well as all Directors other than the Chief Executive Officer) have the right and the responsibility to “call up” disciplinary decisions for review. The Exchange proposes amendments to its Constitution and NYSE Rule 476 to reallocate this responsibility to members of the Board, Board of Executives' members representing the trading floor, members of the Regulation, Enforcement and Listing Standards Committee, the Exchange Division that initiated the proceedings or the respondent, but would preserve the Board's right to designate, by rule, categories of members of the Board of Executives with this responsibility, if warranted. Amendment No. 3 In Amendment No. 3, the Exchange proposes to implement the proposed rule change, as amended, on or about April 1, 2006 and attached an Exhibit 5 to reflect changes made to the rule text in Amendments No.1 and 2. III. Solicitation of Comments Interested persons are invited to submit written data, views, and arguments concerning Amendment No. 3, including whether Amendment No. 3 is consistent with the Act. Comments may be submitted by any of the following methods: Electronic Comments • Use the Commission's Internet comment form ( *http://www.sec.gov/rules/sro.shtml* ); or • Send an e-mail to *rule-comments@sec.gov.* Please include File No. SR-NYSE-2005-37 on the subject line. Paper Comments • Send paper comments in triplicate to Nancy M. Morris, Secretary, Securities and Exchange Commission, Station Place, 100 F Street, NE., Washington, DC 20549-9303. All submissions should refer to File Number SR-NYSE-2005-37. This file number should be included on the subject line if e-mail is used. To help the Commission process and review your comments more efficiently, please use only one method. The Commission will post all comments on the Commission's Internet Web site ( *http://www.sec.gov/rules/sro.shtml* ). Copies of the submission, all subsequent amendments, all written statements with respect to the proposed rule change that are filed with the Commission, and all written communications relating to the proposed rule change between the Commission and any person, other than those that may be withheld from the public in accordance with the provisions of 5 U.S.C. 552, will be available for inspection and copying in the Commission's Public Reference Room. Copies of such filing also will be available for inspection and copying at the principal office of the NYSE. All comments received will be posted without change; the Commission does not edit personal identifying information from submissions. You should submit only information that you wish to make available publicly. All submissions should refer to File Number SR-NYSE-2005-37 and should be submitted on or before February 13, 2006. IV. Discussion After careful consideration, the Commission finds that the proposed rule change, as amended, is consistent with the requirements of the Act and the rules and regulations thereunder applicable to a national securities exchange. 8 In particular, the Commission finds that, the proposed rule change, as amended, is consistent with Section 6(b)(1) of the Act 9 which requires that the exchange be “so organized and [have] the capacity to carry out the purposes of [the Act]” and to “enforce compliance by its members and persons associated with its members with the provisions of [the Act].” The Commission also finds that the proposed amendments relating to the composition of the Hearing Panel comport with the requirements of Section 6(b)(3) of the Act, 10 which requires that the rules of a national securities exchange assure the fair representation of its members in the selection of its directors and administration of its affairs, and provide that one or more directors shall be representative of issuers and investors and not be associated with a member of the exchange, broker, or dealer. The Commission also finds that the proposed rule change, as amended, is consistent with Section 6(b)(5) of the Act 11 in that it is designed, among other things, to prevent fraudulent and manipulative acts and practices, to promote just and equitable principles of trade, to foster cooperation and coordination with persons engaged in regulating, clearing, settling, processing information with respect to, and facilitating transactions in securities, to remove impediments to and perfect the mechanism of a free and open market and a national market system, and, in general, to protect investors and the public interest. Further, the Commission finds that the proposed rule change is consistent with Section 6(b)(7) of the Act, 12 which, among other things, requires that the rules of a national securities exchange provide a fair procedure for the disciplining of members and persons associated with members. 8 In approving this proposed rule change, the Commission has considered the proposed rule's impact on efficiency, competition, and capital formation. 15 U.S.C. 78c(f). 9 15 U.S.C. 78f(b)(1). 10 15 U.S.C. 78f(b)(3). 11 15 U.S.C. 78f(b)(5). 12 15 U.S.C. 78f(b)(7). Specifically, the Commission believes that the proposed changes to the Exchange's disciplinary procedures should help strengthen the Exchange's ability to carry out its oversight and enforcement responsibilities as a self-regulatory organization. The Commission also believes that the proposal is reasonably designed to improve the timeliness, fairness, and efficiency of the disciplinary process to address violations of the Exchange's rules and the federal securities laws by the Exchange's members and persons associated with members. In particular, the Commission believes that it is appropriate for the Exchange to provide a structure in NYSE Rule 475 for a summary suspension hearing to prohibit or limit a person's access to services and to provide a “call-up” procedure for Board review of such proceedings by members of the Board, certain specified members of the Board of Executives, any member of the Regulation, Enforcement and Listing Standards Committee, and either the Division of the Exchange that initiated the proceeding or the respondent. In addition, the Commission believes that it is appropriate for the Exchange to revise Article IX of its Constitution to permit the “call up” for Board review of any disciplinary determination or penalty (other than a proceeding involving a written consent to a specified penalty) by any member of the Board, certain specified members of the Board of Executives, any member of the Regulation, Enforcement and Listing Standards Committee, as well as the Exchange Division that brought the charges or the respondent. The Commission notes, however, that the proposed revision to this “call up” procedure contained in the Exchange's Constitution would preserve the Board's right to designate, by rule, other categories of members of the Board of Executives that can require such review by the Board. In addition, the Commission believes that the proposed changes to Article IX of the Exchange's Constitution and NYSE Rule 476 with respect to the composition of the Hearing Panel should expand the available pool of panelists with the requisite knowledge of the securities industry to serve on the Hearing Panel. At the same time, the Commission believes that the proposed requirement that a Hearing Panel have at least one member who is engaged in securities activities differing from that of the respondent is designed to mitigate the perception of bias that may have occurred when a majority of the panel members in the same line of business as the respondent was not precluded from serving on such panel. Similarly, the Commission believes that the proposed changes to allow recently retired members and employees of members to serve on the Hearing Board and to allow non-NYSE employees to serve as Hearing Officers should enlarge the pool of individuals with the requisite expertise to hear and adjudicate cases and with the ability to readily serve during regular business hours, thereby potentially allowing cases to be resolved more expeditiously. Moreover, the Commission notes that the proposal specifies that, in any disciplinary proceeding involving activities on the floor of the Exchange, no more than one person on the Hearing Panel shall have been active on the floor of the Exchange, which also is intended to reduce the perception of bias in the Exchange's disciplinary process. In addition, the Commission believes that the Exchange's proposal to expand the Hearing Officer's authority to handle stipulations and uncontested cases, procedural and evidentiary matters, and substantive legal motions is designed to expedite the hearing process by allowing the Hearing Officer to resolve efficiently certain matters that currently require action by the full Hearing Panel. The Commission notes that, according to the Exchange, these motions often involve legal issues that the Hearing Officer is best suited to resolve. Finally, the Commission believes that the Exchange's proposal to require that the filing of charges be made with the Hearing Board at the time they are served on the respondent will allow the Hearing Board to immediately assume jurisdiction of the matter and to be able to expeditiously schedule hearings, as well as rule on pre-hearing motions. Accelerated Approval of Amendment No. 3 The Commission finds good cause to approve Amendment No. 3 to the proposed rule change, as amended, prior to the thirtieth day after the amendment is published for comment in the **Federal Register** pursuant to Section 19(b)(2) of the Act. 13 Amendment No. 3 clarifies that the Exchange intends to implement the proposed rule change, as amended, on or about April 1, 2006. The Commission notes that the Exchange has represented that it will issue an Information Memo to alert its members of the proposed rule change and its implementation date which is scheduled to occur on or about April 1, 2006. 14 13 15 U.S.C. 78s(b)(2). 14 Telephone conversation between Peggy Kuo, Chief Hearing Officer, NYSE, and Cyndi N. Rodriguez, Special Counsel, Division of Market Regulation, Commission, on January 11, 2006. Specifically, the Commission finds that Amendment No. 3 provides clarification to members and other appropriate parties of the intended implementation date of the proposed changes to the Exchange's disciplinary procedures that are contained in Article IX of the Exchange's Constitution and NYSE Rules 475 and 476 and raises no new issues of regulatory concern. For these reasons, the Commission believes that good cause exists to accelerate approval of Amendment No. 3. IV. Conclusion For the foregoing reasons, the Commission finds that the proposed rule change, as amended, is consistent with the Act and the rules and regulations thereunder applicable to a national securities exchange, and, in particular, with Sections 6(b)(1), 6(b)(5), and 6(b)(7) of the Act. 15 15 15 U.S.C. 78f(b)(1), 15 U.S.C. 78f(b)(5), and 15 U.S.C. 78f(b)(7). *It is therefore ordered,* pursuant to Section 19(b)(2) of the Act, 16 that the proposed rule change (SR-NYSE-2005-37) and Amendments No. 1 and 2 thereto are approved, and that Amendment No. 3 thereto is approved on an accelerated basis. 16 15 U.S.C. 78s(b)(2). For the Commission, by the Division of Market Regulation, pursuant to delegated authority. 17 17 17 CFR 200.30-3(a)(12). Nancy M. Morris, Secretary. [FR Doc. E6-674 Filed 1-20-06; 8:45 am] BILLING CODE 8010-01-P SECURITIES AND EXCHANGE COMMISSION [Release No. 34-53133; File No. SR-PCX-2005-135] Self-Regulatory Organizations; Pacific Exchange, Inc.; Notice of Filing of Proposed Rule Change Relating to Exposure of Orders in the PCX Plus Crossing Mechanism January 17, 2006. Pursuant to Section 19(b)(1) of the Securities Exchange Act of 1934 (“Act”), 1 and Rule 19b-4 thereunder, 2 notice is hereby given that on December 22, 2005, the Pacific Exchange, Inc. (“PCX” or “Exchange”) filed with the Securities and Exchange Commission (“Commission”) the proposed rule change as described in Items I, II, and III below, which Items have been prepared by the PCX. The Commission is publishing this notice to solicit comments on the proposed rule change from interested persons. 1 15 U.S.C. 78s(b)(1). 2 17 CFR 240.19b-4. I. Self-Regulatory Organization's Statement of the Terms of Substance of the Proposed Rule Change The PCX is proposing to decrease the exposure period in its Crossing Mechanism from ten seconds to three seconds. The text of the proposed rule change is available on the PCX's Web site ( *http://www.pacificex.com* ), at the PCX's Office of the Secretary, and at the Commission's Public Reference Room. II. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change In its filing with the Commission, the PCX included statements concerning the purpose of, and basis for, the proposed rule change and discussed any comments it received on the proposed rule change. The text of these statements may be examined at the places specified in Item IV below. The PCX has prepared summaries, set forth in Sections A, B, and C below, of the most significant aspects of such statements. A. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change 1. Purpose PCX rules provide that a PCX Broker may not facilitate orders or cross two orders, using the Crossing Mechanism of the PCX Plus System (“PCX Plus” or “System”), unless it enters into the System the terms of each order that is to be included as part of a Cross Order, 3 pursuant to PCX Rule 6.76(c)(2)(A). Both facilitation crosses and non-facilitation crosses are executed in the same manner in PCX Plus. Upon entry into PCX Plus, the System will evaluate the terms of the Cross Order and, after accepting the Cross Order, will execute the cross in accordance with PCX Rule 6.76(c)(2)(B). Among other conditions, Rule 6.76(c)(2)(B) requires a ten-second exposure period in which OTP Holders and OTP Firms may enter orders to trade against the side of the Cross Order that has been designated as the Exposed Order. 4 It is this portion of the Crossing Mechanism rule that the PCX proposes to change. The PCX believes that establishing a three-second exposure period within the PCX Plus Crossing Mechanism would be consistent with the three-second exposure period that was recently approved for use at the International Securities Exchange (“ISE”) in SR-ISE-2004-04. 5 3 *See* PCX Rule 6.76(c)(1)(A), which defines Cross Order for the purposes of PCX Rule 6.76(c) as “two orders with instructions to match the identified buy-side with the identified sell-side at a specified price (the “Cross Price”).” 4 *See* PCX Rule 6.76(c)(1)(D), which defines “Exposed Order” as follows: “the buy or sell side of a Cross Order that has been designated by a PCX Broker as the side to be exposed to the market and that is eligible for execution against all trading interest. Public Customer orders will always be deemed to be the Exposed Order in a Cross Order. In the case of a Cross Order involving a non-customer on both the buy side and sell side, the PCX Broker must designate one side of the Cross Order as the Exposed Order.” 5 *See* Securities Exchange Act Release No. 52711 (November 1, 2005), 70 FR 67508 (November 7, 2005) (order approving a reduction in the exposure time under ISE Rule 716). The Exchange proposes to shorten the duration of the exposure period contained in the rules governing the Crossing Mechanism, as set forth in PCX Rule 6.76(c)(2)(B)(i)(a) and PCX Rule 6.76(c)(2)(B)(ii)(b), 6 from ten seconds to three seconds. This shortened exposure period is fully consistent with the electronic nature of the System. All market participants on the PCX utilize electronic trading systems that monitor all updates to the PCX market, including changes resulting from orders being entered into the Crossing Mechanism, and can automatically respond based upon pre-set parameters. In this all-electronic environment, it is not necessary to provide an exposure time sufficiently long to permit a person to manually respond to an updated market in order to provide the opportunity for crowd interaction. Thus, an exposure period of three seconds will permit exposure of orders on the PCX in a manner consistent with the Exchange's electronic market. 6 PCX Rules 6.76(c)(2)(B)(i) and 6.76(c)(2)(B)(ii) govern the execution of Cross Orders when the Cross Price is between the Best Bid and Offer (“BBO”) and when it is at the BBO, respectively. By reducing the exposure period from ten seconds to three seconds the PCX believes that OTP Holders and OTP Firms will be able to provide liquidity to their customers' orders on a timelier basis, thus providing investors with more speedy executions. Timely and accurate executions are consistent with the principles under which PCX Plus was developed. Reducing the exposure period to three seconds will also allow the PCX to remain competitive with the ISE, which has already received approval to reduce its exposure period to three seconds. 2. Statutory Basis The basis under the Act for this proposed rule change is the requirement under Section 6(b)(5) 7 that an exchange have rules that are designed to foster cooperation and coordination with persons engaged in regulating, clearing, settling, processing information with respect to, and facilitating transactions in securities, to remove impediments to and perfect the mechanism of a free and open market and a national market system, and, in general, to protect investors and the public interest. In particular, the proposed rule change will provide investors with more timely execution of their options orders, while ensuring that there is an adequate exposure of all crossing orders in the PCX marketplace. 7 15 U.S.C. 78f(b)(5). B. Self-Regulatory Organization's Statement on Burden on Competition The proposed rule change does not impose any burden on competition that is not necessary or appropriate in furtherance of the purposes of the Act. C. Self-Regulatory Organization's Statement on Comments on the Proposed Rule Change Received From Members, Participants or Others The Exchange has not solicited, and does not intend to solicit, comments on this proposed rule change. The Exchange has not received any unsolicited written comments from members or other interested parties. III. Date of Effectiveness of the Proposed Rule Change and Timing for Commission Action Within 35 days of the date of publication of this notice in the **Federal Register** or within such longer period
(i)as the Commission may designate up to 90 days of such date if it finds such longer period to be appropriate and publishes its reasons for so finding or
(ii)as to which the PCX consents, the Commission will:
(A)By order approve such proposed rule change, or
(B)Institute proceedings to determine whether the proposed rule change should be disapproved. IV. Solicitation of Comments Interested persons are invited to submit written data, views, and arguments concerning the foregoing, including whether the proposed rule change is consistent with the Act. Comments may be submitted by any of the following methods: Electronic Comments • Use the Commission's Internet comment form ( *http://www.sec.gov/rules/sro.shtml* ); or • Send an e-mail to *rule-comments@sec.gov* . Please include File Number SR-PCX-2005-135 on the subject line. Paper Comments • Send paper comments in triplicate to Nancy M. Morris, Secretary, Securities and Exchange Commission, 100 F Street, NE., Washington, DC 20549-9303. All submissions should refer to File Number SR-PCX-2005-135. This file number should be included on the subject line if e-mail is used. To help the Commission process and review your comments more efficiently, please use only one method. The Commission will post all comments on the Commission's Internet Web site ( *http://www.sec.gov/rules/sro.shtml* ). Copies of the submission, all subsequent amendments, all written statements with respect to the proposed rule change that are filed with the Commission, and all written communications relating to the proposed rule change between the Commission and any person, other than those that may be withheld from the public in accordance with the provisions of 5 U.S.C. 552, will be available for inspection and copying in the Commission's Public Reference Room. Copies of such filing also will be available for inspection and copying at the principal office of the PCX. All comments received will be posted without change; the Commission does not edit personal identifying information from submissions. You should submit only information that you wish to make available publicly. All submissions should refer to File Number SR-PCX-2005-135 and should be submitted on or before February 13, 2006. 8 17 CFR 200.30-3(a)(12). For the Commission, by the Division of Market Regulation, pursuant to delegated authority. 8 Nancy M. Morris, Secretary. [FR Doc. E6-703 Filed 1-20-06; 8:45 am] BILLING CODE 8010-01-P SECURITIES AND EXCHANGE COMMISSION [Release No. 34-53115; File No. SR-Phlx-2005-82] Self-Regulatory Organizations; Philadelphia Stock Exchange, Inc.; Notice of Filing and Immediate Effectiveness of Proposed Rule Change and Amendment No. 1 Thereto Relating to its Dividend Spread Strategy Program License Fees January 13, 2006. Pursuant to Section 19(b)(1) of the Securities Exchange Act of 1934 (“Act”), 1 and Rule 19b-4 thereunder, 2 notice is hereby given that on December 14, 2005, the Philadelphia Stock Exchange, Inc. (“Phlx” or “Exchange”) filed with the Securities and Exchange Commission (“Commission”) the proposed rule change as described in Items I, II and III below, which items have been prepared by Phlx. On January 11, 2006, the Exchange filed Amendment No. 1 to the proposal. 3 Phlx has designated the proposed rule change as one establishing or changing a due, fee, or other charge, pursuant to Section 19(b)(3)(A)(ii) of the Act 4 and Rule 19b-4(f)(2) thereunder, 5 which renders the proposal effective upon filing with the Commission. The Commission is publishing this notice to solicit comments on the proposed rule change, as amended, from interested persons. 1 15 U.S.C. 78s(b)(1). 2 17 CFR 240.19b-4. 3 In Amendment No. 1, Phlx revised the proposed rule text and its discussion to clarify which products would be subject to the license fee, that the license fee is not subject to and does not count towards the fee cap, and that the proposed license fee is part of a pilot program due to expire on March 1, 2006. 4 15 U.S.C. 78s(b)(3)(A)(ii). 5 17 CFR 240.19b-4(f)(2). I. Self-Regulatory Organization's Statement of the Terms of Substance of the Proposed Rule Change Phlx proposes to amend its dividend spread strategy program in order to:
(i)Recapture license fees associated with certain equity option and index option contracts that carry a license fee and that are executed as part of a dividend spread strategy transaction, and
(ii)make minor technical changes to its fee schedule. The license fee proposal is scheduled to become effective for dividend strategy transactions settling on or after December 15, 2005, and it will remain in effect as a pilot program that is scheduled to expire on March 1, 2006. The text of the proposed rule change is available on Phlx's Web site at *http://www.phlx.com* , at the Office of the Secretary at Phlx, and at the Commission's Public Reference Room. II. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change In its filing with the Commission, the Exchange included statements concerning the purpose of, and basis for, the proposed rule change, as amended, and discussed any comments it received on the proposal. The text of these statements may be examined at the places specified in Item IV below. The Exchange has prepared summaries, set forth in Sections A, B, and C below, of the most significant aspects of such statements. A. Self-Regulatory Organization's Statement of the Purpose of, and Statutory Basis for, the Proposed Rule Change 1. Purpose Currently, the Exchange imposes a fee cap on equity option transaction and comparison charges for dividend spread strategy transactions 6 executed the day immediately prior to the ex-date 7 and occurring on the same trading day in the same options class. Specifically, Registered Options Traders' (“ROTs) and specialists' equity option transaction and comparison charges are capped at $1,750 for transactions effected pursuant to a dividend spread strategy when the declared dividend or distribution is $0.25 or greater. However, for dividend spread transactions for a security with a declared dividend or distribution of less than $0.25, the ROTs' and specialists' equity option transaction and comparison charges are capped at $1,000 for transactions effected pursuant to a dividend spread strategy executed on the same trading day in the same options class. The fee caps are implemented after any applicable rebates are applied to ROT and specialist equity option transaction and comparison charges. 8 6 A “dividend spread” is any trade done within a defined timeframe in which a dividend arbitrage can be achieved between any two
(2)deep-in-the-money options. 7 The ex-date is the date on or after which a security is traded without a previously declared dividend or distribution. After the ex-date a stock is said to trade ex-dividend. 8 Currently, the Exchange provides a rebate for certain contracts executed in connection with transactions occurring as part of a dividend spread strategy. Specifically, for those options contracts executed pursuant to a dividend spread strategy, the Exchange rebates $0.08 per contract side for ROT executions and $0.07 per side for specialist executions on the business day before the underlying stock's ex-date. The Exchange is now proposing to assess a license fee associated with certain equity option and index option contracts executed as part of a dividend spread strategy transaction. Specifically, the Exchange is proposing to assess a license fee of $0.05 per contract side for dividend spread strategy transactions in options on: Nasdaq-100 Index Tracking Stock SM 9 traded under the symbol QQQQ; Russell 1000 Growth iShares, traded under the symbol IWF; Russell 2000 iShares, traded under the symbol IWM; Russell 2000 Value iShares, traded under the symbol IWN; Russell 2000 Growth iShares, traded under the symbol IWO; Russell Midcap Growth iShares, traded under the symbol IWP; Russell Midcap Value iShares, traded under the symbol IWS; NYSE Composite Index, traded under the symbol NYC; NYSE U.S. 100 Index, traded under the symbol NY; Standard & Poor's Depositary Receipts, 10 Trust Series 1, traded under the symbol SPY; iShares Lehman 1-3 Year Treasury Bond Fund, traded under the symbol SHY; iShares Lehman 7-10 Year Treasury Bond Fund, traded under the symbol IEF; iShares Lehman 20+ Treasury Bond Fund, traded under the symbol TLT; iShares Lehman Aggregate Bond Fund, traded under the symbol AGG; iShares Lehman TIPS Bond Fund, traded under the symbol TIP; KBW Capital Markets Index, 11 traded under the symbol KSX; KBW Insurance Index, traded under the symbol KIX; Phlx/KBW Bank Index, traded under the symbol BKX; iShares S&P 100 Index, traded under the symbol OEF; iShares S&P Europe 350, traded under the symbol IEV; iShares S&P Global 100 Index, traded under the symbol IOO; iShares S&P Global Energy Sector Index, traded under the symbol IXC; iShares S&P Global Financial Sector Index, traded under the symbol IXG; iShares S&P Global Healthcare Sector Index, traded under the symbol IXJ; iShares S&P Global Information Technology Sector Index, traded under the symbol IXN; iShares S&P Global Telecom Sector Index, traded under the symbol IXP; iShares S&P Latin America 40, traded under the symbol ILF; iShares S&P MidCap 400, traded under the symbol IJH; iShares S&P SmallCap 600, traded under the symbol IJR; iShares S&P TOPIX 150, traded under the symbol ITF; iShares S&P 500, traded under the symbol IVV; S&P Industrial Select Sector SPDR, traded under the symbol XLI; S&P Technology Select Sector SPDR, traded under the symbol XLK; S&P Utilities Select Sector SPDR, traded under the symbol XLU; S&P Consumer Staples Select Sector SPDR, traded under the symbol XLP; S&P Energy Select Sector SPDR, traded under the symbol XLE; S&P Financial Select Sector SPDR, traded under the symbol XLF; S&P Health Care Select Sector SPDR, traded under the symbol XLV; S&P Materials Select Sector SPDR, traded under the symbol XLB; S&P Consumer Discretionary Select Sector SPDR, traded under the symbol XLY; MidCap SPDR, traded under the symbol MDY; Keefe, Bruyette & Woods Regional Banking Index or the KBW Regional Banking Index, traded under the symbol KRX; and Keefe, Bruyette & Woods Mortgage Finance Index or the KBW Mortgage Finance Index, traded under the symbol MFX. 9 The Nasdaq-100®, Nasdaq-100 Index®, Nasdaq®, The Nasdaq Stock Market®, Nasdaq-100 Shares SM , Nasdaq-100 Trust SM , Nasdaq-100 Index Tracking Stock SM , and QQQ SM are trademarks or service marks of The Nasdaq Stock Market, Inc. (“Nasdaq”) and have been licensed for use for certain purposes by the Phlx pursuant to a License Agreement with Nasdaq. The Nasdaq-100 Index® (the “Index”) is determined, composed, and calculated by Nasdaq without regard to the licensee, the Nasdaq-100 Trust SM , or the beneficial owners of Nasdaq-100 Shares SM . Nasdaq has complete control and sole discretion in determining, comprising, or calculating the Index or in modifying in any way its method for determining, comprising, or calculating the Index in the future. 10 Standard & Poor's®,” “S&P®,” “S&P 500®,” “Standard & Poor's 500®,” “Standard & Poor's Depositary Receipts®,” and “500” are trademarks of The McGraw-Hill Companies, Inc., and have been licensed for use by the Phlx in connection with the listing and trading of SPDRs on the Phlx. These products are not sponsored, sold or endorsed by S&P, a division of The McGraw-Hill Companies, Inc., and S&P makes no representation regarding the advisability of investing SPDRs. 11 “KBW,” “Keefe, Bruyette & Woods Capital Markets Index,” and “KBW Capital Markets Index” are trademarks of Keefe, Bruyette & Woods, Inc. and have been licensed for use by the Phlx. Keefe, Bruyette & Woods, Inc. makes no recommendations concerning the advisability of investing in options based on the KBW Capital Markets Index. The license fee of $0.05 per contract side will be assessed on every transaction and will not be subject to the $1,750 or $1,000 caps described above. Thus, this fee will be assessed in addition to any other transaction and comparison charges associated with dividend spread strategy transactions, and it will not count towards reaching the $1,750 or $1,000 caps. The license fee proposal is scheduled to become effective for dividend strategy transactions settling on or after December 15, 2005, and it will remain in effect as a pilot program that is scheduled to expire on March 1, 2006. The purpose of this proposal is to recoup the license fees owed in connection with the trading of the products listed above. Even with the assessment of the $0.05 license fee per contract side, Phlx believes that the fee caps and rebates should continue to encourage specialists and ROTs to provide liquidity for dividend spread strategy transactions. The Exchange is also proposing to add a “Q” to the trading symbol “QQQ” on its $60,000 “Firm Related” Equity Option and Index Option Cap Fee Schedule to reflect the current trading symbol of the Nasdaq-100 Index Tracking Stock sm . In addition, the Exchange proposes to delete WellSpring Bio-Clinical Trials Index from the $60,000 “Firm Related” Equity Option and Index Option Cap Fee Schedule, traded under the symbol WHC, 12 as that product is no longer listed or traded at the Exchange. 12 WellSpring Bio-Clinical Trials Index (“WHC”), “ORCHIDs,” and “WellSpring” are trademarks of WellSpring BioCapital Partners, LLC (“WellSpring LLC”) and have been licensed for use by the Phlx. WellSpring LLC makes no recommendations concerning the advisability of investing in options based on the WellSpring Bio-Clinical Trials Index. 2. Statutory Basis The Exchange believes that its proposal to amend its schedule of fees is consistent with Section 6(b) of the Act 13 in general, and furthers the objectives of Section 6(b)(4) of the Act 14 in particular, in that it is an equitable allocation of reasonable dues, fees, and other charges among its members and issuers and other persons using its facilities. 13 15 U.S.C. 78f(b). 14 15 U.S.C. 78f(b)(4). B. Self-Regulatory Organization's Statement on Burden on Competition The Exchange does not believe that the proposed rule change, as amended, will impose any burden on competition that is not necessary or appropriate in furtherance of the purposes of the Act. C. Self-Regulatory Organization's Statement on Comments on the Proposed Rule Change Received From Members, Participants, or Others No written comments were solicited or received on the proposed rule change, as amended. III. Date of Effectiveness of the Proposed Rule Change and Timing for Commission Action The foregoing rule change has become effective pursuant to Section 19(b)(3)(A)(ii) of the Act 15 and subparagraph (f)(2) of Rule 19b-4 thereunder 16 because it establishes or changes a due, fee, or other charge. At any time within 60 days of the filing of the proposed rule change, the Commission may summarily abrogate such rule change if it appears to the Commission that such action is necessary or appropriate in the public interest, for the protection of investors, or otherwise in furtherance of the purposes of the Act. 17 15 15 U.S.C. 78s(b)(3)(A)(ii). 16 17 CFR 240.19b-4(f)(2). 17 The effective date of the original proposed rule change is December 14, 2005, the date of the original filing, and the effective date of Amendment No.1 is January 11, 2006, the filing date of the amendment. For purposes of calculating the 60-day abrogation period within which the Commission may summarily abrogate the proposed rule change, as amended, under Section 19(b)(3)(C) of the Act, the Commission considers the period to commence on January 11, 2006, the date on which the Exchange submitted Amendment No. 1. See 15 U.S.C. 78s(b)(3)(C). IV. Solicitation of Comments Interested persons are invited to submit written data, views, and arguments concerning the foregoing, including whether the proposed rule change, as amended, is consistent with the Act. Comments may be submitted by any of the following methods: Electronic Comments • Use the Commission's Internet comment form ( *http://www.sec.gov/rules/sro.shtml* ); or • Send an e-mail to *rule-comments@sec.gov.* Please include File Number SR-Phlx-2005-82 on the subject line. Paper Comments • Send paper comments in triplicate to Nancy M. Morris, Secretary, Securities and Exchange Commission, 100 F Street, NE., Washington, DC 20549-9303. All submissions should refer to File Number SR-Phlx-2005-82. This file number should be included on the subject line if e-mail is used. To help the Commission process and review your comments more efficiently, please use only one method. The Commission will post all comments on the Commission's Internet Web site ( *http://www.sec.gov/rules/sro.shtml* ). Copies of the submission, all subsequent amendments, all written statements with respect to the proposed rule change that are filed with the Commission, and all written communications relating to the proposed rule change between the Commission and any person, other than those that may be withheld from the public in accordance with the provisions of 5 U.S.C. 552, will be available for inspection and copying in the Commission's Public Reference Room. Copies of such filing also will be available for inspection and copying at the principal office of Phlx. All comments received will be posted without change; the Commission does not edit personal identifying information from submissions. You should submit only information that you wish to make available publicly. All submissions should refer to File Number SR-Phlx-2005-82 and should be submitted on or before February 13, 2006. 18 17 CFR 200.30-3(a)(12). For the Commission, by the Division of Market Regulation, pursuant to delegated authority. 18 Nancy M. Morris, Secretary. [FR Doc. E6-699 Filed 1-20-06; 8:45 am] BILLING CODE 8010-01-P DEPARTMENT OF STATE [Public Notice 5279] Request for Nominations for the General Advisory Committee and the Scientific Advisory Subcommittee to the United States Section to the Inter-American Tropical Tuna Commission SUMMARY: The Department of State is seeking applications and nominations for the renewal of the General Advisory Committee to the Inter-American Tropical Tuna Commission (IATTC) as well as to a Scientific Advisory Subcommittee of the General Advisory Committee. The purpose of the General Advisory Committee and the Scientific Advisory Subcommittee is to provide public input and advice to the United States Section to the IATTC in the formulation of U.S. policy and positions at meetings of the IATTC and its subsidiary bodies. The Scientific Advisory Subcommittee shall also function as the National Scientific Advisory Committee (NATSAC) provided for in the Agreement on the International Dolphin Conservation Program (AIDCP). The United States Section to the IATTC is composed of the Commissioners to the IATTC, appointed by the President, and the Deputy Assistant Secretary of State for Oceans and Fisheries or his or her designated representative. Authority to establish the General Advisory Committee and Scientific Advisory Subcommittee is provided under the Tuna Conventions Act of 1950, as amended by the International Dolphin Conservation Program Act (IDCPA) of 1997. DATES: Nominations must be submitted on or before March 31, 2006. ADDRESSES: Nominations should be submitted to David Balton, Deputy Assistant Secretary for Oceans and Fisheries, Bureau of Oceans and International Environmental and Scientific Affairs, Room 7831, Department of State, Washington, DC 20520-7818; or by fax to 202-736-7350. FOR FURTHER INFORMATION CONTACT: David Hogan, Office of Marine Conservation, Department of State: 202-647-2335. SUPPLEMENTARY INFORMATION: General Advisory Committee The Tuna Conventions Act (16 U.S.C. 951 et seq.), as amended by the IDCPA (Pub. L. 105-42), provides that the Secretary of State, in consultation with the U.S. Commissioners to the IATTC, shall appoint a General Advisory Committee (the Committee) to the U.S. Section to the IATTC (U.S. Section). The Committee shall be composed of not less than 5 nor more than 15 persons, with balanced representation from the various groups participating in the fisheries included under the IATTC Convention, and from non-governmental conservation organizations. Members of the Committee shall be invited to have representatives attend all non-executive meetings of the U.S. Section, and shall be given full opportunity to examine and to be heard on all proposed programs of investigations, reports, recommendations, and regulations adopted by the Commission. Members of the Committee may attend meetings of the IATTC and the AIDCP as members of the U.S. delegation or otherwise in accordance with the rules of those bodies governing such participation. Participation as a member of the U.S. delegation shall be subject to such conditions as may be placed on the size or composition of the delegation. Scientific Advisory Subcommittee The Act, as amended, also provides that the Secretary of State, in consultation with the U.S. Commissioners to the IATTC, shall appoint a Scientific Advisory Subcommittee (the Subcommittee) of the General Advisory Committee. The Subcommittee shall be composed of not less than 5 and not more than 15 qualified scientists with balanced representation from the public and private sectors, including non-governmental conservation organizations. The Subcommittee shall advise the Committee and the U.S. Section on matters including: The conservation of ecosystems; the sustainable uses of living marine resources related to the tuna fishery in the eastern Pacific Ocean; and the long-term conservation and management of stocks of living marine resources in the eastern tropical Pacific Ocean. In addition, at the request of the Committee, the U.S. Commissioners or the Secretary of State, the Subcommittee shall perform such functions and provide such assistance as may be required by formal agreements entered into by the United States for the eastern Pacific tuna fishery, including the AIDCP. The functions may include: The review of data from the International Dolphin Conservation Program (IDCP), including data received from the IATTC staff; recommendations on research needs and the coordination and facilitation of such research; recommendations on scientific reviews and assessments required under the IDCP; recommendations with respect to measures to assure the regular and timely full exchange of data among the Parties to the AIDCP and each nation's NATSAC (or its equivalent); and consulting with other experts as needed. The Subcommittee shall be invited to have representatives attend all non-executive meetings of the U.S. Section and the General Advisory Committee and shall be given full opportunity to examine and to be heard on all proposed programs of scientific investigation, scientific reports, and scientific recommendations of the Commission. Representatives of the Subcommittee may attend meetings of the IATTC and the AIDCP as members of the U.S. delegation or otherwise in accordance with the rules of those bodies governing such participation. Participation as a member of the U.S. delegation shall be subject to such limits as may be placed on the size of the delegation. National Scientific Advisory Committee The Scientific Advisory Subcommittee shall also function as the NATSAC established pursuant to Article IX of the AIDCP. In this regard, the Subcommittee shall perform the functions of the NATSAC as specified in Annex VI of the AIDCP including, but not limited to: Receiving and reviewing relevant data, including data provided to the National Marine Fisheries Service
(NMFS)by the IATTC Staff; advising and recommending to the U.S. Government measures and actions that should be undertaken to conserve and manage stocks of living marine resources in the AIDCP Area; making recommendations to the U.S. Government regarding research needs related to the eastern Pacific Ocean tuna purse seine fishery; promoting the regular and timely full exchange of data among the Parties on a variety of matters related to the implementation of the AIDCP; and consulting with other experts as necessary in order to achieve the objectives of the Agreement. General Provisions Each appointed member of the Committee and the Subcommittee/NATSAC shall be appointed for a term of 3 years and may be reappointed. Logistical and administrative support for the operation of the Committee and the Subcommittee will be provided by the Department of State, Bureau of Oceans and International Environmental and Scientific Affairs, and by the Department of Commerce, National Marine Fisheries Service. Members shall receive no compensation for their service on either the Committee or the Subcommittee/NATSAC, nor will members be compensated for travel or other expenses associated with their participation. Procedures for Submitting Applications/Nominations Applications/nominations for the General Advisory Committee and the Scientific Advisory Subcommittee/NATSAC should be submitted to the Department of State (See ADDRESSES ). Such applications/nominations should include the following information:
(1)Full name/address/phone/fax and e-mail of applicant/nominee;
(2)Whether applying/nominating for the General Advisory Committee or the Scientific Advisory Committee/NATSAC (applicants may specify both);
(3)Applicant/nominee's organization or professional affiliation serving as the basis for the application/nomination;
(4)Background statement describing the applicant/nominee's qualifications and experience, especially as related to the tuna purse seine fishery in the eastern Pacific Ocean or other factors relevant to the implementation of the Convention Establishing the IATTC or the Agreement on the International Dolphin Conservation Program;
(5)A written statement from the applicant/nominee of intent to participate actively and in good faith in the meetings and activities of the General Advisory Committee and/or the Scientific Advisory Subcommittee/NATSAC. Applicants/nominees who submitted material in response to the **Federal Register** Notice published by the National Marine Fisheries Service on November 12, 2002 or February 5, 2003, should resubmit their applications pursuant to this notice. Margaret F. Hayes, Acting Deputy Assistant Secretary for Oceans and Fisheries, Department of State. [FR Doc. E6-714 Filed 1-20-06; 8:45 am] BILLING CODE 4710-09-P DEPARTMENT OF TRANSPORTATION Federal Aviation Administration [Summary Notice No. PE-2006-02] Petitions for Exemption; Summary of Petitions Received AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice of petitions for exemption received. SUMMARY: Pursuant to FAA's rulemaking provisions governing the application, processing, and disposition of petitions for exemption part 11 of Title 14, Code of Federal Regulations (14 CFR), this notice contains a summary of certain petitions seeking relief from specified requirements of 14 CFR. The purpose of this notice is to improve the public's awareness of, and participation in, this aspect of FAA's regulatory activities. Neither publication of this notice nor the inclusion or omission of information in the summary is intended to affect the legal status of any petition or its final disposition. DATES: Comments on petitions received must identify the petition docket number involved and must be received on or before February 13, 2006. ADDRESSES: You may submit comments [identified by DOT DMS Docket Number FAA-2005-23188] by any of the following methods: • Web Site: *http://dms.dot.gov.* Follow the instructions for submitting comments on the DOT electronic docket site. • Fax: 1-202-493-2251. • Mail: Docket Management Facility; U.S. Department of Transportation, 400 Seventh Street, SW., Nassif Building, Room PL-401, Washington, DC 20590-0001. • Hand Delivery: Room PL-401 on the plaza level of the Nassif Building, 400 Seventh Street, SW., Washington, DC, between 9 a.m. and 5 p.m., Monday through Friday, except Federal Holidays. *Docket:* For access to the docket to read background documents or comments received, go to *http://dms.dot.gov* at any time or to Room PL-401 on the plaza level of the Nassif Building, 400 Seventh Street, SW., Washington, DC, between 9 a.m. and 5 p.m., Monday through Friday, except Federal holidays. FOR FURTHER INFORMATION CONTACT: Kenna Sinclair (425-227-1556), Transport Airplane Directorate (ANM-113), Federal Aviation Administration, 1601 Lind Ave. SW., Renton, WA 98055-4056; or John Linsenmeyer (202-267-5174), Office of Rulemaking (ARM-1), Federal Aviation Administration, 800 Independence Avenue, SW., Washington, DC 20591. This notice is published pursuant to 14 CFR 11.85 and 11.91. Issued in Washington, DC, on January 13, 2006. Anthony F. Fazio, Director, Office of Rulemaking. Petitions for Exemption *Docket No.:* FAA-2005-23188. *Petitioner:* The Boeing Company. *Section of 14 CFR Affected:* 14 CFR 25.857(e). *Description of Relief Sought:* To permit the carriage of up to six supernumeraries on Boeing Model 767-200 tanker transport airplanes with a Class E main deck cargo compartment. [FR Doc. E6-656 Filed 1-20-06; 8:45 am] BILLING CODE 4910-13-P DEPARTMENT OF TRANSPORTATION Federal Transit Administration Draft Environmental Impact Statement (DEIS): Kenosha-Racine-Milwaukee Commuter Rail Extension AGENCY: Federal Transit Administration (FTA), Department of Transportation (DOT). ACTION: Notice of intent to prepare an Environmental Impact Statement. SUMMARY: The FTA, in cooperation with the Southeastern Wisconsin Regional Planning Commission (SEWRPC), is issuing this notice to advise the public that a Draft Environmental Impact Statement
(DEIS)will be prepared for the proposed initiation of commuter rail or bus services between Kenosha, Racine and Milwaukee, Wisconsin. The FTA is the lead Federal agency under the National Environmental Policy Act of 1969 (NEPA). The project is being conducted by SEWRPC which is acting as the manager and fiscal agent for the DEIS and associated alternatives analysis study on behalf of an Intergovernmental Partnership of the Cities and Counties of Kenosha, Milwaukee, and Racine, and the Wisconsin Department of Transportation, and SEWRPC. The FTA and SEWRPC invite interested individuals, organizations, and Federal, State, and local agencies to participate in refining the alternatives to be evaluated and identifying any significant social, economic, and environmental issues related to the alternatives. Comments on the appropriateness of the alternatives and impact-related issues are encouraged. Specific suggestions on additional alternatives to be examined and issues to be addressed are welcomed and will be considered in the final study scope. Scoping of these alternatives and their potential impacts will be accomplished through meetings and correspondence with interested persons, organizations, and Federal, State, regional, and local agencies. DATES: There will be three public scoping meetings held on Tuesday, February 21, 2006, Wednesday, February 22, 2006, and Thursday, February 23, 2006 and one interagency scoping meeting held on Thursday, February 23, 2006 at the locations and times identified below under ADDRESSES to ensure that all significant issues are identified and considered. SEWRPC representatives will be available for informal questions and comments throughout the duration of each scoping meeting. Subsequent opportunities for public involvement will be announced by mail and through other appropriate mechanisms, and will be conducted throughout the study area. ADDRESSES: The public scoping meetings will be held on the following dates at the following locations and times: • Tuesday, February 21, 2006—Kenosha Gateway Technical College, Madrigrano Auditorium, 3520 30th Avenue, Kenosha, Wisconsin from 6 p.m. to 8 p.m. Presentation at 6:45 p.m. • Wednesday, February 22, 2006—Racine Gateway Technical College, Great Lakes Room, Racine Building, 901 Pershing Drive, Racine, Wisconsin from 6 p.m. to 8 p.m. Presentation at 6:45 p.m. • Thursday, February 23, 2006—Milwaukee Downtown Transit Center, Harbor Lights Room, 909 E. Michigan Avenue, Milwaukee, Wisconsin from 6 p.m. to 8 p.m. Presentation at 6:45 p.m. The interagency scoping meeting will be held at the following location and time: • Thursday, February 23, 2006—Milwaukee Downtown Transit Center, Harbor Lights Room, 909 E. Michigan Avenue, Milwaukee, Wisconsin from 2 p.m. to 4 p.m. The scoping meeting sites are accessible to mobility-impaired people and interpreter services will be provided for hearing-impaired people upon request. Written comments will be taken at the meeting or may be sent to Mr. Kenneth R. Yunker, Deputy Director, Southeastern Wisconsin Regional Planning Commission, P.O. Box 1607, Waukesha, Wisconsin, 53187-1607 by March 24, 2006. A scoping information packet will be available and may be requested by writing to this address or by calling
(262)547-6721. To ensure that the full range of issues related to this proposed action are addressed and all significant issues are identified, comments and suggestions are invited from all interested parties. Comments on the scope of this proposed action and the impacts to be considered should be directed to the Southeastern Wisconsin Regional Planning Commission at the address provided above by March 24, 2006. Information describing the proposed action and soliciting comments will be sent to appropriate Federal, State, and local agencies and to private organizations and citizens who have previously expressed, or are known to have interest in this proposal. A series of public meetings will be held in the project corridor throughout the data gathering and development of alternatives. In addition, a public hearing will be held. Public notice will be given of the time and place of additional meetings and of the hearing. The DEIS will be available for public and agency review and comment prior to the hearing. As part of the scoping process, coordination activities with other agencies have begun. Scoping meetings will be held on an individual or group meeting basis. Agency coordination will be accomplished during these meetings. FOR FURTHER INFORMATION CONTACT: Mr. Victor M. Austin, Community Planner, Federal Transit Administration, 200 W. Adams Street, Suite 320, Chicago, Illinois, 60606-5232, telephone:
(312)886-1625. You may also contact Mr. Kenneth R. Yunker, Deputy Director, SEWRPC, P.O. Box 1607, Waukesha, Wisconsin 53187-1607;
(262)547-6721. SUPPLEMENTARY INFORMATION: Over the past decade a very high level of interest has developed in the Kenosha-Racine-Milwaukee
(KRM)corridor for improved commuter transportation service. This interest has been manifested by the creation of groups involving major employers and municipalities and counties within the corridor which have as their objective the improvement of transit service within the corridor. At the request of the local units of government, the Southeastern Wisconsin Regional Planning Commission (SEWRPC), the Metropolitan Planning Organization
(MPO)for the seven-county Southeastern Wisconsin region, has completed two studies which focus on transit improvements throughout the KRM corridor. On behalf of an intergovernmental partnership of the counties and cities of Kenosha, Racine and Milwaukee, the Wisconsin Department of Transportation (WisDOT) and SEWRPC, SEWRPC is undertaking the DEIS and Project Development phase of the KRM Alternatives Analysis in order to produce a Draft Environmental Impact Statement (DEIS), refine the previous alternatives analysis, and develop further a commuter transportation project within the corridor. This study is funded by the Federal Transit Administration
(FTA)Section 5309 “New Starts” program, WisDOT, and the members of the KRM Intergovernmental Partnership. The products of this study will be used to support an application to the FTA for funding of Preliminary Engineering
(PE)under the FTA's New Starts program. I. Study Area and Project Need The study area extends from the City of Kenosha through the City of Racine to the City of Milwaukee and is located along State Trunk Highways 31 and 32 and the Union Pacific Railroad Kenosha Subdivision, a distance of about 33 miles. The study area is bounded by Lake Michigan on the east, Interstate Highway 94 on the west, the Wisconsin-Illinois state line on the south, and the Milwaukee Central Business District on the north. The study area includes the eastern portions of Kenosha and Racine Counties and Milwaukee County. In the KRM corridor increasing travel demand and traffic congestion are a problem and there exists a need to improve mobility within this corridor. There is a lack of transportation options for travel between the communities in the corridor, as well as for travel between the corridor and northeastern Illinois. This lack of options affects the mobility of residents and visitors and their ability to travel within the corridor. Persons with limited or no access to private automobiles are particularly limited in their options. Existing transit services do operate within the corridor, but consist largely of separate local systems with services that are slow, operate only in a limited service area, are not coordinated throughout the corridor, do not connect in a convenient manner, and provide limited service. In particular, accessibility to jobs for people within the corridor and accessibility to potential workers for employers within the corridor is affected by this lack of transportation options. The KRM corridor is part of a larger continuous and highly urbanized corridor extending 85 miles from Milwaukee in southeastern Wisconsin to Chicago through the North Shore suburbs in Lake and Cook Counties in northeastern Illinois. There is a need for public transit connections within this corridor in southeastern Wisconsin, and between southeastern Wisconsin and northeastern Illinois, to serve the travel needs and markets that exist in this unique corridor. These needs not only include travel to and from Milwaukee, Chicago, and the two intermediate central cities of Kenosha and Racine, each with a population in excess of 50,000; but also travel to and from the older, inner-ring suburbs and the newer developing suburban communities. Specifically, there is a need to provide access to jobs not only in the Milwaukee and Chicago central business districts, but also in Racine and Kenosha, the older inner-ring and newer suburban communities in southeastern Wisconsin, and the Chicago North Shore communities in Cook and Lake Counties. The corridor has a high potential to generate transit ridership because of its high concentrations of population, including population groups with high transit needs, significant employment, and it includes the downtown areas of three large and well established cities (Milwaukee, Racine, and Kenosha). Arterial street and highway capacity is limited, traffic volumes and congestion are a problem and will continue to grow, and opportunities for new highways are extremely limited, providing an opportunity for an attractive and high-quality transit service in the corridor to be competitive with the private automobile in terms of travel time, cost, and convenience. There is a need to contribute to desirable economic and community development in the KRM corridor. High quality and attractive transit service that is appropriate to the travel needs of a densely developed urban corridor such as this one can help meet regional, state, and national land use objectives through influence on, and promotion of, land development and redevelopment in an efficient, desirable, and sound manner. The provision of attractive and improved transit services and facilities can help focus desirable and positive land use development and redevelopment in the older major cities such as Kenosha, Milwaukee, and Racine, in the older suburban communities such as Cudahy, St. Francis, and South Milwaukee, and in the newer developing communities such as Caledonia, Oak Creek, and Somers. The primary goals of these transportation improvements are to: • Improve transit mobility and access in the KRM corridor. • Attract increased transit ridership. • Contribute to and enhance desirable economic and community development. II. Alternatives The DEIS will assess the environmental impacts of a No-Build Alternative and various Build Alternatives. The Build Alternatives will include, but not be limited to a
(1)Transportation System Management
(TSM)Alternative,
(2)a Bus Rapid Transit
(BRT)Alternative, and
(3)a Commuter Rail Alternative. These alternatives are briefly described below. The No-Build Alternative will include existing transit services and facilities and those planned and programmed new transportation services, facilities, and system management improvements that are included in the 2035 Regional Transportation System Plan for Southeastern Wisconsin. The TSM Alternative will include operational and low cost capital investments to the existing transit services in the corridor, providing a level of capital investment that is greater than the No-Build Alternative but substantially less than either the BRT or Commuter Rail Alternatives. The TSM Alternative will not include major fixed guideway improvements. The BRT Alternative will include a significant expansion of bus service between Kenosha, Racine, and Milwaukee that will be coordinated with the existing Metra Union Pacific North Line commuter rail service between Kenosha and Chicago. It will utilize operational and performance enhancements along the entire corridor such as exclusive or semi-exclusive route alignments, on-line passenger stations, compatible vehicles appropriate for such service, and operating measures to mitigate traffic capacity and congestion constraints. One variation of this alternative will include low to medium cost capital improvements and another variation will include medium to high cost capital improvements. The Commuter Rail Alternative will include the provision of commuter rail service between Kenosha, Racine, and Milwaukee. One variation of this alternative will include a through service combined with the existing Metra Union Pacific North Line commuter rail service between Kenosha and Chicago. Another variation of this alternative will include a separate but coordinated service requiring a cross-platform transfer to and from the Metra Union Pacific North Line commuter rail service. In addition to these initially identified alternatives, other alternatives generated by the scoping process may be considered. The proposed action may include expansion of commuter rail or bus service in the corridor and modifications to existing transit services. It may include modifications or additions of sidings, crossovers, interlockings, signal systems, and retaining walls for potential commuter rail services and bus lanes and roadways, highway improvements, and signal systems for potential bus services. Modifications to existing stations may be required such as changes to station buildings, parking, and platform placement. Additional stations located along the potential rail and bus routes will also be investigated. Property acquisitions may be necessary to accommodate the proposed action, as well as utility relocations. III. Potential Social and Environmental Effects Potential social, economic, and environmental impacts will be identified and evaluated in the DEIS. Impacts may include: Mobility and accessibility; land use, zoning, and economic development, land acquisition, displacements, and relocation of existing uses; historic and archeological resources; parklands and recreational uses; visual and aesthetic qualities; neighborhoods and communities; environmental justice; air quality; noise and vibration; hazardous materials; ecosystems; water resources; energy and construction impacts; safety and security; utilities; cost and financial impacts; and transit, highway, railroad, and other transportation. Other potential impact issues may be added as a result of scoping and agency coordination efforts. The potential impact assessment and evaluation will take into account both positive and negative effects, direct and indirect impacts, short-term (construction) and long-term impacts, and cumulative effects. Measures to avoid or mitigate any significant adverse impacts will be identified. IV. FTA Procedures In accordance with FTA policy, all federal laws, regulations and executive orders affecting project development, including but not limited to the regulations of the Council on Environmental Quality (40 CFR parts 1500-1508 and 23 CFR part 771), the 1990 Clean Air Act Amendments, Section 404 of the Clean Water Act, Executive Order 12898 regarding environmental justice, the National Historic Preservation Act, the Endangered Species Act, and Section 4(f) of the Department of Transportation Act, will be addressed to the maximum extent possible during the NEPA process. A DEIS will be prepared and made available for public and agency review and comment. One or more public hearings will be held on the DEIS. On the basis of the DEIS and the public and agency comments received, the preferred alternative will be further refined as necessary and the Final Environmental Impact Statement will be prepared. Issued on: January 17, 2006. Donald Gismondi, Acting Regional Administrator, Federal Transit Administration, Chicago, Illinois. [FR Doc. E6-657 Filed 1-20-06; 8:45 am] BILLING CODE 4910-57-P DEPARTMENT OF TRANSPORTATION National Highway Traffic Safety Administration [Docket No. NHTSA-2006-23570] Decision That Certain Nonconforming Motor Vehicles Are Eligible for Importation AGENCY: National Highway Traffic Safety Administration (NHTSA), DOT. ACTION: Notice of decision by NHTSA that certain nonconforming motor vehicles are eligible for importation. SUMMARY: This document announces decisions by NHTSA that certain motor vehicles not originally manufactured to comply with all applicable Federal motor vehicle safety standards are eligible for importation into the United States because they are substantially similar to vehicles originally manufactured for importation into and/or sale in the United States and certified by their manufacturers as complying with the safety standards, and they are capable of being readily altered to conform to the standards. DATES: These decisions became effective on the dates specified in Annex A. FOR FURTHER INFORMATION CONTACT: Coleman Sachs, Office of Vehicle Safety Compliance, NHTSA (202-366-3151). SUPPLEMENTARY INFORMATION: Background Under 49 U.S.C. 30141(a)(1)(A), a motor vehicle that was not originally manufactured to conform to all applicable Federal motor vehicle safety standards shall be refused admission into the United States unless NHTSA has decided that the motor vehicle is substantially similar to a motor vehicle originally manufactured for importation into and sale in the United States, certified under 49 U.S.C. 30115, and of the same model year as the model of the motor vehicle to be compared, and is capable of being readily altered to conform to all applicable Federal motor vehicle safety standards. Petitions for eligibility decisions may be submitted by either manufacturers or importers who have registered with NHTSA pursuant to 49 CFR part 592. As specified in 49 CFR 593.7, NHTSA publishes notice in the **Federal Register** of each petition that it receives, and affords interested persons an opportunity to comment on the petition. At the close of the comment period, NHTSA decides, on the basis of the petition and any comments that it has received, whether the vehicle is eligible for importation. The agency then publishes this decision in the **Federal Register** . NHTSA received petitions from registered importers to decide whether the vehicles listed in Annex A to this notice are eligible for importation into the United States. To afford an opportunity for public comment, NHTSA published notice of these petitions as specified in Annex A. The reader is referred to those notices for a thorough description of the petitions. No substantive comments were received in response to these notices. Based on its review of the information submitted by the petitioners, NHTSA has decided to grant the petitions. Vehicle Eligibility Number for Subject Vehicles The importer of a vehicle admissible under any final decision must indicate on the form HS-7 accompanying entry the appropriate vehicle eligibility number indicating that the vehicle is eligible for entry. Vehicle eligibility numbers assigned to vehicles admissible under this decision are specified in Annex A. Final Decision Accordingly, on the basis of the foregoing, NHTSA hereby decides that each motor vehicle listed in Annex A to this notice, which was not originally manufactured to comply with all applicable Federal motor vehicle safety standards, is substantially similar to a motor vehicle manufactured for importation into and/or sale in the United States, and certified under 49 U.S.C. 30115, as specified in Annex A, and is capable of being readily altered to conform to all applicable Federal motor vehicle safety standards. Authority: 49 U.S.C. 30141(a)(1)(A), (a)(1)(B) and (b)(1); 49 CFR 593.8; delegations of authority at 49 CFR 1.50 and 501.8. Claude H. Harris, Director, Office of Vehicle Safety Compliance. Annex A—Nonconforming Motor Vehicles Decided To Be Eligible for Importation 1. Docket No. NHTSA-2005-21844. *Nonconforming Vehicles:* 2003-2005 Mercedes Benz SL Class
(230)European Market Passenger Cars. *Substantially Similar:* U.S.-Certified Vehicles: 2003-2005 Mercedes Benz SL Class
(230)European Market Passenger Cars. *Notice of Petition:* Published at: 70 FR 41477 (July 19, 2005). *Vehicle Eligibility Number:* VSP-470 (effective date August 30, 2005). 2. Docket No. NHTSA-2005-22019. *Nonconforming Vehicles:* 1997 Ford Mustang Passenger Cars. *Substantially Similar:* U.S.-Certified Vehicles: 1997 Ford Mustang Passenger Cars. *Notice of Petition:* Published at: 70 FR 45485 (August 5, 2005). *Vehicle Eligibility Number:* VSP-471 (effective date September 15, 2005). 3. Docket No. NHTSA-2005-22003. *Nonconforming Vehicles:* 2005 Harley Davidson FX, FL, and XL Motorcycles. *Substantially Similar:* U.S.-Certified Vehicles: 2005 Harley Davidson FX, FL, and XL Motorcycles. *Notice of Petition:* Published at: 70 FR 45484 (August 5, 2005). *Vehicle Eligibility Number:* VSP-472 (effective date September 15, 2005). 4. Docket No. NHTSA-2005-22644. *Nonconforming Vehicles:* 2001 Bentley Arnage Passenger Cars, Manufactured From January 1, 2001, Through December 31, 2001. *Substantially Similar:* U.S.-Certified Vehicles: 2001 Bentley Arnage Passenger Cars, Manufactured From January 1, 2001, Through December 31, 2001. *Notice of Petition:* Published at: 70 FR 60878 (October 19, 2005). *Vehicle Eligibility Number:* VSP-473 (effective date December 5, 2005). 5. Docket No. NHTSA-2005-22797. *Nonconforming Vehicles:* 1999-2005 Ducati ST4s Motorcycles. *Substantially Similar:* U.S.-Certified Vehicles: 1999-2005 Ducati ST4s Motorcycles. *Notice of Petition:* Published at: 70 FR 62369 (October 31, 2005). *Vehicle Eligibility Number:* VSP-474 (effective date December 12, 2005). 6. Docket No. NHTSA-2005-22847. *Nonconforming Vehicles:* 1999-2001 Ducati 996 Biposto Motorcycles. *Substantially Similar:* U.S.-Certified Vehicles: 1999-2001 Ducati 996 Biposto Motorcycles. *Notice of Petition:* Published at: 70 FR 66893 (November 3, 2005). *Vehicle Eligibility Number:* VSP-475 (effective date December 13, 2005). 7. Docket No. NHTSA-2005-23083. *Nonconforming Vehicles:* 2005 Lamborghini Murcielago Roadster Passenger Cars. *Substantially Similar:* U.S.-Certified Vehicles: 2005 Lamborghini Murcielago Roadster Passenger Cars. *Notice of Petition:* Published at: 70 FR 71373 (November 28, 2005). *Vehicle Eligibility Number:* VSP-476 (effective date January 6, 2006). [FR Doc. E6-707 Filed 1-20-06; 8:45 am] BILLING CODE 4910-59-P DEPARTMENT OF THE TREASURY Internal Revenue Service Proposed Collection; Comment Request for Revenue Procedure 2003-11 AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice and request for comments. SUMMARY: The Department of the Treasury, as part of its continuing effort to reduce paperwork and respondent burden, invites the general public and other Federal agencies to take this opportunity to comment on proposed and/or continuing information collections, as required by the Paperwork Reduction Act of 1995, Public Law 104-13 (44 U.S.C. 3506(c)(2)(A)). Currently, the IRS is soliciting comments concerning Revenue Procedure 2003-11, Offshore Voluntary Compliance Initiative. DATES: Written comments should be received on or before March 24, 2006 to be assured of consideration. ADDRESSES: Direct all written comments to Glenn Kirkland, Internal Revenue Service, room 6516, 1111 Constitution Avenue, NW., Washington, DC 20224. FOR FURTHER INFORMATION CONTACT: Requests for additional information or copies of the regulations should be directed to Larnice Mack at Internal Revenue Service, room 6512, 1111 Constitution Avenue, NW., Washington, DC 20224, or at
(202)622-3179, or through the Internet at ( *Larnice.Mack@irs.gov* ). SUPPLEMENTARY INFORMATION: *Title:* Offshore Voluntary Compliance Initiative. *OMB Number:* 1545-1822. *Revenue Procedure Number:* Revenue Procedure 2003-11. *Abstract:* Revenue Procedure 2003-11 describes the Offshore Voluntary Compliance Initiative, which is directed at taxpayers that have under-reported their tax liability through financial arrangements outside the United States that rely on the use of credit, debit, or charge cards (offshore credit cards) or foreign banks, financial institutions, corporations, partnerships, trusts, or other entities (offshore financial arrangements). Taxpayers that participate in the initiative and provide the information and material that their participation requires can avoid certain penalties. *Current Actions:* There are no changes being made to the revenue procedure at this time. *Type of Review:* Extension of a currently approved collection. *Affected Public:* Business or other for-profit organizations, individuals, and not-for-profits institutions. *Estimated Number of Respondents:* 2000. *Estimated Time per Respondent:* 50 hours. *Estimated Total Annual Burden Hours:* 100,000. *The following paragraph applies to all the collections of information covered by this notice:* An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the collection of information displays a valid OMB control number. Books or records relating to a collection of information must be retained as long as their contents may become material in the administration of any internal revenue law. Generally, tax returns and tax return information are confidential, as required by 26 U.S.C. 6103. *Request for Comments:* Comments submitted in response to this notice will be summarized and/or included in the request for OMB approval. All comments will become a matter of public record. Comments are invited on:
(a)Whether the collection of information is necessary for the proper performance of the functions of the agency, including whether the information shall have practical utility;
(b)the accuracy of the agency's estimate of the burden of the collection of information;
(c)ways to enhance the quality, utility, and clarity of the information to be collected;
(d)ways to minimize the burden of the collection of information on respondents, including through the use of automated collection techniques or other forms of information technology; and
(e)estimates of capital or start-up costs and costs of operation, maintenance, and purchase of services to provide information. Approved: January 12, 2006. Glenn Kirkland, IRS Reports Clearance Officer. [FR Doc. E6-744 Filed 1-20-06; 8:45 am] BILLING CODE 4830-01-P DEPARTMENT OF THE TREASURY Internal Revenue Service Proposed Collection; Comment Request for Revenue Procedure 96-53 AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice and request for comments. SUMMARY: The Department of the Treasury, as part of its continuing effort to reduce paperwork and respondent burden, invites the general public and other Federal agencies to take this opportunity to comment on proposed and/or continuing information collections, as required by the Paperwork Reduction Act of 1995, Public Law 104-13 (44 U.S.C. 3506(c)(2)(A)). Currently, the IRS is soliciting comments concerning Revenue Procedure 96-53, Section 482—Allocations Between Return Parties. DATES: Written comments should be received on or before March 24, 2006 to be assured of consideration. ADDRESSES: Direct all written comments to Glenn Kirkland, Internal Revenue Service, room 6516, 1111 Constitution Avenue, NW., Washington, DC 20224. FOR FURTHER INFORMATION CONTACT: Requests for additional information or copies of the regulations should be directed to Larnice Mack at Internal Revenue Service, room 6512, 1111 Constitution Avenue, NW., Washington, DC 20224, or at
(202)622-3179, or through the Internet at ( *Larnice.Mack@irs.gov* ). SUPPLEMENTARY INFORMATION: *Title:* Allocations Between Related Parties. *OMB Number:* 1545-1503. *Revenue Procedure Number:* Revenue Procedure 96-53. *Abstract:* The information requested in this revenue procedure is required to enable the Internal Revenue Service to give advice on filing Advance Pricing Agreement applications, to process such applications, to process such applications and negotiate agreements, and to verify compliance with the agreements and whether the agreements require modification. *Current Actions:* There are no changes being made to the revenue procedure at this time. *Type of Review:* Extension of a currently approved collection. *Affected Public:* Business or other for-profit organizations. *Estimated Number of Respondents:* 160. *Estimated Time per Respondent:* 32 hours., 49 minutes. *Estimated Total Annual Burden Hours:* 5,250. *The following paragraph applies to all the collections of information covered by this notice:* An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the collection of information displays a valid OMB control number. Books or records relating to a collection of information must be retained as long as their contents may become material in the administration of any internal revenue law. Generally, tax returns and tax return information are confidential, as required by 26 U.S.C. 6103. *Request for Comments:* Comments submitted in response to this notice will be summarized and/or included in the request for OMB approval. All comments will become a matter of public record. Comments are invited on:
(a)Whether the collection of information is necessary for the proper performance of the functions of the agency, including whether the information shall have practical utility;
(b)the accuracy of the agency's estimate of the burden of the collection of information;
(c)ways to enhance the quality, utility, and clarity of the information to be collected;
(d)ways to minimize the burden of the collection of information on respondents, including through the use of automated collection techniques or other forms of information technology; and
(e)estimates of capital or start-up costs and costs of operation, maintenance, and purchase of services to provide information. Approved: January 12, 2006. Glenn Kirkland, IRS Reports Clearance Officer. [FR Doc. E6-745 Filed 1-20-06; 8:45 am] BILLING CODE 4830-01-P DEPARTMENT OF THE TREASURY Internal Revenue Service [FI-104-90] Proposed Collection; Comment Request for Regulation Project AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice and request for comments. SUMMARY: The Department of the Treasury, as part of its continuing effort to reduce paperwork and respondent burden, invites the general public and other Federal agencies to take this opportunity to comment on proposed and/or continuing information collections, as required by the Paperwork Reduction Act of 1995, Public Law 104-13 (44 U.S.C. 3506(c)(2)(A)). Currently, the IRS is soliciting comments concerning an existing final regulation, FI-104-90 (TD 8390), Tax Treatment of Salvage and Reinsurance (§ 1.832-4). DATES: Written comments should be received on or before March 24, 2006 to be assured of consideration. ADDRESSES: Direct all written comments to Glenn Kirkland, Internal Revenue Service, room 6512, 1111 Constitution Avenue, NW., Washington, DC 20224. FOR FURTHER INFORMATION CONTACT: Requests for additional information or copies of the regulations should be directed to Larnice Mack at Internal Revenue Service, room 6512, 1111 Constitution Avenue, NW., Washington, DC 20224, or at
(202)622-3179, or through the Internet at ( *Larnice.Mack@irs.gov* ). SUPPLEMENTARY INFORMATION: *Title:* Tax Treatment of Salvage and Reinsurance. *OMB Number:* 1545-1227. *Regulation Project Number:* FI-104-90. *Abstract:* Section 1.832-4(d) of this regulation allows a nonlife insurance company to increase unpaid losses on a yearly basis by the amount of estimated salvage recoverable if the company discloses this to the state insurance regulatory authority. *Current Actions:* There is no change to this existing regulation. *Type of Review:* Extension of a currently approved collection. *Affected Public:* Business or other for-profit organizations. *Estimated Number of Respondents:* 2,500. *Estimated Time per Respondent:* 2 hours. *Estimated Total Annual Burden Hours:* 5,000. *The following paragraph applies to all of the collections of information covered by this notice:* An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the collection of information displays a valid OMB control number. Books or records relating to a collection of information must be retained as long as their contents may become material in the administration of any internal revenue law. Generally, tax returns and tax return information are confidential, as required by 26 U.S.C. 6103. *Request for Comments:* Comments submitted in response to this notice will be summarized and/or included in the request for OMB approval. All comments will become a matter of public record. Comments are invited on:
(a)Whether the collection of information is necessary for the proper performance of the functions of the agency, including whether the information shall have practical utility;
(b)the accuracy of the agency's estimate of the burden of the collection of information;
(c)ways to enhance the quality, utility, and clarity of the information to be collected;
(d)ways to minimize the burden of the collection of information on respondents, including through the use of automated collection techniques or other forms of information technology; and
(e)estimates of capital or start-up costs and costs of operation, maintenance, and purchase of services to provide information. Approved: January 12, 2006. Glenn Kirkland, IRS Reports Clearance Officer. [FR Doc. E6-747 Filed 1-20-06; 8:45 am] BILLING CODE 4830-01-P DEPARTMENT OF THE TREASURY Internal Revenue Service [REG-113572-99] Proposed Collection; Comment Request for Regulation Project AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice and request for comments. SUMMARY: The Department of the Treasury, as part of its continuing effort to reduce paperwork and respondent burden, invites the general public and other Federal agencies to take this opportunity to comment on proposed and/or continuing information collections, as required by the Paperwork Reduction Act of 1995, Pub. L. 104-13 (44 U.S.C. 3506(c)(2)(A)). Currently, the IRS is soliciting comments concerning an existing final regulation, REG-133572-99 (TD 8933), Qualified Transportation Fringe Benefits (1.132-9(b)). DATES: Written comments should be received on or before March 24, 2006 to be assured of consideration. ADDRESSES: Direct all written comments to Glenn Kirkland, Internal Revenue Service, room 6512, 1111 Constitution Avenue, NW., Washington, DC 20224. FOR FURTHER INFORMATION CONTACT: Requests for additional information or copies of the regulations should be directed to Larnice Mack at Internal Revenue Service, room 6512, 1111 Constitution Avenue, NW., Washington, DC 20224, or at
(202)622-3179, or through the internet at ( *Larnice.Mack@irs.gov* ). SUPPLEMENTARY INFORMATION: *Title:* Qualified Transportation Fringe Benefits. *OMB Number:* 1545-1676. *Regulation Project Number:* REG-113572-99. *Abstract:* These regulations provide guidance to employers that provide qualified transportation fringe benefits under section 132(f), including guidance to employers that provide cash reimbursement for qualified transportation fringes and employers that offer qualified transportation fringes in lieu of compensation. Employers that provide cash reimbursement are required to keep records of documentation received from employees who receive reimbursement. Employers that offer qualified transportation fringes in lieu of compensation are required to keep records of employee compensation reduction elections. *Current Actions:* There is no change to this existing regulation. *Type of Review:* Extension of a currently approved collection. *Affected Public:* Business or other for-profit organizations, individual or households, and not-for-profit institutions. The burden is reflected in the burden for Form W-2. *Estimated Total Annual Recordkeeping Burden:* 7,020,000. *Estimated Average Annual Recordkeeping Burden per Recordkeeper:* The average annual recordkeeping burden will vary depending on the size of the employer. *Estimated Average Annual Recordkeeping Burden per Recordkeeper:* 26.5 hours. *Estimated Number of Recordkeepers:* 265,343. *Estimated Total Annual Reporting Burden:* 5,948,728 hours. *Estimated Average Annual Reporting Burden per Respondent:* 8 hours. *Estimated Number of Respondents:* 7,264,970. *The following paragraph applies to all of the collections of information covered by this notice:* An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the collection of information displays a valid OMB control number. Books or records relating to a collection of information must be retained as long as their contents may become material in the administration of any internal revenue law. Generally, tax returns and tax return information are confidential, as required by 26 U.S.C. 6103. *Request for Comments:* Comments submitted in response to this notice will be summarized and/or included in the request for OMB approval. All comments will become a matter of public record. Comments are invited on:
(a)Whether the collection of information is necessary for the proper performance of the functions of the agency, including whether the information shall have practical utility;
(b)the accuracy of the agency's estimate of the burden of the collection of information;
(c)ways to enhance the quality, utility, and clarity of the information to be collected;
(d)ways to minimize the burden of the collection of information on respondents, including through the use of automated collection techniques or other forms of information technology; and
(e)estimates of capital or start-up costs and costs of operation, maintenance, and purchase of services to provide information. Approved: January 10, 2006. Glenn Kirkland, IRS Reports Clearance Officer. [FR Doc. E6-748 Filed 1-20-06; 8:45 am] BILLING CODE 4830-01-P DEPARTMENT OF THE TREASURY Internal Revenue Service Open Meeting of the AD Hoc Committee of the Taxpayer Advocacy Panel AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice. SUMMARY: An open meeting of the AD Hoc Committee of the Taxpayer Advocacy Panel will be conducted (via teleconference). The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at the Internal Revenue Service. DATES: The meeting will be held Thursday, February 16, 2006 at 2 p.m. e.t. FOR FURTHER INFORMATION CONTACT: Inez De Jesus at 1-888-912-1227, or 954-423-7977. SUPPLEMENTARY INFORMATION: Notice is hereby given pursuant to section 10(a)(2) of the Federal Advisory Committee Act, 5 U.S.C. App.
(1988)that an open meeting of the Ad Hoc Committee of the Taxpayer Advocacy Panel will be held Thursday, February 16, 2006 at 2 p.m. e.t. via a telephone conference call. If you would like to have the TAP consider a written statement, please call 1-888-912-1227 or 954-423-7977, or write Inez De Jesus, TAP Office, 1000 South Pine Island Road, Suite 340, Plantation, FL 33324. Due to limited conference lines, notification of intent to participate in the telephone conference call meeting must be made with Inez De Jesus. Ms. De Jesus can be reached at 1-888-912-1227 or 954-423-7977, or post comments to the Web site: *http://www.improveirs.org.* The agenda will include: Various IRS issues. Dated: January 18, 2006. Martha Curry, Acting Director, Taxpayer Advocacy Panel. [FR Doc. E6-734 Filed 1-20-06; 8:45 am] BILLING CODE 4830-01-P DEPARTMENT OF THE TREASURY Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Issue Committee AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice. SUMMARY: An open meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Issue Committee will be conducted (via teleconference). The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at the Internal Revenue Service. DATES: The meeting will be held Tuesday, February 14, 2006. FOR FURTHER INFORMATION CONTACT: Audrey Y. Jenkins at 1-888-912-1227 (toll-free), or 718-488-2085 (non toll-free). SUPPLEMENTARY INFORMATION: Notice is hereby given pursuant to Section 10(a)(2) of the Federal Advisory Committee Act, 5 U.S.C. App.
(1988)that an open meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Issue Committee will be held Tuesday, February 14, 2006 from 12 pm to 1 pm e.t. via a telephone conference call. The public is invited to make oral comments. Individual comments will be limited to 5 minutes. For information or to confirm attendance, notification of intent to attend the meeting must be made with Audrey Y. Jenkins. Ms. Jenkins may be reached at 1-888-912-1227 or
(718)488-2085, send written comments to Audrey Y. Jenkins, TAP Office, 10 MetroTech Center, 625 Fulton Street, Brooklyn, NY 11201 or post comments to the Web site: *http://www.improveirs.org.* Due to limited conference lines, notification of intent to participate in the telephone conference call meeting must be made in advance. The agenda will include various IRS issues. Dated: January 18, 2006. Martha Curry, Acting Director, Taxpayer Advocacy Panel. [FR Doc. E6-736 Filed 1-20-06; 8:45 am] BILLING CODE 4830-01-P DEPARTMENT OF THE TREASURY Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance
(VITA)Issue Committee AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice. SUMMARY: An open meeting of the Taxpayer Advocacy Panel VITA Issue Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comment, ideas, and suggestions on improving customer service at the Internal Revenue Service. DATES: The meeting will be held Tuesday, February 7, 2006, at 3 p.m. eastern time. FOR FURTHER INFORMATION CONTACT: Sandy McQuin at 1-888-912-1227, or
(414)297-1604. SUPPLEMENTARY INFORMATION: Notice is hereby given pursuant to Section 10(a)(2) of the Federal Advisory Committee Act, 5 U.S.C. App.
(1988)that a meeting of the Taxpayer Advocacy Panel VITA Issue Committee will be held Tuesday, February 7, 2006, at 3 p.m. eastern time via a telephone conference call. You can submit written comments to the panel by faxing to
(414)297-1623, or by mail to Taxpayer Advocacy Panel, Stop 1006MIL, 310 West Wisconsin Avenue, Milwaukee, WI 53203-2221, or you can contact us at *http://www.improveirs.org.* This meeting is not required to be open to the public, but because we are always interested in community input, we will accept public comments. Please contact Sandy McQuin at 1-888-912-1227 or
(414)297-1604 for additional information. The agenda will include the following: Various IRS issues. Dated: January 18, 2006. Martha Curry, Acting Director, Taxpayer Advocacy Panel. [FR Doc. E6-737 Filed 1-20-06; 8:45 am] BILLING CODE 4830-01-P DEPARTMENT OF THE TREASURY Internal Revenue Service Open Meeting of the Area 5 Taxpayer Advocacy Panel (Including the States of Iowa, Kansas, Minnesota, Missouri, Nebraska, Oklahoma, and Texas) AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice. SUMMARY: An open meeting of the Area 5 Taxpayer Advocacy Panel will be conducted. The Taxpayer Advocacy Panel is soliciting public comment, ideas, and suggestions on improving customer service at the Internal Revenue Service. DATES: The meeting will be held Tuesday, February 14, 2006, at 9:30 a.m. Central Time. FOR FURTHER INFORMATION CONTACT: Mary Ann Delzer at 1-888-912-1227, or
(414)297-1604. SUPPLEMENTARY INFORMATION: Notice is hereby given pursuant to Section 10(a)(2) of the Federal Advisory Committee Act, 5 U.S.C. App.
(1988)that a meeting of the Area 5 Taxpayer Advocacy Panel will be held Tuesday, February 14, 2006, at 9:30 a.m. Central Time via a telephone conference call. You can submit written comments to the panel by faxing to
(414)297-1623, or by mail to Taxpayer Advocacy Panel, Stop1006MIL, 310 West Wisconsin Avenue, Milwaukee, WI 53203-2221, or you can contact us at *http://www.improveirs.org.* This meeting is not required to be open to the public, but because we are always interested in community input, we will accept public comments. Please contact Mary Ann Delzer at 1-888-912-1227 or
(414)297-1604 for additional information. The agenda will include the following: Various IRS issues. Dated: January 18, 2006. Martha Curry, Acting Director, Taxpayer Advocacy Panel. [FR Doc. E6-738 Filed 1-20-06; 8:45 am] BILLING CODE 4830-01-P DEPARTMENT OF THE TREASURY Internal Revenue Service Open Meeting of the Area 3 Taxpayer Advocacy Panel (Including the States of Florida, Georgia, Alabama, Mississippi, Louisiana, Arkansas, and Puerto Rico) AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice. SUMMARY: An open meeting of the Area 3 Taxpayer Advocacy Panel will be conducted (via teleconference). The Taxpayer Advocacy Panel is soliciting public comments, ideas, and suggestions on improving customer service at the Internal Revenue Service. DATES: The meeting will be held Tuesday, February 21, 2006 at 11:30 a.m. ET. FOR FURTHER INFORMATION CONTACT: Sallie Chavez at 1-888-912-1227, or 954-423-7979. SUPPLEMENTARY INFORMATION: Notice is hereby given pursuant to section 10(a)(2) of the Federal Advisory Committee Act, 5 U.S.C. App.
(1988)that an open meeting of the Area 3 Taxpayer Advocacy Panel will be held Tuesday, February 21, 2006, from 11:30 a.m. ET via a telephone conference call. If you would like to have the TAP consider a written statement, please call 1-888-912-1227 or 954-423-7979, or write Sallie Chavez, TAP Office, 1000 South Pine Island Rd., Suite 340, Plantation, FL 33324. Due to limited conference lines, notification of intent to participate in the telephone conference call meeting must be made with Sallie Chavez. Ms. Chavez can be reached at 1-888-912-1227 or 954-423-7979, or post comments to the Web site: *http://www.improveirs.org* . The agenda will include: Various IRS issues. Dated: January 18, 2006. Martha Curry, Acting Director, Taxpayer Advocacy Panel. [FR Doc. E6-739 Filed 1-20-06; 8:45 am] BILLING CODE 4830-01-P DEPARTMENT OF THE TREASURY Internal Revenue Service Open Meeting of the Area 4 Taxpayer Advocacy Panel (Including the States of Illinois, Indiana, Kentucky, Michigan, Ohio, Tennessee, and Wisconsin) AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice. SUMMARY: An open meeting of the Area 4 Taxpayer Advocacy Panel will be conducted (via teleconference). The Taxpayer Advocacy Panel is soliciting public comment, ideas, and suggestions on improving customer service at the Internal Revenue Service. DATES: The meeting will be held Tuesday, February 28, 2006, at 11 a.m., central time. FOR FURTHER INFORMATION CONTACT: Mary Ann Delzer at 1-888-912-1227, or
(414)297-1604. SUPPLEMENTARY INFORMATION: Notice is hereby given pursuant to Section 10(a)(2) of the Federal Advisory Committee Act, 5 U.S.C. App.
(1988)that a meeting of the Area 4 Taxpayer Advocacy Panel will be held Tuesday, February 28, 2006, at 11 a.m., Central time via a telephone conference call. You can submit written comments to the panel by faxing the comments to
(414)297-1623, or by mail to Taxpayer Advocacy Panel, Stop 1006MIL, 310 West Wisconsin Avenue, Milwaukee, WI 53203-2221, or you can contact us at *http://www.improveirs.org* . This meeting is not required to be open to the public, but because we are always interested in community input, we will accept public comments. Please contact Mary Ann Delzer at 1-888-912-1227 or
(414)297-1604 for dial-in information. The agenda will include the following: Various IRS issues. Dated: January 18, 2006. Martha Curry, Acting Director, Taxpayer Advocacy Panel. [FR Doc. E6-740 Filed 1-20-06; 8:45 am] BILLING CODE 4830-01-P DEPARTMENT OF THE TREASURY Internal Revenue Service Open Meeting of the Wage & Investment Reducing Taxpayer Burden (Notices) Issue Committee of the Taxpayer Advocacy Panel AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice. SUMMARY: An open meeting of the Wage & Investment Reducing Taxpayer Burden (Notices) Issue Committee of the Taxpayer Advocacy Panel will be conducted (via teleconference). The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at the Internal Revenue Service. DATES: The meeting will be held Thursday, February 16, 2006, from 11 a.m. ET. FOR FURTHER INFORMATION CONTACT: Sallie Chavez at 1-888-912-1227, or 954-423-7979. SUPPLEMENTARY INFORMATION: Notice is hereby given pursuant to section 10(a)(2) of the Federal Advisory Committee Act, 5 U.S.C. App.
(1988)that an open meeting of the Wage & Investment Reducing Taxpayer Burden (Notices) Issue Committee of the Taxpayer Advocacy Panel will be held Thursday, February 16, 2006, from 11 a.m. ET via a telephone conference call. If you would like to have the TAP consider a written statement, please call 1-888-912-1227 or 954-423-7979, or write Sallie Chavez, TAP Office, 1000 South Pine Island Road, Suite 340, Plantation, FL 33324. Due to limited conference lines, notification of intent to participate in the telephone conference call meeting must be made with Sallie Chavez. Ms. Chavez can be reached at 1-888-912-1227 or 954-423-7979, or post comments to the Web site: *http://www.improveirs.org* . The agenda will include: Various IRS issues. Dated: January 18, 2006. Martha Curry, Acting Director, Taxpayer Advocacy Panel. [FR Doc. E6-741 Filed 1-20-06; 8:45 am] BILLING CODE 4830-01-P DEPARTMENT OF THE TREASURY Internal Revenue Service Open Meeting of the Area 7 Taxpayer Advocacy Panel (Including the States of Alaska, California, Hawaii, and Nevada) AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice. SUMMARY: An open meeting of the Area 7 committee of the Taxpayer Advocacy Panel will be conducted (via teleconference). The Taxpayer Advocacy Panel
(TAP)is soliciting public comments, ideas, and suggestions on improving customer service at the Internal Revenue Service. The TAP will use citizen input to make recommendations to the Internal Revenue Service. DATES: The meeting will be held Wednesday, February 15, 2006. FOR FURTHER INFORMATION CONTACT: Dave Coffman at 1-888-912-1227, or 206-220-6096. SUPPLEMENTARY INFORMATION: Notice is hereby given pursuant to Section 10(a)(2) of the Federal Advisory Committee Act, 5 U.S.C. App.
(1988)that an open meeting of the Area 7 Taxpayer Advocacy Panel will be held Wednesday, February 15, 2006 from 2 p.m. Pacific Time to 3 p.m. Pacific Time via a telephone conference call. The public is invited to make oral comments. Individual comments will be limited to 5 minutes. If you would like to have the TAP consider a written statement, please call 1-888-912-1227 or 206-220-6096, or write to Dave Coffman, TAP Office, 915 2nd Avenue, MS W-406, Seattle, WA 98174 or you can contact us at *http://www.improveirs.org.* Due to limited conference lines, notification of intent to participate in the telephone conference call meeting must be made with Dave Coffman. Mr. Coffman can be reached at 1-888-912-1227 or 206-220-6096. The agenda will include the following: Various IRS issues. Dated: January 17, 2006. Martha Curry, Acting Director, Taxpayer Advocacy Panel. [FR Doc. E6-742 Filed 1-20-06; 8:45 am] BILLING CODE 4830-01-P DEPARTMENT OF THE TREASURY Internal Revenue Service Open Meeting of the Area 1 Taxpayer Advocacy Panel (Including the States of New York, Connecticut, Massachusetts, Rhode Island, New Hampshire, Vermont and Maine) AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice. SUMMARY: An open meeting of the Area 1 Taxpayer Advocacy Panel will be conducted (via teleconference). The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at the Internal Revenue Service. DATES: The meeting will be held Tuesday, February 21, 2006. FOR FURTHER INFORMATION CONTACT: Audrey Y. Jenkins at 1-888-912-1227 (toll-free), or 718-488-2085 (non toll-free). SUPPLEMENTARY INFORMATION: An open meeting of the Area 1 Taxpayer Advocacy Panel will be held Tuesday, February 21, 2006 from 9 a.m. ET to 10 a.m. ET via a telephone conference call. Individual comments will be limited to 5 minutes. If you would like to have the TAP consider a written statement, please call 1-888-912-1227 or 718-488-2085, or write Audrey Y. Jenkins, TAP Office, 10 MetroTech Center, 625 Fulton Street, Brooklyn, NY 11201. Due to limited conference lines, notification of intent to participate in the telephone conference call meeting must be made with Audrey Y. Jenkins. Ms. Jenkins can be reached at 1-888-912-1227 or 718-488-2085, or post comments to the Web site: *http://www.improveirs.org* . The agenda will include various IRS issues. Dated: January 18, 2006. Martha Curry, Acting Director, Taxpayer Advocacy Panel. [FR Doc. E6-751 Filed 1-20-06; 8:45 am] BILLING CODE 4830-01-P DEPARTMENT OF THE TREASURY Internal Revenue Service Open Meeting of The Area 2 Taxpayer Advocacy Panel (Including The States of Delaware, North Carolina, South Carolina, New Jersey, Maryland, Pennsylvania, Virginia, West Virginia And The District of Columbia) AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice. SUMMARY: An open meeting of the Area 2 Taxpayer Advocacy Panel will be conducted (via teleconference). The Taxpayer Advocacy Panel is soliciting public comments, ideas, and suggestions on improving customer service at the Internal Revenue Service. DATES: The meeting will be held Tuesday, February 21, 2006, at 2:30 p.m. ET. FOR FURTHER INFORMATION CONTACT: Inez E. De Jesus at 1-888-912-1227, or 954-423-7977. SUPPLEMENTARY INFORMATION: Notice is hereby given pursuant to section 10(a)(2) of the Federal Advisory Committee Act, 5 U.S.C. App.
(1988)that an open meeting of the Area 2 Taxpayer Advocacy Panel will be held Tuesday, February 21, 2006 at 2:30 p.m. ET via a telephone conference call. If you would like to have the TAP consider a written statement, please call 1-888-912-1227 or 954-423-7977, or write Inez E. De Jesus, TAP Office, 1000 South Pine Island Rd., Suite 340, Plantation, FL 33324. Due to limited conference lines, notification of intent to participate in the telephone conference call meeting must be made with Inez E. De Jesus. Ms. De Jesus can be reached at 1-888-912-1227 or 954-423-7977, or post comments to the Web site: *http://www.improveirs.org* . The agenda will include the following: Various IRS issues. Dated: January 18, 2006. Martha Curry, Acting Director, Taxpayer Advocacy Panel. [FR Doc. E6-752 Filed 1-20-06; 8:45 am] BILLING CODE 4830-01-P 71 14 Monday, January 23, 2006 CORRECTIONS Amelia DEPARTMENT OF LABOR Mine Safety and Health Administration 30 CFR Part 48 RIN 1219-AB35 Training Standards for Shaft and Slope Construction Workers at Underground Mines and Surface Areas of Underground Mines Correction In rule document 05-24624 beginning on page 77716 in the issue of Friday, December 30, 2005, make the following corrections: 1. On page 77718, in Table 2, in the third column, in the first and second lines of the column heading, “UG & ≤ surf.” should read “UG & surf.”. 2. On page 77721, in the first column, in the second full paragraph, in the first line, “Shaft and slope workers” should read, ““Shaft and slope workers”. [FR Doc. C5-24624 Filed 1-20-06; 8:45 am] BILLING CODE 1505-01-D Lois Davis DEPARTMENT OF TRANSPORTATION Federal Motor Carrier Safety Administration 49 CFR Parts 383 and 384 [Docket No. FMCSA-2005-21603] RIN 2126-AA94 Commercial Driver's License Standards; School Bus Endorsement Correction In rule document 06-413 beginning on page 2897 in the issue of Wednesday, January 18, 2006, make the following correction: On page 2897, in the second column, footnote 1 at the bottom of the column should read “ 1 As pertinent to this rule, a CMV is a motor vehicle used in commerce that is designed to transport at least 16 passengers, including the driver. 49 U.S.C. 31301(4)(B)”. [FR Doc. C6-413 Filed 1-20-06; 8:45 am] BILLING CODE 1505-01-D 71 14 Monday, January 23, 2006 Proposed Rules Part II Department of Health and Human Services Centers for Medicare & Medicaid Services 42 CFR Parts 412 and 424 Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System Payment Update for Rate Year Beginning July 1, 2006 (RY 2007); Proposed Rule DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 412 and 424 [CMS-1306-P] Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System Payment Update for Rate Year Beginning July 1, 2006 (RY 2007) AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Proposed rule. SUMMARY: This proposed rule would update the prospective payment rates for Medicare inpatient hospital services provided by inpatient psychiatric facilities (IPFs). These changes are applicable to IPF discharges occurring during the rate year beginning July 1, 2006 through June 30, 2007. We are proposing to adopt the new Office of Management and Budget
(OMB)labor market area definitions for the purpose of geographic classification and the wage index. In addition, we are proposing other new polices and making changes to existing policies. DATES: We will consider comments if we receive them at the appropriate address provided below, no later than 5 p.m. on March 14, 2006. ADDRESSES: In commenting, please refer to file code CMS-1306-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/eRulemaking.* (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-1306-P, P.O. Box 8010, Baltimore, MD 21244. 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 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 Humphrey 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: Janet Samen,
(410)786-4533 for general information. Mary Lee Seifert,
(410)786-0030 for information regarding the market basket and labor-related share. Theresa Bean,
(410)786-2287 for impact. Matthew Quarrick,
(410)786-9867 for wage index. 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-1306-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. Table of Contents I. Background A. General and Legislative History B. Overview of the Establishment of the IPF PPS C. Applicability of the IPF PPS II. Overview for Updating the IPF PPS A. Requirements for Updating the IPF PPS B. Proposed Updates to the IPF PPS C. Transition Period for Implementation of the IPF PPS III. Proposed Updates to the IPF PPS for Rate Year beginning July 1, 2006 A. Calculation of the Average Per Diem Cost B. Determining the Standardized Budget-Neutral Federal Per Diem Rate 1. Standardization of the Federal Per Diem Base Rate 2. Calculation of the Budget Neutrality Adjustment a. Outlier Adjustment b. Stop-Loss Provision Adjustment c. Behavioral Offset 3. Revision of Standardization Factor C. Update of the Federal Per Diem Base Rate 1. Market Basket for IPFs Reimbursed under the IPF PPS a. Proposed IPF Market Basket Index b. Overview of the Proposed RPL Market Basket 2. Proposed Methodology for Operating Portion of the RPL Market Basket 3. Proposed Methodology for Capital Portion of the RPL Market Basket 4. Proposed Labor-Related Share IV. Update of the IPF PPS Adjustment Factors A. Overview of the IPF PPS Adjustment Factors B. Proposed Patient-Level Adjustments 1. Proposed Adjustment for DRG Assignment 2. Proposed Payment for Comorbid Conditions 3. Proposed Patient Age Adjustment 4. Proposed Variable Per Diem Adjustment C. Facility-Level Adjustments 1. Wage Index Adjustment a. Proposed Revisions of the IPF PPS Geographic Classifications b. Current IPF PPS Labor Market Areas Based on MSAs c. Core-Based Statistical Areas d. Proposed Revision of the IPF PPS Labor Market Areas i. New England MSAs ii. Metropolitan Divisions iii. Micropolitan Areas e. Implementation of the Proposed Revised Labor Market Area under the IPF PPS f. Wage Index Budget Neutrality 1. Proposed Adjustment for Rural Location 2. Proposed Teaching Adjustment 3. Proposed Cost of Living Adjustment for IPFs Located in Alaska and Hawaii 4. Proposed Adjustment for IPFs with a Qualifying Emergency Department a. Proposed New Source of Admission Code to Implement the ED Adjustment b. Applicability of the ED Adjustment to IPFs in Critical Access Hospitals D. Other Payment Adjustments and Policies 1. Outlier Payments a. Proposed Update to the Outlier Fixed Dollar Loss Amount b. Proposed Statistical Accuracy of Cost-to-Charge Ratio 2. Proposed Stop-loss Provision 3. Patients who Receive Electroconvulsive Therapy 4. Physician Certification and Recertification Requirements 5. Provisions of Therapeutic Recreation in IPFs 6. Same Day Transfers V. Provisions of the Proposed Rule VI. Collection of Information Requirements VII. Regulatory Impact Analysis Acronyms Because of the many terms to which we refer by acronym in this proposed rule, we are listing the acronyms used and their corresponding terms in alphabetical order below: BBA Balanced Budget Act of 1997, (Pub. L. 105-33) BBRA Medicare, Medicaid and SCHIP [State Children's Health Insurance Program] Balanced Budget Refinement Act of 1999, (Pub. L. 106-113) BIPA Medicare, Medicaid, and SCHIP [State Children's Health Insurance Program] Benefits Improvement and Protection Act of 2000, (Pub. L. 106-554) CBSA Core-Based Statistical Areas CCR Cost-to-charge ratio CMS Centers for Medicare & Medicaid Services CMSA Consolidated Metropolitan Statistical Area DSM-IV-TR Diagnostic and Statistical Manual of Mental Disorders Fourth Edition—Text Revision DRGs Diagnosis-related groups FY Federal fiscal year HCRIS Hospital Cost Report Information System ICD-9-CM International Classification of Diseases, 9th Revision, Clinical Modification IPFs Inpatient psychiatric facilities IRFs Inpatient rehabilitation facilities LTCHs Long-term care hospitals MedPAR Medicare provider analysis and review file MMA Medicare Prescription Drug, Improvement and Modernization Act of 2003, (Pub. L. 108-173) MSA Metropolitan Statistical Area NECMA New England County Metropolitan Area OMB Office of Management and Budget PIP Periodic interim payments RY Rate Year (July 1 through June 30) TEFRA Tax Equity and Fiscal Responsibility Act of 1982, (Pub. L. 97-248) I. Background [If you choose to comment on issues in this section, please include the caption “BACKGROUND” at the beginning of your comments.] A. General and Legislative History The Congress directed implementation of a prospective payment system
(PPS)for acute care hospitals with the enactment of Public Law 98-21. Section 601 of the Social Security Amendments of 1983 (Pub. L. 98-21) added a new section 1886(d) to the Social Security Act (the Act) that replaced the reasonable cost-based payment system for most hospital inpatient services with a PPS. Although most hospital inpatient services became subject to the PPS, certain hospitals, including IPFs, inpatient rehabilitation facilities (IRFs), long term care hospitals (LTCHs), and children's hospitals were excluded from the PPS for acute care hospitals. These hospitals and units were paid their reasonable costs for inpatient services, subject to a per discharge limitation or target amount under the authority of the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA), Public Law 97-248. The regulations implementing the TEFRA (reasonable cost-based) payment provisions are located at 42 CFR part 413. Cancer hospitals were added to the list of excluded hospitals by section 6004(a) of the Omnibus Budget Reconciliation Act of 1989, (Pub. L. 101-239). The Congress enacted various provisions in the Balanced Budget Act of 1997
(BBA)(Pub. L. 105-33), the Medicare, Medicaid, and SCHIP (State Children's Health Insurance Program) Balanced Budget Refinement Act of 1999
(BBRA)(Pub. L. 106-113), and the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000
(BIPA)(Pub. L. 106-554) to replace the reasonable cost-based method of reimbursement with a PPS for IRFs, LTCHs, and IPFs. Section 124 of the BBRA required implementation of the IPF PPS. Section 124 of the BBRA mandated that the Secretary—(1) develop a per diem PPS for inpatient hospital services furnished in psychiatric hospitals and psychiatric units;
(2)include in the PPS an adequate patient classification system that reflects the differences in patient resource use and costs among psychiatric hospitals and psychiatric units;
(3)maintain budget neutrality;
(4)permit the Secretary to require psychiatric hospitals and psychiatric units to submit information necessary for the development of the PPS; and
(5)submit a report to the Congress describing the development of the PPS. Section 124 of the BBRA also required that the IPF PPS be implemented for cost reporting periods beginning on or after October 1, 2002. Section 405(g)(2) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003
(MMA)(Pub. L. 108-173) extended the IPF PPS to distinct part psychiatric units of critical access hospitals (CAHs). B. Overview of the Establishment of the IPF PPS On November 28, 2003, we published a proposed rule in the **Federal Register** (68 FR 66920) that proposed to implement section 124 of the BBRA. In the November 15, 2004 **Federal Register** (69 FR 66922) our final rule implemented the IPF PPS for cost reporting periods beginning on or after January 1, 2005. Although section 124 of the BBRA directed that the IPF PPS be implemented for cost reporting periods beginning on or after October 1, 2002, we explained in the proposed and final rules that the creation of a PPS requires an extraordinary amount of lead-time to create a completely new payment system and that we were unable to perform the analysis required in time for an October 1, 2002 implementation, to ensure that a system based on CMS administrative data would fulfill the statutory mandate of section 124 of the BBRA. We explained that despite our best efforts, we could not engage in notice and comment rulemaking and achieve implementation of the IPF PPS by October 1, 2002. The November 2004 final rule (hereinafter referred to as the IPF PPS final rule) established regulations for the IPF PPS under 42 CFR 412, subpart N. The IPF PPS established the Federal per diem base rate for each patient day in an IPF derived from the national average daily routine operating, ancillary, and capital costs in IPFs in FY 2002. The average per diem cost was updated to the midpoint of the first year under the IPF PPS, standardized to account for the overall positive effects of the IPF PPS payment adjustments, and adjusted for budget neutrality. The Federal per diem payment under the IPF PPS is comprised of the Federal per diem base rate described above and certain patient and facility payment adjustments that were found in the regression analysis to be associated with statistically significant per diem cost differences (see 69 FR 66933 through 66936 for a description of the regression analysis). The patient-level adjustments include age, DRG assignment, comorbidities, and variable per diem adjustments to reflect the higher cost incurred in the early days of a psychiatric stay. Facility-level adjustments include adjustments for the IPF's wage index, rural location, teaching status, a cost of living adjustment for IPFs located in Alaska and Hawaii, and presence of a qualifying emergency department (ED). The IPF PPS provides additional payments for outlier cases, stop-loss protection which is applicable only during the IPF PPS transition period, includes special payment provisions for interrupted stays, and a per treatment adjustment for patients who undergo electroconvulsive therapy (ECT). We refer readers to the IPF PPS final rule for a comprehensive discussion of the research and data that supported the establishment of the IPF PPS. On April 1, 2005, we published a correction to the IPF PPS final rule in the **Federal Register** (70 FR 16724). Any reference to the IPF PPS final rule in this proposed rule includes the provisions in the correction notice. We established a CMS website that contains useful information regarding the IPF PPS including the proposed rule, final rule, and the correction notice. The website URL is *http://www.cms.hhs.gov/InpatientPsychFacilPPS/* and may be accessed to download or view publications and other information pertinent to the IPF PPS. C. Applicability of the IPF PPS The IPF PPS is applicable to freestanding psychiatric hospitals, including government-operated psychiatric hospitals, and distinct part psychiatric units of acute care hospitals and CAHs. The regulations at § 412.402 define an IPF as a hospital that meets the requirements specified in § 412.22, § 412.23(a), § 482.60, § 482.61, and § 482.62, and units that meet the requirements specified in § 412.22, § 412.25, and § 412.27. However, the following hospitals are paid under a special payment provision, as described in § 412.22(c) and, therefore, are not subject to the IPF PPS rules: • Veterans Administration hospitals. • Hospitals that are reimbursed under State cost control systems approved under 42 CFR part 403. • Hospitals that are reimbursed in accordance with demonstration projects specified in section 402(a) of Public Law 90-248 (42 U.S.C. 1395b-1) or section 222(a) of Public Law 92-603 (42 U.S.C. 1395b-1(note)). • Non-participating hospitals furnishing emergency services to Medicare beneficiaries. II. Overview for Updating the IPF PPS [If you choose to comment on issues in this section, please include the caption “OVERVIEW FOR UPDATING THE IPF PPS” at the beginning of your comments.] A. Requirements for Updating the IPF PPS Section 124 of the BBRA does not specify an update strategy for the IPF PPS and is broadly written to give the Secretary discretion in establishing an update methodology. Therefore, we reviewed the update approach used in other hospital PPSs (specifically, the IRF and LTCH PPS update methodologies). As a result of this analysis, we stated in the IPF PPS final rule (69 FR 66966) that we would implement the IPF PPS using the following update strategy—(1) calculate the final Federal per diem base rate to be budget neutral for the 18-month period (that is, January 1, 2005 through June 30, 2006);
(2)use a July 1 through June 30 annual update cycle; and
(3)allow the IPF PPS first update to be effective for discharges July 1, 2006 through June 30, 2007. In this proposed rule, we are proposing updates to the IPF PPS for the period of July 1, 2006 through June 30, 2007. As explained in the IPF PPS final rule, we believe it is important to delay updating the adjustment factors derived from the regression analysis until we have IPF PPS data that include as much information as possible regarding the patient-level characteristics of the population that each IPF serves. For this reason, we do not intend to update the regression analysis and recalculate the Federal per diem base rate until we have analyzed 1 year of IPF PPS claims and cost report data (that is, no earlier than FY 2008). Until that analysis is complete, we stated our intention to publish a notice in the **Federal Register** each spring to update the IPF PPS as specified in § 412.428 to include: • A description of the methodology and data used to calculate the updated Federal per diem base payment amount. • The rate of increase factor as described in § 412.424(a)(2)(iii), which is based on the excluded hospital with capital market basket under the update methodology of 1886(b)(3)(B)(ii) of the Act for each year. • The best available hospital wage index and information regarding whether an adjustment to the Federal per diem base rate is needed to maintain budget neutrality. • Updates to the fixed dollar loss amount in order to maintain the appropriate outlier percentage. • Describe the ICD-9-CM coding and DRG classification changes discussed in the annual update to the hospital inpatient prospective payment system regulations. • Update the ECT adjustment by a factor specified by CMS. B. Proposed Updates to the IPF PPS As discussed above, we intended to publish a notice in the **Federal Register** in the spring of 2006 that would announce the updates to the IPF PPS in accordance with § 412.428 rather than update through rulemaking (69 FR 66966). However, since the implementation of the IPF PPS, a new market basket index was announced in the August 2005 IPPS final rule. We believe that this new market basket should be implemented in the IPF PPS as well in order to update the system using the best data available. Therefore, rather than publish a notice to update the IPF PPS in 2006, we are proposing changes in this proposed rule to give interested parties the opportunity to comment. Furthermore, we indicated in the IPF PPS final rule (69 FR 66952) that we were not adopting the new labor market definitions developed by the OMB and adopted under the IPPS. Rather, we explained that we intended to use the metropolitan statistical areas
(MSAs)developed by OMB in 1993 for the wage index under the IPF PPS. At the time we published the proposed IPF PPS rule, the 2003 MSA definitions had not been implemented for any Medicare programs. In addition, we indicated that we believe that the adoption of the new labor market area definitions may have a significant impact on the wage index applied to IPFs and associated payments and that we would assess the implications of the new MSA definitions on IPFs before proposing to adopt them. We believe that IPFs should be afforded an opportunity to comment on the use of the new labor market definitions before we adopt them under the IPF PPS. For this reason also, we are publishing this proposed rule, rather than a notice, in order to give interested parties an opportunity to comment on the new labor market definitions (see section III.C.1. of this proposed rule). C. Transition Period for Implementation of the IPF PPS In the IPF PPS final rule, we established § 412.426 to provide for a 3-year transition period from reasonable cost-based reimbursement to full prospective payment for IPFs. New IPFs are paid 100 percent of the Federal per diem rate. However, for those IPFs that are transitioning to a new system, during the 3-year period as specified in the IPF PPS final rule, payment is based on an increasing percentage of the PPS payment and a decreasing percentage of each IPF's facility-specific TEFRA reimbursement rate. The blend percentages are as follows: Table 1.—IPF PPS Final Rule Transition Blend Factors Transition year Cost reporting periods beginning on or after TEFRA rate percentage IPF PPS Federal rate percentage 1 January 1, 2005 75 25 2 January 1, 2006 50 50 3 January 1, 2007 25 75 January 1, 2008 0 100 Changes to the blend percentages occur at the beginning of an IPF's cost reporting period. As a result, for discharges occurring during IPF cost reporting periods beginning in CY 2006, IPFs would receive a blended payment consisting of 50 percent of the facility-specific TEFRA payment and 50 percent of the IPF PPS payment amount. However, regardless of when an IPF's cost reporting year begins, the payment update we are proposing would be effective for discharges occurring on or after July 1, 2006 through June 30, 2007. We are not proposing any changes to the transition approach established in the IPF PPS final rule. III. Proposed Updates to the IPF PPS for Rate Year beginning July 1, 2006 The IPF PPS is based on a standardized Federal per diem base rate calculated from IPF average per diem costs and adjusted for budget-neutrality in the implementation year. The Federal per diem base rate is used as the standard payment per day under the IPF PPS and is adjusted by the applicable wage index factor and the patient-level and facility-level adjustments that are applicable to the IPF stay. The following is an explanation of how we calculated the Federal per diem base rate and the standardization and budget neutrality factors as described in the IPF PPS final rule. A. Calculation of the Average Per Diem Cost [If you choose to comment on issues in this section, please include the caption “PER DIEM COST” at the beginning of your comments.] As indicated in the IPF PPS final rule, to calculate the Federal per diem base rate, we estimated the average cost per day for—(1) routine services from FY 2002 cost reports (supplemented with FY 2001 cost reports if the FY 2002 cost report was missing); and
(2)ancillary services using data from the FY 2002 Medicare claims and corresponding data from facility cost reports. For routine services, the per diem operating and capital costs were used to develop the average per diem cost amount. The per diem routine costs were obtained from each facility's Medicare cost report. To estimate the costs for routine services included in the Federal per diem base rate calculation, we added the total routine costs (including costs for capital) submitted on the cost report for each provider and divided it by the total Medicare days. Some average routine costs per day were determined to be aberrant, that is, the costs were extraordinarily high or low and most likely contained data errors. We provided a detailed discussion in the IPF PPS final rule (69 FR 66926 through 66927) of the method used to trim extraordinarily high or low cost values from the per diem rate development file in order to improve the accuracy of our results. For ancillary services, we calculated the costs by converting charges from the FY 2002 Medicare claims into costs using facility-specific, cost-center specific cost-to-charge ratios obtained from each provider's applicable cost reports. We matched each provider's departmental cost-to-charge ratios from their Medicare cost report to each charge on their claims reported in the MedPAR file. Multiplying the total charges for each type of ancillary service by the corresponding cost-to-charge ratio provided an estimate of the costs for all ancillary services received by the patient during the stay. We determined the average ancillary amount per day by dividing the total ancillary costs for all stays by the total number of covered Medicare days. Adding the average ancillary costs per day and the average routine costs per day including capital costs provided the estimated average per diem cost for each patient day of inpatient psychiatric care in FY 2002. B. Determining the Standardized Budget-Neutral Federal Per Diem Base Rate [If you choose to comment on issues in this section, please include the caption “BUDGET NEUTRAL BASE RATE” at the beginning of your comments.] Section 124(a)(1) of the BBRA requires that the implementing IPF PPS be budget neutral. In other words, the amount of total payments under the IPF PPS, including any payment adjustments, must be projected to be equal to the amount of total payments that would have been made if the IPF PPS were not implemented. Therefore, in the IPF PPS final rule, we calculated the budget-neutrality factor by setting the total estimated IPF PPS payments to be equal to the total estimated payments that would have been made under the TEFRA methodology had the IPF PPS not been implemented. The IPF PPS final rule includes a step-by-step description of the methodology we used to estimate payments under the TEFRA payment system (69 FR 66930). For the IPF PPS methodology, we calculated the final Federal per diem base rate to be budget neutral during the implementation period under the IPF PPS using a July 1 update cycle. Thus, the implementation period for the IPF PPS is the 18-month period January 1, 2005 through June 30, 2006. We updated the average cost per day to the midpoint of the IPF PPS implementation period (that is, October 1, 2005). We used the most recent projection of the full percentage increase in the 1997-based excluded hospital with capital market basket index for FY 2003 and later in accordance with § 413.40(c)(3)(viii). The updated average cost per day of $724.43 was used in the payment model to establish the budget neutrality adjustment. 1. Standardization of the Federal Per Diem Base Rate In the IPF PPS final rule, we standardized the IPF PPS Federal per diem base rate in order to account for the overall positive effects of the IPF PPS payment adjustment factors. To standardize the IPF PPS payments, we compared the IPF PPS payment amounts calculated from the psychiatric stays in the FY 2002 MedPAR file to the projected TEFRA payments from the FY 2002 cost report file updated to the midpoint of the IPF PPS implementation period (that is October 2005). The standardization factor was calculated by dividing total estimated payments under the TEFRA payment system by estimated payments under the IPF PPS. The standardization factor was calculated to be 0.8367. As a result, in the IPF PPS final rule, the $724.43 average cost per day was reduced by 16.33 percent (100 percent minus 83.67 percent). 2. Calculation of the Budget Neutrality Adjustment To compute the budget neutrality adjustment for the IPF PPS, we separately identified each component of the adjustment, that is, the outlier adjustment, stop-loss adjustment, and behavioral offset. a. Outlier Adjustment Since the IPF PPS payment amount for each IPF includes applicable outlier amounts, we reduced the standardized Federal per diem base rate to account for aggregate IPF PPS payments estimated to be made as outlier payments. The appropriate outlier amount was determined by comparing the adjusted prospective payment for the entire stay to the computed cost per case. If costs were above the prospective payment plus the adjusted fixed dollar loss threshold amount, an outlier payment was computed using the applicable risk-sharing percentages, as explained in greater detail in section IV.D.1 of this proposed rule. The outlier amount was computed for all stays, and the total outlier amount was added to the final IPF PPS payment. The outlier adjustment was calculated to be 2 percent. As a result, the standardized Federal per diem base rate was reduced by 2 percent to account for projected outlier payments. b. Stop-Loss Provision Adjustment As explained in the IPF PPS final rule, we provide a stop-loss payment to ensure that an IPF's total PPS payments are no less than a minimum percentage of their TEFRA payment, had the IPF PPS not been implemented. We reduced the standardized Federal per diem base rate by the percentage of aggregate IPF PPS payments estimated to be made for stop-loss payments. The stop-loss payment amount was determined by comparing aggregate prospective payments that the provider would receive under the IPF PPS to aggregate TEFRA payments that the provider would have otherwise received without implementation of the IPF PPS. If an IPF's aggregate IPF PPS payments are less than 70 percent of its aggregate payments under TEFRA, a stop-loss payment was computed for that IPF. The stop-loss payment amounts were computed for those IPFs that were projected to receive the payments, and the total amount was added to the final IPF PPS payment amount. As a result, the standardized Federal per diem base rate was reduced by 0.39 percent in order to maintain budget neutrality in the IPF PPS. c. Behavioral Offset As explained in the IPF PPS final rule, implementation of the IPF PPS may result in certain changes in IPF practices especially with respect to coding for comorbid medical conditions. As a result, Medicare may incur higher payments than assumed in our calculations. Accounting for these effects through an adjustment is commonly known as a behavioral offset. Based on accepted actuarial practices and consistent with the assumptions made in other prospective payment systems, we assumed in determining the behavioral offset that IPFs would regain 15 percent of potential “losses” and augment payment increases by 5 percent. We applied this actuarial assumption, which is based on our historical experience with new payment systems, to the estimated “losses” and “gains” among the IPFs. The behavioral offset for the IPF PPS was calculated to be 2.66 percent. As a result, we reduced the standardized Federal per diem base rate by 2.66 percent to maintain budget neutrality. To summarize, the $724.43 updated average per diem cost was reduced by 16.33 percent to account for standardization to projected TEFRA per diem payments for the implementation period, by 2 percent to account for outlier payments, by 0.39 percent to account for stop-loss payments, and by 2.66 percent reduction to account for the behavioral offset. The final standardized budget-neutral Federal per diem base rate for the IPF PPS implementation year was calculated to be $575.95. We discuss the Federal per diem base rate for RY 2007 in section III B.3. of this proposed rule. 3. Revision of Standardization Factor In reviewing the methodology used to simulate the IPF PPS payments used for the IPF PPS final rule, we discovered that the computer code incorrectly assigned non-teaching status to most teaching facilities. As a result, total IPF PPS payments were underestimated by about 1.36 percent. The IPF PPS estimated payment total was used in calculating the IPF PPS standardization factor. The standardization factor indicates the proportion by which the IPF PPS per diem payment rate and the ECT rate must be reduced in order to make total IPF PPS payments equal to estimated total TEFRA payments assuming IPFs continued to be paid solely under TEFRA for the first PPS payment year. The standardization factor is calculated as the ratio of estimated total TEFRA payments to estimated total IPF PPS payments assuming no reduction to the per diem and ECT payment rates. Since the IPF PPS payment total should have been larger than the estimated figure, the standardization factor should have been smaller (0.8254 vs. 0.8367). In turn, the per diem rate and the ECT rate should have been reduced by 0.8254 instead of 0.8367. To resolve this issue, we are proposing to amend the Federal per diem base rate prospectively. Using the standardization factor of 0.8254, the base rate should have been $568.17 for the implementation year of the IPF PPS. It is this base rate that we propose to update using the market basket rate of increase of 4.5 percent and the budget-neutral wage index factor of 1.00156 (as discussed in section IV.C.1.f. of this proposed rule). Applying these factors yields a proposed Federal per diem base rate of $594.66 for the rate year
(RY)beginning July 1, 2006 through June 30, 2007. C. Update of the Federal Per Diem Base Rate [If you choose to comment on issues in this section, please include the caption “UPDATE ON PER DIEM BASE RATE” at the beginning of your comments.] 1. Market Basket for IPFs Reimbursed under the IPF PPS a. Proposed IPF Market Basket Index The market basket index used to develop the IPF PPS is the excluded hospital with capital market basket. This market basket was based on 1997 Medicare cost report data and includes data for Medicare participating IPFs, IRFs, LTCHs, cancer, and children's hospitals. We are presently unable to create a separate market basket specifically for psychiatric hospitals due to the small number of facilities and the limited data that are provided (for instance, approximately 4 percent of psychiatric facilities reported contract labor cost data for 2002). However, since all IRFs, LTCHs, and IPFs are now paid under a PPS, we are proposing to update PPS payments made under the IRF PPS, the LTCH PPS, and the IPF PPS, in their respective **Federal Register** updates, using a market basket reflecting the operating and capital cost structures for IRFs, IPFs, and LTCHs, hereafter referred to as the RPL (rehabilitation, psychiatric, long-term care) market basket. We are excluding children's and cancer hospitals from the RPL market basket because their payments are based entirely on reasonable costs subject to rate-of-increase limits established under the authority of section 1886(b) of the Act, which is implemented in § 413.40 of the regulations. They are not reimbursed under a PPS. Also, the FY 2002 cost structures for children's and cancer hospitals are noticeably different than the cost structures of the IRFs, IPFs, and LTCHs. The services offered in IRFs, IPFs, and LTCHs are typically more labor-intensive than those offered in cancer and children's hospitals. Therefore, the compensation cost weights for IRFs, IPFs, and LTCHs are larger than those in cancer and children's hospitals. In addition, the depreciation cost weights for IRFs, IPFs, and LTCHs are noticeably smaller than those for children's and cancer hospitals. In the following discussion, we provide an overview on the market basket and describe the methodologies we propose to use for purposes of determining the operating and capital portions of the proposed FY 2002-based RPL market basket. b. Overview of the Proposed RPL Market Basket The proposed RPL market basket is a fixed weight, Laspeyres-type price index that is constructed in three steps. First, a base period is selected (in this case, FY 2002) and total base period expenditures are estimated for a set of mutually exclusive and exhaustive spending categories based upon type of expenditure. Then the proportion of total costs that each category represents is determined. These proportions are called cost or expenditure weights. Second, each expenditure category is matched to an appropriate price or wage variable, referred to as a price proxy. In nearly every instance, these price proxies are price levels derived from publicly available statistical series that are published on a consistent schedule, preferably at least on a quarterly basis. Finally, the expenditure weight for each cost category is multiplied by the level of its respective price proxy for a given period. The sum of these products (that is, the expenditure weights multiplied by their price levels) for all cost categories yields the composite index level of the market basket in a given period. Repeating this step for other periods produces a series of market basket levels over time. Dividing an index level for a given period by an index level for an earlier period produces a rate of growth in the input price index over that time period. A market basket is described as a fixed-weight index because it answers the question of how much it would cost, at another time, to purchase the same mix of goods and services purchased to provide hospital services in a base period. The effects on total expenditures resulting from changes in the quantity or mix of goods and services (intensity) purchased subsequent to the base period are not measured. In this manner, the market basket measures only pure price change. Only when the index is rebased would the quantity and intensity effects be captured in the cost weights. Therefore, we rebase the market basket periodically so that cost weights reflect changes in the mix of goods and services that hospitals purchase (hospital inputs) to furnish patient care between base periods. The terms rebasing and revising, while often used interchangeably, actually denote different activities. Rebasing means moving the base year for the structure of costs of an input price index (for example, shifting the base year cost structure from FY 1997 to FY 2002). Revising means changing data sources, methodology, or price proxies used in the input price index. We propose to rebase and revise the market basket used to update the IPF PPS. 2. Proposed Methodology for Operating Portion of the RPL Market Basket The operating portion of the proposed FY 2002-based RPL market basket consists of several major cost categories derived from the FY 2002 Medicare cost reports for IRFs, IPFs, and LTCHs: wages, drugs, professional liability insurance, and a residual. We choose to use FY 2002 as the base year because we believe this is the most recent, complete year of Medicare cost report data and is consistent with the data year on which the IPF PPS is based. Due to insufficient Medicare cost report data for IRFs, IPFs, and LTCHs, we propose to develop cost weights for benefits, contract labor, and blood and blood products using the FY 2002-based IPPS market basket (70 FR 23384), which we explain in more detail later in this section. For example, less than 30 percent of IRFs, IPFs, and LTCHs reported benefit cost data in FY 2002. We have noticed an increase in cost data for these expense categories over the last 4 years. The next time we rebase the RPL market basket there may be sufficient IRFs, IPFs, and LTCHs cost report data to develop the weights for these expenditure categories. Since the cost weights for the RPL market basket are based on facility costs, we are proposing to limit our sample to hospitals with a Medicare average length of stay
(LOS)within a comparable range of the total facility average LOS. We believe this provides a more accurate reflection of the structure of costs for Medicare covered days. Our goal is to measure cost shares that are reflective of case mix and practice patterns associated with providing services to Medicare beneficiaries. We propose to use those cost reports for IRFs and LTCHs whose Medicare average LOS is within 15 percent (that is, 15 percent higher or lower) of the total facility average LOS for the hospital. This is the same edit applied to the FY 1992-based and FY 1997-based excluded hospital with capital market basket. We are proposing 15 percent because it includes those LTCHs and IRFs whose Medicare LOS is within approximately 5 days of the facility LOS. However, we are proposing to use a less stringent measure of Medicare LOS for IPFs whose average LOS is within 30 or 50 percent (depending on the total facility average LOS) of the total facility average LOS. Using this less stringent edit allows us to increase our sample size by over 150 cost reports and produce a cost weight more consistent with the overall facility. The edit we applied to IPFs when developing the FY 1997-based excluded hospital with capital market basket was based on the best available data at the time. The detailed cost categories under the residual (that is, the remaining portion of the market basket after excluding wages and salaries, drugs, and professional liability cost weights) are derived from the FY 2002-based IPPS market basket and the 1997 Benchmark Input-Output (I-O) Tables published by the Bureau of Economic Analysis, U.S. Department of Commerce. The FY 2002-based IPPS market basket was developed using FY 2002 Medicare hospital cost reports with the most recent and detailed cost data (see the IPPS final rule in the August 12, 2005 **Federal Register** (70 FR 47388)). The 1997 Benchmark I-O is the most recent, comprehensive source of cost data for all hospitals. The proposed RPL cost weights for benefits, contract labor, and blood and blood products were derived using the FY 2002-based IPPS market basket. For example, the ratio of the benefit cost weight to the wages and salaries cost weight in the FY 2002-based IPPS market basket was applied to the RPL wages and salaries cost weight to derive a benefit cost weight for the RPL market basket. The remaining proposed RPL operating cost categories were derived using the 1997 Benchmark I-O Tables, aged to 2002 using relative price changes. (The methodology we used to age the data involves applying the annual price changes from the price proxies to the appropriate cost categories. We repeat this practice for each year.) Therefore, using this methodology, roughly 59 percent of the proposed RPL market basket is accounted for by wages, drugs, and professional liability insurance data from FY 2002 Medicare cost report data for IRFs, LTCHs, and IPFs. Table 2 below sets forth the complete proposed 2002-based RPL market basket including cost categories, weights, and price proxies. For comparison purposes, the corresponding FY 1997-based excluded hospital with capital market basket is listed as well. Wages and salaries are 52.895 percent of total costs in the proposed FY 2002-based RPL market basket compared to 47.335 percent for the FY 1997-based excluded hospital with capital market basket. Employee benefits are 12.982 percent in the proposed FY 2002-based RPL market basket compared to 10.244 percent for the FY 1997-based excluded hospital with capital market basket. As a result, compensation costs (wages and salaries plus employee benefits) for the proposed FY 2002-based RPL market basket are 65.877 percent of costs compared to 57.579 percent for the FY 1997-based excluded hospital with capital market basket. Of the 8 percentage-point difference between the compensation shares, approximately 3 percentage points are due to the proposed new base year (FY 2002 instead of FY 1997), 3 percentage points are due to revised length of stay edit, and the remaining 2 percentage points are due to the proposed exclusion of other hospitals (that is, only including IPFs, IRFs, and LTCHs in the market basket). Following the table is a summary outlining the choice of the proxies we propose to use for the operating portion of the market basket. The price proxies for the capital portion are described in more detail in the capital methodology section (see section III.C.3 of this proposed rule). Table 2.—Proposed FY 2002-Based RPL Market Basket Cost Categories, Weights, and Proxies With FY 1997-Based Excluded Hospital With Capital Market Basket Used for Comparison Expense categories FY 1997-based excluded hospital with capital market basket Proposed FY 2002-based RPL market basket Proposed FY 2002 RPL market basket price proxies Total 100.000 100.000 Compensation 57.579 65.877 Wages and Salaries* 47.335 52.895 ECI-Wages and Salaries, Civilian Hospital Workers. Employee Benefits* 10.244 12.982 ECI-Benefits, Civilian Hospital Workers. Professional Fees, Non-Medical 4.423 2.892 ECI-Compensation for Professional, Specialty & Technical Workers. Utilities 1.180 0.656 Electricity 0.726 0.351 PPI-Commercial Electric Power. Fuel Oil, Coal, etc. 0.248 0.108 PPI-Refined Petroleum Products. Water and Sewage 0.206 0.197 CPI-U—Water & Sewage Maintenance. Professional Liability Insurance 0.733 1.161 CMS Professional Liability Premium Index. All Other Products and Services 27.117 19.265 All Other Products 17.914 13.323 Pharmaceuticals 6.318 5.103 PPI Prescription Drugs. Food: Direct Purchase 1.122 0.873 PPI Processed Foods & Feeds. Food: Contract Service 1.043 0.620 CPI-U Food Away From Home. Chemicals 2.133 1.100 PPI Industrial Chemicals. Blood and Blood Products** 0.748 Medical Instruments 1.795 1.014 PPI Medical Instruments & Equipment. Photographic Supplies 0.167 0.096 PPI Photographic Supplies. Rubber and Plastics 1.366 1.052 PPI Rubber & Plastic Products. Paper Products 1.110 1.000 PPI Converted Paper & Paperboard Products. Apparel 0.478 0.207 PPI Apparel. Machinery and Equipment 0.852 0.297 PPI Machinery & Equipment. Miscellaneous 0.783 1.963 PPI Finished Goods less Food & Energy. All Other Services 9.203 5.942 Telephone 0.348 0.240 CPI-U Telephone Services. Postage 0.702 0.682 CPI-U Postage. All Other: Labor Intensive 4.453 2.219 ECI-Compensation for Intensive Private Service Occupations. All Other: Non-labor Intensive 3.700 2.800 CPI-U All Items. Capital-Related Costs 8.968 10.149 Depreciation 5.586 6.186 Fixed Assets 3.503 4.250 Boeckh Institutional Construction 23-year useful life. Movable Equipment 2.083 1.937 WPI Machinery & Equipment 11-year useful life. Interest Costs 2.682 2.775 Nonprofit 2.280 2.081 Average yield on domestic municipal bonds (Bond Buyer 20 bonds) vintage- weighted (23 years). For Profit 0.402 0.694 Average yield on Moody's Aaa bonds vintage weighted (23 years). Other Capital-Related Costs 0.699 1.187 CPI-U Residential Rent. * Labor-related. ** Blood and blood-related products is included in miscellaneous products. Note: Due to rounding, weights may not sum to total. Below we provide the proxies that we are proposing to use for the FY 2002-based RPL market basket. With the exception of the Professional Liability proxy, all the proposed price proxies for the operating portion of the proposed RPL market basket are based on Bureau of Labor Statistics
(BLS)data and are grouped into one of the following BLS categories: • Producer Price Indexes—Producer Price Indexes
(PPIs)measure price changes for goods sold in other than retail markets. PPIs are preferable price proxies for goods that hospitals purchase as inputs in producing their outputs because the PPIs better reflect the prices faced by hospitals. For example, we use a special PPI for prescription drugs, rather than the Consumer Price Index
(CPI)for prescription drugs because hospitals generally purchase drugs directly from the wholesaler. The PPIs that we use measure price change at the final stage of production. • Consumer Price Indexes—Consumer Price Indexes
(CPIs)measure change in the prices of final goods and services bought by the typical consumer. Because they may not represent the price faced by a producer, we use CPIs only if an appropriate PPI is not available, or if the expenditures are more similar to those of retail consumers in general rather than purchases at the wholesale level. For example, the CPI for food purchases away from home is used as a proxy for contracted food services. • Employment Cost Indexes—Employment Cost Indexes
(ECIs)measure the rate of change in employee wage rates and employer costs for employee benefits per hour worked. These indexes are fixed-weight indexes and strictly measure the change in wage rates and employee benefits per hour. Appropriately, they are not affected by shifts in employment mix. We evaluated the price proxies using the criteria of reliability, timeliness, availability, and relevance. Reliability indicates that the index is based on valid statistical methods and has low sampling variability. Timeliness implies that the proxy is published regularly, preferably at least once a quarter. Availability means that the proxy is publicly available. Finally, relevance means that the proxy is applicable and representative of the cost category weight to which it is applied. The CPIs, PPIs, and ECIs selected by us to be proposed in this regulation meet these criteria. We note that the proxies are the same as those used for the FY 1997-based excluded hospital with capital market basket. Because these proxies meet our criteria of reliability, timeliness, availability, and relevance, we believe they continue to be the best measure of price changes for the cost categories. For further discussion on the FY 1997-based excluded hospital with capital market basket, see the IPPS final rule published in the **Federal Register** on August 1, 2002 (67 FR at 50042). Wages and Salaries For measuring the price growth of wages in the proposed FY 2002-based RPL market basket, we propose to use the ECI for wages and salaries for civilian hospital workers as the proxy for wages in the RPL market basket. Employee Benefits The proposed FY 2002-based RPL market basket uses the ECI for employee benefits for civilian hospital workers. Nonmedical Professional Fees The ECI for compensation for professional and technical workers in private industry would be applied to this category since it includes occupations such as management and consulting, legal, accounting, and engineering services. Fuel, Oil, and Gasoline The percentage change in the price of gas fuels as measured by the PPI (Commodity Code #0552) would be applied to this component. Electricity The percentage change in the price of commercial electric power as measured by the PPI (Commodity Code #0542) would be applied to this component. Water and Sewage The percentage change in the price of water and sewage maintenance as measured by the Consumer Price Index
(CPI)for all urban consumers (CPI Code #CUUR0000SEHG01) would be applied to this component. Professional Liability Insurance The proposed FY 2002-based RPL market basket would use the percentage change in hospital professional liability insurance
(PLI)premiums as estimated by the CMS Hospital Professional Liability Index for the proxy of this category. In the FY 1997-based excluded hospital with capital market basket, the same proxy was used. We continue to research options for improving our proxy for professional liability insurance. This research includes exploring various options for expanding our current survey, including the identification of another entity that would be willing to work with us to collect more complete and comprehensive data. We are also exploring other options such as third party or industry data that might assist us in creating a more precise measure of PLI premiums. At this time we have not identified a preferred option, therefore no change is proposed for the proxy in this proposed rule. Pharmaceuticals The percentage change in the price of prescription drugs as measured by the PPI (PPI Code #PPI32541DRX) would be used as a proxy for this cost category. This is a special index produced by BLS as a proxy in the 1997-based excluded hospital with capital market basket. Food, Direct Purchases The percentage change in the price of processed foods and feeds as measured by the PPI (Commodity Code #02) would be applied to this component. Food, Contract Service The percentage change in the price of food purchased away from home as measured by the CPI for all urban consumers (CPI Code #CUUR0000SEFV) would be applied to this component. Chemicals The percentage change in the price of industrial chemical products as measured by the PPI (Commodity Code #061) would be applied to this component. While the chemicals hospitals purchase include industrial as well as other types of chemicals, the industrial chemicals component constitutes the largest proportion by far. Thus we believe that Commodity Code #061 is the appropriate proxy. Medical Instruments The percentage change in the price of medical and surgical instruments as measured by the PPI (Commodity Code #1562) would be applied to this component. Photographic Supplies The percentage change in the price of photographic supplies as measured by the PPI Commodity Code #1542) would be applied to this component. Rubber and Plastics The percentage change in the price of rubber and plastic products as measured by the PPI (Commodity Code #07) would be applied to this component. Paper Products The percentage change in the price of converted paper and paperboard products as measured by the PPI (Commodity Code #0915) would be applied to this component. Apparel The percentage change in the price of apparel as measured by the PPI (Commodity Code #381) would be applied to this component. Machinery and Equipment The percentage change in the price of machinery and equipment as measured by the PPI (Commodity Code #11) would be applied to this component. Miscellaneous Products The percentage change in the price of all finished goods less food and energy as measured by the PPI (Commodity Code #SOP3500) would be applied to this component. Using this index would remove the double-counting of food and energy prices, which are captured elsewhere in the market basket. The weight for this cost category is higher, in part, than in the 1997-based index because the weight for blood and blood products (1.188) is added to it. In the 1997-based excluded hospital with capital market basket, we included a separate cost category for blood and blood products, using the BLS PPI for blood and derivatives as a price proxy. A review of recent trends in the PPI for blood and derivatives suggests that its movements may not be consistent with the trends in blood costs faced by hospitals. While this proxy did not match exactly with the product hospitals are buying, its trend over time appears to be reflective of the historical price changes of blood purchased by hospitals. However, an apparent divergence over recent years led us to reevaluate whether the PPI for blood and derivatives was an appropriate measure of the changing price of blood. We ran test market baskets classifying blood in three separate cost categories: blood and blood products, contained within chemicals as was done for the 1992-based excluded hospital with capital market basket, and within miscellaneous products. These categories use as proxies the following PPIs: The PPI for blood and blood products, the PPI for chemicals, and the PPI for finished goods less food and energy, respectively. Of these three proxies, the PPI for finished goods less food and energy moved most like the recent blood cost and price trends. In addition, the impact on the overall market basket by using different proxies for blood was negligible, mostly due to the relatively small weight for blood in the market basket. Therefore, we are proposing to use the PPI for finished goods less food and energy for the blood proxy because we believe it more appropriately proxies the price changes (not quantities or required tests) associated with blood purchased by hospitals. We will continue to evaluate this proxy for its appropriateness and will explore the development of alternative price indexes to proxy the price changes associated with this cost. Telephone The percentage change in the price of telephone services as measured by the CPI for all urban consumers (CPI Code #CUUR0000SEED) would be applied to this component. Postage The percentage change in the price of postage as measured by the CPI for all urban consumers (CPI Code #CUUR0000SEEC01) would be applied to this component. All Other Services, Labor Intensive The percentage change in the ECI for compensation paid to service workers employed in private industry would be applied to this component. All Other Services, Nonlabor Intensive The percentage change in the all items component of the CPI for all urban consumers (CPI Code # CUUR0000SA0) would be applied to this component. 3. Proposed Methodology for Capital Portion of the RPL Market Basket Unlike for the operating costs of the proposed FY 2002-based RPL market basket, we did not have IRF, IPF, and LTCH FY 2002 Medicare cost report data for the capital cost weights, due to a change in the FY 2002 reporting requirements. Rather, we used these hospitals' expenditure data for the capital cost categories of depreciation, interest, and other capital expenses for FY 2001, and aged the data to a FY 2002 base year using relevant price proxies. We calculated weights for the proposed RPL market basket capital costs using the same set of Medicare cost reports used to develop the operating share for IRFs, IPFs, and LTCHs. The resulting proposed capital weight for the FY 2002 base year is 10.149 percent. This is based on FY 2001 Medicare cost report data for IRFs, IPFs, and LTCHs, aged to FY 2002 using relevant price proxies. Lease expenses are not a separate cost category in the market basket, but are distributed among the cost categories of depreciation, interest, and other, reflecting the assumption that the underlying cost structure of leases is similar to capital costs in general. We assumed 10 percent of lease expenses are overhead and assigned them to the other capital expenses cost category as overhead. We base this assignment of 10 percent of lease expenses to overhead on the common assumption that overhead is 10 percent of costs. The remaining lease expenses were distributed to the three cost categories based on the weights of depreciation, interest, and other capital expenses not including lease expenses. Depreciation contains two subcategories: building and fixed equipment and movable equipment. The split between building and fixed equipment and movable equipment was determined using the FY 2001 Medicare cost reports for IRFs, IPFs, and LTCHs. This methodology was also used to compute the 1997-based index (67 FR at 50044). The total interest expense cost category is split between the government/nonprofit and for-profit hospitals. The 1997-based excluded hospital with capital market basket allocated 85 percent of the total interest cost weight to the government nonprofit interest, proxies by average yield on domestic municipal bonds, and 15 percent to for-profit interest, proxies by average yield on Moody's Aaa bonds. We propose to derive the split using the relative FY 2001 Medicare cost report data for PPS hospitals on interest expenses for the government/nonprofit and for-profit hospitals. Due to insufficient Medicare cost report data for IPFs, IRFs, and LTCHs, we propose to use the same split used in the IPPS capital input price index. We believe it is important that this split reflect the latest relative cost structure of interest expenses for hospitals and, therefore, we propose to use a 75-25 split to allocate interest expenses to government/nonprofit and for-profit (70 FR at 47408). Since capital is acquired and paid for over time, capital expenses in any given year are determined by both past and present purchases of physical and financial capital. The vintage-weighted capital index is intended to capture the long-term consumption of capital, using vintage weights for depreciation (physical capital) and interest (financial capital). These vintage weights reflect the purchase patterns of building and fixed equipment and movable equipment over time. Depreciation and interest expenses are determined by the amount of past and current capital purchases. Therefore we are proposing to use the vintage weights to compute vintage-weighted price changes associated with depreciation and interest expense. Vintage weights are an integral part of the proposed FY 2002-based RPL market basket. Capital costs are inherently complicated and are determined by complex capital purchasing decisions, over time, based on such factors as interest rates and debt financing. In addition, capital is depreciated over time instead of being consumed in the same period it is purchased. The capital portion of the proposed FY 2002-based RPL market basket would reflect the annual price changes associated with capital costs, and would be a useful simplification of the actual capital investment process. By accounting for the vintage nature of capital, we are able to provide an accurate, stable annual measure of price changes. Annual non-vintage price changes for capital are unstable due to the volatility of interest rate changes and, therefore, do not reflect the actual annual price changes for Medicare capital-related costs. The capital component of the proposed FY 2002-based RPL market basket would reflect the underlying stability of the capital acquisition process and provide hospitals with the ability to plan for changes in capital payments. To calculate the vintage weights for depreciation and interest expenses, we needed a time series of capital purchases for building and fixed equipment and movable equipment. We found no single source that provides the best time series of capital purchases by hospitals for all of the above components of capital purchases. The early Medicare Cost Reports did not have sufficient capital data to meet this need. While the American Hospital Association
(AHA)Panel Survey provided a consistent database back to 1963, it did not provide annual capital purchases. However, the AHA Panel Survey provided a time series of depreciation expenses through 1997 which could be used to infer capital purchases over time. From 1998 to 2001, hospital depreciation expenses were calculated by multiplying the AHA Annual Survey total hospital expenses by the ratio of depreciation to total hospital expenses from the Medicare cost reports. Beginning in 2001, the AHA Annual Survey began collecting depreciation expenses. We hope to be able to use these data in future rebasings. In order to estimate capital purchases from AHA data on depreciation and interest expenses, the expected life for each cost category (building and fixed equipment, movable equipment, and debt instruments) is needed. Due to insufficient Medicare cost report data for IPFs, IRFs, and LTCHs, we propose to use FY 2001 Medicare Cost Reports for IPPS hospitals to determine the expected life of building and fixed equipment and movable equipment. We believe this data source reflects the latest relative cost structure of depreciation expenses for hospitals and is analogous to IPFs, IRFs, and LTCHs. The expected life of any piece of equipment can be determined by dividing the value of the asset (excluding fully depreciated assets) by its current year depreciation amount. This calculation yields the estimated useful life of an asset if depreciation were to continue at current year levels, assuming straight-line depreciation. From the FY 2001 Medicare cost reports for IPPS hospitals the expected life of building and fixed equipment was determined to be 23 years, and the expected life of movable equipment was determined to be 11 years. We also propose to use the fixed and movable weights derived from FY 2001 Medicare cost reports for IPFs, IRFs, and LTCHs to separate the depreciation expenses into annual amounts of building and fixed equipment depreciation and movable equipment depreciation. By multiplying the annual depreciation amounts by the expected life calculations from the FY 2001 Medicare cost reports, year-end asset costs for building and fixed equipment and movable equipment were determined. We then calculated a time series back to 1963 of annual capital purchases by subtracting the previous year asset costs from the current year asset costs. From this capital purchase time series we were able to calculate the vintage weights for building and fixed equipment, movable equipment, and debt instruments. An explanation of each of these sets of vintage weights follows. For proposed building and fixed equipment vintage weights, the real annual capital purchase amounts for building and fixed equipment derived from the AHA Panel Survey were used. The real annual purchase amount was used to capture the actual amount of the physical acquisition, net of the effect of price inflation. This real annual purchase amount for building and fixed equipment was produced by deflating the nominal annual purchase amount by the building and fixed equipment price proxy, the Boeckh Institutional Construction Index. This is the same proxy used for the FY 1997-based excluded hospital with capital market basket. We believe this proxy continues to meet our criteria of reliability, timeliness, availability, and relevance. Since building and fixed equipment has an expected life of 23 years, the vintage weights for building and fixed equipment are deemed to represent the average purchase pattern of building and fixed equipment over 23-year periods. With real building and fixed equipment purchase estimates back to 1963, sixteen 23-year periods could be averaged to determine the average vintage weights for building and fixed equipment that are representative of average building and fixed equipment purchase patterns over time. Vintage weights for each 23-year period are calculated by dividing the real building and fixed capital purchase amount in any given year by the total amount of purchases in the 23-year period. This calculation is done for each year in the 23-year period, and for each of the sixteen 23-year periods. The average of each year across the sixteen 23-year periods is used to determine the 2002 average building and fixed equipment vintage weights. For proposed movable equipment vintage weights, the real annual capital purchase amounts for movable equipment derived from the AHA Panel Survey were used to capture the actual amount of the physical acquisition, net of price inflation. This real annual purchase amount for movable equipment was calculated by deflating the nominal annual purchase amount by the movable equipment price proxy, the PPI for Machinery and Equipment. This is the same proxy used for the FY 1997-based excluded hospital with capital market basket. We believe this proxy, which meets our criteria, is the best measure of price changes for this cost category. Since movable equipment has an expected life of 11 years, the vintage weights for movable equipment are deemed to represent the average purchase pattern of movable equipment over an 11-year period. With real movable equipment purchase estimates available back to 1963, twenty-eight 11-year periods could be averaged to determine the average vintage weights for movable equipment that are representative of average movable equipment purchase patterns over time. Vintage weights for each 11-year period would be calculated by dividing the real movable capital purchase amount for any given year by the total amount of purchases in the 11-year period. This calculation is done for each year in the 11-year period, and for each of the twenty-eight 11-year periods. The average of the twenty-eight 11-year periods would be used to determine the FY 2002 average movable equipment vintage weights. For proposed interest vintage weights, the nominal annual capital purchase amounts for total equipment (building and fixed and movable) derived from the AHA Panel and Annual Surveys were used. Nominal annual purchase amounts were used to capture the value of the debt instrument. Since hospital debt instruments have an expected life of 23 years, the vintage weights for interest are deemed to represent the average purchase pattern of total equipment over 23-year periods. With nominal total equipment purchase estimates available back to 1963, sixteen 23-year periods could be averaged to determine the average vintage weights for interest that are representative of average capital purchase patterns over time. Vintage weights for each 23-year period would be calculated by dividing the nominal total capital purchase amount for any given year by the total amount of purchases in the 23-year period. This calculation would be done for each year in the 23-year period and for each of the sixteen 23-year periods. The average of the sixteen 23-year periods would be used to determine the FY 2002 average interest vintage weights. The vintage weights for the index are presented in Table 3 below. In addition to the price proxies for depreciation and interest costs described above in the vintage weighted capital section, we propose to use the CPI-U for Residential Rent as a price proxy for other capital-related costs. The price proxies for each of the capital cost categories are the same as those used for the IPPS final rule (67 FR at 50044) capital input price index. Table 3.—Proposed CMS FY 2002-Based RPL Market Basket Capital Vintage Weights Year Fixed assets (23 year weights) Movable assets (11 year weights) Interest: Capital-related (23 year weights) 1 0.021 0.065 0.010 2 0.022 0.071 0.012 3 0.025 0.077 0.014 4 0.027 0.082 0.016 5 0.029 0.086 0.019 6 0.031 0.091 0.023 7 0.033 0.095 0.026 8 0.035 0.100 0.029 9 0.038 0.106 0.033 10 0.040 0.112 0.036 11 0.042 0.117 0.039 12 0.045 0.043 13 0.047 0.048 14 0.049 0.053 15 0.051 0.056 16 0.053 0.059 17 0.056 0.062 18 0.057 0.064 19 0.058 0.066 20 0.060 0.070 21 0.060 0.071 22 0.061 0.074 23 0.061 0.076 Total 1.000 1.000 1.000 The proposed rate year (that is, beginning July 1, 2006) update for the IPF PPS using the proposed FY 2002-based RPL market basket and Global Insight's 3rd quarter 2005 forecast would be 4.5 percent. This reflects increases in both the operating and capital portions of the market basket from the 18-month period (that is, January 1, 2005 through June 30, 2006). Global Insight, Inc. is a nationally recognized economic and financial forecasting firm that contracts with CMS to forecast the components of the market baskets. Using the current FY 1997-based excluded hospital with capital market basket (66 FR 41427), Global Insight's 3rd quarter 2005 forecast for the proposed rate year beginning July 1, 2006 would be 4.5 percent. Table 4 below compares the proposed FY 2002-based RPL market basket and the FY 1997-based excluded hospital with capital market basket percent changes. For both the historical and forecasted periods between RY 2000 and RY 2008, the difference between the two market baskets is minor with the exception of RY 2002, where the proposed FY 2002-based RPL market basket increased three tenths of a percentage point higher than the FY 1997-based excluded hospital with capital market basket. This is primarily due to the proposed FY 2002-based RPL having a larger compensation (that is, the sum of wages and salaries and benefits) cost weight than the FY 1997-based index and the price changes associated with compensation costs increasing much faster than the prices of other market basket components. Also contributing is the “all other nonlabor intensive” cost weight, which is smaller in the proposed FY 2002-based RPL market basket than in the FY 1997-based index, as well as the slower price changes associated with these costs. Table 4.—Proposed FY 2002-based RPL Market Basket and FY 1997-Based Excluded Hospital With Capital Market Basket, Percent Changes: 2000-2008 Rate year
(RY)Proposed rebased FY 2002-based RPL market basket FY 1997-based excluded hospital market basket with capital Historical data: RY 2000 2.8 2.7 RY 2001 3.8 3.9 RY 2002 4.1 3.8 RY 2003 3.8 3.7 RY 2004 3.6 3.6 Average RY 2000-2004 3.6 3.5 Forecast: RY 2005 3.8 3.9 RY 2006 3.7 3.8 RY 2007 3.6 3.6 RY 2008 3.5 3.5 Average RY 2005-2008 3.7 3.7 Source: Global Insight, Inc. 3rd Qtr 2005, @USMACRO/CNTL0905 @CISSIM/TL0805.SIM Note: The RY forecasts are based on the standard 12-month period of July 1 to June 30. For this proposed rule, we are moving from an 18-month period to a 12-month period. 4. Proposed Labor-Related Share As described in section IV.C.1 of this proposed rule, due to the variations in costs and geographic wage levels, we are proposing that payment rates under the IPF PPS continue to be adjusted by a geographic wage index. This wage index would apply to the labor-related portion of the proposed Federal per diem base rate, hereafter referred to as the labor-related share. The labor-related share is determined by identifying the national average proportion of operating costs that are related to, influenced by, or vary with the local labor market. Using our current definition of labor-related, the labor-related share is the sum of the relative importance of wages and salaries, fringe benefits, professional fees, labor-intensive services, and a portion of the capital share from an appropriate market basket. We are proposing to use the FY 2002-based RPL market basket costs to determine the proposed labor-related share for the IPF PPS. The proposed labor-related share for RY 2007 would be the sum of the proposed RY 2007 relative importance of each labor-related cost category, and would reflect the different rates of price change for these cost categories between the base year (FY 2002) and RY 2007. The sum of the proposed relative importance for RY 2007 for operating costs (wages and salaries, employee benefits, professional fees, and labor-intensive services) would be 71.845, as shown in Table 5 below. The portion of capital that is influenced by the local labor market would be estimated to be 46 percent, which is the same percentage used in the FY 1997-based IRF and IPF payment systems. Since the relative importance for capital would be 8.866 (RY 2007) percent of the proposed FY 2002-based RPL market basket in RY 2007, we are proposing to take 46 percent of 8.866 percent to determine the proposed labor-related share of capital for RY 2007. The result would be 4.078 percent, which we propose to add to 71.845 percent for the operating cost amount to determine the total proposed labor-related share for RY 2007. Thus, the labor-related share that we propose to use for IPF PPS in RY 2007 would be 75.923 percent. This proposed labor-related share is determined using the same methodology as employed in calculating all previous IPF labor-related shares (69 FR at 66952). Table 5 below shows the proposed RY 2007 relative importance labor-related share using the proposed FY 2002-based RPL market basket and the FY 1997-based excluded hospital with capital market basket. We note that the revised and rebased labor-related share would benefit those hospitals with a wage index greater than or equal to 1.000. Table 5.—Total Labor-Related Share—Relative Importance for RY 2007 Cost category FY 2002-based RPL market basket relative importance (Percent) RY 2007 FY 1997 excluded hospital with capital market basket relative importance (Percent) RY 2007 Wages and salaries 52.761 48.301 Employee benefits 14.008 11.517 Professional fees 2.903 4.527 All other labor-intensive services 2.173 4.457 Subtotal 71.845 68.802 Labor-related share of capital costs 4.078 3.225 Total 75.923 72.027 IPFs Paid Based on a Blend of the Reasonable Cost-based Payments Under the broad authority of sections 1886(b)(3)(A) and (b)(3)(B) of the Act and as stated in the FY 2006 IPPS final rule (70 FR 47399), for IPFs that are transitioning to the fully Federal prospective payment rate, we are now using the rebased and revised FY 2002-based excluded hospital market basket to update the reasonable cost-based portion of their payments. We rebase the market basket periodically so that the cost weights reflect changes in the mix of goods and services that hospitals purchase to furnish inpatient care between base periods. We chose FY 2002 as the base year for the excluded hospital market basket because we believe this is the most recent, complete year of Medicare cost report data. The reasonable cost-based payments, subject to TEFRA limits, are determined on a FY basis. For purposes of the update factor for FY 2006, the portion of the IPF PPS transitional blend payment based on reasonable costs was determined by updating the IPF's TEFRA limit by the FY 2002-based excluded hospital market basket (or 3.8 percent) (70 FR 47691). As discussed in section III.B.3 of this proposed rule, the proposed Federal per diem base rate is $594.66 for the RY beginning July 1, 2006 and ending June 30, 2007. IV. Update of the IPF PPS Adjustment Factors [If you choose to comment on issues in this section, please include the caption “ADJUSTMENT FACTORS” at the beginning of your comments.] A. Overview of the IPF PPS Adjustment Factors In developing the IPF PPS, in order to ensure that the IPF PPS would be able to account adequately for each IPF's case-mix, we performed an extensive regression analysis of the relationship between the per diem costs and certain patient and facility characteristics to determine those characteristics associated with statistically significant cost differences on a per diem basis. For characteristics with statistically significant cost differences, we used the regression coefficients of those variables to determine the size of the corresponding payment adjustments. The IPF PPS payment adjustments were derived from a regression analysis of 100 percent of the FY 2002 MedPAR data file which contained 483,038 cases. We propose to use the same results of this regression analysis for this proposed rule. For a more detailed description of the data file used for the regression analysis, see the IPF PPS final rule. We computed a per diem cost for each Medicare inpatient psychiatric stay, including routine operating, ancillary, and capital components using information from the FY 2002 MedPAR file and data from the FY 2002 Medicare cost reports. To calculate the cost per day for each inpatient psychiatric stay, routine costs were estimated by multiplying the routine cost per day from the IPF's FY 2002 Medicare cost report by the number of Medicare covered days on the FY 2002 MedPAR stay record. Ancillary costs were estimated by multiplying each departmental cost-to-charge ratio by the corresponding ancillary charges on the MedPAR stay record. The total cost per day was calculated by summing routine and ancillary costs for the stay and dividing it by the number of Medicare covered days for each day of the stay. As discussed in more detail in section IV.C.5 of this proposed rule, the IPF PPS includes a payment adjustment for IPFs with qualifying Emergency Departments (EDs), and IPFs that are part of acute care hospitals and CAHs with qualifying EDs. As a result, ED costs were excluded from the dependent variable used in the cost regression in order to remove the effects of ED costs from other payment adjustment factors with which ED costs may be correlated and thus avoid overpaying ED costs. The log of per diem cost, like most health care cost measures, appeared to be normally distributed. Therefore, the natural logarithm of the per diem cost was the dependent variable in the regression analysis. We included variables in the regression to control for psychiatric hospitals that do not bill ancillary costs and for ECT costs that we pay separately. The per diem cost was adjusted for differences in labor cost across geographic areas using the FY 2005 hospital wage index unadjusted for geographic reclassifications, in order to be consistent with our use of the market basket labor share in applying the wage index adjustment. As discussed in the IPF PPS final rule (69 FR 66936), we computed a wage adjustment factor for each case by multiplying the Medicare 2005 hospital wage index based on MSA definitions defined by OMB in 1993 for each facility by the labor-related share and adding the non-labor share. We used the 1997-based excluded hospital with capital market basket to determine the labor-related share. The per diem cost for each case was divided by this factor before taking the natural logarithm. The payment adjustment for the wage index was computed consistently with the wage adjustment factor, which is equivalent to separating the per diem cost into a labor portion and a non-labor portion and adjusting the labor portion by the wage index. With the exception of the teaching adjustment, the independent variables were specified as one or more categorical variables. Once the regression model was finalized based on the log normal variables, the regression coefficients for these variables were converted to payment adjustment factors by treating each coefficient as an exponent of the base “e” for natural logarithms, which is approximately equal to 2.718. The payment adjustment factors represent the proportional effect of each variable relative to a reference variable. As a result of the regression analysis, we established patient-level payment adjustments for age, DRG assignment based on patients' principal diagnoses, selected comorbidities, and a day of stay adjustment (the variable per diem adjustments) to reflect higher resource use in the early days of an IPF stay. We also established facility-level payment adjustments for wage area, rural location, teaching status, cost of living adjustment for IPFs located in Alaska and Hawaii, and an adjustment for IPFs with a qualifying ED. We do not intend to update the regression analysis until we can analyze 1 year of IPF PPS claims and cost report data (that is, no earlier than RY 2008). CMS plans to monitor claims and payment data independently from cost report data to assess issues, or whether changes in case-mix or payment shifts have occurred between free-standing governmental, non-profit, and private psychiatric hospitals, and/or psychiatric units of general hospital, and other impact issues of importance to psychiatric facilities. B. Proposed Patient-Level Adjustments [If you choose to comment on issues in this section, please include the caption “PATIENT-LEVEL ADJUSTMENTS” at the beginning of your comments.] We provided payment adjustments for the following payment-level characteristics in the IPF PPS final rule: DRG assignment of the patient's principal diagnosis, selected comorbidities, patient age, and the variable per diem adjustments. 1. Proposed Adjustment for DRG Assignment The IPF PPS includes payment adjustments for the psychiatric DRG assigned to the claim based on each patient's principal diagnosis. In the IPF PPS final rule, we explained that the IPF PPS includes 15 diagnosis-related group
(DRG)adjustment factors (69 FR 66936). The adjustment factors were expressed relative to the most frequently reported DRG in FY 2002, that is, DRG 430. The coefficient values and adjustment factors were derived from the regression analysis. In accordance with § 412.27, payment under the IPF PPS is made for claims with a principal diagnosis included in the Diagnostic and Statistical Manual of Mental Disorder—Fourth Edition—Text Revision (DSM-IV-TR) or Chapter Five of the International Classification of Diseases—9th Revision—Clinical Modifications (ICD-9-CM). The Standards for Electronic Transaction final rule published in the **Federal Register** on August 17, 2000 (65 FR 50312), adopted the ICD-9-CM as the designated code set for reporting diseases, injuries, impairments, other health related problems, their manifestations, and causes of injury, disease, impairment, or other health-related problems. As a result, the DSM-IV-TR, while essential for the diagnosis and treatment of mentally ill patients, may not be reported on Medicare claims. However, in order to recognize the importance of the DSM-IV-TR in mental health treatment, we updated the reference to the DSM in § 412.27 from DSM-III-TR to DSM-IV-TR in the IPF PPS final rule. As a result, under the revised § 412.27, IPFs that are distinct part psychiatric units of acute care hospitals and CAHs may only admit patients who have a principal diagnosis in the DSM-IV-TR or Chapter Five of the ICD-9-CM although DSM codes may not be reported on medical claims. IPF claims with a principal diagnosis included in Chapter Five of the ICD-9-CM or the DSM-IV-TR will be paid the Federal per diem base rate payment under the IPF PPS. Psychiatric principal diagnoses that do not group to one of the 15 designated DRGs receive the Federal per diem base rate and all other applicable adjustments, but the payment does not include a DRG adjustment. Only those claims with diagnoses that group to one of these psychiatric DRGs would receive a DRG adjustment. We believe it is vital to maintain the same diagnostic coding and DRG classification for IPFs that is used under the IPPS for providing the same psychiatric care. As we explained in the IPF PPS proposed rule (68 FR 66924), all changes to the ICD-9-CM coding system that would impact the IPF PPS are addressed annually in the IPPS proposed and final rules published each year. The updated codes are effective October 1 of each year and must be used to report diagnostic or procedure information. The official version of the ICD-9-CM is available on CD-ROM from the U.S. Government Printing Office. The FY 2005 version can be ordered by contacting the Superintendent of Documents, U.S. Government Printing Office, Department 50, Washington, D.C. 20402-9329, telephone number
(202)512-1800. The stock number is 017-022-01544-7, and the price is $25.00. In addition, private vendors publish the ICD-9-CM. Questions concerning the ICD-9-CM should be directed to Patricia E. Brooks, Co-Chairperson, ICD-9-CM Coordination and Maintenance Committee, CMS, Center for Medicare Management, Purchasing Policy Group, Division of Acute Care, Mailstop C4-08-06, 7500 Security Boulevard, Baltimore, Maryland 21244-1850. Questions and comments may be sent via e-mail to: *Patricia.Brooks1@cms.hhs.gov* . Further information concerning the Official Version of the ICD-9-CM can be found in the IPPS final regulation, “Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2006 Rates; Final Rule,” in the August 12, 2005 **Federal Register** (70 FR 47278) and at *http://www.cms.hhs.gov/QuarterlyProviderUpdates/downloads/cms1500f.pdf* . The following two tables below list the FY 2006 new ICD diagnosis codes and FY 2006 revised diagnosis code titles, respectively. These tables are only a listing of FY 2006 changes and do not reflect all of the currently valid and applicable ICD codes classified in the DRGs. Table 6 below lists the new FY 2006 ICD diagnosis codes that are classified to one of the 15 DRGs that are provided a DRG adjustment in the IPF PPS. When coded as a principal code or diagnosis, these codes would receive the correlating DRG adjustment. Table 6.—FY 2006 New Diagnosis Codes Diagnosis Diagnosis code Description DRG 291.82 Alcohol-induced sleep disorders 521, 522, 523 292.85 Drug-induced sleep disorders 521, 522, 523 327.00 Organic insomnia, unspecified 432 327.01 Insomnia due to medical condition classified elsewhere 432 327.02 Insomnia due to mental disorder 432 327.09 Other organic insomnia 432 327.10 Organic hypersomnia, unspecified 432 327.11 Idiopathic hypersomnia with long sleep time 432 327.12 Idiopathic hypersomnia without long sleep time 432 327.13 Recurrent hypersomnia 432 327.14 Hypersomnia due to medical condition classified elsewhere 432 327.15 Hypersomnia due to mental disorder 432 327.19 Other organic hypersomnia 432 Table 7 below lists ICD diagnosis codes whose titles have been modified in FY 2006. Title changes do not impact the DRG adjustment. When used as a principal diagnosis, these codes would still receive the correlating DRG adjustment. Table 7.—Revised Diagnosis Code Titles Diagnosis code Description DRG 307.45 Circadian rhythm sleep disorder of nonorganic origin 432 780.52 Insomnia, unspecified 432 780.54 Hypersomnia, unspecified 432 780.55 Disruption of 24 hour sleep wake cycle, unspecified 432 780.58 Sleep related movement disorder, unspecified 432 In addition to the aforementioned, in the August 2005 IPPS final rule, we finalized ICD code 305.1, Tobacco Use Disorder, in order to designate this code as a noncovered Medicare service when reported as the principal diagnosis. Below we have republished the explanation that was included in the IPPS final rule (70 FR 47312) and published on the CMS website at *http://www.cms.hhs.gov/ QuarterlyProviderUpdates/downloads/cms1500f.pdf* . We have become aware of the possible need to add code 305.1 (Tobacco use disorder) to the MCE in order to make admissions for tobacco use disorder a noncovered Medicare service when code 305.1 is reported as the principal diagnosis. On March 22, 2005, CMS published a final decision memorandum and related national coverage determination
(NCD)on smoking cessation counseling services on its Web site: ( *http://www.cms.hhs.gov/coverage/* ). Among other things, this NCD provides that: ‘Inpatient hospital stays with the principal diagnosis of 305.1, Tobacco Use Disorder, are not reasonable and necessary for the effective delivery of tobacco cessation counseling services. Therefore, we will not cover tobacco cessation services if tobacco cessation is the primary reason for the patient's hospital stay.’ Therefore, in order to maintain internal consistency with CMS programs and decisions, we proposed to add code 305.1 to the MCE edit “Questionable Admission—Principal Diagnosis Only” in order to make tobacco use disorder a noncovered admission. (70 FR 47312). In order to maintain consistency with the IPPS, for discharges on or after October 1, 2005, ICD code 305.1, Tobacco Use Disorder, would not be a covered principal diagnosis under the IPF PPS. Although we are updating the IPF PPS to reflect ICD-9-CM coding changes and DRG classification changes discussed in the annual update to the IPPS, we are proposing that the DRG adjustment factors currently being paid to IPFs would remain the same for discharges occurring during the rate year July 1, 2006 through June 30, 2007. As indicated in the IPF PPS final rule, we do not intend to update the regression analysis until we have analyzed 1 year of IPF PPS claims and cost report data. As a result, we are proposing to adopt the DRG adjustments that are currently being paid as indicated in Table 8 below. Table 8.—FY 2006 Proposed DRGs and Adjustment Factor DRG DRG definition Adjustment factor DRG 424 O.R. Procedure with Principal Diagnosis of Mental Illness 1.22 DRG 425 Acute Adjustment Reaction & Psychosocial Dysfunction 1.05 DRG 426 Depressive Neurosis 0.99 DRG 427 Neurosis, Except Depressive 1.02 DRG 428 Disorders of Personality & Impulse Control 1.02 DRG 429 Organic Disturbances & Mental Retardation 1.03 DRG 430 Psychoses 1.00 DRG 431 Childhood Mental Disorders 0.99 DRG 432 Other Mental Disorder Diagnoses 0.92 DRG 433 Alcohol/Drug Abuse or Dependence, Leave Against Medical Advice
(LAMA)0.97 DRG 521 Alcohol/Drug Abuse or Dependence with CC 1.02 DRG 522 Alcohol/Drug Abuse or Dependence with Rehabilitation Therapy without CC 0.98 DRG 523 Alcohol/Drug Abuse or Dependence without Rehabilitation Therapy without CC 0.88 DRG 12 Degenerative Nervous System Disorders 1.05 DRG 23 Non-traumatic Stupor & Coma 1.07 Section § 412.424(d) separately identifies both “Diagnosis-related group assignment” and “Principal diagnosis” as patient level adjustments. Since publication of the IPF PPS final rule, we have received inquiries related to whether the IPF PPS includes two patient-level payment adjustments for principal diagnosis, an adjustment for the diagnosis-related group assignment and a separate adjustment for providing a principal diagnosis in general. We intended that the IPF PPS provide one patient-level adjustment for principal diagnosis, that is “Diagnosis-related group assignment.” In order to clarify our policy, we are proposing to modify the language in section § 412.424(d). We are proposing to delete sub-paragraph § 412.424(d)(2)(iii). 2. Proposed Payment for Comorbid Conditions In the IPF PPS final rule, we established 17 comorbidity categories and identified the ICD-9-CM diagnosis codes that generate a payment adjustment under the IPF PPS. Comorbidities are specific patient conditions that are secondary to the patient's primary diagnosis, and that require treatment during the stay. Diagnoses that relate to an earlier episode of care and have no bearing on the current hospital stay are excluded and not reported on IPF claims. Comorbid conditions must co-exist at the time of admission, develop subsequently, affect the treatment received, affect the length of stay or affect both treatment and length of stay. The intent of the comorbidity adjustments was to recognize the increased cost associated with comorbid conditions by providing additional payments for certain concurrent medical or psychiatric conditions that are expensive to treat. An IPF may receive only one comorbidity adjustment per comorbidity category, but it may receive an adjustment for more than one comorbidity category. Billing instructions require that IPFs must enter the full ICD-9-CM codes for up to 8 additional diagnoses if they co-exist at the time of admission or developed subsequently. The comorbidity adjustments were determined based on regression analysis using the diagnoses reported by hospitals as other diagnoses in FY 2002. The principal diagnoses were used to establish the DRG adjustment and were not accounted for in establishing the comorbidity category adjustments, except where ICD-9-CM “code first” instructions apply. As we explained in the IPF PPS final rule, the code first rule applies when a condition has both an underlying etiology and a manifestation due to the underlying etiology. For these conditions, the ICD-9-CM has a coding convention that requires the underlying conditions to be sequenced first followed by the manifestation. Whenever a combination exists, there is a “use additional code” note at the etiology code and a “code first” note at the manifestation code. Although we are updating the IPF PPS to reflect updates to the ICD-9-CM codes, we are proposing that the comorbidity adjustment factors currently in effect would remain in effect for the rate year beginning July 1, 2006. As we indicated in the IPF PPS final rule, we do not intend to update the regression analysis until we have analyzed 1 year of IPF PPS claims and cost report data. The proposed comorbidity adjustments are shown in Table 9 below. As previously discussed in the DRG section, we believe it is essential to maintain the same diagnostic coding set for IPFs that is used under the IPPS for providing the same psychiatric care. Therefore, we are proposing to use the most current FY 2006 ICD codes. They are reflected in the FY 2006 GROUPER, version 23.0 and are effective for discharges occurring on or after October 1, 2005. Table 9 lists the updated FY 2006 new ICD diagnosis codes that impact the comorbidity adjustment under the IPF PPS and Table 10 lists the invalid ICD codes no longer applicable for the comorbidity adjustment. Table 9 only lists the FY 2006 new codes and does not reflect all of the currently valid ICD codes applicable for the IPF PPS comorbidity adjustment. We note that ICD diagnosis code 585 Chronic Renal Failure was modified in two ways—(1) by expanding the level of specificity to include seven new codes; and
(2)by changing the original code of 585 to invalid, thereby leaving the remaining more specific codes reportable. Since diagnosis code 585 is no longer valid, we are proposing to eliminate this code from the comorbidity category “Renal Failure, Chronic.” ICD diagnosis code 585 chronic Renal Failure is defined in the ICD-9-CM as “Progressive, persistent inadequate kidney function characterized by anuria, accumulation of urea and other nitrogenous bodies in the blood, nausea, vomiting, gastrointestinal bleeding, and yellowish-brown discoloration of the skin.” This code included the various stages of chronic kidney disease, but it is no longer valid. The new codes listed below reflect the various stages of chronic kidney failure. Since diagnosis code 585 is no longer valid, we are proposing to eliminate it from the comorbidity category, “Renal Failure, Chronic”. We are proposing to provide comorbidity adjustments for 585.3, “Chronic kidney disease, Stage III (moderate),” 585.4, “Chronic kidney disease, Stage IV (severe),” 585.5, “Chronic kidney disease, Stage V,” 585.6, “End Stage renal disease,” and 585.9, “Chronic kidney disease, unspecified.” However, since the purpose of the comorbidity adjustment is to account for the higher resource costs associated with comorbid conditions that are expensive to treat on a per diem basis, we are not proposing a comorbidity adjustment for 585.1, “Chronic kidney disease, Stage I” and 585.2, “Chronic kidney disease, Stage II (mild).” We believe that these conditions (585.1 and 585.2) are less costly to treat on a per diem basis because patients with these conditions are either asymptomatic or may have only mild symptoms. These conditions represent a minimal to mild decrease in kidney function that is almost completely compensated such that the only finding is typically an abnormal laboratory test. Unlike patients with more significant kidney dysfunction, these patients do not usually require more costly patient care interventions such as additional lab tests to monitor renal function, special pharmacy attention to reduced dosages or kidney-sparing medications, or fluid and electrolyte precautions with special diets, frequent weights, Input/Output balance, and fluid restriction. As such, the resources and costs that these patients require for staff time, medications and supplies, and administrative services are expected to be similar to other patients without these conditions. Table 9.—FY 2006 New ICD Codes Applicable for the Comorbidity Adjustment Diagnosis code Description DRG Comorbidity category 585.3 Chronic kidney disease, Stage III (moderate) 315-316 Renal Failure, Chronic. 585.4 Chronic kidney disease, Stage IV (severe) 315-316 Renal Failure, Chronic. 585.5 Chronic kidney disease, Stage V 315-316 Renal Failure, Chronic. 585.6 End stage renal disease 315-316 Renal Failure, Chronic. 585.9 Chronic kidney disease, unspecified 315-316 Renal Failure, Chronic. V46.13 Encounter for weaning from respirator [ventilator] 467 Chronic Obstructive Pulmonary Disease. V46.14 Mechanical complication of respirator [ventilator] 467 Chronic Obstructive Pulmonary Disease. In Table 10 below, we list the FY 2006 invalid ICD diagnosis code 585 that we are proposing to remove from the comorbidity adjustment under the IPF PPS. This table does not reflect all of the currently valid ICD codes applicable for the IPF PPS comorbidity adjustment. Table 10.—FY 2006 Invalid ICD Codes No Longer Applicable for the Comorbidity Adjustment Diagnosis code Description DR Comorbidity category 585 Chronic renal failure 315-36 Renal Failure, Chronic. We are aware that ICD code 404.03, Hypertensive Heart and Renal Disease, Malignant, with Heart Failure and Renal Failure, has caused confusion since this ICD code is currently used to code an adjustment in two separate IPF comorbidity categories, (that is, both “Renal Failure, Chronic” and “Cardiac Conditions”). After a careful review of this code, we believe that it more appropriately corresponds to the “Cardiac Conditions” comorbidity than to the “Renal Failure, Chronic” comorbidity. Therefore, to be more clinically cohesive and to eliminate confusion, we are proposing to remove ICD code 404.03 from the comorbidity adjustment category “Renal Failure, Chronic,” but retaining it in the “Cardiac Conditions” comorbidity category. Since both comorbidity categories have the same adjustment factor of 1.11, no negative payment consequence would result from this change. The seventeen comorbidity categories for which we are proposing to provide an adjustment, their respective codes including the new FY 2006 ICD codes, and their respective adjustment factors are listed below in Table 11. Table 11.—FY 2006 Diagnosis Codes and Adjustment Factors for Comorbidity Categories Description of comorbidity ICD-9CM Code Adjustment factor Development Disabilities 317, 3180, 3181, 3182, and 319 1.04 Coagulation Factor deficits 2860 through 2864 1.13 Tracheotomy 51900—through 51909 and V440 1.06 Renal Failure, Acute 5845 through 5849, 63630, 63631, 63632, 63730, 63731, 63732, 6383, 6393, 66932, 66934, 9585 1.11 Renal Failure, Chronic 40301, 40311, 40391, 40402, 40412, 40413, 40492, 40493, 5853, 5854, 5855, 5856, 5859, 586, V451, V560, V561, and V562 1.11 Oncology Treatment 1400 through 2399 with a radiation therapy code 92.21-92.29 or chemotherapy code 99.25 1.07 Uncontrolled Diabetes-Mellitus with or without complications 25002, 25003, 25012, 25013, 25022, 25023, 25032, 25033, 25042, 25043, 25052, 25053, 25062, 25063, 25072, 25073, 25082, 25083, 25092, and 25093 1.05 Severe Protein calorie malnutrition 260 through 262 1.13 Eating and Conduct Disorders 3071, 30750, 31203, 31233, and 31234 1.12 Infectious Disease 01000 through 04110, 042, 04500 through 05319, 05440 through 05449, 0550 through 0770, 0782 through 07889, and 07950 through 07959 1.07 Drug and/or Alcohol Induced Mental Disorders 2910, 2920, 29212, 2922, 30300, and 30400 1.03 Cardiac Conditions 3910, 3911, 3912, 40201, 40403, 4160, 4210, 4211, and 4219 1.11 Gangrene 44024 and 7854 1.10 Chronic Obstructive Pulmonary Disease 49121, 4941, 5100, 51883, 51884, V4611 and V4612, V4613 and V4614 1.12 Artificial Openings—Digestive and Urinary 56960 through 56969, 9975, and V441 through V446 1.08 Severe Musculoskeletal and Connective Tissue Diseases 6960, 7100, 73000 through 73009, 73010 through 73019, and 73020 through 73029 1.11 Poisoning 96500 through 96509, 9654, 9670 through 9699, 9770, 9800 through 9809, 9830 through 9839, 986, 9890 through 9897 1.11 3. Proposed Patient Age Adjustments As explained in the IPF PPS final rule, we analyzed the impact of age on per diem cost by examining the age variable (that is, the range of ages) for payment adjustments. In general, we found that the cost per day increases with increasing age. The older age groups are more costly than the under 45 years of age group, the differences in per diem cost increase for each successive age group, and the differences are statistically significant. Based on the results of the regression analysis, we established 8 adjustment factors for age beginning with age groupings, 45 and under 50, 50 and under 55, 55 and under 60, 60 and under 65, 65 and under 70, 70 and under 75, 75 and under 80, and 80 years of age and over. Patients under 45 years of age are assigned an age adjustment factor of 1.00. As we indicated in the IPF PPS final rule, we do not intend to update the regression analysis until we can analyze 1 year of IPF PPS claims and cost report data. As a result, in this proposed rule, we are proposing to adopt the patient age adjustments currently in effect and shown in Table 12 below. Table 12.—Age Groupings and Adjustment Factors Age Adjustment factor Under 45 1.00 45 and under 50 1.01 50 and under 55 1.02 55 and under 60 1.04 60 and under 65 1.07 65 and under 70 1.10 70 and under 75 1.13 75 and under 80 1.15 80 and over 1.17 4. Proposed Variable Per Diem Adjustments We explained in the IPF PPS final rule that cost regressions indicated that per diem cost declines as the length of stay increases (69 FR 66947). The variable per diem adjustments to the Federal per diem base rate account for ancillary and administrative costs that occur disproportionately in the first days after admission to an IPF. We used regression analysis to estimate the average differences in per diem cost among stays of different length. Regression analysis simultaneously controls for cost differences associated with the other variables (for example, age, DRG, and presence of specific comorbidities). The regression coefficients measure the relative average cost per day for stays of differing lengths compared to a reference group's length of stay. We analyzed through cost regression, the relative cost per day for day 1 through day 30. We determined that the average per diem cost declined smoothly until the 22nd day. As a result of this analysis, we established variable per diem adjustments that begin on day 1 and decline gradually until day 21 of a patient's stay. For day 22 and thereafter, the variable per diem adjustment remains the same each day for the remainder of the stay. However, the adjustment applied to day 1 depends upon whether the IPF has a qualifying Emergency Department (ED). If an IPF has a qualifying ED, it receives a 1.31 adjustment for day 1 of each patient stay. If an IPF does not have a qualifying ED, it receives a 1.19 adjustment for day 1 of the stay. The ED adjustment is explained in more detail in section IV.C.5. of this proposed rule. As we indicated in the IPF PPS final rule, we do not intend to make changes to the regression analysis until we can analyze 1 year of IPF PPS claims and cost report data. As a result, for the rate year beginning July 1, 2006, we are proposing to adopt the variable per diem adjustment factors currently in effect. Table 13 below shows the variable per diem adjustments we are proposing for updating the IPF PPS. Higher payments for the early days of stay in IPFs are not fully compensated by the lower payments after day 10, but are paid for by the standardization portion which is applied to the federal per diem base rate. Table 13.—Variable Per Diem Adjustments Day-of-stay Adjustment factor Day 1-IPF Without a Qualified ED 1.19 Day 1-IPF With a Qualified ED 1.31 Day 2 1.12 Day 3 1.08 Day 4 1.05 Day 5 1.04 Day 6 1.02 Day 7 1.01 Day 8 1.01 Day 9 1.00 Day 10 1.00 Day 11 0.99 Day 12 0.99 Day 13 0.99 Day 14 0.99 Day 15 0.98 Day 16 0.97 Day 17 0.97 Day 18 0.96 Day 19 0.95 Day 20 0.95 Day 21 0.95 After Day 21 0.92 C. Facility-Level Adjustments [If you choose to comment on issues in this section, please include the caption “FACILITY-LEVEL ADJUSTMENTS” at the beginning of your comments.] The IPF PPS includes facility-level adjustments for the wage index, IPFs located in rural areas, teaching IPFs, cost of living adjustments for IPFs located in Alaska and Hawaii, and IPFs with a qualifying ED. 1. Wage Index Adjustment a. Proposed Revisions of IPF PPS Geographic Classifications In the IPF PPS final rule, we explained that in establishing an adjustment for area wage levels, the labor-related portion of an IPF's Federal prospective payment is adjusted by using an appropriate wage index. We also explained that an IPF's wage index is determined based on the location of the IPF in an urban or rural area as defined in § 412.62(f)(1)(ii) and (f)(1)(iii), respectively. An urban area under the IPF PPS is defined at § 412.62(f)(1)(ii)(A) and (B). In general, an urban area is defined as a Metropolitan Statistical Area
(MSA)or New England County Metropolitan Area (NECMA) as defined by the Office of Management and Budget (OMB). In addition, a few counties located outside of MSAs are considered urban as specified at § 412.62(f)(1)(ii)(B). Under § 412.62(f)(1)(iii), a rural area is defined as any area outside of an urban area. The geographic classifications defined in § 412.62(f)(1)(ii) and (f)(1)(iii), were used under the IPPS from FYs 1984 through 2004 (§ 412.62(f) and § 412.63(b)), and have been used under the IPF PPS since it was implemented for cost reporting periods beginning on or after January 1, 2005. Under the IPPS, the wage index is calculated and assigned to hospitals on the basis of the labor market area in which the hospital is located or geographically reclassified to in accordance with sections 1886(d)(8) and (d)(10) of the Act. Under the IPF PPS, the wage index is calculated using IPPS wage index data (as discussed below in section IV C.1.d of this preamble) on the basis of the labor market area in which the IPF is located, without taking into account geographic reclassification under sections 1886(d)(8) and (d)(10) of the Act and without applying the “rural floor” established under section 4410 of the BBA. (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. This provision is commonly referred to as the “rural floor” under the IPPS.) However, when we established the IPF PPS, we did not apply the rural floor to IPFs. For this reason, the hospital wage index used for IPFs is commonly referred to as the “pre-floor” hospital wage index indicating that the “rural floor” provision of the BBA is not applied. As a result, the applicable IPF wage index value is assigned to the IPF on the basis of the labor market area in which the IPF is geographically located. As noted above, the current IPF 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”). The MSA definitions, which are discussed in greater detail below, are currently used under the IPF PPS and other PPSs (that is, the IRF PPS, the LTCH PPS, and the PPSs for home health agencies (HHA PPS) and skilled nursing facilities (SNF PPS)). In the FY 2005 IPPS final rule (69 FR 49026 through 49034), revised labor market area definitions were adopted under the IPPS (§ 412.64(b)), which were effective October 1, 2004. These new standards, called Core-Based Statistical Areas (CBSAs), were announced by the OMB late in 2000 and are discussed in greater detail below. b. Current IPF PPS Labor Market Areas Based on MSAs When we published the IPF PPS final rule, we explained that we were not adopting the new statistical area definitions defined by OMB for the following reasons. First, the change in labor market areas under the IPPS had not changed at the time we published the IPF PPS proposed rule on November 28, 2003. As a result, IPFs and other interested parties were not afforded an opportunity to comment on the use of the new labor market area definitions under the IPF PPS. Second, we wanted to conduct a thorough analysis of the impact of the new labor market area definitions on payments under the IPF PPS. Finally, in the IPF PPS final rule, we indicated our intent to publish in a proposed rule any changes we were considering for new labor market definitions. The analysis of the impact of the new labor market definitions has been completed and we are proposing to adopt new labor market area definitions under the IPF PPS. As a result, we believe it is helpful to provide a detailed description of the current IPF PPS labor market areas, in order to better understand the proposed changes to the IPF PPS labor market areas presented in this proposed rule. As mentioned earlier, since the implementation of the IPF PPS, we have used labor market areas to further characterize urban and rural areas as determined under § 412.62(f)(1)(ii) and (iii). To this end, we have defined labor market areas under the IPF PPS based on the definitions of MSAs, PMSAs, and NECMAs issued by the OMB in 1993, which is consistent with the IPPS approach prior to FY 2005. We note that OMB also defines Consolidated MSAs (CMSAs). A CMSA is a metropolitan area with a population of 1 million or more, comprising two or more PMSAs (identified by their separate economic and social character). However, 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, under the IPF PPS, hospitals are assigned to either an MSA, PMSA, or NECMA based on whether the county in which the IPF 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. c. Core-Based Statistical Areas The OMB reviews its Metropolitan Area definitions preceding each decennial census. As discussed in the FY 2005 IPPS final rule (69 FR 49026), in the fall of 1998, OMB chartered the Metropolitan Area Standards Review Committee to examine the Metropolitan Area 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), OMB announced its new standards. In that notice, 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: Metropolitan Statistical Areas and Micropolitan Statistical Areas.” (65 FR 82236 through 82238). 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, 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 MSAs and 565 new Micropolitan Areas, and extensively revise the composition of many of the existing 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 prior to 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 FY 2005 IPPS final rule (67 FR 49026 through 49034). d. Proposed Revision of the IPF PPS Labor Market Areas In its June 6, 2003 announcement, 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.” We currently use MSAs to define labor market areas for purposes of Medicare wage indices in the IPF PPS since its implementation for cost reporting periods beginning on or after January 1, 2005. Until recently, MSAs were used to define labor market areas for purposes of the wage index for many of the other Medicare payment systems (for example, IRF PPS, SNF PPS, HHA PPS, and Outpatient PPS). While we recognize MSAs are not designed specifically to define labor market areas, we believe they represent a useful proxy for this purpose, because they are based upon characteristics we believe also generally reflect the characteristics of unified labor market areas. For example, CBSAs consist of 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. Our analysis and discussion here are focused on issues related to adopting the new CBSA designations to define labor market areas for the purposes of the IPF PPS. Historically, Medicare PPSs have utilized Metropolitan Area definitions developed by the OMB. As noted above, the labor market areas currently used under the IPF PPS are based on the Metropolitan Area definitions issued by the OMB and the OMB reviews its Metropolitan Area definitions preceding each decennial census to reflect more recent population changes. The CBSAs are OMB's latest Metropolitan Area definitions based on the Census 2000 data. Because we believe that the OMB's latest Metropolitan Area designations more accurately reflect the local economies and wage levels of the areas in which hospitals are currently located, we adopted revised labor market area designations based on the OMB's CBSA designations under the IPPS effective October 1, 2004. When we implemented the wage index adjustment at § 412.424(d)(1)(i) under the IPF PPS final rule (69 FR 66952 through 66954), we explained that the IPF 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. The OMB's CBSA designations based on Census 2000 data reflect the most recent available geographic classifications (Metropolitan Area definitions). Therefore, we are proposing to revise the labor market area definitions used under the IPF PPS based on the OMB's CBSA designations. This change would ensure that the IPF PPS wage index adjustment most appropriately accounts for and reflects the relative hospital wage levels in the geographic area of the hospital as compared to the national average hospital wage level. Specifically, we are proposing to revise the IPF PPS labor market definitions based on the OMB's new CBSA designations (as discussed in greater detail below) effective for IPF PPS discharges occurring on or after July 1, 2006. Accordingly, we are proposing to revise § 412.402, definitions for rural and urban areas, effective for discharges occurring on or after July 1, 2006 would be defined in § 412.64(b)(1)(ii)(A) through (C). These definitions are the labor market definitions based on OMB's CBSA designations. For clarity, we are proposing to revise the regulation text to explicitly reference urban and rural definitions for a cost reporting period beginning on or after January 1, 2005, with respect to discharges occurring during the period covered by such cost reports but before July 1, 2006 under § 412.62(f)(1)(ii) and § 412.62(f)(1)(iii). We note that these are the same labor market area definitions (based on the OMB's new CBSA designations) implemented for acute care hospitals under the IPPS at § 412.64(b), which were effective for those hospitals beginning October 1, 2004 as discussed in the FY 2005 IPPS final rule (69 FR 49026-49034). The IPF PPS uses the acute care inpatient hospitals' wage data in calculating the IPF PPS wage index. However, unlike the IPPS, and similar to other Medicare payment systems (for example, SNF PPS and IRF PPS), the IPF PPS uses the pre-floor, pre-reclassified hospital wage index. Below, we discuss the composition of the proposed IPF PPS labor market areas based on OMB's new CBSA designations. It should be noted that OMB's new CBSA designations are comprised of several county-based area definitions as explained above, which include Metropolitan Areas, Micropolitan Areas, and areas “outside CBSAs.” We implemented the IPF PPS using two types of labor market areas, that is, urban and rural. In this proposed rule, we are proposing to adopt the revised labor market areas based on OMB's new CBSA-based designations. We are also proposing to continue to have 2 types of labor market areas (urban and rural). In the discussion that follows, we explain our proposal to recognize Metropolitan Areas, which include New England MSAs and Metropolitan Divisions, as urban. We also explain our proposal to recognize Micropolitan Areas and areas “outside CBSAs” as rural. The following discussion describes the proposed methodology for mapping OMB's CBSA-based designations into the IPF PPS (urban area or rural area) format. i. New England MSAs As stated above, 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 across all IPF labor market areas, we are proposing to use the county-based areas for all MSAs in the nation, including those in New England. The OMB 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 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 county, and minimizes 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. Since we have never used cities and towns for defining IPF labor market areas, employing a county-based system in New England maintains that consistent practice. We note that this is consistent with the implementation of the CBSA-based designations under the IPPS for New England (69 FR 49028). Accordingly, for the IPF 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 IPF PPS labor market areas. ii. Metropolitan Divisions Under 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. 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. 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 (65 FR 82236). The construct of relatively large MSAs being comprised of Metropolitan Divisions is similar to the current construct of CMSAs comprised of PMSAs. As noted above, in the past, the OMB designated CMSAs as Metropolitan Areas with a population of 1 million or more and comprised of two or more PMSAs. Under the IPF 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 of an area with a relatively large number of hospitals, to accurately reflect the local labor costs of all of the individual hospitals included in that relatively “large” area. A large market area designation increases the likelihood of including many hospitals located in areas with very different labor market conditions within the same market area designation. This variation could increase the difficulty in calculating a single wage index that would be relevant for all hospitals within the market area designation. Similarly, we believe that MSAs with a population of 2.5 million or greater may be too large of an area to accurately reflect the local labor costs of all of the individual hospitals included in that relatively “large” area. Furthermore, as indicated above, Metropolitan Divisions represent the closest approximation to PMSAs, the building block of the current IPF PPS labor market area definitions, and therefore, would most accurately maintain our current structuring of the IPF 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 (that is, the use of PMSAs rather than CMSAs), we believe that using Metropolitan Divisions where applicable (as described below) under the IPF PPS would result in a more accurate adjustment for the variation in local labor market areas for IPFs. Specifically, if we would 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. As mentioned earlier, a large market area designation increases the likelihood of including many hospitals located in areas with very different labor market conditions within the same market area designation. This variation could increase the difficulty in calculating a single wage index that would be relevant for all hospitals within the market area designation. Rather, by proposing to recognize Metropolitan Divisions where applicable (as described below) under the proposed new CBSA-based labor market area definitions under the IPF PPS, we believe that in addition to more accurately maintaining the current structuring of the IPF PPS labor market areas, 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 IPFs located in these relatively “smaller” areas. Below we describe where Metropolitan Divisions would be applicable under the proposed new CBSA-based labor market area definitions under the IPF PPS. Under OMB's new CBSA-based designations, there are 11 MSAs containing Metropolitan Divisions: Boston; Chicago; Dallas; Detroit; Los Angeles; Miami; New York; Philadelphia; San Francisco; Seattle; and Washington, DC. Although these MSAs were also CMSAs under the prior definitions, in some cases these areas have been significantly altered. Under the current IPF PPS MSA designations, Boston is a single NECMA. Under the proposed CBSA-based labor market area designations, it would be comprised of four Metropolitan Divisions. Los Angeles would go from four PMSAs under the current IPF PPS MSA designations to two Metropolitan Divisions under the proposed CBSA-based labor market area designations because two MSAs became separate MSAs. The New York CMSA would go from 15 PMSAs under the current IPF PPS MSA designations down to only four Metropolitan Divisions under the proposed CBSA-based labor market area designations. The five PMSAs in Connecticut under the current IPF PPS MSA designations would become separate MSAs under the proposed CBSA-based labor market area designations, and the number of PMSAs in New Jersey under the current IPF PPS MSA designations would go from five to two, with the consolidation of two 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 two Metropolitan Divisions. Currently, there are six PMSAs, some of which are now separate MSAs under the current IPF PPS labor market area designations. Under the current IPF 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 as a CMSA under the current IPF PPS labor market area designations is 1 million. In most of these cases, counties currently in a PMSA under the current IPF PPS labor market area designations would become separate, independent MSAs under the proposed CBSA-based labor market area designations. iii. Micropolitan Areas Under OMB's new CBSA-based designations, Micropolitan Areas are essentially a third area definition consisting primarily of currently rural areas, but also include some or all of areas that are currently designated as an urban MSA. As discussed in greater detail in the FY 2005 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 indices would impact the value of statewide rural wage index of any State that contains a Micropolitan Area because 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 IV.C.1.b. we combine all of the counties in a State outside a designated urban area together to calculate the statewide rural wage index for each State. Including Micropolitan Areas 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, if Micropolitan Areas would be recognized as independent labor market areas, because there would be so few hospitals in each labor market area, the wage indices for IPFs 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 the hospitals in counties within each State that are not assigned to an MSA together into a statewide rural labor market area. We have 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 IPF PPS for the reasons outlined below. That is, counties that are assigned to a Micropolitan Area under the CBSA-based designations would be treated the same as other “rural” counties that are not assigned to either an MSA (Metropolitan Statistical Area) or a Micropolitan Area. Therefore, in determining an IPF's applicable wage index (based on IPPS hospital wage index data), we are proposing that an IPF in a Micropolitan Area under OMB's CBSA-based designations would be classified as “rural” and would be assigned the statewide rural wage index for the State in which it resides. In the FY 2005 IPPS final rule (69 FR 49029 through 49032), we discuss our evaluation of the impact of treating Micropolitan Areas as part of the statewide rural labor market area instead of treating Micropolitan Areas as independent labor market areas for hospitals paid under the IPPS. As discussed in that same final rule, one of the reasons Micropolitan Areas have such a dramatic impact on the wage index is because Micropolitan Areas encompass smaller populations than MSAs. In addition, they tend to include fewer hospitals per Micropolitan Area. Currently, there are only 25 MSAs with one hospital in the MSA. However, under the new proposed CBSA-based definitions, there are 373 Micropolitan Areas with one hospital, and 49 MSAs with only one hospital. Since Micropolitan Areas encompass smaller populations than MSAs, they tend to include fewer hospitals per Micropolitan Area, recognizing Micropolitan Areas as independent labor market areas would generally increase the potential for dramatic shifts in those areas' wage indices 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. The large number of labor market areas with only one hospital and the increased potential for dramatic shifts in the wage indexes from 1 year to the next is a problem for several reasons. First, it creates instability in the wage index from year to year for a large number of hospitals. Second, it reduces the averaging effect (averaging effect allows for more data points to be used to calculate a representative standard of measured labor costs within a market area.) lessening some of the incentive for hospitals to operate efficiently. This incentive is inherent in a system based on the average hourly wages for a large number of hospitals, as hospitals could profit more by operating below that average. In labor market areas with a single hospital, high wage costs are passed directly into the wage index with no counterbalancing averaging with lower wages paid at nearby competing hospitals. Third, it creates an arguably inequitable system when so many hospitals have wage indexes based solely on their own wages, while other hospitals' wage indexes are based on an average hourly wage across many hospitals. For the reasons noted above, and consistent with the treatment of these areas under the IPPS, we are proposing not to adopt Micropolitan Areas as independent labor market areas under the IPF PPS. However, we are proposing that Micropolitan Areas, under the CBSA-based labor market area definitions, would be considered part of the statewide rural labor market area. Accordingly, we are proposing that the IPF PPS statewide rural wage index would be determined using acute-care IPPS hospital wage data (the rationale for using IPPS hospital wage data is discussed in greater detail above in section IV.C.1.d.iii of this proposed rule) from hospitals located in non-MSA areas (for example, rural areas, including Micropolitan Areas) and that statewide rural wage index would be assigned to IPFs located in those non-MSA areas. e. Implementation of the Proposed Revised Labor Market Areas Under the IPF PPS Section 124 of the BBRA, is broadly written and gives the Secretary discretion in developing and making adjustments to the IPF PPS. When the revised labor market areas based on the OMB's new CBSA-based designations were adopted under the acute care hospital IPPS beginning on October 1, 2004, a transition to the new labor market area designations was established due to the scope and substantial implications of these new boundaries and to buffer the subsequent significant impacts it may have on payments to numerous hospitals. As discussed in the FY 2005 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. While we recognize that, just like IPPS hospitals, some IPFs may experience decreases in their wage index as a result of the proposed labor market area changes, our analysis shows that a majority of IPFs either expect no change in wage index or an increase in wage index based on CBSA definitions. In addition, a very small number of IPFs (fewer than 3 percent) would experience a decline of 5 percent or more in the wage index based on CBSA designations. We also found that a very small number of IPFs (approximately 5 percent) would experience a change in either rural or urban designation under the CBSA-based definitions. Since a majority of IPFs would not be significantly impacted by the proposed labor market areas, we believe it is not necessary to propose a transition to the proposed new CBSA-based labor market area for the purposes of the IPF PPS wage index. In addition, because we are in the midst of a transition to a full wage-index adjustment under the IPF PPS, we believe that the effects on the IPF PPS wage index from the proposed changes to the IPF PPS labor market areas definitions would be mitigated. Specifically, most IPFs would be in their FY 2006 cost reporting period and therefore would be in the second year of the 3-year phase-in of the IPF PPS wage index adjustment when the revised labor market area designations would be applied. During the second year of the transition to the IPF PPS, the applicable wage index value is one-half (50 percent) of the applicable full IPF PPS wage index adjustment. Since most IPFs would be in the second year of the 3-year phase-in of the wage index adjustment, for most IPFs, the labor-related portion of the standard Federal rate is only adjusted by 50 percent of the applicable full wage index (that is, one-half wage index value). As noted above, the IPF PPS wage index adjustment is made by multiplying the labor-related share of the IPF PPS standard Federal per diem base rate by the applicable wage index value, and the proposed IPF PPS labor related-share is 75.923 percent. Consequently, for most IPFs, only 38 percent of the standard Federal per diem base rate is affected by the wage index adjustment (75.923 percent × 0.50 = 37.9615 percent), and the proposed revision to the labor market area definitions based on OMB's new CBSA-based designations would only have a minimal impact on IPF PPS payments. Therefore, because the impact of the proposed revision to the labor market area definitions would only have a minimal impact on IPF PPS payments, we do not believe it is necessary to propose a transition policy for the proposed revision to the IPF PPS labor market area definitions. For the reasons discussed above, we are not proposing a transition under the IPF PPS from the current MSA-based labor market areas designations to the new CBSA-based labor market area designations. Rather, we are proposing under the IPF PPS to adopt the new CBSA-based labor market area definitions beginning with the July 1, 2006 IPF PPS rate year without a transition period. As discussed below, the IPPS adopted a hold-harmless policy and an “out-commuting” adjustment. We are also not proposing a hold harmless policy or an “out-commuting” adjustment under the IPF PPS from the current MSA-based labor market areas designations to the new CBSA-based labor market area designations as discussed below. We are proposing to adopt the new CBSA-based labor market area definitions beginning with the July 1, 2006 IPF PPS rate year without a hold harmless policy and without an “out-commuting” adjustment. We believe that our proposed policies are appropriate for IPFs because, despite some similarities between the IPF PPS and the IPPS, there are clear distinctions between the payment systems, particularly regarding wage index issues. Where a wage index adjustment has been a stable feature of the acute care hospital IPPS since its 1983 implementation and had utilized the prior MSA-based labor market area designation for over 10 years, this is not the case for the IPF PPS, which has only been implemented since January 1, 2005. The most significant distinction between acute care hospitals under the IPPS and IPFs under the IPF PPS, is that acute care hospitals have been paid using full wage index adjusted payments since 1983 and had used the previous IPPS MSA-based labor market area designations for over 10 years, whereas under the IPF PPS, a wage index adjustment is being phased-in over a 3-year period. As previously explained, the impact that the wage index can have on IPF PPS payments is limited at this point, since only a small percentage of the IPF PPS Federal per diem base rate is affected by the wage index (approximately 38 percent in most cases) because of the 3-year phase-in of the wage index adjustment. In contrast, a transition policy to the revised IPPS labor market area definitions under the IPPS was appropriate because there is no phase-in of a wage index adjustment under the IPPS and the full labor-related share of the IPPS standardized amount (that is, Federal rate) is affected by the IPPS wage index adjustment, which resulted in a more significant projected impact for acute care hospitals under the IPPS. As discussed in the August 11, 2004 IPPS final rule (69 FR 49032), during FY 2005, a hold harmless policy was implemented to minimize the overall impact of hospitals that were in FY 2004 designated as urban under the MSA designations, but would become rural under the CBSA designations. In the same final rule, hospitals were afforded a 3-year hold harmless policy because the IPPS determined that acute-care hospitals that changed designations from urban to rural would be substantially impacted by the significant change in wage index. Currently, under the IPF PPS urban facilities that become rural would receive the rural facility adjustment (that is, 17 percent). As discussed in section IV.C.2 of this proposed rule, we are proposing to keep the rural adjustment at 17 percent. The rural facility adjustment would be applied in the same way to urban facilities that would become rural under the CBSA-based definitions, if we were to adopt them. Thus, we believe that the impact on any urban facilities that become rural under the new definitions would be mitigated by the rural adjustment. Therefore, we do not believe it is appropriate or necessary to adopt a hold harmless policy for facilities that would experience a change in designation under the CBSA-based definitions. In addition, we note that section 505 of the MMA established new section 1886(d)(13) of the Act. The new section 1886(d)(13) of the Act 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 IPPS. Therefore, we are not proposing an adjustment for the IPF PPS. We note that for 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 July 1, 2006 rate year IPF 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. We have determined that there are no rural hospitals in those locations. Since 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. This approach is consistent with other Medicare PPSs (for example, SNF PPS and IRF PPS). The second situation has to do with the urban area of Hinesville, GA (CBSA 25980). Under the proposed new labor market areas there are no urban hospitals within this area. 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 IPF PPS wage index. Therefore, in this proposed rule, we are calculating 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. This approach is consistent with other Medicare PPSs (for example, SNF PPS and IRF PPS). 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 RY 2007 and subsequent years. To facilitate an understanding of the proposed policies related to the proposed change to the IPF PPS labor market areas discussed above, in the MSA/CBSA Crosswalk included as Addendum B 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. We are also providing in Addenda C1 and C2 the proposed wage index for urban and rural areas based on CBSA labor market areas. f. Wage Index Budget Neutrality Any proposed adjustment or update to the IPF wage index would be made in a budget neutral manner that assures that the estimated aggregated payments under this subsection in the RY beginning July 1, 2006 are not greater or less than those that would have been made in the year without such an adjustment. Therefore, we would calculate a budget-neutral wage index adjustment factor. We propose to calculate this factor using the following steps: *Steps 1:* Determine the total amount of the estimated IPF PPS payments for the implementation year using the labor-related share and wage indices from FY 2005 (based on MSAs). *Step 2:* Calculate the total amount of estimated IPF PPS payments for RY 2007 using the proposed labor-related share and wage indices from FY 2006 (based on CBSAs). *Step 3:* Divide the amount calculated in *Step 1* by the amount calculated in *Step 2* which yields a RY 2007 budget-neutral wage adjustment of 1.00156. This factor would be applied in the update of the Federal per diem base rate for RY 2007. 1. Proposed Adjustment for Rural Location In the IPF PPS Final Rule (69 FR 66954), we provided a 17 percent payment adjustment for IPFs located in a rural area. This adjustment was based on the regression analysis which indicated that the per diem cost of rural facilities was 17 percent higher than that of urban facilities after accounting for the influence of the other variables included in the regression. Many rural IPFs are small psychiatric units within small general acute care hospitals. We also stated in the IPF PPS final rule that small-scale facilities are more costly on a per diem basis because there are minimum levels of fixed costs that cannot be avoided, and they do not have the economies of size advantage. Based on the results of our regression analysis for the final rule using the most recent complete data available (that is, FY 2002 data), we provided a payment adjustment for IPFs located in rural areas of 17 percent. In this proposed rule, we are not proposing to change this adjustment factor. In addition, we stated that we do not intend to conduct another regression analysis until we are able to analyze 1 year of IPF PPS claims and cost report data. At that time, we can compare rural and urban IPFs to determine how much more costly rural facilities are on a per diem basis under the IPF PPS. In the meantime, we are proposing to apply a 17 percent payment adjustment for IPFs located in a rural area as defined at § 412.64(b)(1)(ii)(C). 2. Proposed Teaching Adjustment In the IPF PPS final rule, we established a facility-level adjustment for IPFs that are, or are part of, teaching institutions. The teaching status adjustment accounts for the higher indirect operating costs experienced by facilities that participate in graduate medical education
(GME)programs. We have received numerous requests for clarification of the IPF PPS teaching adjustment, especially with regard to comparisons with the IPPS IME adjustment that were included in the IPF PPS final rule. As a result, we are including an expanded explanation of the IPF PPS teaching status adjustment and are proposing clarifying changes to § 412.424(d)(1)(iii) regarding the teaching adjustment. Medicare makes direct GME payments (for direct costs such as resident and teaching physician salaries, and other direct teaching costs) to all teaching hospitals including those paid under the IPPS, and those that were once paid under the TEFRA rate-of-increase limits but are now paid under other PPSs. These direct GME payments are made separately from payments for hospital operating costs and are not part of the PPSs. However, the direct GME payments do not address the higher indirect operating costs experienced by teaching hospitals. For teaching hospitals paid under the TEFRA rate-of-increase limits, Medicare did not make separate medical education payments because payments to these hospitals were based on the hospitals' reasonable costs. Since payments under TEFRA were based on hospitals' reasonable costs, the higher indirect costs that might be associated with teaching programs would automatically have been factored into the TEFRA payments. As previously mentioned, we conducted regression analysis of FY 2002 IPF data as the basis for the payment adjustments included in the IPF PPS final rule. In conducting the analysis, we used the resident counts reported on hospital cost reports (worksheet S-3, Part 1, line 12, column 7 for freestanding psychiatric hospitals and worksheet S-3, Part 1, line 14 (or line 14.01 for subprovider 2), column 7 for psychiatric units of acute care hospitals). That is, for the freestanding psychiatric hospitals, we used the number of residents and interns reported for the entire hospital. For the psychiatric units of acute care hospitals, we used the number of residents and interns reported for the psychiatric unit, which are reported separately on the cost report from the number reported for the rest of the hospital. The regression analysis (with the logarithm of costs as the dependent variable) showed that the indirect teaching cost variable is significant in explaining the higher costs of IPFs that have teaching programs. We calculated the teaching adjustment based on the IPF's “teaching variable,” which is one plus the ratio of the number of full-time equivalent
(FTE)residents training in the IPF (subject to limitations described below) to the IPF's average daily census (ADC). In the cost regressions conducted for the IPF PPS final rule, the logarithm of the teaching variable had a coefficient value of 0.5150. We converted this cost effect to a teaching payment adjustment by treating the regression coefficient as an exponent and raising the teaching variable to a power equal to the coefficient value. In other words, the teaching adjustment is calculated by raising the teaching variable (1 + FTE residents/ADC) to the 0.5150 power. To compute the percentage increase in the IPF PPS payment attributable to the teaching adjustment (that is, the amount to be reconciled at cost report settlement), raise the teaching variable (1 + FTE residents/ADC) to the 0.5150 power. For example, for an IPF with a teaching variable of 0.10 and using a coefficient value of 0.5150, the per diem payment would increase by 5.03 percent; for an IPF with a teaching variable of 0.05, the per diem payment would increase by 2.54 percent. We note that the coefficient value of 0.5150 was based on regression analysis holding all other components of the payment system constant. In addition, we established the teaching adjustment in a manner that limited the incentives for IPFs to add FTE residents for the purpose of increasing their teaching adjustment. We imposed a cap on the number of FTE residents that may be counted for purposes of calculating the teaching adjustment, similar to that established by sections 4621 (IME FTE cap for IPPS hospitals) and 4623 (direct GME FTE cap for all hospitals) of the BBA. We emphasize that the cap limits the number of FTE residents that teaching IPFs may count for the purposes of calculating the IPF PPS teaching adjustment, not the number of residents teaching institutions can hire or train. The FTE resident cap is applied the same way in freestanding teaching psychiatric hospitals and in distinct part psychiatric units with GME programs. Similar to the regulations for counting FTE residents under the IPPS as described in § 412.105(f), we calculated the number of FTE residents that trained in the IPF during a “base year” and use that FTE resident number as the cap. An IPF's FTE resident cap would ultimately be determined based on the final settlement of the IPF's most recent cost report filed before November 15, 2004 (that is, the publication date of the IPF PPS final rule). Similar to teaching hospitals under the IPPS, IPFs that first begin training residents after November 15, 2004 initially receive an FTE cap of “0”. The FTE caps for teaching IPFs (whether they are new or existing IPFs) that start training residents in a new GME program (may be subsequently adjusted in accordance with the IPPS policies described in § 412.105(f)(1)(vii) and GME policies described in § 413.79(e)(1)(i) and (ii). For purposes of this section, a new medical residency training program means a medical residency that receives initial accreditation by the appropriate accrediting body or begins training residents on or after November 15, 2004. However, contrary to the policy for IME FTE resident caps under the IPPS, we do not allow IPFs to aggregate the FTE resident caps used to compute the IPF PPS teaching adjustment through affiliation agreements. We included these policies because we believe it is important to limit the total pool of resident FTE cap positions within the IPF community and avoid incentives for IPFs to add FTE residents in order to increase their payments. Residents with less than full-time status and residents rotating through the psychiatric hospital or unit for less than a full year are counted in proportion to the time they spend in their assignment with the IPF (for example, a resident on a full-time, 3-month rotation to the IPF would be counted as 0.25 FTE for purposes of counting residents to calculate the ratio). No FTE resident time counted for purposes of the IPPS IME adjustment is counted for purposes of the teaching status adjustment for the IPF PPS. As noted previously, the denominator used to calculate the teaching adjustment under the IPF PPS is the IPF's average daily census
(ADC)from the current cost reporting period. We chose to use the ADC because it is closely related to the IPF's patient load, which affects the number of interns and residents the IPF can train. We also believe the ADC is a measure that can be defined precisely and is difficult to manipulate. Although the IPPS IME adjustment uses the hospital's number of beds as the denominator, the capital PPS (as specified at § 412.322) and the IRF PPS (as specified at § 412.624(e)(4) both use the ADC as the denominator for the indirect medical education and teaching adjustments, respectively. If a psychiatric hospital's or unit's FTE count of residents in a given year is higher than the FTE count in the base year (the base year being used to establish the cap), we base payments in that year on the lower number (the cap amount). This approach is consistent with the IME adjustment under the IPPS and the teaching adjustment under the IRF PPS. The IPF remains free to add FTE residents above the cap amount, but it cannot count the number of FTE residents above the cap for purposes of calculating the teaching adjustment. This means that the cap serves as an upper limit on the number of FTE residents that may be counted for purposes of calculating the teaching status adjustment. IPFs can adjust their number of FTE residents counted for purposes of calculating the teaching adjustment as long as they remain under the cap. On the other hand, if a psychiatric hospital or unit were to have fewer FTE residents in a given year than in the base year (that is, fewer residents than its FTE resident cap), teaching adjustment payments in that year would be based on the lower number (that is, the current year's FTE count of resident). In response to inquiries about how the teaching adjustment is applied under the IPF PPS, we are proposing to add a new paragraph § 412.424(d)(1)(iii)(E) to clarify that the teaching adjustment is made on a claim basis as an interim payment and the final payment for the claim would be made in full during the final settlement of the cost report. The difference between those interim payments and the actual teaching adjustment amount computed in the cost report would be adjusted through lump sum payments/recoupments when the cost report is filed and later settled. As noted in section III.B.3 of this proposed rule, in reviewing the methodology used to simulate the IPF PPS payments used for the IPF PPS final rule, we discovered that the computer code incorrectly assigned non-teaching status to most teaching facilities. As a result, total IPF PPS payments were underestimated by about 1.36 percent. To resolve the issue, as discussed in section III.B.3 of this proposed rule, we are proposing to amend the Federal per diem base rate prospectively for all IPFs. As with other adjustment factors derived through the regression analysis, we do not intend to rerun the regression analysis until we can analyze 1 year of IPF PPS claims and cost report data. Until then, we are proposing to retain the 0.5150 teaching adjustment to the Federal per diem base rate. 3. Proposed Cost of Living Adjustment for IPFs Located in Alaska and Hawaii The IPF PPS includes a payment adjustment for IPFs located in Alaska and Hawaii based upon the county in which the IPF is located. As we explained in the IPF PPS final rule, the FY 2002 data demonstrated that IPFs in Alaska and Hawaii had per diem costs that were disproportionately higher than other IPFs. Other Medicare prospective payment systems (for example, IPPS and IRF PPS) have adopted a cost of living adjustment
(COLA)to account for the cost differential of care furnished in Alaska and Hawaii. We analyzed the effect of applying a COLA to payments for IPFs located in Alaska and Hawaii. The results of our analysis demonstrated that a COLA for IPFs located in Alaska and Hawaii would improve payment equity for these facilities. As a result of this analysis, we provided a COLA adjustment in the IPF PPS final rule. In general, the COLA would account for the higher costs in the IPF and eliminate the projected loss that IPFs in Alaska and Hawaii would experience absent the COLA. A COLA adjustment for IPFs located in Alaska and Hawaii is made by multiplying the non-labor share of the Federal per diem base rate by the applicable COLA factor based on the county in which the IPF is located. Table 14 lists the specific COLA for Alaska and Hawaii IPFs. The COLA factors were obtained from the U.S. Office of Personnel Management (OPM). The COLA factors are published on the U.S. Office of Personnel Management
(OPM)website ( *http://www.opm.gov/oca/cola/rates.asp* ). We are proposing to adopt the COLA adjustments obtained from OPM. We propose to update the COLA factors if OPM updates them and as updated by OPM. Any change in the COLA factors would be made in one of our IPF PPS RY update documents. We are proposing to amend § 412.428 to update the COLA factors if appropriate. Table 14.—Proposed COLA Factors for Alaska and Hawaii IPFs Location COLA Alaska: All areas 1.25 Hawaii: Honolulu County 1.25 Hawaii County 1.165 Kauai County 1.2325 Maui County 1.2375 Kalawao County 1.2375 4. Proposed Adjustment for IPFs With a Qualifying Emergency Department
(ED)Currently, the IPF PPS includes a facility-level adjustment for IPFs with qualifying EDs. As explained in the IPF PPS final rule, we provide an adjustment to the standardized Federal per diem base rate to account for the costs associated with maintaining a full-service ED. The adjustment is intended to account for ED costs allocated to the hospital's distinct part psychiatric unit for preadmission services otherwise payable under Medicare Part B furnished to a beneficiary during the day immediately preceding the date of admission to the IPF (see § 413.40(c)) and the overhead cost of maintaining the ED. This payment is a facility-level adjustment that applies to all IPF admissions (with the one exception as described below), regardless of whether a particular patient receives preadmission services in the hospital's ED. The ED adjustment is incorporated into the variable per diem adjustment for the first day of each stay for IPFs with a qualifying ED. That is, IPFs with a qualifying ED receive a 31 percent adjustment as the variable per diem adjustment for day 1 of each stay. If an IPF does not have a qualifying ED, it receives a 19 percent adjustment as the variable per diem adjustment for day 1 of each patient stay. While any IPF with a qualifying ED receives the adjustment, the adjustment is paid most often to IPFs that are psychiatric units of acute care hospitals or CAHs because these providers are more likely to have an ED that meets the definition of a qualified ED in § 412.424(d)(1)(v). We defined a qualifying ED in order to avoid providing the ED adjustment to an intake unit that is not comparable to a full-service ED with respect to the array of emergency services available or cost. We defined a qualifying ED as one that is staffed and equipped to furnish a comprehensive array of emergency services and that meets the definition of a “dedicated emergency department” as specified in § 489.24(b) and the definition of “provider-based status” as specified in § 413.65. We intended that a qualifying ED provide a comprehensive array of medical and psychiatric services. Therefore, in order to clarify that a comprehensive array of emergency services includes medical as well as psychiatric services, we are proposing to amend § 412.424(d)(1)(V)(A). As specified in § 489.24, a dedicated ED means “any department or facility of the hospital, regardless of whether it is located on or off the main hospital campus, that meets at least one of the following requirements: • It is licensed by the State in which it is located under applicable State law as an emergency room or emergency department; • It is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or • During the calendar year immediately preceding the calendar year in which a determination under this section is being made, based on a representative sample of patient visits that occurred during the calendar year, it provides at least one-third of all its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment.” As specified in § 413.65, provider-based status means “the relationship between a main provider and a provider-based entity or a department of a provider, remote location of a hospital, or satellite facility that complies with the provisions.” Including provider-based status in the definition of a qualifying ED reflects the common ownership of the hospital and the distinct part psychiatric unit. As discussed in the IPF PPS final rule, three steps were involved in the calculation of the ED adjustment factor. *Step 1:* We estimated the proportion by which the ED costs of a case would increase the cost of the first day of the stay. Using the IPFs with ED admissions in FY 2002, we divided their average ED cost per stay admitted through the ED ($198) by their average cost per day ($715), which equals 0.28. *Step 2:* We adjusted the factor estimated in Step 1 to account for the fact that we would pay the higher first day adjustment for all cases in the qualifying IPFs, not just the cases admitted through the ED. Since on average, 44 percent of the cases in IPFs with ED admissions are admitted through the ED, we multiplied 0.28 by 0.44, which equals 0.12. *Step 3:* We added the adjusted factor calculated in the previous 2 steps to the variable per diem adjustment derived from the regression equation that we used to derive our other payment adjustment factors. The first day payment factor from this regression is 1.19. Adding the 0.12, we obtained a first day variable per diem adjustment for IPFs with a qualifying ED equal to 1.31. The ED adjustment is made on every qualifying claim except as described below. As specified in § 412.424(d)(1)(V)(B), the ED adjustment is not made where a patient is discharged from an acute care hospital or CAH and admitted to the same hospital's or CAH's psychiatric unit. An ED adjustment is not made in this case because the costs associated with ED services are reflected in the DRG payment to the acute care hospital or through the reasonable cost payment made to the CAH. As we explained in the IPF PPS final rule, if we provided the ED adjustment in these cases, the hospital would be paid twice for the overhead costs of the ED (69 FR 66960). Therefore, when patients are discharged from an acute care hospital or CAH and admitted to the same hospital's or CAH's psychiatric unit, the IPF receives the 1.19 adjustment factor as the variable per diem adjustment for the first day of the patient's stay in the IPF. As with other adjustment factors under the IPF PPS, we do not intend to conduct a new regression analysis for this IPF PPS update. Rather, we intend to wait until we can analyze 1 year of IPF PPS claims and cost report data. Therefore, we are proposing to retain the 1.31 adjustment factor for IPFs with qualifying EDs for the rate year beginning July 1, 2006. As we indicated in the final rule, in FY 2002, one third of the IPFs admissions were through the ED. Commenters on the IPF PPS proposed rule indicated that the percentage of admissions through the ED were understated. We plan to monitor claims data to determine the number of IPF admissions admitted through the ED. a. Proposed New Source of Admission Code To Implement the ED Adjustment In order to ensure that the ED adjustment is not paid for patients who are discharged from an acute care hospital or CAH and admitted to the same hospital's or CAH's psychiatric unit, we directed IPFs to enter source of admission code 4 (transfers from hospital inpatient) on those claims. The source of admission code is a required field on Medicare claims and indicates the source of the patient admissions. However, as we have implemented the IPF PPS, we have realized that admission code 4 is too broad to distinguish these claims because it reflects transfers from any acute care hospital or CAH. Currently, where admission code 4 is entered on a claim, the ED adjustment is not paid, even if the patient is transferred from a different acute hospital or CAH. In order to pay these IPF claims appropriately, CMS requested a new source of admission code from the National Uniform Billing Committee to identify transfers from the same hospital or CAH. On June 7, 2005, the National Uniform Billing Committee granted our request to establish a new source of admission code to indicate transfers from the same hospital or CAH. The new source of admission code “D” is effective April 1, 2006. We are proposing that the new code would be used by IPFs to identify IPF patients who have been transferred to the IPF from the same hospital or CAH. Claims with source of admission code “D” would not receive the ED adjustment. b. Applicability of the ED Adjustment to IPFs in Critical Access Hospitals The BBA created the CAH program, designed to represent a separate provider type to provide acute care services in rural areas. Generally, in order to qualify as a CAH, a hospital must be located in a rural area, provide 24-hour emergency care services, have an average length of stay of 96 hours or less, operate up to 25 beds for inpatient critical access care, be located more than 35 miles from a hospital or another CAH or more than 15 miles in mountainous terrain or only secondary roads, or be certified by the State as of December 31, 2005 as being a “necessary provider” of health care services to residents in the area. Section 405(g) of the MMA authorizes CAHs to establish distinct part psychiatric and rehabilitation units of up to 10 beds effective for cost reporting periods beginning on or after October 1, 2004. Services in these units are paid under the payment methodology that would apply if such services were provided in a distinct part psychiatric or rehabilitation unit of a hospital. As a result, IPFs that are distinct part units of CAHs are paid the same as if they were a distinct part unit of a hospital. Otherwise, the CAH is paid on a reasonable cost basis for inpatient critical access services. In the IPF PPS final rule, we amended §413.70(e) to clarify that payments for services of distinct part psychiatric units in CAHs are made in accordance with the IPF PPS. In order to pay CAHs the same as other IPFs, CAHs would be subject to the 1-day preadmission services bundling provision specified in § 413.40(c)(2) for patients who are admitted to the CAH's IPF. As a result, the cost of preadmission services, including ED services furnished to CAH IPF patients would be allocated to the IPF. D. Other Payment Adjustments and Policies [If you choose to comment on issues in this section, please include the caption “OTHER ADJUSTMENTS AND POLICIES” at the beginning of your comments.] The IPF PPS includes the following payment adjustments:
(1)An outlier policy to promote access to IPF care for those patients who require expensive care and to limit the financial risk of IPFs treating unusually costly patients;
(2)a stop-loss provision, applicable during the transition period, to reduce financial risk to IPFs projected to experience substantial reductions in Medicare payments under the IPF PPS;
(3)an interrupted stay policy to avoid overpaying stays that include a brief absence from the IPF followed by readmission to the IPF; and
(4)a payment for patients who receive ECT. We are proposing to update those policies in this proposed rule. We are also proposing clarifications to the physician certification and recertification requirements in order to ensure consistent practices across IPFs. In addition, we are clarifying coverage of recreation therapy. 1. Outlier Payments In the IPF PPS final rule, we implemented regulations at § 412.424(d)(3)(i) to provide a payment adjustment for IPF stays that have extraordinarily high costs. Providing additional payments for outlier cases to IPFs that are beyond the IPF's control strongly improves the accuracy of the IPF PPS in determining resource costs at the patient and facility level because facilities receive additional compensation over and above the adjusted Federal prospective payment amount for uniquely high-cost cases. These additional payments reduce the financial losses that would otherwise be caused by treating patients who require more costly care and, therefore, reduce the incentives to under-serve these patients. Under the IPF PPS, outlier payments are made on a per case basis rather than on a per diem basis because it is the overall financial “gain” or “loss” of the case, and not of individual days, that determines an IPF's financial risk. In addition, because patient-level charges (from which costs are estimated) are typically aggregated for the entire IPF stay, they are not reported in a manner that would permit accurate accounting on a daily basis. Currently, we make outlier payments for discharges in which an IPF's estimated total cost for a case exceeds a fixed dollar loss threshold amount (multiplied by the IPF's facility-level adjustments) plus the Federal per diem payment amount for the case. In instances when the case qualifies for an outlier payment, we pay 80 percent of the difference between the estimated cost for the case and the adjusted threshold amount for days 1 through 9 of the stay (consistent with the median length of stay for IPFs in FY 2002), and 60 percent of the difference for day 10 and thereafter. We established the 80 percent and 60 percent loss sharing ratios because we were concerned that a single ratio established at 80 percent (like other Medicare hospital PPSs) might provide an incentive under the IPF per diem payment system to increase length of stay in order to receive additional payments. After establishing the loss sharing ratios, we determined the current fixed dollar loss threshold amount of $5,700 through payment simulations designed to compute a dollar loss beyond which payments are estimated to meet the 2 percent outlier spending target. a. Proposed Update to the Outlier Fixed Dollar Loss Threshold Amount As indicated in section II.A of this proposed rule, in accordance with the update methodology described in § 412.428(d), we are proposing to update the fixed dollar loss threshold amount used under the IPF PPS outlier policy. Based on the regression analysis and payment simulations used to develop the IPF PPS, we established a 2 percent outlier policy to make an appropriate balance between protecting IPFs from extraordinarily costly cases while ensuring the adequacy of the Federal per diem base rate for all other cases that are not outlier cases. We continue to believe a 2 percent outlier policy is an appropriate target percentage and are proposing to retain the 2 percent outlier policy. However, we believe it is necessary to update the fixed dollar loss threshold amount because analysis of the latest available data indicates adjusting the fixed dollar loss amount is necessary in order to maintain an outlier percentage that equals 2 percent of total estimated IPF PPS payments. We intend to continue to analyze estimated outlier payments for subsequent years using the best available data in order to maintain estimated outlier payments at 2 percent of total estimated IPF PPS payments. We have determined that in certain sections of the IPF PPS final rule, we used the phrase “Fixed-dollar loss threshold” and, in other sections, we used the phrase “Fixed-dollar loss amount” to describe the dollar amount by which the costs of a case exceed payment in order to qualify for an outlier payment. In order to avoid confusion regarding these phrases, we are proposing to use the term “fixed-dollar loss threshold amount” when we are referring to the dollar amount by which the costs of a case exceed payment in order to qualify for an outlier payment. As a result of this clarification, in § 412.402, we are proposing to revise the term “Fixed dollar loss threshold” to “Fixed dollar loss threshold amount.” We are also proposing clarifying changes to § 412.424(d)(3)(i) and § 412.424(d)(3)(i)(A) to state that we would provide an outlier payment if an IPF's estimated total cost for a case exceeds a “fixed dollar loss threshold amount” plus the total IPF adjusted payment amount for the stay, and that it is the fixed dollar loss threshold amount that is adjusted by the IPF's facility-level adjustments. Aside from updating the terminology “fixed dollar loss threshold amount” and making the conforming changes to the regulation text described above, we are not proposing any other changes to the outlier policy. Therefore, we would continue to adjust the fixed dollar loss threshold amount by the applicable facility-level payment adjustments and add this amount to the IPF PPS payment amount in order to determine if a case qualifies for an outlier payment. For cases that meet the threshold amount, we would pay 80 percent for days 1 through 9 and 60 percent for day 10 and thereafter. In the IPF PPS final rule, we described the process by which we calculate the outlier fixed dollar loss threshold amount. We are proposing to continue to use this process in this proposed rule. We begin by simulating aggregate payments with and without an outlier policy, and applying an iterative process to a fixed dollar loss amount that would result in outlier payments being equal to 2 percent of total simulated payments under the simulation. Based on this process, we are proposing $6200 as the fixed dollar loss threshold amount in the outlier calculation in order to maintain the proposed 2 percent outlier policy. We note that the simulation analysis used to calculate the proposed $6200 fixed dollar loss threshold amount includes all of the proposed changes to the IPF PPS discussed in this proposed rule. As a result, for the RY beginning July 1, 2006, the final fixed dollar loss threshold amount is subject to change in the final rule depending on the policies contained in the final rule. b. Proposed Statistical Accuracy of Cost-to-Charge Ratios As stated previously, under the IPF PPS, an outlier payment is made if an IPF's cost for a stay exceeds a fixed dollar loss threshold amount. In order to establish an IPF's cost for a particular case, we multiply the IPF's reported charges on the discharge bill by their overall cost to charge ratio (CCR). This approach to determining a provider's cost is consistent with the approach used under the IPPS and other prospective payment systems. In FY 2004, we implemented changes to the IPPS outlier policy used to determine CCRs for acute care hospitals because we became aware that payment vulnerabilities resulted in inappropriate outlier payments. Under the IPPS, we established a statistical measure of accuracy for CCRs in order to ensure that aberrant CCR data did not result in inappropriate outlier payments. As we indicated in the IPF PPS final rule, because we believe the IPF outlier policy is susceptible to the same payment vulnerabilities as the IPPS, we adopted an approach to ensure the statistical accuracy of CCRs under the IPF PPS. Therefore, we adopted the following two procedures in the IPF PPS final rule: • We calculated two national ceilings, one for IPFs located in rural areas and one for IPFs located in urban areas. We computed the ceilings by first calculating the national average and the standard deviation of the CCR for both urban and rural IPFs. To determine the rural and urban ceilings, we multiplied each of the standard deviations by 3 and added the result to the appropriate national CCR average (either rural or urban). The current upper threshold CCR for IPFs is 1.8853 for rural IPFs, and 1.8040 for urban IPFs, based upon MSA-based geographic designations. If an IPF's CCR is above the applicable ceiling, the ratio is considered statistically inaccurate and we assign the appropriate national (either rural or urban) median CCR to the IPF. Additional information regarding the national median CCRs is included in the IPF PPS final rule (69 FR 66961). • We do not apply the applicable national median CCR when an IPF's CCR falls below a floor. We made this decision because using the national median CCR in place of the provider's actual CCR would overstate the IPF's costs. We are proposing to apply the national CCRs to the following situations: ++ New IPFs that have not yet submitted their first Medicare cost report. ++ IPFs whose operating or capital CCR is in excess of 3 standard deviations above the corresponding national geometric mean (that is, above the ceiling). ++ Other IPFs for whom the fiscal intermediary obtains inaccurate or incomplete data with which to calculate either an operating or capital CCR or both. The current national CCRs were estimated to be 0.7115 for rural IPFs and 0.5658 for urban IPFs and would be used in each of the three situations cited above. These estimates were based on the IPF's location (either urban or rural) using the MSA-based geographic designations. For new facilities, we are proposing to use these national ratios until the facility's actual CCR can be computed using the first tentatively settled or final settled cost report, which would then be used for the subsequent cost report period. We are not proposing any changes to the procedures for ensuring the statistical accuracy of CCRs in RY 2007. However, we are proposing to update the national urban and rural CCRs (ceilings and medians) for IPFs for RY 2007 based on the full calendar year 2005 CCRs entered in the Provider-Specific File. In addition, we are proposing that the updated ceilings and national median CCRs would be based on CBSA-based geographic designations because the CBSAs are the geographic designations we are proposing to adopt for purposes of computing the proposed wage index adjustment to IPF payments beginning July 1, 2006. We would include the updated ceiling and national median CCRs in the final RY 2007 regulations. In subsequent years, we are proposing to update the national urban and rural CCRs (median and ceilings) based on the previous full calendar year's Provider-Specific File. These CCRs would be announced in each year's annual notice of prospective payment rates published in the **Federal Register** . We are proposing to add a new paragraph
(g)to § 412.428 to clarify that we intend to update the national urban and rural ceilings and medians as part of the annual update of the IPF PPS and to specify when the national median urban and rural CCRs would be used. 1. Proposed Stop-Loss Provision In the IPF PPS final rule, we implemented a stop-loss policy to reduce financial risk for those facilities expected to experience substantial reductions in Medicare payments during the IPF PPS transition period. This stop-loss policy guarantees that each facility receives total IPF PPS payments that are no less than 70 percent of its TEFRA payments, had the IPF PPS not been implemented. This policy is applied to the IPF PPS portion of Medicare payments during the 3-year transition. Hence, during year 1, three-quarters of the payment were based on TEFRA and one-quarter on the IPF PPS. Under the 70 percent policy, 75 percent of total payment is TEFRA payments, and the 25 percent is IPF PPS payments, which are at least 70 percent of the TEFRA payments. The resulting 92.5 percent of TEFRA payments in year 1 is the sum of 75 percent and 25 percent times 70 percent. In year 2, one-half of the payment will be based on TEFRA and one-half on the IPF PPS. In year 3, one-quarter of the payment will be based on TEFRA and three-quarters on the IPF PPS. In year 4 of the IPF PPS, Medicare payments are based 100 percent on the IPF PPS. The combined effects of the transition and the stop-loss policies will be to ensure that the total estimated IPF PPS payments were no less than 92.5 percent in year 1, 85 percent in year 2, and 77.5 percent in year 3. The 70 percent of TEFRA payment stop-loss policy will require a reduction in the Federal per diem and ECT base rates of 0.39 percent in order to make the stop-loss payments budget neutral. We estimate that about 10 percent of IPFs would receive stop-loss payments under the 70 percent policy. We are not proposing to make any changes to the stop-loss policy. 2. Patients Who Receive Electroconvulsive Therapy
(ECT)In developing the IPF PPS, we received numerous public comments recommending that we include a payment adjustment for patients who receive ECT treatments during their IPF stay because furnishing ECT treatment, either directly or under arrangements, adds significantly to the cost of these stays. When we analyzed the FY 2002 MedPAR data, we found that ECT cases comprised about 6 percent of all cases and that almost 95 percent of ECT cases were treated in IPFs that are psychiatric units of acute care hospitals. Even among psychiatric units, ECT cases are concentrated among a relatively small number of facilities. Overall, approximately 450 facilities had cases with ECT. Among these facilities, we estimated the mean number of ECT cases per facility to be approximately 25. In addition, approximately one-half of the IPFs providing ECT had no more than 15 cases in FY 2002. Our analysis confirmed that cases with ECT are substantially more costly than cases without ECT. We found that on a per case basis, ECT cases are approximately twice as expensive as non-ECT cases ($16,287 compared to $7,684). Most of this difference is due to variation in length of stay (20.5 days for ECT cases compared to 11.6 days for non-ECT cases). In addition, the ancillary costs per case for ECT cases are $2,740 higher than those for non-ECT cases. Although we are able to determine the cost of stays with ECT, we are unable to develop an ECT cost per treatment using the FY 2002 IPF claims data because the claims do not include the number of treatments. As a result, in the IPF PPS final rule, we established the following methodology for calculating the IPF PPS ECT payment adjustment. We established an ECT base rate using the pre-scaled and pre-adjusted median hospital cost for CPT procedure code 90870 used for payment under hospital outpatient PPS (OPPS), based on hospital claims data. The median cost for all OPPS services are posted after publication of the OPPS proposed rule at the following address: *http://www.cms.hhs.gov/hospitaloutpatientPPS.* We used unadjusted hospital claims data under the OPPS, that is, the pre-scaled and pre-adjusted median hospital cost per treatment, to establish the ECT base rate because we did not want the ECT payment under the IPF PPS to be affected by factors that are relevant to OPPS but not specifically applicable to IPFs. The median cost ($311.88) was then standardized and adjusted for budget neutrality, resulting in an ECT payment adjustment of $247.96 per treatment. The ECT base rate is adjusted for wage and COLA differences in the same manner that we adjust the Federal per diem base rate. In order to receive the payment adjustment, IPFs must indicate on their claims the revenue code for ECT (901), along with the total number of units (ECT treatments) provided to the patient during their IPF stay. In addition, IPFs must include the ICD-9-CM procedure code for ECT (94.27) and the date of the last ECT treatment the patient received. As we stated in the IPF PPS final rule, although we established the ECT adjustment as a distinct payment under the IPF PPS, our preferred approach would be to include a patient level adjustment as a component of the model (for example, determined through the regression analyses) to account for the higher costs associated with ECT (69 FR 66951). Although our analysis will continue, we do not intend to redo the regression analysis until we are able to analyze 1 year of IPF PPS claims and cost report data. However, we believe the data currently being submitted by IPFs may permit development of an IPF-specific ECT base rate, rather than using hospital outpatient claims data. It is important to note that since ECT treatment is a specialized procedure, not all providers are equipped to provide the treatment. Therefore, many patients who need ECT treatment during their IPF stay must be referred to other providers to receive the ECT treatments, and then return to the IPF. In accordance with § 412.404(d)(3), in these cases where the IPF is not able to furnish necessary treatment directly, the IPF would furnish ECT under arrangements with another provider. While a patient is an inpatient of the IPF, the IPF is responsible for all services furnished, including those furnished under arrangements by another provider. As a result, the IPF claim for these cases should reflect the services furnished under arrangements by other providers. Therefore, in accordance with the update methodology specified in § 412.428(f), we are proposing to update the ECT base rate using the pre-scaled pre-adjusted hospital median cost for ECT used for the CY 2006 update of the OPPS. The median cost would then be standardized, adjusted for budget neutrality, and adjusted for wage and COLA differences in the same manner that we adjust the per diem rate. We are proposing to pay the median cost for an ECT treatment, posted as part of the calendar year
(CY)2006 OPPS update, which is based on CY 2004 outpatient hospital claims. The median cost is $324.44. After applying the standardization factor and the wage index budget neutrality factor (as described in section III.C.1.f. of this proposed rule), the adjusted proposed ECT payment for RY 2007 is $268.21. We would monitor this area to ensure that the increased payments for ECT do not lead to changes in the frequency of utilization by reviewing the CY 2005 MedPAR claims data. 3. Physician Certification and Recertification Requirements Since the publication of the IPF PPS final rule, we have received inquiries related to physician certification and recertification. It appears that some psychiatric units in acute care hospitals have been following the timeframes that are applicable to the acute care hospital of which they are a part (as specified in § 424.13) rather than those that apply to psychiatric hospitals (as specified in § 424.14). To eliminate the confusion that we believe may be caused by the titles of § 424.13 and § 424.14, to ensure consistency in compliance of the requirements among all IPFs, we are proposing to revise the title of § 424.14 from “Requirements for inpatient services of psychiatric hospitals” to “Requirements for inpatient services of inpatient psychiatric facilities.” We are proposing that for the purposes of payment under the IPF PPS, all IPFs would follow the physician certification and recertification requirements as specified in § 424.14. In the IPF proposed rule published on November 28, 2003 (68 FR 66920), we proposed to—(1) amend § 424.14 to state that in recertifying a patient's need for continued inpatient care in an IPF, a physician must indicate that the patient continues to need, on a daily basis, inpatient psychiatric care (furnished directly by or requiring the supervision of IPF personnel) or other professional services that, as a practical matter, can be provided only on an inpatient basis; and
(2)revise § 424.14(d) to require that a physician recertify a patient's continued need for inpatient psychiatric care on the 10th day following admission to the IPF rather than the 18th day following admission to the IPF (68 FR 66939). However, in the IPF PPS final rule, we did not include the proposed physician recertification requirement changes because most of the public comments we received on this issue did not support the proposed changes and indicated that there are inconsistencies in the timeframes currently required for IPFs that warranted additional analysis. Instead, we stated that we would continue to require that a physician recertify a patient's continued need for inpatient psychiatric care on the 18th day following admission to the IPF. Since publication of the final rule, we have received additional inquiries related to the physician certification and recertification timeframes that currently apply to IPFs. As noted above, it appears that some psychiatric units in acute care hospitals have been following the timeframes that are applicable to the acute care hospital of which they are a part (as specified in § 424.13) rather than those that apply to psychiatric hospitals (as specified in § 424.14). Section 424.13(d) requires the initial certification no later than as of the 12th day of hospitalization and the first recertification is required no later than as of the 18th day of hospitalization. Section § 424.14(d) requires certification at the time of admission or as soon thereafter as is reasonable and practicable and the first recertification is required as of the 18th day of hospitalization. We are proposing that, for purposes of payment under the IPF PPS, all IPFs (distinct part units of acute care hospitals and CAHs and psychiatric hospitals) would meet the following physician certification and recertification timeframes. We would revise § 424.14(d) to provide that the initial physician certification would be required at the time of admission or as soon thereafter as is reasonable and practicable and the first recertification would be required as of the 12th day of hospitalization. Subsequent recertifications would be required at intervals established by the hospital's UR committee (on a case-by-case basis if desired), but no less frequently than every 30 days. We chose the 12th day because it is more in line with the average LOS and it is current practice for certification in psychiatric units. We have also received inquiries from Fiscal Intermediaries requesting guidance on the content requirement of physician certifications at § 424.14(c), relating to the medical necessity of continued inpatient psychiatric care. As a result, we are proposing to add language to clarify that for purposes of payment under the IPF PPS, the physician would also recertify that the patient continues to need, on a daily basis, active treatment furnished directly by or requiring the supervision of inpatient psychiatric facility personnel. 4. Provision of Therapeutic Recreation in IPFs Before the implementation of the IPPS payment methodology, Medicare coverage guidelines gave specific recognition to therapeutic recreation in inpatient psychiatric hospitals. The guidelines in § 3102.1.A of the Medicare Intermediary Manual, Part 3 (MIM-3), and in § 212.1 of the Medicare Hospital Manual (which now appear in the CMS Internet Online Manual at Pub. 100-02, Chapter 2, §§ 20.1ff.) specifically identify therapeutic recreation as one of the services that can constitute “active treatment” in this setting when they are— • Provided under an individualized treatment or diagnostic plan; • Reasonably expected to improve the patient's condition or for the purpose of diagnosis; and • Supervised and evaluated by a physician. However, these guidelines refer to therapeutic recreation in terms of being an “adjunctive” therapy, indicating that even in this setting, it would not independently serve as a patient's sole or primary form of therapeutic treatment, but rather, would be furnished in support of (but subordinate to) some other, primary form of therapy. When the IPPS was developed in 1983, to the extent that therapeutic recreation and other services had been furnished during the IPPS base period, the bundled IPPS payment for that setting would reflect these costs. However, during the IPPS rulemaking process, we received public comments stating “* * * concern that the cost-saving incentives of the prospective payment system would lead hospitals paid under the system to stop providing recreational therapy services.” In response, in the January 3, 1984 IPPS final rule (49 FR 242) we indicated that implementation of the IPPS would not, in fact, prohibit the provision of recreational therapy services, and that “* * * these services will continue to be covered to the same extent they always have been under existing Medicare policies”. In implementing the IPPS regulations, we included criteria for identifying certain types of institutions (for example, psychiatric hospitals) that would be excluded from the IPPS and, thus, would continue to be paid under some other methodology. The regulations also introduced criteria for identifying an IPPS-excluded inpatient psychiatric unit housed within a larger acute-care hospital that would itself be subject to the IPPS. One of these identifying criteria at 42 CFR 405.471(c)(4)(ii)(B) (later recodified at 42 CFR 412.27(b)) was the provision, through the use of qualified personnel, of a number of specified types of services, including psychological services, social work services, psychiatric nursing, occupational therapy, and recreational therapy. As we explained in the IPPS interim final rule published on September 1, 1983 (48 FR 39758), the regulations designated these particular services because their provision “* * * is typical of units which treat patients whose characteristics are like those in psychiatric hospitals. Consequently, the provision of these services is an identifier of such a patient population”. We note that the designation of these particular services in this context did not serve to define the scope of their coverage under Medicare, nor to mandate their provision in this setting, but merely to identify them as being characteristic of the type of psychiatric unit that would qualify for exclusion from the IPPS. At the same time the IPPS was being developed, a parallel evolution was taking place in the certification requirements that facilities must meet in order to participate in the Medicare program: A shift from primarily “process-oriented” requirements to more “outcome-oriented” requirements, which focus more on direct indicators of the quality of care actually being furnished to the facility's patients (as reflected in the presence of positive results and the absence of negative ones), and less on the specific “process” through which the facility achieves the desired outcome. In order to participate in the Medicare program, psychiatric hospitals not only had to meet the conditions of participation
(COPs)that apply to general, acute-care hospitals, but additionally had to meet special conditions related to medical records and staffing. Consistent with the recognition of therapeutic recreation as constituting active treatment in this one particular setting (as discussed above), the original COPs for psychiatric hospitals at 42 CFR 405.1038(g) mandated the presence of qualified therapists, assistants, or aides “* * * sufficient in number to provide comprehensive therapeutic activities, including at least occupational, recreational and physical therapy, as needed, to assure that appropriate treatment is rendered for each patient, and to establish and maintain a therapeutic milieu.” Furthermore, 42 CFR 405.1038(g)(3) further specified that “recreational or activity therapy services are available under the direct supervision of a member of the staff who has demonstrated competence in therapeutic recreation programs,” and §§ 405.1038(g)(4) and
(5)went on to prescribe additional standards regarding therapy assistants or aides and overall staffing for recreational and activity therapy. However, when the special medical record and staffing COPs for psychiatric hospitals were subsequently recodified at 42 CFR 482.62(g), the specific references to recreation therapy were deleted and replaced with a more general requirement to provide a therapeutic activities program. In response to public comments that recommended us to restore the deleted requirements, we indicated that we believe that the deleted requirements concerning therapeutic activities were overly and unnecessarily prescriptive and that the hospital should have the flexibility to determine which activities are most appropriate to its patient population and to determine the criteria to be met by employees providing these services. (see the IPPS PPS rule published on June 17, 1986 (51 FR 22032)). When the 1986 COP changes applicable to psychiatric hospitals were made, we inadvertently retained specific references to recreation therapy in § 412.27. Since the intent of § 412.27(b) is to identify services provided in psychiatric units that are characteristic of services furnished in psychiatric hospitals, we believe it is no longer appropriate to include references to specific therapies in § 412.27. In order to have consistent requirements among IPFs, we are proposing to remove recreational therapy from § 412.27(b). Although we are proposing to remove the specific reference to recreation therapy, we want to emphasize that recreation therapy is, and would continue to be, an accepted therapeutic intervention in psychiatric treatment. In addition, we believe the IPF PPS base rate which was developed using FY 2002 data, reflects the provision of recreation therapy. 5. Same Day Transfers Currently, when a transfer, discharge, or death occurs on the same day as an admission to an IPF, the IPF PPS PRICER does not recognize any covered IPF days and the IPF claims are suspended. Based on review of a limited sample of the IPF and subsequent IPPS claims, it appears that many of these patients are first seen in a hospital's ED, are admitted to the hospital's psychiatric unit and, later the same day, determined to be too medically compromised to be managed in the psychiatric unit. This scenario may occur because the patient presents at the ED and is admitted to the psychiatric unit in the middle of the night, and when the patient's admission to the unit is reviewed by a psychiatrist the next morning, the physician determines that the patient should be discharged for acute care. In other cases, a patient may have been admitted to a freestanding psychiatric hospital based on the information furnished by an ED of an acute care hospital. However, after admission, the psychiatric hospital staff evaluates the patient and determines that the patient has medical needs that they are not staffed or equipped to meet. The Provider Reimbursement Manual addresses the same day transfer issue from the perspective of counting Medicare days for the purpose of Medicare cost reporting. Section 2205 indicates that only full patient days may be used to apportion inpatient routine care service costs and that a day begins at midnight and ends 24 hours later. However, section 2205.1 explains how to count a day if the day of admission and the day of discharge are the same. Section 2205.1 indicates that when a patient is admitted and then transferred from one participating provider to another before midnight of the same day, a day (except for utilization purposes) is counted at both providers. A day of Medicare utilization is charged only for the admission to the second provider. This distinction is important for psychiatric admissions because IPF stays are subject to the 190-day lifetime limit on inpatient psychiatric care. Section 1812(b) of the Act and 42 CFR 409.62 indicate that payment is not available for inpatient psychiatric hospital services furnished beyond the 190-day lifetime limit. Thus, Medicare coverage of IPF services, specifically IPF services furnished in freestanding psychiatric hospitals is limited to 190 days. In consideration of the limit on coverage of IPF services, where there is a same day transfer between Medicare participating providers, we only count the second admission for utilization purposes. Therefore, the initial admission to the IPF does not count against a beneficiary's lifetime psychiatric services limit. We have some concerns regarding same day transfers from an IPF. Under TEFRA, a hospital receives its cost up to the hospital's TEFRA limit. The TEFRA limit is based on the hospital's average cost per discharge in a base period. When an admission and discharge occur on the same day, the hospital's cost is unlikely to exceed the TEFRA limit, so the hospital receives its cost for the day. These same day transfers also improve the hospital's payment under TEFRA by slightly reducing its cost per discharge. We are also concerned that when the transfer occurs in the same hospital, this practice circumvents bundling rules under the IPPS, in that it unbundles the ED charges from the IPPS claim and allocates the ED costs to the psychiatric unit even though the patient may have been inappropriately admitted to the unit. Based on the review of IPF PPS claims we conducted, it did not appear that the admissions to the IPF were medically reasonable and necessary. However, we believe it is important to base a decision regarding coverage of these days on a comprehensive review of the claims. Therefore, we are not proposing a change in payment policy in this proposed rule. However, we are considering several alternative methods for addressing same day transfers under the IPF PPS which are described below. Any change to treatment of same day transfers would be made prospectively. We could treat these days as covered days under the IPF PPS. However, under the IPF PPS, a 19 percent adjustment to the base rate is applied to day 1 of the stay to reflect the additional administrative and clinical costs associated with admission and the day 1 adjustment is increased to 31 percent when the IPF has a qualifying ED. The IPF may also receive, for example, a teaching adjustment or rural adjustment, for these partial days of care. Several of the claims in our analysis indicate a stay of 2 hours. We are concerned that this approach would overpay IPFs and encourage inappropriate admissions and transfers. Another option would be to make no PPS payment, but continue making TEFRA payments during the IPF PPS transition period. For example, for cost reporting periods beginning in 2006, IPFs will receive a blended payment consisting of 50 percent PPS and 50 percent TEFRA. Therefore, under this approach we would allow some payment for these days for cost reporting periods in 2006 and 2007, but once the IPF PPS transition period is over, the IPFs would receive no payment for these days. We think this approach would encourage changes in admission practices in order to avoid the need to transfer patients. However, once the IPF PPS transition is over, there would be no payment mechanism to pay IPFs for stays in which there is a circumstance, not reasonably foreseeable by the admitting IPF such as a serious change in health status on the day of admission. We could treat these same day transfer cases as covered days under the IPF PPS but limit payment to the Federal per diem base rate or some other payment amount, for example, half the Federal per diem base rate. This approach would limit payment to IPFs in order to provide an incentive for IPFs to make medical clearance determinations as early in the IPF stay as possible. However, we are concerned that this approach would not lead to changes in admission practices to avoid inappropriate admissions and the need for subsequent transfers. It is important to note that the cost for these days was included in the cost reports used to develop the IPF PPS, and, as a result, the average cost per day that was used to establish the Federal per diem base rate is higher than it would otherwise have been had those days not been included. We specifically request public comment from IPFs on this issue to help us to develop a payment policy that pays IPFs appropriately for these days and provides an incentive to avoid same day transfers wherever possible. V. Provisions of the Proposed Rule [If you choose to comment on issues in this section, please include the caption “PROVISIONS” at the beginning of your comments.] We are proposing to make revisions to the regulation in order to implement the proposed prospective payment for IPFs for discharges occurring during the RY beginning July 1, 2006. As part of the update, we are proposing to incorporate OMB's revised definitions for MSAs and its new definitions of Micropolitan Statistical Areas and Core-Based Statistical Areas. In addition, we are proposing the following— • Update payments for IPF facilities using a market basket reflecting the operating and capital cost structures for the RPL market basket. • Develop cost weights for benefits, contract labor, and blood and blood products using the FY 2002-based IPPS market. • Provide weights and proxies for the FY 2002-based RPL market basket. • Indicate the methodology for the capital portion of the FY 2002-based RPL market basket. • Update the outlier threshold amount to maintain total outlier payments at 2 percent of total estimated payments. • Use source code “D” to identify IPF patients who have been transferred to the IPF from the same hospital or CAH. • Retain the 17 percent adjustment for IPFs located in rural areas, the 1.31 adjustment for IPFs with a qualifying ED, the 0.5150 teaching adjustment to the Federal per diem base rate, and the DRG adjustment factor currently being paid to IPFs for discharges occurring during RY 2007. • Update the payment rate for ECT. • Update the DRG listing and comorbidity categories to reflect the ICD-9-CM revisions effective October 1, 2005. In addition to discussing these general issues in the IPF PPS 2007 RY, we also proposed making the following specific revisions to the existing text of the regulations. Specifically, we are proposing to make conforming changes in 42 CFR part 412 and 424 as discussed through out this preamble. In § 412.27, we are proposing to revise paragraph
(b)to remove the reference to recreational therapy. In § 412.402, we are proposing to revise the heading of “Fixed dollar loss-threshold” to “Fixed dollar loss threshold amount” and revise the definitions of “Fixed dollar loss threshold amount”, “Qualifying emergency department”, “Rural area” and “Urban area.” For consistency, we are proposing to make conforming changes to these terminologies wherever they appear in the regulations text. In § 412.424, we are also proposing to add paragraph (d)(1)(iii)(E) to clarify that the teaching adjustment is made on a claim basis as an interim payment and the final payment in full is made during the final settlement of the cost report. For clarity, we are proposing to revise paragraph (d)(2) introductory text. The current language in (d)(2)(iii) would become the introductory text for paragraph (d)(2) and paragraph (d)(2)(iii) would be removed. In addition, we are proposing to revise § 412.424(d)(3)(i)(A) to clarify that an outlier payment is made if an IPF's estimated total cost for a case exceeds a fixed dollar loss threshold amount plus the Federal payment amount for the case. In § 412.426(a), we are proposing to correct the cross reference to the Federal per diem payment amount. We incorrectly referenced the Federal per diem base rate at § 424.424(c). The correct cross reference to the Federal per diem payment amount is § 424.424(d). In § 412.428, we are proposing to revise paragraph
(b)to specify that for discharges occurring on or after January 1, 2005 but before July 1, 2006 the rate of increase factor for the Federal portion of the payment is based on the FY 1997-based excluded hospital with capital market basket and for discharges occurring on or after July 1, 2006, the rate of increase factor for the Federal portion of the payment is based on the FY 2002-based RPL market basket. In addition, we are proposing to add a new paragraph
(g)to state that we would update the national urban and rural cost to charge ratio median and ceiling. Paragraph
(1)through
(3)would specify the types of IPFs in which to apply the national cost to charge ratio. Furthermore, we are proposing to add a new paragraph
(h)to update the cost of living adjustment factors if appropriate. In § 424.14, we are proposing to revise the title to read, “Requirements for inpatient services of inpatient psychiatric facilities,” to ensure consistency in compliance with the requirements among all IPFs. We are proposing to add a new paragraph (c)(3) to clarify for purposes of payment under the IPF PPS, that the physician would also recertify that the patient continues to need, on a daily basis, active inpatient psychiatric care (furnished directly by or requiring the supervision of inpatient psychiatric facility personnel) or other professional services that can only be provided on an inpatient basis. In addition, we are revising paragraph (d)(2) to state that the first recertification is required as of the 12th day of hospitalization. Subsequent recertifications are required at intervals established by the UR committee (on a case-by-case basis if it so chooses), but no less frequently than every 30 days. VI. Collection of Information Requirement [If you choose to comment on issues in this section, please include the caption “INFORMATION COLLECTION” at the beginning of your comments.] 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. VII. Regulatory Impact Analysis [If you choose to comment on issues in this section, please include the caption “IMPACT” at the beginning of your comments.] A. Overall Impact We have examined the impact of this proposed rule as required by Executive Order 12866 (September 1993, Regulatory Planning and Review), the Regulatory Flexibility Act
(RFA)(September 19, 1980, Pub. L. 96-354), section 1102(b) of the Social Security Act, the Unfunded Mandates Reform Act of 1995
(UMRA)(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). Based on the impact analysis, we estimate the expenditures from the IPF PPS implementation year to the 2007 IPF PPS RY will be increased by $180 million. The updates to the IPF labor-related share and wage indices are made in a budget neutral manner and thus have no effect on estimated costs to the Medicare program. Therefore, the estimated increased cost to the Medicare program is the result of a combination of the updated IPF market baskets, which is offset by the transition blend and the revision of the standardization factor. CMS notes that aspects of the transition, including the stop-loss policy and the transition to the 50/50 percent blend in the 2007 IPF PPS RY and the transition to the 75/25 percent blend in the 2008 IPF PPS RY, were included in the 2004 final rule and are thus not incremental to this rulemaking. Nevertheless, it is essential to analyze the impact of the transition blend in order to calculate the increase in cost to the Medicare program. The impact of the transition blend is an approximately .2 percent (about $10 million) decrease in overall payments for the 2007 IPF PPS RY and the distribution of that impact is summarized in Table 15. Therefore, the impact attributable to the policy changes proposed in this rulemaking, primarily the market basket update and the standardization correction, is approximately $180 million in the 2007 IPF PPS RY. Since costs to the Medicare program are estimated to be greater than $100 million, this proposed rule is considered a major economic rule, as defined in 5 U.S.C. 40(2). 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 governmental jurisdictions. Most IPFs and most other providers and suppliers are considered small entities, either by nonprofit status or by having revenues of $6 million to $29 million in any 1 year. (For details, see the Small Business Administration's regulation that set forth size standards for health care industries at 65 FR 69432.) HHS considers that a substantial number of entities are affected if the rule impacts more than 5 percent of the total number of small entities as it does in this rule. We included all freestanding psychiatric hospitals (79 are non-profit hospitals) in the analysis since their total revenues do not exceed the $29 million threshold. We also included psychiatric units of small hospitals, that is, those hospitals with fewer than 100 beds. We did not include psychiatric units within larger hospitals in the analysis because we believe this proposed rule would not significantly impact total revenues of the entire hospital that supports the unit. We have provided the following RFA analysis in section B to emphasize that, although the proposed rule would impact a substantial number of IPFs that were identified as small entities, we do not believe it would have a significant economic impact. Based on the analysis of the 1063 psychiatric facilities that were classified as small entities as described above, we estimate the combined impact of the IPF PPS will be a 4.6-percent increase in payments in RY 2007 relative to their payments in the implementation year of the IPF PPS. Based on the information available, we believe that Medicare payments may constitute a small portion of governmental IPF's revenue stream. We have prepared the impact analysis in section VI.B.2 to describe the impact of the proposed rule in order to provide a factual basis for our conclusions regarding small business impact. In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis if a proposed 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. With the exception of hospitals located in certain New England counties, for purposes of section 1102(b) of the Act, we previously defined a small rural hospital as a hospital with fewer than 100 beds that is located outside of a Metropolitan Statistical Area
(MSA)or New England County Metropolitan Area (NECMA). However, under the new labor market definitions that we are proposing to adopt, we would no longer employ NECMAs to define urban areas in New England. Therefore, for purposes of this analysis, we now define a small rural hospital as a hospital with fewer than 100 beds that is located outside of an MSA. We have determined that this proposed rule would have a substantial impact on hospitals classified as located in rural areas. As discussed earlier in this preamble, we are proposing to continue to provide a payment adjustment of 17 percent for IPFs located in rural areas. In addition, we have established a 3-year transition to the new system to allow IPFs an opportunity to adjust to the new system. Therefore, the impacts shown in Table 15 below reflect the adjustments that are designed to minimize or eliminate any potentially significant negative impact that the IPF PPS may otherwise have on small rural IPFs. Section 202 of the Unfunded Mandates Reform Act of 1995 also requires that agencies assess anticipated costs and benefits before issuing any proposed rule whose mandates require spending in any 1 year of $100 million in 1995 dollars, updated annually for inflation. That threshold level is currently approximately $120 million. This proposed rule would not mandate any requirements for State, local, or tribal governments, nor would it affect private sector costs. Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed rule that imposes substantial direct requirement costs on State and local governments, preempts State law, or otherwise has Federalism implications. We have reviewed this proposed rule under the criteria set forth in Executive Order 13132 and have determined that the proposed rule would not have any substantial impact on the rights, roles, and responsibilities of State, local, or tribal governments. B. Anticipated Effects of the Proposed Rule We discuss below the impact of this proposed rule on the Federal Medicare budget and on IPFs. 1. Budgetary Impact As discussed in detail in the IPF PPS final rule and summarized in section III.B. of this proposed rule, we applied a budget neutrality factor to the Federal per diem and ECT base rates to ensure that total payments under the IPF PPS in the implementation period would equal the amount that would have been paid if the IPF PPS had not been implemented. In addition, as discussed in section IV.C.1 of this proposed rule, we are proposing to adopt the new CBSAs and labor market share in a budget neutral manner by applying a wage index budget neutrality factor to the Federal per diem and ECT base rates. Thus, the budgetary impact to the Medicare program by the update of the IPF PPS will be the combination of the proposed market basket updates (see section III.C of this proposed rule), the proposed revision of the standardization factor (see section III.B.3 of this proposed rule), and the planned update of the payment blend discussed below. 2. Impacts on Providers To understand the impact of the changes to the IPF PPS discussed in this proposed rule on providers, it is necessary to compare estimated payments under the IPF PPS rates and factors for the 2007 IPF rate year to estimated payments under the IPF PPS rates and factors for the IPF PPS implementation year. The estimated payments for the IPF implementation year are a blend of: 75 percent of the facility-specific TEFRA payment and 25 percent of the IPF PPS payment with stop loss payment. The estimated payments for the 2007 IPF rate year are a blend of: 50 percent of the facility-specific TEFRA payment and 50 percent of the IPF PPS payment with stop loss payment. We determined the percent change of estimated 2007 IPF PPS rate year payments to estimated IPF PPS implementation year payments for each category of IPFs. In addition, for each category of IPFs, we have included the estimated percent change in payments resulting from the revision of the standardization factor (as discussed in section III.B.3 of this proposed rule, the ratio of estimated total TEFRA payments to estimated total PPS payments in the implementation year was overestimated and therefore needed to be reduced. We are proposing to apply the revised standardization factor prospectively to the Federal per diem base rate and ECT amount), the wage index changes for the 2007 IPF PPS rate year, the proposed market basket update to IPF PPS payments, and the transition blend for the 2007 rate year of the IPF PPS payment and the facility-specific TEFRA payment. To illustrate the impacts of the proposed RY 2007 changes, our analysis begins with an implementation year baseline simulation model based on FY 2002 IPF payments inflated to 2005 with market baskets; the estimated outlier payments in 2005; the estimated stop-loss payments in 2005; the MSA designations for IPFs based on OMB's MSA definitions before June 2003; the 2005 MSA wage index; the implementation year labor-market share; and the implementation year percentage amount of the rural adjustment. During the simulation, the outlier payment is maintained at the target of 2 percent of total PPS payments. Each of the following proposed changes is added incrementally to this baseline model in order for us to isolate the effects of each change: • IPF PPS payments adjusted by the revised standardization factor. • The new CBSAs based on new geographic area definitions announced by OMB in June 2003 and the RY 2007 proposed budget-neutral labor-related share and wage index adjustment. • A blended market basket update of 4.7 percent resulting in an update to the hospital-specific TEFRA target amount and an update to the IPF PPS base rates as discussed below. ++ As discussed in section III.C.4 of this proposed rule and in the IPPS final rule published August 12, 2005 (70 FR 47707), we established an update factor of 3.8 percent effective for cost reporting periods beginning on or after October 1, 2005 using the 2002-based excluded hospital market basket. The 3.8 percent update is applied to the IPF's target cost per discharge established under TEFRA for cost reporting periods beginning on or after October 1, 2005. However, since the midpoints of the 2007 rate year and the IPF PPS implementation period are 15 months apart, the TEFRA payment increase is projected to be 4.8 percent. ++ An update to the Federal per diem base rate of 4.5 percent based on the 2002-based RPL market basket (see section III.C.1.b of this proposed rule). The market basket update is based on a 15-month time period (from the midpoint of the IPF PPS implementation period to the midpoint of the 2007 rate year). • The transition to 50 percent IPF PPS payment and 50 percent facility-specific TEFRA payment. Our final comparison illustrates the percent change in payments from the IPF PPS implementation year (that is, January 1, 2005 to June 30, 2006) to RY 2007 (that is, July 1, 2006 to June 30, 2007). Table 15.—Projected Impacts Facility by type Number of facilities Standardization factor correction CBSA wage index and labor share Market basket Transition blend Total
(7)All Facilities 1,806 −0.3% 0.0% 4.7% −0.2% 4.2% By Type of Ownership: Psychiatric Hospitals Government 178 −0.4% 0.0% 4.7% 11.0% 15.7% Non-profit 79 −0.3% 0.1% 4.7% 1.6% 6.1% For-profit 150 −0.4% 0.1% 4.7% 4.3% 8.9% Psychiatric Units 1,399 −0.3% 0.0% 4.7% −1.8% 2.5% Rural 384 −0.3% −0.2% 4.7% −1.1% 3.0% Urban 1,422 −0.3% 0.0% 4.7% −0.1% 4.3% By Urban or Rural Classification: Urban by Facility Type Psychiatric Hospitals Government 144 −0.4% 0.1% 4.7% 10.8% 15.6% Non-profit 73 −0.3% 0.1% 4.7% 1.7% 6.2% For-profit 143 −0.4% 0.1% 4.7% 4.4% 9.0% Psychiatric Units 1,062 −0.3% 0.0% 4.7% −1.7% 2.6% Rural by Facility Type Psychiatric Hospitals Government 34 −0.5% −0.3% 4.7% 11.8% 16.1% Non-profit 6 −0.3% 0.3% 4.7% −0.7% 3.9% For-profit 7 −0.2% −0.1% 4.7% −1.8% 2.4% Psychiatric Units 337 −0.3% −0.2% 4.7% −2.2% 1.8% By Teaching Status: Non-teaching 1,537 −0.3% 0.0% 4.7% −0.3% 4.0% Less than 10% interns and residents to beds 148 −0.3% 0.0% 4.7% 0.4% 4.8% 10% to 30% interns and residents to beds 72 −0.3% −0.1% 4.7% 0.4% 4.6% More than 30% interns and residents to beds 49 −0.3% 0.1% 4.7% −0.1% 4.4% By Region: New England 126 −0.3% 0.0% 4.7% −0.5% 3.9% Mid-Atlantic 306 −0.4% 0.1% 4.7% 2.8% 7.3% South Atlantic 238 −0.3% −0.1% 4.7% 0.2% 4.5% East North Central 325 −0.3% −0.1% 4.7% −1.5% 2.8% East South Central 159 −0.3% 0.0% 4.7% −0.2% 4.2% West North Central 169 −0.3% −0.2% 4.7% −1.1% 3.1% West South Central 237 −0.3% −0.1% 4.7% −2.7% 1.6% Mountain 83 −0.3% 0.0% 4.7% −0.4% 4.0% Pacific 156 −0.3% 0.3% 4.7% −0.6% 4.1% By Bed Size: Psychiatric Hospitals Under 12 beds 26 −0.1% 0.1% 4.7% −3.8% 0.8% 12 to 25 beds 46 −0.2% −0.1% 4.7% 0.3% 4.7% 25 to 50 beds 91 −0.4% 0.2% 4.7% 4.3% 8.9% 50 to 75 beds 82 −0.4% 0.1% 4.7% 3.8% 8.4% Over 75 beds 162 −0.4% 0.0% 4.7% 8.5% 13.1% Psychiatric Units Under 12 beds 600 −0.2% 0.0% 4.7% −4.5% −0.2% 12 to 25 beds 474 −0.3% 0.0% 4.7% −1.9% 2.4% 25 to 50 beds 228 −0.3% 0.0% 4.7% −0.6% 3.7% 50 to 75 beds 58 −0.3% 0.0% 4.7% 0.1% 4.4% Over 75 beds 39 −0.3% −0.1% 4.7% 1.2% 5.5% 3. Results Table 15 above displays the results of our analysis. The table groups IPFs into the categories listed below based on characteristics provided in the Online Survey and Certification and Reporting (OSCAR) file and the 2002 cost report data from HCRIS: • Facility Type • Location • Teaching Status Adjustment • Census Region • Size The top row of the table shows the overall impact on the 1,806 IPFs included in the analysis. In column 3, we present the effects of the revised standardization factor (refer to section III.B.3 of this proposed rule for a discussion of this revision). This is defined to be the comparison of the simulated implementation year payment under the revised budget neutral factor to the simulated implementation year payment under the original budget neutral factor. In aggregate, the proposed revision would result in a 0.3 percent decrease in overall payments to IPFs. There are small distributional effects among different categories of IPFs. For example, rural government psychiatric hospitals would receive the largest decrease of 0.5 percent while rural for-profit psychiatric hospitals would receive a 0.2 percent decrease. Also psychiatric hospitals with over 75 beds would receive a decrease of 0.4 percent while psychiatric hospitals with fewer than 12 beds would receive the smallest decrease of 0.1 percent. In column 4, we present the effects of the budget-neutral update to the labor-related share and the wage index adjustment under the new CBSA geographic area definitions announced by OMB in June 2003. This is a comparison of the simulated implementation year payment under revised budget neutral factor and labor-related share and wage index under CBSA classification to the simulated implementation year payment under revised budget neutral factor and labor-related share and wage index under current MSA classification. There is no change in aggregate payments to IPFs as indicated in the first row of column 4. There would, however, be small distributional effects among different categories of IPFs. For example, rural IPFs would experience a 0.2 percent decrease in payments while urban IPFs would experience no change in payments. Rural government hospitals would receive the largest decrease of 0.3 percent while rural non-profit hospitals would receive the largest increase of 0.3 percent. In column 5, we present the effects of the proposed market basket update to the IPF PPS payments by applying the TEFRA and PPS updates to payments under revised budget neutral factor and labor-related share and wage index under CBSA classification. In the aggregate the proposed update would result in a 4.7 percent increase in overall payments to IPFs. This 4.7 percent reflects the current blend of the 4.8 percent update for IPF TEFRA payments and the 4.5 percent update for the IPF PPS payments. In column 6, we present the effects of the payment change in transition blend percentages to transition year 2 (TEFRA Rate Percentage = 50 percent, IPF PPS Federal Rate Percentage = 50 percent) from transition year 1 (TEFRA Rate Percentage = 75 percent, IPF PPS Federal Rate Percentage = 25 percent) of the IPF PPS under revised budget neutral factor, labor-related share and wage index under CBSA classification, and TEFRA and PPS updates to RY 2007. The overall aggregate effect, across all hospital groups, would be a 0.2 percent decrease in payments to IPFs. There are distributional effects of these changes among different categories of IPFs. The largest increases would be among government psychiatric hospitals, with rural government hospitals receiving an 11.8 percent increase and urban government hospitals receiving a 10.8 percent increase. Alternatively, psychiatric hospitals and units with fewer than 12 beds would receive the largest decreases of 3.8 percent and 4.5 percent respectively. Column 7 compares our estimates of proposed changes reflected in this proposed rule for RY 2007, to our estimates of payments in the implementation year (without these proposed changes). This column reflects all RY 2007 proposed changes relative to the implementation year, shown in columns 3 through 6. The average increase for all IPFs is approximately 4.2 percent. This increase includes the effects of the market basket updates resulting in a 4.7 percent increase in total RY 2007 payments. It also includes a 0.3 percent decrease in RY 2007 payments for the standardization factor revision and a 0.2 percent decrease in RY 2007 payments for the transition blend. Overall, the largest payment increase would be among government IPFs. Urban government psychiatric hospitals would receive a 15.6 percent increase and rural government psychiatric hospitals would receive a 16.1 percent increase. Psychiatric hospitals with fewer than 12 beds would receive a 0.8 percent increase and psychiatric units with fewer than 12 beds would receive a 0.2 percent decrease. 4. Effect on the Medicare Program Based on actuarial projections resulting from our experience with other PPSs, we estimate that Medicare spending (total Medicare program payments) for IPF services over the next 5 years would be as follows: Table 16.—Estimated Payments Rate year Dollars in millions July 1, 2006 to June 30, 2007 $4,257 July 1, 2007 to June 30, 2008 4,382 July 1, 2008 to June 30, 2009 4,559 July 1, 2009 to June 30, 2010 4,762 July 1, 2010 to June 30, 2011 4,979 These estimates are based on the current estimate of increases in the excluded hospital with capital market basket as follows: • 3.6 percent for RY 2007; • 3.5 percent for RY 2008; • 3.1 percent for RY 2009; • 2.6 percent for RY 2010; and • 3.0 percent for RY 2011. We estimate that there would be a change in fee-for-service Medicare beneficiary enrollment as follows: • −2.3 percent in RY 2007; • −1.0 percent in RY 2008; • 0.3 percent in RY 2009; • 0.3 percent in RY 2010; and • 0.6 percent in RY 2011. In the implementation year we estimated aggregate payments under the IPF PPS to equal the estimated aggregate payments that would be made if the IPF PPS were not implemented. Our methodology for estimating payments for purposes of the budget-neutrality calculations uses the best available data. We will evaluate the accuracy of the assumptions used to compute the budget-neutrality calculation in the implementation year. We intend to analyze claims and cost report data from the implementation year of the IPF PPS to determine whether the factors used to develop the Federal per diem base rate are not significantly different from the actual results experienced in that year. We are planning to compare payments under the final IPF PPS (which relies on an estimate of cost-based TEFRA payments using historical data from a base year and assumptions that trend the data to the initial implementation period) to estimated cost-based TEFRA payments based on actual data from the first year of the IPF PPS. If we find that an adjustment is necessary, the percent difference (either positive or negative) would be applied prospectively to the established prospective payment rates to ensure the rates accurately reflect the payment levels intended by the statute. Section 124 of Public Law 106-113 provides the Secretary broad authority to make an adjustment. We intend to perform this analysis within the first 5 years of the implementation of the IPF PPS. 5. Effect on Beneficiaries Under the IPF PPS, IPFs would receive payment based on the average resources consumed by patients for each day. We do not expect changes in the quality of care or access to services for Medicare beneficiaries under the IPF PPS. In fact, we believe that access to IPF services would be enhanced due to the patient and facility level adjustment factors, all of which are intended to adequately reimburse IPFs for expensive cases. Finally, the stop-loss policy is intended to assist IPFs during the transition. In addition, we expect that paying prospectively for IPF services would enhance the efficiency of the Medicare program. 6. Computer Hardware and Software We do not anticipate that IPFs would incur additional systems operating costs in order to effectively participate in the IPF PPS. We believe that IPFs and CAHs possess the computer hardware capability to handle the billing requirements under the IPF PPS. Our belief is based on indications that approximately 99 percent of hospital inpatient claims are submitted electronically. In addition, we are not adopting significant changes in claims processing (see section IV.C of this proposed rule). C. Accounting Statement As required by OMB Circular A-4 (available at *http://www.whitehouse.gov/omb/circulars/a004/a-4.pdf)* , in Table 17 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 increase in Medicare payments under the IPF PPS as a result of the changes presented in this proposed rule based on the data for 1,806 IPFs in our database. All expenditures are classified as transfers to Medicare providers (that is, IPFs). Table 17.—Accounting Statement: Classification of Estimated Expenditures, from the 2006 IPF PPS RY to the 2007 IPF PPS RY (In millions) Category Transfers Annualized Monetized Transfers $180. From Whom To Whom? Federal Government To IPFs Medicare Providers. D. Alternatives Considered We considered the following alternatives in developing the update to the IPF PPS: One option we considered was incorporating a transition from MSA-based labor market definitions to CBSA-based labor market definitions for the purpose of applying the area wage index. As stated in section IV.C.1.e of this proposed rule, we are not adopting a transition policy here because IPFs are already in a transition from reasonable cost based reimbursement to IPF PPS payments. In addition, as evident in Table 15 above, the wage index change does not appear to have a large impact on IPFs. We also considered increasing our outlier percentage so that outlier payments would be projected to be 3 percent (or higher) of total PPS payments. However, this approach would not target the truly costly cases. Instead, implementing such a policy would have the effect of lowering the fixed dollar loss amount, therefore spreading outlier payments across more IPFs. In addition, the Federal per diem base rate would have to be reduced by another percentage point. It is also worth noting that in this proposed rule, we used the best available complete data set (that is, FY 2002 claims and cost report data) to assess the impact of the various policy changes. As previously stated, we won't know the true impact of the wage index changes, the transition blend period, or the market basket increases until we are able to analyze 1 year of IPF PPS claims and cost report data. We considered alternative policies in order to reduce financial risk to facilities in the event that they experience substantial reductions in Medicare payments during the period of transition to the IPF PPS. As discussed previously in this proposed rule, we have adopted a provision that would guarantee each facility an average payment per case under the IPF PPS that is estimated to be no less than a minimum proportion of its average payment per case under TEFRA. We analyzed the impact on losses if we were to make a payment adjustment to ensure that the minimum IPF PPS per case payment to an IPF is at least 70 percent of its TEFRA payment. The stop-loss adjustment is applied to the IPF PPS portion of Medicare payments during the transition. For example, during year 2 of the 3-year transition period, half of the payment is based on TEFRA, and half of the payment is based on the Federal rate. We apply the stop-loss adjustment to the portion of the IPF's payments during the transition based on the Federal rate. We estimate that the combined effects of the transition and the stop-loss policies will ensure that per case payments relative to pre-IPF PPS TEFRA per case payments are no less than 92.5 percent in year 1, 85 percent in year 2, and 77.5 percent in year 3. We estimate that about 10 percent of IPFs would receive additional payments under the stop-loss policy. The 70 percent of TEFRA stop-loss policy required a reduction in the per diem rate to make the stop-loss policy budget neutral during the implementation year. As a result, in the IPF PPS final rule, we made a reduction to the Federal per diem base rate of 0.4 percent in order to maintain budget neutrality. In the IPF PPS final rule, we considered an 80 percent stop-loss policy as well as a 70 percent policy. In order to target the stop-loss policy to the IPFs that experience the greatest impact relative to current payments and to limit the size of the reduction to the Federal per diem base rate, we adopted the 70 percent policy. In developing this proposed rule, we again considered an 80 percent stop-loss policy for RY 2007. Adopting an 80 percent policy would require a reduction in the Federal per diem base rate of over 2.5 percent, and we estimate that about 29 percent of IPFs would receive additional payments. We chose to stay with the 70 percent policy for the same reasons discussed in the IPF PPS final rule. Specifically, the 70 percent stop-loss policy targets the IPFs that experience the greatest impact relative to current payments, and it limits the size of the reduction to the Federal per diem base rate. In accordance with the provisions of Executive Order 12866, this rule was previously reviewed by OMB. List of Subjects 42 CFR Part 412 Administrative practice and procedure, Health facilities, Medicare, Puerto Rico, Reporting and recordkeeping requirements. 42 CFR Part 424 Emergency medical services, Health facilities, Health professions, Medicare, Reporting and recordkeeping requirements. For the reasons set forth in the preamble, the Centers for Medicare & Medicaid Services proposes to amend 42 CFR chapter IV as follows: PART 412—PROSPECTIVE PAYMENT SYSTEMS FOR HOSPITAL SERVICES 1. The authority citation for part 412 is revised to read as follows: Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh), Sec. 124 of Pub. L. 106-113, 113 Stat. 1515, and Sec. 405 of Pub. L. of 108-173, 117 Stat. 2266. 2. Amend § 412.27 by revising paragraph
(b)to read as follows: § 412.27 Excluded psychiatric units: Additional requirements.
(b)Furnish, through the use of qualified personnel, psychological services, social work services, psychiatric nursing, and occupational therapy. 3. Section 412.402 is amended by— A. Republishing the introductory text. B. Revising the heading of “Fixed dollar loss threshold,” to read “Fixed dollar loss threshold amount.” C. Revising the definition of “Fixed dollar loss threshold amount,” “Qualifying emergency department,” “Rural area,” and “Urban area.” The revisions read as follows: § 412.402 Definitions. As used in this subpart— *Fixed dollar loss threshold amount* means a dollar amount which, when added to the Federal payment amount for case, the estimated costs of a case must exceed in order for the case to qualify for an outlier payment. *Qualifying emergency department* means an emergency department that is staffed and equipped to furnish a comprehensive array of emergency services and meeting the definitions of a dedicated emergency department as specified in § 489.24(b) of this chapter and the definition of “provider-based status” as specified in § 413.65 of this chapter. *Rural area* means for cost reporting periods beginning January 1, 2005, with respect to discharges occurring during the period covered by such cost reports but before July 1, 2006, an area as defined in § 412.62(f)(1)(iii). For discharges occurring on or after July 1, 2006, rural area means an area as defined in § 412.64(b)(1)(ii)(C). *Urban area* means for cost reporting periods beginning on or after January 1, 2005, with respect to discharges occurring during the period covered by such cost reports but before July 1, 2006, an area as defined in § 412.62(f)(1)(ii). For discharges occurring on or after July 1, 2006, urban area means an area as defined in § 412.64(b)(1)(ii)(A) and § 412.64(b)(1)(ii)(B). 4. Section 412.424 is amended by— A. Revising paragraph (d)(1)(iii). B. Republishing the heading of paragraph (d)(1)(v). C. Revising paragraph (d)(1)(v)(A). D. Adding paragraph (d)(2) introductory text. E. Removing and reserving paragraph (d)(2)(iii). F. Revising paragraphs (d)(3)(i) introductory text and (d)(3)(i)(A). The revisions and additions read as follows: § 412.424 Methodology for calculating the Federal per diem payment amount.
(d)* * *
(1)* * *
(iii)*Teaching adjustment.* CMS adjusts the Federal per diem base rate by a factor to account for indirect teaching costs.
(A)An inpatient psychiatric facility's teaching adjustment is based on the ratio of the number of full-time equivalent residents training in the inpatient psychiatric facility divided by the facility's average daily census.
(B)Residents with less than full-time status and residents rotating through the inpatient psychiatric facility for less than a full year will be counted in proportion to the time they spend in the inpatient psychiatric facility.
(C)Except as described in paragraph (d)(1)(iii)(D) of this section, the actual number of current year full-time equivalent residents used in calculating the teaching adjustment is limited to the number of full-time equivalent residents in the inpatient psychiatric facility's most recently filed cost report filed with its fiscal intermediary before November 15, 2004 (base year).
(D)If the inpatient psychiatric facility first begins training residents in a new approved graduate medical education program after November 15, 2004, the number of full-time equivalent residents determined under paragraph (d)(1)(iii)(C) of this section may be adjusted using the method described in § 413.79(e)(1)(i) and
(ii)of this chapter.
(E)The teaching adjustment is made on a claim basis as an interim payment, and the final payment in full for the claim is made during the final settlement of the cost report.
(v)*Adjustment for IPF with qualifying emergency departments.*
(A)CMS adjusts the Federal per diem base rate to account for the costs associated with maintaining a qualifying emergency department. A qualifying emergency department is staffed and equipped to furnish a comprehensive array of emergency services (medical and psychiatric) and meets the requirements of § 489.24(b) and § 413.65 of this chapter.
(2)*Patient-level adjustments.* The inpatient psychiatric facility must identify a principal psychiatric diagnosis as specified in § 412.27(a) for each patient. CMS adjusts the Federal per diem base rate by a factor to account for the diagnosis-related group assignment associated with the principal diagnosis, as specified by CMS.
(3)*Other adjustments.*
(i)*Outlier payments.* CMS provides an outlier payment if an inpatient psychiatric facility's estimated total cost for a case exceeds a fixed dollar loss threshold amount for an inpatient psychiatric facility as defined in § 412.402 plus the Federal payment amount for the case.
(A)The fixed dollar loss threshold amount is adjusted for the inpatient psychiatric facility's adjustments for wage area, teaching, rural locations, and cost of living adjustment for facilities located in Alaska and Hawaii. § 412.426 [Amended] 5. In § 412.426, paragraph
(a)introductory text is amended by removing the reference “§ 412.424(c)” and adding the reference “§ 412.424(d)” in its place. 6. Section 412.428 is amended by— A. Republishing the introductory text. B. Revising paragraph
(b)and (d). C. Adding a new paragraph (g). D. Adding a new paragraph (h). The revision and additions reads as follows: § 412.428 Publication of updates to the inpatient psychiatric facility prospective payment system. CMS will publish annually in the **Federal Register** information pertaining to updates to the inpatient psychiatric facility prospective payment system. This information includes: (b)(1) For discharges occurring on or after January 1, 2005 but before July 1, 2006, the rate of increase factor, described in § 412.424(a)(2)(iii), for the Federal portion of the inpatient psychiatric facility's payment is based on the excluded hospital with capital market basket under the update methodology described in section 1886(b)(3)(B)(ii) of the Act for each year.
(2)For discharges occurring on or after July 1, 2006, the rate of increase factor for the Federal portion of the inpatient psychiatric facility's payment is based on the Rehabilitation, Psychiatric, and Long-Term Care
(RPL)market basket.
(3)For discharges occurring on or after January 1, 2005 but before July 1, 2006, the rate of increase factor, described in § 412.424(a)(2)(iii), for the reasonable cost portion of the inpatient psychiatric facility's payment is based on the 1997-based excluded hospital market basket under the updated methodology described in section 1886(b)(3)(B)(ii) of the Act for each year.
(4)For discharges occurring on or after July 1, 2006, the rate of increase factor for the reasonable cost portion of the inpatient psychiatric facility's payment is based on the 2002-based excluded hospital market basket.
(d)Updates to the fixed dollar loss threshold amount in order to maintain the appropriate outlier percentage.
(g)Update the national urban and rural cost to charge ratio median and ceilings. CMS will apply the national cost to charge ratio to—
(1)New inpatient psychiatric facilities that have not submitted their first Medicare cost report.
(2)Inpatient psychiatric facilities whose operating or capital cost to charge ratio is in excess of 3 standard deviations above the corresponding national geometric mean.
(3)Other inpatient psychiatric facilities for which the fiscal intermediary obtains inaccurate or incomplete date with which to calculate either an operating or capital cost to charge ratio or both.
(h)Update the cost of living adjustment factor if appropriate. 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). 2. Section 424.14 is amended by— A. Revising the heading. B. Adding a new paragraph (c)(3). C. Revising paragraph (d)(2). The addition and revisions read as follows: § 424.14 Requirements for inpatient services of inpatient psychiatric facilities.
(c)* * *
(3)The patient continues to need, on a daily basis, active inpatient psychiatric care (furnished directly by or requiring the supervision of inpatient psychiatric facility personnel) or other professional services that can only be provided on an inpatient basis.
(d)* * *
(2)The first recertification is required as of the 12th day of hospitalization. Subsequent recertifications are required at intervals established by the UR committee (on a case-by-case basis if it so chooses), but no less frequently than every 30 days. (Catalog of Federal Domestic Assistance Program No. 93.778, Medical Assistance Program) (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program) Dated: November 3, 2005. Mark B. McClellan, Administrator, Centers for Medicare & Medicaid Services. Approved: January 13, 2006. Michael O. Leavitt, Secretary. Note: The following addenda will not appear in the Code of Federal Regulations. Addendum A—Rate and Adjustment Factors Per Diem Rate Federal Per Diem Base Rate $594.66 Labor Share (0.75923) $451.48 Non-Labor Share (0.24077) $143.18 Fixed Dollar Loss Threshold Amount $6200 Facility Adjustments Rural Adjustment Factor 1.17. Teaching Adjustment Factor 0.5150. Wage Index Pre-reclass Hospital Wage Index (FY2006). Cost of Living Adjustments (COLAs) Alaska 1.25 Hawaii Honolulu County 1.25 Hawaii County 1.165 Kauai County 1.2325 Maui County 1.2375 Kalawao County 1.2375 Patient Adjustments ECT—Per Treatment $268.21 Variable Per Diem Adjustments Adjustment Factor Day 1—Facility Without a 24/7 Full-service Emergency Department 1.19 Day 1—Facility With a 24/7 Full-service Emergency Department 1.31 Day 2 1.12 Day 3 1.08 Day 4 1.05 Day 5 1.04 Day 6 1.02 Day 7 1.01 Day 8 1.01 Day 9 1.00 Day 10 1.00 Day 11 0.99 Day 12 0.99 Day 13 0.99 Day 14 0.99 Day 15 0.98 Day 16 0.97 Day 17 0.97 Day 18 0.96 Day 19 0.95 Day 20 0.95 Day 21 0.95 After Day 21 0.92 Age Adjustments Age (in years) Adjustment Factor Under 45 1.00 45 and under 50 1.01 50 and under 55 1.02 55 and under 60 1.04 60 and under 65 1.07 65 and under 70 1.10 70 and under 75 1.13 75 and under 80 1.15 80 and over 1.17 DRG Adjustments DRG DRG Definition DRG Adjustment Factor DRG 424 Procedure with principal diagnosis of mental illness 1.22 DRG 425 Acute adjustment reaction 1.05 DRG 426 Depressive neurosis 0.99 DRG 427 Neurosis, except depressive 1.02 DRG 428 Disorders of personality 1.02 DRG 429 Organic disturbances 1.03 DRG 430 Psychosis 1.00 DRG 431 Childhood disorders 0.99 DRG 432 Other mental disorders 0.92 DRG 433 Alcohol/Drug use Leave against Medical Advice
(LAMA)0.97 DRG 521 Alcohol/Drug use with comorbid conditions 1.02 DRG 522 Alcohol/Drug use without comorbid conditions 0.98 DRG 523 Alcohol/Drug use without rehabilitation 0.88 DRG 12 Degenerative nervous system disorders 1.05 DRG 23 Non-traumatic stupor & coma 1.07 Comorbidity Adjustments Comorbidity Adjustment Factor Developmental Disabilities 1.04 Coagulation Factor Deficit 1.13 Tracheostomy 1.06 Eating and Conduct Disorders 1.12 Infectious Diseases 1.07 Renal Failure, Acute 1.11 Renal Failure, Chronic 1.11 Oncology Treatment 1.07 Uncontrolled Diabetes Mellitus 1.05 Severe Protein Malnutrition 1.13 Drug/Alcohol Induced Mental Disorders 1.03 Cardiac Conditions 1.11 Gangrene 1.10 Chronic Obstructive Pulmonary Disease 1.12 Artificial Openings - Digestive & Urinary 1.08 Musculoskeletal & Connective Tissue Diseases 1.09 Poisoning 1.11 Addendum B—RY 2007 IPF PPS Wage Index Table SSA State/County Code County name MSA Number MSA Urban/Rural 2006 MSA-based WI CBSA Number CBSA Urban/Rural 2006 CBSA-based WI 01000 Autauga County, Alabama 5240 Urban 0.8618 33860 Urban 0.8618 01010 Baldwin County, Alabama 5160 Urban 0.7861 99901 Rural 0.7446 01020 Barbour County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01030 Bibb County, Alabama 01 Rural 0.7432 13820 Urban 0.8959 01040 Blount County, Alabama 1000 Urban 0.9000 13820 Urban 0.8959 01050 Bullock County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01060 Butler County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01070 Calhoun County, Alabama 0450 Urban 0.7682 11500 Urban 0.7682 01080 Chambers County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01090 Cherokee County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01100 Chilton County, Alabama 01 Rural 0.7432 13820 Urban 0.8959 01110 Choctaw County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01120 Clarke County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01130 Clay County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01140 Cleburne County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01150 Coffee County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01160 Colbert County, Alabama 2650 Urban 0.8272 22520 Urban 0.8272 01170 Conecuh County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01180 Coosa County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01190 Covington County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01200 Crenshaw County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01210 Cullman County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01220 Dale County, Alabama 2180 Urban 0.7701 99901 Rural 0.7446 01230 Dallas County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01240 De Kalb County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01250 Elmore County, Alabama 5240 Urban 0.8618 33860 Urban 0.8618 01260 Escambia County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01270 Etowah County, Alabama 2880 Urban 0.7938 23460 Urban 0.7938 01280 Fayette County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01290 Franklin County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01300 Geneva County, Alabama 01 Rural 0.7432 20020 Urban 0.7721 01310 Greene County, Alabama 01 Rural 0.7432 46220 Urban 0.8645 01320 Hale County, Alabama 01 Rural 0.7432 46220 Urban 0.8645 01330 Henry County, Alabama 01 Rural 0.7432 20020 Urban 0.7721 01340 Houston County, Alabama 2180 Urban 0.7701 20020 Urban 0.7721 01350 Jackson County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01360 Jefferson County, Alabama 1000 Urban 0.9000 13820 Urban 0.8959 01370 Lamar County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01380 Lauderdale County, Alabama 2650 Urban 0.8272 22520 Urban 0.8272 01390 Lawrence County, Alabama 2030 Urban 0.8469 19460 Urban 0.8469 01400 Lee County, Alabama 0580 Urban 0.8100 12220 Urban 0.8100 01410 Limestone County, Alabama 3440 Urban 0.9146 26620 Urban 0.9146 01420 Lowndes County, Alabama 01 Rural 0.7432 33860 Urban 0.8618 01430 Macon County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01440 Madison County, Alabama 3440 Urban 0.9146 26620 Urban 0.9146 01450 Marengo County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01460 Marion County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01470 Marshall County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01480 Mobile County, Alabama 5160 Urban 0.7861 33660 Urban 0.7891 01490 Monroe County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01500 Montgomery County, Alabama 5240 Urban 0.8618 33860 Urban 0.8618 01510 Morgan County, Alabama 2030 Urban 0.8469 19460 Urban 0.8469 01520 Perry County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01530 Pickens County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01540 Pike County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01550 Randolph County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01560 Russell County, Alabama 1800 Urban 0.8560 17980 Urban 0.8560 01570 St Clair County, Alabama 1000 Urban 0.9000 13820 Urban 0.8959 01580 Shelby County, Alabama 1000 Urban 0.9000 13820 Urban 0.8959 01590 Sumter County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01600 Talladega County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01610 Tallapoosa County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01620 Tuscaloosa County, Alabama 8600 Urban 0.8764 46220 Urban 0.8645 01630 Walker County, Alabama 01 Rural 0.7432 13820 Urban 0.8959 01640 Washington County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01650 Wilcox County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 01660 Winston County, Alabama 01 Rural 0.7432 99901 Rural 0.7446 02013 Aleutians County East, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02016 Aleutians County West, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02020 Anchorage County, Alaska 0380 Urban 1.1784 11260 Urban 1.1895 02030 Angoon County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02040 Barrow-North Slope County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02050 Bethel County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02060 Bristol Bay Borough County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02068 Denali County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02070 Bristol Bay County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02080 Cordova-Mc Carthy County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02090 Fairbanks County, Alaska 02 Rural 1.1888 21820 Urban 1.1408 02100 Haines County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02110 Juneau County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02120 Kenai-Cook Inlet County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02122 Kenai Peninsula Borough, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02130 Ketchikan County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02140 Kobuk County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02150 Kodiak County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02160 Kuskokwin County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02164 Lake and Peninsula Borough, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02170 Matanuska County, Alaska 02 Rural 1.1888 11260 Urban 1.1895 02180 Nome County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02185 North Slope Borough, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02188 Northwest Arctic Borough, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02190 Outer Ketchikan County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02200 Prince Of Wales County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02201 Prince of Wales-Outer Ketchikan Census Area, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02210 Seward County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02220 Sitka County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02230 Skagway-Yakutat County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02231 Skagway-Yakutat-Angoon Census Area, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02232 Skagway-Hoonah-Angoon Census Area, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02240 Southeast Fairbanks County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02250 Upper Yukon County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02260 Valdz-Chitna-Whitier County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02261 Valdex-Cordove Census Area, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02270 Wade Hampton County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02280 Wrangell-Petersburg County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02282 Yakutat Borough, Alaska 02 Rural 1.1888 99902 Rural 1.1977 02290 Yukon-Koyukuk County, Alaska 02 Rural 1.1888 99902 Rural 1.1977 03000 Apache County, Arizona 03 Rural 0.9045 99903 Rural 0.8768 03010 Cochise County, Arizona 03 Rural 0.9045 99903 Rural 0.8768 03020 Coconino County, Arizona 2620 Urban 1.1845 22380 Urban 1.2092 03030 Gila County, Arizona 03 Rural 0.9045 99903 Rural 0.8768 03040 Graham County, Arizona 03 Rural 0.9045 99903 Rural 0.8768 03050 Greenlee County, Arizona 03 Rural 0.9045 99903 Rural 0.8768 03055 La Paz County, Arizona 03 Rural 0.9045 99903 Rural 0.8768 03060 Maricopa County, Arizona 6200 Urban 1.0127 38060 Urban 1.0127 03070 Mohave County, Arizona 4120 Urban 1.1155 99903 Rural 0.8768 03080 Navajo County, Arizona 03 Rural 0.9045 99903 Rural 0.8768 03090 Pima County, Arizona 8520 Urban 0.9007 46060 Urban 0.9007 03100 Pinal County, Arizona 6200 Urban 1.0127 38060 Urban 1.0127 03110 Santa Cruz County, Arizona 03 Rural 0.9045 99903 Rural 0.8768 03120 Yavapai County, Arizona 03 Rural 0.9045 39140 Urban 0.9869 03130 Yuma County, Arizona 9360 Urban 0.9126 49740 Urban 0.9126 04000 Arkansas County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04010 Ashley County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04020 Baxter County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04030 Benton County, Arkansas 2580 Urban 0.8661 22220 Urban 0.8661 04040 Boone County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04050 Bradley County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04060 Calhoun County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04070 Carroll County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04080 Chicot County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04090 Clark County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04100 Clay County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04110 Cleburne County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04120 Cleveland County, Arkansas 04 Rural 0.7744 38220 Urban 0.8680 04130 Columbia County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04140 Conway County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04150 Craighead County, Arkansas 3700 Urban 0.7911 27860 Urban 0.7911 04160 Crawford County, Arkansas 2720 Urban 0.8246 22900 Urban 0.8230 04170 Crittenden County, Arkansas 4920 Urban 0.9416 32820 Urban 0.9397 04180 Cross County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04190 Dallas County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04200 Desha County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04210 Drew County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04220 Faulkner County, Arkansas 4400 Urban 0.8747 30780 Urban 0.8747 04230 Franklin County, Arkansas 04 Rural 0.7744 22900 Urban 0.8230 04240 Fulton County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04250 Garland County, Arkansas 04 Rural 0.7744 26300 Urban 0.9005 04260 Grant County, Arkansas 04 Rural 0.7744 30780 Urban 0.8747 04270 Greene County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04280 Hempstead County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04290 Hot Spring County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04300 Howard County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04310 Independence County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04320 Izard County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04330 Jackson County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04340 Jefferson County, Arkansas 6240 Urban 0.8680 38220 Urban 0.8680 04350 Johnson County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04360 Lafayette County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04370 Lawrence County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04380 Lee County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04390 Lincoln County, Arkansas 04 Rural 0.7744 38220 Urban 0.8680 04400 Little River County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04410 Logan County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04420 Lonoke County, Arkansas 4400 Urban 0.8747 30780 Urban 0.8747 04430 Madison County, Arkansas 04 Rural 0.7744 22220 Urban 0.8661 04440 Marion County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04450 Miller County, Arkansas 8360 Urban 0.8283 45500 Urban 0.8283 04460 Mississippi County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04470 Monroe County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04480 Montgomery County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04490 Nevada County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04500 Newton County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04510 Ouachita County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04520 Perry County, Arkansas 04 Rural 0.7744 30780 Urban 0.8747 04530 Phillips County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04540 Pike County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04550 Poinsett County, Arkansas 04 Rural 0.7744 27860 Urban 0.7911 04560 Polk County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04570 Pope County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04580 Prairie County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04590 Pulaski County, Arkansas 4400 Urban 0.8747 30780 Urban 0.8747 04600 Randolph County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04610 St Francis County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04620 Saline County, Arkansas 4400 Urban 0.8747 30780 Urban 0.8747 04630 Scott County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04640 Searcy County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04650 Sebastian County, Arkansas 2720 Urban 0.8246 22900 Urban 0.8230 04660 Sevier County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04670 Sharp County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04680 Stone County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04690 Union County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04700 Van Buren County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04710 Washington County, Arkansas 2580 Urban 0.8661 22220 Urban 0.8661 04720 White County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04730 Woodruff County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 04740 Yell County, Arkansas 04 Rural 0.7744 99904 Rural 0.7466 05000 Alameda County, California 5775 Urban 1.5346 36084 Urban 1.5346 05010 Alpine County, California 05 Rural 1.0775 99905 Rural 1.1054 05020 Amador County, California 05 Rural 1.0775 99905 Rural 1.1054 05030 Butte County, California 1620 Urban 1.0511 17020 Urban 1.0511 05040 Calaveras County, California 05 Rural 1.0775 99905 Rural 1.1054 05050 Colusa County, California 05 Rural 1.0775 99905 Rural 1.1054 05060 Contra Costa County, California 5775 Urban 1.5346 36084 Urban 1.5346 05070 Del Norte County, California 05 Rural 1.0775 99905 Rural 1.1054 05080 Eldorado County, California 6920 Urban 1.3143 40900 Urban 1.2969 05090 Fresno County, California 2840 Urban 1.0428 23420 Urban 1.0538 05100 Glenn County, California 05 Rural 1.0775 99905 Rural 1.1054 05110 Humboldt County, California 05 Rural 1.0775 99905 Rural 1.1054 05120 Imperial County, California 05 Rural 1.0775 20940 Urban 0.8906 05130 Inyo County, California 05 Rural 1.0775 99905 Rural 1.1054 05140 Kern County, California 0680 Urban 1.0470 12540 Urban 1.0470 05150 Kings County, California 05 Rural 1.0775 25260 Urban 1.0036 05160 Lake County, California 05 Rural 1.0775 99905 Rural 1.1054 05170 Lassen County, California 05 Rural 1.0775 99905 Rural 1.1054 05200 Los Angeles County, California 4480 Urban 1.1783 31084 Urban 1.1783 05210 Los Angeles County, California 4480 Urban 1.1783 31084 Urban 1.1783 05300 Madera County, California 2840 Urban 1.0428 31460 Urban 0.8713 05310 Marin County, California 7360 Urban 1.4994 41884 Urban 1.4994 05320 Mariposa County, California 05 Rural 1.0775 99905 Rural 1.1054 05330 Mendocino County, California 05 Rural 1.0775 99905 Rural 1.1054 05340 Merced County, California 4940 Urban 1.1109 32900 Urban 1.1109 05350 Modoc County, California 05 Rural 1.0775 99905 Rural 1.1054 05360 Mono County, California 05 Rural 1.0775 99905 Rural 1.1054 05370 Monterey County, California 7120 Urban 1.4128 41500 Urban 1.4128 05380 Napa County, California 8720 Urban 1.3983 34900 Urban 1.2643 05390 Nevada County, California 05 Rural 1.0775 99905 Rural 1.1054 05400 Orange County, California 5945 Urban 1.1559 42044 Urban 1.1559 05410 Placer County, California 6920 Urban 1.3143 40900 Urban 1.2969 05420 Plumas County, California 05 Rural 1.0775 99905 Rural 1.1054 05430 Riverside County, California 6780 Urban 1.1027 40140 Urban 1.1027 05440 Sacramento County, California 6920 Urban 1.3143 40900 Urban 1.2969 05450 San Benito County, California 05 Rural 1.0775 41940 Urban 1.5099 05460 San Bernardino County, California 6780 Urban 1.1027 40140 Urban 1.1027 05470 San Diego County, California 7320 Urban 1.1413 41740 Urban 1.1413 05480 San Francisco County, California 7360 Urban 1.4994 41884 Urban 1.4994 05490 San Joaquin County, California 8120 Urban 1.1307 44700 Urban 1.1307 05500 San Luis Obispo County, California 7460 Urban 1.1349 42020 Urban 1.1349 05510 San Mateo County, California 7360 Urban 1.4994 41884 Urban 1.4994 05520 Santa Barbara County, California 7480 Urban 1.1694 42060 Urban 1.1694 05530 Santa Clara County, California 7400 Urban 1.5118 41940 Urban 1.5099 05540 Santa Cruz County, California 7485 Urban 1.5166 42100 Urban 1.5166 05550 Shasta County, California 6690 Urban 1.2203 39820 Urban 1.2203 05560 Sierra County, California 05 Rural 1.0775 99905 Rural 1.1054 05570 Siskiyou County, California 05 Rural 1.0775 99905 Rural 1.1054 05580 Solano County, California 8720 Urban 1.3983 46700 Urban 1.4936 05590 Sonoma County, California 7500 Urban 1.3493 42220 Urban 1.3493 05600 Stanislaus County, California 5170 Urban 1.1885 33700 Urban 1.1885 05610 Sutter County, California 9340 Urban 1.0921 49700 Urban 1.0921 05620 Tehama County, California 05 Rural 1.0775 99905 Rural 1.1054 05630 Trinity County, California 05 Rural 1.0775 99905 Rural 1.1054 05640 Tulare County, California 8780 Urban 1.0123 47300 Urban 1.0123 05650 Tuolumne County, California 05 Rural 1.0775 99905 Rural 1.1054 05660 Ventura County, California 8735 Urban 1.1622 37100 Urban 1.1622 05670 Yolo County, California 9270 Urban 0.9950 40900 Urban 1.2969 05680 Yuba County, California 9340 Urban 1.0921 49700 Urban 1.0921 06000 Adams County, Colorado 2080 Urban 1.0723 19740 Urban 1.0723 06010 Alamosa County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06020 Arapahoe County, Colorado 2080 Urban 1.0723 19740 Urban 1.0723 06030 Archuleta County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06040 Baca County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06050 Bent County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06060 Boulder County, Colorado 1125 Urban 0.9734 14500 Urban 0.9734 06070 Chaffee County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06080 Cheyenne County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06090 Clear Creek County, Colorado 06 Rural 0.9380 19740 Urban 1.0723 06100 Conejos County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06110 Costilla County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06120 Crowley County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06130 Custer County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06140 Delta County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06150 Denver County, Colorado 2080 Urban 1.0723 19740 Urban 1.0723 06160 Dolores County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06170 Douglas County, Colorado 2080 Urban 1.0723 19740 Urban 1.0723 06180 Eagle County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06190 Elbert County, Colorado 06 Rural 0.9380 19740 Urban 1.0723 06200 El Paso County, Colorado 1720 Urban 0.9468 17820 Urban 0.9468 06210 Fremont County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06220 Garfield County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06230 Gilpin County, Colorado 06 Rural 0.9380 19740 Urban 1.0723 06240 Grand County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06250 Gunnison County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06260 Hinsdale County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06270 Huerfano County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06280 Jackson County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06290 Jefferson County, Colorado 2080 Urban 1.0723 19740 Urban 1.0723 06300 Kiowa County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06310 Kit Carson County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06320 Lake County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06330 La Plata County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06340 Larimer County, Colorado 2670 Urban 1.0122 22660 Urban 1.0122 06350 Las Animas County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06360 Lincoln County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06370 Logan County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06380 Mesa County, Colorado 2995 Urban 0.9550 24300 Urban 0.9550 06390 Mineral County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06400 Moffat County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06410 Montezuma County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06420 Montrose County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06430 Morgan County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06440 Otero County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06450 Ouray County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06460 Park County, Colorado 06 Rural 0.9380 19740 Urban 1.0723 06470 Phillips County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06480 Pitkin County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06490 Prowers County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06500 Pueblo County, Colorado 6560 Urban 0.8623 39380 Urban 0.8623 06510 Rio Blanco County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06520 Rio Grande County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06530 Routt County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06540 Saguache County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06550 San Juan County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06560 San Miguel County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06570 Sedgwick County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06580 Summit County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06590 Teller County, Colorado 06 Rural 0.9380 17820 Urban 0.9468 06600 Washington County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06610 Weld County, Colorado 3060 Urban 0.9570 24540 Urban 0.9570 06620 Yuma County, Colorado 06 Rural 0.9380 99906 Rural 0.9380 06630 Broomfield County, Colorado 2080 Urban 1.0723 19740 Urban 1.0723 07000 Fairfield County, Connecticut 5483 Urban 1.2196 14860 Urban 1.2592 07010 Hartford County, Connecticut 3283 Urban 1.1073 25540 Urban 1.1073 07020 Litchfield County, Connecticut 3283 Urban 1.1073 25540 Urban 1.1073 07030 Middlesex County, Connecticut 3283 Urban 1.1073 25540 Urban 1.1073 07040 New Haven County, Connecticut 5483 Urban 1.2196 35300 Urban 1.1887 07050 New London County, Connecticut 5523 Urban 1.1345 35980 Urban 1.1345 07060 Tolland County, Connecticut 3283 Urban 1.1073 25540 Urban 1.1073 07070 Windham County, Connecticut 07 Rural 1.1730 99907 Rural 1.1730 08000 Kent County, Delaware 2190 Urban 0.9776 20100 Urban 0.9776 08010 New Castle County, Delaware 9160 Urban 1.0527 48864 Urban 1.0471 08020 Sussex County, Delaware 08 Rural 0.9579 99908 Rural 0.9579 09000 Washington DC County, Dist Of Col 8840 Urban 1.0976 47894 Urban 1.0926 10000 Alachua County, Florida 2900 Urban 0.9388 23540 Urban 0.9388 10010 Baker County, Florida 10 Rural 0.8677 27260 Urban 0.9290 10020 Bay County, Florida 6015 Urban 0.8005 37460 Urban 0.8005 10030 Bradford County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10040 Brevard County, Florida 4900 Urban 0.9839 37340 Urban 0.9839 10050 Broward County, Florida 2680 Urban 1.0432 22744 Urban 1.0432 10060 Calhoun County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10070 Charlotte County, Florida 6580 Urban 0.9255 39460 Urban 0.9255 10080 Citrus County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10090 Clay County, Florida 3600 Urban 0.9299 27260 Urban 0.9290 10100 Collier County, Florida 5345 Urban 1.0139 34940 Urban 1.0139 10110 Columbia County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10120 Dade County, Florida 5000 Urban 0.9750 33124 Urban 0.9750 10130 De Soto County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10140 Dixie County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10150 Duval County, Florida 3600 Urban 0.9299 27260 Urban 0.9290 10160 Escambia County, Florida 6080 Urban 0.8096 37860 Urban 0.8096 10170 Flagler County, Florida 2020 Urban 0.9325 99910 Rural 0.8568 10180 Franklin County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10190 Gadsden County, Florida 8240 Urban 0.8688 45220 Urban 0.8688 10200 Gilchrist County, Florida 10 Rural 0.8677 23540 Urban 0.9388 10210 Glades County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10220 Gulf County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10230 Hamilton County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10240 Hardee County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10250 Hendry County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10260 Hernando County, Florida 8280 Urban 0.9233 45300 Urban 0.9233 10270 Highlands County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10280 Hillsborough County, Florida 8280 Urban 0.9233 45300 Urban 0.9233 10290 Holmes County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10300 Indian River County, Florida 10 Rural 0.8677 46940 Urban 0.9434 10310 Jackson County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10320 Jefferson County, Florida 10 Rural 0.8677 45220 Urban 0.8688 10330 Lafayette County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10340 Lake County, Florida 5960 Urban 0.9464 36740 Urban 0.9464 10350 Lee County, Florida 2700 Urban 0.9356 15980 Urban 0.9356 10360 Leon County, Florida 8240 Urban 0.8688 45220 Urban 0.8688 10370 Levy County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10380 Liberty County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10390 Madison County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10400 Manatee County, Florida 7510 Urban 0.9639 42260 Urban 0.9639 10410 Marion County, Florida 5790 Urban 0.8925 36100 Urban 0.8925 10420 Martin County, Florida 2710 Urban 1.0123 38940 Urban 1.0123 10430 Monroe County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10440 Nassau County, Florida 3600 Urban 0.9299 27260 Urban 0.9290 10450 Okaloosa County, Florida 2750 Urban 0.8872 23020 Urban 0.8872 10460 Okeechobee County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10470 Orange County, Florida 5960 Urban 0.9464 36740 Urban 0.9464 10480 Osceola County, Florida 5960 Urban 0.9464 36740 Urban 0.9464 10490 Palm Beach County, Florida 8960 Urban 1.0067 48424 Urban 1.0067 10500 Pasco County, Florida 8280 Urban 0.9233 45300 Urban 0.9233 10510 Pinellas County, Florida 8280 Urban 0.9233 45300 Urban 0.9233 10520 Polk County, Florida 3980 Urban 0.8912 29460 Urban 0.8912 10530 Putnam County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10540 Johns County, Florida 3600 Urban 0.9299 27260 Urban 0.9290 10550 St Lucie County, Florida 2710 Urban 1.0123 38940 Urban 1.0123 10560 Santa Rosa County, Florida 6080 Urban 0.8096 37860 Urban 0.8096 10570 Sarasota County, Florida 7510 Urban 0.9639 42260 Urban 0.9639 10580 Seminole County, Florida 5960 Urban 0.9464 36740 Urban 0.9464 10590 Sumter County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10600 Suwannee County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10610 Taylor County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10620 Union County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10630 Volusia County, Florida 2020 Urban 0.9325 19660 Urban 0.9299 10640 Wakulla County, Florida 10 Rural 0.8677 45220 Urban 0.8688 10650 Walton County, Florida 10 Rural 0.8677 99910 Rural 0.8568 10660 Washington County, Florida 10 Rural 0.8677 99910 Rural 0.8568 11000 Appling County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11010 Atkinson County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11011 Bacon County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11020 Baker County, Georgia 11 Rural 0.8166 10500 Urban 0.8628 11030 Baldwin County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11040 Banks County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11050 Barrow County, Georgia 0520 Urban 0.9793 12060 Urban 0.9793 11060 Bartow County, Georgia 0520 Urban 0.9793 12060 Urban 0.9793 11070 Ben Hill County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11080 Berrien County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11090 Bibb County, Georgia 4680 Urban 0.9277 31420 Urban 0.9443 11100 Bleckley County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11110 Brantley County, Georgia 11 Rural 0.8166 15260 Urban 0.9311 11120 Brooks County, Georgia 11 Rural 0.8166 46660 Urban 0.8866 11130 Bryan County, Georgia 7520 Urban 0.9461 42340 Urban 0.9461 11140 Bulloch County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11150 Burke County, Georgia 11 Rural 0.8166 12260 Urban 0.9748 11160 Butts County, Georgia 11 Rural 0.8166 12060 Urban 0.9793 11161 Calhoun County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11170 Camden County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11180 Candler County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11190 Carroll County, Georgia 0520 Urban 0.9793 12060 Urban 0.9793 11200 Catoosa County, Georgia 1560 Urban 0.9088 16860 Urban 0.9088 11210 Charlton County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11220 Chatham County, Georgia 7520 Urban 0.9461 42340 Urban 0.9461 11230 Chattahoochee County, Georgia 1800 Urban 0.8560 17980 Urban 0.8560 11240 Chattooga County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11250 Cherokee County, Georgia 0520 Urban 0.9793 12060 Urban 0.9793 11260 Clarke County, Georgia 0500 Urban 0.9855 12020 Urban 0.9855 11270 Clay County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11280 Clayton County, Georgia 0520 Urban 0.9793 12060 Urban 0.9793 11281 Clinch County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11290 Cobb County, Georgia 0520 Urban 0.9793 12060 Urban 0.9793 11291 Coffee County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11300 Colquitt County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11310 Columbia County, Georgia 0600 Urban 0.9808 12260 Urban 0.9748 11311 Cook County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11320 Coweta County, Georgia 0520 Urban 0.9793 12060 Urban 0.9793 11330 Crawford County, Georgia 11 Rural 0.8166 31420 Urban 0.9443 11340 Crisp County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11341 Dade County, Georgia 1560 Urban 0.9088 16860 Urban 0.9088 11350 Dawson County, Georgia 11 Rural 0.8166 12060 Urban 0.9793 11360 Decatur County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11370 De Kalb County, Georgia 0520 Urban 0.9793 12060 Urban 0.9793 11380 Dodge County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11381 Dooly County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11390 Dougherty County, Georgia 0120 Urban 0.8628 10500 Urban 0.8628 11400 Douglas County, Georgia 0520 Urban 0.9793 12060 Urban 0.9793 11410 Early County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11420 Echols County, Georgia 11 Rural 0.8166 46660 Urban 0.8866 11421 Effingham County, Georgia 7520 Urban 0.9461 42340 Urban 0.9461 11430 Elbert County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11440 Emanuel County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11441 Evans County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11450 Fannin County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11451 Fayette County, Georgia 0520 Urban 0.9793 12060 Urban 0.9793 11460 Floyd County, Georgia 11 Rural 0.8166 40660 Urban 0.9414 11461 Forsyth County, Georgia 0520 Urban 0.9793 12060 Urban 0.9793 11462 Franklin County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11470 Fulton County, Georgia 0520 Urban 0.9793 12060 Urban 0.9793 11471 Gilmer County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11480 Glascock County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11490 Glynn County, Georgia 11 Rural 0.8166 15260 Urban 0.9311 11500 Gordon County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11510 Grady County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11520 Greene County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11530 Gwinnett County, Georgia 0520 Urban 0.9793 12060 Urban 0.9793 11540 Habersham County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11550 Hall County, Georgia 11 Rural 0.8166 23580 Urban 0.8874 11560 Hancock County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11570 Haralson County, Georgia 11 Rural 0.8166 12060 Urban 0.9793 11580 Harris County, Georgia 1800 Urban 0.8560 17980 Urban 0.8560 11581 Hart County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11590 Heard County, Georgia 11 Rural 0.8166 12060 Urban 0.9793 11591 Henry County, Georgia 0520 Urban 0.9793 12060 Urban 0.9793 11600 Houston County, Georgia 4680 Urban 0.9277 47580 Urban 0.8645 11601 Irwin County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11610 Jackson County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11611 Jasper County, Georgia 11 Rural 0.8166 12060 Urban 0.9793 11612 Jeff Davis County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11620 Jefferson County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11630 Jenkins County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11640 Johnson County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11650 Jones County, Georgia 4680 Urban 0.9277 31420 Urban 0.9443 11651 Lamar County, Georgia 11 Rural 0.8166 12060 Urban 0.9793 11652 Lanier County, Georgia 11 Rural 0.8166 46660 Urban 0.8866 11660 Laurens County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11670 Lee County, Georgia 0120 Urban 0.8628 10500 Urban 0.8628 11680 Liberty County, Georgia 11 Rural 0.8166 25980 Urban 1 0.9198 11690 Lincoln County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11691 Long County, Georgia 11 Rural 0.8166 25980 Urban 1 0.9198 11700 Lowndes County, Georgia 11 Rural 0.8166 46660 Urban 0.8866 11701 Lumpkin County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11702 Mc Duffie County, Georgia 0600 Urban 0.9808 12260 Urban 0.9748 11703 Mc Intosh County, Georgia 11 Rural 0.8166 15260 Urban 0.9311 11710 Macon County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11720 Madison County, Georgia 0500 Urban 0.9855 12020 Urban 0.9855 11730 Marion County, Georgia 11 Rural 0.8166 17980 Urban 0.8560 11740 Meriwether County, Georgia 11 Rural 0.8166 12060 Urban 0.9793 11741 Miller County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11750 Mitchell County, Georgia 11 Rural 0.8166 99911 Rural 0.7662 11760 Monroe County, Georgia 11 Rural .08166 31420 Urban 0.9443 11770 Montgomery County, Georgia 11 Rural .08166 99911 Rural 0.7662 11771 Morgan County, Georgia 11 Rural .08166 99911 Rural 0.7662 11772 Murray County, Georgia 11 Rural .08166 19140 Urban 0.9079 11780 Muscogee County, Georgia 1800 Urban .08560 17980 Urban 0.8560 11790 Newton County, Georgia 0520 Urban .09793 12060 Urban 0.9793 11800 Oconee County, Georgia 0500 Urban .09855 12020 Urban 0.9855 11801 Oglethorpe County, Georgia 11 Rural .08166 12020 Urban 0.9855 11810 Paulding County, Georgia 0520 Urban .09793 12060 Urban 0.9793 11811 Peach County, Georgia 4680 Urban .09277 99911 Rural 0.7662 11812 Pickens County, Georgia 0520 Urban .09793 12060 Urban 0.9793 11820 Pierce County, Georgia 11 Rural .08166 99911 Rural 0.7662 11821 Pike County, Georgia 11 Rural .08166 12060 Urban 0.9793 11830 Polk County, Georgia 11 Rural .08166 99911 Rural 0.7662 11831 Pulaski County, Georgia 11 Rural .08166 99911 Rural 0.7662 11832 Putnam County, Georgia 11 Rural .08166 99911 Rural 0.7662 11833 Quitman County, Georgia 11 Rural .08166 99911 Rural 0.7662 11834 Rabun County, Georgia 11 Rural .08166 99911 Rural 0.7662 11835 Randolph County, Georgia 11 Rural .08166 99911 Rural 0.7662 11840 Richmond County, Georgia 0600 Urban .09808 12260 Urban 0.9748 11841 Rockdale County, Georgia 0520 Urban .09793 12060 Urban 0.9793 11842 Schley County, Georgia 11 Rural .08166 99911 Rural 0.7662 11850 Screven County, Georgia 11 Rural .08166 99911 Rural 0.7662 11851 Seminole County, Georgia 11 Rural .08166 99911 Rural 0.7662 11860 Spalding County, Georgia 0520 Urban .09793 12060 Urban 0.9793 11861 Stephens County, Georgia 11 Rural .08166 99911 Rural 0.7662 11862 Stewart County, Georgia 11 Rural .08166 99911 Rural 0.7662 11870 Sumter County, Georgia 11 Rural .08166 99911 Rural 0.7662 11880 Talbot County, Georgia 11 Rural .08166 99911 Rural 0.7662 11881 Taliaferro County, Georgia 11 Rural .08166 99911 Rural 0.7662 11882 Tattnall County, Georgia 11 Rural .08166 99911 Rural 0.7662 11883 Taylor County, Georgia 11 Rural .08166 99911 Rural 0.7662 11884 Telfair County, Georgia 11 Rural .08166 99911 Rural 0.7662 11885 Terrell County, Georgia 11 Rural .08166 10500 Urban 0.8628 11890 Thomas County, Georgia 11 Rural .08166 99911 Rural 0.7662 11900 Tift County, Georgia 11 Rural .08166 99911 Rural 0.7662 11901 Toombs County, Georgia 11 Rural .08166 99911 Rural 0.7662 11902 Towns County, Georgia 11 Rural .08166 99911 Rural 0.7662 11903 Treutlen County, Georgia 11 Rural .08166 99911 Rural 0.7662 11910 Troup County, Georgia 11 Rural .08166 99911 Rural 0.7662 11911 Turner County, Georgia 11 Rural .08166 99911 Rural 0.7662 11912 Twiggs County, Georgia 4680 Urban .09277 31420 Urban 0.9443 11913 Union County, Georgia 11 Rural .08166 99911 Rural 0.7662 11920 Upson County, Georgia 11 Rural .08166 99911 Rural 0.7662 11921 Walker County, Georgia 1560 Urban .09088 16860 Urban 0.9088 11930 Walton County, Georgia 0520 Urban .09793 12060 Urban 0.9793 11940 Ware County, Georgia 11 Rural .08166 99911 Rural 0.7662 11941 Warren County, Georgia 11 Rural .08166 99911 Rural 0.7662 11950 Washington County, Georgia 11 Rural .08166 99911 Rural 0.7662 11960 Wayne County, Georgia 11 Rural .08166 99911 Rural 0.7662 11961 Webster County, Georgia 11 Rural .08166 99911 Rural 0.7662 11962 Wheeler County, Georgia 11 Rural .08166 99911 Rural 0.7662 11963 White County, Georgia 11 Rural .08166 99911 Rural 0.7662 11970 Whitfield County, Georgia 11 Rural .08166 19140 Urban 0.9079 11971 Wilcox County, Georgia 11 Rural .08166 99911 Rural 0.7662 11972 Wilkes County, Georgia 11 Rural .08166 99911 Rural 0.7662 11973 Wilkinson County, Georgia 11 Rural .08166 99911 Rural 0.7662 11980 Worth County, Georgia 11 Rural .08166 10500 Urban 0.8628 12005 Kalawao County, Hawaii 12 Rural 1.0551 99912 Rural 1.0551 12010 Hawaii County, Hawaii 12 Rural 1.0551 99912 Rural 1.0551 12020 Honolulu County, Hawaii 3320 Urban 1.1214 26180 Urban 1.1214 12040 Kauai County, Hawaii 12 Rural 1.0551 99912 Rural 1.0551 12050 Maui County, Hawaii 12 Rural 1.0551 99912 Rural 1.0551 13000 Ada County, Idaho 1080 Urban 0.9052 14260 Urban 0.9052 13010 Adams County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13020 Bannock County, Idaho 6340 Urban 0.9351 38540 Urban 0.9351 13030 Bear Lake County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13040 Benewah County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13050 Bingham County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13060 Blaine County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13070 Boise County, Idaho 13 Rural 0.9097 14260 Urban 0.9052 13080 Bonner County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13090 Bonneville County, Idaho 13 Rural 0.9097 26820 Urban 0.9420 13100 Boundary County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13110 Butte County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13120 Camas County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13130 Canyon County, Idaho 1080 Urban 0.9052 14260 Urban 0.9052 13140 Caribou County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13150 Cassia County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13160 Clark County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13170 Clearwater County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13180 Custer County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13190 Elmore County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13200 Franklin County, Idaho 13 Rural 0.9097 30860 Urban 0.9164 13210 Fremont County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13220 Gem County, Idaho 13 Rural 0.9097 14260 Urban 0.9052 13230 Gooding County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13240 Idaho County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13250 Jefferson County, Idaho 13 Rural 0.9097 26820 Urban 0.9420 13260 Jerome County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13270 Kootenai County, Idaho 13 Rural 0.9097 17660 Urban 0.9647 13280 Latah County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13290 Lemhi County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13300 Lewis County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13310 Lincoln County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13320 Madison County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13330 Minidoka County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13340 Nez Perce County, Idaho 13 Rural 0.9097 30300 Urban 0.9886 13350 Oneida County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13360 Owyhee County, Idaho 13 Rural 0.9097 14260 Urban 0.9052 13370 Payette County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13380 Power County, Idaho 13 Rural 0.9097 38540 Urban 0.9351 13390 Shoshone County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13400 Teton County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13410 Twin Falls County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13420 Valley County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 13430 Washington County, Idaho 13 Rural 0.9097 99913 Rural 0.8037 14000 Adams County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14010 Alexander County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14020 Bond County, Illinois 14 Rural 0.8301 41180 Urban 0.8954 14030 Boone County, Illinois 6880 Urban 0.9984 40420 Urban 0.9984 14040 Brown County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14050 Bureau County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14060 Calhoun County, Illinois 14 Rural 0.8301 41180 Urban 0.8954 14070 Carroll County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14080 Cass County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14090 Champaign County, Illinois 1400 Urban 0.9594 16580 Urban 0.9594 14100 Christian County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14110 Clark County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14120 Clay County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14130 Clinton County, Illinois 7040 Urban 0.8962 41180 Urban 0.8954 14140 Coles County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14141 Cook County, Illinois 1600 Urban 1.0783 16974 Urban 1.0790 14150 Crawford County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14160 Cumberland County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14170 De Kalb County, Illinois 1600 Urban 1.0783 16974 Urban 1.0790 14180 De Witt County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14190 Douglas County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14250 Du Page County, Illinois 1600 Urban 1.0783 16974 Urban 1.0790 14310 Edgar County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14320 Edwards County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14330 Effingham County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14340 Fayette County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14350 Ford County, Illinois 14 Rural 0.8301 16580 Urban 0.9594 14360 Franklin County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14370 Fulton County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14380 Gallatin County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14390 Greene County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14400 Grundy County, Illinois 1600 Urban 1.0783 16974 Urban 1.0790 14410 Hamilton County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14420 Hancock County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14421 Hardin County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14440 Henderson County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14450 Henry County, Illinois 1960 Urban 0.8724 19340 Urban 0.8724 14460 Iroquois County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14470 Jackson County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14480 Jasper County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14490 Jefferson County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14500 Jersey County, Illinois 7040 Urban 0.8962 41180 Urban 0.8954 14510 Jo Daviess County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14520 Johnson County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14530 Kane County, Illinois 1600 Urban 1.0783 16974 Urban 1.0790 14540 Kankakee County, Illinois 3740 Urban 1.0721 28100 Urban 1.0721 14550 Kendall County, Illinois 1600 Urban 1.0783 16974 Urban 1.0790 14560 Knox County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14570 Lake County, Illinois 1600 Urban 1.0783 29404 Urban 1.0429 14580 La Salle County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14590 Lawrence County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14600 Lee County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14610 Livingston County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14620 Logan County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14630 Mc Donough County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14640 Mc Henry County, Illinois 1600 Urban 1.0783 16974 Urban 1.0790 14650 Mclean County, Illinois 1040 Urban 0.9075 14060 Urban 0.9075 14660 Macon County, Illinois 2040 Urban 0.8067 19500 Urban 0.8067 14670 Macoupin County, Illinois 14 Rural 0.8301 41180 Urban 0.8954 14680 Madison County, Illinois 7040 Urban 0.8962 41180 Urban 0.8954 14690 Marion County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14700 Marshall County, Illinois 14 Rural 0.8301 37900 Urban 0.8870 14710 Mason County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14720 Massac County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14730 Menard County, Illinois 7880 Urban 0.8792 44100 Urban 0.8792 14740 Mercer County, Illinois 14 Rural 0.8301 19340 Urban 0.8724 14750 Monroe County, Illinois 7040 Urban 0.8962 41180 Urban 0.8954 14760 Montgomery County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14770 Morgan County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14780 Moultrie County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14790 Ogle County, Illinois 6880 Urban 0.9984 99914 Rural 0.8271 14800 Peoria County, Illinois 6120 Urban 0.8870 37900 Urban 0.8870 14810 Perry County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14820 Piatt County, Illinois 14 Rural 0.8301 16580 Urban 0.9594 14830 Pike County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14831 Pope County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14850 Pulaski County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14860 Putnam County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14870 Randolph County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14880 Richland County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14890 Rock Island County, Illinois 1960 Urban 0.8724 19340 Urban 0.8724 14900 St Clair County, Illinois 7040 Urban 0.8962 41180 Urban 0.8954 14910 Saline County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14920 Sangamon County, Illinois 7880 Urban 0.8792 44100 Urban 0.8792 14921 Schuyler County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14940 Scott County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14950 Shelby County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14960 Stark County, Illinois 14 Rural 0.8301 37900 Urban 0.8870 14970 Stephenson County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14980 Tazewell County, Illinois 6120 Urban 0.8870 37900 Urban 0.8870 14981 Union County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14982 Vermilion County, Illinois 14 Rural 0.8301 19180 Urban 0.9028 14983 Wabash County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14984 Warren County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14985 Washington County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14986 Wayne County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14987 White County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14988 Whiteside County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14989 Will County, Illinois 1600 Urban 1.0783 16974 Urban 1.0790 14990 Williamson County, Illinois 14 Rural 0.8301 99914 Rural 0.8271 14991 Winnebago County, Illinois 6880 Urban 0.9984 40420 Urban 0.9984 14992 Woodford County, Illinois 6120 Urban 0.8870 37900 Urban 0.8870 15000 Adams County, Indiana 2760 Urban 0.9706 99915 Rural 0.8624 15010 Allen County, Indiana 2760 Urban 0.9706 23060 Urban 0.9793 15020 Bartholomew County, Indiana 15 Rural 0.8739 18020 Urban 0.9588 15030 Benton County, Indiana 15 Rural 0.8739 29140 Urban 0.8736 15040 Blackford County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15050 Boone County, Indiana 3480 Urban 0.9865 26900 Urban 0.9920 15060 Brown County, Indiana 15 Rural 0.8739 26900 Urban 0.9920 15070 Carroll County, Indiana 15 Rural 0.8739 29140 Urban 0.8736 15080 Cass County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15090 Clark County, Indiana 4520 Urban 0.9293 31140 Urban 0.9251 15100 Clay County, Indiana 8320 Urban 0.8337 45460 Urban 0.8304 15110 Clinton County, Indiana 3920 Urban 0.8736 99915 Rural 0.8624 15120 Crawford County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15130 Daviess County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15140 Dearborn County, Indiana 1640 Urban 0.9734 17140 Urban 0.9615 15150 Decatur County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15160 De Kalb County, Indiana 2760 Urban 0.9706 99915 Rural 0.8624 15170 Delaware County, Indiana 5280 Urban 0.8930 34620 Urban 0.8930 15180 Dubois County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15190 Elkhart County, Indiana 2330 Urban 0.9627 21140 Urban 0.9627 15200 Fayette County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15210 Floyd County, Indiana 4520 Urban 0.9293 31140 Urban 0.9251 15220 Fountain County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15230 Franklin County, Indiana 15 Rural 0.8739 17140 Urban 0.9615 15240 Fulton County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15250 Gibson County, Indiana 15 Rural 0.8739 21780 Urban 0.8713 15260 Grant County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15270 Greene County, Indiana 15 Rural 0.8739 14020 Urban 0.8447 15280 Hamilton County, Indiana 3480 Urban 0.9865 26900 Urban 0.9920 15290 Hancock County, Indiana 3480 Urban 0.9865 26900 Urban 0.9920 15300 Harrison County, Indiana 4520 Urban 0.9293 31140 Urban 0.9251 15310 Hendricks County, Indiana 3480 Urban 0.9865 26900 Urban 0.9920 15320 Henry County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15330 Howard County, Indiana 3850 Urban 0.9508 29020 Urban 0.9508 15340 Huntington County, Indiana 2760 Urban 0.9706 99915 Rural 0.8624 15350 Jackson County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15360 Jasper County, Indiana 15 Rural 0.8739 23844 Urban 0.9395 15370 Jay County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15380 Jefferson County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15390 Jennings County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15400 Johnson County, Indiana 3480 Urban 0.9865 26900 Urban 0.9920 15410 Knox County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15420 Kosciusko County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15430 Lagrange County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15440 Lake County, Indiana 2960 Urban 0.9395 23844 Urban 0.9395 15450 La Porte County, Indiana 15 Rural 0.8739 33140 Urban 0.9399 15460 Lawrence County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15470 Madison County, Indiana 3480 Urban 0.9865 11300 Urban 0.8586 15480 Marion County, Indiana 3480 Urban 0.9865 26900 Urban 0.9920 15490 Marshall County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15500 Martin County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15510 Miami County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15520 Monroe County, Indiana 1020 Urban 0.8447 14020 Urban 0.8447 15530 Montgomery County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15540 Morgan County, Indiana 3480 Urban 0.9865 26900 Urban 0.9920 15550 Newton County, Indiana 15 Rural 0.8739 23844 Urban 0.9395 15560 Noble County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15570 Ohio County, Indiana 1640 Urban 0.9734 17140 Urban 0.9615 15580 Orange County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15590 Owen County, Indiana 15 Rural 0.8739 14020 Urban 0.8447 15600 Parke County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15610 Perry County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15620 Pike County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15630 Porter County, Indiana 2960 Urban 0.9395 23844 Urban 0.9395 15640 Posey County, Indiana 2440 Urban 0.8713 21780 Urban 0.8713 15650 Pulaski County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15660 Putnam County, Indiana 15 Rural 0.8739 26900 Urban 0.9920 15670 Randolph County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15680 Ripley County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15690 Rush County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15700 St Joseph County, Indiana 7800 Urban 0.9788 43780 Urban 0.9788 15710 Scott County, Indiana 4520 Urban 0.9293 99915 Rural 0.8624 15720 Shelby County, Indiana 3480 Urban 0.9865 26900 Urban 0.9920 15730 Spencer County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15740 Starke County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15750 Steuben County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15760 Sullivan County, Indiana 15 Rural 0.8739 45460 Urban 0.8304 15770 Switzerland County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15780 Tippecanoe County, Indiana 3920 Urban 0.8736 29140 Urban 0.8736 15790 Tipton County, Indiana 3850 Urban 0.9508 29020 Urban 0.9508 15800 Union County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15810 Vanderburgh County, Indiana 2440 Urban 0.8713 21780 Urban 0.8713 15820 Vermillion County, Indiana 8320 Urban 0.8337 45460 Urban 0.8304 15830 Vigo County, Indiana 8320 Urban 0.8337 45460 Urban 0.8304 15840 Wabash County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15850 Warren County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15860 Warrick County, Indiana 2440 Urban 0.8713 21780 Urban 0.8713 15870 Washington County, Indiana 15 Rural 0.8739 31140 Urban 0.9251 15880 Wayne County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15890 Wells County, Indiana 2760 Urban 0.9706 23060 Urban 0.9793 15900 White County, Indiana 15 Rural 0.8739 99915 Rural 0.8624 15910 Whitley County, Indiana 2760 Urban 0.9706 23060 Urban 0.9793 16000 Adair County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16010 Adams County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16020 Allamakee County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16030 Appanoose County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16040 Audubon County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16050 Benton County, Iowa 16 Rural 0.8594 16300 Urban 0.8825 16060 Black Hawk County, Iowa 8920 Urban 0.8557 47940 Urban 0.8557 16070 Boone County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16080 Bremer County, Iowa 16 Rural 0.8594 47940 Urban 0.8557 16090 Buchanan County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16100 Buena Vista County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16110 Butler County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16120 Calhoun County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16130 Carroll County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16140 Cass County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16150 Cedar County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16160 Cerro Gordo County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16170 Cherokee County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16180 Chickasaw County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16190 Clarke County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16200 Clay County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16210 Clayton County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16220 Clinton County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16230 Crawford County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16240 Dallas County, Iowa 2120 Urban 0.9669 19780 Urban 0.9669 16250 Davis County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16260 Decatur County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16270 Delaware County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16280 Des Moines County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16290 Dickinson County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16300 Dubuque County, Iowa 2200 Urban 0.9024 20220 Urban 0.9024 16310 Emmet County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16320 Fayette County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16330 Floyd County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16340 Franklin County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16350 Fremont County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16360 Greene County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16370 Grundy County, Iowa 16 Rural 0.8594 47940 Urban 0.8557 16380 Guthrie County, Iowa 16 Rural 0.8594 19780 Urban 0.9669 16390 Hamilton County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16400 Hancock County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16410 Hardin County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16420 Harrison County, Iowa 16 Rural 0.8594 36540 Urban 0.9560 16430 Henry County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16440 Howard County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16450 Humboldt County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16460 Ida County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16470 Iowa County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16480 Jackson County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16490 Jasper County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16500 Jefferson County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16510 Johnson County, Iowa 3500 Urban 0.9747 26980 Urban 0.9747 16520 Jones County, Iowa 16 Rural 0.8594 16300 Urban 0.8825 16530 Keokuk County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16540 Kossuth County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16550 Lee County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16560 Linn County, Iowa 1360 Urban 0.8825 16300 Urban 0.8825 16570 Louisa County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16580 Lucas County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16590 Lyon County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16600 Madison County, Iowa 16 Rural 0.8594 19780 Urban 0.9669 16610 Mahaska County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16620 Marion County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16630 Marshall County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16640 Mills County, Iowa 16 Rural 0.8594 36540 Urban 0.9560 16650 Mitchell County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16660 Monona County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16670 Monroe County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16680 Montgomery County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16690 Muscatine County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16700 O Brien County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16710 Osceola County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16720 Page County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16730 Palo Alto County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16740 Plymouth County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16750 Pocahontas County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16760 Polk County, Iowa 2120 Urban 0.9669 19780 Urban 0.9669 16770 Pottawattamie County, Iowa 5920 Urban 0.9560 36540 Urban 0.9560 16780 Poweshiek County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16790 Ringgold County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16800 Sac County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16810 Scott County, Iowa 1960 Urban 0.8724 19340 Urban 0.8724 16820 Shelby County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16830 Sioux County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16840 Story County, Iowa 16 Rural 0.8594 11180 Urban 0.9536 16850 Tama County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16860 Taylor County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16870 Union County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16880 Van Buren County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16890 Wapello County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16900 Warren County, Iowa 2120 Urban 0.9669 19780 Urban 0.9669 16910 Washington County, Iowa 16 Rural 0.8594 26980 Urban 0.9747 16920 Wayne County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16930 Webster County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16940 Winnebago County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16950 Winneshiek County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16960 Woodbury County, Iowa 7720 Urban 0.9416 43580 Urban 0.9381 16970 Worth County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 16980 Wright County, Iowa 16 Rural 0.8594 99916 Rural 0.8509 17000 Allen County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17010 Anderson County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17020 Atchison County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17030 Barber County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17040 Barton County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17050 Bourbon County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17060 Brown County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17070 Butler County, Kansas 9040 Urban 0.9175 48620 Urban 0.9153 17080 Chase County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17090 Chautauqua County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17100 Cherokee County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17110 Cheyenne County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17120 Clark County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17130 Clay County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17140 Cloud County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17150 Coffey County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17160 Comanche County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17170 Cowley County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17180 Crawford County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17190 Decatur County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17200 Dickinson County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17210 Doniphan County, Kansas 17 Rural 0.8040 41140 Urban 0.9519 17220 Douglas County, Kansas 4150 Urban 0.8537 29940 Urban 0.8537 17230 Edwards County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17240 Elk County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17250 Ellis County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17260 Ellsworth County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17270 Finney County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17280 Ford County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17290 Franklin County, Kansas 17 Rural 0.8040 28140 Urban 0.9476 17300 Geary County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17310 Gove County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17320 Graham County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17330 Grant County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17340 Gray County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17350 Greeley County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17360 Greenwood County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17370 Hamilton County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17380 Harper County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17390 Harvey County, Kansas 9040 Urban 0.9175 48620 Urban 0.9153 17391 Haskell County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17410 Hodgeman County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17420 Jackson County, Kansas 17 Rural 0.8040 45820 Urban 0.8920 17430 Jefferson County, Kansas 17 Rural 0.8040 45820 Urban 0.8920 17440 Jewell County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17450 Johnson County, Kansas 3760 Urban 0.9490 28140 Urban 0.9476 17451 Kearny County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17470 Kingman County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17480 Kiowa County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17490 Labette County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17500 Lane County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17510 Leavenworth County, Kansas 3760 Urban 0.9490 28140 Urban 0.9476 17520 Lincoln County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17530 Linn County, Kansas 17 Rural 0.8040 28140 Urban 0.9476 17540 Logan County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17550 Lyon County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17560 Mc Pherson County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17570 Marion County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17580 Marshall County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17590 Meade County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17600 Miami County, Kansas 3760 Urban 0.9490 28140 Urban 0.9476 17610 Mitchell County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17620 Montgomery County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17630 Morris County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17640 Morton County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17650 Nemaha County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17660 Neosho County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17670 Ness County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17680 Norton County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17690 Osage County, Kansas 17 Rural 0.8040 45820 Urban 0.8920 17700 Osborne County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17710 Ottawa County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17720 Pawnee County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17730 Phillips County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17740 Pottawatomie County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17750 Pratt County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17760 Rawlins County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17770 Reno County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17780 Republic County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17790 Rice County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17800 Riley County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17810 Rooks County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17820 Rush County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17830 Russell County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17840 Saline County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17841 Scott County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17860 Sedgwick County, Kansas 9040 Urban 0.9175 48620 Urban 0.9153 17870 Seward County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17880 Shawnee County, Kansas 8440 Urban 0.8920 45820 Urban 0.8920 17890 Sheridan County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17900 Sherman County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17910 Smith County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17920 Stafford County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17921 Stanton County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17940 Stevens County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17950 Sumner County, Kansas 17 Rural 0.8040 48620 Urban 0.9153 17960 Thomas County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17970 Trego County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17980 Wabaunsee County, Kansas 17 Rural 0.8040 45820 Urban 0.8920 17981 Wallace County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17982 Washington County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17983 Wichita County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17984 Wilson County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17985 Woodson County, Kansas 17 Rural 0.8040 99917 Rural 0.8035 17986 Wyandotte County, Kansas 3760 Urban 0.9490 28140 Urban 0.9476 18000 Adair County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18010 Allen County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18020 Anderson County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18030 Ballard County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18040 Barren County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18050 Bath County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18060 Bell County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18070 Boone County, Kentucky 1640 Urban 0.9734 17140 Urban 0.9615 18080 Bourbon County, Kentucky 4280 Urban 0.8988 30460 Urban 0.9075 18090 Boyd County, Kentucky 3400 Urban 0.9477 26580 Urban 0.9477 18100 Boyle County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18110 Bracken County, Kentucky 18 Rural 0.7858 17140 Urban 0.9615 18120 Breathitt County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18130 Breckinridge County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18140 Bullitt County, Kentucky 4520 Urban 0.9293 31140 Urban 0.9251 18150 Butler County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18160 Caldwell County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18170 Calloway County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18180 Campbell County, Kentucky 1640 Urban 0.9734 17140 Urban 0.9615 18190 Carlisle County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18191 Carroll County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18210 Carter County, Kentucky 3400 Urban 0.9477 99918 Rural 0.7766 18220 Casey County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18230 Christian County, Kentucky 1660 Urban 0.8284 17300 Urban 0.8284 18240 Clark County, Kentucky 4280 Urban 0.8988 30460 Urban 0.9075 18250 Clay County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18260 Clinton County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18270 Crittenden County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18271 Cumberland County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18290 Daviess County, Kentucky 5990 Urban 0.8780 36980 Urban 0.8780 18291 Edmonson County, Kentucky 18 Rural 0.7858 14540 Urban 0.8211 18310 Elliott County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18320 Estill County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18330 Fayette County, Kentucky 4280 Urban 0.8988 30460 Urban 0.9075 18340 Fleming County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18350 Floyd County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18360 Franklin County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18361 Fulton County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18362 Gallatin County, Kentucky 1640 Urban 0.9734 17140 Urban 0.9615 18390 Garrard County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18400 Grant County, Kentucky 1640 Urban 0.9734 17140 Urban 0.9615 18410 Graves County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18420 Grayson County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18421 Green County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18440 Greenup County, Kentucky 3400 Urban 0.9477 26580 Urban 0.9477 18450 Hancock County, Kentucky 18 Rural 0.7858 36980 Urban 0.8780 18460 Hardin County, Kentucky 18 Rural 0.7858 21060 Urban 0.8802 18470 Harlan County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18480 Harrison County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18490 Hart County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18500 Henderson County, Kentucky 2440 Urban 0.8713 21780 Urban 0.8713 18510 Henry County, Kentucky 18 Rural 0.7858 31140 Urban 0.9251 18511 Hickman County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18530 Hopkins County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18540 Jackson County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18550 Jefferson County, Kentucky 4520 Urban 0.9293 31140 Urban 0.9251 18560 Jessamine County, Kentucky 4280 Urban 0.8988 30460 Urban 0.9075 18570 Johnson County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18580 Kenton County, Kentucky 1640 Urban 0.9734 17140 Urban 0.9615 18590 Knott County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18600 Knox County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18610 Larue County, Kentucky 18 Rural 0.7858 21060 Urban 0.8802 18620 Laurel County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18630 Lawrence County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18640 Lee County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18650 Leslie County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18660 Letcher County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18670 Lewis County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18680 Lincoln County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18690 Livingston County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18700 Logan County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18710 Lyon County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18720 Mc Cracken County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18730 Mc Creary County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18740 Mc Lean County, Kentucky 18 Rural 0.7858 36980 Urban 0.8780 18750 Madison County, Kentucky 4280 Urban 0.8988 99918 Rural 0.7766 18760 Magoffin County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18770 Marion County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18780 Marshall County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18790 Martin County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18800 Mason County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18801 Meade County, Kentucky 18 Rural 0.7858 31140 Urban 0.9251 18802 Menifee County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18830 Mercer County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18831 Metcalfe County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18850 Monroe County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18860 Montgomery County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18861 Morgan County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18880 Muhlenberg County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18890 Nelson County, Kentucky 18 Rural 0.7858 31140 Urban 0.9251 18900 Nicholas County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18910 Ohio County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18920 Oldham County, Kentucky 4520 Urban 0.9293 31140 Urban 0.9251 18930 Owen County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18931 Owsley County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18932 Pendleton County, Kentucky 1640 Urban 0.9734 17140 Urban 0.9615 18960 Perry County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18970 Pike County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18971 Powell County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18972 Pulaski County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18973 Robertson County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18974 Rockcastle County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18975 Rowan County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18976 Russell County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18977 Scott County, Kentucky 4280 Urban 0.8988 30460 Urban 0.9075 18978 Shelby County, Kentucky 18 Rural 0.7858 31140 Urban 0.9251 18979 Simpson County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18980 Spencer County, Kentucky 18 Rural 0.7858 31140 Urban 0.9251 18981 Taylor County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18982 Todd County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18983 Trigg County, Kentucky 18 Rural 0.7858 17300 Urban 0.8284 18984 Trimble County, Kentucky 18 Rural 0.7858 31140 Urban 0.9251 18985 Union County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18986 Warren County, Kentucky 18 Rural 0.7858 14540 Urban 0.8211 18987 Washington County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18988 Wayne County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18989 Webster County, Kentucky 18 Rural 0.7858 21780 Urban 0.8713 18990 Whitley County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18991 Wolfe County, Kentucky 18 Rural 0.7858 99918 Rural 0.7766 18992 Woodford County, Kentucky 4280 Urban 0.8988 30460 Urban 0.9075 19000 Acadia County, Louisiana 3880 Urban 0.8251 99919 Rural 0.7411 19010 Allen County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19020 Ascension County, Louisiana 0760 Urban 0.8643 12940 Urban 0.8593 19030 Assumption County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19040 Avoyelles County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19050 Beauregard County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19060 Bienville County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19070 Bossier County, Louisiana 7680 Urban 0.8737 43340 Urban 0.8760 19080 Caddo County, Louisiana 7680 Urban 0.8737 43340 Urban 0.8760 19090 Calcasieu County, Louisiana 3960 Urban 0.7858 29340 Urban 0.7833 19100 Caldwell County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19110 Cameron County, Louisiana 19 Rural 0.7340 29340 Urban 0.7833 19120 Catahoula County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19130 Claiborne County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19140 Concordia County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19150 De Soto County, Louisiana 19 Rural 0.7340 43340 Urban 0.8760 19160 East Baton Rouge County, Louisiana 0760 Urban 0.8643 12940 Urban 0.8593 19170 East Carroll County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19180 East Feliciana County, Louisiana 19 Rural 0.7340 12940 Urban 0.8593 19190 Evangeline County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19200 Franklin County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19210 Grant County, Louisiana 19 Rural 0.7340 10780 Urban 0.8033 19220 Iberia County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19230 Iberville County, Louisiana 19 Rural 0.7340 12940 Urban 0.8593 19240 Jackson County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19250 Jefferson County, Louisiana 5560 Urban 0.8995 35380 Urban 0.8995 19260 Jefferson Davis County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19270 Lafayette County, Louisiana 3880 Urban 0.8251 29180 Urban 0.8428 19280 Lafourche County, Louisiana 3350 Urban 0.7894 26380 Urban 0.7894 19290 La Salle County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19300 Lincoln County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19310 Livingston County, Louisiana 0760 Urban 0.8643 12940 Urban 0.8593 19320 Madison County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19330 Morehouse County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19340 Natchitoches County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19350 Orleans County, Louisiana 5560 Urban 0.8995 35380 Urban 0.8995 19360 Ouachita County, Louisiana 5200 Urban 0.8044 33740 Urban 0.8031 19370 Plaquemines County, Louisiana 5560 Urban 0.8995 35380 Urban 0.8995 19380 Pointe Coupee County, Louisiana 19 Rural 0.7340 12940 Urban 0.8593 19390 Rapides County, Louisiana 0220 Urban 0.8033 10780 Urban 0.8033 19400 Red River County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19410 Richland County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19420 Sabine County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19430 St Bernard County, Louisiana 5560 Urban 0.8995 35380 Urban 0.8995 19440 St Charles County, Louisiana 5560 Urban 0.8995 35380 Urban 0.8995 19450 St Helena County, Louisiana 19 Rural 0.7340 12940 Urban 0.8593 19460 St James County, Louisiana 5560 Urban 0.8995 99919 Rural 0.7411 19470 St John Baptist County, Louisiana 5560 Urban 0.8995 35380 Urban 0.8995 19480 St Landry County, Louisiana 3880 Urban 0.8251 99919 Rural 0.7411 19490 St Martin County, Louisiana 3880 Urban 0.8251 29180 Urban 0.8428 19500 St Mary County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19510 St Tammany County, Louisiana 5560 Urban 0.8995 35380 Urban 0.8995 19520 Tangipahoa County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19530 Tensas County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19540 Terrebonne County, Louisiana 3350 Urban 0.7894 26380 Urban 0.7894 19550 Union County, Louisiana 19 Rural 0.7340 33740 Urban 0.8031 19560 Vermilion County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19570 Vernon County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19580 Washington County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19590 Webster County, Louisiana 7680 Urban 0.8737 99919 Rural 0.7411 19600 West Baton Rouge County, Louisiana 0760 Urban 0.8643 12940 Urban 0.8593 19610 West Carroll County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 19620 West Feliciana County, Louisiana 19 Rural 0.7340 12940 Urban 0.8593 19630 Winn County, Louisiana 19 Rural 0.7340 99919 Rural 0.7411 20000 Androscoggin County, Maine 4243 Urban 0.9331 30340 Urban 0.9331 20010 Aroostook County, Maine 20 Rural 0.8843 99920 Rural 0.8843 20020 Cumberland County, Maine 6403 Urban 1.0382 38860 Urban 1.0382 20030 Franklin County, Maine 20 Rural 0.8843 99920 Rural 0.8843 20040 Hancock County, Maine 20 Rural 0.8843 99920 Rural 0.8843 20050 Kennebec County, Maine 20 Rural 0.8843 99920 Rural 0.8843 20060 Knox County, Maine 20 Rural 0.8843 99920 Rural 0.8843 20070 Lincoln County, Maine 20 Rural 0.8843 99920 Rural 0.8843 20080 Oxford County, Maine 20 Rural 0.8843 99920 Rural 0.8843 20090 Penobscot County, Maine 0733 Urban 0.9993 12620 Urban 0.9993 20100 Piscataquis County, Maine 20 Rural 0.8843 99920 Rural 0.8843 20110 Sagadahoc County, Maine 6403 Urban 1.0382 38860 Urban 1.0382 20120 Somerset County, Maine 20 Rural 0.8843 99920 Rural 0.8843 20130 Waldo County, Maine 20 Rural 0.8843 99920 Rural 0.8843 20140 Washington County, Maine 20 Rural 0.8843 99920 Rural 0.8843 20150 York County, Maine 6403 Urban 1.0382 38860 Urban 1.0382 21000 Allegany County, Maryland 1900 Urban 0.9317 19060 Urban 0.9317 21010 Anne Arundel County, Maryland 0720 Urban 0.9897 12580 Urban 0.9897 21020 Baltimore County, Maryland 0720 Urban 0.9897 12580 Urban 0.9897 21030 Baltimore City County, Maryland 0720 Urban 0.9897 12580 Urban 0.9897 21040 Calvert County, Maryland 8840 Urban 1.0976 47894 Urban 1.0926 21050 Caroline County, Maryland 21 Rural 0.9230 99921 Rural 0.9353 21060 Carroll County, Maryland 0720 Urban 0.9897 12580 Urban 0.9897 21070 Cecil County, Maryland 9160 Urban 1.0527 48864 Urban 1.0471 21080 Charles County, Maryland 8840 Urban 1.0976 47894 Urban 1.0926 21090 Dorchester County, Maryland 21 Rural 0.9230 99921 Rural 0.9353 21100 Frederick County, Maryland 8840 Urban 1.0976 13644 Urban 1.1483 21110 Garrett County, Maryland 21 Rural 0.9230 99921 Rural 0.9353 21120 Harford County, Maryland 0720 Urban 0.9897 12580 Urban 0.9897 21130 Howard County, Maryland 0720 Urban 0.9897 12580 Urban 0.9897 21140 Kent County, Maryland 21 Rural 0.9230 99921 Rural 0.9353 21150 Montgomery County, Maryland 8840 Urban 1.0976 13644 Urban 1.1483 21160 Prince Georges County, Maryland 8840 Urban 1.0976 47894 Urban 1.0926 21170 Queen Annes County, Maryland 0720 Urban 0.9897 12580 Urban 0.9897 21180 St Marys County, Maryland 21 Rural 0.9230 99921 Rural 0.9353 21190 Somerset County, Maryland 21 Rural 0.9230 41540 Urban 0.9064 21200 Talbot County, Maryland 21 Rural 0.9230 99921 Rural 0.9353 21210 Washington County, Maryland 3180 Urban 0.9869 25180 Urban 0.9489 21220 Wicomico County, Maryland 21 Rural 0.9230 41540 Urban 0.9064 21230 Worcester County, Maryland 21 Rural 0.9230 99921 Rural 0.9353 22000 Barnstable County, Massachusetts 0743 Urban 1.2600 12700 Urban 1.2600 22010 Berkshire County, Massachusetts 6323 Urban 1.0181 38340 Urban 1.0181 22020 Bristol County, Massachusetts 1123 Urban 1.1178 39300 Urban 1.0966 22030 Dukes County, Massachusetts 22 Rural 1.0216 99922 Rural 1.0216 22040 Essex County, Massachusetts 1123 Urban 1.1178 21604 Urban 1.0538 22060 Franklin County, Massachusetts 22 Rural 1.0216 44140 Urban 1.0248 22070 Hampden County, Massachusetts 8003 Urban 1.0263 44140 Urban 1.0248 22080 Hampshire County, Massachusetts 8003 Urban 1.0263 44140 Urban 1.0248 22090 Middlesex County, Massachusetts 1123 Urban 1.1178 15764 Urban 1.1172 22120 Nantucket County, Massachusetts 22 Rural 1.0216 99922 Rural 1.0216 22130 Norfolk County, Massachusetts 1123 Urban 1.1178 14484 Urban 1.1558 22150 Plymouth County, Massachusetts 1123 Urban 1.1178 14484 Urban 1.1558 22160 Suffolk County, Massachusetts 1123 Urban 1.1178 14484 Urban 1.1558 22170 Worcester County, Massachusetts 1123 Urban 1.1178 49340 Urban 1.1028 23000 Alcona County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23010 Alger County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23020 Allegan County, Michigan 3000 Urban 0.9445 99923 Rural 0.8895 23030 Alpena County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23040 Antrim County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23050 Arenac County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23060 Baraga County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23070 Barry County, Michigan 23 Rural 0.8824 24340 Urban 0.9390 23080 Bay County, Michigan 6960 Urban 0.9241 13020 Urban 0.9343 23090 Benzie County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23100 Berrien County, Michigan 0870 Urban 0.8879 35660 Urban 0.8879 23110 Branch County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23120 Calhoun County, Michigan 3720 Urban 1.0143 12980 Urban 0.9508 23130 Cass County, Michigan 23 Rural 0.8824 43780 Urban 0.9788 23140 Charlevoix County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23150 Cheboygan County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23160 Chippewa County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23170 Clare County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23180 Clinton County, Michigan 4040 Urban 0.9794 29620 Urban 0.9794 23190 Crawford County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23200 Delta County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23210 Dickinson County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23220 Eaton County, Michigan 4040 Urban 0.9794 29620 Urban 0.9794 23230 Emmet County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23240 Genesee County, Michigan 2640 Urban 1.0655 22420 Urban 1.0655 23250 Gladwin County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23260 Gogebic County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23270 Grand Traverse County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23280 Gratiot County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23290 Hillsdale County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23300 Houghton County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23310 Huron County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23320 Ingham County, Michigan 4040 Urban 0.9794 29620 Urban 0.9794 23330 Ionia County, Michigan 23 Rural 0.8824 24340 Urban 0.9390 23340 Iosco County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23350 Iron County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23360 Isabella County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23370 Jackson County, Michigan 3520 Urban 0.9304 27100 Urban 0.9304 23380 Kalamazoo County, Michigan 3720 Urban 1.0143 28020 Urban 1.0381 23390 Kalkaska County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23400 Kent County, Michigan 3000 Urban 0.9445 24340 Urban 0.9390 23410 Keweenaw County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23420 Lake County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23430 Lapeer County, Michigan 2160 Urban 1.0147 47644 Urban 0.9871 23440 Leelanau County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23450 Lenawee County, Michigan 0440 Urban 1.0707 99923 Rural 0.8895 23460 Livingston County, Michigan 0440 Urban 1.0707 47644 Urban 0.9871 23470 Luce County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23480 Mackinac County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23490 Macomb County, Michigan 2160 Urban 1.0147 47644 Urban 0.9871 23500 Manistee County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23510 Marquette County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23520 Mason County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23530 Mecosta County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23540 Menominee County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23550 Midland County, Michigan 6960 Urban 0.9241 99923 Rural 0.8895 23560 Missaukee County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23570 Monroe County, Michigan 2160 Urban 1.0147 33780 Urban 0.9468 23580 Montcalm County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23590 Montmorency County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23600 Muskegon County, Michigan 3000 Urban 0.9445 34740 Urban 0.9664 23610 Newaygo County, Michigan 23 Rural 0.8824 24340 Urban 0.9390 23620 Oakland County, Michigan 2160 Urban 1.0147 47644 Urban 0.9871 23630 Oceana County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23640 Ogemaw County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23650 Ontonagon County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23660 Osceola County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23670 Oscoda County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23680 Otsego County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23690 Ottawa County, Michigan 3000 Urban 0.9445 26100 Urban 0.9055 23700 Presque Isle County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23710 Roscommon County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23720 Saginaw County, Michigan 6960 Urban 0.9241 40980 Urban 0.9088 23730 St Clair County, Michigan 2160 Urban 1.0147 47644 Urban 0.9871 23740 St Joseph County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23750 Sanilac County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23760 Schoolcraft County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23770 Shiawassee County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23780 Tuscola County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 23790 Van Buren County, Michigan 3720 Urban 1.0143 28020 Urban 1.0381 23800 Washtenaw County, Michigan 0440 Urban 1.0707 11460 Urban 1.0859 23810 Wayne County, Michigan 2160 Urban 1.0147 19804 Urban 1.0424 23830 Wexford County, Michigan 23 Rural 0.8824 99923 Rural 0.8895 24000 Aitkin County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24010 Anoka County, Minnesota 5120 Urban 1.1075 33460 Urban 1.1075 24020 Becker County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24030 Beltrami County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24040 Benton County, Minnesota 6980 Urban 0.9965 41060 Urban 0.9965 24050 Big Stone County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24060 Blue Earth County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24070 Brown County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24080 Carlton County, Minnesota 24 Rural 0.9132 20260 Urban 1.0213 24090 Carver County, Minnesota 5120 Urban 1.1075 33460 Urban 1.1075 24100 Cass County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24110 Chippewa County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24120 Chisago County, Minnesota 5120 Urban 1.1075 33460 Urban 1.1075 24130 Clay County, Minnesota 2520 Urban 0.8486 22020 Urban 0.8486 24140 Clearwater County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24150 Cook County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24160 Cottonwood County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24170 Crow Wing County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24180 Dakota County, Minnesota 5120 Urban 1.1075 33460 Urban 1.1075 24190 Dodge County, Minnesota 24 Rural 0.9132 40340 Urban 1.1131 24200 Douglas County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24210 Faribault County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24220 Fillmore County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24230 Freeborn County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24240 Goodhue County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24250 Grant County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24260 Hennepin County, Minnesota 5120 Urban 1.1075 33460 Urban 1.1075 24270 Houston County, Minnesota 3870 Urban 0.9564 29100 Urban 0.9564 24280 Hubbard County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24290 Isanti County, Minnesota 5120 Urban 1.1075 33460 Urban 1.1075 24300 Itasca County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24310 Jackson County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24320 Kanabec County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24330 Kandiyohi County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24340 Kittson County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24350 Koochiching County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24360 Lac Qui Parle County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24370 Lake County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24380 Lake Of Woods County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24390 Le Sueur County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24400 Lincoln County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24410 Lyon County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24420 Mc Leod County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24430 Mahnomen County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24440 Marshall County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24450 Martin County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24460 Meeker County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24470 Mille Lacs County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24480 Morrison County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24490 Mower County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24500 Murray County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24510 Nicollet County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24520 Nobles County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24530 Norman County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24540 Olmsted County, Minnesota 6820 Urban 1.1131 40340 Urban 1.1131 24550 Otter Tail County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24560 Pennington County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24570 Pine County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24580 Pipestone County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24590 Polk County, Minnesota 2985 Urban 0.7901 24220 Urban 0.7901 24600 Pope County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24610 Ramsey County, Minnesota 5120 Urban 1.1075 33460 Urban 1.1075 24620 Red Lake County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24630 Redwood County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24640 Renville County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24650 Rice County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24660 Rock County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24670 Roseau County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24680 St Louis County, Minnesota 2240 Urban 1.0213 20260 Urban 1.0213 24690 Scott County, Minnesota 5120 Urban 1.1075 33460 Urban 1.1075 24700 Sherburne County, Minnesota 5120 Urban 1.1075 33460 Urban 1.1075 24710 Sibley County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24720 Stearns County, Minnesota 6980 Urban 0.9965 41060 Urban 0.9965 24730 Steele County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24740 Stevens County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24750 Swift County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24760 Todd County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24770 Traverse County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24780 Wabasha County, Minnesota 24 Rural 0.9132 40340 Urban 1.1131 24790 Wadena County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24800 Waseca County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24810 Washington County, Minnesota 5120 Urban 1.1075 33460 Urban 1.1075 24820 Watonwan County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24830 Wilkin County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24840 Winona County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 24850 Wright County, Minnesota 5120 Urban 1.1075 33460 Urban 1.1075 24860 Yellow Medicine County, Minnesota 24 Rural 0.9132 99924 Rural 0.9132 25000 Adams County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25010 Alcorn County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25020 Amite County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25030 Attala County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25040 Benton County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25050 Bolivar County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25060 Calhoun County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25070 Carroll County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25080 Chickasaw County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25090 Choctaw County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25100 Claiborne County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25110 Clarke County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25120 Clay County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25130 Coahoma County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25140 Copiah County, Mississippi 25 Rural 0.7634 27140 Urban 0.8311 25150 Covington County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25160 Desoto County, Mississippi 4920 Urban 0.9416 32820 Urban 0.9397 25170 Forrest County, Mississippi 3285 Urban 0.7601 25620 Urban 0.7601 25180 Franklin County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25190 George County, Mississippi 25 Rural 0.7634 37700 Urban 0.8156 25200 Greene County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25210 Grenada County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25220 Hancock County, Mississippi 0920 Urban 0.8706 25060 Urban 0.8929 25230 Harrison County, Mississippi 0920 Urban 0.8706 25060 Urban 0.8929 25240 Hinds County, Mississippi 3560 Urban 0.8382 27140 Urban 0.8311 25250 Holmes County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25260 Humphreys County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25270 Issaquena County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25280 Itawamba County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25290 Jackson County, Mississippi 0920 Urban 0.8706 37700 Urban 0.8156 25300 Jasper County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25310 Jefferson County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25320 Jefferson Davis County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25330 Jones County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25340 Kemper County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25350 Lafayette County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25360 Lamar County, Mississippi 3285 Urban 0.7601 25620 Urban 0.7601 25370 Lauderdale County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25380 Lawrence County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25390 Leake County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25400 Lee County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25410 Leflore County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25420 Lincoln County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25430 Lowndes County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25440 Madison County, Mississippi 3560 Urban 0.8382 27140 Urban 0.8311 25450 Marion County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25460 Marshall County, Mississippi 25 Rural 0.7634 32820 Urban 0.9397 25470 Monroe County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25480 Montgomery County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25490 Neshoba County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25500 Newton County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25510 Noxubee County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25520 Oktibbeha County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25530 Panola County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25540 Pearl River County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25550 Perry County, Mississippi 25 Rural 0.7634 25620 Urban 0.7601 25560 Pike County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25570 Pontotoc County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25580 Prentiss County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25590 Quitman County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25600 Rankin County, Mississippi 3560 Urban 0.8382 27140 Urban 0.8311 25610 Scott County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25620 Sharkey County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25630 Simpson County, Mississippi 25 Rural 0.7634 27140 Urban 0.8311 25640 Smith County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25650 Stone County, Mississippi 25 Rural 0.7634 25060 Urban 0.8929 25660 Sunflower County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25670 Tallahatchie County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25680 Tate County, Mississippi 25 Rural 0.7634 32820 Urban 0.9397 25690 Tippah County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25700 Tishomingo County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25710 Tunica County, Mississippi 25 Rural 0.7634 32820 Urban 0.9397 25720 Union County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25730 Walthall County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25740 Warren County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25750 Washington County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25760 Wayne County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25770 Webster County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25780 Wilkinson County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25790 Winston County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25800 Yalobusha County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 25810 Yazoo County, Mississippi 25 Rural 0.7634 99925 Rural 0.7674 26000 Adair County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26010 Andrew County, Missouri 7000 Urban 0.9519 41140 Urban 0.9519 26020 Atchison County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26030 Audrain County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26040 Barry County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26050 Barton County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26060 Bates County, Missouri 26 Rural 0.7959 28140 Urban 0.9476 26070 Benton County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26080 Bollinger County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26090 Boone County, Missouri 1740 Urban 0.8345 17860 Urban 0.8345 26100 Buchanan County, Missouri 7000 Urban 0.9519 41140 Urban 0.9519 26110 Butler County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26120 Caldwell County, Missouri 26 Rural 0.7959 28140 Urban 0.9476 26130 Callaway County, Missouri 26 Rural 0.7959 27620 Urban 0.8387 26140 Camden County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26150 Cape Girardeau County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26160 Carroll County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26170 Carter County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26180 Cass County, Missouri 3760 Urban 0.9490 28140 Urban 0.9476 26190 Cedar County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26200 Chariton County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26210 Christian County, Missouri 7920 Urban 0.8250 44180 Urban 0.8237 26220 Clark County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26230 Clay County, Missouri 3760 Urban 0.9490 28140 Urban 0.9476 26240 Clinton County, Missouri 3760 Urban 0.9490 28140 Urban 0.9476 26250 Cole County, Missouri 26 Rural 0.7959 27620 Urban 0.8387 26260 Cooper County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26270 Crawford County, Missouri 26 Rural 0.7959 41180 Urban 0.8954 26280 Dade County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26290 Dallas County, Missouri 26 Rural 0.7959 44180 Urban 0.8237 26300 Daviess County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26310 De Kalb County, Missouri 26 Rural 0.7959 41140 Urban 0.9519 26320 Dent County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26330 Douglas County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26340 Dunklin County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26350 Franklin County, Missouri 7040 Urban 0.8962 41180 Urban 0.8954 26360 Gasconade County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26370 Gentry County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26380 Greene County, Missouri 7920 Urban 0.8250 44180 Urban 0.8237 26390 Grundy County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26400 Harrison County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26410 Henry County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26411 Hickory County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26412 Holt County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26440 Howard County, Missouri 26 Rural 0.7959 17860 Urban 0.8345 26450 Howell County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26460 Iron County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26470 Jackson County, Missouri 3760 Urban 0.9490 28140 Urban 0.9476 26480 Jasper County, Missouri 3710 Urban 0.8582 27900 Urban 0.8582 26490 Jefferson County, Missouri 7040 Urban 0.8962 41180 Urban 0.8954 26500 Johnson County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26510 Knox County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26520 Laclede County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26530 Lafayette County, Missouri 3760 Urban 0.9490 28140 Urban 0.9476 26540 Lawrence County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26541 Lewis County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26560 Lincoln County, Missouri 7040 Urban 0.8962 41180 Urban 0.8954 26570 Linn County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26580 Livingston County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26590 Mc Donald County, Missouri 26 Rural 0.7959 22220 Urban 0.8661 26600 Macon County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26601 Madison County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26620 Maries County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26630 Marion County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26631 Mercer County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26650 Miller County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26660 Mississippi County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26670 Moniteau County, Missouri 26 Rural 0.7959 27620 Urban 0.8387 26680 Monroe County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26690 Montgomery County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26700 Morgan County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26710 New Madrid County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26720 Newton County, Missouri 3710 Urban 0.8582 27900 Urban 0.8582 26730 Nodaway County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26740 Oregon County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26750 Osage County, Missouri 26 Rural 0.7959 27620 Urban 0.8387 26751 Ozark County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26770 Pemiscot County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26780 Perry County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26790 Pettis County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26800 Phelps County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26810 Pike County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26820 Platte County, Missouri 3760 Urban 0.9490 28140 Urban 0.9476 26821 Polk County, Missouri 26 Rural 0.7959 44180 Urban 0.8237 26840 Pulaski County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26850 Putnam County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26860 Ralls County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26870 Randolph County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26880 Ray County, Missouri 3760 Urban 0.9490 28140 Urban 0.9476 26881 Reynolds County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26900 Ripley County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26910 St Charles County, Missouri 7040 Urban 0.8962 41180 Urban 0.8954 26911 St Clair County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26930 St Francois County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26940 St Louis County, Missouri 7040 Urban 0.8962 41180 Urban 0.8954 26950 St Louis City County, Missouri 7040 Urban 0.8962 41180 Urban 0.8954 26960 Ste Genevieve County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26970 Saline County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26980 Schuyler County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26981 Scotland County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26982 Scott County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26983 Shannon County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26984 Shelby County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26985 Stoddard County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26986 Stone County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26987 Sullivan County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26988 Taney County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26989 Texas County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26990 Vernon County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26991 Warren County, Missouri 7040 Urban 0.8962 41180 Urban 0.8954 26992 Washington County, Missouri 26 Rural 0.7959 41180 Urban 0.8954 26993 Wayne County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26994 Webster County, Missouri 7920 Urban 0.8250 44180 Urban 0.8237 26995 Worth County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 26996 Wright County, Missouri 26 Rural 0.7959 99926 Rural 0.7900 27000 Beaverhead County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27010 Big Horn County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27020 Blaine County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27030 Broadwater County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27040 Carbon County, Montana 27 Rural 0.8762 13740 Urban 0.8834 27050 Carter County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27060 Cascade County, Montana 3040 Urban 0.9052 24500 Urban 0.9052 27070 Chouteau County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27080 Custer County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27090 Daniels County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27100 Dawson County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27110 Deer Lodge County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27113 Yellowstone National Park, Montana 27 Rural 0.8762 99927 Rural 0.8762 27120 Fallon County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27130 Fergus County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27140 Flathead County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27150 Gallatin County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27160 Garfield County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27170 Glacier County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27180 Golden Valley County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27190 Granite County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27200 Hill County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27210 Jefferson County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27220 Judith Basin County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27230 Lake County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27240 Lewis And Clark County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27250 Liberty County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27260 Lincoln County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27270 Mc Cone County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27280 Madison County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27290 Meagher County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27300 Mineral County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27310 Missoula County, Montana 5140 Urban 0.9473 33540 Urban 0.9473 27320 Musselshell County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27330 Park County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27340 Petroleum County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27350 Phillips County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27360 Pondera County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27370 Powder River County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27380 Powell County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27390 Prairie County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27400 Ravalli County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27410 Richland County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27420 Roosevelt County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27430 Rosebud County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27440 Sanders County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27450 Sheridan County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27460 Silver Bow County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27470 Stillwater County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27480 Sweet Grass County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27490 Teton County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27500 Toole County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27510 Treasure County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27520 Valley County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27530 Wheatland County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27540 Wibaux County, Montana 27 Rural 0.8762 99927 Rural 0.8762 27550 Yellowstone County, Montana 0880 Urban 0.8834 13740 Urban 0.8834 28000 Adams County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28010 Antelope County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28020 Arthur County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28030 Banner County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28040 Blaine County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28050 Boone County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28060 Box Butte County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28070 Boyd County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28080 Brown County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28090 Buffalo County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28100 Burt County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28110 Butler County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28120 Cass County, Nebraska 5920 Urban 0.9560 36540 Urban 0.9560 28130 Cedar County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28140 Chase County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28150 Cherry County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28160 Cheyenne County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28170 Clay County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28180 Colfax County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28190 Cuming County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28200 Custer County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28210 Dakota County, Nebraska 7720 Urban 0.9416 43580 Urban 0.9381 28220 Dawes County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28230 Dawson County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28240 Deuel County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28250 Dixon County, Nebraska 28 Rural 0.8657 43580 Urban 0.9381 28260 Dodge County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28270 Douglas County, Nebraska 5920 Urban 0.9560 36540 Urban 0.9560 28280 Dundy County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28290 Fillmore County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28300 Franklin County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28310 Frontier County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28320 Furnas County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28330 Gage County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28340 Garden County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28350 Garfield County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28360 Gosper County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28370 Grant County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28380 Greeley County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28390 Hall County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28400 Hamilton County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28410 Harlan County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28420 Hayes County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28430 Hitchcock County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28440 Holt County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28450 Hooker County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28460 Howard County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28470 Jefferson County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28480 Johnson County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28490 Kearney County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28500 Keith County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28510 Keya Paha County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28520 Kimball County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28530 Knox County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28540 Lancaster County, Nebraska 4360 Urban 1.0214 30700 Urban 1.0214 28550 Lincoln County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28560 Logan County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28570 Loup County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28580 Mc Pherson County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28590 Madison County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28600 Merrick County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28610 Morrill County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28620 Nance County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28630 Nemaha County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28640 Nuckolls County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28650 Otoe County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28660 Pawnee County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28670 Perkins County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28680 Phelps County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28690 Pierce County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28700 Platte County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28710 Polk County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28720 Redwillow County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28730 Richardson County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28740 Rock County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28750 Saline County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28760 Sarpy County, Nebraska 5920 Urban 0.9560 36540 Urban 0.9560 28770 Saunders County, Nebraska 28 Rural 0.8657 36540 Urban 0.9560 28780 Scotts Bluff County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28790 Seward County, Nebraska 28 Rural 0.8657 30700 Urban 1.0214 28800 Sheridan County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28810 Sherman County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28820 Sioux County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28830 Stanton County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28840 Thayer County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28850 Thomas County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28860 Thurston County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28870 Valley County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28880 Washington County, Nebraska 5920 Urban 0.9560 36540 Urban 0.9560 28890 Wayne County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28900 Webster County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28910 Wheeler County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 28920 York County, Nebraska 28 Rural 0.8657 99928 Rural 0.8657 29000 Churchill County, Nevada 29 Rural 0.9687 99929 Rural 0.9065 29010 Clark County, Nevada 4120 Urban 1.1155 29820 Urban 1.1437 29020 Douglas County, Nevada 29 Rural 0.9687 99929 Rural 0.9065 29030 Elko County, Nevada 29 Rural 0.9687 99929 Rural 0.9065 29040 Esmeralda County, Nevada 29 Rural 0.9687 99929 Rural 0.9065 29050 Eureka County, Nevada 29 Rural 0.9687 99929 Rural 0.9065 29060 Humboldt County, Nevada 29 Rural 0.9687 99929 Rural 0.9065 29070 Lander County, Nevada 29 Rural 0.9687 99929 Rural 0.9065 29080 Lincoln County, Nevada 29 Rural 0.9687 99929 Rural 0.9065 29090 Lyon County, Nevada 29 Rural 0.9687 99929 Rural 0.9065 29100 Mineral County, Nevada 29 Rural 0.9687 99929 Rural 0.9065 29110 Nye County, Nevada 4120 Urban 1.1155 99929 Rural 0.9065 29120 Carson City County, Nevada 29 Rural 0.9687 16180 Urban 1.0234 29130 Pershing County, Nevada 29 Rural 0.9687 99929 Rural 0.9065 29140 Storey County, Nevada 29 Rural 0.9687 39900 Urban 1.0982 29150 Washoe County, Nevada 6720 Urban 1.0982 39900 Urban 1.0982 29160 White Pine County, Nevada 29 Rural 0.9687 99929 Rural 0.9065 30000 Belknap County, New Hampshire 30 Rural 1.0817 99930 Rural 1.0817 30010 Carroll County, New Hampshire 30 Rural 1.0817 99930 Rural 1.0817 30020 Cheshire County, New Hampshire 30 Rural 1.0817 99930 Rural 1.0817 30030 Coos County, New Hampshire 30 Rural 1.0817 99930 Rural 1.0817 30040 Grafton County, New Hampshire 30 Rural 1.0817 99930 Rural 1.0817 30050 Hillsboro County, New Hampshire 1123 Urban 1.1178 31700 Urban 1.0354 30060 Merrimack County, New Hampshire 1123 Urban 1.1178 31700 Urban 1.0354 30070 Rockingham County, New Hampshire 1123 Urban 1.1178 40484 Urban 1.0374 30080 Strafford County, New Hampshire 1123 Urban 1.1178 40484 Urban 1.0374 30090 Sullivan County, New Hampshire 30 Rural 1.0817 99930 Rural 1.0817 31000 Atlantic County, New Jersey 0560 Urban 1.1496 12100 Urban 1.1615 31100 Bergen County, New Jersey 0875 Urban 1.1651 35644 Urban 1.3188 31150 Burlington County, New Jersey 6160 Urban 1.0922 15804 Urban 1.0517 31160 Camden County, New Jersey 6160 Urban 1.0922 15804 Urban 1.0517 31180 Cape May County, New Jersey 0560 Urban 1.1496 36140 Urban 1.1011 31190 Cumberland County, New Jersey 8760 Urban 0.9827 47220 Urban 0.9827 31200 Essex County, New Jersey 5640 Urban 1.1834 35084 Urban 1.1883 31220 Gloucester County, New Jersey 6160 Urban 1.0922 15804 Urban 1.0517 31230 Hudson County, New Jersey 3640 Urban 1.1338 35644 Urban 1.3188 31250 Hunterdon County, New Jersey 5015 Urban 1.1167 35084 Urban 1.1883 31260 Mercer County, New Jersey 8480 Urban 1.0834 45940 Urban 1.0834 31270 Middlesex County, New Jersey 5015 Urban 1.1167 20764 Urban 1.1249 31290 Monmouth County, New Jersey 5190 Urban 1.1260 20764 Urban 1.1249 31300 Morris County, New Jersey 5640 Urban 1.1834 35084 Urban 1.1883 31310 Ocean County, New Jersey 5190 Urban 1.1260 20764 Urban 1.1249 31320 Passaic County, New Jersey 0875 Urban 1.1651 35644 Urban 1.3188 31340 Salem County, New Jersey 6160 Urban 1.0922 48864 Urban 1.0471 31350 Somerset County, New Jersey 5015 Urban 1.1167 20764 Urban 1.1249 31360 Sussex County, New Jersey 5640 Urban 1.1834 35084 Urban 1.1883 31370 Union County, New Jersey 5640 Urban 1.1834 35084 Urban 1.1883 31390 Warren County, New Jersey 5640 Urban 1.1834 10900 Urban 0.9818 32000 Bernalillo County, New Mexico 0200 Urban 0.9684 10740 Urban 0.9684 32010 Catron County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32020 Chaves County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32025 Cibola County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32030 Colfax County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32040 Curry County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32050 De Baca County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32060 Dona Ana County, New Mexico 4100 Urban 0.8467 29740 Urban 0.8467 32070 Eddy County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32080 Grant County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32090 Guadalupe County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32100 Harding County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32110 Hidalgo County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32120 Lea County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32130 Lincoln County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32131 Los Alamos County, New Mexico 7490 Urban 1.0748 99932 Rural 0.8635 32140 Luna County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32150 Mc Kinley County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32160 Mora County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32170 Otero County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32180 Quay County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32190 Rio Arriba County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32200 Roosevelt County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32210 Sandoval County, New Mexico 0200 Urban 0.9684 10740 Urban 0.9684 32220 San Juan County, New Mexico 32 Rural 0.8563 22140 Urban 0.8509 32230 San Miguel County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32240 Santa Fe County, New Mexico 7490 Urban 1.0748 42140 Urban 1.0920 32250 Sierra County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32260 Socorro County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32270 Taos County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32280 Torrance County, New Mexico 32 Rural 0.8563 10740 Urban 0.9684 32290 Union County, New Mexico 32 Rural 0.8563 99932 Rural 0.8635 32300 Valencia County, New Mexico 0200 Urban 0.9684 10740 Urban 0.9684 33000 Albany County, New York 0160 Urban 0.8559 10580 Urban 0.8589 33010 Allegany County, New York 33 Rural 0.8395 99933 Rural 0.8154 33020 Bronx County, New York 5600 Urban 1.3464 35644 Urban 1.3188 33030 Broome County, New York 0960 Urban 0.8562 13780 Urban 0.8562 33040 Cattaraugus County, New York 33 Rural 0.8395 99933 Rural 0.8154 33050 Cayuga County, New York 8160 Urban 0.9492 99933 Rural 0.8154 33060 Chautauqua County, New York 3610 Urban 0.7544 99933 Rural 0.8154 33070 Chemung County, New York 2335 Urban 0.8250 21300 Urban 0.8250 33080 Chenango County, New York 33 Rural 0.8395 99933 Rural 0.8154 33090 Clinton County, New York 33 Rural 0.8395 99933 Rural 0.8154 33200 Columbia County, New York 33 Rural 0.8395 99933 Rural 0.8154 33210 Cortland County, New York 33 Rural 0.8395 99933 Rural 0.8154 33220 Delaware County, New York 33 Rural 0.8395 99933 Rural 0.8154 33230 Dutchess County, New York 2281 Urban 1.0475 39100 Urban 1.0891 33240 Erie County, New York 1280 Urban 0.9511 15380 Urban 0.9511 33260 Essex County, New York 33 Rural 0.8395 99933 Rural 0.8154 33270 Franklin County, New York 33 Rural 0.8395 99933 Rural 0.8154 33280 Fulton County, New York 33 Rural 0.8395 99933 Rural 0.8154 33290 Genesee County, New York 6840 Urban 0.9049 99933 Rural 0.8154 33300 Greene County, New York 33 Rural 0.8395 99933 Rural 0.8154 33310 Hamilton County, New York 33 Rural 0.8395 99933 Rural 0.8154 33320 Herkimer County, New York 8680 Urban 0.8358 46540 Urban 0.8358 33330 Jefferson County, New York 33 Rural 0.8395 99933 Rural 0.8154 33331 Kings County, New York 5600 Urban 1.3464 35644 Urban 1.3188 33340 Lewis County, New York 33 Rural 0.8395 99933 Rural 0.8154 33350 Livingston County, New York 6840 Urban 0.9049 40380 Urban 0.9121 33360 Madison County, New York 8160 Urban 0.9492 45060 Urban 0.9574 33370 Monroe County, New York 6840 Urban 0.9049 40380 Urban 0.9121 33380 Montgomery County, New York 0160 Urban 0.8559 99933 Rural 0.8154 33400 Nassau County, New York 5380 Urban 1.2719 35004 Urban 1.2719 33420 New York County, New York 5600 Urban 1.3464 35644 Urban 1.3188 33500 Niagara County, New York 1280 Urban 0.9511 15380 Urban 0.9511 33510 Oneida County, New York 8680 Urban 0.8358 46540 Urban 0.8358 33520 Onondaga County, New York 8160 Urban 0.9492 45060 Urban 0.9574 33530 Ontario County, New York 6840 Urban 0.9049 40380 Urban 0.9121 33540 Orange County, New York 5660 Urban 1.1207 39100 Urban 1.0891 33550 Orleans County, New York 6840 Urban 0.9049 40380 Urban 0.9121 33560 Oswego County, New York 8160 Urban 0.9492 45060 Urban 0.9574 33570 Otsego County, New York 33 Rural 0.8395 99933 Rural 0.8154 33580 Putnam County, New York 5600 Urban 1.3464 35644 Urban 1.3188 33590 Queens County, New York 5600 Urban 1.3464 35644 Urban 1.3188 33600 Rensselaer County, New York 0160 Urban 0.8559 10580 Urban 0.8589 33610 Richmond County, New York 5600 Urban 1.3464 35644 Urban 1.3188 33620 Rockland County, New York 5600 Urban 1.3464 35644 Urban 1.3188 33630 St Lawrence County, New York 33 Rural 0.8395 99933 Rural 0.8154 33640 Saratoga County, New York 0160 Urban 0.8559 10580 Urban 0.8589 33650 Schenectady County, New York 0160 Urban 0.8559 10580 Urban 0.8589 33660 Schoharie County, New York 0160 Urban 0.8559 10580 Urban 0.8589 33670 Schuyler County, New York 33 Rural 0.8395 99933 Rural 0.8154 33680 Seneca County, New York 33 Rural 0.8395 99933 Rural 0.8154 33690 Steuben County, New York 33 Rural 0.8395 99933 Rural 0.8154 33700 Suffolk County, New York 5380 Urban 1.2719 35004 Urban 1.2719 33710 Sullivan County, New York 33 Rural 0.8395 99933 Rural 0.8154 33720 Tioga County, New York 0960 Urban 0.8562 13780 Urban 0.8562 33730 Tompkins County, New York 33 Rural 0.8395 27060 Urban 0.9793 33740 Ulster County, New York 33 Rural 0.8395 28740 Urban 0.9255 33750 Warren County, New York 2975 Urban 0.8559 24020 Urban 0.8559 33760 Washington County, New York 2975 Urban 0.8559 24020 Urban 0.8559 33770 Wayne County, New York 6840 Urban 0.9049 40380 Urban 0.9121 33800 Westchester County, New York 5600 Urban 1.3464 35644 Urban 1.3188 33900 Wyoming County, New York 33 Rural 0.8395 99933 Rural 0.8154 33910 Yates County, New York 33 Rural 0.8395 99933 Rural 0.8154 34000 Alamance County, N Carolina 3120 Urban 0.9018 15500 Urban 0.8905 34010 Alexander County, N Carolina 3290 Urban 0.8921 25860 Urban 0.8921 34020 Alleghany County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34030 Anson County, N Carolina 34 Rural 0.8462 16740 Urban 0.9750 34040 Ashe County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34050 Avery County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34060 Beaufort County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34070 Bertie County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34080 Bladen County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34090 Brunswick County, N Carolina 9200 Urban 0.9582 48900 Urban 0.9582 34100 Buncombe County, N Carolina 0480 Urban 0.9737 11700 Urban 0.9285 34110 Burke County, N Carolina 3290 Urban 0.8921 25860 Urban 0.8921 34120 Cabarrus County, N Carolina 1520 Urban 0.9715 16740 Urban 0.9750 34130 Caldwell County, N Carolina 3290 Urban 0.8921 25860 Urban 0.8921 34140 Camden County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34150 Carteret County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34160 Caswell County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34170 Catawba County, N Carolina 3290 Urban 0.8921 25860 Urban 0.8921 34180 Chatham County, N Carolina 6640 Urban 1.0034 20500 Urban 1.0244 34190 Cherokee County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34200 Chowan County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34210 Clay County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34220 Cleveland County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34230 Columbus County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34240 Craven County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34250 Cumberland County, N Carolina 2560 Urban 0.9416 22180 Urban 0.9416 34251 Currituck County, N Carolina 5720 Urban 0.8799 47260 Urban 0.8799 34270 Dare County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34280 Davidson County, N Carolina 3120 Urban 0.9018 99934 Rural 0.8540 34290 Davie County, N Carolina 3120 Urban 0.9018 49180 Urban 0.8944 34300 Duplin County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34310 Durham County, N Carolina 6640 Urban 1.0034 20500 Urban 1.0244 34320 Edgecombe County, N Carolina 6895 Urban 0.8915 40580 Urban 0.8915 34330 Forsyth County, N Carolina 3120 Urban 0.9018 49180 Urban 0.8944 34340 Franklin County, N Carolina 6640 Urban 1.0034 39580 Urban 0.9691 34350 Gaston County, N Carolina 1520 Urban 0.9715 16740 Urban 0.9750 34360 Gates County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34370 Graham County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34380 Granville County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34390 Greene County, N Carolina 34 Rural 0.8462 24780 Urban 0.9425 34400 Guilford County, N Carolina 3120 Urban 0.9018 24660 Urban 0.9104 34410 Halifax County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34420 Harnett County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34430 Haywood County, N Carolina 34 Rural 0.8462 11700 Urban 0.9285 34440 Henderson County, N Carolina 34 Rural 0.8462 11700 Urban 0.9285 34450 Hertford County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34460 Hoke County, N Carolina 34 Rural 0.8462 22180 Urban 0.9416 34470 Hyde County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34480 Iredell County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34490 Jackson County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34500 Johnston County, N Carolina 6640 Urban 1.0034 39580 Urban 0.9691 34510 Jones County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34520 Lee County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34530 Lenoir County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34540 Lincoln County, N Carolina 1520 Urban 0.9715 99934 Rural 0.8540 34550 Mc Dowell County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34560 Macon County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34570 Madison County, N Carolina 0480 Urban 0.9737 11700 Urban 0.9285 34580 Martin County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34590 Mecklenburg County, N Carolina 1520 Urban 0.9715 16740 Urban 0.9750 34600 Mitchell County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34610 Montgomery County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34620 Moore County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34630 Nash County, N Carolina 6895 Urban 0.8915 40580 Urban 0.8915 34640 New Hanover County, N Carolina 9200 Urban 0.9582 48900 Urban 0.9582 34650 Northampton County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34660 Onslow County, N Carolina 3605 Urban 0.8236 27340 Urban 0.8236 34670 Orange County, N Carolina 6640 Urban 1.0034 20500 Urban 1.0244 34680 Pamlico County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34690 Pasquotank County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34700 Pender County, N Carolina 34 Rural 0.8462 48900 Urban 0.9582 34710 Perquimans County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34720 Person County, N Carolina 34 Rural 0.8462 20500 Urban 1.0244 34730 Pitt County, N Carolina 3150 Urban 0.9425 24780 Urban 0.9425 34740 Polk County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34750 Randolph County, N Carolina 3120 Urban 0.9018 24660 Urban 0.9104 34760 Richmond County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34770 Robeson County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34780 Rockingham County, N Carolina 34 Rural 0.8462 24660 Urban 0.9104 34790 Rowan County, N Carolina 1520 Urban 0.9715 99934 Rural 0.8540 34800 Rutherford County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34810 Sampson County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34820 Scotland County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34830 Stanly County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34840 Stokes County, N Carolina 3120 Urban 0.9018 49180 Urban 0.8944 34850 Surry County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34860 Swain County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34870 Transylvania County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34880 Tyrrell County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34890 Union County, N Carolina 1520 Urban 0.9715 16740 Urban 0.9750 34900 Vance County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34910 Wake County, N Carolina 6640 Urban 1.0034 39580 Urban 0.9691 34920 Warren County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34930 Washington County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34940 Watauga County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34950 Wayne County, N Carolina 2980 Urban 0.8775 24140 Urban 0.8775 34960 Wilkes County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34970 Wilson County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 34980 Yadkin County, N Carolina 3120 Urban 0.9018 49180 Urban 0.8944 34981 Yancey County, N Carolina 34 Rural 0.8462 99934 Rural 0.8540 35000 Adams County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35010 Barnes County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35020 Benson County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35030 Billings County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35040 Bottineau County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35050 Bowman County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35060 Burke County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35070 Burleigh County, N Dakota 1010 Urban 0.7574 13900 Urban 0.7574 35080 Cass County, N Dakota 2520 Urban 0.8486 22020 Urban 0.8486 35090 Cavalier County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35100 Dickey County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35110 Divide County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35120 Dunn County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35130 Eddy County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35140 Emmons County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35150 Foster County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35160 Golden Valley County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35170 Grand Forks County, N Dakota 2985 Urban 0.7901 24220 Urban 0.7901 35180 Grant County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35190 Griggs County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35200 Hettinger County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35210 Kidder County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35220 La Moure County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35230 Logan County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35240 Mc Henry County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35250 Mc Intosh County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35260 Mc Kenzie County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35270 Mc Lean County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35280 Mercer County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35290 Morton County, N Dakota 1010 Urban 0.7574 13900 Urban 0.7574 35300 Mountrail County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35310 Nelson County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35320 Oliver County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35330 Pembina County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35340 Pierce County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35350 Ramsey County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35360 Ransom County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35370 Renville County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35380 Richland County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35390 Rolette County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35400 Sargent County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35410 Sheridan County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35420 Sioux County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35430 Slope County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35440 Stark County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35450 Steele County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35460 Stutsman County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35470 Towner County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35480 Traill County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35490 Walsh County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35500 Ward County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35510 Wells County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 35520 Williams County, N Dakota 35 Rural 0.7261 99935 Rural 0.7261 36000 Adams County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36010 Allen County, Ohio 4320 Urban 0.9119 30620 Urban 0.9225 36020 Ashland County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36030 Ashtabula County, Ohio 1680 Urban 0.9183 99936 Rural 0.8826 36040 Athens County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36050 Auglaize County, Ohio 4320 Urban 0.9119 99936 Rural 0.8826 36060 Belmont County, Ohio 9000 Urban 0.7161 48540 Urban 0.7161 36070 Brown County, Ohio 1640 Urban 0.9734 17140 Urban 0.9615 36080 Butler County, Ohio 3200 Urban 0.8951 17140 Urban 0.9615 36090 Carroll County, Ohio 1320 Urban 0.8935 15940 Urban 0.8935 36100 Champaign County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36110 Clark County, Ohio 2000 Urban 0.8980 44220 Urban 0.8396 36120 Clermont County, Ohio 1640 Urban 0.9734 17140 Urban 0.9615 36130 Clinton County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36140 Columbiana County, Ohio 9320 Urban 0.8848 99936 Rural 0.8826 36150 Coshocton County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36160 Crawford County, Ohio 4800 Urban 0.9891 99936 Rural 0.8826 36170 Cuyahoga County, Ohio 1680 Urban 0.9183 17460 Urban 0.9213 36190 Darke County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36200 Defiance County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36210 Delaware County, Ohio 1840 Urban 0.9874 18140 Urban 0.9860 36220 Erie County, Ohio 36 Rural 0.8921 41780 Urban 0.9019 36230 Fairfield County, Ohio 1840 Urban 0.9874 18140 Urban 0.9860 36240 Fayette County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36250 Franklin County, Ohio 1840 Urban 0.9874 18140 Urban 0.9860 36260 Fulton County, Ohio 8400 Urban 0.9574 45780 Urban 0.9574 36270 Gallia County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36280 Geauga County, Ohio 1680 Urban 0.9183 17460 Urban 0.9213 36290 Greene County, Ohio 2000 Urban 0.8980 19380 Urban 0.9064 36300 Guernsey County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36310 Hamilton County, Ohio 1640 Urban 0.9734 17140 Urban 0.9615 36330 Hancock County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36340 Hardin County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36350 Harrison County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36360 Henry County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36370 Highland County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36380 Hocking County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36390 Holmes County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36400 Huron County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36410 Jackson County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36420 Jefferson County, Ohio 8080 Urban 0.7819 48260 Urban 0.7819 36430 Knox County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36440 Lake County, Ohio 1680 Urban 0.9183 17460 Urban 0.9213 36450 Lawrence County, Ohio 3400 Urban 0.9477 26580 Urban 0.9477 36460 Licking County, Ohio 1840 Urban 0.9874 18140 Urban 0.9860 36470 Logan County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36480 Lorain County, Ohio 1680 Urban 0.9183 17460 Urban 0.9213 36490 Lucas County, Ohio 8400 Urban 0.9574 45780 Urban 0.9574 36500 Madison County, Ohio 1840 Urban 0.9874 18140 Urban 0.9860 36510 Mahoning County, Ohio 9320 Urban 0.8848 49660 Urban 0.8603 36520 Marion County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36530 Medina County, Ohio 1680 Urban 0.9183 17460 Urban 0.9213 36540 Meigs County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36550 Mercer County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36560 Miami County, Ohio 2000 Urban 0.8980 19380 Urban 0.9064 36570 Monroe County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36580 Montgomery County, Ohio 2000 Urban 0.8980 19380 Urban 0.9064 36590 Morgan County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36600 Morrow County, Ohio 36 Rural 0.8921 18140 Urban 0.9860 36610 Muskingum County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36620 Noble County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36630 Ottawa County, Ohio 36 Rural 0.8921 45780 Urban 0.9574 36640 Paulding County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36650 Perry County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36660 Pickaway County, Ohio 1840 Urban 0.9874 18140 Urban 0.9860 36670 Pike County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36680 Portage County, Ohio 0080 Urban 0.8982 10420 Urban 0.8982 36690 Preble County, Ohio 36 Rural 0.8921 19380 Urban 0.9064 36700 Putnam County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36710 Richland County, Ohio 4800 Urban 0.9891 31900 Urban 0.9891 36720 Ross County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36730 Sandusky County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36740 Scioto County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36750 Seneca County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36760 Shelby County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36770 Stark County, Ohio 1320 Urban 0.8935 15940 Urban 0.8935 36780 Summit County, Ohio 0080 Urban 0.8982 10420 Urban 0.8982 36790 Trumbull County, Ohio 9320 Urban 0.8848 49660 Urban 0.8603 36800 Tuscarawas County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36810 Union County, Ohio 36 Rural 0.8921 18140 Urban 0.9860 36820 Van Wert County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36830 Vinton County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36840 Warren County, Ohio 1640 Urban 0.9734 17140 Urban 0.9615 36850 Washington County, Ohio 6020 Urban 0.8270 37620 Urban 0.8270 36860 Wayne County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36870 Williams County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 36880 Wood County, Ohio 8400 Urban 0.9574 45780 Urban 0.9574 36890 Wyandot County, Ohio 36 Rural 0.8921 99936 Rural 0.8826 37000 Adair County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37010 Alfalfa County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37020 Atoka County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37030 Beaver County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37040 Beckham County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37050 Blaine County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37060 Bryan County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37070 Caddo County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37080 Canadian County, Oklahoma 5880 Urban 0.9025 36420 Urban 0.9031 37090 Carter County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37100 Cherokee County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37110 Choctaw County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37120 Cimarron County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37130 Cleveland County, Oklahoma 5880 Urban 0.9025 36420 Urban 0.9031 37140 Coal County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37150 Comanche County, Oklahoma 4200 Urban 0.7872 30020 Urban 0.7872 37160 Cotton County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37170 Craig County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37180 Creek County, Oklahoma 8560 Urban 0.8587 46140 Urban 0.8543 37190 Custer County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37200 Delaware County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37210 Dewey County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37220 Ellis County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37230 Garfield County, Oklahoma 2340 Urban 0.8666 99937 Rural 0.7581 37240 Garvin County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37250 Grady County, Oklahoma 37 Rural 0.7442 36420 Urban 0.9031 37260 Grant County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37270 Greer County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37280 Harmon County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37290 Harper County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37300 Haskell County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37310 Hughes County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37320 Jackson County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37330 Jefferson County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37340 Johnston County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37350 Kay County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37360 Kingfisher County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37370 Kiowa County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37380 Latimer County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37390 Le Flore County, Oklahoma 37 Rural 0.7442 22900 Urban 0.8230 37400 Lincoln County, Oklahoma 37 Rural 0.7442 36420 Urban 0.9031 37410 Logan County, Oklahoma 5880 Urban 0.9025 36420 Urban 0.9031 37420 Love County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37430 Mc Clain County, Oklahoma 5880 Urban 0.9025 36420 Urban 0.9031 37440 Mc Curtain County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37450 Mc Intosh County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37460 Major County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37470 Marshall County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37480 Mayes County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37490 Murray County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37500 Muskogee County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37510 Noble County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37520 Nowata County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37530 Okfuskee County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37540 Oklahoma County, Oklahoma 5880 Urban 0.9025 36420 Urban 0.9031 37550 Okmulgee County, Oklahoma 37 Rural 0.7442 46140 Urban 0.8543 37560 Osage County, Oklahoma 8560 Urban 0.8587 46140 Urban 0.8543 37570 Ottawa County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37580 Pawnee County, Oklahoma 37 Rural 0.7442 46140 Urban 0.8543 37590 Payne County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37600 Pittsburg County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37610 Pontotoc County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37620 Pottawatomie County, Oklahoma 5880 Urban 0.9025 99937 Rural 0.7581 37630 Pushmataha County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37640 Roger Mills County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37650 Rogers County, Oklahoma 8560 Urban 0.8587 46140 Urban 0.8543 37660 Seminole County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37670 Sequoyah County, Oklahoma 2720 Urban 0.8246 22900 Urban 0.8230 37680 Stephens County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37690 Texas County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37700 Tillman County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37710 Tulsa County, Oklahoma 8560 Urban 0.8587 46140 Urban 0.8543 37720 Wagoner County, Oklahoma 8560 Urban 0.8587 46140 Urban 0.8543 37730 Washington County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37740 Washita County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37750 Woods County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 37760 Woodward County, Oklahoma 37 Rural 0.7442 99937 Rural 0.7581 38000 Baker County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38010 Benton County, Oregon 1890 Urban 1.0729 18700 Urban 1.0729 38020 Clackamas County, Oregon 6440 Urban 1.1266 38900 Urban 1.1266 38030 Clatsop County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38040 Columbia County, Oregon 6440 Urban 1.1266 38900 Urban 1.1266 38050 Coos County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38060 Crook County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38070 Curry County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38080 Deschutes County, Oregon 38 Rural 1.0052 13460 Urban 1.0786 38090 Douglas County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38100 Gilliam County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38110 Grant County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38120 Harney County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38130 Hood River County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38140 Jackson County, Oregon 4890 Urban 1.0225 32780 Urban 1.0225 38150 Jefferson County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38160 Josephine County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38170 Klamath County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38180 Lake County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38190 Lane County, Oregon 2400 Urban 1.0818 21660 Urban 1.0818 38200 Lincoln County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38210 Linn County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38220 Malheur County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38230 Marion County, Oregon 7080 Urban 1.0442 41420 Urban 1.0442 38240 Morrow County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38250 Multnomah County, Oregon 6440 Urban 1.1266 38900 Urban 1.1266 38260 Polk County, Oregon 7080 Urban 1.0442 41420 Urban 1.0442 38270 Sherman County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38280 Tillamook County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38290 Umatilla County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38300 Union County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38310 Wallowa County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38320 Wasco County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38330 Washington County, Oregon 6440 Urban 1.1266 38900 Urban 1.1266 38340 Wheeler County, Oregon 38 Rural 1.0052 99938 Rural 0.9826 38350 Yamhill County, Oregon 6440 Urban 1.1266 38900 Urban 1.1266 39000 Adams County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39010 Allegheny County, Pennsylvania 6280 Urban 0.8860 38300 Urban 0.8845 39070 Armstrong County, Pennsylvania 39 Rural 0.8319 38300 Urban 0.8845 39080 Beaver County, Pennsylvania 6280 Urban 0.8860 38300 Urban 0.8845 39100 Bedford County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39110 Berks County, Pennsylvania 6680 Urban 0.9686 39740 Urban 0.9686 39120 Blair County, Pennsylvania 0280 Urban 0.8944 11020 Urban 0.8944 39130 Bradford County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39140 Bucks County, Pennsylvania 6160 Urban 1.0922 37964 Urban 1.1038 39150 Butler County, Pennsylvania 6280 Urban 0.8860 38300 Urban 0.8845 39160 Cambria County, Pennsylvania 3680 Urban 0.8086 27780 Urban 0.8354 39180 Cameron County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39190 Carbon County, Pennsylvania 0240 Urban 0.9845 10900 Urban 0.9818 39200 Centre County, Pennsylvania 8050 Urban 0.8356 44300 Urban 0.8356 39210 Chester County, Pennsylvania 6160 Urban 1.0922 37964 Urban 1.1038 39220 Clarion County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39230 Clearfield County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39240 Clinton County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39250 Columbia County, Pennsylvania 7560 Urban 0.8524 99939 Rural 0.8291 39260 Crawford County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39270 Cumberland County, Pennsylvania 3240 Urban 0.9233 25420 Urban 0.9313 39280 Dauphin County, Pennsylvania 3240 Urban 0.9233 25420 Urban 0.9313 39290 Delaware County, Pennsylvania 6160 Urban 1.0922 37964 Urban 1.1038 39310 Elk County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39320 Erie County, Pennsylvania 2360 Urban 0.8737 21500 Urban 0.8737 39330 Fayette County, Pennsylvania 6280 Urban 0.8860 38300 Urban 0.8845 39340 Forest County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39350 Franklin County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39360 Fulton County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39370 Greene County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39380 Huntingdon County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39390 Indiana County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39400 Jefferson County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39410 Juniata County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39420 Lackawanna County, Pennsylvania 7560 Urban 0.8524 42540 Urban 0.8540 39440 Lancaster County, Pennsylvania 4000 Urban 0.9694 29540 Urban 0.9694 39450 Lawrence County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39460 Lebanon County, Pennsylvania 3240 Urban 0.9233 30140 Urban 0.8459 39470 Lehigh County, Pennsylvania 0240 Urban 0.9845 10900 Urban 0.9818 39480 Luzerne County, Pennsylvania 7560 Urban 0.8524 42540 Urban 0.8540 39510 Lycoming County, Pennsylvania 9140 Urban 0.8364 48700 Urban 0.8364 39520 Mc Kean County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39530 Mercer County, Pennsylvania 7610 Urban 0.7793 49660 Urban 0.8603 39540 Mifflin County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39550 Monroe County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39560 Montgomery County, Pennsylvania 6160 Urban 1.0922 37964 Urban 1.1038 39580 Montour County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39590 Northampton County, Pennsylvania 0240 Urban 0.9845 10900 Urban 0.9818 39600 Northumberland County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39610 Perry County, Pennsylvania 3240 Urban 0.9233 25420 Urban 0.9313 39620 Philadelphia County, Pennsylvania 6160 Urban 1.0922 37964 Urban 1.1038 39630 Pike County, Pennsylvania 5660 Urban 1.1207 35084 Urban 1.1883 39640 Potter County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39650 Schuylkill County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39670 Snyder County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39680 Somerset County, Pennsylvania 3680 Urban 0.8086 99939 Rural 0.8291 39690 Sullivan County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39700 Susquehanna County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39710 Tioga County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39720 Union County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39730 Venango County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39740 Warren County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39750 Washington County, Pennsylvania 6280 Urban 0.8860 38300 Urban 0.8845 39760 Wayne County, Pennsylvania 39 Rural 0.8319 99939 Rural 0.8291 39770 Westmoreland County, Pennsylvania 6280 Urban 0.8860 38300 Urban 0.8845 39790 Wyoming County, Pennsylvania 7560 Urban 0.8524 42540 Urban 0.8540 39800 York County, Pennsylvania 9280 Urban 0.9347 49620 Urban 0.9347 40010 Adjuntas County, Puerto Rico 40 Rural 0.3604 99940 Rural 0.4047 40020 Aguada County, Puerto Rico 0060 Urban 0.4876 10380 Urban 0.4738 40030 Aguadilla County, Puerto Rico 0060 Urban 0.4876 10380 Urban 0.4738 40040 Aguas Buenas County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40050 Aibonito County, Puerto Rico 40 Rural 0.3604 41980 Urban 0.4621 40060 Anasco County, Puerto Rico 4840 Urban 0.4243 10380 Urban 0.4738 40070 Arecibo County, Puerto Rico 0470 Urban 0.4112 41980 Urban 0.4621 40080 Arroyo County, Puerto Rico 40 Rural 0.3604 25020 Urban 0.3181 40090 Barceloneta County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40100 Barranquitas County, Puerto Rico 40 Rural 0.3604 41980 Urban 0.4621 40110 Bayamon County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40120 Cabo Rojo County, Puerto Rico 4840 Urban 0.4243 41900 Urban 0.4650 40130 Caguas County, Puerto Rico 1310 Urban 0.4120 41980 Urban 0.4621 40140 Camuy County, Puerto Rico 0470 Urban 0.4112 41980 Urban 0.4621 40145 Canovanas County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40150 Carolina County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40160 Catano County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40170 Cayey County, Puerto Rico 1310 Urban 0.4120 41980 Urban 0.4621 40180 Ceiba County, Puerto Rico 7440 Urban 0.4752 21940 Urban 0.4153 40190 Ciales County, Puerto Rico 40 Rural 0.3604 41980 Urban 0.4621 40200 Cidra County, Puerto Rico 1310 Urban 0.4120 41980 Urban 0.4621 40210 Coamo County, Puerto Rico 40 Rural 0.3604 99940 Rural 0.4047 40220 Comerio County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40230 Corozal County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40240 Culebra County, Puerto Rico 40 Rural 0.3604 99940 Rural 0.4047 40250 Dorado County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40260 Fajardo County, Puerto Rico 7440 Urban 0.4752 21940 Urban 0.4153 40265 Florida County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40270 Guanica County, Puerto Rico 40 Rural 0.3604 49500 Urban 0.4408 40280 Guayama County, Puerto Rico 40 Rural 0.3604 25020 Urban 0.3181 40290 Guayanilla County, Puerto Rico 6360 Urban 0.4881 49500 Urban 0.4408 40300 Guaynabo County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40310 Gurabo County, Puerto Rico 1310 Urban 0.4120 41980 Urban 0.4621 40320 Hatillo County, Puerto Rico 0470 Urban 0.4112 41980 Urban 0.4621 40330 Hormigueros County, Puerto Rico 4840 Urban 0.4243 32420 Urban 0.4020 40340 Humacao County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40350 Isabela County, Puerto Rico 40 Rural 0.3604 10380 Urban 0.4738 40360 Jayuya County, Puerto Rico 40 Rural 0.3604 99940 Rural 0.4047 40370 Juana Diaz County, Puerto Rico 6360 Urban 0.4881 38660 Urban 0.4939 40380 Juncos County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40390 Lajas County, Puerto Rico 40 Rural 0.3604 41900 Urban 0.4650 40400 Lares County, Puerto Rico 40 Rural 0.3604 10380 Urban 0.4738 40410 Las Marias County, Puerto Rico 40 Rural 0.3604 99940 Rural 0.4047 40420 Las Piedras County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40430 Loiza County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40440 Luquillo County, Puerto Rico 7440 Urban 0.4752 21940 Urban 0.4153 40450 Manati County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40460 Maricao County, Puerto Rico 40 Rural 0.3604 99940 Rural 0.4047 40470 Maunabo County, Puerto Rico 40 Rural 0.3604 41980 Urban 0.4621 40480 Mayaguez County, Puerto Rico 4840 Urban 0.4243 32420 Urban 0.4020 40490 Moca County, Puerto Rico 0060 Urban 0.4876 10380 Urban 0.4738 40500 Morovis County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40510 Naguabo County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40520 Naranjito County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40530 Orocovis County, Puerto Rico 40 Rural 0.3604 41980 Urban 0.4621 40540 Patillas County, Puerto Rico 40 Rural 0.3604 25020 Urban 0.3181 40550 Penuelas County, Puerto Rico 6360 Urban 0.4881 49500 Urban 0.4408 40560 Ponce County, Puerto Rico 6360 Urban 0.4881 38660 Urban 0.4939 40570 Quebradillas County, Puerto Rico 40 Rural 0.3604 41980 Urban 0.4621 40580 Rincon County, Puerto Rico 40 Rural 0.3604 10380 Urban 0.4738 40590 Rio Grande County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40610 Sabana Grande County, Puerto Rico 4840 Urban 0.4243 41900 Urban 0.4650 40620 Salinas County, Puerto Rico 40 Rural 0.3604 99940 Rural 0.4047 40630 San German County, Puerto Rico 4840 Urban 0.4243 41900 Urban 0.4650 40640 San Juan County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40650 San Lorenzo County, Puerto Rico 1310 Urban 0.4120 41980 Urban 0.4621 40660 San Sebastian County, Puerto Rico 40 Rural 0.3604 10380 Urban 0.4738 40670 Santa Isabel County, Puerto Rico 40 Rural 0.3604 99940 Rural 0.4047 40680 Toa Alta County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40690 Toa Baja County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40700 Trujillo Alto County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40710 Utuado County, Puerto Rico 40 Rural 0.3604 99940 Rural 0.4047 40720 Vega Alta County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40730 Vega Baja County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40740 Vieques County, Puerto Rico 40 Rural 0.3604 99940 Rural 0.4047 40750 Villalba County, Puerto Rico 6360 Urban 0.4881 38660 Urban 0.4939 40760 Yabucoa County, Puerto Rico 7440 Urban 0.4752 41980 Urban 0.4621 40770 Yauco County, Puerto Rico 6360 Urban 0.4881 49500 Urban 0.4408 41000 Bristol County, Rhode Island 6483 Urban 1.1058 39300 Urban 1.0966 41010 Kent County, Rhode Island 6483 Urban 1.1058 39300 Urban 1.0966 41020 Newport County, Rhode Island 6483 Urban 1.1058 39300 Urban 1.0966 41030 Providence County, Rhode Island 6483 Urban 1.1058 39300 Urban 1.0966 41050 Washington County, Rhode Island 6483 Urban 1.1058 39300 Urban 1.0966 42000 Abbeville County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42010 Aiken County, S Carolina 0600 Urban 0.9808 12260 Urban 0.9748 42020 Allendale County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42030 Anderson County, S Carolina 3160 Urban 0.9615 11340 Urban 0.8997 42040 Bamberg County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42050 Barnwell County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42060 Beaufort County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42070 Berkeley County, S Carolina 1440 Urban 0.9245 16700 Urban 0.9245 42080 Calhoun County, S Carolina 42 Rural 0.8631 17900 Urban 0.9057 42090 Charleston County, S Carolina 1440 Urban 0.9245 16700 Urban 0.9245 42100 Cherokee County, S Carolina 3160 Urban 0.9615 99942 Rural 0.8638 42110 Chester County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42120 Chesterfield County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42130 Clarendon County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42140 Colleton County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42150 Darlington County, S Carolina 42 Rural 0.8631 22500 Urban 0.8947 42160 Dillon County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42170 Dorchester County, S Carolina 1440 Urban 0.9245 16700 Urban 0.9245 42180 Edgefield County, S Carolina 0600 Urban 0.9808 12260 Urban 0.9748 42190 Fairfield County, S Carolina 42 Rural 0.8631 17900 Urban 0.9057 42200 Florence County, S Carolina 2655 Urban 0.9042 22500 Urban 0.8947 42210 Georgetown County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42220 Greenville County, S Carolina 3160 Urban 0.9615 24860 Urban 1.0027 42230 Greenwood County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42240 Hampton County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42250 Horry County, S Carolina 5330 Urban 0.8934 34820 Urban 0.8934 42260 Jasper County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42270 Kershaw County, S Carolina 42 Rural 0.8631 17900 Urban 0.9057 42280 Lancaster County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42290 Laurens County, S Carolina 42 Rural 0.8631 24860 Urban 1.0027 42300 Lee County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42310 Lexington County, S Carolina 1760 Urban 0.9082 17900 Urban 0.9057 42320 Mc Cormick County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42330 Marion County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42340 Marlboro County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42350 Newberry County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42360 Oconee County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42370 Orangeburg County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42380 Pickens County, S Carolina 3160 Urban 0.9615 24860 Urban 1.0027 42390 Richland County, S Carolina 1760 Urban 0.9082 17900 Urban 0.9057 42400 Saluda County, S Carolina 42 Rural 0.8631 17900 Urban 0.9057 42410 Spartanburg County, S Carolina 3160 Urban 0.9615 43900 Urban 0.9172 42420 Sumter County, S Carolina 8140 Urban 0.8377 44940 Urban 0.8377 42430 Union County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42440 Williamsburg County, S Carolina 42 Rural 0.8631 99942 Rural 0.8638 42450 York County, S Carolina 1520 Urban 0.9715 16740 Urban 0.9750 43010 Aurora County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43020 Beadle County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43030 Bennett County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43040 Bon Homme County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43050 Brookings County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43060 Brown County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43070 Brule County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43080 Buffalo County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43090 Butte County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43100 Campbell County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43110 Charles Mix County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43120 Clark County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43130 Clay County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43140 Codington County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43150 Corson County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43160 Custer County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43170 Davison County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43180 Day County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43190 Deuel County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43200 Dewey County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43210 Douglas County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43220 Edmunds County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43230 Fall River County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43240 Faulk County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43250 Grant County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43260 Gregory County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43270 Haakon County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43280 Hamlin County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43290 Hand County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43300 Hanson County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43310 Harding County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43320 Hughes County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43330 Hutchinson County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43340 Hyde County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43350 Jackson County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43360 Jerauld County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43370 Jones County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43380 Kingsbury County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43390 Lake County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43400 Lawrence County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43410 Lincoln County, S Dakota 7760 Urban 0.9635 43620 Urban 0.9635 43420 Lyman County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43430 Mc Cook County, S Dakota 43 Rural 0.8551 43620 Urban 0.9635 43440 Mc Pherson County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43450 Marshall County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43460 Meade County, S Dakota 43 Rural 0.8551 39660 Urban 0.8987 43470 Mellette County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43480 Miner County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43490 Minnehaha County, S Dakota 7760 Urban 0.9635 43620 Urban 0.9635 43500 Moody County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43510 Pennington County, S Dakota 6660 Urban 0.8987 39660 Urban 0.8987 43520 Perkins County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43530 Potter County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43540 Roberts County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43550 Sanborn County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43560 Shannon County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43570 Spink County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43580 Stanley County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43590 Sully County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43600 Todd County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43610 Tripp County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43620 Turner County, S Dakota 43 Rural 0.8551 43620 Urban 0.9635 43630 Union County, S Dakota 43 Rural 0.8551 43580 Urban 0.9381 43640 Walworth County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43650 Washabaugh County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43670 Yankton County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 43680 Ziebach County, S Dakota 43 Rural 0.8551 99943 Rural 0.8560 44000 Anderson County, Tennessee 3840 Urban 0.8397 28940 Urban 0.8441 44010 Bedford County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44020 Benton County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44030 Bledsoe County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44040 Blount County, Tennessee 3840 Urban 0.8397 28940 Urban 0.8441 44050 Bradley County, Tennessee 44 Rural 0.7935 17420 Urban 0.8139 44060 Campbell County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44070 Cannon County, Tennessee 44 Rural 0.7935 34980 Urban 0.9790 44080 Carroll County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44090 Carter County, Tennessee 3660 Urban 0.8007 27740 Urban 0.7937 44100 Cheatham County, Tennessee 5360 Urban 0.9808 34980 Urban 0.9790 44110 Chester County, Tennessee 3580 Urban 0.8964 27180 Urban 0.8964 44120 Claiborne County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44130 Clay County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44140 Cocke County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44150 Coffee County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44160 Crockett County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44170 Cumberland County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44180 Davidson County, Tennessee 5360 Urban 0.9808 34980 Urban 0.9790 44190 Decatur County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44200 De Kalb County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44210 Dickson County, Tennessee 5360 Urban 0.9808 34980 Urban 0.9790 44220 Dyer County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44230 Fayette County, Tennessee 4920 Urban 0.9416 32820 Urban 0.9397 44240 Fentress County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44250 Franklin County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44260 Gibson County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44270 Giles County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44280 Grainger County, Tennessee 44 Rural 0.7935 34100 Urban 0.7961 44290 Greene County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44300 Grundy County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44310 Hamblen County, Tennessee 44 Rural 0.7935 34100 Urban 0.7961 44320 Hamilton County, Tennessee 1560 Urban 0.9088 16860 Urban 0.9088 44330 Hancock County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44340 Hardeman County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44350 Hardin County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44360 Hawkins County, Tennessee 3660 Urban 0.8007 28700 Urban 0.8054 44370 Haywood County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44380 Henderson County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44390 Henry County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44400 Hickman County, Tennessee 44 Rural 0.7935 34980 Urban 0.9790 44410 Houston County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44420 Humphreys County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44430 Jackson County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44440 Jefferson County, Tennessee 44 Rural 0.7935 34100 Urban 0.7961 44450 Johnson County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44460 Knox County, Tennessee 3840 Urban 0.8397 28940 Urban 0.8441 44470 Lake County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44480 Lauderdale County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44490 Lawrence County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44500 Lewis County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44510 Lincoln County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44520 Loudon County, Tennessee 3840 Urban 0.8397 28940 Urban 0.8441 44530 Mc Minn County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44540 Mc Nairy County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44550 Macon County, Tennessee 44 Rural 0.7935 34980 Urban 0.9790 44560 Madison County, Tennessee 3580 Urban 0.8964 27180 Urban 0.8964 44570 Marion County, Tennessee 1560 Urban 0.9088 16860 Urban 0.9088 44580 Marshall County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44590 Maury County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44600 Meigs County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44610 Monroe County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44620 Montgomery County, Tennessee 1660 Urban 0.8284 17300 Urban 0.8284 44630 Moore County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44640 Morgan County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44650 Obion County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44660 Overton County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44670 Perry County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44680 Pickett County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44690 Polk County, Tennessee 44 Rural 0.7935 17420 Urban 0.8139 44700 Putnam County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44710 Rhea County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44720 Roane County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44730 Robertson County, Tennessee 5360 Urban 0.9808 34980 Urban 0.9790 44740 Rutherford County, Tennessee 5360 Urban 0.9808 34980 Urban 0.9790 44750 Scott County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44760 Sequatchie County, Tennessee 44 Rural 0.7935 16860 Urban 0.9088 44770 Sevier County, Tennessee 3840 Urban 0.8397 99944 Rural 0.7895 44780 Shelby County, Tennessee 4920 Urban 0.9416 32820 Urban 0.9397 44790 Smith County, Tennessee 44 Rural 0.7935 34980 Urban 0.9790 44800 Stewart County, Tennessee 44 Rural 0.7935 17300 Urban 0.8284 44810 Sullivan County, Tennessee 3660 Urban 0.8007 28700 Urban 0.8054 44820 Sumner County, Tennessee 5360 Urban 0.9808 34980 Urban 0.9790 44830 Tipton County, Tennessee 4920 Urban 0.9416 32820 Urban 0.9397 44840 Trousdale County, Tennessee 44 Rural 0.7935 34980 Urban 0.9790 44850 Unicoi County, Tennessee 3660 Urban 0.8007 27740 Urban 0.7937 44860 Union County, Tennessee 3840 Urban 0.8397 28940 Urban 0.8441 44870 Van Buren County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44880 Warren County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44890 Washington County, Tennessee 3660 Urban 0.8007 27740 Urban 0.7937 44900 Wayne County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44910 Weakley County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44920 White County, Tennessee 44 Rural 0.7935 99944 Rural 0.7895 44930 Williamson County, Tennessee 5360 Urban 0.9808 34980 Urban 0.9790 44940 Wilson County, Tennessee 5360 Urban 0.9808 34980 Urban 0.9790 45000 Anderson County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45010 Andrews County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45020 Angelina County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45030 Aransas County, Texas 45 Rural 0.7931 18580 Urban 0.8550 45040 Archer County, Texas 9080 Urban 0.8365 48660 Urban 0.8285 45050 Armstrong County, Texas 45 Rural 0.7931 11100 Urban 0.9156 45060 Atascosa County, Texas 45 Rural 0.7931 41700 Urban 0.8980 45070 Austin County, Texas 45 Rural 0.7931 26420 Urban 0.9996 45080 Bailey County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45090 Bandera County, Texas 45 Rural 0.7931 41700 Urban 0.8980 45100 Bastrop County, Texas 0640 Urban 0.9437 12420 Urban 0.9437 45110 Baylor County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45113 Bee County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45120 Bell County, Texas 3810 Urban 0.8526 28660 Urban 0.8526 45130 Bexar County, Texas 7240 Urban 0.8984 41700 Urban 0.8980 45140 Blanco County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45150 Borden County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45160 Bosque County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45170 Bowie County, Texas 8360 Urban 0.8283 45500 Urban 0.8283 45180 Brazoria County, Texas 1145 Urban 0.8563 26420 Urban 0.9996 45190 Brazos County, Texas 1260 Urban 0.8900 17780 Urban 0.8900 45200 Brewster County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45201 Briscoe County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45210 Brooks County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45220 Brown County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45221 Burleson County, Texas 45 Rural 0.7931 17780 Urban 0.8900 45222 Burnet County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45223 Caldwell County, Texas 0640 Urban 0.9437 12420 Urban 0.9437 45224 Calhoun County, Texas 45 Rural 0.7931 47020 Urban 0.8160 45230 Callahan County, Texas 45 Rural 0.7931 10180 Urban 0.7896 45240 Cameron County, Texas 1240 Urban 0.9804 15180 Urban 0.9804 45250 Camp County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45251 Carson County, Texas 45 Rural 0.7931 11100 Urban 0.9156 45260 Cass County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45270 Castro County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45280 Chambers County, Texas 3360 Urban 1.0091 26420 Urban 0.9996 45281 Cherokee County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45290 Childress County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45291 Clay County, Texas 45 Rural 0.7931 48660 Urban 0.8285 45292 Cochran County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45300 Coke County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45301 Coleman County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45310 Collin County, Texas 1920 Urban 1.0205 19124 Urban 1.0228 45311 Collingsworth County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45312 Colorado County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45320 Comal County, Texas 7240 Urban 0.8984 41700 Urban 0.8980 45321 Comanche County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45330 Concho County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45340 Cooke County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45341 Coryell County, Texas 3810 Urban 0.8526 28660 Urban 0.8526 45350 Cottle County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45360 Crane County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45361 Crockett County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45362 Crosby County, Texas 45 Rural 0.7931 31180 Urban 0.8783 45370 Culberson County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45380 Dallam County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45390 Dallas County, Texas 1920 Urban 1.0205 19124 Urban 1.0228 45391 Dawson County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45392 Deaf Smith County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45400 Delta County, Texas 45 Rural 0.7931 19124 Urban 1.0228 45410 Denton County, Texas 1920 Urban 1.0205 19124 Urban 1.0228 45420 De Witt County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45421 Dickens County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45430 Dimmit County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45431 Donley County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45440 Duval County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45450 Eastland County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45451 Ector County, Texas 5800 Urban 0.9741 36220 Urban 0.9884 45460 Edwards County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45470 Ellis County, Texas 1920 Urban 1.0205 19124 Urban 1.0228 45480 El Paso County, Texas 2320 Urban 0.8977 21340 Urban 0.8977 45490 Erath County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45500 Falls County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45510 Fannin County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45511 Fayette County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45520 Fisher County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45521 Floyd County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45522 Foard County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45530 Fort Bend County, Texas 3360 Urban 1.0091 26420 Urban 0.9996 45531 Franklin County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45540 Freestone County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45541 Frio County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45542 Gaines County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45550 Galveston County, Texas 2920 Urban 0.9635 26420 Urban 0.9996 45551 Garza County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45552 Gillespie County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45560 Glasscock County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45561 Goliad County, Texas 45 Rural 0.7931 47020 Urban 0.8160 45562 Gonzales County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45563 Gray County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45564 Grayson County, Texas 7640 Urban 0.9507 43300 Urban 0.9507 45570 Gregg County, Texas 4420 Urban 0.8888 30980 Urban 0.8730 45580 Grimes County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45581 Guadaloupe County, Texas 7240 Urban 0.8984 41700 Urban 0.8980 45582 Hale County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45583 Hall County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45590 Hamilton County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45591 Hansford County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45592 Hardeman County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45600 Hardin County, Texas 0840 Urban 0.8412 13140 Urban 0.8412 45610 Harris County, Texas 3360 Urban 1.0091 26420 Urban 0.9996 45620 Harrison County, Texas 4420 Urban 0.8888 99945 Rural 0.8003 45621 Hartley County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45630 Haskell County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45631 Hays County, Texas 0640 Urban 0.9437 12420 Urban 0.9437 45632 Hemphill County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45640 Henderson County, Texas 1920 Urban 1.0205 99945 Rural 0.8003 45650 Hidalgo County, Texas 4880 Urban 0.8934 32580 Urban 0.8934 45651 Hill County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45652 Hockley County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45653 Hood County, Texas 2800 Urban 0.9522 99945 Rural 0.8003 45654 Hopkins County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45660 Houston County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45661 Howard County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45662 Hudspeth County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45670 Hunt County, Texas 1920 Urban 1.0205 19124 Urban 1.0228 45671 Hutchinson County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45672 Irion County, Texas 45 Rural 0.7931 41660 Urban 0.8271 45680 Jack County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45681 Jackson County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45690 Jasper County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45691 Jeff Davis County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45700 Jefferson County, Texas 0840 Urban 0.8412 13140 Urban 0.8412 45710 Jim Hogg County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45711 Jim Wells County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45720 Johnson County, Texas 2800 Urban 0.9522 23104 Urban 0.9486 45721 Jones County, Texas 45 Rural 0.7931 10180 Urban 0.7896 45722 Karnes County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45730 Kaufman County, Texas 1920 Urban 1.0205 19124 Urban 1.0228 45731 Kendall County, Texas 45 Rural 0.7931 41700 Urban 0.8980 45732 Kenedy County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45733 Kent County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45734 Kerr County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45740 Kimble County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45741 King County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45742 Kinney County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45743 Kleberg County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45744 Knox County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45750 Lamar County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45751 Lamb County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45752 Lampasas County, Texas 45 Rural 0.7931 28660 Urban 0.8526 45753 La Salle County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45754 Lavaca County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45755 Lee County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45756 Leon County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45757 Liberty County, Texas 3360 Urban 1.0091 26420 Urban 0.9996 45758 Limestone County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45759 Lipscomb County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45760 Live Oak County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45761 Llano County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45762 Loving County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45770 Lubbock County, Texas 4600 Urban 0.8783 31180 Urban 0.8783 45771 Lynn County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45772 Mc Culloch County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45780 Mc Lennan County, Texas 8800 Urban 0.8518 47380 Urban 0.8518 45781 Mc Mullen County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45782 Madison County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45783 Marion County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45784 Martin County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45785 Mason County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45790 Matagorda County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45791 Maverick County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45792 Medina County, Texas 45 Rural 0.7931 41700 Urban 0.8980 45793 Menard County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45794 Midland County, Texas 5800 Urban 0.9741 33260 Urban 0.9514 45795 Milam County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45796 Mills County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45797 Mitchell County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45800 Montague County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45801 Montgomery County, Texas 3360 Urban 1.0091 26420 Urban 0.9996 45802 Moore County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45803 Morris County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45804 Motley County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45810 Nacogdoches County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45820 Navarro County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45821 Newton County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45822 Nolan County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45830 Nueces County, Texas 1880 Urban 0.8550 18580 Urban 0.8550 45831 Ochiltree County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45832 Oldham County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45840 Orange County, Texas 0840 Urban 0.8412 13140 Urban 0.8412 45841 Palo Pinto County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45842 Panola County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45843 Parker County, Texas 2800 Urban 0.9522 23104 Urban 0.9486 45844 Parmer County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45845 Pecos County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45850 Polk County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45860 Potter County, Texas 0320 Urban 0.9156 11100 Urban 0.9156 45861 Presidio County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45870 Rains County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45871 Randall County, Texas 0320 Urban 0.9156 11100 Urban 0.9156 45872 Reagan County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45873 Real County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45874 Red River County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45875 Reeves County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45876 Refugio County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45877 Roberts County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45878 Robertson County, Texas 45 Rural 0.7931 17780 Urban 0.8900 45879 Rockwall County, Texas 1920 Urban 1.0205 19124 Urban 1.0228 45880 Runnels County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45881 Rusk County, Texas 45 Rural 0.7931 30980 Urban 0.8730 45882 Sabine County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45883 San Augustine County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45884 San Jacinto County, Texas 45 Rural 0.7931 26420 Urban 0.9996 45885 San Patricio County, Texas 1880 Urban 0.8550 18580 Urban 0.8550 45886 San Saba County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45887 Schleicher County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45888 Scurry County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45889 Shackelford County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45890 Shelby County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45891 Sherman County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45892 Smith County, Texas 8640 Urban 0.9168 46340 Urban 0.9168 45893 Somervell County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45900 Starr County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45901 Stephens County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45902 Sterling County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45903 Stonewall County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45904 Sutton County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45905 Swisher County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45910 Tarrant County, Texas 2800 Urban 0.9522 23104 Urban 0.9486 45911 Taylor County, Texas 0040 Urban 0.8054 10180 Urban 0.7896 45912 Terrell County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45913 Terry County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45920 Throckmorton County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45921 Titus County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45930 Tom Green County, Texas 7200 Urban 0.8271 41660 Urban 0.8271 45940 Travis County, Texas 0640 Urban 0.9437 12420 Urban 0.9437 45941 Trinity County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45942 Tyler County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45943 Upshur County, Texas 4420 Urban 0.8888 30980 Urban 0.8730 45944 Upton County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45945 Uvalde County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45946 Val Verde County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45947 Van Zandt County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45948 Victoria County, Texas 8750 Urban 0.8160 47020 Urban 0.8160 45949 Walker County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45950 Waller County, Texas 3360 Urban 1.0091 26420 Urban 0.9996 45951 Ward County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45952 Washington County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45953 Webb County, Texas 4080 Urban 0.8068 29700 Urban 0.8068 45954 Wharton County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45955 Wheeler County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45960 Wichita County, Texas 9080 Urban 0.8365 48660 Urban 0.8285 45961 Wilbarger County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45962 Willacy County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45970 Williamson County, Texas 0640 Urban 0.9437 12420 Urban 0.9437 45971 Wilson County, Texas 7240 Urban 0.8984 41700 Urban 0.8980 45972 Winkler County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45973 Wise County, Texas 45 Rural 0.7931 23104 Urban 0.9486 45974 Wood County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45980 Yoakum County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45981 Young County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45982 Zapata County, Texas 45 Rural 0.7931 99945 Rural 0.8003 45983 Zavala County, Texas 45 Rural 0.7931 99945 Rural 0.8003 46000 Beaver County, Utah 46 Rural 0.8762 99946 Rural 0.8118 46010 Box Elder County, Utah 46 Rural 0.8762 99946 Rural 0.8118 46020 Cache County, Utah 46 Rural 0.8762 30860 Urban 0.9164 46030 Carbon County, Utah 46 Rural 0.8762 99946 Rural 0.8118 46040 Daggett County, Utah 46 Rural 0.8762 99946 Rural 0.8118 46050 Davis County, Utah 7160 Urban 0.9340 36260 Urban 0.9029 46060 Duchesne County, Utah 46 Rural 0.8762 99946 Rural 0.8118 46070 Emery County, Utah 46 Rural 0.8762 99946 Rural 0.8118 46080 Garfield County, Utah 46 Rural 0.8762 99946 Rural 0.8118 46090 Grand County, Utah 46 Rural 0.8762 99946 Rural 0.8118 46100 Iron County, Utah 46 Rural 0.8762 99946 Rural 0.8118 46110 Juab County, Utah 46 Rural 0.8762 39340 Urban 0.9500 46120 Kane County, Utah 2620 Urban 1.1845 99946 Rural 0.8118 46130 Millard County, Utah 46 Rural 0.8762 99946 Rural 0.8118 46140 Morgan County, Utah 46 Rural 0.8762 36260 Urban 0.9029 46150 Piute County, Utah 46 Rural 0.8762 99946 Rural 0.8118 46160 Rich County, Utah 46 Rural 0.8762 99946 Rural 0.8118 46170 Salt Lake County, Utah 7160 Urban 0.9340 41620 Urban 0.9421 46180 San Juan County, Utah 46 Rural 0.8762 99946 Rural 0.8118 46190 Sanpete County, Utah 46 Rural 0.8762 99946 Rural 0.8118 46200 Sevier County, Utah 46 Rural 0.8762 99946 Rural 0.8118 46210 Summit County, Utah 46 Rural 0.8762 41620 Urban 0.9421 46220 Tooele County, Utah 46 Rural 0.8762 41620 Urban 0.9421 46230 Uintah County, Utah 46 Rural 0.8762 99946 Rural 0.8118 46240 Utah County, Utah 6520 Urban 0.9500 39340 Urban 0.9500 46250 Wasatch County, Utah 46 Rural 0.8762 99946 Rural 0.8118 46260 Washington County, Utah 46 Rural 0.8762 41100 Urban 0.9392 46270 Wayne County, Utah 46 Rural 0.8762 99946 Rural 0.8118 46280 Weber County, Utah 7160 Urban 0.9340 36260 Urban 0.9029 47000 Addison County, Vermont 47 Rural 0.9830 99947 Rural 0.9830 47010 Bennington County, Vermont 47 Rural 0.9830 99947 Rural 0.9830 47020 Caledonia County, Vermont 47 Rural 0.9830 99947 Rural 0.9830 47030 Chittenden County, Vermont 1303 Urban 0.9410 15540 Urban 0.9410 47040 Essex County, Vermont 47 Rural 0.9830 99947 Rural 0.9830 47050 Franklin County, Vermont 1303 Urban 0.9410 15540 Urban 0.9410 47060 Grand Isle County, Vermont 1303 Urban 0.9410 15540 Urban 0.9410 47070 Lamoille County, Vermont 47 Rural 0.9830 99947 Rural 0.9830 47080 Orange County, Vermont 47 Rural 0.9830 99947 Rural 0.9830 47090 Orleans County, Vermont 47 Rural 0.9830 99947 Rural 0.9830 47100 Rutland County, Vermont 47 Rural 0.9830 99947 Rural 0.9830 47110 Washington County, Vermont 47 Rural 0.9830 99947 Rural 0.9830 47120 Windham County, Vermont 47 Rural 0.9830 99947 Rural 0.9830 47130 Windsor County, Vermont 47 Rural 0.9830 99947 Rural 0.9830 48010 St Croix County, Virgin Islands 48 Rural 0.7615 99948 Rural 0.7615 48020 St Thomas-John County, Virgin Islands 48 Rural 0.7615 99948 Rural 0.7615 49000 Accomack County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49010 Albemarle County, Virginia 1540 Urban 1.0187 16820 Urban 1.0187 49011 Alexandria City County, Virginia 8840 Urban 1.0976 47894 Urban 1.0926 49020 Alleghany County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49030 Amelia County, Virginia 49 Rural 0.8417 40060 Urban 0.9328 49040 Amherst County, Virginia 4640 Urban 0.8691 31340 Urban 0.8691 49050 Appomattox County, Virginia 49 Rural 0.8417 31340 Urban 0.8691 49060 Arlington County, Virginia 8840 Urban 1.0976 47894 Urban 1.0926 49070 Augusta County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49080 Bath County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49088 Bedford City County, Virginia 4640 Urban 0.8691 31340 Urban 0.8691 49090 Bedford County, Virginia 4640 Urban 0.8691 31340 Urban 0.8691 49100 Bland County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49110 Botetourt County, Virginia 6800 Urban 0.8387 40220 Urban 0.8374 49111 Bristol City County, Virginia 3660 Urban 0.8007 28700 Urban 0.8054 49120 Brunswick County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49130 Buchanan County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49140 Buckingham County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49141 Buena Vista City County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49150 Campbell County, Virginia 4640 Urban 0.8691 31340 Urban 0.8691 49160 Caroline County, Virginia 49 Rural 0.8417 40060 Urban 0.9328 49170 Carroll County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49180 Charles City County, Virginia 6760 Urban 0.9328 40060 Urban 0.9328 49190 Charlotte County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49191 Charlottesville City County, Virginia 1540 Urban 1.0187 16820 Urban 1.0187 49194 Chesapeake County, Virginia 5720 Urban 0.8799 47260 Urban 0.8799 49200 Chesterfield County, Virginia 6760 Urban 0.9328 40060 Urban 0.9328 49210 Clarke County, Virginia 8840 Urban 1.0976 47894 Urban 1.0926 49211 Clifton Forge City County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49212 Colonial Heights County, Virginia 6760 Urban 0.9328 40060 Urban 0.9328 49213 Covington City County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49220 Craig County, Virginia 49 Rural 0.8417 40220 Urban 0.8374 49230 Culpeper County, Virginia 8840 Urban 1.0976 99949 Rural 0.8013 49240 Cumberland County, Virginia 49 Rural 0.8417 40060 Urban 0.9328 49241 Danville City County, Virginia 1950 Urban 0.8489 19260 Urban 0.8489 49250 Dickenson County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49260 Dinniddie County, Virginia 6760 Urban 0.9328 40060 Urban 0.9328 49270 Emporia County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49280 Essex County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49288 Fairfax City County, Virginia 8840 Urban 1.0976 47894 Urban 1.0926 49290 Fairfax County, Virginia 8840 Urban 1.0976 47894 Urban 1.0926 49291 Falls Church City County, Virginia 8840 Urban 1.0976 47894 Urban 1.0926 49300 Fauquier County, Virginia 8840 Urban 1.0976 47894 Urban 1.0926 49310 Floyd County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49320 Fluvanna County, Virginia 1540 Urban 1.0187 16820 Urban 1.0187 49328 Franklin City County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49330 Franklin County, Virginia 49 Rural 0.8417 40220 Urban 0.8374 49340 Frederick County, Virginia 49 Rural 0.8417 49020 Urban 1.0214 49342 Fredericksburg City County, Virginia 8840 Urban 1.0976 47894 Urban 1.0926 49343 Galax City County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49350 Giles County, Virginia 49 Rural 0.8417 13980 Urban 0.7954 49360 Gloucester County, Virginia 5720 Urban 0.8799 47260 Urban 0.8799 49370 Goochland County, Virginia 6760 Urban 0.9328 40060 Urban 0.9328 49380 Grayson County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49390 Greene County, Virginia 1540 Urban 1.0187 16820 Urban 1.0187 49400 Greensville County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49410 Halifax County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49411 Hampton City County, Virginia 5720 Urban 0.8799 47260 Urban 0.8799 49420 Hanover County, Virginia 6760 Urban 0.9328 40060 Urban 0.9328 49421 Harrisonburg City County, Virginia 49 Rural 0.8417 25500 Urban 0.9088 49430 Henrico County, Virginia 6760 Urban 0.9328 40060 Urban 0.9328 49440 Henry County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49450 Highland County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49451 Hopewell City County, Virginia 6760 Urban 0.9328 40060 Urban 0.9328 49460 Isle Of Wight County, Virginia 5720 Urban 0.8799 47260 Urban 0.8799 49470 James City Co County, Virginia 5720 Urban 0.8799 47260 Urban 0.8799 49480 King And Queen County, Virginia 49 Rural 0.8417 40060 Urban 0.9328 49490 King George County, Virginia 8840 Urban 1.0976 99949 Rural 0.8013 49500 King William County, Virginia 49 Rural 0.8417 40060 Urban 0.9328 49510 Lancaster County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49520 Lee County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49522 Lexington County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49530 Loudoun County, Virginia 8840 Urban 1.0976 47894 Urban 1.0926 49540 Louisa County, Virginia 49 Rural 0.8417 40060 Urban 0.9328 49550 Lunenburg County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49551 Lynchburg City County, Virginia 4640 Urban 0.8691 31340 Urban 0.8691 49560 Madison County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49561 Martinsville City County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49563 Manassas City County, Virginia 8840 Urban 1.0976 47894 Urban 1.0926 49565 Manassas Park City County, Virginia 8840 Urban 1.0976 47894 Urban 1.0926 49570 Mathews County, Virginia 5720 Urban 0.8799 47260 Urban 0.8799 49580 Mecklenburg County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49590 Middlesex County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49600 Montgomery County, Virginia 49 Rural 0.8417 13980 Urban 0.7954 49610 Nansemond County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49620 Nelson County, Virginia 49 Rural 0.8417 16820 Urban 1.0187 49621 New Kent County, Virginia 6760 Urban 0.9328 40060 Urban 0.9328 49622 Newport News City County, Virginia 5720 Urban 0.8799 47260 Urban 0.8799 49641 Norfolk City County, Virginia 5720 Urban 0.8799 47260 Urban 0.8799 49650 Northampton County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49660 Northumberland County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49661 Norton City County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49670 Nottoway County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49680 Orange County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49690 Page County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49700 Patrick County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49701 Petersburg City County, Virginia 6760 Urban 0.9328 40060 Urban 0.9328 49710 Pittsylvania County, Virginia 1950 Urban 0.8489 19260 Urban 0.8489 49711 Portsmouth City County, Virginia 5720 Urban 0.8799 47260 Urban 0.8799 49712 Poquoson City County, Virginia 5720 Urban 0.8799 47260 Urban 0.8799 49720 Powhatan County, Virginia 6760 Urban 0.9328 40060 Urban 0.9328 49730 Prince Edward County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49740 Prince George County, Virginia 6760 Urban 0.9328 40060 Urban 0.9328 49750 Prince William County, Virginia 8840 Urban 1.0976 47894 Urban 1.0926 49770 Pulaski County, Virginia 49 Rural 0.8417 13980 Urban 0.7954 49771 Radford City County, Virginia 49 Rural 0.8417 13980 Urban 0.7954 49780 Rappahannock County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49790 Richmond County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49791 Richmond City County, Virginia 6760 Urban 0.9328 40060 Urban 0.9328 49800 Roanoke County, Virginia 6800 Urban 0.8387 40220 Urban 0.8374 49801 Roanoke City County, Virginia 6800 Urban 0.8387 40220 Urban 0.8374 49810 Rockbridge County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49820 Rockingham County, Virginia 49 Rural 0.8417 25500 Urban 0.9088 49830 Russell County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49838 Salem County, Virginia 6800 Urban 0.8387 40220 Urban 0.8374 49840 Scott County, Virginia 3660 Urban 0.8007 28700 Urban 0.8054 49850 Shenandoah County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49860 Smyth County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49867 South Boston City County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49870 Southampton County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49880 Spotsylvania County, Virginia 8840 Urban 1.0976 47894 Urban 1.0926 49890 Stafford County, Virginia 8840 Urban 1.0976 47894 Urban 1.0926 49891 Staunton City County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49892 Suffolk City County, Virginia 5720 Urban 0.8799 47260 Urban 0.8799 49900 Surry County, Virginia 49 Rural 0.8417 47260 Urban 0.8799 49910 Sussex County, Virginia 49 Rural 0.8417 40060 Urban 0.9328 49920 Tazewell County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49921 Virginia Beach City County, Virginia 5720 Urban 0.8799 47260 Urban 0.8799 49930 Warren County, Virginia 8840 Urban 1.0976 47894 Urban 1.0926 49950 Washington County, Virginia 3660 Urban 0.8007 28700 Urban 0.8054 49951 Waynesboro City County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49960 Westmoreland County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49961 Williamsburg City County, Virginia 5720 Urban 0.8799 47260 Urban 0.8799 49962 Winchester City County, Virginia 49 Rural 0.8417 49020 Urban 1.0214 49970 Wise County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49980 Wythe County, Virginia 49 Rural 0.8417 99949 Rural 0.8013 49981 York County, Virginia 5720 Urban 0.8799 47260 Urban 0.8799 50000 Adams County, Washington 50 Rural 1.0217 99950 Rural 1.0510 50010 Asotin County, Washington 50 Rural 1.0217 30300 Urban 0.9886 50020 Benton County, Washington 6740 Urban 1.0619 28420 Urban 1.0619 50030 Chelan County, Washington 50 Rural 1.0217 48300 Urban 1.0070 50040 Clallam County, Washington 50 Rural 1.0217 99950 Rural 1.0510 50050 Clark County, Washington 6440 Urban 1.1266 38900 Urban 1.1266 50060 Columbia County, Washington 50 Rural 1.0217 99950 Rural 1.0510 50070 Cowlitz County, Washington 50 Rural 1.0217 31020 Urban 0.9579 50080 Douglas County, Washington 50 Rural 1.0217 48300 Urban 1.0070 50090 Ferry County, Washington 50 Rural 1.0217 99950 Rural 1.0510 50100 Franklin County, Washington 6740 Urban 1.0619 28420 Urban 1.0619 50110 Garfield County, Washington 50 Rural 1.0217 99950 Rural 1.0510 50120 Grant County, Washington 50 Rural 1.0217 99950 Rural 1.0510 50130 Grays Harbor County, Washington 50 Rural 1.0217 99950 Rural 1.0510 50140 Island County, Washington 7600 Urban 1.1567 99950 Rural 1.0510 50150 Jefferson County, Washington 50 Rural 1.0217 99950 Rural 1.0510 50160 King County, Washington 7600 Urban 1.1567 42644 Urban 1.1577 50170 Kitsap County, Washington 1150 Urban 1.0675 14740 Urban 1.0675 50180 Kittitas County, Washington 50 Rural 1.0217 99950 Rural 1.0510 50190 Klickitat County, Washington 50 Rural 1.0217 99950 Rural 1.0510 50200 Lewis County, Washington 50 Rural 1.0217 99950 Rural 1.0510 50210 Lincoln County, Washington 50 Rural 1.0217 99950 Rural 1.0510 50220 Mason County, Washington 50 Rural 1.0217 99950 Rural 1.0510 50230 Okanogan County, Washington 50 Rural 1.0217 99950 Rural 1.0510 50240 Pacific County, Washington 50 Rural 1.0217 99950 Rural 1.0510 50250 Pend Oreille County, Washington 50 Rural 1.0217 99950 Rural 1.0510 50260 Pierce County, Washington 8200 Urban 1.0742 45104 Urban 1.0742 50270 San Juan County, Washington 50 Rural 1.0217 99950 Rural 1.0510 50280 Skagit County, Washington 50 Rural 1.0217 34580 Urban 1.0454 50290 Skamania County, Washington 50 Rural 1.0217 38900 Urban 1.1266 50300 Snohomish County, Washington 7600 Urban 1.1567 42644 Urban 1.1577 50310 Spokane County, Washington 7840 Urban 1.0905 44060 Urban 1.0905 50320 Stevens County, Washington 50 Rural 1.0217 99950 Rural 1.0510 50330 Thurston County, Washington 5910 Urban 1.0927 36500 Urban 1.0927 50340 Wahkiakum County, Washington 50 Rural 1.0217 99950 Rural 1.0510 50350 Walla Walla County, Washington 50 Rural 1.0217 99950 Rural 1.0510 50360 Whatcom County, Washington 0860 Urban 1.1731 13380 Urban 1.1731 50370 Whitman County, Washington 50 Rural 1.0217 99950 Rural 1.0510 50380 Yakima County, Washington 9260 Urban 1.0155 49420 Urban 1.0155 51000 Barbour County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51010 Berkeley County, W Virginia 8840 Urban 1.0976 25180 Urban 0.9489 51020 Boone County, W Virginia 51 Rural 0.7900 16620 Urban 0.8445 51030 Braxton County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51040 Brooke County, W Virginia 8080 Urban 0.7819 48260 Urban 0.7819 51050 Cabell County, W Virginia 3400 Urban 0.9477 26580 Urban 0.9477 51060 Calhoun County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51070 Clay County, W Virginia 51 Rural 0.7900 16620 Urban 0.8445 51080 Doddridge County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51090 Fayette County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51100 Gilmer County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51110 Grant County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51120 Greenbrier County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51130 Hampshire County, W Virginia 51 Rural 0.7900 49020 Urban 1.0214 51140 Hancock County, W Virginia 8080 Urban 0.7819 48260 Urban 0.7819 51150 Hardy County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51160 Harrison County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51170 Jackson County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51180 Jefferson County, W Virginia 8840 Urban 1.0976 47894 Urban 1.0926 51190 Kanawha County, W Virginia 1480 Urban 0.8445 16620 Urban 0.8445 51200 Lewis County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51210 Lincoln County, W Virginia 51 Rural 0.7900 16620 Urban 0.8445 51220 Logan County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51230 Mc Dowell County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51240 Marion County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51250 Marshall County, W Virginia 9000 Urban 0.7161 48540 Urban 0.7161 51260 Mason County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51270 Mercer County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51280 Mineral County, W Virginia 1900 Urban 0.9317 19060 Urban 0.9317 51290 Mingo County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51300 Monongalia County, W Virginia 51 Rural 0.7900 34060 Urban 0.8420 51310 Monroe County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51320 Morgan County, W Virginia 51 Rural 0.7900 25180 Urban 0.9489 51330 Nicholas County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51340 Ohio County, W Virginia 9000 Urban 0.7161 48540 Urban 0.7161 51350 Pendleton County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51360 Pleasants County, W Virginia 51 Rural 0.7900 37620 Urban 0.8270 51370 Pocahontas County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51380 Preston County, W Virginia 51 Rural 0.7900 34060 Urban 0.8420 51390 Putnam County, W Virginia 1480 Urban 0.8445 16620 Urban 0.8445 51400 Raleigh County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51410 Randolph County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51420 Ritchie County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51430 Roane County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51440 Summers County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51450 Taylor County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51460 Tucker County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51470 Tyler County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51480 Upshur County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51490 Wayne County, W Virginia 3400 Urban 0.9477 26580 Urban 0.9477 51500 Webster County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51510 Wetzel County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 51520 Wirt County, W Virginia 51 Rural 0.7900 37620 Urban 0.8270 51530 Wood County, W Virginia 6020 Urban 0.8270 37620 Urban 0.8270 51540 Wyoming County, W Virginia 51 Rural 0.7900 99951 Rural 0.7717 52000 Adams County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52010 Ashland County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52020 Barron County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52030 Bayfield County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52040 Brown County, Wisconsin 3080 Urban 0.9483 24580 Urban 0.9483 52050 Buffalo County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52060 Burnett County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52070 Calumet County, Wisconsin 0460 Urban 0.9239 11540 Urban 0.9288 52080 Chippewa County, Wisconsin 2290 Urban 0.9201 20740 Urban 0.9201 52090 Clark County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52100 Columbia County, Wisconsin 52 Rural 0.9478 31540 Urban 1.0659 52110 Crawford County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52120 Dane County, Wisconsin 4720 Urban 1.0754 31540 Urban 1.0659 52130 Dodge County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52140 Door County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52150 Douglas County, Wisconsin 2240 Urban 1.0213 20260 Urban 1.0213 52160 Dunn County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52170 Eau Claire County, Wisconsin 2290 Urban 0.9201 20740 Urban 0.9201 52180 Florence County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52190 Fond Du Lac County, Wisconsin 52 Rural 0.9478 22540 Urban 0.9640 52200 Forest County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52210 Grant County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52220 Green County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52230 Green Lake County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52240 Iowa County, Wisconsin 52 Rural 0.9478 31540 Urban 1.0659 52250 Iron County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52260 Jackson County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52270 Jefferson County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52280 Juneau County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52290 Kenosha County, Wisconsin 3800 Urban 0.9760 29404 Urban 1.0429 52300 Kewaunee County, Wisconsin 52 Rural 0.9478 24580 Urban 0.9483 52310 La Crosse County, Wisconsin 3870 Urban 0.9564 29100 Urban 0.9564 52320 Lafayette County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52330 Langlade County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52340 Lincoln County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52350 Manitowoc County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52360 Marathon County, Wisconsin 8940 Urban 0.9590 48140 Urban 0.9590 52370 Marinette County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52380 Marquette County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52381 Menominee County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52390 Milwaukee County, Wisconsin 5080 Urban 1.0146 33340 Urban 1.0146 52400 Monroe County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52410 Oconto County, Wisconsin 52 Rural 0.9478 24580 Urban 0.9483 52420 Oneida County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52430 Outagamie County, Wisconsin 0460 Urban 0.9239 11540 Urban 0.9288 52440 Ozaukee County, Wisconsin 5080 Urban 1.0146 33340 Urban 1.0146 52450 Pepin County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52460 Pierce County, Wisconsin 5120 Urban 1.1075 33460 Urban 1.1075 52470 Polk County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52480 Portage County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52490 Price County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52500 Racine County, Wisconsin 6600 Urban 0.8997 39540 Urban 0.8997 52510 Richland County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52520 Rock County, Wisconsin 3620 Urban 0.9538 27500 Urban 0.9538 52530 Rusk County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52540 St Croix County, Wisconsin 5120 Urban 1.1075 33460 Urban 1.1075 52550 Sauk County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52560 Sawyer County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52570 Shawano County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52580 Sheboygan County, Wisconsin 7620 Urban 0.8911 43100 Urban 0.8911 52590 Taylor County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52600 Trempealeau County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52610 Vernon County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52620 Vilas County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52630 Walworth County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52640 Washburn County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52650 Washington County, Wisconsin 5080 Urban 1.0146 33340 Urban 1.0146 52660 Waukesha County, Wisconsin 5080 Urban 1.0146 33340 Urban 1.0146 52670 Waupaca County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52680 Waushara County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 52690 Winnebago County, Wisconsin 0460 Urban 0.9239 36780 Urban 0.9183 52700 Wood County, Wisconsin 52 Rural 0.9478 99952 Rural 0.9509 53000 Albany County, Wyoming 53 Rural 0.9257 99953 Rural 0.9257 53010 Big Horn County, Wyoming 53 Rural 0.9257 99953 Rural 0.9257 53020 Campbell County, Wyoming 53 Rural 0.9257 99953 Rural 0.9257 53030 Carbon County, Wyoming 53 Rural 0.9257 99953 Rural 0.9257 53040 Converse County, Wyoming 53 Rural 0.9257 99953 Rural 0.9257 53050 Crook County, Wyoming 53 Rural 0.9257 99953 Rural 0.9257 53060 Fremont County, Wyoming 53 Rural 0.9257 99953 Rural 0.9257 53070 Goshen County, Wyoming 53 Rural 0.9257 99953 Rural 0.9257 53080 Hot Springs County, Wyoming 53 Rural 0.9257 99953 Rural 0.9257 53090 Johnson County, Wyoming 53 Rural 0.9257 99953 Rural 0.9257 53100 Laramie County, Wyoming 1580 Urban 0.8775 16940 Urban 0.8775 53110 Lincoln County, Wyoming 53 Rural 0.9257 99953 Rural 0.9257 53120 Natrona County, Wyoming 1350 Urban 0.9026 16220 Urban 0.9026 53130 Niobrara County, Wyoming 53 Rural 0.9257 99953 Rural 0.9257 53140 Park County, Wyoming 53 Rural 0.9257 99953 Rural 0.9257 53150 Platte County, Wyoming 53 Rural 0.9257 99953 Rural 0.9257 53160 Sheridan County, Wyoming 53 Rural 0.9257 99953 Rural 0.9257 53170 Sublette County, Wyoming 53 Rural 0.9257 99953 Rural 0.9257 53180 Sweetwater County, Wyoming 53 Rural 0.9257 99953 Rural 0.9257 53190 Teton County, Wyoming 53 Rural 0.9257 99953 Rural 0.9257 53200 Uinta County, Wyoming 53 Rural 0.9257 99953 Rural 0.9257 53210 Washakie County, Wyoming 53 Rural 0.9257 99953 Rural 0.9257 53220 Weston County, Wyoming 53 Rural 0.9257 99953 Rural 0.9257 65010 Agana County, Guam 65 Rural 0.9611 99965 Rural 0.9611 65020 Agana Heights County, Guam 65 Rural 0.9611 99965 Rural 0.9611 65030 Agat County, Guam 65 Rural 0.9611 99965 Rural 0.9611 65040 Asan County, Guam 65 Rural 0.9611 99965 Rural 0.9611 65050 Barrigada County, Guam 65 Rural 0.9611 99965 Rural 0.9611 65060 Chalan Pago County, Guam 65 Rural 0.9611 99965 Rural 0.9611 65070 Dededo County, Guam 65 Rural 0.9611 99965 Rural 0.9611 65080 Inarajan County, Guam 65 Rural 0.9611 99965 Rural 0.9611 65090 Maite County, Guam 65 Rural 0.9611 99965 Rural 0.9611 65100 Mangilao County, Guam 65 Rural 0.9611 99965 Rural 0.9611 65110 Merizo County, Guam 65 Rural 0.9611 99965 Rural 0.9611 65120 Mongmong County, Guam 65 Rural 0.9611 99965 Rural 0.9611 65130 Ordot County, Guam 65 Rural 0.9611 99965 Rural 0.9611 65140 Piti County, Guam 65 Rural 0.9611 99965 Rural 0.9611 65150 Santa Rita County, Guam 65 Rural 0.9611 99965 Rural 0.9611 65160 Sinajana County, Guam 65 Rural 0.9611 99965 Rural 0.9611 65170 Talofofo County, Guam 65 Rural 0.9611 99965 Rural 0.9611 65180 Tamuning County, Guam 65 Rural 0.9611 99965 Rural 0.9611 65190 Toto County, Guam 65 Rural 0.9611 99965 Rural 0.9611 65200 Umatac County, Guam 65 Rural 0.9611 99965 Rural 0.9611 65210 Yigo County, Guam 65 Rural 0.9611 99965 Rural 0.9611 65220 Yona County, Guam 65 Rural 0.9611 99965 Rural 0.9611 *Transition wage index value should be used with the CBSA urban/rural designation for rate calculation purposes. 1 At this time, there are no hospitals located in these CBSA-based urban areas on which to base a wage index. Therefore, the transition wage index value is based on the average transition wage index for all urban areas within the state. Addendum C—Wage Index Tables In this addendum, we provide the tables referred to throughout the preamble to this proposed rule. Tables 1 and 2 below provide the proposed CBSA-based wage index values for urban and rural providers. EP23JA06.000 EP23JA06.001 EP23JA06.002 EP23JA06.003 EP23JA06.004 EP23JA06.005 EP23JA06.006 EP23JA06.007 EP23JA06.008 EP23JA06.009 EP23JA06.010 EP23JA06.011 EP23JA06.012 EP23JA06.013 EP23JA06.014 EP23JA06.015 EP23JA06.016 EP23JA06.017 EP23JA06.018 EP23JA06.019 EP23JA06.020 EP23JA06.021 EP23JA06.022 EP23JA06.023 EP23JA06.024 EP23JA06.025 EP23JA06.026 EP23JA06.027 EP23JA06.028 EP23JA06.029 EP23JA06.030 EP23JA06.031 EP23JA06.032 EP23JA06.033 EP23JA06.034 EP23JA06.035 EP23JA06.036 EP23JA06.037 EP23JA06.038 EP23JA06.039 EP23JA06.040 EP23JA06.041 EP23JA06.042 EP23JA06.043 EP23JA06.044 EP23JA06.045 EP23JA06.046 EP23JA06.047 EP23JA06.048 Table 2.—Proposed Wage Index Based on CBSA Labor Market Areas for Rural Areas CBSA Code Nonurban Area Wage Index 01 Alabama 0.7446 02 Alaska 1.1977 03 Arizona 0.8768 04 Arkansas 0.7466 05 California 1.1054 06 Colorado 0.9380 07 Connecticut 1.1730 08 Delaware 0.9579 10 Florida 0.8568 11 Georgia 0.7662 12 Hawaii 1.0551 13 Idaho 0.8037 14 Illinois 0.8271 15 Indiana 0.8624 16 Iowa 0.8509 17 Kansas 0.8035 18 Kentucky 0.7766 19 Louisiana 0.7411 20 Maine 0.8843 21 Maryland 0.9353 22 Massachusetts 1.0216 23 Michigan 0.8895 24 Minnesota 0.9132 25 Mississippi 0.7674 26 Missouri 0.7900 27 Montana 0.8762 28 Nebraska 0.8657 29 Nevada 0.9065 30 New Hampshire 1.0817 31 New Jersey 1 32 New Mexico 0.8635 33 New York 0.8154 34 North Carolina 0.8540 35 North Dakota 0.7261 36 Ohio 0.8826 37 Oklahoma 0.7581 38 Oregon 0.9826 39 Pennsylvania 0.8291 40 Puerto Rico 1 0.4047 41 Rhode Island 1 42 South Carolina 0.8638 43 South Dakota 0.8560 44 Tennessee 0.7895 45 Texas 0.8003 46 Utah 0.8118 47 Vermont 0.9830 48 Virgin Islands 0.7615 49 Virginia 0.8013 50 Washington 1.0510 51 West Virginia 0.7717 52 Wisconsin 0.9509 53 Wyoming 0.9257 65 Guam 0.9611 1 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. [FR Doc. 06-488 Filed 1-13-06; 4:01 pm]
Connectionstraces to 24
Traces to 24 documents
37 references not yet in our index
  • 17 CFR 240.19
  • 17 CFR 240
  • 17 CFR 240.15
  • Pub. L. 105-42
  • 23 CFR 771
  • 49 CFR 592
  • 49 CFR 593.7
  • 49 CFR 593.8
  • 49 CFR 1.50
  • Pub. L. 104-13
  • T.D. 8390
  • T.D. 8933
  • 30 CFR 48
  • Pub. L. 105-33
  • Pub. L. 106-113
  • Pub. L. 106-554
  • Pub. L. 108-173
  • Pub. L. 97-248
  • Pub. L. 98-21
  • 42 CFR 413
  • Pub. L. 101-239
  • 42 CFR 412
  • 42 CFR 403
  • Pub. L. 90-248
  • Pub. L. 92-603
  • 42 CFR 405.471(c)(4)(ii)(B)
  • 42 CFR 412.27(b)
  • 42 CFR 405.1038(g)
  • 42 CFR 405.1038(g)(3)
  • 42 CFR 482.62(g)
  • 42 CFR 409.62
  • Pub. L. 96-354
  • Pub. L. 104-4
  • 5 USC 40(2)
  • 42 CFR 424
  • 113 Stat. 1515
  • 117 Stat. 2266
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U.S.C.§ 78s
U.S.C.§ 78f
U.S.C.§ 552
C.F.R.§ 200.30-3
C.F.R.§ 242.602
U.S.C.§ 78c
C.F.R.§ 242.611
U.S.C.§ 78o–3
U.S.C.§ 78g
Cite17 CFR 240.19
Cite17 CFR 240
Cite17 CFR 240.15
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