issue-1996-08-30•Federal Register final rules — 1996-08-30
Federal Register final rules — 1996-08-30
issue-1996-08-30Federal Register final rules — 1996-08-30Regulation
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FR Doc. 96-22249 Migratory Bird Hunting; Migratory Bird Hunting Regulations on Certain Federal Indian Reservations and Ceded Lands for the 1996-97 Early Season
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Pages 46352-46357]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22249]
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DEPARTMENT OF THE INTERIOR
50 CFR Part 20
RIN 1018-AD69
Migratory Bird Hunting; Migratory Bird Hunting Regulations on
Certain Federal Indian Reservations and Ceded Lands for the 1996-97
Early Season
AGENCY: Fish and Wildlife Service, Interior.
ACTION: Final rule.
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SUMMARY: This rule prescribes special early season migratory bird
hunting regulations for certain tribes on Federal Indian reservations,
off-reservation trust lands and ceded lands. This responds to tribal
requests for U.S. Fish and Wildlife Service (hereinafter Service)
recognition of their authority to regulate hunting under established
guidelines. This rule allows the establishment of season bag limits
and, thus, harvest at levels compatible with populations and habitat
conditions.
EFFECTIVE DATE: This rule takes effect on September 1, 1996.
ADDRESSES: The public may inspect comments received, if any, on the
proposed special hunting regulations and tribal proposals during normal
business hours in Room 634, Arlington Square Building, 4401 N. Fairfax
Drive, Arlington, Virginia. The public should send communications
regarding the documents to: Director (FWS/MBMO), U.S. Fish and Wildlife
Service, Room 634-ARLSQ, 1849 C Street, NW., Washington, DC 20240.
FOR FURTHER INFORMATION CONTACT: Ron W. Kokel, Office of Migratory Bird
Management, U.S. Fish and Wildlife Service, (703/358-1714).
SUPPLEMENTARY INFORMATION: The Migratory Bird Treaty Act of July 3,
1918 (40 Stat. 755; 16 U.S.C. 703 et seq.), authorizes and directs the
Secretary of the Department of the Interior, having due regard for the
zones of temperature and for the distribution, abundance, economic
value, breeding habits, and times and lines of flight of migratory game
birds, to determine when, to what extent, and by what means such birds
or any part, nest or egg thereof may be taken, hunted, captured,
killed, possessed, sold, purchased, shipped, carried, exported or
transported.
In the August 16, 1996, Federal Register (61 FR 42730), the Service
proposed special migratory bird hunting regulations for the 1996-97
hunting season for certain Indian tribes, under the guidelines
described in the June 4, 1985, Federal Register (50 FR 23467). The
guidelines responds to tribal requests for Service recognition of their
reserved hunting rights, and for some tribes, recognition of their
authority to regulate hunting by both tribal members and nonmembers on
their reservations. The guidelines include possibilities for:
(1) On-reservation hunting by both tribal members and nonmembers,
with hunting by nontribal members on some reservations to take place
within Federal frameworks but on dates different from those selected by
the surrounding State(s);
(2) On-reservation hunting by tribal members only, outside of usual
Federal frameworks for season dates and length, and for daily bag and
possession limits; and
(3) Off-reservation hunting by tribal members on ceded lands,
outside of usual framework dates and season length, with some added
flexibility in daily bag and possession limits.
In all cases, the regulations established under the guidelines must
be consistent with the March 10-September 1 closed season mandated by
the 1916 Migratory Bird Treaty with Canada.
In the March 22, 1996, Federal Register (61 FR 11986), the Service
requested that tribes desiring special hunting regulations in the 1996-
97 hunting season submit a proposal including details on:
(1) Requested season dates and other regulations to be observed;
(2) Harvest anticipated under the requested regulations;
(3) Methods that will be employed to measure or monitor harvest;
(4) Steps that will be taken to limit level of harvest, where it
could be shown that failure to limit such harvest would impact
seriously on the migratory bird resource; and
(5) Tribal capabilities to establish and enforce migratory bird
hunting regulations.
No action is required if a tribe wishes to observe the hunting
regulations established by the State(s) in which an Indian reservation
is located. The Service has successfully used the guidelines since the
1985-86 hunting season. The Service finalized the guidelines beginning
with the 1988-89 hunting season (August 18, 1988, Federal Register [53
FR 31612]).
Although the proposed rule included generalized regulations for
both early- and late-season hunting, this rulemaking addresses only the
early-season proposals. Late-season hunting will be addressed in late-
September. As
[[Page 46353]]
a general rule, early seasons begin during September each year and have
a primary emphasis on such species as mourning and white-winged dove.
Late seasons begin about October 1 or later each year and have a
primary emphasis on waterfowl.
Comments and Issues Concerning Tribal Proposals
For the 1996-97 migratory bird hunting season, the Service proposed
regulations for 22 tribes and/or Indian groups that followed the 1985
guidelines and were considered appropriate for final rulemaking. Some
of the proposals submitted by the tribes had both early- and late-
season elements. However, as noted earlier, only those with early-
season proposals are included in this final rulemaking; 10 tribes have
proposals with early seasons. Comments and revised proposals received
to date are addressed in the following section. The comment period for
the proposed rule, published on August 16, 1996, closed on August 26,
1996. Because of the necessary brief comment period, the Service will
respond to any comments received on the proposed rule and/or these
early-season regulations not responded to herein in the September late-
season final rule.
Great Lakes Indian Fish and Wildlife Commission, Odanah, Wisconsin
To date, the Service has received one comment letter. The Wisconsin
Department of Natural Resources (WIDNR) July 5, 1996, letter to the
Great Lakes Indian Fish and Wildlife Commission (GLIFWC), was copied to
the Service. In this letter, the WIDNR communicated concerns regarding:
(1) The suggested monitoring of harvest impacts on giant Canada geese;
(2) the consistency between the length of other goose seasons and bag
limits for the GLIFWC and the State of Wisconsin; (3) the initiation
and completion of studies on the impacts of a September 15 duck season
opening on local breeding populations; and (4) honoring the noon
opening for shooting hours for the first day of the State's duck season
and the State's open water hunting restrictions.
The Service believes it is necessary to place this GLIFWC proposal
in the context of a tribal entity having court established legal rights
on ceded lands. Further, the Service's policy is to recognize treaty
rights wherever there is substantial proof that they occur, e.g., more
recently in the Michigan 1836 Treaty area. Thus, the GLIFWC proposal
has as its umbrella the recognition by the Federal Government of those
reserved rights by bands to an unquantified amount of any harvestable
migratory bird surpluses in the ceded areas. Our position derives from
the special status that Native Americans have with regard to the
Federal Government's trust responsibility, as well as precedent setting
court decisions in Wisconsin and elsewhere when these reserved treaty
rights have been at issue.
As to the details of the proposal comments, our response remains
that the current populations of birds can support the bands' limited
harvest. In past years, the GLIFWC's member bands have annually
harvested about 2,000 and 500 ducks and geese, respectively. In 1995-
96, under nearly identical regulations, 2,747 ducks and 319 geese were
harvested. Under the proposed regulations, the GLIFWC anticipates an
annual harvest of approximately 3,000 ducks and 900 geese. Further, the
GLIFWC's proposed specific sex and species considerations are in line
with current management concerns. If approved, the GLIFWC is obligated
to monitor harvest to ensure that local breeding populations of ducks
are not being adversely affected.
The September 15 opening date for the GLIFWC meets the Service's
established framework for approval of tribal duck seasons. This date
should provide ample time for even late broods and molting ducks to be
flighted. Originally established by the Service's Region 3 Office in
the Twin Cities, Minnesota, for use in the Great Lakes areas, these
guidelines have been generally applied elsewhere in the States, as
appropriate. The Service also requests that tribal members honor both
the noon opening for shooting hours for the first day of the State's
duck season and Wisconsin's open water hunting restrictions.
As the Service is approving these regulations in this early season
final rule, it is incumbent upon the GLIFWC to continue to closely
monitor both duck and goose harvests to ensure that local and/or
regional breeding populations are not being negatively impacted by
harvest.
NEPA Consideration
NEPA considerations are covered by the programmatic document,
``Final Supplemental Environmental Impact Statement: Issuance of Annual
Regulations Permitting the Sport Hunting of Migratory Birds (FSES 88-
14),'' filed with EPA on June 9, 1988. The Service published a Notice
of Availability in the June 16, 1988, Federal Register (53 FR 22582).
The Service published its Record of Decision on August 18, 1988 (53 FR
31341). Copies of these documents are available from the Service at the
address indicated under the caption ADDRESSES.
Endangered Species Act Consideration
As in the past, the Service designs hunting regulations to remove
or alleviate chances of conflict between migratory game bird hunting
seasons and the protection and conservation of endangered and
threatened species. Consultations were conducted to ensure that actions
resulting from these regulatory proposals will not likely jeopardize
the continued existence of endangered or threatened species or result
in the destruction or adverse modification of their critical habitat.
Findings from these consultations are included in a biological opinion
and may have caused modification of some regulatory measures previously
proposed. The final frameworks reflect any modifications. The Service's
biological opinions resulting from its Section 7 consultation are
public documents available for public inspection in the Service's
Division of Endangered Species and MBMO, at the address indicated under
the caption ADDRESSES.
Regulatory Flexibility Act; Executive Order (E.O.) 12866 and the
Paperwork Reduction Act
In the March 22, 1996, Federal Register, the Service reported
measures it took to comply with requirements of the Regulatory
Flexibility Act and E.O. 12866. One measure was to prepare a Small
Entity Flexibility Analysis (Analysis) in 1995 documenting the
significant beneficial economic effect on a substantial number of small
entities. The Analysis estimated that migratory bird hunters would
spend between $258 and $586 million at small businesses. Copies of the
Analysis are available upon request from the Office of Migratory Bird
Management. The Service is currently updating and expanding the 1995
Analysis. This rule was not subject to review by the Office of
Management and Budget under E.O. 12866.
The Department examined these proposed regulations under the
Paperwork Reduction Act of 1995 and found no information collection
requirements.
Regulations Promulgation
The rulemaking process for migratory game bird hunting must, by its
nature, operate under severe time constraints. However, the Service
intends that the public be given the greatest possible opportunity to
comment on the regulations. Thus, when the preliminary proposed
rulemaking was published,
[[Page 46354]]
the Service established what it believed were the longest periods
possible for public comment. In doing this, the Service recognized that
when the comment period closed, time would be of the essence. That is,
if there were a delay in the effective date of these regulations after
this final rulemaking, the States would have insufficient time to
select season dates and limits; to communicate those selections to the
Service; and to establish and publicize the necessary regulations and
procedures to implement their decisions.
Therefore, the Service, under authority of the Migratory Bird
Treaty Act (July 3, 1918), as amended, (16 U.S.C. 703-711), prescribes
final frameworks setting forth the species to be hunted, the daily bag
and possession limits, the shooting hours, the season lengths, the
earliest opening and latest closing season dates, and hunting areas,
from which State conservation agency officials may select hunting
season dates and other options. Upon receipt of season and option
selections from these officials, the Service will publish in the
Federal Register a final rulemaking amending 50 CFR part 20 to reflect
seasons, limits, and shooting hours for the conterminous United States
for the 1996-97 season.
The Service therefore finds that ``good cause'' exists, within the
terms of 5 U.S.C. 553(d)(3) of the Administrative Procedure Act, and
these frameworks will, therefore, take effect immediately upon
publication.
Unfunded Mandates
The Service has determined and certifies in compliance with the
requirements of the Unfunded Mandates Act, 2 U.S.C. 1502 et seq., that
this rulemaking will not impose a cost of $100 million or more in any
given year on local or State government or private entities.
Civil Justice Reform--Executive Order 12988
The Department, in promulgating this proposed rule, has determined
that these regulations meet the applicable standards provided in
Sections 3(a) and 3(b)(2) of Executive Order 12988.
List of Subjects in 50 CFR Part 20
Exports, Hunting, Imports, Reporting and recordkeeping
requirements, Transportation, Wildlife.
1. The authority citation for part 20 continues to read as follows:
Authority: 16 U.S.C. 703-712 and 16 U.S.C. 742 a-j.
(Editorial Note: The following hunting regulations provided for by
Sec. 20.110 of 50 CFR Part 20 will not appear in the Code of Federal
Regulations because of their seasonal nature.)
2. Section 20.110 is revised to read as follows:
Sec. 20.110 Seasons, limits and other regulations for certain Federal
Indian reservations, Indian Territory, and ceded lands.
(a) Colorado River Indian Tribes, Parker, Arizona (Tribal Members and
Non-Tribal Hunters)
Doves
Season Dates: Open September 1, close September 15, 1996; then open
November 16, close January 15, 1997.
Daily Bag and Possession Limits: For the early season, daily bag
limit is 10 mourning or 10 white-winged doves, singly, or in the
aggregate. For the late season, the daily bag limit is 10 mourning
doves. Possession limits are twice the daily bag limits.
General Conditions: A valid Colorado River Indian Reservation
hunting permit is required for all persons 14 years and older and must
be in possession before taking any wildlife on tribal lands. Any person
transporting game birds off the Colorado River Indian Reservation must
have a valid transport declaration form. Other tribal regulations
apply, and may be obtained at the Fish and Game Office in Parker,
Arizona.
(b) Fond du Lac Band of Lake Superior Chippewa Indians, Cloquet,
Minnesota (Tribal Members Only)
Ducks
Minnesota 1854 Zone:
Season Dates: Open September 14, close November 24, 1996.
Daily Bag Limit: 20 ducks, including no more than 10 mallards; only
5 of which may be hen mallards; 4 black ducks; 4 redheads, 4 pintails
and 2 canvasbacks.
Mergansers
Minnesota 1854 Zone:
Season Dates: Open September 14, close November 24, 1996.
Daily Bag Limit: 5 mergansers, including no more than 1 hooded
merganser.
Geese
Minnesota 1854 Zone:
Season Dates: Open September 7, close November 24, 1996.
Daily Bag Limit: 10 geese.
Coots and Common Moorhens (Gallinule)
Minnesota 1854 Zone:
Season Dates: Open September 14, close November 24, 1996.
Daily Bag Limit: 20 coots and common moorhens, singly or in the
aggregate.
Sora and Virginia Rails
Minnesota 1854 Zone:
Season Dates: Open September 7, close November 24, 1996.
Daily Bag Limit: 25 sora and Virginia rails, singly or in the
aggregate. The possession limit is 25.
Common Snipe
Minnesota 1854 Zone:
Season Dates: Open September 1, close November 24, 1996.
Daily Bag Limit: 8 snipe.
Woodcock
Minnesota 1854 Zone:
Season Dates: Open September 1, close November 24, 1996.
Daily Bag Limit: 5 woodcock.
General Conditions:
(i) While hunting waterfowl, a tribal member must carry on his/her
person a valid tribal waterfowl hunting permit.
(ii) Except as otherwise noted, tribal members will be required to
comply with tribal codes that will be no less restrictive than the
provisions of Chapter 10 of the Model Off-Reservation Code. This Model
Code was the subject of the stipulation in Lac Courte Oreilles v. State
of Wisconsin regarding migratory bird hunting. Except as modified
herein, these amended regulations parallel Federal requirements, 50 CFR
Part 20, and shooting hour regulations in 50 CFR Part 20, subpart K, as
to hunting methods, transportation, sale, exportation and other
conditions generally applicable to migratory bird hunting.
(iii) Tribal members in each zone will comply with State
regulations providing for closed and restricted waterfowl hunting
areas.
(iv) Minnesota--Duck Blinds and Decoys. Tribal members hunting in
Minnesota will comply with tribal codes that contain provisions
parallel to applicable State statutes.
(v) Possession limits for each species are double the daily bag
limit, except on the opening day of the season, when the possession
limit equals the daily bag limit, unless otherwise specified.
(vi) Possession limits are applicable only to transportation and do
not include birds which are cleaned, dressed, and at a member's primary
residence. For purposes of enforcing bag and possession limits, all
migratory birds in the possession or custody of tribal members on ceded
lands will be considered to have been taken on those lands unless
tagged by a tribal or State
[[Page 46355]]
conservation warden as having been taken on-reservation. In Wisconsin,
such tagging will comply with applicable State statutes. All migratory
birds which fall on reservation lands will not count as part of any
off-reservation bag or possession limit.
(c) Grand Traverse Band of Ottawa and Chippewa Indians, Suttons Bay,
Michigan (Tribal Members Only)
Ducks
Michigan, 1836 Treaty Zone:
Season Dates: Open September 15, close November 30, 1996.
Daily Bag Limit: 7 ducks, which may include no more than 1 pintail,
1 canvasback, 1 black duck, 2 wood ducks, 2 redheads, and 2 hen
mallards.
Canada Geese
Michigan, 1836 Treaty Zone:
Season Dates: Open September 1, close November 30, 1996, and open
January 1, close February 7, 1997.
Daily Bag Limit: 5 geese.
General Conditions: A valid Grand Traverse Band Tribal license is
required for all persons 12 years and older and must be in possession
before taking any wildlife. All other basic regulations contained in 50
CFR part 20 are valid. Other tribal regulations apply, and may be
obtained at the tribal office in Suttons Bay, Michigan.
(d) Great Lakes Indian Fish and Wildlife Commission, Odanah, Wisconsin
(Tribal Members Only)
Ducks
Wisconsin and Minnesota 1837 and 1842 Zones:
Season Dates: Open September 15, close November 7, 1996.
Daily Bag Limit: 20 ducks, including no more than 10 mallards; only
5 of which may be hen mallards; 4 black ducks; 4 redheads, 4 pintails
and 2 canvasbacks.
Mergansers
Wisconsin and Minnesota 1837 and 1842 Zones:
Season Dates: Open September 15, close November 7, 1996.
Daily Bag Limit: 5 mergansers, including no more than 1 hooded
merganser.
Canada Geese
Wisconsin and Minnesota 1837 and 1842 Zones:
Season Dates: Open September 15, close December 1, 1996.
Daily Bag Limit: 10 geese, minus the number of blue, snow or white-
fronted geese taken.
Michigan, 1842 Treaty Zone:
Season Dates: Open September 1, close September 10, 1996.
Daily Bag Limit: 5 geese.
Michigan, 1836 Treaty Zone:
Season Dates: Open September 1, close September 10, 1996, except
for that small portion of the ceded territory which coincides with the
State of Michigan's Southern Zone will open September 1 and close on
September 15.
Daily Bag Limit: 5 geese.
Other Geese (Blue, Snow, and White-fronted)
Wisconsin and Minnesota 1837 and 1842 Zones:
Season Dates: Open September 15, close December 1, 1996.
Daily Bag Limit: 10 geese, minus the number of Canada geese taken.
Coots and Common Moorhens (Gallinules)
Wisconsin and Minnesota 1837 and 1842 Zones:
Season Dates: Open September 15, close November 7, 1996.
Daily Bag Limit: 20 coots and common moorhens, singly or in the
aggregate.
Sora and Virginia Rails
Wisconsin and Minnesota 1837 and 1842 Zones:
Season Dates: Open September 15, close November 7, 1996.
Daily Bag Limit: 25 sora and Virginia rails, singly or in the
aggregate. The possession limit is 25.
Michigan, 1842 and 1836 Zones:
Season Dates: Open September 15, close November 14, 1996.
Daily Bag and Possession Limits: 25 sora and Virginia rails, singly
or in aggregate. The possession limit is 25.
Common Snipe
Wisconsin and Minnesota 1837 and 1842 Zones:
Season Dates: Open September 15, close November 7, 1996.
Daily Bag Limit: 8 snipe.
Michigan, 1842 and 1836 Zones:
Season Dates: Open September 15, close November 14, 1996.
Daily Bag Limit: 8 snipe.
Woodcock
Wisconsin and Minnesota 1837 and 1842 Zones:
Season Dates: Open September 3, close November 30, 1996.
Daily Bag Limit: 5 woodcock.
Michigan, 1842 and 1836 Zones:
Season Dates: Open September 15, close November 14, 1996.
Daily Bag Limit: 5 woodcock.
General Conditions:
(i) While hunting waterfowl, a tribal member must carry on his/her
person a valid tribal waterfowl hunting permit.
(ii) Except as otherwise noted, tribal members will be required to
comply with tribal codes that will be no less restrictive than the
provisions of Chapter 10 of the Model Off-Reservation Code. This Model
Code was the subject of the stipulation in Lac Courte Oreilles v. State
of Wisconsin regarding migratory bird hunting. Except as modified
herein, these amended regulations parallel Federal requirements, 50 CFR
Part 20, and shooting hour regulations in 50 CFR Part 20, subpart K, as
to hunting methods, transportation, sale, exportation and other
conditions generally applicable to migratory bird hunting.
(iii) Tribal members in each zone will comply with State
regulations providing for closed and restricted waterfowl hunting
areas.
(iv) Minnesota and Michigan--Duck Blinds and Decoys. Tribal members
hunting in Minnesota will comply with tribal codes that contain
provisions parallel to applicable State statutes. Tribal members
hunting in Michigan will comply with tribal codes that contain
provisions parallel to Michigan law regarding duck blinds and decoys.
(v) Possession limits for each species are double the daily bag
limit, except on the opening day of the season, when the possession
limit equals the daily bag limit, unless otherwise specified.
(vi) Possession limits are applicable only to transportation and do
not include birds which are cleaned, dressed, and at a member's primary
residence. For purposes of enforcing bag and possession limits, all
migratory birds in the possession or custody of tribal members on ceded
lands will be considered to have been taken on those lands unless
tagged by a tribal or State conservation warden as having been taken
on-reservation. In Wisconsin, such tagging will comply with applicable
State statutes. All migratory birds which fall on reservation lands
will not count as part of any off-reservation bag or possession limit.
(e) Navajo Indian Reservation, Window Rock, Arizona (Tribal Members and
Nonmembers)
Band-tailed Pigeons
Season Dates: Open September 1, close September 30, 1996.
Daily Bag and Possession Limits: 5 and 10 pigeons, respectively.
Mourning Doves
Season Dates: Open September 1, close September 30, 1996.
Daily Bag and Possession Limits: 10 and 20 doves, respectively.
[[Page 46356]]
General Conditions: Tribal and nontribal hunters will comply with
all basic Federal migratory bird hunting regulations in 50 CFR Part 20,
regarding shooting hours and manner of taking. In addition, each
waterfowl hunter 16 years of age or over must carry on his/her person a
valid Migratory Bird Hunting and Conservation Stamp (Duck Stamp) signed
in ink across the face. Special regulations established by the Navajo
Nation also apply on the reservation.
(f) Oneida Tribe of Indians of Wisconsin, Oneida, Wisconsin (Tribal
Members)
Ducks
Season Dates: Open September 15, close November 30, 1996.
Daily Bag and Possession Limits: 5 ducks, including no more than 3
mallards (only 1 of which can be a mallard hen), 4 wood ducks, 1
canvasback, 1 redhead, 2 pintails, and 1 hooded merganser. Possession
limit is twice the daily bag limit.
Geese
Season Dates: Open September 1, close November 30, 1996.
Daily Bag and Limits: 2 Canada geese, that must be tagged after
harvest with tribal tags. The tribe will reissue tags upon registration
of the daily bag limit. A season quota of 150 birds is adopted. If the
quota is reached before the season concludes, the season will be closed
at that time.
Mourning Dove
Season Dates: Open September 1, close November 30, 1996.
Daily Bag and Possession Limits: 10 and 20 doves, respectively.
Woodcock
Season Dates: Open September 1, close November 30, 1996.
Daily Bag and Possession Limits: 6 and 12 woodcock, respectively.
General Conditions: Indians and non-Indians hunting on the Oneida
Indian Reservation or on lands under the jurisdiction of the Oneida
Nation will observe all basic Federal migratory bird hunting
regulations found in 50 CFR. Indian hunters are exempt from the
requirement to purchase a Migratory Waterfowl Hunting and Conservation
Stamp (Duck Stamp) and the plugging of shotgun to limit capacity to 3
shells.
(g) Point No Point Treaty Tribes, Kingston, Washington (Tribal and Non-
Tribal Hunters)
Mourning Doves
Season Dates: Open September 1, close September 15, 1996.
Daily Bag and Possession Limits: 10 and 20 doves, respectively.
Snipe
Season Dates: Open September 1, close December 16, 1996.
Daily Bag and Possession Limits: 8 and 16 snipe, respectively.
(h) Seminole Tribe of Florida, Big Cypress Seminole Reservation,
Clewiston, Florida (Tribal and Non-Tribal Hunters)
Mourning Doves
Season Dates: Open September 22, 1996, close January 15, 1997.
Daily Bag and Possession Limits: 12 and 24 doves, respectively.
General Conditions: Hunting would be on Sundays only from 1:00 p.m.
to sunset. All other Federal regulations contained in 50 CFR part 20
would apply.
(i) Squaxin Island Tribe, Squaxin Island Reservation, Shelton,
Washington (Tribal Members)
Ducks
Season Dates: Open September 15, 1996, close January 15, 1997.
Daily Bag and Possession Limits: 5 ducks, including no more than 1
canvasback. The season on harlequin ducks is closed. Possession limit
is twice the daily bag limit.
Geese
Season Dates: Open September 15, 1996, close January 15, 1997.
Daily Bag and Possession Limits: 4 geese, and may include no more
than 2 snow geese and 1 dusky Canada goose. The season on Aleutian and
Cackling Canada geese is closed. Possession limit is twice the daily
bag limit.
Brant
Season Dates: Open September 15, close December 31, 1996.
Daily Bag and Possession Limits: 2 and 4 brant, respectively.
Coots
Season Dates: Open September 15, 1996, close January 15, 1997.
Daily Bag Limits: 25 coots.
Snipe
Season Dates: Open September 15, 1996, and close January 15, 1997.
Daily Bag and Possession Limits: 8 and 16 snipe, respectively.
Band-tailed Pigeons
Season Dates: Open September 15, close December 1, 1996.
Daily Bag and Possession Limits: 2 and 4 pigeons, respectively.
General Conditions: All tribal hunters must obtain a Tribal Hunting
Tag and Permit from the tribe's Natural Resources Department and must
have the permit, along with the member's treaty enrollment card, on his
or her person while hunting. Shooting hours are one-half hour before
sunrise to one-half hour after sunset and steel shot is required for
all migratory bird hunting. Other special regulations are available at
the tribal office in Shelton, Washington.
(j) Tulalip Tribes of Washington, Tulalip Indian Reservation,
Marysville, Washington (Tribal Members)
Ducks/Coot
Season Dates: Open September 15, 1996, and close February 1, 1997.
Daily Bag and Possession Limits: 6 and 12 ducks, respectively;
except that bag and possession limits are restricted for blue-winged
teal, canvasback, harlequin, pintail and wood duck to those established
for the Pacific Flyway by final Federal frameworks, to be announced.
Geese
Season Dates: Open September 15, 1996, and close February 1, 1997.
Daily Bag and Possession Limits: 6 and 12 geese, respectively;
except that the bag limits for brant and cackling and dusky Canada
geese are those established for the Pacific Flyway in accordance with
final Federal frameworks, to be announced. The tribes also set a
maximum annual bag limit on ducks and geese for those tribal members
who engage in subsistence hunting.
Snipe
Season Dates: Open September 15, 1996, and close February 1, 1997.
Daily Bag and Possession Limits: 6 and 12 snipe, respectively.
General Conditions: All waterfowl hunters, members and non-members,
must obtain and possess while hunting a valid hunting permit from the
Tulalip tribes. Also, non-tribal members sixteen years of age and
older, hunting pursuant to Tulalip Tribes' Ordinance No. 67, must
possess a validated Federal Migratory Bird Hunting and Conservation
Stamp and a validated State of Washington Migratory Waterfowl Stamp.
All Tulalip tribal members must have in their possession while hunting,
or accompanying another, their valid tribal identification card. All
hunters are required to adhere to a number of other special regulations
[[Page 46357]]
enforced by the tribes and available at the tribal office.
(k) White Mountain Apache Tribe, Fort Apache Indian Reservation,
Whiteriver, Arizona (Tribal Members and Non-tribal Hunters)
Band-Tailed Pigeons
Season Dates: Open September 6, close September 15, 1996.
Daily Bag and Possession Limits: 3 and 6 pigeons, respectively.
Mourning Doves
Season Dates: Open September 6, close September 15, 1996.
Daily Bag and Possession Limits: 8 and 16 doves, respectively.
General Conditions: All non-tribal hunters hunting band-tailed
pigeons and mourning doves on Reservation lands shall have in their
possession a valid White Mountain Apache Daily or Yearly Small Game
Permit. In addition to a small game permit, all non-tribal hunters
hunting band-tailed pigeons must have in their possession a White
Mountain Special Band-tailed Pigeon Permit. Other special regulations
established by the White Mountain Apache Tribe apply on the
reservation. Tribal and nontribal hunters will comply with all basic
Federal migratory bird hunting regulations in 50 CFR Part 20 regarding
shooting hours and manner of taking.
Dated: August 27, 1996.
George T. Frampton, Jr.,
Assistant Secretary for Fish and Wildlife and Parks.
[FR Doc. 96-22249 Filed 8-29-96; 8:45 am]
BILLING CODE 4310-55-F
Complete official Federal Register PDF
FR Doc. 96-22246 Direct Food Substances Affirmed as Generally Recognized as Safe; Enzyme-Modified Lecithin
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Pages 45886-45889]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22246]
=======================================================================
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration
21 CFR Part 184
[Docket No. 85G-0335]
Direct Food Substances Affirmed as Generally Recognized as Safe;
Enzyme-Modified Lecithin
AGENCY: Food and Drug Administration, HHS.
ACTION: Final rule.
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SUMMARY: The Food and Drug Administration (FDA) is amending its
regulations to affirm that the use of enzyme-modified lecithin as a
direct human food ingredient is generally recognized as safe (GRAS).
This action is in response to a petition filed by Kyowa Hakko Kogyo
Co., Ltd.
DATES: Effective August 30, 1996. The Director of the Office of the
Federal Register approves the incorporation by reference in accordance
with 5 U.S.C. 552(a) and 1 CFR part 51 of two publications listed in
new Sec. 184.1063, effective August 30, 1996.
FOR FURTHER INFORMATION CONTACT: Aydin Orstan, Center for Food Safety
and Applied Nutrition (HFS-217), Food and Drug Administration, 200 C
St. SW., Washington, DC 20204, 202-418-3076.
SUPPLEMENTARY INFORMATION:
I. Background
In accordance with the procedures described in Sec. 170.35 (21 CFR
170.35),
[[Page 45887]]
Kyowa Hakko Kogyo Co., Ltd., Tokyo, Japan, submitted a petition (GRASP
5G0301) proposing that enzyme-modified lecithin be affirmed as GRAS as
a direct human food ingredient.
FDA published a notice of filing of this petition in the Federal
Register of August 27, 1985 (50 FR 34758), and gave interested parties
an opportunity to submit comments to the Dockets Management Branch
(HFA-305), Food and Drug Administration, 12420 Parklawn Dr., rm. 1-23,
Rockville, MD 20857. FDA received two comments in response to that
notice. One of the comments stated that the specifications proposed by
the petitioner for enzyme-modified lecithin did not agree with the
specifications for lecithin in the Food Chemicals Codex, 3d ed. (1981)
and argued that because of the differences in the specifications,
enzyme-modified lecithin should be the subject of a food additive
petition rather than a GRAS affirmation petition. FDA finds that the
specifications of enzyme-modified lecithin need not agree with those of
lecithin, because the two substances are chemically different. The
agency further concludes that the differences between the
specifications should not affect the classification of this petition.
The second comment endorsed the petitioned use of enzyme-modified
lecithin. Subsequently, the same commenter requested that FDA regulate
enzyme-modified lecithin under the existing GRAS affirmation regulation
for lecithin (Sec. 184.1400) (21 CFR 184.1400)). The agency concludes
that because the chemical composition of enzyme-modified lecithin is
different than that of lecithin, enzyme-modified lecithin should be
regulated separately.
II. Standards for GRAS Affirmation
Under Sec. 170.30 (21 CFR 170.30), general recognition of safety
may be based only on the views of experts qualified by scientific
training and experience to evaluate the safety of substances added to
food. The basis of such views may be either: (1) Scientific procedures,
or (2) in the case of a substance used in food prior to January 1,
1958, experience based on common use in food (Sec. 170.30(a)). General
recognition of safety based upon scientific procedures requires the
same quantity and quality of scientific evidence as is required to
obtain approval of a food additive and ordinarily is to be based upon
published studies, which may be corroborated by unpublished studies and
other data and information (Sec. 170.30(b)). In its petition, Kyowa
Hakko Kogyo Co., Ltd., relies on scientific procedures, primarily
published scientific papers and books, corroborated by unpublished
information, to demonstrate that enzyme-modified lecithin is GRAS.
III. Identity, Production, and Technical Effect
Lecithin is a complex mixture primarily composed of phospholipids,
triglycerides, fatty acids, and carbohydrates (Refs. 1 and 2). The
removal of most of the triglycerides and fatty acids of lecithin
produces an ``oil-free'' or ``deoiled'' lecithin with a 90 percent or
more phospholipid content. The enzyme phospholipase A2, identified
with the Enzyme Commission (EC) number EC 3.1.1.4, converts the
principal phospholipids of lecithin to their corresponding
lysophospholipids. This reaction produces enzyme-modified lecithin
(Refs. 3 through 6).
Enzyme-modified lecithin is prepared from various types of crude or
deoiled lecithin, using either purified phospholipase A2 or
pancreatin, an enzyme preparation from porcine pancreas that contains
phospholipase A2. Added calcium chloride supplies calcium ions
required for the activation of phospholipase A2. The process is
carried out at pH 6 to 10 and within the temperature range of 30 to
70 deg.C. At completion, phospholipase A2 is inactivated by
raising the temperature to 90 to 100 deg.C.
The resulting enzyme-modified lecithin contains lysophospholipids
and fatty acids produced by the enzymic reaction, as well as other
components of lecithin (e.g., phospholipids, carbohydrates).
Inactivated phospholipase A2 and calcium chloride are also present
in enzyme-modified lecithin. The exact composition of enzyme-modified
lecithin varies depending on the type and the composition of lecithin
used and on the degree of modification of lecithin achieved during the
production of enzyme-modified lecithin (Ref. 7).
The petitioner intends to use enzyme-modified lecithin as an
emulsifier in various foods, including bakery products, pasta products,
margarine, mayonnaise, and salad dressings. The petition contains a
published report and several patents demonstrating the effectiveness of
enzyme-modified lecithin as an emulsifier in foods (Refs. 4, 5, 6, 8,
and 9).
IV. Safety Evaluation
In evaluating the safety of enzyme-modified lecithin, the agency
considered the following issues: (1) The safety of lecithin and
phospholipase A2, (2) the safety of enzyme-modified lecithin, (3)
exposure to levels of the ingredient in food, and (4) specifications.
A. The Safety of Lecithin and Phospholipase A2
FDA has affirmed lecithin as GRAS (Sec. 184.1400). Therefore, the
agency has no safety concerns about the use of lecithin for the
manufacture of enzyme-modified lecithin.
Phospholipase A2 is one of the digestive enzymes present in
the pancreatic juice of mammals, including humans (Refs. 10 through
12). Phospholipase A2 is irreversibly inactivated by heat at the
end of the manufacture of enzyme-modified lecithin. Active and inactive
enzymes are constituents of many foods normally consumed by humans.
Therefore, FDA concludes that inactive phospholipase A2 in enzyme-
modified lecithin will be digested like any other protein present in
food. The agency also notes that calcium chloride, which is used to
activate phospholipase A2 during the production of enzyme-modified
lecithin, has been affirmed as GRAS (21 CFR 184.1193).
B. The Safety of Enzyme-Modified Lecithin
The end products of the modification of lecithin by phospholipase
A2 are lysophospholipids and fatty acids. Fatty acids are normal
constituents of lecithin. They also occur naturally in many foods and
form in the human body during normal cellular metabolism (Refs. 11 and
12). FDA has approved the use of salts of fatty acids as binders,
emulsifiers and anticaking agents in food (21 CFR 172.863). Therefore,
the agency has no safety concerns about the presence of fatty acids in
enzyme-modified lecithin.
Numerous published reports establish that the lysophospholipids
produced during the manufacture of enzyme-modified lecithin also occur
naturally in a variety of foods, especially in cereal grains and eggs
(Refs. 13 through 19). Furthermore, these lysophospholipids form in the
human body from the action of pancreatic phospholipase A2 on
dietary lecithin (Refs. 11 and 12).
FDA reviewed several published studies suggesting that under
certain pathologic conditions the intestinal fluid containing
lysophospholipids may regurgitate into the stomach and damage the
stomach mucosal tissue (Refs. 12 and 20 through 23). The agency
evaluated these studies in light of the possible adverse effects of
enzyme-modified lecithin ingested in food. FDA concludes that the
results of the studies suggesting that regurgitated lysophospholipids
may damage the
[[Page 45888]]
stomach mucosal tissue are not relevant to the food ingredient uses of
enzyme-modified lecithin, because the lysophospholipids present in
enzyme-modified lecithin will be emulsified within a large excess of
undigested food, which would provide a physical barrier to direct
interaction of the lysophospholipids with the mucosal lining.
Moreover, in 1979, the Select Committee on GRAS Substances reviewed
the available information on the metabolism of lecithin, including its
breakdown to lysophospholipids in the human body, and concluded that
there was no evidence of a hazard to the public from the use of
lecithin in food at existing levels or levels that might reasonably be
expected in the future (Ref. 24).
FDA also reviewed one published animal feeding study included in
the petition (Ref. 6). During this study two groups of rats were fed
for 3 and 13 weeks, respectively, diets containing various doses of
enzyme-modified lecithin. The results of this study did not reveal any
significant adverse effects in rats attributable to enzyme-modified
lecithin.
Furthermore, the petitioner provided one unpublished corroborative
feeding study. During this study enzyme-modified lecithin was
administered to rats at a dose of 2,000 milligrams per kilogram body
weight per day (mg/kg bw/d) for 30 days, followed by 6 days per week
for 60 days, for a total of 90 days. The results of this study did not
reveal any adverse effects on the gastric mucosa of the rats or any
other significant adverse effects attributable to enzyme-modified
lecithin.
C. Estimated Exposure Levels
Based on the petitioner's intended use of enzyme-modified lecithin
in a manner similar to lecithin, and using information on consumption
of various food categories containing lecithin (Ref. 25), the agency
calculated the estimated daily intake (EDI) of enzyme-modified lecithin
as 326 mg/person/d.
Moreover, the data obtained in the published 13-week rat feeding
study (Ref. 6) showed no adverse effects at a level of 20 grams enzyme-
modified lecithin/kg bw/d. Application of a 1,000-fold safety factor to
this value produces, for a 60 kg person, an acceptable daily intake of
1,200 mg enzyme-modified lecithin/person/d, which exceeds the EDI
reported above (326 mg/person/d).
D. Specifications
FDA reviewed the specifications for enzyme-modified lecithin
suggested in the petition. The agency notes that the petitioner
originally suggested a lead limit of not more than 10 parts per
million. However, after discussions with FDA about the agency's desire
to limit human exposure to lead to the lowest level possible in food
(see 59 FR 5363, February 4, 1994), the petitioner amended the petition
to suggest a lead limit of not more than 1.0 part per million. FDA
agrees that this lower limit should be adopted. Also, the agency notes
that in a notice published in the Federal Register of March 14, 1994
(59 FR 11789), the National Academy of Sciences/Institute of Medicine
Committee on Food Chemicals Codex (the Committee) announced its new
policy that inclusion of arsenic limits in Food Chemicals Codex
monographs should no longer be routine, but should be considered on an
``as-needed'' basis. To implement this new policy, the Committee
proposed to delete the arsenic specification for various Food Chemicals
Codex substances, including lecithin. The proposal became final when
the fourth edition of the Food Chemicals Codex was published in 1996.
FDA agrees that a specification for arsenic in enzyme-modified lecithin
is not necessary. Therefore, no such specification is being adopted in
this final rule. FDA concludes that the other specifications suggested
in the petition should be adopted.
V. Conclusion
FDA has evaluated the published information in the petition, along
with other corroborative information, and finds that the use of enzyme-
modified lecithin as an emulsifier in foods is GRAS.
Furthermore, these data show no potential risk from any foreseeable
use of enzyme-modified lecithin. Therefore, in accordance with 21 CFR
184.1(b)(1), the agency is affirming that the use of enzyme-modified
lecithin in foods is GRAS with no limits other than current good
manufacturing practice.
VI. Environmental Impact
The agency has carefully considered the potential environmental
effects of this action. FDA has concluded that the action will not have
a significant impact on the human environment, and that an
environmental impact statement is not required. The agency's finding of
no significant impact and the evidence supporting that finding,
contained in an environmental impact analysis report submitted under
previous 21 CFR part 25, may be seen in the Dockets Management Branch
(address above) between 9 a.m. and 4 p.m., Monday through Friday.
VII. Analysis of Impacts
FDA has examined the economic implications of this final rule
affirming the GRAS status of the use of enzyme-modified lecithin in
foods under Executive Order 12866. Executive Order 12866 directs
agencies to assess all costs and benefits of available regulatory
alternatives and, when regulation is necessary, to select regulatory
approaches that maximize net benefits (including potential economic,
environmental, public health, and safety issues; distributive impacts;
and equity). The agency believes that this final rule is consistent
with the regulatory philosophy and principles identified in the
Executive Order. In addition, the final rule is not a significant
regulatory action as defined by the Executive Order and so is not
subject to review under the Executive Order.
If a rule has a significant economic impact on a substantial number
of small entities, the Regulatory Flexibility Act requires agencies to
analyze regulatory options that would minimize the significant economic
impact of the rule on small entities. This final rule recognizes the
applicability of a statutory exemption. The impact of the rule is to
remove uncertainty about the regulatory status of enzyme-modified
lecithin for use in foods. Therefore, pursuant to the Regulatory
Flexibility Act, 5 U.S.C. 605(b), the Commissioner certifies that this
rule will not have a significant economic impact on a substantial
number of small entities.
VIII. Effective Date
As this rule recognizes an exemption from the food additive
definition in the Federal Food, Drug, and Cosmetic Act, and from the
approval requirements applicable to food additives, no delay in
effective date is required by the Administrative Procedure Act (5
U.S.C. 553(d)). The rule will therefore be effective immediately (5
U.S.C. 553(d)(1)).
IX. References
The following references have been placed on display in the Dockets
Management Branch (address above) and may be seen by interested persons
between 9 a.m. and 4 p.m., Monday through Friday.
1. Scholfield, C. R., ``Composition of Soybean Lecithin,''
Journal of American Oil Chemists' Society, 58:889-892, 1981.
2. Rydhag, L., ``The Importance of the Phase Behaviour of
Phospholipids for Emulsion Stability,'' Fette Seifen Anstrichmittel,
81:168-173, 1979.
3. Van Nieuwenhuyzen, W., ``The Industrial Uses of Special
Lecithins: A Review,'' Journal of American Oil Chemists' Society,
58:886-888, 1981.
[[Page 45889]]
4. Lincklaen, H. W., and J. H. M. Rek, ``Pourable Emulsion,''
U.S. Patent 3,796,815, March 12, 1974.
5. Van Dam, A. F., ``Emulsions,'' U.S. Patent 4,034,124, July 5,
1977.
6. Dutilh, C. E., and W. Groger, ``Improvement of Product
Attributes of Mayonnaise by Enzymic Hydrolysis of Egg Yolk with
Phospholipase A2,'' Journal of Science of Food and Agriculture,
32:451-458, 1981.
7. Pardun, H., ``Advances in the Extraction and Processing of
Phytolecithins,'' Fette Seifen Anstrichmittel, 84:1-29, 1982.
8. Pardun, H., ``Phosphatide Emulsifiers,'' U.S. Patent
3,661,795, May 9, 1972.
9. Van Dam, A. F., ``Oil-in-Water Emulsion and Process for the
Preparation Thereof,'' U.S. Patent 4,119,564, October 10, 1978.
10. De Haas, G. H., N. M. Postema, W. Nieuwenhuizen, and L. L.
M. Van Deenen, ``Purification and Properties of Phospholipase A from
Porcine Pancreas,'' Biochimica et Biophysica Acta, 159:103-117,
1968.
11. Rossiter, R. J., ``Metabolism of Phosphatides,'' in
``Metabolic Pathways,'' edited by D. M. Greenberg, vol. II, pp. 69-
115, Academic Press, New York, 1968.
12. Johnson, A. G., and S. J. McDermott, ``Lysolecithin: A
Factor in the Pathogenesis of Gastric Ulceration?'' Gut, 15:710-713,
1974.
13. Acker, L., and G. Becker, ``On the Subject of the Grain
Starch Lipids,'' Gordian, 72:275-278, 1972.
14. Hargin, K. D., and W. R. Morrison, ``The Distribution of
Acyl Lipids in the Germ, Aleurone, Starch and Non-starch Endosperm
of Four Wheat Varieties,'' Journal of Science of Food and
Agriculture, 31:877-888, 1980.
15. Morrison, W. R., D. L. Mann, W. Soon, and A. M. Coventry,
``Selective Extraction and Quantitative Analysis of Non-starch and
Starch Lipids from Wheat Flour,'' Journal of Science of Food and
Agriculture, 26:507-521, 1975.
16. Clayton, T. A., and W. R. Morrison, ``Changes in Flour
Lipids During the Storage of Wheat Flour,'' Journal of Science of
Food and Agriculture, 23:721-736, 1972.
17. Mano, Y., and Y. Fujino, ``Combined Lipid in Rice Starch,''
Denpun Kagaku, 22:1-5, 1975.
18. Tan, S. L., and W. R. Morrison, ``The Distribution of Lipids
in the Germ, Endosperm, Pericarp and Tip Cap of Amylomaize, LG-11
Hybrid Maize and Waxy Maize,'' Journal of American Oil Chemists'
Society, 56:531-535, 1979.
19. Weihrauch, J. L., and Y. Son, ``The Phospholipid Content of
Foods,'' Journal of American Oil Chemists' Society, 60:1971-1978,
1983.
20. Davenport, H. W., ``Effect of Lysolecithin, Digitonin, and
Phospholipase A upon the Dog's Gastric Mucosal Barrier,''
Gastroenterology, 59:505-509, 1970.
21. Bolin, T., L. Franzen, R. Sjodahl, and C. Tagesson,
``Passage of Molecules Through the Wall of the Gastrointestinal
Tract,'' Scandinavian Journal of Gastroenterology, 21:441-448, 1986.
22. Salo, J. A., H. Myllarniemi, and E. Kivilaakso, ``Morphology
of Lysolecithin-Induced Damage on Esophageal Mucosa,'' Journal of
Surgical Research, 42:290-297, 1987.
23. Ritchie, W. P., ``Other Causes of GI Mucosal Injury: Upper
Intestinal Content,'' Clinical and Investigative Medicine, 10:264-
269, 1987.
24. Select Committee on GRAS Substances, ``Evaluation of the
Health Aspects of Lecithin as a Food Ingredient,'' Report No. 106,
Life Sciences Research Office, Federation of American Societies for
Experimental Biology, Bethesda, Maryland, 1979.
25. Memorandum from the Food Additive Chemistry Evaluation
Branch to the GRAS Review Branch, June 3, 1985.
List of Subjects in 21 CFR Part 184
Food ingredients, Incorporation by reference.
Therefore, under the Federal Food, Drug, and Cosmetic Act and under
authority delegated to the Commissioner of Food and Drugs and
redelegated to the Director, Center for Food Safety and Applied
Nutrition, 21 CFR part 184 is amended as follows:
PART 184--DIRECT FOOD SUBSTANCES AFFIRMED AS GENERALLY RECOGNIZED
AS SAFE
1. The authority citation for 21 CFR part 184 continues to read as
follows:
Authority: Secs. 201, 402, 409, 701 of the Federal Food, Drug,
and Cosmetic Act (21 U.S.C. 321, 342, 348, 371).
2. New Sec. 184.1063 is added to subpart B to read as follows:
Sec. 184.1063 Enzyme-modified lecithin.
(a) Enzyme-modified lecithin is prepared by treating lecithin with
either phospholipase A2 (EC 3.1.1.4) or pancreatin.
(b) The ingredient meets the specifications in paragraphs (b)(1)
through (b)(8) of this section. Unless otherwise noted, compliance with
the specifications listed below is determined according to the methods
set forth for lecithin in the Food Chemicals Codex, 4th ed. (1996), pp.
220-221, which are incorporated by reference in accordance with 5
U.S.C. 552(a) and 1 CFR part 51. Copies are available from the National
Academy Press, 2101 Constitution Ave. NW., Washington DC 20418, or may
be examined at the Center for Food Safety and Applied Nutrition's
Library, 200 C St. SW., rm. 3321, Washington, DC, or at the Office of
the Federal Register, 800 North Capitol St. NW., suite 700, Washington,
DC.
(1) Acetone-insoluble matter (phosphatides), not less than 50.0
percent.
(2) Acid value, not more than 40.
(3) Lead, not more than 1.0 part per million, as determined by
atomic absorption spectroscopy.
(4) Heavy metals (as Pb), not more than 20 parts per million.
(5) Hexane-insoluble matter, not more than 0.3 percent.
(6) Peroxide value, not more than 20.
(7) Water, not more than 4.0 percent.
(8) Lysolecithin, 50 to 80 mole percent of total phosphatides as
determined by ``Determination of Lysolecithin Content of Enzyme-
Modified Lecithin: Method I,'' dated 1985, which is incorporated by
reference in accordance with 5 U.S.C. 552(a) and 1 CFR part 51. Copies
are available from the
Division of Petition Control, Center for Food Safety and Applied
Nutrition (HFS-215), Food and Drug Administration, 200 C St. SW.,
Washington, DC 20204, or may be examined at the Center for Food Safety
and Applied Nutrition's Library, 200 C St. SW., rm. 3321, Washington,
DC, or at the Office of the Federal Register, 800 North Capitol St.
NW., suite 700, Washington, DC.
(c) In accordance with Sec. 184.1(b)(1), the ingredient is used in
food with no limitation other than current good manufacturing practice.
The affirmation of this ingredient as generally recognized as safe as a
direct human food ingredient is based upon the following current good
manufacturing practice conditions of use:
(1) The ingredient is used as an emulsifier as defined in
Sec. 170.3(o)(8) of this chapter.
(2) The ingredient is used at levels not to exceed current good
manufacturing practice.
Dated: July 31, 1996.
Fred R. Shank,
Director, Center for Food Safety and Applied Nutrition.
[FR Doc. 96-22246 Filed 8-29-96; 8:45 am]
BILLING CODE 4160-01-F
Complete official Federal Register PDF
FR Doc. 96-22245 Migratory Bird Harvest Information Program
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Pages 46350-46352]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22245]
[[Page 46349]]
_______________________________________________________________________
Part IX
Department of the Interior
_______________________________________________________________________
Fish and Wildlife Service
_______________________________________________________________________
50 CFR Part 20
Migratory Bird Hunting; Harvest Information Program; Hunting
Regulations on Certain Federal Indian Reservations and Ceded Lands;
Early Seasons and Bag and Possession Limits; Final Rules
Federal Register / Vol. 61, No. 170 / Friday, August 30, 1996 / Rules
and Regulations
[[Page 46350]]
DEPARTMENT OF THE INTERIOR
Fish and Wildlife Service
50 CFR Part 20
RIN 1018-AD08
Migratory Bird Harvest Information Program
AGENCY: Fish and Wildlife Service, Interior.
ACTION: Final rule.
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SUMMARY: The Fish and Wildlife Service (Service) and State wildlife
agencies (States) are cooperatively establishing a national Migratory
Bird Harvest Information Program (Program). The Program requires
licensed migratory game bird hunters to supply their names, addresses,
and other necessary information to the hunting licensing authority of
the State in which they hunt. The Program improves the quality and
extent of information about the harvests of migratory game birds to
better manage these populations. The Program requires hunters to have
evidence of current Program participation (Program validation) on their
person while hunting migratory game birds in participating States.
Hunters' names and addresses will provide a sample frame for voluntary
hunter surveys needed to improve harvest estimates for all migratory
game birds. States will gather migratory bird hunters' names and
addresses and the Service will conduct the harvest surveys. This
specific action adds 7 States to the list of those participating in the
Program, bringing the total to 17.
EFFECTIVE DATE: This rule takes effect on September 1, 1996.
FOR FURTHER INFORMATION CONTACT: Larry J. Hindman, Migratory Bird
Harvest Information Program Coordinator, Office of Migratory Bird
Management, U.S. Fish and Wildlife Service, (410) 827-8612, FAX (410)
827-5186.
SUPPLEMENTARY INFORMATION: This final rule facilitates the collection
of needed information about migratory game birds harvests. A proposed
rule was published in the April 29, 1996, Federal Register (61 FR
18936). This final rule amends Section 20.20 of 50 CFR by adding
Alabama, Georgia, Idaho, Illinois, Maine, Minnesota, Mississippi,
Pennsylvania, Tennessee, and Vermont to the list of participating
States. Licensed hunters, as a condition for hunting migratory game
birds in these States, would be required to annually provide their
names, addresses, and other necessary information to the licensing
authority of the State in which they hunt. This information will
provide a nationwide sampling frame of migratory bird hunters, from
which representative samples of hunters will be selected and asked to
participate in voluntary harvest surveys that the Service will conduct
annually.
The Service and States are currently implementing this Program over
a 5-year period, starting with the 1994-95 hunting season. During this
implementation, the Program's participation requirement will not apply
on Federal Indian Reservations or to tribal members hunting on ceded
lands. Participating States will provide the sample frame by annually
collecting the name, address, and date of birth of each State licensed
migratory bird hunter. To reduce survey costs and to identify hunters
who hunt less commonly-hunted species, States will also request that
each migratory bird hunter provide a brief summary of his or her
migratory bird hunting activity for the previous year. States will send
this information to the Service, and the Service will sample hunters
and conduct national hunter activity and harvest surveys.
A notice of intent to establish the Program was published in the
June 24, 1991, Federal Register (56 FR 28812). A final rule
establishing the Program and initiating a 2-year pilot phase in three
volunteer States (California, Missouri, and South Dakota) was published
in the March 19, 1993, Federal Register (58 FR 15093). The pilot phase
was completed following the 1993-94 migratory bird hunting seasons in
California, Missouri, and South Dakota.
A State/Federal group was formed to evaluate Program requirements,
the different approaches used by the pilot States, and the Service's
survey procedures during the pilot phase. Their evaluation resulted in
Program changes specified in a final rule, published in the October 21,
1994, Federal Register (59 FR 53334), initiating the implementation
phase of the Program.
Currently, all licensed migratory game bird hunters in
participating States are required to have a Program validation,
indicating that they have identified themselves as migratory bird
hunters and have provided the required information to the State
wildlife agency. Hunters must provide the required information to each
State in which they hunt migratory birds. Validations are printed on or
attached to the annual State hunting license or on a State-specific
supplementary permit.
The State/Federal technical group continues evaluating the Program
to determine the adequacy and timeliness of the sample frame, time
burden, cost, and other impacts on hunters, State license agents, State
wildlife agencies, and the Service. Current emphasis is on the time
requirement for the sample frame and alternative survey methods for
special groups of unlicensed hunters (e.g., junior and senior hunters).
Names, addresses, and other information are needed in time to
distribute hunting record forms to selected hunters before they forget
the details of their hunts. Previously, the Service's survey design
required participating States to send the required information to the
Service within 5 business days of the hunting license or permit
issuance (10 business days if the information is in electronic form).
Several States expressed concern that they could not meet this time
requirement. The Service conducted an experiment during the 1994-95
hunting season to determine whether extending the time requirement
would adversely affect the accuracy of survey results. Based on the
results of that experiment, the Service now requires participating
States to forward hunter information to the Service within 30 calendar
days from the date of license or permit issuance.
The Service does not require hunters exempted from State permit and
licensing requirements to participate in the Program. This would
include junior hunters, senior hunters, landowners, and other special
categories. Exemptions vary on a State-by-State basis. Excluding these
hunters from the Program also excludes their harvest from the estimates
which may result in serious bias. Thus States may require exempted
hunters to participate; and the Service encourages States to provide
any available information about these groups (for example, junior
hunter safety course participant lists, names and addresses of
landowners, State harvest estimates for exempted categories) to the
Service for use in improving harvest estimates. Methodology may vary by
State and will be incorporated into individual Memoranda of Agreement
with the Service.
The Service will use the names and addresses only for conducting
hunter surveys. Names and addresses will be deleted after the surveys.
State uses of these names and addresses will be governed by State laws.
Under 5 U.S.C. 553(d)(3) at least 30 days is required for a rule to
become effective unless an agency has good cause to make it sooner. The
Service and the States are currently implementing this Program over a
five-year period at the request of the International Association of
Fish and
[[Page 46351]]
Wildlife Agencies. The States added by this rule to the list of
participating States, Alabama, Georgia, Idaho, Illinois, Maine,
Minnesota, Mississippi, Pennsylvania, Tennessee, and Vermont, have all
prepared for a September 1 implementation date of the Program.
Generally, migratory game bird hunting seasons may begin as early as
September 1, 1996, and since migratory game bird hunters are required
to have a Program validation on their person while hunting migratory
game birds in these States, the Service believes this rule should be
effective on September 1, 1996.
Review of Comments and the Service's Response
The Service received comments on the proposed rule from six States.
All supported the Program, but requested a delay in their
implementation date.
1. Implementation Phase--Schedule of State Participation
Comment: North Carolina requested implementation be delayed to
1997. North Carolina is considering a major license system change in
1997 and wants to implement the Harvest Information Program with this
change. Arkansas, Colorado, Virginia, and Wisconsin requested
implementation be delayed to 1998, due to anticipated changes in their
licensing systems. South Carolina requested implementation be delayed
to 1998 to obtain approval from their State legislature to implement
the Program.
Service Response: The Service has consistently encouraged States to
advance in the implementation schedule, and discourage any delays.
However, the proposed delays by Arkansas, Colorado, North Carolina,
Virginia, and Wisconsin are premised on improved license procedures
that will better accommodate the Program. South Carolina's proposed
delay is based on implementing the Program with the endorsement of
their State legislature which will help ensure successful
implementation. Thus, the Service agrees to North Carolina's Program
implementation and implementation in 1998 for Arkansas, Colorado, South
Carolina, Virginia, and Wisconsin.
NEPA Consideration
The Service considered the establishment of this Harvest
Information Program and options in the ``Environmental Assessment:
Migratory Bird Harvest Information Program.'' Copies of this document
are available from the Service at the address indicated under the
caption FOR FURTHER INFORMATION CONTACT.
Regulatory Flexibility Act and the Paperwork Reduction Act
On June 14, 1991, the Assistant Secretary for Fish and Wildlife and
Parks concluded the rule would not have a significant effect on a
substantial number of small entities under the Regulatory Flexibility
Act 5 USC 601 et seq. This rule will eventually affect about 3-5
million migratory game bird hunters when it is fully implemented. It
will require licensed migratory game bird hunters to identify
themselves and to supply their names, addresses, and birth dates to the
State licensing authority. Additional information will be requested in
order that they can be efficiently sampled for a voluntary national
harvest survey. Hunters will be required to have Program validation on
their person while hunting migratory game birds.
The States may require a fee to cover their administrative costs.
State hunting-license vendors range from small to very large entities.
This rule should not economically impact any vendors/agents. Only
migratory game bird hunters (individuals) must provide this
information, so this rule should not adversely affect small entities.
The collection of information contained in this rule was approved
by the Office of Management and Budget under 44 U.S.C. 3501 et seq. and
assigned clearance number 1018-0015. The Service requires information
from licensed hunters before they can hunt migratory game birds.
The public reporting burden for this collection of information is
estimated to average 0.015 hours per response. This includes the time
needed to review instructions; search existing data sources; gather and
maintain data; and complete and review the collection of information.
Comments regarding the burden estimate or any other aspect of these
reporting requirements should be directed to the Service Information
Collection Clearance Officer, ms 224 ARLSQ, U.S. Fish and Wildlife
Service, 1849 C Street, NW., Washington, DC 20240, or the Office of
Management and Budget, Paperwork Reduction Project 1018-0015,
Washington, DC 20503.
Executive Order 12866
This rule was not subject to Office of Management and Budget review
under Executive Order 12866.
Executive Order 12612--Federalism
The regulations do not have significant Federalism effects as
provided in Executive Order 12612. Due to the migratory nature of
certain bird species, the Federal Government was given responsibility
for their management under the Migratory Bird Treaty Act. State harvest
surveys presently cannot provide adequate national estimates of
migratory game bird harvests for the following reasons: (1) Some States
do not now conduct annual harvest surveys or maintain accessible lists
of hunter names and addresses; (2) comparable information is not
available from all States because States have different survey
procedures; (3) many State license lists are not available in time to
permit distribution of hunter records early in the hunting season; and
(4) budget constraints often prevent States from conducting harvest
surveys during certain years and may cause some States to eliminate
them completely.
The regulations do not have a substantial direct effect on fiscal
capacity; do not change the roles or responsibilities of Federal or
State Governments; and do not intrude on State policy or
administration. Therefore, these regulations have no significant
Federalism effects and do not warrant the preparing of a Federalism
Assessment. In fact, they promote Federal/State cooperation and reduce
duplication of survey efforts.
These regulations do not constitute a significant regulatory action
as defined by Executive Order 12866. Therefore an assessment of their
effects on State governments, under the Unfunded Mandates Reform Act of
1995 (Pub. L. 104-4), is not required. The States may require a
handling fee from licensed migratory bird hunters to cover the
administrative costs of implementing the Program. Thus these
regulations will not have a significant economic impact on the States.
Executive Order 12360--Taking of Individual Property Rights
Executive Order 12360 discussed guidelines for the taking of
individual property rights. These regulations, authorized by the
Migratory Bird Treaty Act, do not affect any constitutionally-protected
property rights. They would not result in the physical occupancy,
physical invasion, or regulatory taking of any property.
Authorship
The primary author of this rule is Larry J. Hindman, Office of
Migratory Bird Management.
List of Subjects in 50 CFR Part 20
Exports, Hunting, Imports, Reporting and record keeping
requirements, Transportation, Wildlife.
[[Page 46352]]
For the reasons set out in the preamble, 50 CFR Part 20 is amended
as set forth below.
PART 20--[AMENDED]
1. The authority citation for Part 20 continues to read as follows:
Authority: 16 U.S.C. 703-712 and 16 U.S.C. 742 a-j.
2. Section 20.20 is amended by revising paragraphs (b) and (e) to
read as follows:
Sec. 20.20 Migratory Bird Harvest Information Program.
* * * * *
(b) General provisions. Each person hunting migratory game birds in
Alabama, California, Georgia, Idaho, Illinois, Maine, Maryland,
Michigan, Minnesota, Mississippi, Missouri, Oklahoma, Oregon,
Pennsylvania, South Dakota, Tennessee, and Vermont must identify
himself or herself as a migratory bird hunter and give his or her name,
address, and date of birth to the respective State hunting licensing
authority and must have on his or her person evidence, provided by that
State, of compliance with this requirement.
* * * * *
(e) Implementation schedule. The Service continues to implement the
Program over the next 2-year period from 1997-1998. States must
participate on or before the following schedule:
1997--Arizona, Florida, Kentucky, Ohio, North Carolina, and Texas.
1998--Alaska, Arkansas, Colorado, Connecticut, Delaware, Indiana,
Iowa, Kansas, Louisiana, Massachusetts, Montana, Nebraska, Nevada, New
Hampshire, New Jersey, New Mexico, New York, North Dakota, Rhode
Island, South Carolina, Utah, Virginia, Washington, West Virginia,
Wisconsin, and Wyoming.
Dated: August 27, 1996.
George T. Frampton, Jr.,
Assistant Secretary for Fish and Wildlife and Parks.
[FR Doc. 96-22245 Filed 8-29-96; 8:45 am]
BILLING CODE 4310-55-F
Complete official Federal Register PDF
FR Doc. 96-22244 Migratory Bird Hunting; Early Seasons and Bag and Possession Limits for Certain Migratory Game Birds in the Contiguous United States, Alaska, Hawaii, Puerto Rico, and the Virgin Islands
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Pages 46357-46372]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22244]
-----------------------------------------------------------------------
DEPARTMENT OF THE INTERIOR
50 CFR Part 20
RIN 1018-AD69
Migratory Bird Hunting; Early Seasons and Bag and Possession
Limits for Certain Migratory Game Birds in the Contiguous United
States, Alaska, Hawaii, Puerto Rico, and the Virgin Islands
AGENCY: Fish and Wildlife Service, Interior.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: This rule prescribes the hunting seasons, hours, areas, and
daily bag and possession limits of mourning, white-winged, and white-
tipped doves; band-tailed pigeons; rails; moorhens and gallinules;
woodcock; common snipe; sandhill cranes; sea ducks; early (September)
waterfowl seasons; migratory game birds in Alaska, Hawaii, Puerto Rico,
and the Virgin Islands; and some extended falconry seasons. Taking of
migratory birds is prohibited unless specifically provided for by
annual regulations. This rule permits taking of designated species
during the 1996-97 season.
EFFECTIVE DATE: August 30, 1996.
FOR FURTHER INFORMATION CONTACT: Paul R. Schmidt, Chief, Office of
Migratory Bird Management, U.S. Fish and Wildlife Service, Department
of the Interior, ms 634-ARLSQ, 1849 C Street, NW., Washington, DC 20240
(703) 358-1714.
SUPPLEMENTARY INFORMATION:
Regulations Schedule for 1996
On March 22, 1996, the Service published in the Federal Register
(61 FR 11992) a proposal to amend 50 CFR part 20. The proposal dealt
with the establishment of seasons, limits, and other regulations for
migratory game birds under Sections 20.101 through 20.107, 20.109, and
20.110 of subpart K. On June 13, 1996, the Service published in the
Federal Register (61 FR 30114) a second document providing supplemental
proposals for early- and late-season migratory bird hunting regulations
frameworks. The June 13 supplement also provided detailed information
on the 1996-97 regulatory schedule and announced the Service Migratory
Bird Regulations Committee and Flyway Council meetings. On June 14,
1996, the Service published in the Federal Register (61 FR 30490) a
third document describing the Service's proposed 1996-97 regulatory
alternatives for duck hunting and its intent to consider establishing a
special youth waterfowl hunting day.
On June 27, 1996, the Service held a public hearing in Washington,
DC, as announced in the March 22 and June 14 Federal Registers to
review the status of migratory shore and upland game birds. The Service
discussed hunting regulations for these species and for other early
seasons. On July 22, 1996, the Service published in the Federal
Register (61 FR 37994) a fourth document specifically dealing with
proposed early-season frameworks for the 1996-97 season. This document
also extended the public comment period to August 1, 1996, for early-
season proposals.
On August 2, 1996, the Service held a public hearing in Washington,
DC, as announced in the March 22, June 14, and July 22 Federal
Registers to review the status of waterfowl. Proposed hunting
regulations were discussed for late seasons. On August 15, 1996, (61 FR
42506), the Service published a fifth and sixth document on migratory
bird hunting. The fifth document dealt specifically with proposed
frameworks for the 1996-97 late-season migratory bird hunting
regulations. The sixth document proposed establishing a youth waterfowl
hunting day for the 1996-97 duck-hunting season. On August 29, 1996,
the Service published a seventh document containing final frameworks
for early migratory bird hunting seasons from which wildlife
conservation agency officials from the States, Puerto Rico, and the
Virgin Islands selected early-season hunting dates, hours, areas, and
limits. The final rule described here is the eighth in the series of
proposed, supplemental, and final rulemaking documents for migratory
game bird hunting regulations and deals specifically with amending
subpart K of 50 CFR 20. It sets hunting seasons, hours, areas, and
limits for mourning, white-winged, and white-tipped doves; band-tailed
pigeons; rails; moorhens and gallinules; woodcock; common snipe;
sandhill cranes; sea ducks; early (September) waterfowl seasons;
mourning doves in Hawaii; migratory game birds in Alaska, Puerto Rico,
and the Virgin Islands; and some extended falconry seasons.
NEPA Consideration
NEPA considerations are covered by the programmatic document,
``Final Supplemental Environmental Impact Statement: Issuance of Annual
Regulations Permitting the Sport Hunting of Migratory Birds (FSES 88-
14),'' filed with EPA on June 9, 1988. The Service published a Notice
of Availability in the June 16, 1988, Federal Register (53 FR 22582).
The Service published its Record of Decision on August 18, 1988 (53 FR
31341). Copies of these documents are available from the Service at the
address indicated under the caption ADDRESSES.
Endangered Species Act Consideration
As in the past, the Service designs hunting regulations to remove
or alleviate chances of conflict between migratory game bird hunting
seasons and the protection and conservation of endangered and
threatened species. Consultations were conducted to ensure that actions
resulting from these regulatory proposals will not likely jeopardize
the continued existence of endangered or threatened species or result
in the destruction or adverse modification of their critical habitat.
Findings from these consultations are
[[Page 46358]]
included in a biological opinion and may have modified some regulatory
measures previously proposed. The final frameworks here reflect any
such modifications. The Service's biological opinions resulting from
its Section 7 consultation are public documents available for public
inspection in the Service's Division of Endangered Species and Office
of Migratory Bird Management, at the address indicated under the
caption ADDRESSES.
Regulatory Flexibility Act; Executive Order 12866 and the Paperwork
Reduction Act
In the March 22, 1996, Federal Register, the Service reported
measures it took to comply with requirements of the Regulatory
Flexibility Act and E.O. 12866. One measure was to prepare a Small
Entity Flexibility Analysis (Analysis) in 1996 documenting the
significant beneficial economic effect on a substantial number of small
entities. The Analysis estimated that migratory bird hunters would
spend between $254 and $592 million at small businesses. Copies of the
Analysis are available upon request from the Office of Migratory Bird
Management. This rule was not subject to review by the Office of
Management and Budget under E.O. 12866.
The Department examined these proposed regulations under the
Paperwork Reduction Act of 1995. The various information collection
requirements are utilized in the formulation of migratory game bird
hunting regulations. OMB has approved these information collection
requirements and assigned clearance numbers 1018-0015 and 1018-0023.
Regulations Promulgation
The rulemaking process for migratory game bird hunting must, by its
nature, operate under severe time constraints. However, the Service
intends that the public be given the greatest possible opportunity to
comment on the regulations. Thus, when the preliminary proposed
rulemaking was published, the Service established what it believed were
the longest periods possible for public comment. In doing this, the
Service recognized that when the comment period closed, time would be
of the essence. That is, if there were a delay in the effective date of
these regulations after this final rulemaking, the States would have
insufficient time to select season dates and limits; to communicate
those selections to the Service; and to establish and publicize the
necessary regulations and procedures to implement their decisions.
Therefore, the Service, under authority of the Migratory Bird Treaty
Act (July 3, 1918), as amended, (16 U.S.C. 703-711), prescribes final
frameworks setting forth the species to be hunted, the daily bag and
possession limits, the shooting hours, the season lengths, the earliest
opening and latest closing season dates, and hunting areas, from which
State conservation agency officials may select hunting season dates and
other options. Upon receipt of season and option selections from these
officials, the Service will publish in the Federal Register a final
rulemaking amending 50 CFR part 20 to reflect seasons, limits, and
shooting hours for the conterminous United States for the 1996-97
season.
The Service therefore finds that ``good cause'' exists, within the
terms of 5 U.S.C. 553(d)(3) of the Administrative Procedure Act, and
these frameworks will, therefore, take effect immediately upon
publication.
Unfunded Mandates
The Service has determined and certifies in compliance with the
requirements of the Unfunded Mandates Act, 2 U.S.C. 1502 et seq., that
this rulemaking will not impose a cost of $100 million or more in any
given year on local or State government or private entities.
Civil Justice Reform--Executive Order 12988
The Department, in promulgating this proposed rule, has determined
that these regulations meet the applicable standards provided in
Sections 3(a) and 3(b)(2) of Executive Order 12988.
List of Subjects in 50 CFR Part 20
Exports, Hunting, Imports, Reporting and recordkeeping
requirements, Transportation, Wildlife.
Dated: August 27, 1996.
George T. Frampton, Jr.,
Assistant Secretary for Fish and Wildlife and Parks.
PART 20--[AMENDED]
For the reasons set out in the preamble, title 50, chapter I,
subchapter B, Part 20, subpart K is amended as follows.
1. The authority citation for Part 20 is revised to read as
follows:
Authority: 16 U.S.C. 703-712 and 16 U.S.C. 742 a-j.
BILLING CODE 4310-55-P
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[FR Doc. 96-22244 Filed 8-29-96; 8:45 am]
BILLING CODE 4310-55-C
Complete official Federal Register PDF
FR Doc. 96-22221 Regulations Under the Comprehensive Smokeless Tobacco Health Education Act of 1986
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Pages 45883-45886]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22221]
=======================================================================
-----------------------------------------------------------------------
FEDERAL TRADE COMMISSION
16 CFR Part 307
Regulations Under the Comprehensive Smokeless Tobacco Health
Education Act of 1986
AGENCY: Federal Trade Commission.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: The Comprehensive Smokeless Tobacco Health Education Act of
1986 (``Smokeless Tobacco Act'') requires that all packaging and
advertising for smokeless tobacco products display one of three health
warnings in rotating sequence. On January 16, 1993, the Commission
published a Notice of Proposed Rulemaking seeking public comment on a
method for rotating the health warnings on promotional materials based
on the date of dissemination of the materials. On February 14, 1995,
the Commission published another Notice of Proposed Rulemaking seeking
public comment on a proposal to permit rotation of warnings on
utilitarian items based on either the date of order or the date of
dissemination of the items, provided the production of such items is
carried out in a manner consistent with customary business practices.
Having considered all of the issues raised during the two public
comment periods, the Commission is now amending the regulations
governing utilitarian items and the regulations governing promotional
materials to permit rotation based on either the date of order or the
date of dissemination, provided the production of such items or
materials is carried out in a manner consistent with customary business
practices. This document contains the statement of basis and purpose
and the text of the final regulations.
EFFECTIVE DATE: The effective date of these regulations will be
September 30, 1996.
ADDRESSES: Requests for copies of the regulations and the statement of
basis and purpose should be sent to Public Reference Branch, Room 130,
Federal Trade Commission, 6th & Pennsylvania Ave. NW, Washington, DC
20580.
FOR FURTHER INFORMATION CONTACT: Phillip S. Priesman, Attorney,
Division of Advertising Practices, Federal Trade
[[Page 45884]]
Commission, 6th & Pennsylvania Ave. NW, Washington, DC 20580. (202)
326-2484.
SUPPLEMENTARY INFORMATION:
Statement of Basis and Purpose
I. Introduction
Congress enacted the Comprehensive Smokeless Tobacco Health
Education Act of 1986 for the express purpose of educating the public
about the health consequences of using smokeless tobacco products.
(Public Law No. 99-252, 100 Stat. 30 (1986), 15 U.S.C. 4401 et seq.).
To achieve this end, the Act required the random display of three
warnings on the packaging and the rotation of these warnings in the
advertising of smokeless tobacco products.
Specifically, the Smokeless Tobacco Act mandated that one of the
following three health warnings appear in the labeling and advertising
(with the exception of outdoor billboard advertising) of smokeless
tobacco products:
Warning: This product may cause mouth cancer.
Warning: This product may cause gum disease and tooth loss.
Warning: This product is not a safe alternative to cigarettes.
The Commission's original regulations applying the Act to
promotional materials provided that ``[a] satisfactory plan for point-
of-sale and non-point-of-sale promotional materials * * * could provide
for rotation according to the time that the material is scheduled to be
disseminated or the order date for the material.'' 51 Fed. Reg. 40005,
40023 (1986). Point-of-sale materials include shelf-talkers (a card or
brochure attached to the shelf where the product is located in a retail
outlet), rack header cards (cards identifying a particular smokeless
brand on semi-circular racks displaying cans of snuff), and tear pads.
Non-point-of-sale materials include direct mail circulars, coupons,
leaflets and pamphlets.
The Commission's original regulations exempted utilitarian items
from the regulations governing the rotation and display of the health
warnings. The exemption for utilitarian items was challenged in court,
and the court ultimately ordered the Commission to delete the
exemption.1 Accordingly, in 1991, the Commission issued final
regulations setting out requirements for the rotation and display of
health warnings on utilitarian items. During its consideration of the
1991 rulemaking proceeding, the Commission became concerned that
companies could order a year's supply of utilitarian items at one time,
and thereby display only one warning over an entire year. The
Commission also was concerned that this apparent loophole could
likewise apply to promotional materials. Thus, the Commission amended
its regulations governing rotation of both promotional objects and
utilitarian objects, and called for ``rotation according to the date
the materials or objects are disseminated.'' The Commission noted,
however, that this could impose a hardship on a company that was unable
to foresee its distribution schedule when placing the order. To
alleviate this hardship, the rule also permitted rotational plans
whereby each warning would be displayed on an equal number of objects
comprising any given order. Under this option, for promotions lasting
one year or longer, the company could distribute promotional materials
or utilitarian items bearing the same warning for four months, and then
switch to another warning. If the promotion was scheduled to last less
than one year, the materials or items bearing the various warnings
could be distributed randomly.
---------------------------------------------------------------------------
\1\ Public Citizen v. FTC, 869 F.2d 1541 (D.C. Cir. 1989),
aff'g, 588 F. Supp. 667 (D.D.C. 1988).
---------------------------------------------------------------------------
With regard to promotional materials, the Commission published this
rule for additional public comment on January 16, 1993. The initial
comment period was to expire on February 16, 1993, but the Commission
extended the deadline until March 23, 1993. During this time, the
Commission received five comments. Four of the comments were from
manufacturers of smokeless tobacco products, and one was from a trade
association representing the manufacturers.
On February 14, 1995, the Commission published a Notice of Proposed
Rulemaking seeking comment on whether the requirements for rotating the
health warnings on utilitarian items should be amended. The proposed
rule permitted the rotation of warnings on utilitarian items according
to either the date the item is ordered or the date of dissemination,
provided that the production of the materials is carried out consistent
with customary business practices. The Commission received four
comments, all of which supported the proposed rule. All four comments
were from manufacturers of smokeless tobacco products.
II. The Regulations
The Commission's original regulations were written, for the most
part, as creating safe harbors rather than imposing mandatory
requirements for compliance with the Smokeless Tobacco Act. The
regulations issued in 1991 with respect to utilitarian items and
promotional materials and those proposed again in 1993 regarding
promotional materials removed the safe harbor provisions, and specified
that the appropriate warning would be determined by the date the
materials were scheduled for dissemination, with a limited option for
random display. The comments the Commission received indicated that
requiring rotation based on date of dissemination, even with the
limited option for random display, was likely to impose additional,
possibly significant, costs on smokeless tobacco manufacturers and
their suppliers. Both the date of dissemination requirement and the
more flexible date of order safe harbor appear likely to meet the chief
benefit intended by the regulations: Providing a system for the
rotation of health warnings as required by the Smokeless Tobacco Act.
Consequently, the Commission is returning to the previous more flexible
approach and specifying safe harbors for complying with the Smokeless
Tobacco Act's warning requirements by amending the regulation governing
utilitarian items, and retaining the present rotation schedule for
promotional materials except for the amendment that such materials be
produced in accordance with customary business practices. With these
amendments, the regulations governing the rotation of warnings for
utilitarian items will mirror those for promotional materials.
Given the practical constraints associated with the production and
dissemination of utilitarian items and those for promotional materials,
the Commission believes that the industry should be given some
flexibility in conforming the rotation requirements to these types of
advertising, while at the same time ensuring that the warnings rotate
as required by the Smokeless Tobacco Act. If, however, there is a
pattern of abuse or confusion suggesting that the safe harbors do not
provide for adequate rotation of the warnings, the Commission will
reconsider whether it is necessary to promulgate regulations providing
less flexibility and more specificity. In particular, the Commission
may reconsider whether to impose the mandatory date of dissemination
requirement for the rotation of both utilitarian items and promotional
materials.
A. Comments Regarding the Rotation of Utilitarian Items
The comments indicate that producing utilitarian items that comply
with a rotation standard based upon
[[Page 45885]]
date of dissemination is expensive and imposes burdens on the smokeless
tobacco manufacturers. According to one comment, the date of
dissemination requirement is burdensome due to the difficulty of
predicting the demand for any item in advance. This comment notes that
such prediction is difficult both because methods of forecasting demand
are imprecise and because premium promotions offering utilitarian items
often change during the course of the promotion due to competitive
conditions.2 Several comments state that the date of dissemination
requirement requires companies to order an excess supply of utilitarian
items to ensure that the supply is not exhausted before the promotion
ends.3 These comments likewise state that the need to order an
excess supply of items adds both warehousing and inventory costs (both
in terms of manpower and facilities).4 And, as inventory costs
increase, so do freight costs, according to these comments. Another
comment states that its inability to accurately forecast demand as well
as the lead time needed to order items adds planning and administrative
costs, including added costs of coordinating with suppliers,
warehousing inventory, tracking inventory, and distributing
items.5
---------------------------------------------------------------------------
\2\ Comment of Pinkerton at 5 (April 17, 1995).
\3\ Comments of Conwood at 3 (April 17, 1995); Pinkerton at 6
(April 17, 1995).
\4\ Comment of Pinkerton at 6 (April 17, 1995).
\5\ Comment of United States Tobacco Co. at 9 (April 11, 1995).
---------------------------------------------------------------------------
B. Comments Regarding the Rotation of Promotional Materials
The comments from the smokeless tobacco manufacturers are similar
to those for utilitarian items. The comments state that the companies
exercise very little control over the actual rate or date of
dissemination of promotional materials.6 In addition, to comply
with the proposed date of dissemination requirement, manufacturers
would need to produce most of their materials in significantly larger
quantities to ensure an adequate supply of materials with each of the
warnings. This would increase their production expenses, as well as the
cost of shipping, warehousing, and distributing the materials.7
Several companies might also need to hire additional employees to
handle the increased workload.8 Further, much of the additional
burden would fall on the businesses that produce and supply the
materials to the tobacco companies. While these businesses would likely
pass on their increased costs to their customers, some of these
suppliers might lack the resources to meet the increased production
requirements, thus forcing them to lose a significant portion of their
business.
---------------------------------------------------------------------------
\6\ Comments of Conwood at 2-3 (April 17, 1993); Smokeless
Tobacco Council at 3 (March 18, 1993); Pinkerton at 5 (March 17,
1993).
\7\ Comments of Helme at 2 (March 5, 1993); United States
Tobacco Co. at 10-11 (March 18, 1993); Pinkerton at 3-4 (March 17,
1993).
\8\ Comments of Smokeless Tobacco Council at 6 (March 18, 1993);
United States Tobacco Co. at 18-20 (March 18, 1993); Conwood at 5
(March 16, 1993); Pinkerton at 4 (March 17, 1993); Helme at 2 (March
5, 1993).
---------------------------------------------------------------------------
According to some of the comments, the proposed regulations would
also raise environmental issues by increasing the amount of waste
generated in producing materials.9 To comply with the proposed
requirements, manufacturers of smokeless tobacco would need to order
greater quantities of materials displaying each different warning
label. Rather than being able to exhaust the existing supply of
materials before re-ordering, companies would need to switch to
materials printed with a different warning on the specified date, and
throw out or otherwise destroy all of the remaining materials with the
outdated warning. According to the comments, this would only add to the
nation's growing environmental concerns.10
---------------------------------------------------------------------------
\9\ Comment of Conwood at 6 (March 16, 1993).
\10\ Id.
---------------------------------------------------------------------------
C. Commission Conclusions
Based on its review of these comments, the Commission believes it
is appropriate to adopt a rotation method that allows rotation to be
based on either the date of order or the date of dissemination, as long
as ``the production of such materials is carried out in a manner
consistent with customary business practices.'' Such a method will
fulfill the purpose of the Smokeless Tobacco Act and prevent
manufacturers from circumventing the rotation requirement without
imposing a substantial hardship on the manufacturers and their
suppliers. Almost all of the members of the industry have demonstrated
their ability to comply with a rotation requirement based on the date
of order by submitting rotational plans that follow this schedule.
Moreover, the addition of the requirement that production be based upon
business considerations will ensure that permitting rotation based on
date of order will not frustrate the Act's requirement that the
warnings rotate. The inclusion of this ``caveat'' is intended to
inhibit bulk-ordering by companies to avoid any one particular
warning.11
---------------------------------------------------------------------------
\11\ Such bulk-ordering was raised as a concern during the
Commission's 1991 rulemaking regarding the rotation of warnings on
smokeless tobacco utilitarian items. 56 FR 11653, 11659 (1991).
---------------------------------------------------------------------------
Some comments suggest that the Commission could lessen the burden
on the smokeless tobacco manufacturers by allowing for the random
simultaneous display of the various warnings on promotional materials.
The Smokeless Tobacco Act and the Commission's regulations specifically
permit random simultaneous display for packaging. However, the
Smokeless Tobacco Act expressly provided for different methods of
assuring the rotation of the three warnings for packaging and
advertising. On packaging, the Act specifies that the warnings be
displayed randomly in as equal a number of times as possible. In
advertising, however, the Act mandates the rotation of the three
warnings in alternating sequence every four months. While random
simultaneous display may meet the Act's directives applicable to
packaging, it generally would not appear to satisfy the prescribed
rotation in alternating sequence in advertising. The Commission,
therefore, concludes that the regulations should not provide for random
simultaneous display of either utilitarian items or promotional
materials.12
---------------------------------------------------------------------------
\12\ In 1985, the Commission reached a similar conclusion with
respect to the rotation of warnings on cigarette packaging. The
Comprehensive Smoking Education Act (``Cigarette Act'') specified
that the four statutory health warnings had to rotate quarterly. 15
U.S.C. 1331(c). Pursuant to the Cigarette Act, the cigarette
companies submitted a rotational warning plan that called for the
random simultaneous display of the warnings on cigarette packages.
The Commission rejected this proposal, notifying the companies and
the relevant committees of Congress of its action. Subsequently, the
Congress amended the rotational warning requirements of the
Cigarette Act to allow simultaneous rotation on packaging only for
those cigarette companies that sold less than one-fourth of one
percent of all cigarettes sold in the United States. The Nurse
Education Amendments of 1985, Pub. L. 99-92, 99 Stat. 393, 402-403
(1985). The same Congress later enacted the Smokeless Tobacco Act,
with its different rotational warning schemes for smokeless tobacco
packages and for smokeless tobacco advertisements.
---------------------------------------------------------------------------
Thus, the Commission's final regulations provide that the rotation
of the health warnings on utilitarian items and promotional materials
may be based upon either the date of order or the date of dissemination
of the materials, provided that the items or materials are produced in
accordance with customary business practices.
III. Regulatory Flexibility Act
When the Commission first promulgated the smokeless tobacco
regulations, the agency certified that the Regulatory Flexibility Act's
requirement for regulatory analysis was not applicable because the
regulation did
[[Page 45886]]
not appear to have a significant economic impact on a substantial
number of small entities. 51 FR 40005, 40014 (1986). In its subsequent
Notice, the Commission noted that the proposed amendments did not
change the regulations sufficient to alter its previous ``no impact''
determination; nonetheless, to ensure that no substantial impact was
being overlooked, the Commission requested public comment on the effect
of the proposed regulations on costs, profitability, competitiveness,
and employment in small entities. 54 FR 31541 (1989).
Two of the comments received during the comment period for
promotional materials discussed the effect that regulations requiring
rotation based upon date of dissemination would have on small
businesses. The Smokeless Tobacco Council noted that smaller smokeless
tobacco manufacturers may be unable to absorb any additional production
costs, and may eliminate their promotional programs. The Smokeless
Tobacco Council and Conwood Tobacco Company noted that small suppliers
may be unable to make the necessary adjustments. No other comments on
burden were received during the 1993 comment period for promotional
materials and no comments on burden were received during the 1995
comment period for utilitarian items. By permitting rotation based upon
date of order or date of dissemination, the final regulations will
avoid any of these potential burdens on small entities. Thus, the
Commission certifies that the amendments will not have a significant
economic impact on a substantial number of small entities. 5 U.S.C.
Sec. 605(b) (1982).
IV. Effective Date
During the comment period concerning the proposed regulations for
promotional items, the Commission received two comments requesting that
if the Commission adopts a requirement that promotional items rotate
according to the date of dissemination, the Commission include a
grandfather clause delaying the effective date of the rule for at least
two years from publication of the final rule, to enable companies to
use up their existing inventory of materials, and to allow suppliers
time to make the necessary adjustments.13 The Commission, however,
does not believe that any grandfather period is necessary given the
flexibility permitted by the amended regulations. In addition, the
Commission notes that the major smokeless tobacco manufacturers have
all previously filed plans calling for rotation based on date of order,
one of the permitted methods of rotation under the amended regulations.
However, the Commission will provide thirty (30) days for companies to
come into compliance with these amendments. Thus, the effective date
for the regulations governing the date that serves as the basis for
rotating warnings on promotional materials is thirty (30) days from the
date of publication of the final rule.
---------------------------------------------------------------------------
\13\ Comments of Smokeless Tobacco Council at 7 (March 18,
1993); United States Tobacco Co. at 23 (March 18, 1993).
---------------------------------------------------------------------------
List of Subjects in 16 CFR Part 307
Health warnings, Smokeless tobacco, Trade practices.
Accordingly, Part 307 of 16 CFR Chapter I is amended as follows:
PART 307--REGULATIONS UNDER THE COMPREHENSIVE SMOKELESS TOBACCO
HEALTH EDUCATION ACT OF 1986
1. The authority for Part 307 continues to read as follows:
Authority: 15 U.S.C. 4401 et seq.
2. Section 307.12(b) is revised to read as follows:
Sec. 307.12 Rotation, display, and dissemination of warning statements
in smokeless tobacco advertising.
* * * * *
(b) Each manufacturer, packager, or importer of a smokeless tobacco
product must submit a plan to the Commission or its designated
representative that ensures that the three warning statements are
rotated every four (4) months in alternating sequence. There may be
more than one system, however, that complies with the Act and these
regulations. For example, a plan may require all brands to display the
same warning during each four-month period or require each brand to
display a different warning during a given four-month period. A plan
shall describe the method of rotation and shall include a list of the
designated warnings for each four-month period during the first year
for each brand. A plan shall describe the method that will be used to
ensure the proper rotation in different advertising media in sufficient
detail to ensure compliance with the Act and these regulations,
although a number of different methods may satisfy these requirements.
For example, a satisfactory plan for advertising in newspapers,
magazines, or other periodicals could provide for rotation according to
either the cover or closing date of the publication. A satisfactory
plan for posters and placards, other than billboard advertising, could
provide for rotation according to either the scheduled or the actual
appearance of the advertising. A satisfactory plan for point-of-sale
and non-point-of-sale promotional materials such as leaflets,
pamphlets, coupons, direct mail circulars, paperback book inserts, or
non-print items, or for utilitarian objects, could provide for rotation
according to the date the materials or objects are ordered by the
smokeless tobacco manufacturer, or the date the objects or materials
are scheduled to be disseminated, provided that the production of such
materials or objects is carried out in a manner consistent with
customary business practices.
* * * * *
By direction of the Commission.
Donald S. Clark,
Secretary.
[FR Doc. 96-22221 Filed 8-29-96; 8:45 am]
BILLING CODE 6750-01-P
Complete official Federal Register PDF
FR Doc. 96-22216 Indian Fellowship and Professional Development Programs
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Pages 46338-46342]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22216]
[[Page 46337]]
_______________________________________________________________________
Part VII
Department of Education
_______________________________________________________________________
34 CFR Part 263
Indian Fellowship and Professional Development Programs; Final Rule
Federal Register / Vol. 61, No. 170 / Friday, August 30, 1996 / Rules
and Regulations
[[Page 46338]]
DEPARTMENT OF EDUCATION
34 CFR Part 263
RIN 1810-AA79
Indian Fellowship and Professional Development Programs
AGENCY: Department of Education.
ACTION: Final regulations.
-----------------------------------------------------------------------
SUMMARY: The Secretary amends the regulations governing grants for the
Indian Fellowship Program. This program is authorized under Title IX of
the Elementary and Secondary Education Act (ESEA) of 1965, as amended
by the Improving America's Schools Act of 1994, enacted October 20,
1994. These regulations identify eligible applicants for the program
and the specific application and other program requirements that
applicants must meet in order to be considered for funding. These
regulations also provide certain general provisions and requirements
for the new payback provisions that apply to both the Indian Fellowship
Program and the Professional Development Program.
EFFECTIVE DATE: These regulations take effect September 29, 1996.
FOR FURTHER INFORMATION CONTACT: Cathie Martin, U.S. Department of
Education, 600 Independence Avenue, SW., Room 4300 Portals Building,
Washington, DC 20202-6335. Telephone: (202) 260-1683. Individuals who
use a telecommunications device for the deaf (TDD) may call the Federal
Information Relay Service (FIRS) at 1-800-877-8339 between 8 a.m. and 8
p.m., Eastern time, Monday through Friday.
SUPPLEMENTARY INFORMATION: On October 20, 1994 the Professional
Development Program and the Indian Fellowship Program were
substantially revised and recodified, respectively, as sections 9122
and 9123 of Subpart 2 of Part A of Title IX of the Elementary and
Secondary Education Act of 1965, as amended by Pub. L. 103-382. These
regulations identify eligible applicants for the Indian Fellowship
Program and address the specific program requirements, including
application requirements and requirements concerning the new payback
provisions that applicants must meet in order to be considered for
funding for both new and continuation awards. The criteria for
selecting participants for the Professional Development Program are not
included in these regulations. The selection criteria in the Education
Department General Administrative Regulations (EDGAR), 34 CFR part 75,
are used for competitions under the Professional Development Program.
In addition, certain of these regulations govern the Professional
Development Program (Sec. 263.3, (definitions), Sec. 263.1 (b) and (c),
and Secs. 263.35 through 263.37 (the new payback provisions that also
apply to this program)).
With regard to the payback provisions, the Indian Fellowship
Program and Professional Development Program now require that an
individual receiving financial assistance either (1) perform work
related to the training for which assistance was received and that
benefits Indian people; or (2) repay all or a prorated portion of the
assistance.
These regulations apply to all FY 1996 awards, both new and
continuation, and subsequent fiscal years' awards.
On July 26, 1996 the Secretary published a notice of proposed
rulemaking (NPRM) for these programs in the Federal Register (61 FR
39246). Except for minor editorial and technical revisions, there are
no differences between the NPRM and these final regulations.
Public Comment
In the NPRM the Secretary invited comments on the proposed
regulations. The Secretary did not receive any comments.
Paperwork Reduction Act of 1995
Under the Paperwork Reduction Act of 1995, no persons are required
to respond to a collection of information unless it displays a valid
OMB control number. The valid OMB control number assigned to the
collection of information in these final regulations is displayed at
the end of the affected sections of the regulations.
Intergovernmental Review
The Indian Fellowship Program is not subject to the requirements of
Executive Order 12372 and the regulations in 34 CFR part 79.
The Professional Development Program, with the exception of
assistance to federally recognized tribes, is subject to the
requirements of Executive Order 12372 and the regulations in 34 CFR
part 79. The objective of the Executive order is to foster an
intergovernmental partnership and a strengthened federalism by relying
on processes developed by State and local governments for coordination
and review of proposed Federal financial assistance.
In accordance with the order, this document is intended to provide
early notification of the Department's specific plans and actions for
this program.
Assessment of Educational Impact
In the notice of proposed rulemaking, the Secretary requested
comments on whether the proposed regulations would require transmission
of information that is being gathered by or is available from any other
agency or authority of the United States.
Based on the response to the proposed rules and on its own review,
the Department has determined that the regulations in this document do
not require transmission of information that is being gathered by or is
available from any other agency or authority of the United States.
List of Subjects in 34 CFR Part 263
Grant programs--education, Indians--education, Reporting and
recordkeeping requirements, Scholarships and fellowships.
Dated: August 27, 1996.
(Catalog of Federal Domestic Assistance Numbers: 84.087 Indian
Education--Fellowships for Indian Students; and 84.299 Indian
Education--Special Programs.)
Gerald N. Tirozzi,
Assistant Secretary for Elementary and Secondary Education.
The Secretary amends title 34 of the Code of Federal Regulations by
revising part 263 to read as follows:
PART 263--INDIAN FELLOWSHIP AND PROFESSIONAL DEVELOPMENT PROGRAMS
Subpart A--General
Sec.
263.1 What are the Indian Fellowship and the Professional
Development Programs?
263.2 Who is eligible to apply under the Indian Fellowship Program?
263.3 What definitions apply to the Indian Fellowship and
Professional Development Programs?
263.4 What are the allowable fields of study in the Indian
Fellowship Program?
263.5 What does a fellowship award include?
263.6 What is the time period for a fellowship award?
Subpart B--How Does the Secretary Select Fellows?
263.20 What priority is given to certain applicants?
263.21 What should the fellowship application contain?
263.22 How does the Secretary evaluate applications?
Subpart C--What Conditions Must be Met by Fellows?
263.30 What are the basic requirements of a fellow?
263.31 What information must be submitted after a fellowship is
awarded?
[[Page 46339]]
263.32 What are the requirements for a leave of absence?
263.33 What is required for continued funding under a fellowship?
263.34 When is a fellowship discontinued?
263.35 What are the payback requirements?
263.36 When does payback begin?
263.37 What are the payback reporting requirements?
Subpart D--How Are Fellowship Payments Made?
263.40 How are payments made?
Authority: 20 U.S.C. 7832 and 7833, unless otherwise noted.
Subpart A--General
Sec. 263.1 What are the Indian Fellowship and the Professional
Development Programs?
(a) The Indian Fellowship Program provides fellowships to enable
Indian students to pursue a course of study leading to--
(1) A postbaccalaureate degree in medicine, law, education,
psychology, clinical psychology, or a related field; or
(2) An undergraduate or postbaccalaureate degree in business
administration, engineering, natural resources, or a related field.
(b) The Professional Development Program provides grants to
eligible entities to--
(1) Increase the number of qualified Indian individuals in
professions that serve Indian people;
(2) Provide training to qualified Indian individuals to become
teachers, administrators, teacher aides, social workers, and ancillary
educational personnel; and
(3) Improve the skills of qualified Indian individuals who serve in
the capacities described in paragraph (b)(2) of this section.
(c) The Indian Fellowship and the Professional Development Programs
require individuals who receive training under either program to--
(1) Perform work that is related to the training received under
either program and that benefits Indian people or to repay all or a
prorated part of the assistance received under the program; and
(2) Report to the Secretary on the individual's compliance with the
work requirement.
(Authority: 20 U.S.C. 7832 and 7833)
Sec. 263.2 Who is eligible to apply under the Indian Fellowship
Program?
In order to be eligible for a fellowship, an applicant must be--
(a) An Indian as defined in Sec. 263.3;
(b) A United States citizen;
(c) Currently in attendance or have been accepted for admission as
a full-time undergraduate or graduate student at an accredited
institution of higher education in one of the fields listed in
Sec. 263.4 or a related field;
(d) Recognized by the institution as a degree candidate; and
(e) Eligible under 34 CFR 75.60.
(Authority: 20 U.S.C. 7833; 20 U.S.C. 1221e-3(a)(1) and 3474)
Sec. 263.3 What definitions apply to the Indian Fellowship and
Professional Development Programs?
(a) Definitions in EDGAR. The following terms used in this part are
defined in 34 CFR 77.1:
Department
Secretary
(b) Other definitions. The following definitions also apply to this
part:
Dependent allowance means costs for the care of minor children who
reside with the fellow and for whom the fellow has responsibility.
Expenses means tuition and required fees; required university
health insurance; room, personal living expenses, and board at or near
the institution; dependent allowance; instructional supplies; and
reasonable travel and research costs associated with doctoral
dissertation completion.
Fellow means the recipient of a fellowship under the Indian
Fellowship Program. The term ``fellow'' also includes individual
project participants under the Professional Development Program with
regard to the payback provisions contained in Secs. 263.35 through
263.37.
Fellowship means an award under the Indian Fellowship Program.
Full course load means the number of credit hours that the
institution requires of a full-time student.
Full-time student means a student who--
(1) Is a degree candidate;
(2) Carries a full course load; and
(3) Is not employed for more than 20 hours a week.
Good standing means a cumulative grade point average of at least
2.0 on a 4.0 grade point scale in which failing grades are computed as
part of the average, or another appropriate standard established by the
institution.
Graduate degree means a postbaccalaureate degree awarded by an
institution of higher education beyond the undergraduate level.
Indian means an individual who is--
(1) A member of an Indian tribe or band, as membership is defined
by the Indian tribe or band, including any tribe or band terminated
since 1940, and any tribe or band recognized by the State in which the
tribe or band resides; or
(2) A descendant, in the first or second degree, of an individual
described in paragraph (1) of this definition; or
(3) Considered by the Secretary of the Interior to be an Indian for
any purpose; or
(4) An Eskimo, Aleut, or other Alaska Native; or
(5) A member of an organized Indian group that received a grant
under the Indian Education Act of 1988 as it was in effect on October
19, 1994.
Institution of higher education means an accredited college or
university within the United States that offers a baccalaureate or
postbaccalaureate degree.
Payback means work-related service or cash reimbursement to the
Department of Education for the training received under the Indian
Fellowship or the Professional Development Program.
Stipend means that portion of an award that is used for room and
board and personal living expenses.
Undergraduate degree means a baccalaureate (bachelor's) degree
awarded by an institution of higher education.
(Authority: 20 U.S.C. 7832, 7833, and 7881)
Sec. 263.4 What are the allowable fields of study in the Indian
Fellowship Program?
(a) The following are allowable fields for an undergraduate degree
under this program:
(1) Business administration.
(2) Engineering.
(3) Natural resources.
(b) The following are allowable fields for a graduate degree under
this program:
(1) Medicine.
(2) Clinical psychology.
(3) Law.
(4) Education.
(5) Psychology.
(6) Engineering.
(7) Natural resources.
(8) Business administration.
(c) The Secretary considers under paragraphs (a) and (b) of this
section, on a case-by-case basis, the eligibility of applications for
fellowships in related fields of study.
(Authority: 20 U.S.C. 7833)
Sec. 263.5 What does a fellowship award include?
(a) The Secretary awards a fellowship in an amount up to, but not
more than, the expenses as defined in this part. The assistance
provided by the program either--
(1) Fully finances a student's educational expenses; or
(2) Supplements other sources of financial aid, including other
Federal financial aid other than loans, for meeting educational
expenses.
[[Page 46340]]
(b) The Secretary announces the expected maximum amounts for
subsistence and other fellowship costs in the annual application notice
published in the Federal Register.
(Authority: 20 U.S.C. 7833)
Sec. 263.6 What is the time period for a fellowship award?
(a) The Secretary awards a fellowship for a period of time not
exceeding--
(1) Four academic years for an undergraduate or doctorate degree;
and
(2) Two academic years for a master's degree.
(b) With prior approval from the Secretary, summer school may be
allowed for eligible continuation students after completion of the
first academic year.
(Authority: 20 U.S.C. 7833)
Subpart B--How Does the Secretary Select Fellows?
Sec. 263.20 What priority is given to certain applicants?
The Secretary awards not more than 10 percent of the fellowships,
on a priority basis, to persons receiving training in guidance
counseling with a specialty in the area of alcohol and substance abuse
counseling and education.
(Authority: 20 U.S.C. 7833)
Sec. 263.21 What should the fellowship application contain?
In addition to the requirements specified in Sec. 263.22, an
applicant shall provide--
(a) Evidence that the applicant is an Indian as defined in
Sec. 263.3. Evidence may be in the form of--
(1)(i) A copy of the applicant's documentation of tribal enrollment
or membership; or
(ii) A copy of the parent's or grandparent's documentation of
tribal enrollment or membership, with supporting birth certificates or
similar documents showing the applicant's descendance from the enrolled
member;
(2) A letter of certification on official letterhead with the
appropriate signature from a federally or State recognized tribe or
band; or
(3) A certificate of degree of Indian blood (CDIB) issued by an
authorized representative of the Bureau of Indian Affairs or an
official of a federally recognized tribe;
(b)(1) Evidence that the applicant is currently in attendance or
has been accepted for admission as a full-time student at an accredited
institution of higher education in one of the eligible fields of study
listed in Sec. 263.4; or
(2) For an applicant who has not yet been accepted for admission,
documentation of having been accepted by an accredited institution of
higher education by a date to be specified by the Secretary;
(c)(1) The most current official high school and, if appropriate,
undergraduate transcripts for undergraduate applicants; or
(2) The most current official undergraduate and, if appropriate,
graduate transcripts for graduate applicants;
(d) The certification required under 34 CFR 75.61; and
(e) The certification contained within the application regarding
agreement to fulfill the requirements of the payback provision that is
signed and dated by the applicant.
(Approved by the Office of Management and Budget under control
number 1810-0020)
(Authority: 20 U.S.C. 7833; 20 U.S.C. 1221e-3(a)(1) and 3474)
Sec. 263.22 How does the Secretary evaluate applications?
(a) The Secretary reviews and ranks an application with other
applications for the same field and related fields of study.
(b) The following criteria, with the total number of points
available in parenthesis, are used to evaluate an application for a new
fellowship award:
(1) Official academic record (60 points). The Secretary considers
the quality of the applicant's academic record by reviewing--
(i) The applicant's grade point average and, if applicable, scores
from such standardized tests as the Scholastic Aptitude Test (SAT),
American College Testing Assessment Program (ACT), Graduate Record
Examination (GRE), Law School Admissions Test (LSAT), Medical College
Admission Test (MCAT), and achievement tests; and
(ii) The applicant's official transcripts and any grade reports.
(2) Letters of recommendation (15 points). The Secretary considers
the applicant's potential for success in completing the academic
requirements for his or her field of study by reviewing one letter of
recommendation from each of the following categories:
(i) A school principal, teacher, academic or non-academic
instructor or counselor, a college professor, or academic advisor.
(ii) A member of the community or civic leader who has observed the
applicant in educational, social, or civic activities.
(iii) A tribal representative or an Indian community member.
(3) Commitment essay (25 points). The Secretary considers the
applicant's commitment by reviewing an essay, written by the applicant
that addresses--
(i) The applicant's career goals and why the chosen field of study
will benefit Indian people;
(ii) The applicant's life experiences and personal and family
expectations that will enhance the applicant's anticipated career
accomplishments; and
(iii) The applicant's anticipated commitment to providing service
to Indian people.
(Approved by the Office of Management and Budget under control
number 1810-0020)
(Authority: 20 U.S.C. 7833)
Subpart C--What Conditions Must be Met by Fellows?
Sec. 263.30 What are the basic requirements of a fellow?
A fellow shall--
(a) Start school during the first semester of the award at the
institution named on the grant award document and complete at least one
full academic term;
(b) Submit to the Secretary two copies of his or her official grade
report at the close of each academic term and upon completion of the
training program at that institution;
(c) Submit an annual continuation application, in the form and
timeframes specified by the Secretary, to request funding for each
remaining academic year approved under the initial application;
(d) Request from the Secretary a written leave of absence at least
30 days prior to withdrawal, unless an emergency situation has
occurred, for any interruption in his or her program of academic
studies; and
(e) Sign an agreement with the Department to meet the provisions of
the payback requirement.
(Approved by the Office of Management and Budget under control
number 1810-0020)
(Authority: 20 U.S.C. 7833)
Sec. 263.31 What information must be submitted after a fellowship is
awarded?
To verify further the accuracy of the information provided in the
application, the applicant shall provide all information and documents
as requested by the Secretary, including information on other financial
aid sources for educational purposes. The applicant's failure to
provide the requested information and documents invalidates the
application, and the Secretary will not consider it for funding.
(Approved by the Office of Management and Budget under control
number 1810-0020)
(Authority: 20 U.S.C. 7833)
[[Page 46341]]
Sec. 263.32 What are the requirements for a leave of absence?
(a) The Secretary may approve a leave of absence for a period not
longer than one academic year if a fellow has successfully completed at
least one academic year.
(b) A written request for a leave of absence must be submitted to
the Secretary not less than 30 days prior to withdrawal or completion
of a grading period, unless an emergency situation has occurred and the
Secretary waives the prior notification requirement.
(c) The Secretary permits a leave of absence only if the
institution certifies that the fellow is eligible to resume his or her
course of study at the end of the leave of absence.
(d) The Secretary withdraws any remaining funds of the fellow's
award if a leave of absence occurs prior to the end of an academic
term.
(Approved by the Office of Management and Budget under control
number 1810-0020)
(Authority: 20 U.S.C. 7833)
Sec. 263.33 What is required for continued funding under a fellowship?
(a) The Secretary reviews the status of each fellow at the end of
each year and continues support only if the fellow--
(1) Has complied with requirements under this part;
(2) Has remained a full-time student in good standing in the field
in which the fellowship was awarded; and
(3) Has submitted a noncompeting continuation application
requesting additional support.
(b) A fellowship terminates when the fellow receives the degree
being sought or after the fellow has received the fellowship for the
maximum number of years allowed as defined in Sec. 263.6, whichever
comes first.
(Approved by the Office of Management and Budget under control
number 1810-0020)
(Authority: 20 U.S.C. 7833)
Sec. 263.34 When is a fellowship discontinued?
(a) The Secretary may discontinue the fellowship if the fellow--
(1) Fails to comply with the provisions under this part, including
failure to obtain an approved leave of absence under Sec. 263.32, or
with the terms and conditions of the fellowship award; or
(2) Fails to report any change in his or her academic status.
(b) The Secretary discontinues a fellowship only after providing
reasonable notice and an opportunity for the fellow to rebut, in
writing or in an informal meeting with the responsible official in the
Department of Education, the basis for the decision.
(Authority: 20 U.S.C. 7833)
Sec. 263.35 What are the payback requirements?
(a) Individuals receiving assistance under the Indian Fellowship
Program or the Professional Development Program are required to--
(1) Perform work related to the training received and that benefits
Indian people; or
(2) Repay all or a prorated part of the assistance received.
(b) The period of time required for a work-related payback is
equivalent to the total period of time for which training was actually
received under the Indian Fellowship Program or the Professional
Development Program.
(c) The cash payback required must be equivalent to the total
amount of funds received and expended for training received under
either of these programs and may be prorated based on any approved
work-related service the participant performs.
(Approved by the Office of Management and Budget under control
number 1810-0020)
(Authority: 20 U.S.C. 7832 and 7833)
Sec. 263.36 When does payback begin?
(a) For all fellows who complete their training under the Indian
Fellowship Program or the Professional Development Program, except for
medical degree and doctoral degree candidates, payback must begin
within six months from the date of completion of the training.
(b) For fellows in a doctoral degree program requiring a
dissertation, payback must begin not later than two years after the
program's academic course work has been completed or the institution
determines the student is no longer eligible to participate in the
training program, whichever occurs first.
(1) After academic course work has been completed, fellows in a
doctoral degree program shall submit an annual written report to the
Secretary on the status of the dissertation.
(2) Within 30 days of completion of the dissertation, fellows in a
doctoral degree program shall provide written notification to the
Secretary of completion of the dissertation and of the participant's
plans for completing a work-related or cash payback.
(c) For fellows in a doctoral degree program with clinical or
internship requirements, payback must begin within six months after the
clinical or internship requirements have been met or the institution
determines the student is no longer eligible to participate in the
training program, whichever occurs first.
(1) After academic course work has been completed, fellows in a
doctoral degree program with clinical or internship requirements shall
submit an annual written report to the Secretary on the status of
completion of the clinical or internship requirements.
(2) Within 30 days of completion of the clinical or internship
requirements, fellows shall provide written notification to the
Secretary of completion of those requirements and the participant's
plans for completing a work-related or cash payback.
(d) For fellows in a medical degree program, payback must begin six
months from the date that all residency requirements of the program
have been met or the institution determines the student is no longer
eligible to participate in the training program, whichever occurs
first.
(1) After academic course work has been completed, fellows in a
medical degree program shall submit an annual written report to the
Secretary on the status of completion of the residency requirements of
the program.
(2) Within 30 days of completion of the residency requirements,
fellows in a medical degree program shall provide written notification
to the Secretary of completion of the residency requirements and of the
participant's plans for completing a work-related or cash payback.
(e) For fellows who do not complete their training under the Indian
Fellowship Program or the Professional Development Program, payback
must begin within six months from the date the fellow leaves the Indian
Fellowship Program or the Professional Development Program, unless he
or she continues as a full-time student, without interruption, in a
program leading to a degree in an accredited institution of higher
education.
(1) If the fellow leaves the Indian Fellowship Program or the
Professional Development Program, but plans to continue his or her
education as a full-time student, the Secretary may defer the payback
requirement until the participant has completed his or her educational
program. Written requests for deferment must be submitted to the
Secretary within 30 days of leaving the Indian Fellowship Program or
the Professional Development Program and must provide the following
information:
(i) The name of the accredited institution the student will be
attending.
(ii) A copy of the letter of admission from the institution.
(iii) The degree being sought.
(iv) The projected date of completion.
(2) After approval by the Secretary of the deferment of the payback
provision
[[Page 46342]]
on the basis of continuing as a full-time student, former fellows are
required to submit to the Secretary, after every grading period, a
status report from an academic advisor or other authorized
representative of the institution of higher education showing
verification of enrollment and status.
(Approved by the Office of Management and Budget under control
number 1810-0020)
(Authority: 20 U.S.C. 7832 and 7833)
Sec. 263.37 What are the payback reporting requirements?
(a) Written notice. Participants shall submit to the Secretary,
within 30 days of completion of their training program, a written
notice of intent to complete a work-related or cash payback or to
continue in a degree program as a full-time student.
(b) Work-related payback. If the participant proposes a work-
related payback, the written notice of intent must include information
explaining how the work-related service is related to the training
received and benefits Indian people.
(1) For work-related service, the Secretary reviews each
participant's payback plan to determine if the work-related service is
related to the training received and benefits Indian people. The
Secretary approves the payback plan if a determination is made that the
work-related service to be performed is related to the training
received and benefits Indian people, meets all applicable statutory and
regulatory requirements, and is otherwise appropriate.
(2) The payback plan for work-related service must identify where,
when, the type of service, and for whom the work will be performed.
(3) A participant shall notify the Secretary in writing of any
change in the work-related service being performed within 30 days of
such a change.
(4) For work-related payback, individuals shall submit a status
report every six months beginning from the date the work-related
service is to begin. The reports must include a certification from the
participant's employer that the service or services have been performed
without interruption.
(5) Upon written request, and if appropriate, the Secretary may
extend the period for completing a work-related payback by a total of
18 months.
(6) For participants who initiate, but cannot complete, a work-
related payback, the payback reverts to a cash payback.
(c) Cash payback. If a cash payback is to be made, the Department
will contact the participant to establish an appropriate schedule for
payments.
(Approved by the Office of Management and Budget under control
number 1810-0020)
(Authority: 20 U.S.C. 7832 and 7833)
Subpart D--How Are Fellowship Payments Made?
Sec. 263.40 How are payments made?
(a) Fellowship payments are made directly to the institution of
higher education where a fellow is enrolled, with stipends provided to
the fellow in installments by the institution. No fewer than two
installments per academic year may be made.
(b) If a fellow transfers to another institution, the fellowship
may also be transferred provided the fellow maintains basic eligibility
for the award.
(c) A fellow who officially or unofficially withdraws or is
expelled from an institution before completion of a term shall refund a
prorated portion of the stipends received, as determined by the
Secretary. The Secretary requires the institution to return any
unexpended funds.
(Authority: 20 U.S.C. 7833)
[FR Doc. 96-22216 Filed 8-29-96; 8:45 am]
BILLING CODE 4000-01-P
Complete official Federal Register PDF
FR Doc. 96-22214 Office of the Assistant Secretary for Public and Indian Housing; Optional Earned Income Exclusions
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Pages 46344-46347]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22214]
[[Page 46343]]
_______________________________________________________________________
Part VIII
Department of Housing and Urban Development
_______________________________________________________________________
24 CFR Parts 913 and 950
Office of the Assistant Secretary for Public and Indian Housing:
Optional Earned Income Exclusions; Interim Final Rule
Federal Register / Vol. 61, No. 170 / Friday, August 30, 1996 / Rules
and Regulations
[[Page 46344]]
DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
24 CFR Parts 913 and 950
[Docket No. FR-4080-I-01]
RIN 2577-AB66
Office of the Assistant Secretary for Public and Indian Housing;
Optional Earned Income Exclusions
AGENCY: Office of the Assistant Secretary for Public and Indian
Housing, HUD.
ACTION: Interim rule.
-----------------------------------------------------------------------
SUMMARY: This rule amends HUD's regulations for the definition of
``annual income'' applicable to Public Housing Agencies and Indian
Housing Authorities (collectively called Housing Agencies or HAs) in
the operation of public housing and Indian housing programs. The change
is not applicable to the Section 8 Housing Assistance Payments program.
The rule is necessary to encourage HAs to take action to further the
efforts of applicants and tenants to seek employment and to increase
their earned income. The intended effect is to permit HAs to adopt an
exclusion for earned income, tailored to their own circumstances, to
support the efforts of working families.
DATES: Effective date: September 30, 1996.
Comment due date: October 29, 1996.
ADDRESSES: Interested persons are invited to submit comments regarding
this rule to the Office of the General Counsel, Rules Docket Clerk,
Room 10276, Department of Housing and Urban Development, 451 Seventh
Street, SW., Washington, DC 20410-0500. Comments should refer to the
above docket number and title. A copy of each communication submitted
will be available for public inspection and copying during regular
business hours (weekdays 7:30 a.m. to 5:30 p.m. Eastern time) at the
above address. Facsimile (FAX) comments are not acceptable.
FOR FURTHER INFORMATION CONTACT: For the public housing program,
contact Linda Campbell, Director, Marketing and Leasing Management
Division, Office of Public and Assisted Housing Operations, Department
of Housing and Urban Development, 451 Seventh Street, SW., Washington,
DC 20410, telephone (voice): (202) 708-0744, extension 4020. (This is
not a toll-free number.) For hearing- and speech-impaired persons, this
number may be accessed via text telephone by dialing the Federal
Information Relay Service at 1-800-877-8339.
For the Indian housing programs, contact Deborah Lalancette,
Director, Housing Management Division, Office of Native American
Programs, Department of Housing and Urban Development, Room B-133, 451
Seventh Street, SW., Washington, DC 20410, telephone (voice): (202)
755-0088, extension 122. (This is not a toll-free number.) For hearing-
and speech-impaired persons, this number may be accessed via text
telephone by dialing the Federal Information Relay Service at 1-800-
877-8339.
SUPPLEMENTARY INFORMATION:
I. General
This rule amends HUD's regulations for the public housing and
Indian housing programs that govern the definition of annual income,
which the Secretary is authorized to define. Since income eligibility
for the public and Indian housing programs is determined based on this
term, and rents are based on annual income, as modified by statutorily
prescribed adjustments, changes in this definition influence who lives
in these types of housing and how much they are required to pay. (The
change is not applicable to the Section 8 Housing Assistance Payments
program.)
The rule is necessary to encourage public housing agencies and
Indian Housing Authorities (collectively called housing authorities or
HAs) to take action to further the efforts of applicants and tenants to
seek employment and to increase their earned income. The intended
effect is to permit HAs to adopt an exclusion for earned income,
tailored to their own circumstances, to support the efforts of working
families.
The Department believes that, in light of the shortfall in funding
full HA eligibility for the Performance Funding System (PFS) expected
over the next two years and the possibility that an HA can develop a
higher income base by use of this type of exclusion, it is in the best
interests of the program to encourage occupancy in these programs by
working families.
II. The Nature of Special Treatment for Earned Income
The Balanced Budget Downpayment Act I, enacted on January 26, 1996
(Pub. L. No. 104-99), also known as the Continuing Resolution or
``CR'', specifically authorized housing agencies to allow earned income
adjustments, as long as HUD's operating subsidy obligation was not
affected. That provision and others were implemented by HUD by issuance
of a Notice to HAs (PIH 96-6) on February 13, 1996, which expires on
September 30, 1996, based on the expiration of the CR on that date.
The CR enacted by Congress, effective for Federal Fiscal Year 1996,
permitted housing agencies to take actions to attract and retain
working families in occupancy such as the adoption of ceiling rents and
the adoption of earned income adjustments that would ease the impact on
working tenants. The Act also repealed Federal admissions preferences,
permitting HAs to use working preferences to greater advantage. This
rule codifies for Federal Fiscal Years 1997 and 1998 a provision
permitting housing agencies to provide for special treatment of earned
income.
The rationale for making this provision effective via a rule is to
ensure some degree of consistency in Departmental policy, on which HAs
can rely. The Department believes that this measure can contribute to
improving the stability of HAs by permitting them to improve the income
mix in their developments, thus increasing dwelling rental income.
There is a difference between the special treatment of earned
income specifically authorized by the CR and that authorized by this
rule. There are two defined terms related to income under the United
States Housing Act of 1937: ``annual income'' and ``adjusted income.''
The former is a gross income amount, which is used to determine the
eligibility of a family for participation in the program based on
whether that amount is less that 50% or 80% of median income for the
area (adjusted by family size). The latter is a net amount after
adjustments are made to the gross income, which is used to determine
the amount of rent a family pays under the affected programs because
rent is generally based on a percentage of ``adjusted income.'' The CR
authorized an ``adjustment'' to income affecting the amount of
``adjusted income'', while this rule authorizes an ``exclusion'' from
income, which affects income at an earlier stage--the definition of
``annual income.''
The reason that this rule authorizes an exclusion rather than an
adjustment is that the scope of the Department's authority does not
clearly include authorizing ``adjustments'' without specific
Congressional action. The statute prescribes the definition of
``adjusted income'' but leaves to the Secretary of HUD the authority
(under section 3 of the United States Housing Act of 1937, 42 U.S.C.
1437a) to define the term ``income,'' as it is used for purposes of
determining eligibility and rental payment in the public and Indian
housing programs. The term HUD uses
[[Page 46345]]
that corresponds to this statutory term is ``annual income.''
Although the CR provision expires at the end of the current fiscal
year (September 30, 1996), a change made by the Secretary in the
definition of income permitting an exclusion for earned income can have
longer lasting effect. The Secretary is exercising this authority in
this rule.
Under this rule, HAs have the authority to establish their own
earned income exclusion, as a means of attracting and retaining more
tenants with earned income. The ``exclusion'' an HA adopts may be
similar or identical to the ``adjustment'' it had adopted under the CR.
The adoption of an earned income exclusion under this rule will
have the same effect on an HA's operating subsidy as the adoption of an
earned income adjustment under the previously issued HUD Notice. (See
discussion below.) In general, HAs that opt to adopt earned income
exclusions will increase their total income if they are successful in
obtaining more and/or higher income working tenants but will lose
income if their policies do not produce a net increase in rent
revenues.
III. Specific Changes in Existing Rules
For the public housing program, this change to permit a new
exclusion is accomplished by adding a new paragraph (d) to
Sec. 913.106, which states the definition of ``annual income.'' The
change to the Indian housing program occurs in Sec. 950.102, in the
definition of ``annual income,'' where a new paragraph (3) is added.
The new paragraphs authorize an HA to adopt a written earned income
exclusion, after considering certain enumerated possibilities. No HUD
approval is required for adoption of such an exclusion. However, if the
HA experiences a decrease in dwelling rental income as a result, it
will have to absorb the cost.
IV. Effect on Operating Subsidy
In addition to the HUD Notice to housing agencies described above,
HUD issued a second Notice (PIH 96-24) in the spring of 1996,
implementing the CR with respect to its impact on the Performance
Funding System of determining operating subsidy eligibility.
Specifically, that Notice permitted HAs to offset PFS funding
shortfalls by retaining increases in dwelling rental income that result
from increases in residents' earned incomes and non-dwelling rental
income earned by the HAs through entrepreneurial activities. That
Notice made the changes effective for the shorter period through
Federal Fiscal Year 1998 or the time by which HUD no longer has a
shortfall in the availability of funds to pay full operating subsidy
eligibility to all HAs.
Under this rule, as under that Notice, the special treatment given
earned income by an HA will not affect its PFS subsidy eligibility.
That eligibility will be calculated without respect to either decreases
in rental income resulting from the exclusion, or increases resulting
from higher rents received from households with earned income. Another
pending rulemaking (FR-4072) codifies those changes.
V. Scope of rule
The CR authorized the earned income adjustment only for the public
and Indian housing programs and only based on the premise that
operating subsidy obligations of the Department would not be affected.
This rule follows those limits on the scope of the optional special
treatment of earned income. Therefore, the change is not applied to
other programs usually governed by the same definition of ``annual
income,'' such as the Section 8, Section 236, and Rent Supplement
programs.
Findings and Certifications
Justification for Interim Rule
The Department generally publishes a rule for public comment before
issuing a rule for effect, in accordance with its regulations on
rulemaking in 24 CFR part 10. However, part 10 provides that prior
public procedure will be omitted if HUD determines that it is
``impracticable, unnecessary, or contrary to the public interest'' (24
CFR 10.1).
The change made by this interim rule merely adds an optional
exclusion to the definition of income used by Housing Agencies, which
supports the policy of obtaining a broad range of income levels in
public housing and Indian housing developments and the Secretary's
policy of encouraging HAs to increase the number of working families
residing in these developments. As noted earlier, the Department has
already authorized the use of such income exclusions for a limited
period of time, based on the Balanced Budget Downpayment Act I, in a
Notice. Authorization of such an optional exclusion in this rule is
expected to increase the number of HAs using it, helping to encourage
the participation of working families in these programs.
Implementation of the rule's provisions is needed as soon as
possible to facilitate the adoption of this type of exclusion to
realize the benefits of increasing the incentives for working families
to participate and to prevent HAs that are now deducting earned income
from having to change their policy starting on October 1, 1996, only to
institute earned income exclusions later. Therefore, the Department has
determined that good cause exists to omit prior public procedure for
this interim rule because such delay would be contrary to the public
interest and unnecessary.
In the interest of obtaining the fullest participation possible in
determining the factors that should be considered in an HA's
determination to adopt an earned income exclusion, the Department does
invite public comment on the rule. The comments received within the 60-
day comment period will be considered during development of a final
rule that will supersede this interim rule.
Impact on the Environment
A Finding of No Significant Impact with respect to the environment
has been made in accordance with HUD regulations at 24 CFR part 50 that
implement section 102(2)(C) of the National Environmental Policy Act of
1969, 42 U.S.C. 4332. The Finding of No Significant Impact is available
for public inspection and copying during regular business hours (7:30
a.m. to 5:30 p.m.) in the Office of the Rules Docket Clerk, Room 10276,
451 Seventh Street, SW., Washington, DC 20410-0500.
Federalism Impact
The General Counsel, as the Designated Official under section 6(a)
of Executive Order 12612, Federalism, has determined that the policies
contained in this rule do not have significant impact on States or
their political subdivisions since the provisions of this interim rule
simply add an option for housing agencies to adopt. To the extent there
is an impact, it is advantageous to the HAs, which are creatures of
State or local government.
Impact on the Family
The General Counsel, as the Designated Official under Executive
Order 12606, The Family, has determined that this rule does not have
potential for significant impact on family formation, maintenance, and
general well-being. Therefore, the rule is not subject to review under
the Order. The rule merely broadens the options for housing agencies in
managing their public housing or Indian housing programs to encourage
families to obtain employment and to increase their earnings.
[[Page 46346]]
Impact on Small Entities
The Secretary, in accordance with the Regulatory Flexibility Act (5
U.S.C. 605(b)), has reviewed this rule before publication and by
approving it certifies that this rule will not have a significant
impact on a substantial number of small entities, because it makes
available additional options for housing agencies but does not impose
mandatory obligations.
Catalog
The Catalog of Federal Domestic Assistance number for the
programs affected by this rule is 14.850.
List of Subjects
24 CFR Part 913
Grant programs--housing and community development, Public housing,
Reporting and recordkeeping requirements.
24 CFR Part 950
Aged, Grant programs--housing and community development, Grant
programs--Indians, Indians, Individuals with disabilities, Low and
moderate income housing, Public housing, Reporting and recordkeeping
requirements.
Accordingly, parts 913 and 950 of title 24 of the Code of Federal
Regulations are amended as follows:
PART 913--DEFINITION OF INCOME, INCOME LIMITS, RENT AND
REEXAMINATION OF FAMILY INCOME FOR THE PUBLIC HOUSING PROGRAM
1. The authority citation for part 913 continues to read as
follows:
Authority: 42 U.S.C. 1437a, 1437d, 1437n and 3535(d).
2. In Sec. 913.106, paragraphs (d) and (e) are redesignated as
paragraphs (e) and (f), and a new paragraph (d) is added, to read as
follows:
Sec. 913.106 Annual income.
* * * * *
(d) In addition to the exclusions from annual income covered in
paragraph (c) of this section, a housing agency may adopt additional
exclusions for earned income pursuant to an established written policy.
(1) In establishing such a policy, a housing agency must adopt one
or more of the following types of earned income exclusions, including
variations thereof:
(i) Exclude all or part of the family's earned income;
(ii) Apply the exclusion only to new sources of earned income or
only to increases in earned income;
(iii) Apply the exclusion to the earned income of the head, the
spouse, or any other family member age 18 or older;
(iv) Apply the exclusion only to the earned income of persons other
than the primary earner;
(v) Apply the exclusion to applicants, newly admitted families,
existing tenants, or persons joining the family;
(vi) Make the exclusion temporary or permanent, for the HA, the
family, or the affected family member;
(vii) Make the exclusion graduated, so that more earned income is
excluded at first and less earned income is excluded after a period of
time;
(viii) Exclude any or all of the costs that are incurred in order
to go to work but are not compensated, such as the cost of special
tools, equipment, or clothing;
(ix) Exclude any or all of the costs that result from earning
income, such as social security taxes or other items that are withheld
in payroll deductions;
(x) Exclude any portion of the earned income that is not available
to meet the family's own needs, such as amounts that are paid to
someone outside the family for alimony or child support; and
(xi) Exclude any portion of the earned income that is necessary to
replace benefits lost because a family member becomes employed, such as
amounts that the family pays for medical costs or to obtain medical
insurance.
(2) Any amounts that are excluded from annual income under this
paragraph (d) may not also be deducted in determining adjusted income,
as defined in Sec. 913.102.
(3) Housing agencies do not need HUD approval to adopt optional
earned income exclusions.
(4) In the calculation of Performance Funding System operating
subsidy eligibility, housing agencies will have to absorb any loss in
rental income that results from the adoption of any of the optional
earned income exclusions discussed in paragraph (d)(1) of this section,
including any variations of the listed options.
PART 950--INDIAN HOUSING PROGRAMS
3. The authority citation for part 950 continues to read as
follows:
Authority: 25 U.S.C. 450e(b); 42 U.S.C. 1437aa-1437ee and
3535(d).
4. In the definition of ``Annual income'' in Sec. 950.102,
paragraphs (3) and (4) are redesignated as paragraphs (4) and (5), and
a new paragraph (3) is added, to read as follows:
Sec. 950.102 Definitions.
* * * * *
Annual income. * * *
(3) In addition to the exclusions from annual income covered in
paragraph (2) of this definition, an IHA may adopt additional
exclusions for earned income pursuant to an established written policy.
(i) In establishing such a policy, an IHA must adopt one or more of
the following types of earned income exclusions, including variations
thereof:
(A) Exclude all or part of the family's earned income;
(B) Apply the exclusion only to new sources of earned income or
only to increases in earned income;
(C) Apply the exclusion to the earned income of the head, the
spouse, or any other family member age 18 or older;
(D) Apply the exclusion only to the earned income of persons other
than the primary earner;
(E) Apply the exclusion to applicants, newly admitted families,
existing residents, or persons joining the family;
(F) Make the exclusion temporary or permanent, for the IHA, the
family, or the affected family member;
(G) Make the exclusion graduated, so that more earned income is
excluded at first and less earned income is excluded after a period of
time;
(H) Exclude any or all of the costs that are incurred in order to
go to work but are not compensated, such as the cost of special tools,
equipment, or clothing;
(I) Exclude any or all of the costs that result from earning
income, such as social security taxes or other items that are withheld
in payroll deductions;
(J) Exclude any portion of the earned income that is not available
to meet the family's own needs, such as amounts that are paid to
someone outside the family for alimony or child support; and
(K) Exclude any portion of the earned income that is necessary to
replace benefits lost because a family member becomes employed, such as
amounts that the family pays for medical costs or to obtain medical
insurance.
(ii) Any amounts that are excluded from annual income under
paragraph (3) of this definition may not also be deducted in
determining adjusted income, as defined in this section.
(iii) IHAs do not need HUD approval to adopt optional earned income
exclusions.
(iv) In the calculation of Performance Funding System operating
subsidy eligibility, IHAs will have to absorb any loss in rental income
that results from the adoption of any of the optional earned income
exclusions discussed in paragraph (3)(i) of this definition, including
any variations of the listed options.
* * * * *
[[Page 46347]]
Dated: August 6, 1996.
Kevin Emanuel Marchman,
Acting Assistant Secretary for Public and Indian Housing.
[FR Doc. 96-22214 Filed 8-29-96; 8:45 am]
BILLING CODE 4210-33-P
Complete official Federal Register PDF
FR Doc. 96-22211 Safety Zone: New York Super Boat Race, New York
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Pages 45891-45892]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22211]
-----------------------------------------------------------------------
DEPARTMENT OF TRANSPORTATION
33 CFR Part 165
[CGD01-96-072]
RIN 2121-AA97
Safety Zone: New York Super Boat Race, New York
AGENCY: Coast Guard, DOT.
ACTION: Temporary final rule.
-----------------------------------------------------------------------
SUMMARY: The Coast Guard is establishing a temporary safety zone in the
lower Hudson River, for the New York Super Boat Race. The temporary
safety zone will be in effect on Sunday, September 8, 1996, from 12
p.m. until 4 p.m. unless extended or terminated sooner by the Captain
of the Port, New York. The safety zone will close the entire Lower
Hudson River between Battery Park and Pier 76 in Manhattan.
EFFECTIVE DATE: This rule is effective from 12 p.m. until 4 p.m. on
Sunday, September 8, 1996, unless extended or terminated sooner by the
Captain of the Port, New York.
FOR FURTHER INFORMATION CONTACT:
Lieutenant John W. Green, Waterways Oversight Branch Chief, Coast Guard
Activities New York at (212) 668-7906.
SUPPLEMENTARY INFORMATION:
Regulatory History
On August 5, 1996, the Coast Guard published a notice of proposed
rulemaking (NPRM) in the Federal Register (61 FR 40587). Interested
persons were requested to submit comments on or before August 20, 1996.
The Coast Guard received four comments on this proposal. A public
hearing was not requested and one was not held. The Coast Guard is
promulgating the final rule as proposed. Good cause exists for making
this regulation effective less than 30 days after Federal Register
publication. Due to the NPRM comment period deemed necessary to give
the public adequate notice, there was insufficient time to publish this
temporary final rule 30 days prior to the event. The delay that would
be encountered to allow for a 30 day delayed effective date would cause
the cancellation of this event. Cancellation of this event is contrary
to the public interest since this event is intended for public
entertainment.
Background and Purpose
Super Boat Racing Inc. submitted an Application for Approval of
Marine Event for a Super Boat Race in the waters of the Lower Hudson
River. This event will include up to 45 powerboats, 40 to 50 feet in
length, racing on an 8 mile oval course at speeds in excess of 100 mph.
No more than 100 spectator craft are expected for the event. This
regulation establishes a temporary safety zone in the waters of the
Lower Hudson River south of a line drawn from Pier 76 in Manhattan to a
point in Weehawken, New Jersey at 40 deg.45'52'' N latitude,
74 deg.01'01'' W longitude, and north of a line connecting the
following points:
Latitude Longitude
40 deg.42'16.0'' N 74 deg.01'09.0'' W, then south to
40 deg.41'55.0'' N 74 deg.01'16.0'' W, then west to
40 deg.41'47.0'' N 74 deg.01'36.0'' W, then northwest
to
40 deg.41'55.0'' N 74 deg.01'59.0'' W, then to shore
at
40 deg.42'20.5'' N 74 deg.02'06.0'' W (NAD 1983)
The safety zone will be effective on Sunday, September 8, 1996,
from 12 p.m. until 4 p.m., unless extended or terminated sooner by the
Captain of the Port New York. This section prohibits all vessels and
persons from entering the safety zone unless authorized by the Coast
Guard Captain of the Port. The safety zone is needed to protect
mariners from the hazards associated with high speed boat races.
Discussion of Comments and Changes
Of the four comments received, two were from companies operating
sightseeing cruises, one was from a company operating an excursion
boat, and one was from a ferry company. Three requested limited access
through the safety zone in order to meet commitments previously
reserved by paying customers and one requested the race route be moved
in order for its ferryboat to meet a published schedule. All responses
were considered and limited access was granted to meet the majority of
the responders needs. Movement of the race course was not possible nor
warranted and the ferryboat company was provided limited access in
order to meet its operating schedule.
Regulatory Evaluation
This proposal is not a significant regulatory action under section
3(f) of Executive Order 12866 and does not require an assessment of
potential costs and benefits under section 6(a)(3) of that order. It
has been exempted from review by the Office of Management and
[[Page 45892]]
Budget under that order. It is not significant under the regulatory
policies and procedures of the Department of Transportation (DOT) (44
FR 11040, February 26, 1979). The Coast Guard expects the economic
impact of this proposal to be so minimal that a full Regulatory
Evaluation under paragraph 10(e) of the regulatory policies and
procedures of DOT is unnecessary. This safety zone will close all
waters of the Lower Hudson River south of a line drawn from Pier 76 in
Manhattan to a point located directly opposite on the New Jersey
shoreline and north of a line drawn between Battery Park in Manhattan
and the southern most point of Ellis Island in the Upper New York Bay
on Sunday, September 8, 1996, from 12 p.m. until 4 p.m. This portion of
the Hudson River experiences moderate commercial and recreational
marine traffic. Although this regulation prevents traffic from
transiting this area, the effect of this regulation will not be
significant for several reasons: limited access has been arranged with
time-sensitive commercial traffic; the volume of commercial vessel
traffic transiting the Lower Hudson River on a Sunday is less than half
of the normal daily traffic volume; pleasure craft desiring to view the
event will be directed to designated spectator viewing areas outside
the safety zone; pleasure craft can take an alternate route through the
East River and the Harlem River; the duration of the event is limited
to four hours; and the extensive advisories which will be made to the
affected maritime community by Local Notice to Mariners, Safety Voice
Broadcast, and facsimile notification.
Small Entities
Under the Regulatory Flexibility Act (5 U.S.C. 601 et seq.), the
Coast Guard must consider whether this proposal will have a significant
economic impact on a substantial number of small entities. ``Small
entities'' include independently owned and operated small businesses
that are not dominant in their field and that otherwise qualify as
``small business concerns'' under Section 3 of the Small Business Act
(21 U.S.C. 632).
For reasons set forth in the above Regulatory Evaluation, the Coast
Guard expects the impact of this proposal to be minimal. The Coast
Guard certifies under 5 U.S.C. 605(b) that this proposal will not have
a significant economic impact on a substantial number of small
entities.
Collection of Information
This proposal contains no collection of information requirements
under the Paperwork Reduction Act (44 U.S.C. 3501).
Federalism
The Coast Guard has analyzed this action in accordance with the
principles and criteria contained in Executive Order 12612 and has
determined that this proposal does not raise sufficient federalism
implications to warrant the preparation of a Federalism Assessment.
Environment
The Coast Guard has considered the environmental impact of this
proposal and concluded that under section 2.B.2.e. of Commandant
Instruction M16475.1B, it is categorically excluded from further
environmental documentation. A Categorical Exclusion Determination and
Environmental Analysis Checklist is included in the docket.
List of Subjects in 33 CFR Part 165
Harbors, Marine safety, Navigation (water), Reporting and
recordkeeping requirements, Security measures, Waterways.
Regulation
For reasons set out in the preamble, the Coast Guard amends 33 CFR
part 165 as follows:
PART 165--[AMENDED]
1. The authority citation for part 165 continues to read as
follows:
Authority: 33 U.S.C. 1231; 50 U.S.C. 191; 33 CFR 1.05-1(g),
6.04-1, 6.04-6, and 160.5; 49 CFR 1.46.
2. A temporary Sec. 165.T01-072, is added to read as follows:
Sec. 165.T01-072 Safety Zone; New York Super Boat Race, Hudson River,
New York and New Jersey.
(a) Location. All waters of the Lower Hudson River between Pier 76
in Manhattan and a point on the New Jersey shore in Weehawken, New
Jersey at 40 deg.45'52'' N latitude, 74 deg.01'01'' W longitude, and
north of a line connecting the following points:
Latitude Longitude
40 deg.42'16.0'' N 74 deg.01'09.0'' W, then south to
40 deg.41'55.0'' N 74 deg.01'16.0'' W, then west to
40 deg.41'47.0'' N 74 deg.01'36.0'' W, then northwest
to
40 deg.41'55.0'' N 74 deg.01'59.0'' W, then to shore
at
40 deg.42'20.5'' N 74 deg.02'06.0'' W (NAD 1983)
(b) Effective period. This section is in effect on Sunday,
September 8, 1996, from 12 p.m. until 4 p.m., unless extended or
terminated sooner by the Captain of the Port, New York.
(c) Regulations. (1) The general regulations contained in 33 CFR
165.23 apply.
(2) All persons and vessels shall comply with the instructions of
the Coast Guard Captain of the Port or the designated on scene patrol
personnel. U.S. Coast Guard patrol personnel include commissioned,
warrant, and petty officers of the Coast Guard. Upon being hailed by a
U.S. Coast Guard vessel via siren, radio, flashing light, or other
means, the operator of a vessel shall proceed as directed.
Dated: August 23, 1996.
Richard C. Vlaun,
Captain, U.S. Coast Guard, Captain of the Port, New York.
[FR Doc. 96-22211 Filed 8-29-96; 8:45 am]
BILLING CODE 4910-14-M
Complete official Federal Register PDF
FR Doc. 96-22210 Special Local Regulation: Provincetown Harbor Swim for Life, Provincetown, MA
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Pages 45890-45891]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22210]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF TRANSPORTATION
Coast Guard
33 CFR Part 100
[CGD01-95-169]
RIN 2115-AE46
Special Local Regulation: Provincetown Harbor Swim for Life,
Provincetown, MA
AGENCY: Coast Guard, DOT.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: The Coast Guard is establishing a permanent special local
regulation for a swimming event known as the Provincetown Harbor Swim
for Life. The event will be held on September 7, 1996, and annually
thereafter on a date and times published in a Federal Register
document. This regulation is needed to protect the participants from
transiting vessel traffic during the swimming event.
EFFECTIVE DATE: This regulation is effective on September 7, 1996.
FOR FURTHER INFORMATION CONTACT: Lieutenant Commander James B. Donovan,
Office of Search and Rescue, First Coast Guard District, (617) 223-
8268.
SUPPLEMENTARY INFORMATION:
Regulatory History
A Notice of Proposed Rulemaking (NPRM) was published on March 20,
1996, (61 FR 11352) proposing the establishment of a permanent special
local regulation for the annual swimming benefit Provincetown Harbor
Swim for Life. The NPRM proposed to restrict vessels from approaching
within 200 feet of any participating swimmer to ensure the safety of
participants during the event. No comments were received and no hearing
was requested. This rule varies from the NPRM in one regard; it
provides the date and time of the 1996 event and provides for the dates
and times of future events to be published in a Federal Register
document.
Background and Purpose
The annual Provincetown Harbor Swim for Life benefit is a local,
traditional event which has been held for several years in Provincetown
Harbor, Provincetown, MA. In the past, the Coast Guard has promulgated
individual regulations for each year's event. Given the recurring
nature of the event, the Coast Guard is establishing a permanent
regulation. This rule establishes a regulated area in Provincetown
Harbor, Cape Cod Bay, and provides specific guidance to control vessel
movement during the event. This rule restricts vessels from approaching
within 200 feet of participating benefit swimmers.
The event will consist of approximately 150 swimmers traveling 1.4
miles from Long Point Lighthouse to a point 200 yards east of the Coast
Guard pier. There will be approximately 25-30 support boats on scene to
augment a Coast Guard patrol to alert boating traffic of the presence
of the swimmers. In emergency situations, provisions may be made to
establish safe escort by a Coast Guard or Coast Guard designated vessel
for vessels requiring transit within 200 feet of participating
swimmers.
Good cause exists for providing for this rule to become effective
in less than 30 days after Federal Register publication. Due to the
need to provide the opportunity for notice and comment in the NPRM,
there is insufficient time to publish this rule 30 days before the
event is scheduled to begin. The Coast Guard believes delaying the
event in order to provide a 30 day delayed effective date would be
contrary to the public interest given this event's local popularity.
Regulatory Evaluation
This rule is not a significant regulatory action under section 3(f)
of Executive Order 12866, and does not require an assessment of
potential costs and benefits under section 6(a)(3) of that order. It
has been exempted from review by the Office of Management and Budget
under that order. It is not significant under the regulatory policies
and procedures of the Department of Transportation (DOT) (44 FR 11040,
February 26, 1979). The Coast Guard expects the economic impact to be
so minimal that a full Regulatory Evaluation, under paragraph 10e of
the regulatory policies and procedures of DOT, is unnecessary. This
conclusion is based on the limited duration of the event, the extensive
advisories that will be made to the affected maritime community, and
the minimal restrictions which the regulation places on vessel traffic.
Small Entities
Under the Regulatory Flexibility Act (5 U.S.C. 601 et seq.), the
Coast Guard must consider the economic impact on small entities of a
rule for which a general notice of proposed rulemaking is required.
``Small entities'' may include (1) small businesses and not-for-profit
organizations that are independently owned and operated and are not
dominant in their fields and (2) governmental jurisdictions with
populations of less than 50,000.
For the reasons discussed in the Regulatory Evaluation, the Coast
Guard certifies under 5 U.S.C. 605(b) that this rule will not have a
significant economic impact on a substantial number of small entities.
Collection of Information
This rule contains no collection of information requirements under
the Paperwork Reduction Act (44 U.S.C. 3501 et seq.).
Federalism
The Coast Guard has analyzed this rule in accordance with the
principles and criteria contained in Executive Order 12612, and has
determined that this rule does not raise sufficient federalism
implications to warrant the preparation of a Federalism Assessment.
Environment
The Coast Guard has considered the environmental impacts of this
rule and concluded that, under paragraph 2.B.2.e.34(h) of COMDTINST
16475.1B,
[[Page 45891]]
(as revised by 61 FR 13563, March 27, 1996) this rule is a special
local regulation issued in conjunction with a regatta or marine parade
and is categorically excluded from further environmental documentation.
List of Subjects in 33 CFR Part 100
Marine safety, Navigation (water), Reporting and recordkeeping
requirements, Waterways.
Final Regulation
For reasons set out in the preamble, the Coast Guard is amending 33
CFR Part 100 as follows:
PART 100--[AMENDED]
1. The authority citation for Part 100 continues to read as
follows:
Authority: 33 U.S.C. 1233; 49 CFR 1.46 and 33 CFR 100.35.
2. A new section, 100.113, is added to read as follows:
Sec. 100.113 Provincetown Harbor Swim for Life, Provincetown, MA.
(a) Regulated Area. All waters of Provincetown Harbor within 200
feet of participating benefit swimmers.
(b) Special Local Regulations. (1) The Coast Guard patrol commander
may delay, modify, or cancel the race as conditions or circumstances
require.
(2) No person or vessel may enter, transit, or remain in the
regulated area unless participating in the event or unless authorized
by the Coast Guard patrol commander.
(3) Vessels encountering emergencies which require transit through
the regulated area should contact the Coast Guard patrol commander on
VHF Channel 16. In the event of an emergency, the Coast Guard patrol
commander may authorize a vessel to transit through the regulated area
with a Coast Guard designated escort.
(4) All persons and vessels shall comply with the instructions of
the Coast Guard on-scene patrol commander. On-scene patrol personnel
may include commissioned, warrant, and petty officers of the U.S. Coast
Guard. Upon hearing five or more short blasts from a U.S. Coast Guard
vessel, the operator of a vessel shall proceed as directed. Members of
the Coast Guard Auxiliary may also be present to inform vessel
operators of this regulation and other applicable laws.
(c) Effective period. This section is effective on September 7,
1996, from 10 a.m. to 4 p.m. and annually thereafter on a date and
times published in a Federal Register document. If the event is
canceled due to weather, this regulation is effective the following day
at the same times.
Dated: August 22, 1996.
James D. Garrison,
Captain, U.S. Coast Guard, Acting Commander, First Coast Guard
District.
[FR Doc. 96-22210 Filed 8-29-96; 8:45 am]
BILLING CODE 4910-14-M
Complete official Federal Register PDF
FR Doc. 96-22209 Safety Zone: MTV Music Awards Fireworks Display, East River, New York
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Pages 45892-45893]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22209]
-----------------------------------------------------------------------
DEPARTMENT OF TRANSPORTATION
33 CFR Part 165
[CGD01-96-100]
RIN 2115-AA97
Safety Zone: MTV Music Awards Fireworks Display, East River, New
York
AGENCY: Coast Guard, DOT.
ACTION: Temporary final rule.
-----------------------------------------------------------------------
SUMMARY: The Coast Guard is establishing a temporary safety zone for
the MTV Music Awards fireworks display located in the East River, New
York. The safety zone will be in effect from 10:30 p.m. until 11:45
p.m. on Wednesday, September 4, 1996. The safety zone will close all
waters of the East River south of the Brooklyn Bridge and north of a
line drawn from Pier 9, Manhattan to Pier 3, Brooklyn.
EFFECTIVE DATE: This rule is effective from 10:30 p.m. until 11:45 p.m.
on Wednesday, September 4, 1996, unless extended or terminated sooner
by the Captain of the Port New York.
FOR FURTHER INFORMATION CONTACT:
Lieutenant J. W. Green, Waterways Oversight Branch Chief, Coast Guard
Activities New York at (202) 668-7906.
SUPPLEMENTARY INFORMATION:
Regulatory History
Pursuant to 5 U.S.C. 553, a notice of proposed rulemaking (NPRM)
was not published for this regulation. Good cause exists for not
publishing a NPRM and for making this regulation effective less than 30
days after Federal Register publication. Due to the date on which
complete information regarding this event was received, there was
[[Page 45893]]
insufficient time to draft and publish a NPRM. The delay encountered if
normal rulemaking procedures were followed would effectively cancel the
event. Cancellation of the event is contrary to public interest since
the event is intended to provide public entertainment.
Background and Purpose
MTV submitted an Application for Approval of Marine Event to hold a
fireworks program in the waters of the East River. This regulation
establishes a safety zone in the waters of the East River from 10:30
p.m. until 11:45 p.m. on Wednesday, September 4, 1996, unless extended
or terminated sooner by the Captain of the Port New York. This safety
zone precludes all vessels from transiting south of the Brooklyn Bridge
and north of a line drawn from Pier 9, Manhattan to Pier 3, Brooklyn.
It is needed to protect mariners from the hazards associated with
fireworks exploding in the area.
Regulatory Evaluation
This regulation is not a significant regulatory action under
section 3(f) of Executive Order 12866 and does not require an
assessment of potential costs and benefits under section 6(a)(3) of
that order. It has been exempted from review by the Office of
Management and Budget under that order. It is not significant under the
regulatory policies and procedures of the Department of Transportation
(DOT) (44 FR 11040, February 26, 1979). The Coast Guard expects the
economic impact of this regulation to be so minimal that a full
Regulatory Evaluation under paragraph 10(e) of the regulatory policies
and procedures of DOT is unnecessary. This safety zone closes a portion
of the East River to all vessel traffic from 10:30 p.m. until 11:45
p.m. on Wednesday, September 4, 1996, unless extended or terminated
sooner by the Captain of the Port New York. This section of the East
River experiences moderate commercial and recreational marine traffic.
Although this regulation prevents traffic from transiting this area,
the effect of this regulation will not be significant for several
reasons: the duration of the event is limited; the event is at a late
hour; pleasure craft and some commercial vessels can take an alternate
route via the Hudson and Harlem Rivers; and the extensive, advance
advisories that will be made. Accordingly, the Coast Guard expects the
economic impact of this regulation to be so minimal that a Regulatory
Evaluation is unnecessary.
Small Entities
Under the Regulatory Flexibility Act (5 U.S.C. 601 et seq.), the
Coast Guard must consider whether this regulation will have a
significant economic impact on a substantial number of small entities.
``Small entities'' include independently owned and operated small
businesses that are not dominant in their field and that otherwise
qualify as ``small business concerns'' under Section 3 of the Small
Business Act (15 U.S.C. 632).
For reasons set forth in the Regulatory Evaluation, the Coast Guard
certifies under 5 U.S.C. 605(b) that this regulation will not have a
significant economic impact on a substantial number of small entities.
If, however, you think that your business or organization qualifies as
a small entity and that this rule will have significant economic impact
on your business or organization, please submit a comment explaining
why you think it qualifies and in what way and to what degree this rule
will economically affect it.
Collection of Information
This regulation contains no collection of information requirements
under the Paperwork Reduction Act (44 U.S.C. 3501).
Federalism
The Coast Guard has analyzed this action in accordance with the
principles and criteria contained in Executive Order 12612 and has
determined that this regulation does not raise sufficient federalism
implications to warrant the preparation of a Federalism Assessment.
Environment
The Coast Guard has considered the environmental impact of this
regulation and concluded that under section 2.B.2.e.(34)(g) of
Commandant Instruction M16475.1B (as revised by 59 FR 38654, July 29,
1994), the promulgation of this regulation is categorically excluded
from further environmental documentation. A Categorical Exclusion
Determination and Environmental Analysis Checklist are included in the
docket.
List of Subjects in 33 CFR Part 165
Harbors, Marine safety, Navigation (water), Reporting and
recordkeeping requirements, Security measures, Waterways.
Regulation
For reasons set out in the preamble, the Coast Guard amends 33 CFR
part 165 as follows:
PART 165--[AMENDED]
1. The authority citation for part 165 continues to read as
follows:
Authority: 33 U.S.C. 1231; 50 U.S.C. 191; 33 CFR 1.05-1(g),
6.04-1, 6.04-6, and 160.5; 49 CFR 1.46
2. A temporary Sec. 165.T01-100, is added to read as follows:
Sec. 165.T01-100 Safety Zone; MTV Music Awards Fireworks Display, East
River, New York.
(a) Location. All waters of the East River south of the Brooklyn
Bridge and north of a line drawn from Pier 9, Manhattan to Pier 3,
Brooklyn.
(b) Effective period. This section is effective from 10:30 p.m.
until 11:45 p.m. on Wednesday, September 4, 1996, unless extended or
terminated sooner by the Captain of the Port New York.
(c) Regulations. (1) The general regulations contained in 33 C.F.R.
165.23 apply.
(2) All persons and vessels shall comply with the instructions of
the Coast Guard Captain of the Port or the designated on scene patrol
personnel. U.S. Coast Guard patrol personnel include commissioned,
warrant, and petty officers of the Coast Guard. Upon being hailed by a
U.S. Coast Guard vessel via siren, radio, flashing light, or other
means, the operator of a vessel shall proceed as directed.
Dated: August 23, 1996.
Richard C. Vlaun,
Captain, U.S. Coast Guard, Captain of the Port New York.
[FR Doc. 96-22209 Filed 8-29-96; 8:45 am]
BILLING CODE 4910-14-M
Complete official Federal Register PDF
FR Doc. 96-22195 Omnipoint Communications New York MTA Frequency Block A; Establishment of New Personal Communications Services
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Pages 45903-45905]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22195]
=======================================================================
-----------------------------------------------------------------------
FEDERAL COMMUNICATIONS COMMISSION
47 CFR Part 1
[GEN Docket No. 90-314; FCC 96-340]
Omnipoint Communications New York MTA Frequency Block A;
Establishment of New Personal Communications Services
AGENCY: Federal Communications Commission.
ACTION: Final Rule.
-----------------------------------------------------------------------
SUMMARY: By this action, the Commission denies a petition for
declaratory ruling filed by The Wireless Communications Council (WCC).
The Commission finds that WCC has not demonstrated the existence of a
controversy or uncertainty sufficient to warrant exercise of the
Commission's discretion to issue a declaratory ruling. The intended
effect of this action is to clarify when it is appropriate for the
Commission to issue a declaratory ruling regarding whether a party
awarded a pioneer's preference has made substantial use of its
pioneering technology.
EFFECTIVE DATE: August 30, 1996.
FOR FURTHER INFORMATION CONTACT: Rodney Small or Charles Iseman, Office
of Engineering and Technology, at (202) 418-2452 or (202) 418-2444,
respectively.
SUPPLEMENTARY INFORMATION: This is a summary of the Commission's
Memorandum Opinion and Order (MO&O) in GEN Docket 90-314, FCC 96-340,
adopted August 9, 1996, and released August 23, 1996. The full text of
this Commission decision is available for inspection and copying during
regular business hours in the FCC Reference Center (Room 239), 1919 M
Street, NW, Washington, DC. The complete text of this decision also may
be purchased from the Commission's duplication contractor,
International Transcription Service, Inc., (202) 857-3800, 2100 M
Street, N.W., Suite 140, Washington, D.C. 20037.
Summary of MO&O
1. In the Third Report and Order (Third R&O) in GEN Docket No. 90-
314 (the broadband Personal Communications Services (PCS) proceeding),
59 FR 9419 (February 28, 1994), the Commission awarded pioneer's
preferences to American Personal Communications (APC), Cox Enterprises,
Inc. (Cox), and Omnipoint Communications, Inc. (Omnipoint). The
Commission directed the Wireless Telecommunications Bureau (Bureau) to
condition the broadband PCS licenses received by APC, Cox, and
Omnipoint upon each licensee building a system that substantially uses
the design and technologies upon which its preference award is based.
Specifically, the Commission stated that this condition would apply in
the service area for which the preference is being granted and for the
initial required five-year build-out period specified in the rules for
broadband PCS.
2. Omnipoint was awarded a pioneer's preference for having designed
and manufactured a 2 GHz spread spectrum handset and associated base
station equipment, and for proposing a viable service with the
flexibility to be implemented in a variety of environments with
capabilities useful to subscribers. This preference granted Omnipoint
the right, if otherwise qualified, to use a 30 megahertz channel block
(Block A, 1850-1865 MHz and 1930-1945 MHz) in the Major Trading Area
that includes northern New Jersey (New York MTA). On December 13, 1994,
the Bureau granted a pioneer's preference license to Omnipoint, on
condition that ``Omnipoint * * * shall construct a * * * system * * *
that substantially uses the design and technology upon which the
pioneer's preference award * * * was based,'' and on condition that
Omnipoint retain control of the license for three years or until it has
met the five-year build-out requirement, whichever is the first to
occur.
3. On January 16, 1996, WCC submitted a petition for declaratory
ruling, urging the Commission to clarify the ``substantial use''
condition, as
[[Page 45904]]
specified in the pioneer's preference license awarded to
Omnipoint.1 WCC asserts that public evidence indicates that
Omnipoint will initially use Global System for Mobile Communications
(GSM) equipment for its New York PCS network, rather than the IS-661
technology for which the Commission awarded Omnipoint a preference.
Specifically, WCC attaches the statement of its consulting engineer,
Charles Jackson, who asserts that he has reviewed the publicly
available information and believes that Omnipoint is currently
constructing a GSM system with only minor use of IS-661 technology. WCC
requests the Commission to clarify the extent to which Omnipoint must
use its own technology to retain its preference award and asks several
questions, including whether the substantial use condition requires
Omnipoint to use its IS-661 interface from the inception of its
broadband PCS operations pursuant to its license.
---------------------------------------------------------------------------
\1\ The WCC petition is styled as a ``Petition for
Clarification.'' Because the petition essentially asks the
Commission to issue a declaratory ruling defining in greater detail
the meaning and scope of the ``substantial use'' condition placed on
pioneer's preference licenses, the Commission is treating it as a
petition for declaratory ruling pursuant to 47 C.F.R. Sec. 1.2.
---------------------------------------------------------------------------
4. On January 31, 1996, Omnipoint submitted a response, in which it
argues that WCC's petition should be dismissed or denied on five
grounds. Omnipoint first states that ``WCC has failed to articulate who
it is, whom it represents, or how it or its membership, if any, is
affected by Omnipoint's activities in the New York MTA.'' Omnipoint
notes that the Commission's rules permit requests for clarification of
a decision only when the petitioner demonstrates the existence of a
genuine decisional controversy or uncertainty, and argues that WCC has
failed to make such a demonstration. Second, Omnipoint contends that
WCC's petition is in substance not a petition for clarification but an
untimely filed petition for reconsideration of the Third R&O. Third,
Omnipoint addresses WCC's substantive allegations. Omnipoint avers that
in the deployment of its New York MTA PCS system, it is, in fact,
substantially using the IS-661 technology for which it received a
preference. It adds that other companies are ``licensing and
commercializing'' this technology. Omnipoint stresses that it is
deploying and using its IS-661 technology in conjunction with GSM, and
that such use of multiple technologies is similar to the practices of
most cellular and other broadband PCS licensees. Omnipoint concludes
that WCC is unfairly asking the Commission to prohibit only Omnipoint
from using multiple technologies in deploying a broadband PCS system.
Fourth, Omnipoint submits that WCC's petition is not ripe for
consideration because there is no Commission requirement that pioneers
demonstrate compliance with the substantial use condition prior to the
expiration of the five-year build-out requirement. Hence, Omnipoint
argues that it should be afforded five years to comply fully with the
condition in the New York MTA. Finally, Omnipoint states that the
substantial use condition is not vague and does not need to be
clarified by an order that could inadvertently delay the rapid
deployment of pioneers' systems.
5. On February 7, 1996, WCC submitted a reply to Omnipoint's
response in which it contends that Omnipoint offers no information to
suggest that WCC's petition is unwarranted. WCC states that it is not
arguing that Omnipoint must use only IS-661 technology in the New York
MTA, but is asking merely that the Commission define the substantial
use condition associated with Omnipoint's pioneer's preference license.
WCC also states that Omnipoint does not attempt to clarify the extent
to which Omnipoint will use its IS-661 technology in the New York MTA,
either initially or over a five-year period.
6. The Commission has discretionary authority to issue a
declaratory ruling to ``terminat[e] a controversy or remov[e]
uncertainty.'' The doctrine of standing was developed by the courts as
an analytic tool to determine whether the exercise of jurisdiction by a
court over a given case would exceed the limitation of ``the scope of
the federal judicial power to the resolution of `cases' or
`controversies.' '' This jurisdictional limitation is set forth in
Article III of the U.S. Constitution. Although this limit on
jurisdiction is not directly applicable to administrative agencies such
as the Commission and there are no statutory or regulatory standing
requirements applicable to the Commission in the declaratory ruling
context, the Commission believes that the presence or absence of
standing is a useful factor to consider in determining whether a
``controversy'' or ``uncertainty'' exists in a form sufficiently
crystallized to warrant our consideration in the context of a
declaratory ruling.
7. To establish standing in the context of federal appellate
proceedings, a petitioner must satisfy a three-pronged test. That is,
the petitioner must allege (1) A ``distinct and palpable'' personal
injury-in-fact that is (2) ``fairly traceable'' to the respondent's
conduct and (3) redressable by the relief requested. By analogy, in
considering similar factors in the declaratory ruling context, the
Commission's review of the pleadings indicates that WCC has not
identified itself, its membership, or its interest in the Omnipoint
application. Though WCC has alleged a general concern that the
``substantial use'' condition should be clarified to ``ensure that
Omnipoint is in full compliance with the condition[ ] * * *, and that
it is deserving of the substantial financial benefits attached to its
license,'' it has not alleged how it personally would be injured if
Omnipoint were not to comply with the ``substantial use'' condition.
Its general allegations of potential harm to Omnipoint's competitors
and to the U.S. Treasury are not distinct and palpable injuries
personal to WCC.
8. In addition, although ripeness concerns addressed by federal
courts in the context of Article III do not apply to agency declaratory
rulings, concepts of ripeness can also provide a useful analogy in
determining whether the Commission should exercise its discretion to
issue declaratory rulings. The Commission concludes that this is not an
appropriate case to issue such a ruling because the question of the
extent to which technology must be deployed in order to satisfy the
``substantial use'' condition is not ripe for our consideration at this
time and no unusual and compelling circumstances are present. A finding
of ``substantial use'' entails a judgment of the degree and/or nature
of deployment and use, which can be affected by the nature and extent
of other technologies with which the pioneer's preference technology is
entwined, the effect of market forces, the effect of ensuing
technological advancements, and other factors. Such judgments are best
made on a case-by-case basis. No precise formula for ``substantial
use'' can productively be set forth at this time, and any effort to do
so would only serve to delay unnecessarily the deployment and use of
pioneer's preference technology. In the instant case, Omnipoint's
broadband PCS system in the New York MTA is still under construction,
and Omnipoint has until the five-year build-out date specified in its
license authorization, December 13, 1999, to meet its build-out
requirements. Therefore, the issue of substantial use is not yet ripe
for Commission review.
9. Therefore, for these reasons, the Commission declines to
exercise its discretion to issue a declaratory ruling here.
Accordingly, it is ordered that the petition for declaratory ruling
filed on
[[Page 45905]]
January 16, 1996 by The Wireless Communications Council is denied.
List of Subjects in 47 CFR Part 1
Administrative practice and procedure.
Federal Communications Commission.
William F. Caton,
Acting Secretary.
[FR Doc. 96-22195 Filed 8-29-96; 8:45 am]
BILLING CODE 6712-01-U
Complete official Federal Register PDF
FR Doc. 96-22171 Regulatory Reinvention Initiative: Pipeline Safety Program Procedures; Reporting Requirements; Gas Pipeline Standards; and Liquefied Natural Gas Facilities Standards; Correction
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Page 45905]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22171]
=======================================================================
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DEPARTMENT OF TRANSPORTATION
Research and Special Programs Administration
49 CFR Parts 190, 191, 192 and 193
[Docket PS-125; [Amdt Nos. 190-7; 191-11; 192-77; 193-12]]
RIN 2137-AC28
Regulatory Reinvention Initiative: Pipeline Safety Program
Procedures; Reporting Requirements; Gas Pipeline Standards; and
Liquefied Natural Gas Facilities Standards; Correction
AGENCY: Research and Special Programs Administration (RSPA), DOT.
ACTION: Correction to final rule.
-----------------------------------------------------------------------
SUMMARY: This document contains corrections to final regulations Docket
PS-125, which were published Monday, June 3, 1996 (61 FR 27789). The
regulations made various changes to administrative practices in the
pipeline safety program and made minor modifications to requirements
for gas detection, protective enclosures, and pipeline testing
temperatures.
EFFECTIVE DATE: July 3, 1996.
FOR FURTHER INFORMATION CONTACT: L.E. Herrick, (202) 366-5523 or online
at [email protected] regarding the subject matter of this
correction, or the Dockets Unit, (202) 366-5046, regarding copies of
this final rule or other information in the docket.
SUPPLEMENTARY INFORMATION:
Need for Correction
The final rule that is the subject of these corrections was
published with several errors and omissions. The document did not
contain the amendment numbers. A hidden formatting inconsistency from
imported text resulted in the misprinting of some of the typographical
symbols used to denote degrees. As a result some of the degree symbols
were printed as the letter ``N'' instead of the symbol `` deg.''. And,
the instructions for amending Sec. 193.2907 ``Protective enclosure
construction'' did not specify that (c) was to be removed.
Correction of Publication
Accordingly, the publication on June 3, 1996 of the final rule
Docket PS-125, is corrected as follows:
1. On page 27789, in the Heading, the docket number reference
``[Docket PS-125; Notice 2'', is corrected to read: ``[Docket PS-125;
Amdt. 190-7; 191-11; 192-77; 193-12]''.
2. On page 27791, in the first column, line 24, the temperature
``100NF'' is amended to read ``100 deg.F''.
3. On page 27791, in the first column, last paragraph, the
temperatures ``23NC'' and ``73NF'' in all three instances are amended
to read ``23 deg.C'' and ``73 deg.F''.
4. On page 27791, in the second column second line, the temperature
``100NF'' is amended to read ``100 deg.F''.
5. On page 27791, in the second column second paragraph, the
temperature ``100NF'' is amended to read ``100 deg.F''.
6. On page 27793, in the first column, last paragraph, the
temperature ``100NF'' is amended to read ``100 deg.F''.
7. On page 27793, in the second column paragraph 3, the
instructions are amended by inserting the phrase ``and by removing
paragraph (c)'' following the section designation (b). and by removing
the five asterisks following the word ``opening''.
Issued in Washington, D.C. on August 22, 1996.
Kelley S. Coyner,
Deputy Administrator, Research and Special Programs Administration.
[FR Doc. 96-22171 Filed 8-29-96; 8:45 am]
BILLING CODE 4910-60-U
Complete official Federal Register PDF
FR Doc. 96-22170 Loan of Army Materiel and Property Returns; Correction
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Pages 45889-45890]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22170]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Department of the Army
32 CFR Part 623
[AR 700-131]
Loan of Army Materiel and Property Returns; Correction
AGENCY: Department of the Army, DoD.
ACTION: Correcting amendments.
-----------------------------------------------------------------------
SUMMARY: This document contains corrections to the final regulations
which were published on September 18, 1980 (45 FR 62038) the
regulations related to the process of Army property returns.
[[Page 45890]]
EFFECTIVE DATE: August 30, 1996.
FOR FURTHER INFORMATION CONTACT: Mr. Showalter, U.S. Army Publications
and Printing Command, ATTN: ASQZ-PDS, 2461 Eisenhower Ave., Alexandria,
VA 22331, or telephone: (703) 428-0567.
SUPPLEMENTARY INFORMATION: The final regulation being corrected is
Sec. 623.5. In this section paragraphs (c)(5) (A) through (D) are
incorrectly designated.
Need for Correction
As published, the final regulation contains errors which may be
misleading and are in need of clarification.
List of Subjects in 32 CFR Part 623
Accordingly, 32 CFR part 623 is corrected by making the following
correcting amendments:
PART 623--LOAN OF ARMY MATERIEL
1. The authority citation continues to read as follows:
Authority: 10 U.S.C. 2571; 31 U.S.C. 686; 10 U.S.C. 2667.
Sec. 623.5 [Corrected]
2. In Sec. 623.5, paragraphs (c)(5)(A) through (c)(5)(D) are
redesignated as paragraphs (c)(5)(i) through (c)(5)(iv).
Gregory D. Showalter,
Army Federal Register Liaison Officer.
[FR Doc. 96-22170 Filed 8-29-96; 8:45 am]
BILLING CODE 3710-08-M
Complete official Federal Register PDF
FR Doc. 96-22169 Changes in Office Description and References
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Pages 45875-45876]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22169]
=======================================================================
-----------------------------------------------------------------------
NATIONAL CREDIT UNION ADMINISTRATION
12 CFR Parts 705, 747 and 790
Changes in Office Description and References
AGENCY: National Credit Union Administration (``NCUA'').
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: Last year, the NCUA Board established the Office of Chief
Financial Officer, transferring to it the functions of the Office of
the Controller and some of the responsibilities of the Office of
Examination and Insurance. The description of and references to the
Office of the Controller are deleted, and a description of and
references to the Office of Chief Financial Officer are added. The
description of the Office of Examination and Insurance is updated to
reflect redistribution of duties. Two references in other parts of the
Regulations are also updated. These changes update the Regulations to
reflect the current structure and responsibilities of various agency
offices and make technical corrections to references within the
regulations.
EFFECTIVE DATE: August 30, 1996.
ADDRESSES: National Credit Union Administration, 1775 Duke Street,
Alexandria, VA 22314-3428.
FOR FURTHER INFORMATION CONTACT: Hattie Ulan, Special Counsel to the
General Counsel, at the above address or 703-518-6540.
SUPPLEMENTARY INFORMATION: Part 790 of the NCUA Regulations sets forth
NCUA organization, including descriptions of duties of all agency
components. On July 25, 1995, the NCUA Board established the Office of
Chief Financial Officer, transferring to it the functions of the Office
of the Controller and some of responsibilities of the Office of
Examination of Insurance. This document deletes the description of the
Office of the Controller, and replaces it with a new description of the
Office of Chief Financial Officer. It also makes changes to the
description of the Office of Examination and Insurance to reflect
current duties. Two additional technical changes are made. First, in
Section 705.3, the reference to Sec. 701.32(d)(1) is changed to
Sec. 701.34(a)(1) to reflect a recent change to Part 701. Second, the
reference to 12 CFR part 4 in Sec. 747.25(b) is corrected to read 12
CFR Sec. 792.5(b). Section 747.25 was recently amended with the
incorrect reference.
Regulatory Procedures
Regulatory Flexibility Act
The Regulatory Flexibility Act requires the NCUA to prepare an
analysis to describe any significant economic impact a regulation may
have on a substantial number of small credit unions (primarily those
under $1 million in assets). The types of changes made by this rule
have no economic impact on credit unions. These are merely housekeeping
changes. Therefore, the NCUA Board has determined and certifies that,
under the authority granted in 5 U.S.C. 605(b), this final rule will
not have a significant economic impact on a substantial number of small
credit unions. Accordingly, the Board has determined that a Regulatory
Flexibility Analysis is not required.
Paperwork Reduction Act
This final rule does not change any paperwork requirements.
Executive Order
Executive Order 12612 requires NCUA to consider the effect of its
actions on state interests. Since these are housekeeping changes only,
there is no effect on state interests.
List of Subjects in 12 CFR Parts 705, 747 and 790
Credit unions.
By the National Credit Union Administration on August 8, 1996.
Becky Baker,
Secretary of the Board.
Accordingly, for the reasons set out in the preamble, 12 CFR Ch.
VII is amended as set forth below.
PART 705--COMMUNITY DEVELOPMENT REVOLVING LOAN PROGRAM FOR CREDIT
UNIONS
1. The authority citation for part 705 continues to read as
follows:
Authority: Pub. L. 97-35, 42 U.S.C. 9822; Pub. L. 99-609, note
to 42 U.S.C. 9822; Pub. L. 101-144, 12 U.S.C. 1766(k).
2. Section 705.3 is amended by revising the reference
``Sec. 701.32(d)(1)'' to ``Sec. 701.34(a)(1)'' in paragraph (b).
[[Page 45876]]
PART 747--ADMINISTRATIVE ACTIONS, ADJUDICATIVE HEARINGS, RULES OF
PRACTICE AND PROCEDURE, AND INVESTIGATIONS
3. The authority citation for part 747 continues to read as
follows:
Authority: 12 U.S.C. 1766, 12 U.S.C. 1786, 12 U.S.C. 1784, 12
U.S.C. 1787.
4. Section 747.25 is amended by revising the reference ``12 CFR
part 4'' to ``12 CFR 792.5(b)'' in the fifth sentence of paragraph (b).
PART 790--DESCRIPTION OF NCUA; REQUESTS FOR AGENCY ACTION
5. The authority citation for part 790 continues to read as
follows:
Authority: 12 U.S.C. 1766, 12 U.S.C. 1789, 12 U.S.C. 1795f.
6. Section 790.2 is amended by revising paragraph (b)(5); revising
the first sentence of paragraph (b)(6)(i); replacing the last three
sentences of paragraph (b)(6)(ii) with four new sentences; and
replacing ``Controller'' with ``Chief Financial Officer'' in paragraph
(b)(7) to read as follows:
Sec. 790.2 Central and regional office organization.
* * * * *
(b) * * *
(5) Office of Chief Financial Officer. NCUA's chief financial
officer is in charge of budgetary, accounting and financial matters for
the NCUA, including responsibility for submitting annual budget and
staffing requests for approval by the Board and, as required, by the
Office of Management and Budget; for managing NCUA's budgetary
resources; for managing the operations of the National Credit Union
Share Insurance Fund (NCUSIF) to include accounting, financial
reporting and the collection and payment of capitalization deposits,
insurance premiums and insurance dividends; for collecting annual
operating fees from federal credit unions, for maintaining NCUA's
accounting system and accounting records; for processing payroll,
travel, and accounts payable disbursements; and for preparing internal
and external financial reports.
(6) Office of Examination and Insurance. (i) The Director of the
Office of Examination and Insurance: Formulates standards and
procedures for examination and supervision of the community of
federally insured credit unions, and reports to the Board on the
performance of the examination program; manages the risk to the NCUSIF,
to include overseeing the NCUSIF Investment Committee, monitoring the
adequacy of NCUSIF reserves, analyzing the reasons for NCUSIF losses,
formulating policies and procedures regarding the supervision of
financially troubled credit unions, and evaluating certain requests for
special assistance pursuant to Section 208 of the Federal Credit Union
Act and for certain proposed administrative actions regarding
federally-insured credit unions; serves as the Board expert on
accounting principles and standards and on auditing standards;
represents NCUA at meetings with the American Institute of Certified
Public Accountants (AICPA), Federal Financial Institutions Examination
Council (FFIEC) and General Accounting Office (GAO); and collects data
and provides statistical reports. * * *
(ii) * * * The CLF is managed by the President of the CLF, under
the general supervision of the NCUA Board which serves as the CLF Board
of Directors. The Chairman of the NCUA Board serves as the Chairman of
the CLF Board of Directors. The Secretary of the NCUA Board serves as
the Secretary of the CLF Board. The Director of the Division of Risk
Management, Office of Examination and Insurance, serves as the
President of the CLF.
* * * * *
[FR Doc. 96-22169 Filed 8-29-96; 8:45 am]
BILLING CODE 7535-01-U
Complete official Federal Register PDF
FR Doc. 96-22168 Investment Adviser Activities
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Pages 45873-45875]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22168]
========================================================================
Rules and Regulations
Federal Register
________________________________________________________________________
This section of the FEDERAL REGISTER contains regulatory documents
having general applicability and legal effect, most of which are keyed
to and codified in the Code of Federal Regulations, which is published
under 50 titles pursuant to 44 U.S.C. 1510.
The Code of Federal Regulations is sold by the Superintendent of Documents.
Prices of new books are listed in the first FEDERAL REGISTER issue of each
week.
========================================================================
Federal Register / Vol. 61, No. 170 / Friday, August 30, 1996 / Rules
and Regulations
[[Page 45873]]
FEDERAL RESERVE SYSTEM
12 CFR Part 225
[Regulation Y; Docket No. R-0868]
Investment Adviser Activities
AGENCY: Board of Governors of the Federal Reserve System.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: The Board is adopting a final rule amending its interpretive
rule regarding investment adviser activities of bank holding companies
to allow a bank holding company (and its bank and nonbank subsidiaries)
to purchase, in a fiduciary capacity, securities of an investment
company advised by the bank holding company if the purchase is
specifically authorized by the terms of the instrument creating the
fiduciary relationship, by court order, or by the law of the
jurisdiction under which the trust is administered. This amendment
would reflect changes that have occurred since the rule was adopted;
and would conform the Board's interpretive rule to rules applied to
banks by the Federal Deposit Insurance Corporation and the Office of
the Comptroller of the Currency, and the standard in section 23B of the
Federal Reserve Act for this type of activity.
EFFECTIVE DATE: September 30, 1996.
FOR FURTHER INFORMATION CONTACT: Thomas M. Corsi, Senior Attorney (202/
452-3275); or David S. Simon, Attorney (202/452-3611), Legal Division,
Board of Governors of the Federal Reserve System. For the hearing
impaired only, Telecommunication Device for the Deaf (TDD), Dorothea
Thompson (202/452-3544).
SUPPLEMENTARY INFORMATION:
Background
In 1972, the Board permitted bank holding companies to serve as
investment advisers to mutual funds and other registered investment
companies, and adopted an interpretive rule setting forth limitations
on this activity. Among the restrictions in the rule is a requirement
that a bank holding company not purchase in its sole discretion in a
fiduciary capacity any securities of an investment company advised by
the bank holding company. The Board adopted this restriction because of
concern that a bank holding company might use its position as a
fiduciary to support an investment company that the bank holding
company advises, increase the asset size of the investment company, or
increase advisory fees.
The Board has sought public comment on a proposal to relax this
restriction to permit a bank holding company to purchase in its sole
discretion in a fiduciary capacity securities of an investment company
advised by the bank holding company if the purchase is specifically
authorized by the terms of the instrument creating the fiduciary
relationship, by court order, or by the law of the jurisdiction under
which the trust is administered.1 This change would reflect
current practice in this area.2
---------------------------------------------------------------------------
\1\ 59 FR 67,654 (December 30, 1994).
\2\ The Board's proposal was in response to requests by several
bank holding companies. These bank holding companies indicated that
a mutual fund advised by the holding company is often the most cost-
effective method of providing investment advice to customers and is
increasingly attractive to customers because a mutual fund provides
customers with a readily marketable and easily valued investment
product. See Letter dated August 12, 1994, from the American Bankers
Association to Chairman Greenspan.
---------------------------------------------------------------------------
Since the Board adopted its investment advisory interpretive rule,
Congress enacted section 23B of the Federal Reserve Act, which permits
a bank or its subsidiary to purchase securities, as a fiduciary, from
an affiliate if such purchases are permitted by the instrument creating
the fiduciary relationship, by court order, or by the law of the
jurisdiction governing the fiduciary relationship.3 Both the
Office of the Comptroller of the Currency (OCC) and the Federal Deposit
Insurance Corporation (FDIC) recently permitted the banks that they
regulate to purchase, in a fiduciary capacity, securities of an
investment company advised by an affiliate of the bank if the purchase
is specifically authorized by the terms of the instrument creating the
fiduciary relationship, by court order, or by local law.4 In
addition, many states have amended their laws to permit a fiduciary to
purchase, on behalf of customer accounts, shares of an investment
company advised by the fiduciary or its affiliate.5 In an
analogous area, the Board has permitted fiduciary purchases of
securities that are underwritten by a section 20 affiliate if the
purchase is specifically authorized under the instrument creating the
fiduciary relationship, by court order, or by the law of the
jurisdiction under which the trust is administered.6
---------------------------------------------------------------------------
\3\ 12 U.S.C. 371c-1(b)(1).
\4\ See OCC Trust Interpretation No. 234 (September 21, 1989);
12 CFR 9.12; and 12 CFR 337.4(e).
\5\ See, e.g., Mich. Comp. Laws Sec. 487.485 (1992) (amended in
1992); Md. Code Ann., Est. & Trusts Sec. 15-106 (1993) (amended in
1991); Ind. Code Ann. Sec. 28-1-12-3 (Burns 1993).
\6\ Citicorp, J.P. Morgan & Company Incorporated, and Bankers
Trust New York Corporation, 73 Federal Reserve Bulletin 473 (1987)
(Citicorp Order), aff'd sub nom. Securities Industry Association v.
Board of Governors of the Federal Reserve System, 839 F.2d 47 (2d
Cir. 1988), cert. denied, 486 U.S. 1059 (1988).
---------------------------------------------------------------------------
The proposed amendment would have required that a bank holding
company disclose to its fiduciary customers in writing that the bank
holding company or its subsidiary serves as investment adviser to the
investment company whose shares are purchased in a fiduciary capacity.
The Board specifically requested public comment on whether the proposed
disclosure requirement is necessary. The Board also requested public
comment on whether the proposed disclosure requirement would be
adequate if given only at the time the fiduciary relationship is
created, or whether written disclosure should be given immediately
prior to each initial investment in an investment company advised by
the bank holding company.
Summary of Public Comments
The Board received 21 comments on its proposal.7 Overall, the
comments supported the Board's proposal. Regarding disclosures, twelve
commenters stated that the Board should not require any special
disclosure when a bank holding company purchases as fiduciary shares of
an investment company advised by the fiduciary or its affiliates.
Several commenters argued that special
[[Page 45874]]
disclosures are unnecessary in cases in which the purchase is permitted
by court order or by the instrument creating the fiduciary relationship
because the court or person creating the fiduciary relationship would
be aware of the potential conflicts of interest. Commenters also stated
that, in the case in which the purchase of shares is permitted by state
law, the timing and content of disclosures should be governed
exclusively by the laws of the state. These commenters generally
maintained that the proposed disclosure would unnecessarily interfere
with state law, could confuse fiduciary customers, and could be
expensive and cumbersome.8
---------------------------------------------------------------------------
\7\ These commenters included 17 banking organizations, two
trade associations, one law firm, and one bank consulting firm.
\8\ One commenter argued that the proposed disclosure was
appropriate and should be required immediately prior to each initial
investment in an investment company advised by the bank holding
company, as well as at the time the fiduciary relationship is
created.
---------------------------------------------------------------------------
Discussion
After further review, the Board has determined that it is
unnecessary to impose a general disclosure requirement when a bank
holding company purchases as fiduciary shares of an investment company
it advises. The Board believes that existing disclosure requirements
are generally sufficient to ensure that fiduciary customers are aware
of potential conflicts of interest that may arise from this activity.
As noted by commenters, the instrument or court order creating the
fiduciary relationship, or state law, often contains or requires the
disclosure of any potential conflict of interest. In addition, the
common law has addressed conflicts of interest, disclosures, and other
remedies in this area. Thus, any disclosure requirement adopted by the
Board may be duplicative or conflict with other disclosure
requirements.
In addition, other federal statutes require certain fiduciaries,
including nonbanking subsidiaries of bank holding companies, to
disclose potential conflicts of interest that may affect the
fiduciary's recommendations. For example, under the Investment Advisers
Act of 1940 (Advisers Act), an investment adviser has a fiduciary duty
to disclose to a client any compensation it receives that may affect
its recommendations.9 Thus, according to the Securities and
Exchange Commission (SEC), an investment adviser that receives fees
from an investment company in which the adviser places trust funds as
fiduciary must disclose to the trust customer the receipt of those fees
and the potential conflict of interest presented.10
---------------------------------------------------------------------------
\9\ 15 U.S.C. Sec. 80b-6. See Hornor Townsend & Kent, Inc., SEC
No-Act. LEXIS 495 (April 4, 1995), citing SEC v. Capital Gains
Research Bureau, Inc., 375 U.S. 180, 194-95 (1963).
\10\ See Neuberger & Berman, SEC No-Act. LEXIS 1496 (May 29,
1984).
---------------------------------------------------------------------------
Although banks, trust companies, and bank holding companies
themselves are exempt from the definition of investment adviser under
the Advisers Act, the Act covers the advisory activities of affiliates
of banks and bank holding companies.11 According to the SEC, a
nonbank subsidiary of a bank holding company--other than a trust
company--has an obligation under the Advisers Act to disclose to its
fiduciary customers that it may acquire for them shares of investment
companies from which the nonbank subsidiary or its affiliate receives
advisory fees.12
---------------------------------------------------------------------------
\11\ See, e.g., First Commerce Investors, Inc., SEC No-Act.
LEXIS 221 (January 31, 1991) (* * * the Advisers Act does not
specifically except a subsidiary of a bank or a bank holding company
from the definition of investment adviser, unless that subsidiary is
itself a bank or bank holding company.); 15 U.S.C. Sec. 80b-1(11).
\12\ Bank holding companies acting as fiduciaries to employee
retirement plans also may be required to make disclosures under the
Employee Retirement Income Security Act (ERISA) and Department of
Labor Regulations. See 29 U.S.C. Secs. 1106 and 1108; Prohibited
Transaction Exception 77-4, 42 FR 18,732 (April 8, 1977).
---------------------------------------------------------------------------
Neither the OCC nor the FDIC generally require a bank to
specifically disclose to its fiduciary customers that the bank serves
as investment adviser to an investment company whose shares the bank
purchases in a fiduciary capacity.13 The OCC recently indicated
that a national bank that invests fiduciary assets in mutual funds that
pay fees to the bank for services may, if the bank also receives fees
for acting as a fiduciary, do so only to the extent authorized under
state law, the trust instrument, or court order. The OCC further
indicated that a trustee's overall fees must be consistent with any
state law requirements that fees be reasonable, necessary, or
appropriate, and the fee arrangement must be disclosed pursuant to any
relevant state law disclosure requirements.14
---------------------------------------------------------------------------
\13\ See 12 CFR 9.12 and 337.4(e). In addition, section 23B does
not require a bank or its subsidiary to disclose to its fiduciary
customers that it may purchase securities from an affiliate.
Moreover, the Citicorp Order does not require specific disclosure of
fiduciary purchases of securities underwritten by a section 20
affiliate.
\14\ See OCC Interpretive Letter No. 704, November 2, 1995.
---------------------------------------------------------------------------
While the Board is not adopting a disclosure requirement, the Board
believes, as a general matter, that the disclosure of potential
conflicts of interest is consistent with sound fiduciary principles.
Accordingly, the Board encourages bank holding companies not already
required to disclose potential conflicts of interest (by the instrument
or court order creating the trust or by state or federal law) to make
such disclosures. Bank holding companies engaging in this activity
should recognize that their activities may be subject to disclosure
requirements under state and federal laws, and should engage in the
activities in a manner consistent with common law principles of trust
law.
Other Comments
Four commenters stated that the Board should seek public comment on
amending other restrictions contained in paragraph (g) of the
interpretive rule. In particular, these commenters suggested that the
Board reconsider the appropriateness of paragraphs (g) (1), (3) and (4)
of the interpretive rule, which prohibit a bank holding company and its
bank and nonbank subsidiaries from (i) purchasing for their own account
securities of any investment company for which the bank holding company
acts as investment adviser, (ii) extending credit to any such
investment company, or (iii) accepting securities of such investment
company as collateral for a loan which is for the purpose of purchasing
securities of the investment company. Two of these commenters stated
that national and state-member banks can engage in these activities
subject only to the limitations contained in sections 23A and 23B of
the Federal Reserve Act. Another commenter stated that these
prohibitions prevent bank holding companies from competing effectively
with other organizations because bank holding companies cannot provide
the initial seed or start-up capital for advised investment companies
or provide liquidity to such funds. One commenter also stated that the
restrictions of paragraph (g) should apply to investment companies
advised by subsidiary banks of bank holding companies.15 The Board
has decided to seek comment on amending other provisions of paragraph
(g) in a separate proceeding.
---------------------------------------------------------------------------
\15\ The restrictions contained in paragraph (g) only apply to
investment companies advised by a bank holding company or its
nonbank subsidiaries. See Norwest Corporation, 76 Federal Reserve
Bulletin 79, 80 n.3 (1990).
---------------------------------------------------------------------------
Regulatory Flexibility Act Analysis
Pursuant to section 605(b) of the Regulatory Flexibility Act (Pub.
L. 95-354, 5 U.S.C. 601 et seq.), the Board of Governors of the Federal
Reserve System certifies that adoption of this final rule would not
have a significant economic impact on a substantial number of small
entities that would be subject to the regulation.
[[Page 45875]]
This amendment will remove a restriction currently contained in the
Board's regulations that the Board believes is no longer necessary. The
amendment does not impose more burdensome requirements on bank holding
companies than are currently applicable.
Paperwork Reduction Act
In accordance with the Paperwork Reduction Act of 1995 (44 U.S.C.
3506; 5 CFR 1320 Appendix A.1), the Board reviewed the final rule under
the authority delegated to the Board by the Office of Management and
Budget. No collections of information pursuant to the Paperwork
Reduction Act are contained in the final rule.
List of Subjects in 12 CFR Part 225
Administrative practice and procedure, Banks, banking, Federal
Reserve System, Holding companies, Reporting and recordkeeping
requirements, Securities.
For the reasons set forth in the preamble, the Board amends 12 CFR
Part 225 as set forth below:
PART 225--BANK HOLDING COMPANIES AND CHANGE IN BANK CONTROL
(REGULATION Y)
1. The authority citation for 12 CFR 225 continues to read as
follows:
Authority: 12 U.S.C. 1817(j)(13), 1818, 1831i, 1831p-1,
1843(c)(8), 1844(b), 1972(1), 3106, 3108, 3310, 3331-3351, 3907, and
3909.
2. Section 225.125 is amended by revising paragraph (g) to read as
follows:
Sec. 225.125 Investment adviser activities.
* * * * *
(g) In view of the potential conflicts of interests that may exist,
a bank holding company and its bank and nonbank subsidiaries should
not:
(1) Purchase for their own account securities of any investment
company for which the bank holding company acts as investment adviser;
(2) Purchase in their sole discretion, any such securities in a
fiduciary capacity (including as managing agent) unless the purchase is
specifically authorized by the terms of the instrument creating the
fiduciary relationship, by court order, or by the law of the
jurisdiction under which the trust is administered;
(3) Extend credit to any such investment company; or
(4) Accept the securities of any such investment company as
collateral for a loan which is for the purpose of purchasing securities
of the investment company.
* * * * *
By order of the Board of Governors of the Federal Reserve
System, August 26, 1996.
William W. Wiles,
Secretary of the Board.
[FR Doc. 96-22168 Filed 8-29-96; 8:45 am]
BILLING CODE 6210-01-P
Complete official Federal Register PDF
FR Doc. 96-22145 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1997 Rates
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Pages 46166-46328]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22145]
[[Page 46165]]
_______________________________________________________________________
Part V
Department of Health and Human Services
_______________________________________________________________________
Health Care Financing Administration
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42 CFR Part 412, et al.
Medicare Program; Changes to the Hospital Inpatient Prospective Payment
Systems and Fiscal Year 1997 Rates; Final Rule
Federal Register / Vol. 61, No. 170 / Friday, August 30, 1996 / Rules
and Regulations
[[Page 46166]]
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
42 CFR Parts 412, 413, and 489
[BPD-847-F]
RIN 0938-AH34
Medicare Program; Changes to the Hospital Inpatient Prospective
Payment Systems and Fiscal Year 1997 Rates
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Final rule.
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SUMMARY: We are revising the Medicare hospital inpatient prospective
payment systems for operating costs and capital- related costs to
implement necessary changes arising from our continuing experience with
the systems. In addition, in the addendum to this final rule, we are
describing changes in the amounts and factors necessary to determine
prospective payment rates for Medicare hospital inpatient services for
operating costs and capital-related costs. These changes are applicable
to discharges occurring on or after October 1, 1996. We are also
setting forth rate-of-increase limits as well as policy changes for
hospitals and hospital units excluded from the prospective payment
systems.
EFFECTIVE DATE: This rule is a major rule as defined in Title 5, United
States Code, section 804(2). Pursuant to 5 U.S.C. section 801(a)(3),
this rule may not take effect until 60 days after the report required
by that section is submitted to the Congress, which is October 29,
1996. However, for purposes of the policy discussions in this document,
we have assumed that the effective date of this final rule will be
October 1, 1996, the earliest date by which this rule could take effect
under 5 U.S.C. section 801 and the Medicare statute.
ADDRESSES: Copies: To order copies of the Federal Register containing
this document, send your request to: New Orders, Superintendent of
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and photocopy the Federal Register document at most libraries
designated as Federal Depository Libraries and at many other public and
academic libraries throughout the country that receive the Federal
Register.
FOR FURTHER INFORMATION CONTACT:
Nancy Edwards (410) 786-4531: Operating Prospective Payment, DRG, Wage
Index Issues.
Tzvi Hefter (410) 786-4529: Capital Prospective Payment, Direct
Graduate Medical Education, Excluded Hospitals.
SUPPLEMENTARY INFORMATION:
I. Background
A. Summary
Under section 1886(d) of the Social Security Act (the Act), a
system of payment for the operating costs of acute care hospital
inpatient stays under Medicare Part A (Hospital Insurance) based on
prospectively-set rates was established effective with hospital cost
reporting periods beginning on or after October 1, 1983. Under this
system, Medicare payment for hospital inpatient operating costs is made
at a predetermined, specific rate for each hospital discharge. All
discharges are classified according to a list of diagnosis-related
groups (DRGs). The regulations governing the hospital inpatient
prospective payment system are located in 42 CFR part 412.
For cost reporting periods beginning before October 1, 1991,
hospital inpatient operating costs were the only costs covered under
the prospective payment system. Payment for capital-related costs had
been made on a reasonable cost basis because, under sections 1886(a)(4)
and (d)(1)(A) of the Act, those costs had been specifically excluded
from the definition of inpatient operating costs. However, section
4006(b) of the Omnibus Budget Reconciliation Act of 1987 (Public Law
100-203) revised section 1886(g)(1) of the Act to require that, for
hospitals paid under the prospective payment system for operating
costs, capital-related costs would also be paid under a prospective
payment system effective with cost reporting periods beginning on or
after October 1, 1991. As required by section 1886(g) of the Act, we
replaced the reasonable cost-based payment methodology with a
prospective payment methodology for hospital inpatient capital-related
costs. Under the new methodology, effective for cost reporting periods
beginning on or after October 1, 1991, a predetermined payment amount
per discharge is made for Medicare inpatient capital-related costs.
(See subpart M of 42 CFR part 412, and the August 30, 1991 final rule
(56 FR 43358) for a complete discussion of the prospective payment
system for hospital inpatient capital-related costs.)
B. Major Contents of the Provisions of the May 31, 1996 Proposed Rule
On May 31, 1996, we published a proposed rule in the Federal
Register (61 FR 27444) setting forth proposed changes to the Medicare
hospital inpatient prospective payment systems for both operating costs
and capital-related costs which would be effective for discharges
occurring on or after October 1, 1996. The following is a summary of
the major issues addressed and changes that we proposed to make:
We proposed changes for FY 1997 DRG classifications and
relative weighting factors as required by section 1886(d)(4)(c) of the
Act.
We proposed to update the wage index for FY 1997. We also
solicited comments on the possible expansion of the types of contract
labor costs included in the wage index and on possible revisions in
Puerto Rico labor market areas.
We proposed revisions to the regulations governing the
composition of the Medicare Geographic Classification Review Board
(MGCRB).
We proposed to use a rebased and revised hospital market
basket in developing the FY 1997 update factor for the operating
prospective payment rates, the capital prospective payment rates, and
the excluded hospital rate-of-increase limits.
We discussed several provisions of the regulations in 42
CFR parts 412, 413, and 489 and set forth proposed changes concerning
the following:
--Sole community hospitals.
--Rural referral centers.
--Disproportionate share adjustment.
--Direct graduate medical education payments.
--Hospital distribution of ``An Important Message from Medicare.''
We discussed several provisions of the regulations in 42
CFR part 412 concerning the prospective payment system for capital-
related costs, including possible adjustments to the capital Federal
and hospital-specific rates, and set forth a proposed change concerning
the use of simplified cost accounting.
We discussed clarifications concerning the calculation of
payments to hospitals excluded from the prospective payment system.
In the addendum to the proposed rule, we set forth
proposed changes to the amounts and factors for determining
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the FY 1997 prospective payment rates for operating costs and capital-
related costs. We also proposed new update factors for determining the
rate-of-increase limits for cost reporting periods beginning in FY 1997
for hospitals and hospital units excluded from the prospective payment
system.
In Appendix A to the proposed rule, we set forth an
analysis of the impact that the proposed changes would have on affected
entities.
In Appendix B to the proposed rule, we set forth our
technical appendix on the proposed FY 1997 capital acquisition model.
In Appendix C to the proposed rule, we set forth the data
sources used to determine the market basket relative weights and choice
of price proxies.
In Appendix D to the proposed rule, we included our report
to Congress on our initial estimate of an update factor for FY 1997 for
both hospitals included in and hospitals excluded from the prospective
payment systems as required by section 1886(e)(3)(B) of the Act.
As required by sections 1886(e)(4) and (e)(5) of the Act,
in Appendix E we provided our recommendation of the appropriate
percentage change for FY 1997 for the following:
--Large urban area and other area average standardized amounts (and
hospital-specific rates applicable to sole community hospitals) for
hospital inpatient services paid for under the prospective payment
system for operating costs.
--Target rate-of-increase limits to the allowable operating costs of
hospital inpatient services furnished by hospitals and hospital units
excluded from the prospective payment system.
In the proposed rule, we discussed in detail the March 1,
1996 recommendations made by the Prospective Payment Assessment
Commission (ProPAC). ProPAC is directed by section 1886(e)(2)(A) of the
Act to make recommendations on the appropriate percentage change factor
to be used in updating the average standardized amounts. In addition,
section 1886(e)(2)(B) of the Act directs ProPAC to make recommendations
regarding changes in each of the Medicare payment policies under which
payments to an institution are prospectively determined. In particular,
the recommendations relating to the hospital inpatient prospective
payment systems are to include recommendations concerning the number of
DRGs used to classify patients, adjustments to the DRGs to reflect
severity of illness, and changes in the methods under which hospitals
are paid for capital-related costs. Under section 1886(e)(3)(A) of the
Act, the recommendations required of ProPAC under sections 1886(e)(2)
(A) and (B) of the Act are to be reported to Congress not later than
March 1 of each year.
We printed ProPAC's March 1, 1996 report, which included its
recommendations, as Appendix F to the proposed rule. The
recommendations, and the actions we proposed to take with regard to
them (when an action is recommended), were discussed in detail in the
appropriate sections of the preamble, the addendum, or the appendices
to the proposed rule.
Set forth below in this preamble, the addendum to this final rule,
and the appendices are detailed discussions of the May 31 proposed
rule, the public comments received in response to the proposed rule,
and the responses to those comments, as well as the changes we are
making. In addition, in section V.E.3 of this preamble, we address a
recent statutory amendment to the Public Health Service Act that
prohibits certain abortion-related discrimination by the Federal
Government and State and local governments. The new statutory provision
requires the Federal Government to deem accredited for certain purposes
any postgraduate physician training program that would otherwise be
accredited, except for the accrediting agency's reliance on certain
standards concerning induced abortions.
C. Public Comments Received in Response to the May 31 Proposed Rule
A total of 511 items of correspondence containing comments on the
proposed rule were received timely. We received over 300 letters on
payments for direct graduate medical education programs. The main other
areas of concern addressed by the commenters were the following:
Requests for changes in DRG classification and relative
weights.
Issues related to the wage index.
Disproportionate share adjustment.
Possible adjustments to the capital Federal and hospital-
specific rates.
II. Changes to DRG Classifications and Relative Weights
A. Background
Under the prospective payment system, we pay for inpatient hospital
services on the basis of a rate per discharge that varies by the DRG to
which a beneficiary's stay is assigned. The formula used to calculate
payment for a specific case takes an individual hospital's payment rate
per case and multiplies it by the weight of the DRG to which the case
is assigned. Each DRG weight represents the average resources required
to care for cases in that particular DRG relative to the average
resources used to treat cases in all DRGs.
Congress recognized that it would be necessary to recalculate the
DRG relative weights periodically to account for changes in resource
consumption. Accordingly, section 1886(d)(4)(C) of the Act requires
that the Secretary adjust the DRG classifications and relative weights
annually. These adjustments are made to reflect changes in treatment
patterns, technology, and any other factors that may change the
relative use of hospital resources. The changes to the DRG
classification system and the recalibration of the DRG weights for
discharges occurring on or after October 1, 1996 are discussed below.
B. DRG Reclassification
1. General
Cases are classified into DRGs for payment under the prospective
payment system based on the principal diagnosis, up to eight additional
diagnoses, and up to six procedures performed during the stay, as well
as age, sex, and discharge status of the patient. The diagnosis and
procedure information is reported by the hospital using codes from the
International Classification of Diseases, Ninth Edition, Clinical
Modification (ICD-9-CM). The Medicare fiscal intermediary enters the
information into its claims system and subjects it to a series of
automated screens called the Medicare Code Editor (MCE). These screens
are designed to identify cases that require further review before
classification into a DRG can be accomplished.
After screening through the MCE and any further development of the
claims, cases are classified by the GROUPER software program into the
appropriate DRG. The GROUPER program was developed as a means of
classifying each case into a DRG on the basis of the diagnosis and
procedure codes and demographic information (that is, sex, age, and
discharge status). It is used both to classify past cases in order to
measure relative hospital resource consumption to establish the DRG
weights and to classify current cases for purposes of determining
payment. The records for all Medicare hospital inpatient discharges are
maintained in the Medicare Provider Analysis and Review (MedPAR) file.
The data in this file are used to evaluate possible DRG
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classification changes and to recalibrate the DRG weights.
Currently, cases are assigned to one of 492 DRGs in 25 major
diagnostic categories (MDCs). Most MDCs are based on a particular organ
system of the body (for example, MDC 6, Diseases and Disorders of the
Digestive System); however, some MDCs are not constructed on this basis
since they involve multiple organ systems (for example, MDC 22, Burns).
In general, principal diagnosis determines MDC assignment. However,
there are five DRGs to which cases are assigned on the basis of
procedure codes rather than first assigning them to an MDC based on the
principal diagnosis. These are the DRGs for liver, bone marrow, and
lung transplant (DRGs 480, 481, and 495, respectively) and the two DRGs
for tracheostomies (DRGs 482 and 483). Cases are assigned to these DRGs
before classification to an MDC.
Within most MDCs, cases are then divided into surgical DRGs (based
on a surgical hierarchy that orders individual procedures or groups of
procedures by resource intensity) and medical DRGs. Medical DRGs
generally are differentiated on the basis of diagnosis and age. Some
surgical and medical DRGs are further differentiated based on the
presence or absence of complications or comorbidities (hereafter CC).
Generally, GROUPER does not consider other procedures; that is,
nonsurgical procedures or minor surgical procedures generally not
performed in an operating room are not listed as operating room (OR)
procedures in the GROUPER decision tables. However, there are a few
non-OR procedures that do affect DRG assignment for certain principal
diagnoses, such as extracorporeal shock wave lithotripsy for patients
with a principal diagnosis of urinary stones.
We proposed to make several changes to the DRG classification
system for FY 1997 and other decisions concerning DRGs. These proposed
changes and other revisions, the comments we received concerning them,
our responses to those comments, and the final DRG changes are set
forth below.
2. Pre-MDC DRGs
Effective October 1, 1994, ICD-9-CM procedure code 41.04,
Autologous hematopoietic stem cell transplant, was created to capture
the transplantation of stem cells obtained from bone marrow or
peripheral blood. At that time, we designated the code as non-OR. When
we created this code, we received comments requesting that it be
designated as an OR procedure and assigned to DRG 481 (Bone Marrow
Transplant) based on the resource use associated with the type of
transplant. However, as we stated in the September 1, 1994 final rule
(59 FR 45340), when a new code is introduced, our longstanding practice
is to assign it to the same DRG category as its predecessor code.
Because we could not separately identify the stem cell transplant cases
from the other cases coded with 99.73 (the code previously used for
stem cell transplant) in order to reclassify them and their charges to
a new DRG, we were unable to predict the new weights of both the DRGs
in which this code currently is classified and the new DRG to which it
would be assigned. Therefore, we were prevented from redesignating code
41.04 as an OR procedure or assigning it to a DRG. However, we stated
that we would analyze the stem cell cases as soon as the FY 1995 cases
were available.
This year, the FY 1995 MedPAR file is available for use in DRG
analysis and weight setting for FY 1997. Since the average resource use
associated with stem cell transplant is similar to that associated with
bone marrow transplant, we proposed to assign procedure code 41.04 to
DRG 481 effective with discharges occurring on or after October 1,
1996. In addition, we proposed to designate stem cell transplant as an
OR procedure. In the proposed rule, we noted that, as set forth in the
Medicare Coverage Issues Manual at section 35-30.1 (see Transmittal No.
84, April 1996), autologous stem cell transplants are not covered when
performed for the following conditions:
Acute leukemia not in remission (diagnosis codes 204.00,
205.00, 206.00, 207.00 and 208.00).
Chronic granulocytic leukemia (diagnosis codes 205.10 and
205.11).
Solid tumors (other than neuroblastomas) (diagnosis codes
140.0 through 199.1).
Multiple myeloma (diagnosis codes 203.00, 203.01, and
238.6).
We received five comments supporting our proposal to assign
procedure code 41.04 to DRG 481, and we will include this change in the
final DRG classifications. Two other commenters had specific questions
concerning the assignment of cases to DRG 481.
Comment: One commenter questioned the DRG assignment of cases in
which an autologous hematopoietic stem cell transplant is performed for
one of the noncovered conditions such as acute leukemia not in
remission or multiple myeloma. The commenter is unsure whether those
cases would be assigned to DRG 481 or retain their current DRG
assignment.
Response: When a stem cell transplant is performed for a noncovered
condition, the case will not be assigned to DRG 481. If the only reason
that the patient is admitted to the hospital is to receive the
noncovered procedure, then the case receives no Medicare payment
because the hospital stay is not covered. If a patient receives a
noncovered stem cell transplant during an otherwise Medicare-covered
stay, then the case is assigned to a DRG based on the patient's
principal and secondary diagnoses as well as any other covered
procedure the patient receives. The stem cell transplant will not be
considered in the DRG assignment.
Comment: One commenter was concerned about the assignment of a case
in which a kidney transplant patient receives an allogeneic bone marrow
transplant (procedure code 41.03) from the kidney donor to reduce the
incidence and magnitude of organ rejection. The commenter believes it
is inappropriate to assign such a case to DRG 481 rather than DRG 302
(Kidney Transplant) and that we should therefore revise the pre-MDC
surgical hierarchy.
Response: Allogeneic bone marrow transplants performed for purposes
of reducing rejection during a kidney transplant have not yet been
subject to a national coverage decision. Therefore, under HCFA policy,
the Medicare contractors (Part A fiscal intermediaries and Part B
carriers) determine, on a case-by-case basis, whether or not to cover
and pay for such claims. If a contractor did decide that one of these
claims should be covered, then it would be paid under DRG 481. If the
contractor determines that the bone marrow transplant is not covered,
the claim would be assigned to a DRG without considering the bone
marrow transplant. In most cases, this assignment would be DRG 302.
3. MDC 1 (Diseases and Disorders of the Nervous System)
a. Sleep apnea. As discussed in the proposed rule, we have received
correspondence requesting that we review the DRG assignment of cases in
which surgery is performed to correct obstructive sleep apnea
(diagnosis code 780.57). When coded as a principal diagnosis, sleep
apnea is assigned to DRGS 34 and 35 (Other Disorders of the Nervous
System) 1 in MDC 1.
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\1\ A single title combined with two DRG numbers is used to
signify pairs. Generally, the first DRG is for cases with CC and the
second DRG is for cases without CC. If a third number is included,
it represents cases of patients who are age 0-17. Occasionally, a
pair of DRGs is split on age>17 and age 0-17.
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Recently, new surgical interventions to correct sleep apnea have
been introduced. The procedures most frequently performed for this
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condition are the following:
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Code Description
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27.69............................ Other plastic repair of palate.
29.4............................. Plastic operation on pharynx.
29.59............................ Other repair of pharynx.
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Since none of these surgical procedures is assigned to MDC 1, cases
of sleep apnea treated with one of these surgeries are assigned to DRG
468 (Extensive OR procedure Unrelated to Principal Diagnosis) or to DRG
477 (Nonextensive OR Procedure Unrelated to Principal Diagnosis),
depending on the procedure.
We proposed to address this situation by assigning the three
surgical procedures to MDC 1. Based on the charges associated with
these cases and the fact that they are not clinically similar to the
other surgical DRGs in MDC 1, we proposed to include them in DRGs 7 and
8 (Peripheral and Cranial Nerve and Other Nervous System Procedures).
We received two comments in support of the addition of codes 27.69,
29.4 and 29.59 to DRGS 7 and 8. The commenters agree that these
procedures are frequently used as surgical interventions to correct
sleep apnea and are appropriately classified to DRGs 7 and 8. We also
received two comments that disagreed, as discussed below.
Comment: One commenter was opposed to moving the procedure codes to
DRGS 7 and 8. The commenter stated that if the patient had obstructive
sleep apnea, the more appropriate diagnosis code would be the
underlying cause of the obstruction, such as upper airway blockage
(diagnosis code 528.9, Other and Unspecified Diseases of the Oral Soft
Tissues) or diagnosis code 478.29, Other Diseases of Pharynx for
Redundant Pharyngeal Mucosa.
Response: We agree that if the medical record provides a precise
diagnosis for the obstruction, then that condition should be coded.
However, information supporting these codes is not always provided in
the medical record. Physicians frequently document obstructive sleep
apnea as the reason for the surgery. In these cases, medical record
coders are assigning code 780.57. As explained above, we believe that
it is inappropriate to continue to assign these cases to DRGS 468 and
477 and that the better policy is to assign the procedures to MDC 1.
Comment: We received one comment suggesting that obstructive sleep
apnea reported in conjunction with procedure codes 27.69, 29.4, or
29.59 would be more appropriately classified to DRGs 76 and 77 (Other
Respiratory System Procedures) in MDC 4 (Diseases of the Respiratory
System). In addition, the commenter recommended that obstructive sleep
apnea medical cases be assigned to DRGs 101 and 102 (Other Respiratory
Diagnoses).
Response: In order to properly classify each case, a diagnosis code
may be assigned to only one MDC. Diagnoses in each MDC correspond to a
single organ system or etiology and in general are associated with a
particular medical specialty. In order to classify cases of obstructive
sleep apnea to DRGs 76, 77, 101, and 102, code 780.57 would have to be
reassigned from MDC 1 to MDC 4. We believe that obstructive sleep apnea
is more appropriately classified to MDC 1; therefore, these cases
cannot be assigned to a DRG in MDC 4.
Comment: One commenter noted an error in the discussion of sleep
apnea in the proposed rule. The second time we referred to the codes to
be moved to MDC 1, we listed them as 25.59, 78.49, and 29.4 (see 61 FR
27447).
Response: In the proposed rule, we inadvertently referred to
procedures codes 25.59 and 78.49. The codes that will be added to DRGs
7 and 8 are 27.69, 29.4 and 29.59.
b. Guillain-Barre Syndrome. Guillain-Barre syndrome (diagnosis code
357.0) is a post-infectious polyneuropathy in which severely affected
patients may require ventilatory assistance and long stays in intensive
care. In recognition of the high resource consumption associated with
this diagnosis, effective with FY 1991, we reassigned code 357.0 from
DRGs 18 and 19 (Cranial and Peripheral Nerve Disorders) to DRG 20
(Nervous System Infection Except Viral Meningitis). (See the September
4, 1990 final rule (55 FR 36024).)
We have recently received requests that we again review this
assignment. These commenters stated that the treatment for these cases
remains very costly and often entails long hospital stays. Therefore,
we conducted an analysis of the cases assigned to DRG 20 using the 10
percent random sample of the FY 1995 MedPAR file that we use for
analyzing possible classification changes.
Cases coded with 357.0 constitute approximately 20 percent of the
cases assigned to DRG 20. The average standardized charges for these
cases, approximately $22,400, was higher than the average charge for
the DRG, approximately $17,100. However, the length of stay was
virtually the same. Since we believe that DRG 20 is the appropriate
assignment clinically for Guillain-Barre cases, we reviewed the other
cases assigned to DRG 20 for possible change.
We found that herpes zoster of the nervous system, NOS (diagnosis
code 053.10) and herpes zoster of the nervous system, NEC (diagnosis
code 053.19) had average charges of only $7,700 and $7,100,
respectively. They also had lower average lengths of stay (6.2 and 6.1
days, respectively). (In the proposed rule, we mistakenly cited these
lengths of stay as 4.4 and 4.2, respectively (61 FR 27447).) Because
these two diagnoses account for approximately 20 percent of the cases
in DRG 20, their low average charge has the effect of significantly
lowering the average charge for the DRG. We proposed to reassign these
codes to DRGs 18 and 19.
Comment: We received two comments regarding our proposal to assign
diagnosis codes 053.10 and 053.19 to DRGs 18 and 19, both of which
supported the change. However, one commenter noted that even though
these cases obviously do not consume the amount of resources as other
cases assigned to DRG 20, clinically, they are more closely related to
cases in DRG 20 than those in DRGs 18 and 19. The commenter also
expressed an interest in the length of stay and charges for geniculate
herpes zoster (diagnosis code 053.11), which we did not propose to move
from DRG 20.
Response: We do not believe that reassigning these codes to DRGs 18
and 19 is clinically unsound. There are currently two other herpes
zoster diagnoses classified to those DRGs (Postherpetic trigeminal
neuralgia (code 053.12) and postherpetic polyneuropathy (code 053.13)).
Further, as the commenter noted, the charges and length of stay for
053.10 and 053.19 are very close to those for the cases assigned to
DRGs 18 and 19.
We had considered moving all three herpes diagnosis codes (035.10,
053.11, and 053.19) from DRG 20 to DRGs 18 and 19. However, the higher
charges associated with geniculate herpes zoster ($11,000) and slightly
higher length of stay (6.7 days) led us to decide instead to leave
053.11 in DRG 20 and to closely monitor these cases in upcoming years.
4. MDC 5 (Diseases and Disorders of the Circulatory System)
Effective for discharges occurring on or after October 1, 1995, we
created a
[[Page 46170]]
new code for insertion of a coronary artery stent (procedure code
36.06). Until creation of the new code, insertion of coronary artery
stent had been included in the codes for percutaneous transluminal
coronary angioplasty (PTCA) (procedure codes 36.01, 36.02, and 36.05).
When a new code is introduced, our longstanding practice is to
assign it to the same DRG category as its predecessor code or codes.
Therefore, in the September 1, 1995 final rule (60 FR 45785), we
assigned procedure code 36.06 to DRG 112 (Percutaneous Cardiovascular
Procedures), the DRG to which PTCA is assigned. We also stated that the
resource use and other data associated with procedure code 36.06 will
be available in the FY 1996 Medicare cases which are used for analysis
as part of FY 1998 DRG changes. We will evaluate the DRG assignment of
coronary artery stent insertion at that time.
Since publication of the September 1, 1995 final rule, we have
received data on stent cases provided by the manufacturer of one of the
two stent devices currently approved by the Food and Drug
Administration (FDA). In addition, the manufacturer has provided us
with an analysis of the charges and length of stay of approximately
7,500 Medicare patients who received stents in FY 1995.
The manufacturer's analysis found that the FY 1995 average charge
for PTCA cases without stent is approximately $15,700 and the average
charge for cases with stent is approximately $21,000. However, our
analysis of the data shows that there is wide variation in the hospital
standardized charges reported for cases with implant of coronary artery
stent. Individual hospital average charges for these cases range from
about $9,000 to over $45,000.
This inconsistency in the data illustrates why our policy of not
reassigning new codes until we have collected an entire year of coded
Medicare data for analysis is prudent. The uncertainty associated with
using incomplete data collected outside the Medicare program that
cannot be verified remains a problem. Therefore, we did not propose any
DRG assignment change for implant of coronary artery stent.
Comment: We received five comments on this issue. One commenter
agreed that the strategy of not assigning new codes into different DRGs
until Medicare data have been collected and reviewed is appropriate.
Four commenters requested that we take action this year. The commenters
suggested various options for reassigning code 36.06: assign the code
to its own DRG; move the code to a higher-weighted DRG (DRG 116, Other
Permanent Cardiac Pacemaker Implant or AICD Lead or Generator Procedure
was suggested); or increase the weight for DRG 112 to recognize that
some of these cases involve stents.
One commenter believes that if we delay action, hospitals will not
be able to provide stent therapy to Medicare beneficiaries, thereby
depriving them of state-of-the-art technology and better outcomes. The
commenter noted that although the literature has reported higher costs
(for example, cost of the device itself, increased anticoagulation
therapy, more frequent monitoring) related to this procedure, there has
also been some offset noted because of the reduction in followup
medical costs. There is also the potential that further improvement in
stent design, implantation techniques, and other anticoagulant therapy
could further increase this offset by reducing vascular complications
or length of stay.
One commenter, the manufacturer of a coronary stent device, stated
that the assignment of coronary stent implant to DRG 112 is
inappropriate in light of the higher average lengths of stay and
charges associated with this procedure compared to traditional
angioplasty. The commenter argued that, given these differences, DRG
reclassification of procedure code 36.06 would be consistent with the
statutory mandate to adjust the DRG classifications and relative
weights to ``reflect changes in treatment patterns, technology, and
other factors which may change the relative use of hospital
resources.'' (Section 1886(d)(4)(C) of the Act.)
The commenter also cited 1,200 peer-reviewed clinical publications
that demonstrate superior clinical outcomes with coronary stent
implant. Finally, the commenter stated that the variation in hospital
standardized charges for coronary stent implant cases is less than the
variation in charges for all PTCA cases without stent implant.
Response: As we stated in the proposed rule (61 FR 27447) and in
the September 1, 1995 final rule (60 FR 45785), our practice is to
assign a new code to the same DRG or DRGs as its predecessor code. One
compelling reason for this practice is our inability to move the cases
associated with the new code to a new DRG assignment as part of the DRG
reclassification and recalibration process. Because the code is new, we
cannot identify the stent cases in DRG 112 to remove the charges from
that DRG, revise the relative weight accordingly, and move those cases
to another DRG and establish the revised weight of that DRG.
We do not disagree with the commenters that the stent implant cases
are more costly, on average, than other PTCA cases. We also do not
dispute the clinical superiority of this treatment for certain
patients. However, until we can review actual Medicare data to
determine exactly what the difference in charges is, we cannot make a
reasoned decision as to whether those cases should be moved to another
DRG or be assigned to a new DRG. We believe that waiting for
appropriate data is entirely consistent with our statutory duty to
adjust DRG classifications.
Regarding the comment on the variation in charges for stent versus
nonstent PTCA cases, we note that the charges for a specific procedure
should vary less than the charges for a set of cases that vary in
severity and for which many different treatments may be performed. That
is, the homogeneity of the patients who received a stent implant should
reflect a lower degree of variation.
Finally, analysis of data provided by the stent manufacturer
convinced us that Medicare beneficiaries have access to stent implants
that is at least equal to the general population. Moreover, we note
that it is a violation of a hospital's Medicare provider agreement to
place restrictions on the number of Medicare beneficiaries it will
accept for treatment unless it places the same restrictions on all
other patients. We will carefully examine the PTCA cases with and
without stent implant in the FY 1996 claims data file as soon as it is
available. Any DRG changes we determine are supported by the data will
be addressed in the FY 1998 proposed rule.
5. MDC 8 (Diseases and Disorders of the Musculoskeletal System and
Connective Tissue)
In the proposed rule, we reviewed the DRG assignment in MDC 8 of
bipolar hip replacement cases as a follow-up to a comment received last
year. The commenter believed that the procedure for partial hip
replacement (code 81.52), currently assigned to DRG 209 (Major Joint
and Limb Reattachment Procedures of Lower Extremity), is very similar
to the procedure for open reduction of fracture of the femur with
internal fixation (code 79.35), which is assigned to DRGs 210, 211, and
212 (Hip and Femur Procedures Except Major Joint). Further, the
commenter noted that partial hip replacement patients are more frail
individuals than the population that elects total hip replacement and
need longer hospital stays to recover.
[[Page 46171]]
After reviewing the FY 1995 MedPAR file, we concluded that the
charges and lengths of stay for partial hip replacement cases assigned
to DRG 209 were very similar to the other cases assigned to DRG 209.
However, the average charge for cases in DRG 210 was significantly less
than the partial hip replacement charges. We note that the length of
stay for partial hip replacement cases was closer to the average length
of stay for DRG 210. However, the higher charges of the partial hip
replacement cases indicate that they are more resource-intensive than
the cases in DRG 210 and similar to the cases in DRG 209. Therefore, we
proposed to retain procedure code 81.52 in DRG 209.
We received three comments, all of which supported our proposal,
and we will continue to assign partial hip replacement cases to DRG
209.
6. Surgical Hierarchies
Some inpatient stays entail multiple surgical procedures, each one
of which, occurring by itself, could result in assignment of the case
to a different DRG within the MDC to which the principal diagnosis is
assigned. It is, therefore, necessary to have a decision rule by which
these cases are assigned to a single DRG. The surgical hierarchy, an
ordering of surgical classes from most to least resource-intensive,
performs that function. Its application ensures that cases involving
multiple surgical procedures are assigned to the DRG associated with
the most resource-intensive surgical class.
Because the relative resource intensity of surgical classes can
shift as a function of DRG reclassification and recalibration, we
reviewed the surgical hierarchy of each MDC, as we have for previous
reclassifications, to determine if the ordering of classes coincided
with the intensity of resource utilization, as measured by the same
billing data used to compute the DRG relative weights.
A relative class can be composed of one or more DRGs. For example,
in MDC 5, the surgical class ``heart transplant'' consists of a single
DRG (DRG 103) and the class ``coronary bypass'' consists of two DRGs
(DRGS 106 and 107). Consequently, in many cases, the surgical hierarchy
has an impact on more than one DRG. The methodology for determining the
most resource-intensive surgical class, therefore, involves weighting
each DRG for frequency to determine the average resources for each
surgical class. For example, assume surgical class A includes DRGs 1
and 2 and surgical class B includes DRGs 3, 4, and 5, and that the
average charge of DRG 1 is higher than that of DRG 3, but the average
charges of DRGs 4 and 5 are higher than the average charge of DRG 2. To
determine whether surgical class A should be higher or lower than
surgical class B in the surgical hierarchy, we would weight the average
charge of each DRG by frequency (that is, by the number of cases in the
DRG) to determine average resource consumption for the surgical class.
The surgical classes would then be ordered from the class with the
highest average resource utilization to that with the lowest, with the
exception of ``other OR procedures'' as discussed below.
This methodology may occasionally result in a case involving
multiple procedures being assigned to the lower- weighted DRG (in the
highest, most resource-intensive surgical class) of the available
alternatives. However, given that the logic underlying the surgical
hierarchy provides that the GROUPER searches for the procedure in the
most resource-intensive surgical class, which may sometimes occur in
cases involving multiple procedures, this result is unavoidable.
We note that, notwithstanding the foregoing discussion, there are a
few instances when a surgical class with a lower average relative
weight is ordered above a surgical class with a higher average relative
weight. For example, the ``other OR procedure'' surgical class is
uniformly ordered last in the surgical hierarchy of each MDC in which
it occurs, regardless of the fact that the relative weights for the DRG
or DRGS in that surgical class may be higher than that for other
surgical classes in the MDC. The ``other OR procedures'' class is a
group of procedures that are least likely to be related to the
diagnosis in the MDC but are occasionally performed on patients with
these diagnoses. Therefore, these procedures should only be considered
if no other procedure more closely related to the diagnoses in the MDC
has been performed.
A second example occurs when the difference between the average
weights for two surgical classes is very small. We have found that
small differences generally do not warrant reordering of the hierarchy
since, by virtue of the hierarchy change, the relative weights are
likely to shift such that the higher-ordered surgical class has a lower
average weight than the class ordered below it.
Based on the preliminary recalibration of the DRGs, we proposed to
modify the surgical hierarchy as set forth below. As we stated in the
September 1, 1989 final rule (54 FR 36457), we are unable to test the
effects of the proposed revisions to the surgical hierarchy and to
reflect these changes in the proposed relative weights due to the
unavailability of revised GROUPER software at the time the proposed
rule is prepared. Rather, we simulate most major classification changes
to approximate the placement of cases under the proposed
reclassification and then determine the average charge for each DRG.
These average charges then serve as our best estimate of relative
resource use for each surgical class. We test the proposed surgical
hierarchy changes after the revised GROUPER is received and reflect the
final changes in the DRG relative weights in the final rule.
We proposed to revise the surgical hierarchy for the Pre-MDC DRGs,
MDC 3 (Diseases and Disorders of the Ear, Nose, Mouth, and Throat), and
MDC 10 (Endocrine, Nutritional and Metabolic Diseases and Disorders) as
follows:
In the Pre-MDC DRGs, we proposed to reorder Tracheostomy
Except for Face, Mouth and Neck diagnoses (DRG 483) above Liver
Transplant (DRG 480).
In MDC 3, we proposed to reorder Cleft Lip and Palate
Repair (DRG 52) and Sinus and Mastoid Procedures (DRGs 53 and 54) above
Tonsillectomy and Adenoidectomy, Except Tonsillectomy and/or
Adenoidectomy Only (DRGs 57 and 58).
In MDC 10, we proposed to reorder Adrenal and Pituitary
Procedures (DRG 286) above Amputation of Lower Limb for Endocrine,
Nutritional, and Metabolic Disorders (DRG 285).
We received two comments in support of the three surgical hierarchy
changes. In addition, based on a test of the proposed changes using the
most recent MedPAR file and the revised GROUPER software, we have found
that the changes are still supported by the data and no additional
changes are indicated. Therefore, we are incorporating these changes in
this final rule.
7. Refinement of Complications and Comorbidities List
a. Addition or Deletion of CCs. There is a standard list of
diagnoses that are considered complications or comorbidities (CCs). We
developed this list using physician panels to include those diagnoses
that, when present as a secondary condition, would be considered a
substantial complication or comorbidity. In previous years, we have
made changes to the standard list of CCs, either by adding new CCs or
deleting any of the diagnosis codes on the CC list.
In the September 1, 1995 final rule (60 FR 45782), we added
diagnosis code 008.49 (Bacterial enteritis) to the CC list.
[[Page 46172]]
In response to a request from one commenter that we also add diagnosis
code 008.45 (Clostridium difficile), we stated that we would review
that request as part of our DRG analysis for FY 1997. We have
reevaluated diagnosis code 008.45 as well as the remainder of the
``family'' of codes assigned to the category of Intestinal infections
due to other specified bacteria (008.41, 008.42, 008.43, 008.44,
008.46, and 008.47). Our analysis shows that all of these diagnoses,
when present as a secondary condition, do lead to higher resource use.
Therefore, we proposed to add the following diagnosis codes to the CC
list:
008.41 Intestinal infections due to staphylococcus
008.42 Intestinal infections due to pseudomonas
008.43 Intestinal infections due to campylobacter
008.44 Intestinal infections due to yersinia enterocolitica
008.45 Intestinal infections due to clostridium difficile
008.46 Intestinal infections due to other anaerobes
008.47 Intestinal infections due to other gram-negative bacteria
These diagnoses would be considered CCs for any principal diagnosis
not shown in Table 6f, Additions to the CC Exclusions List (see
discussion of CC Exclusions list in section V of the addendum below).
This same commenter also requested that we add the following codes
to the CC list:
331.0 Alzheimer's disease
423.9 Unspecified disease of the pericardium
348.5 Cerebral edema
333.4 Huntington's chorea
458.0 Orthostatic hypotension
458.9 Hypotension, not otherwise specified
Our analysis of these codes demonstrated that their presence as a
secondary diagnosis did not significantly add to the resource use of
the case. Therefore, we did not propose to add them to the CC list.
Finally, the commenter suggested that the following diagnoses be
added as cardiovascular complications for DRG 121 (Circulatory
Disorders with AMI and Cardiovascular Complications, Discharged Alive):
434.xx Occlusion of cerebral arteries
436 Acute, but ill-defined, cerebrovascular disease
Based on our analysis, charges associated with those cases were
indeed comparable to the other cases assigned to DRG 121. However, when
we sought the advice of our medical specialists (physicians who work
directly for or under contract with HCFA), they strongly opposed adding
these codes to the list of conditions for DRG 121 based on the fact
that these are not cardiovascular complications. Therefore, they are
not clinically similar to other cases assigned to this DRG.
Our analysis of DRG 121 did reveal a large variation in the charges
and lengths of stay within this DRG. We believe that a close
examination of the list of complicating conditions assigned to DRG 121
is needed. Therefore, we plan to perform a thorough analysis of the
cases assigned to that DRG as part of our DRG analysis agenda for FY
1998. In the meantime, we did not propose any change to DRG 121.
We received three comments supporting the addition of the remainder
of the ``family'' of codes for intestinal infection due to bacteria to
the CC list. We received one comment in support of our decision not to
add 331.0, 423.9, 348.5, 333.4, 458.0, and 458.9 to the CC list.
Comment: Two commenters requested that we reconsider our decision
not to add codes 434.xx (Occlusion of cerebral arteries) and 436
(Acute, but ill-defined, cerebrovascular disease) to the list of
conditions that are designated cardiovascular complications for
assignment to DRG 121 (Circulatory Disorders with AMI and
Cardiovascular Complications, Discharged Alive). One commenter noted
that even though these diagnoses are not cardiac in nature, they are
vascular complications. The other commenter stated that there are other
conditions assigned to DRG 121, such as acute renal failure, that are
not strictly cardiovascular conditions. The commenter supports our
decisions to completely review DRG 121, but believes diagnosis codes
434.xx and 436 should be added this year.
Response: As explained in the proposed rule (61 FR 27449), in our
initial analysis, cases assigned to DRG 121 that had these diagnoses
coded as secondary conditions contained charges that were indeed
comparable to the other cases assigned to DRG 121. However, our
analysis of DRG 121 and the list of cardiovascular conditions revealed
large variations in the charges and lengths of stay for cases within
this DRG. Because the diagnoses associated with codes 434.xx and 436
are not strictly cardiovascular in nature, we believe the better course
would be to do a comprehensive review of DRG 121, including considering
adding additional diagnosis as complicating conditions. We will address
these issues as part of our DRG analysis agenda for FY 1998.
b. CC Exclusions List. In the September 1, 1987 final notice
concerning changes to the DRG classification system (52 FR 33143), we
modified the GROUPER logic so that certain diagnoses included on the
standard list of CCs would not be considered a valid CC in combination
with a particular principal diagnosis. Thus, we created the CC
Exclusions List. We made these changes to preclude duplicative coding
or inconsistent coding from being treated as CCs, and to ensure that
cases are appropriately classified between the complicated and
uncomplicated DRGs in a pair.
In the May 19, 1987 proposed notIce concerning changes to the DRG
classification system (52 FR 18877), we explained that the excluded
secondary diagnoses were established using the following five
principles:
Chronic and acute manifestations of the same condition
should not be considered CCs for one another (as subsequently corrected
in the September 1, 1987 final notice (52 FR 33154)).
Specific and nonspecific (that is, not otherwise specified
(NOS)) diagnosis codes for a condition should not be considered CCs for
one another.
Conditions that may not co-exist, such as partial/total,
unilateral/bilateral, obstructed/unobstructed, and benign/malignant,
should not be considered CCs for one another.
The same condition in anatomically proximal sites should
not be considered CCs for one another.
Closely related conditions should not be considered CCs
for one another.
The creation of the CC Exclusions List was a major project
involving hundreds of codes. The FY 1988 revisions were intended to be
only a first step toward refinement of the CC list in that the criteria
used for eliminating certain diagnoses from consideration as CCS were
intended to identify only the most obvious diagnoses that should not be
considered complications or comorbidities of another diagnosis. For
that reason, and in light of comments and questions on the CC list, we
have continued to review the remaining CCs to identify additional
exclusions and to remove diagnoses from the master list that have been
shown not to meet the definition a CC. (See the September 30, 1988
final rule for the revisions made for the discharges occurring in FY
1989 (53 FR 38485); the September 1, 1989 final rule for the FY 1990
revisions (54 FR 36552); the September 4, 1990 final rule for the FY
1991 revisions (55 FR 36126); the August 30, 1991 final rule for the FY
1992 revision (56 FR 43209); the September 1, 1992 final rule for the
[[Page 46173]]
FY 1993 revisions (57 FR 39753); the September 1, 1993 final rule for
the FY 1994 revisions (58 FR 46278); the September 1, 1994 final rule
for the FY 1995 revisions (59 FR 45334); and the September 1, 1995 rule
for the FY 1996 revisions (60 FR 45782).)
The proposed rule reflected a limited revision of the CC Exclusions
List to take into account the changes that will be made in the ICD-9-CM
diagnosis coding system effective October 1, 1996, as well as the
proposed CC changes described above. (See section II.B.8, below, for a
discussion of ICD-9-CM changes.) These changes are being made in
accordance with the principles established when we created the CC
Exclusions List in 1987.
The changes discussed above have been added to Table 6g, Additions
to the CC Exclusions List, in section V of the addendum to this final
rule.
Table 6g and 6h in section V of the addendum to this final rule
contain the revisions to the CC Exclusions List that will be effective
for discharges occurring on or after October 1, 1996. Each table shows
the principal diagnoses with final changes to the excluded CCs. Each of
these principal diagnoses is shown with an asterisk, and the additions
or deletions to the CC Exclusions List are provided in an indented
column immediately following the affected principal diagnosis.
CCs that are added to the list are in Table 6g--Additions to the CC
Exclusions List. Beginning with discharges on or after October 1, 1996,
the indented diagnoses will not be recognized by the GROUPER as valid
CCs for the asterisked principal diagnosis.
CCs that are deleted from the list are in Table 6h--Deletions from
the CC Exclusions List. Beginning with discharges on or after October
1, 1996, the indented diagnoses will be recognized by the GROUPER as
valid CCs for the asterisked principal diagnosis.
Copies of the original CC Exclusions List applicable to FY 1988 can
be obtained for the National Technical Information Service (NTIS) of
the Department of Commerce. It is available in hard copy for $92.00
plus $6.00 shipping and handling and on microfiche for $20.50, plus
$4.00 for shipping and handling. A request for the FY 1988 CC
Exclusions List (which should include the identification accession
number, (PB) 88-133970) should be made to the following address:
National Technical Information Service; United States Department of
Commerce; 5285 Port Royal Road; Springfield, Virginia 22161; or by
calling (703) 487-4650.
Users should be aware of the fact that all revisions to the CC
Exclusions List (FYs 1989, 1990, 1991, 1992, 1993, 1994, 1995, and
1996) and those in Tables 6g and 6h of this document must be
incorporated into the list purchased from NTIS in order to obtain the
CC Exclusions List applicable for discharges occurring on or after
October 1, 1996.
Alternatively, the complete documentation of the GROUPER logic,
including the current CC Exclusions List, is available from 3M/Health
Information Systems (HIS), which under contract with HCFA, is
responsible for updating and maintaining the GROUPER program. The
current DRG Definitions Manual, Version 13.0, is available for $195.00,
which includes $15.00 for shipping and handling. Version 14.0 of this
manual, which will include the final FY 1997 DRG changes, will be
available in October 1996 for $195.00. These manuals may be obtained by
writing 3M/HIS at the following address: 100 Barnes Road; Wallingford,
Connecticut 06492; or by calling (203) 949-0303. Please specify the
revision or revisions requested.
8. Review of Procedure Codes in DRGs 468, 476, and 477
Each year, we review cases assigned to DRG 468 (Extensive OR
Procedure Unrelated to Principal Diagnosis), DRG 476 (Prostatic OR
Procedure Unrelated to Principal Diagnosis), and DRG 477 (Nonextensive
OR Procedure Unrelated to Principal Diagnosis) in order to determine
whether it would be appropriate to change the procedures assigned among
these DRGs.
DRGs 468, 476, and 477 are reserved for those cases in which none
of the OR procedures performed is related to the principal diagnosis.
These DRGs are intended to capture atypical cases, that is, those cases
not occurring with sufficient frequency to represent a distinct,
recognizable clinical group. DRG 476 is assigned to those discharges in
which one or more of the following prostatic procedures are performed
and are unrelated to the principal diagnosis:
60.0 Incision of prostate
60.12 Open biopsy of prostate
60.15 Biopsy of periprostatic tissue
60.18 Other diagnostic procedures on prostate and periprostatic tissue
60.21 Transurethral prostatectomy
60.29 Other transurethral prostatectomy
60.61 Local excision of lesion of prostate
60.69 Prostatectomy NEC
60.81 Incision of periprostatic tissue
60.82 Excision of periprostatic tissue
60.93 Repair of prostate
60.94 Control of (postoperative) hemorrhage of prostate
60.95 Transurethral balloon dilation of the prostatic urethra
60.99 Other operations on prostate
All remaining OR procedures are assigned to DRGs 468 and 477, with
DRG 477 assigned to those discharges in which the only procedures
performed are nonextensive procedures that are unrelated to the
principal diagnosis. The original list of the ICD-9-CM procedure codes
for the procedures we consider nonextensive procedures if performed
with an unrelated principal diagnosis was published in Table 6c in
section IV of the addendum to the September 30, 1988 final rule (53 FR
38591). As part of the final rules published on September 4, 1990,
August 30, 1991, September 1, 1992, September 1, 1993, September 1,
1994, and September 1, 1995, we moved several other procedures from DRG
468 to 477. (See 55 FR 36135, 56 FR 43212, 57 FR 23625, 58 FR 46279, 59
FR 45336, and 60 FR 45783, respectively.)
a. Adding Procedure Codes to MDCs. We annually conduct a review of
procedures producing DRG 468 or 477 assignments on the basis of volume
of cases in these DRGs with each procedure. Our medical consultants
then identify those procedures occurring in conjunction with certain
principal diagnoses with sufficient frequency to justify adding them to
one of the surgical DRGs for the MDC in which the diagnosis falls. This
year's review did not identify any necessary changes; therefore, we did
not propose to move any procedures from DRG 468 or DRG 477 to one of
the surgical DRGs.
b. Reassignment of Procedures Among DRGs 468, 476, and 477. We also
reviewed the list of procedures that produce assignments to DRGs 468,
476, and 477 to ascertain if any of those procedures should be moved
from one of these DRGs to another based on average charges and length
of stay. Generally, we move only those procedures for which we have an
adequate number of discharges to analyze the data. Based on our review
this year, we moved one procedure from DRG 468 to DRG 477.
In reviewing the list of OR procedures that produce DRG 468
assignments, we analyzed the average charge and length of stay data for
cases assigned to that DRG to identify those procedures that are more
similar to the discharges that currently group to either DRG 476 or
477. We identified one procedure, Closed endoscopic biopsy of lung
(code
[[Page 46174]]
33.27), a needle biopsy, that is significantly less resource-intensive
than the other procedures assigned to DRG 468. Therefore, we proposed
to move procedure code 33.27 to the list of procedures that result in
assignment to DRG 477.
In reviewing the list of procedures assigned to DRG 477, we did not
identify any procedures that should be assigned to either DRG 468 or
476. We did, however, identify the following procedures that we believe
should be reassigned from an OR to a non-OR designation:
08.81 Linear repair of laceration of eyelid or eyebrow
08.82 Repair of laceration involving lid margin, partial-thickness
08.83 Other repair of laceration of eyelid, partial-thickness
08.84 Repair of laceration involving lid margin, full-thickness
08.85 Other repair of laceration of eyelid, full-thickness
08.86 Lower eyelid rhytidectomy
08.87 Upper eyelid rhytidectomy
08.89 Other eyelid repair
Our analysis of the data associated with these eyelid repair
procedures leads us to conclude that the procedures are performed
following accidental injury or falls, incurred while the patient is in
the hospital. These procedures, which are normally performed at bedside
and do not necessitate a trip to the operating room, are significantly
less resource-intensive than other procedures designated as OR
procedures. Therefore, we proposed to change the procedures from OR to
non-OR procedures. We noted that these procedures are assigned to
surgical DRGs in MDCs 2, 9, 21, 22, and 24. With this change, cases in
which procedure codes 08.81 through 08.89 are the only OR procedure
codes listed would no longer be assigned to a surgical DRG.
Comment: We received two comments that generally supported our
proposal to move procedure code 33.27 to the list of procedures that
result in assignment to DRG 477. However, one of the commenters was
concerned because this code also includes transbronchial lung biopsy.
The commenter believes that transbronchial lung biopsy is a high-risk
procedure and questions whether this would be considered a nonextensive
procedure.
Response: In analyzing the procedures that produce assignments to
each of DRG 468, 476, and 477 for possible reassignment, we evaluate
average charges and lengths of stay. The cases in DRG 468 with
procedure code 33.27 are significantly less resource-intensive than the
other procedures assigned to DRG 468, and more closely resemble the
average charge and length of stay for procedures classified to DRG 477.
Although transbronchial lung biopsy may be a more difficult procedure
to perform than other procedures assigned to 33.27, we do not know how
many of these cases are actually assigned to DRG 468, that is, how many
times this procedure is performed for an unrelated principal diagnosis.
It is possible that the lower charges associated with closed endoscopic
biopsy of lung cases in DRG 468 do not include many transbronchial lung
biopsy cases. We also note that in MDC 4, procedure code 33.27 is not
assigned to the major procedures DRG (DRG 75). In any case, our data
support the reclassification of these procedures to DRG 477. Therefore,
we are reassigning procedure code 33.27 from DRG 468 to DRG 477, as
proposed.
Comment: We received four comments regarding our proposal to
designate procedure code category ``other repair of eyelid'' (codes
08.81 through 08.89) as non-OR. Two commenters supported our decision,
although one of those commenters stated that even though these
procedures may not require an operating room, they may require a
specialist. One commenter requested that we consider designating these
eyelid repair codes as non-OR procedures that affect DRG assignment
when the procedure is the only one performed in connection with a
related principal diagnosis. The fourth commenter understood that our
reason for making this change had to do with our belief that many of
these injuries are sustained during hospital stays. That commenter
believes that the causes surrounding the injury are not necessarily
indicative of the nature of the services furnished or the procedures
performed and that we should not make this change unless we reviewed
the resources consumed delivering these services.
Response: Our proposal to change the OR designation for these
procedures was not based on where the injuries were incurred. Rather,
we based the decision on our analysis of claims data as part of our
annual review of procedures that result in assignment to DRGs 468, 476,
and 477, and on the clinical opinions of our physician consultants.
Cases in which 08.81 was coded as the only OR procedure, unrelated to
the principal diagnosis, were the second most frequently assigned to
DRG 477. Our evaluation of the average charges and length of stay for
these cases was the deciding factor in our proposal. Both of these
statistics were much lower for the eyelid repair cases than the average
case assigned to DRG 477. In addition, the opinion of our medical staff
was that these repairs would not normally necessitate a trip to the OR,
even if they are performed by a specialist. Because there are so many
cases of eyelid repair performed for unrelated diagnoses, we speculated
that they were the result of injuries sustained while the patient was
in the hospital.
Regarding the request to designate codes 08.81 through 08.89 as
non-OR procedures that affect DRG assignment in the MDCs to which they
were previously assigned, we analyzed the FY 1995 MedPAR file cases in
which one of these codes is assigned to DRG 40 and 41 (Extraocular
Procedures Except Orbit) in MDC 2 (Diseases and Disorders of the Eye)
and DRG 268 (Skin, Subcutaneous Tissue and Breast Plastic Procedures)
in MDC 9 (Disease and Disorders of the Skin, Subcutaneous Tissue and
Breast). In both DRGs 40 and 268 (no cases were assigned to DRG 41 in
FY 1995), there were no cases in which an eyelid repair was the only
related procedure coded. That is, in every case, there was another OR
procedure code present on the claim that would cause it to be assigned
to either DRG 40 or 268. This means that assignment of cases to these
DRGs will not be affected by changing the OR designation for the eyelid
repair codes.
9. Changes to the ICD-9-CM Coding System
As discussed above in section II.B.1 of this preamble, the ICD-9-CM
is a coding system that is used for the reporting of diagnoses and
procedures performed on a patient. In September 1985, the ICD-9-CM
Coordination and Maintenance Committee was formed. This is a Federal
interdepartmental committee charged with the mission of maintaining and
updating the ICD-9-CM. That mission includes approving coding changes,
and developing errata, addenda, and other modifications to the ICD-9-CM
to reflect newly developed procedures and technologies and newly
identified diseases. The Committee is also responsible for promoting
the use of Federal and non-Federal educational programs and other
communication techniques with a view toward standardizing coding
applications and upgrading the quality of the system.
The Committee is co-chaired by the National Center for Health
Statistics (NCHS) and HCFA. The NCHS has lead responsibility for the
ICD-9-CM diagnosis codes included in Volume 1--Diseases: Tabular List
and Volume 2--Diseases: Alphabetic Index, while HCFA has lead
responsibility for the ICD-9-CM procedure codes included in
[[Page 46175]]
Volume 3--Procedures: Tabular List and Alphabetic Index.
The Committee encourages participation in the above process by
health-related organizations. In this regard, the Committee holds
public meetings for discussion of educational issues and proposed
coding changes. These meetings provide an opportunity for
representatives of recognized organizations in the coding field, such
as the American Health Information Management Association (AHIMA)
(formerly American Medical Record Association (AMRA)), the American
Hospital Association (AHA), and various physician specialty groups as
well as physicians, medical record administrators, health information
management professionals, and other members of the public to contribute
ideas on coding matters. After considering the opinions expressed at
the public meetings and in writing, the Committee formulates
recommendations, which then must be approved by the agencies.
The Committee presented proposals for coding changes at public
meetings held on May 5 and November 30, 1995, and finalized the coding
changes after consideration of comments received at the meetings and in
writing within 30 days following the November 1995 meeting. The initial
meeting for consideration of coding issues for implementation in FY
1998 was held on June 6, 1996. Copies of the minutes of these meetings
may be obtained by writing to one of the co-chairpersons representing
NCHS and HCFA. We encourage commenters to address suggestions on coding
issues involving diagnosis codes to: Donna Pickett, Co-Chairperson;
ICD-9-CM Coordination and Maintenance Committee; NCHS; Room 1100; 6525
Belcrest Road; Hyattsville, Maryland 20782. Comments may be sent by E-
mail to: [email protected].
Questions and comments concerning the procedure codes should be
addressed to: Patricia E. Brooks, Co-Chairperson; ICD-9-CM Coordination
and Maintenance Committee; HCFA, Office of Hospital Policy; Division of
Prospective Payment System; C5-06-27; 7500 Security Boulevard;
Baltimore, Maryland 21244-1850. Comments may be sent by E-mail to:
[email protected].
The ICD-9-CM codes changes that have been approved will become
effective October 1, 1996. The new ICD-9-CM codes are listed, along
with their DRG classifications, in Tables 6a and 6b (New Diagnosis
Codes and New Procedure Codes, respectively) in section V of the
addendum to this final rule. As we stated above, the code numbers and
their titles were presented for public comment in the ICD-9-CM
Coordination and Maintenance Committee meetings. Both oral and written
comments were considered before the codes were approved.
Further, the Committee has approved the expansion of certain ICD-9-
CM codes to require an additional digit for valid code assignment.
Diagnosis codes that have been replaced by expanded codes, and other
codes, or have been deleted, are in Table 6c (Invalid Diagnosis Codes).
The procedure codes that have been replaced by expanded codes or have
been deleted are in Table 6d (Invalid Procedure Codes). These invalid
diagnosis and procedure codes will not be recognized by the GROUPER
beginning with discharges occurring on or after October 1, 1996. The
corresponding new or expanded codes are included in Tables 6a and 6b.
Revisions to diagnosis and procedure code titles are in Tables 6e
(Revised Diagnosis Code Titles) and 6f (Revised Procedure Code Titles),
which also include the DRG assignments for these revised codes.
Based on the comments received and our own review, we have
corrected a code title and added omitted secondary DRG assignments to
several codes in Tables 6a and 6b. The code title corrected is 995.59,
Other child abuse and neglect. The codes for which DRG changes have
been made are as follows:
In Table 6a, MDC 15 and DRG 391 were added to 752.51 and
752.52 because they are considered ``major problems'' in this DRG;
922.31, 922.32, and 922.33 were modified to add MDC 24 and DRGs 484,
485, 486, and 487; and MDC 15 and DRGs 387 and 389 were added to
998.11, 998.12, 998.13, 998.51 and 998.59 because they are considered
``major problems'' in these DRGs.
In Table 6b, DRG 303 was added to code 59.03.
Comment: One commenter supported the creation of new procedure
codes for partial cholecystectomies; however, the commenter disagreed
with their assignment to DRGs 193 and 194 (Biliary Tract Procedures
except only Cholecystectomy with or without C.D.E.). The commenter
believes that partial cholecystectomy (code 51.21) is similar to
cholecystectomy (code 51.22) and laparoscopic partial cholecystectomy
(51.23) is similar to laparoscopic cholecystectomy (51.24). Therefore,
procedure codes 51.21 and 51.23 should be assigned to the same DRGs as
51.22 and 51.24, respectively.
Response: We agree with the commenter. Partial cholecystectomies
are clinically similar to cholecystectomies and laparoscopic partial
cholecystectomies are clinically similar to laparoscopic
cholecystectomies, as well as being similar in terms of resource use.
Therefore, we have revised Table 6b to indicate that procedure code
51.21 is assigned to DRGs 195 and 196 (Cholecystectomy with C.D.E.) and
DRGs 197 and 198 (Cholecystectomy except by Laparoscope) and 51.23 is
assigned to DRGs 195 and 196 and DRGs 493 and 494 (Laparoscopic
Cholecystectomy).
Comment: We received one comment on modifications made to the ICD-
9-CM codes involving psychiatric diagnoses. The commenter had
participated in the ICD-9-CM Coordination and Maintenance Committee
meetings and had submitted written proposals for revisions. The
commenter stated that although the proposed rule listed all final code
revisions, it did not explain the final action on specific proposals or
why that action was taken. The commenter suggested that this
information be included in the final rule. The commenter also objected
to changing the title of category V61.1 from ``Marital Problems'' to
``Counseling for Marital and Partner Problems'' because it narrows the
use of the category.
Response: The National Center for Health Statistics (NCHS) has the
lead responsibility for maintaining the diagnosis part of ICD-9-CM. As
explained above, after receiving comments at the public meetings held
by the Coordination and Maintenance Committee and reviewing subsequent
written comments, NCHS proposes final revisions to ICD-9-CM diagnosis
codes. These revisions are then jointly approved by NCHS and HCFA. The
purpose of printing the final codes in the Federal Register is simply
to notify the public and solicit comment on the proposed DRG
classifications. We recommend that the commenter, or any other
interested party, contact NCHS directly to discuss the final codes. If
further revisions are sought, then these can be handled through future
meetings of the Coordination and Maintenance Committee. We will forward
the commenter's concerns on category V61.1 to NCHS for review.
Comment: One commenter supported the ICD-9-CM code revisions for
October 1, 1996, but suggested that rules relating to the sequencing of
the new code V66.7, Encounter for palliative care, should be developed
prior to its use beginning on October 1, 1996.
Response: We agree with the commenter that medical records
technicians and administrators will
[[Page 46176]]
need advice on coding this diagnosis. Specific directions in the for
FR Doc. 96-22145 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1997 Rates
m
of a note within the tabular section of the ICD-9-CM will direct the
coder to ``code first underlying disease'' when coding V66.7. The NCHS
has also developed an extensive set of V code guidelines that will also
clarify that V66.7 should be sequenced second. In addition, AHA
routinely includes advice on the use of new and modified codes in the
fourth quarter issue of their publication, Coding Clinic for ICD-9-CM
Coding. This year's issue will clarify that V66.7 will be used only as
a secondary diagnosis. The coding advice in Coding Clinic is a
collaborative effort among HCFA, NCHS, AHA, and AHIMA. Information on
ordering Coding Clinic can be obtained from the following: American
Hospital Association, Central Office on ICD-9-CM, One North Franklin,
Chicago, IL 60606, (312) 422-3366.
Comment: Although the Committee made no revisions to the pacemaker
codes, a commenter noted that there have been advances in pacemaker
technology that may have an effect on coding and DRG classification.
One new pacemaker device functions as a dual-chamber pacemaker
(procedure code 37.83) but has only a single lead (procedure code 37.71
or 37.73). If these pairs of codes are reported on a claim, the case is
assigned to a medical DRG rather than DRG 115 or 116 (Permanent Cardiac
Pacemaker Implant).
Response: This coding issue was addressed recently by the Editorial
Advisory Board of the Coding Clinic for ICD-9-CM. After consultation
with the manufacturer of the new pacemaker device, the Board decided
that, although this pacemaker has a single lead, it functions as dual
electrodes. Therefore, the insertion of this pacemaker should be coded
with procedure codes 37.83 and 37.72 (dual lead insertion). If a
hospital follows this coding advice, the case will be classified to DRG
115 or 116. This advice will be included in an upcoming issue of Coding
Clinic. We will monitor this situation to determine if hospitals are
following this coding advice or if a change in the DRG software is
necessary.
C. Recalibration of DRG Weights
We used the same basic methodology for the FY 1997 recalibration as
we did for FY 1996. (See the September 1, 1995 final rule (60 FR
45791).) That is, we recalibrated the weights based on charge data for
Medicare discharges. However, we used the most current charge
information available, the FY 1995 MedPAR file, rather than the FY 1994
MedPAR file. The MedPAR file is based on fully-coded diagnostic and
surgical procedure data for all Medicare inpatient hospital bills.
The recalibrated DRG relative weights are constructed from FY 1995
MedPAR data, based on bills received by HCFA through June 1996, from
all hospitals subject to the prospective payment system and short-term
acute care hospitals in waiver States. The FY 1995 MedPAR file includes
data for approximately 11.1 million Medicare discharges.
The methodology used to calculate the DRG relative weights from the
FY 1995 MedPAR file is as follows:
All the claims were regrouped using the final DRG
classification revisions discussed above in section II.B of this
preamble.
Charges were standardized to remove the effects of
differences in area wage levels, indirect medical education costs,
disproportionate share payments, and for hospitals in Alaska and
Hawaii, the applicable cost-of-living adjustment.
The average standardized charge per DRG was calculated by
summing the standardized charges for all cases in the DRG and dividing
that amount by the number of cases classified in the DRG.
We then eliminated statistical outliers, using the same
criteria as were used in computing the current weights. That is, we
eliminated all cases that are outside of 3.0 standard deviations from
the mean of the log distribution of both the charges per case and the
charges per day for each DRG.
The average charge for each DRG was then recomputed
(excluding the statistical outliers) and divided by the national
average standardized charge per case to determine the relative weight.
A transfer case is counted as a fraction of a case based on the ratio
of its length of stay to the geometric mean length of stay of the cases
assigned to the DRG. That is, a 5-day length of stay transfer case
assigned to a DRG with a geometric mean length of stay of 10 days is
counted as 0.5 of a total case.
We established the relative weight for heart and heart-
lung, liver, and lung transplants (DRGs 103, 480, and 495) in a manner
consistent with the methodology for all other DRGs except that the
transplant cases that were used to establish the weights were limited
to those Medicare-approved heart, heart-lung, liver, and lung
transplant centers that have cases in the FY 1995 MedPAR file.
(Medicare coverage for heart, heart-lung, liver, and lung transplants
is limited to those facilities that have received approval from HCFA as
transplant centers.)
Acquisition cost for kidney, heart, heart-lung, liver, and
lung transplants continue to be paid on a reasonable cost basis. Unlike
other excluded costs, the acquisition costs are concentrated in
specific DRGs (DRG 302 (Kidney Transplant); DRG 103 (Heart Transplant
for heart and heart-lung transplants); DRG 480 (Liver Transplant); and
DRG 495 (Lung Transplant)). Because these costs are paid separately
from the prospective payment rate, it is necessary to make an
adjustment to prevent the relative weights for these DRGs from
including the effect of the acquisition costs. Therefore, we subtracted
the acquisition charges from the total charges on each transplant bill
that showed acquisition charges before computing the average charge for
the DRG and before eliminating statistical outliers.
When we recalibrated the DRG weights for previous years, we set a
threshold of 10 cases as the minimum number of cases required to
compute a reasonable weight. We proposed to use that same case
threshold in recalibrating the DRG weights for FY 1997. For this final
rule, using the June 1996 FY 1995 MedPAR data set, there are 37 DRGs
that contain fewer than 10 cases. We computed the weights for the 37
low-volume DRGs by adjusting the FY 1996 weights of these DRGs by the
percentage change in the average weight of the cases in the other DRGs.
We note that the FY 1996 weights for the low-volume DRGs were
recalculated based on non-Medicare data we acquired from 19 States.
This was the first update of the weights since they were initially
calculated for FY 1984 based on data from Maryland and Michigan. For a
complete description of this process, see the September 1, 1995 final
rule (60 FR 45781).
The weights developed according to the methodology described above,
using the DRG classification changes, result in an average case weight
that is different from the average case weight before recalibration.
Therefore, the new weights are normalized by an adjustment factor, so
that the average case weight after recalibration is equal to the
average case weight before recalibration. This adjustment is intended
to ensure that recalibration by itself neither increases nor decreases
total payments under the prospective payment system.
Section 1886(d)(4)(C)(iii) of the Act requires that beginning with
FY 1991, reclassification and recalibration changes be made in a manner
that assures that the aggregate payments are neither greater than nor
less than the aggregate payments that would have been made without the
changes. Although normalization is intended to
[[Page 46177]]
achieve this effect, equating the average case weight after
recalibration to the average case weight before recalibration does not
necessarily achieve budget neutrality with respect to aggregate
payments to hospitals because payment to hospitals is affected by
factors other than average case weight. Therefore, as we have done in
past years and as discussed in section II.A.4.b. of the addendum to
this final rule, we are making a budget neutrality adjustment to assure
that the requirement of section 1886(d)(4)(C)(iii) of the Act is met.
III. Changes to the Hospital Wage Index
A. Background
Section 1886(d)(3)(E) of the Act requires that, as part of the
methodology for determining prospective payments to hospitals, the
Secretary must adjust the standardized amounts ``for area differences
in hospital wage levels by a factor (established by the Secretary)
reflecting the relative hospital wage level in the geographic area of
the hospital compared to the national average hospital wage level.'' In
accordance with the broad discretion conferred by this provision, we
currently define hospital labor market areas based on the definitions
of Metropolitan Statistical Areas (MSAs) (and New England County
Metropolitan Areas), issued by the Office of Management and Budget
(OMB). In addition, as discussed below, we adjust the wage index to
take into account the geographic reclassification of hospitals in
accordance with sections 1886(d)(8)(B) and 1886(d)(10) of the Act.
Section 1886(d)(3)(E) of the Act requires that the wage index be
updated annually beginning October 1, 1993. Furthermore, this section
provides that the Secretary base the update on a survey of wages and
wage-related costs of short-term, acute care hospitals. The survey
should measure, to the extent feasible, the earnings and paid hours of
employment by occupational category, and must exclude the wages and
wage-related costs incurred in furnishing skilled nursing services.
B. FY 1997 Wage Index Update
The final FY 1997 wage index (effective for hospital discharges
occurring on or after October 1, 1996 and before October 1, 1997) is
based on the data collected from the Medicare cost reports submitted by
hospitals for cost reporting periods beginning in FY 1993 (the FY 1996
wage index is based on FY 1992 wage data). We used the same categories
of data that were used in the FY 1996 wage index. Therefore, the FY
1997 wage index reflects the following:
Total salaries and hours from short-term, acute care
hospitals.
Home office costs and hours.
Fringe benefits associated with hospital and home office
salaries.
Direct patient care contract labor costs and hours.
The exclusion of salaries and hours for nonhospital type
services such as skilled nursing facility services, home health
services, or other subprovider components that are not subject to the
prospective payment system.
Finally, we are making a minor revision to Sec. 412.63(s)(1) to
state clearly that we update the wage index annually as required by
section 1886(d)(3)(E) of the Act.
Although we did not propose any changes in the reporting of
hospital wage index data, we received comments regarding our current
policies. (Comments specifically related to our policy on contract
labor are addressed below in section III.D of this preamble.)
Comment: We received several comments concerning the treatment of
Medicare Part A physician salaries in the wage index calculation. One
commenter stated that we should immediately exclude all of these costs,
using Worksheet A-8-2 of the Medicare cost report to identify physician
Part A costs. Alternatively, the commenter suggested that we should
include contracted Part A physician salaries in those States where
hospitals are prohibited from employing physicians. Two other
commenters suggested we should prepare an impact analysis of the
effects of the exclusion of Part A physician salaries.
Response: As stated in the September 1, 1994 final rule (59 FR
45355), effective with cost reporting periods beginning on or after
October 1, 1994, we revised the Medicare cost report to provide for the
separate reporting of all salary costs for physicians (including
teaching physicians), interns and residents, and certified registered
nurse anesthetists. After evaluating these data, we will consider
appropriate changes in developing the FY 1999 wage index update.
In response to the suggestion that we should use Worksheet A-8-2 to
expedite our evaluation of excluding physician Part A salaries, we will
explore the technical feasibility of using the data from that
worksheet. Regarding the suggestion that we should allow contracted
Part A physician salaries to be included in the wage index calculation
in those States that do not allow hospitals to employ physicians
directly, we note that, if we were to adopt such a policy it would not
be effective until hospitals' FY 1997 cost reporting periods.
Therefore, the data would not be available until the FY 2001 wage
index. Because we are already collecting data that would allow us to
exclude all physician Part A salaries by the FY 1999 wage index, we are
not adopting this comment.
With respect to the comments that we should prepare an analysis of
the impact on the wage index of excluding Part A physician salaries,
any such analysis is, of course, contingent upon having reliable data
to analyze. At this point, we do not foresee having such data prior to
the availability of hospitals' FY 1995 cost reports.
Comment: A commenter stated that the wage index value of rural
hospitals with swing-bed programs is unfairly deflated by the inclusion
of the lower salaries related to skilled nursing level care provided to
patients in swing-beds. The commenter indicated that since hospitals
can separately identify these salaries, they should be excluded from
total salaries to be consistent with the way salaries are reported for
hospitals without a swing-bed program.
Response: Salaries related to skilled nursing level care provided
to patients in swing-beds are not reported separately on the Medicare
cost report. Salary costs for swing-beds are combined with those for
general adult and pediatric care on the cost report at line 25 of
Worksheet A. Therefore, it would not be possible under the current cost
report format to remove from the wage index calculation these costs as
we do for direct salaries associated with distinct part skilled nursing
facilities and units. Furthermore, given the nature of the swing-bed
program, we do not believe it would be appropriate to impose on
hospitals the additional recordkeeping requirements that would be
necessary to report these salaries.
1. Verification of Wage Data from the Medicare Cost Report
The data for the FY 1997 wage index were obtained from Worksheet S-
3, Part II of the Medicare cost report. The data file used to construct
the wage index includes FY 1993 data submitted to the Hospital Cost
Report Information System (HCRIS). As in past years, we performed an
intensive review of the wage data, mostly through the use of edits
designed to identify aberrant data.
In the proposed rule, we discussed in detail our review of the wage
data as well as the process that hospitals could use to verify their
wage data and submit requests for corrections if necessary (61 FR
27455). To be reflected in the final wage index, wage data corrections
had
[[Page 46178]]
to be reviewed, verified, and transmitted to HCFA through HCRIS by June
17, 1996 (any changes after this date are limited to errors related to
handling the data, as described below in section III.C of this
preamble). All data elements that failed edits have been resolved and
are reflected in this final rule.
2. Computation of the Wage Index
As noted above, we are basing the FY 1997 wage index on wage data
reported on the FY 1993 cost reports. The final wage index is based on
data from 5,231 hospitals paid under the prospective payment system and
short-term acute care hospitals in waiver States. The method used to
compute the final wage index is as follows:
Step 1--We gathered data from each of the non-Federal short-term,
acute care hospitals for which data were reported on the Worksheet S-3,
Part II of the Medicare cost report for the hospital's cost reporting
periods beginning on or after October 1, 1992 and before October 1,
1993. In addition, we included data from a few hospitals that had cost
reporting periods beginning in September 1992 and reported a cost
reporting period exceeding 52 weeks. The data were included because no
other data from these hospitals would be available for the cost
reporting period described above, and particular labor market areas
might be affected due to the omission of these hospitals. However, we
generally describe these wage data as FY 1993 data.
Step 2--For each hospital, we subtracted the excluded salaries
(that is, direct salaries attributable to skilled nursing facility
services, home health services, and other subprovider components not
subject to the prospective payment system) from gross hospital salaries
to determine net hospital salaries. To determine total salaries plus
fringe benefits, we added direct patient care contract labor costs,
hospital fringe benefits, and any home office salaries and fringe
benefits reported by the hospital, to the net hospital salaries.
Step 3--For each hospital, we adjusted the total salaries plus
fringe benefits resulting from Step 2 to a common period to determine
total adjusted wages. To make the wage inflation adjustment, we used
the percentage change in average hourly earnings for each 30-day
increment from October 14, 1992 through September 15, 1994, for
hospital industry workers from Standard Industry Classification 806,
Bureau of Labor Statistics Employment and Earnings Bulletin. The annual
inflation rates used were 4.8 percent for FY 1992, 3.6 percent for FY
1993, and 2.7 percent for FY 1994. The inflation factors used to
inflate the hospital's data were based on the midpoint of the cost
reporting period as indicated below.
Midpoint of Cost Reporting Period
------------------------------------------------------------------------
After Before Adjustment factor
------------------------------------------------------------------------
10/14/92............... 11/15/92............... 1.044482
11/14/92............... 12/15/92............... 1.041408
12/14/92............... 01/15/93............... 1.038343
01/14/93............... 02/15/93............... 1.035287
02/14/93............... 03/15/93............... 1.032240
03/14/93............... 04/15/93............... 1.029203
04/14/93............... 05/15/93............... 1.026174
05/14/93............... 06/15/93............... 1.023154
06/14/93............... 07/15/93............... 1.020143
07/14/93............... 08/15/93............... 1.017141
08/14/93............... 09/15/93............... 1.014147
09/14/93............... 10/15/93............... 1.011163
10/14/93............... 11/15/93............... 1.008920
11/14/93............... 12/15/93............... 1.006683
12/14/93............... 01/15/94............... 1.004450
01/14/94............... 02/15/94............... 1.002223
02/14/94............... 03/15/94............... 1.000000
03/14/94............... 04/15/94............... 0.997782
04/14/94............... 05/15/94............... 0.995570
05/14/94............... 06/15/94............... 0.993362
06/14/94............... 07/15/94............... 0.991159
07/14/94............... 08/15/94............... 0.988961
08/14/94............... 09/15/94............... 0.986767
------------------------------------------------------------------------
For example, the midpoint of a cost reporting period beginning
January 1, 1993 and ending December 31, 1993 is June 30, 1993. An
inflation adjustment factor of 1.020143 would be applied to the wages
of a hospital with such a cost reporting period. In addition, for the
data for any cost reporting period that began in FY 1993 and covers a
period of less than 360 days or greater than 370 days, we annualized
the data to reflect a 1-year cost report. Annualization is accomplished
by dividing the data by the number of days in the cost report and then
multiplying the results by 365.
Step 4--For each hospital, we subtracted the reported excluded
hours from the gross hospital hours to determine net hospital hours. We
increased the net hours by the addition of any direct patient care
contract labor hours and home office hours to determine total hours.
Step 5--As part of our editing process, we deleted data for eight
hospitals for which we lacked sufficient documentation to verify data
that failed edits because the hospitals are no longer participating in
the Medicare program or are in bankruptcy status. We retained the data
for other hospitals that are no longer participating in the Medicare
program because these hospitals reflected the relative wage levels in
their labor market areas during their FY 1993 cost reporting period.
Step 6--Each hospital was assigned to its appropriate urban or
rural labor market area prior to any reclassifications under sections
1886(d)(8)(B) or 1886(d)(10) of the Act. Within each urban or rural
labor market area, we added the total adjusted wages obtained in Step 3
for all hospitals in that area to determine the total adjusted wages
for the labor market area.
Step 7--We divided the total adjusted wages obtained in Step 6 by
the sum of the total hours (from Step 4) for all hospitals in each
labor market area to determine an average hourly wage for the area.
Step 8--We added the total adjusted wages obtained in Step 3 for
all hospitals in the nation and then divided the sum by the national
sum of total hours from Step 4 to arrive at a national average hourly
wage. Using the data as described above, the national average hourly
wage is $19.5533.
Step 9--For each urban or rural labor market area, we calculated
the hospital wage index value by dividing the area average hourly wage
obtained in Step 7 by the national average hourly wage computed in Step
8.
We note that on June 28, 1996, OMB announced the designation of the
Pocatello, Idaho MSA comprising Bannock County, Idaho and the
Jonesboro, Arkansas MSA comprising Craighead County, Arkansas and the
addition of Chester County, Tennessee to the Jackson, Tennessee MSA.
These changes are reflected in the final wage index.
3. Revisions to the Wage Index Based on Hospital Redesignation
Under section 1886(d)(8)(B) of the Act, hospitals in certain rural
counties adjacent to one or more MSAs are considered to be located in
one of the adjacent MSAs if certain standards are met. Under section
1886(d)(10) of the Act, the Medicare Geographic Classification Review
Board (MGCRB) considers applications by hospitals for geographic
reclassification for purposes of payment under the prospective payment
system.
The methodology for determining the wage index values for
redesignated hospitals is applied jointly to the hospitals located in
those rural counties that were deemed urban under section 1886(d)(8)(B)
of the Act and those hospitals that were reclassified as a result of
the MGCRB decisions under section 1886(d)(10) of the Act. Section
1886(d)(8)(C) of the Act provides that the application of the wage
index to redesignated hospitals is dependent on the hypothetical impact
that the wage data from these hospitals would have on
[[Page 46179]]
the wage index value for the area to which they have been redesignated.
Therefore, as provided in section 1886(d)(8)(C) of the Act, the wage
index values were determined by considering the following:
If including the wage data for the redesignated hospitals
reduces the MSA wage index value by 1 percentage point or less, the MSA
wage index value determined exclusive of the wage data for the
redesignated hospitals applies to the redesignated hospitals.
If including the wage data for the redesignated hospitals
reduces the wage index value for the area to which the hospitals are
redesignated by more than 1 percentage point, the hospitals that are
redesignated are subject to the wage index value of the area that
results from including the wage data of the redesignated hospitals (the
``combined'' wage index value). However, the wage index value for the
redesignated hospitals cannot be reduced below the wage index value for
the rural areas of the State in which the hospitals are located.
If including the wage data for the redesignated hospitals
increases the MSA wage index value, the MSA and the redesignated
hospitals receive the combined wage index value.
Rural areas whose wage index values would be reduced by
excluding the data for hospitals that have been redesignated to another
area continue to have their wage index calculated as if no
redesignation had occurred. Those rural areas whose wage index values
increase as a result of excluding the wage data for the hospitals that
have been redesignated to another area have their wage indexes
calculated exclusive of the redesignated hospitals.
The wage index value for an urban area is calculated
exclusive of the wage data for hospitals that have been reclassified to
another area. However, geographic reclassification may not reduce the
wage index for an urban area below the Statewide rural average,
provided the wage index prior to reclassification was greater than the
Statewide rural wage index value.
A change in classification of hospitals from one area to
another may not result in the reduction in the wage index for any urban
area whose wage index is below the rural wage index for the State. This
provision also applies to any urban area that encompasses an entire
State.
We note that, except for those rural areas where redesignation
would reduce the rural wage index value, and those urban areas whose
wage index values are already below the rural wage index and would be
reduced by redesignations, the wage index value for each area is
computed exclusive of the data for hospitals that have been
redesignated from the area for purposes of their wage index. As a
result, several MSAs listed in Table 4a have no hospitals remaining in
the MSA. This is because all the hospitals originally in these MSAs
have been reclassified to another area by the MGCRB. These areas
receive the prereclassified wage index value. The prereclassified wage
index value will apply as long as the MSA remains empty.
The final wage index values for FY 1997 are shown in Tables 4a, 4b,
and 4c in the Addendum to this final rule. The FY 1997 wage index
values incorporate all hospital redesignations for FY 1997, withdrawals
of requests for reclassification, wage index corrections, appeals, and
the Administrator's review process. For FY 1997, 385 hospitals are
redesignated for purposes of the wage index (hospitals redesignated
under section 1886(d)(8)(B) or 1886(d)(10) of the Act). For hospitals
that are redesignated, the wage index values are shown in Table 4c. For
some areas, Table 4c shows more than one wage index value. This occurs
when hospitals from more than one State are included in the group of
redesignated hospitals, and one State has a higher Statewide rural wage
index value than the wage index value otherwise applicable to the
redesignated hospitals.
Tables 4d and 4e list the average hourly wage for each labor market
area, prior to the redesignation of hospitals, based on the FY 1993
wage data. In addition, Table 3C in the addendum to this final rule
includes the adjusted average hourly wage for each hospital based on
the FY 1993 data. Hospitals should use the average hourly wage
published in this final rule in applying to the MGCRB for wage index
reclassifications that would be effective for FY 1998. The MGCRB will
use the average hourly wage published in the final rule to evaluate a
hospital's application for reclassification, unless that average hourly
wage is later revised in accordance with the wage data correction
policy described in Sec. 412.63(s)(2). In such cases, the MGCRB will
use the most recent revised data used for purposes of the hospital wage
index.
C. Requests for Wage Data Corrections
In the proposed rule, we noted that we would make a diskette
available in mid-August that contained the wage data used to construct
the wage index values in this final rule. As with the diskette made
available in March 1996, HCFA made the August diskette available to
hospital associations and the public. (Please note that this data file
is also available on HCFA's World-Wide Web page, public use files
address (http://www.hcfa.gov/stats/stats.html).) This file is made
available only for the purpose of identifying any potential errors made
by HCFA or the intermediary in the handling of the final wage data that
result from the process described above, not for the initiation of new
wage data correction requests.
In addition, as noted above, Table 3C in the Addendum to this final
rule contains each hospital's adjusted average hourly wage used to
construct the wage index values. A hospital can verify its average
hourly wage as reflected on its cost report (after taking into account
any adjustments made by the intermediary), by dividing the adjusted
average hourly wage in Table 3C by the applicable wage inflation
adjustment factors as set forth above in Step 3 of the computation of
the wage index.
As noted in the proposed rule, after mid-August, we will make
changes to the hospital wage data only in those very limited situations
involving an error by the intermediary or HCFA that the hospital could
not have known about before its review of the August diskette.
Specifically, after that point, neither the intermediary nor HCFA will
accept the following types of requests in conjunction with this
process:
Requests for wage data corrections that were submitted too
late to be included in the data transmitted to the HCRIS system on or
before June 17, 1996.
Requests for correction of errors made by the hospital
that were not, but could have been, identified during the hospital's
review of the March 1996 data.
Requests to revisit factual determinations or policy
interpretations made by the intermediary or HCFA during the wage data
correction process.
If, after reviewing the data in the August diskette or this final
rule, a hospital believes that its wage data are incorrect due to a
fiscal intermediary or HCFA error in the entry or tabulation of the
final wage data, it should send a letter to both its fiscal
intermediary and HCFA. The letters should outline why the hospital
believes an error exists and provide all supporting information. These
requests must be received by HCFA and the intermediaries no later than
September 16, 1996. We have set this year's deadline one week earlier
than last year's deadline because we found the later deadline made it
difficult to evaluate the requests and recalculate the wage index
values before
[[Page 46180]]
the start of FY 1997 (that is, October 1, 1996). Requests sent to HCFA
should be sent to: Health Care Financing Administration, Office of
Hospital Policy, Attention: Stephen Phillips, Technical Advisor,
Division of Prospective Payment System; C5-06-27, 7500 Security
Boulevard, Baltimore, Maryland 21244-1850. Each request must also be
sent to the hospital's fiscal intermediary. The intermediary will
review requests upon receipt, and, if it is determined that an
intermediary or HCFA error exists, the fiscal intermediary will notify
HCFA immediately.
We believe the wage data correction process described above and in
the proposed rule provides hospitals with sufficient opportunity to
bring errors made during the preparation of the Worksheet S-3 to the
intermediary's attention. Moreover, because hospitals had access to the
wage data in mid-August, they will have had the opportunity to detect
any data entry or tabulation errors made by the intermediary or HCFA
before the implementation of the FY 1997 wage index on October 1, 1996.
If hospitals avail themselves of this opportunity, the wage index
implemented on October 1 should be free of such errors. Nevertheless,
in the unlikely event that such errors should occur, we retain the
right to make midyear changes to the wage index under very limited
circumstances.
Specifically, in accordance with Sec. 412.63(s)(2), we may make
midyear corrections to the wage index only in those limited
circumstances where a hospital can show: (1) That the intermediary or
HCFA made an error in tabulating its data, and (2) that the hospital
could not have known about the error, or did not have an opportunity to
correct the error, before the beginning of FY 1997 (that is, by the
September 16, 1996 deadline). As indicated earlier, since a hospital
will have had the opportunity to verify its data, and the intermediary
will notify the hospital of any changes, we do not foresee any specific
circumstances under which midyear corrections would be made. However,
should a midyear correction be necessary, the wage index change for the
affected area will be effective prospectively from the date the
correction is made.
Comment: One commenter commended us for making the wage data file
available on the HCFA home page. The commenter also suggested that the
file be updated frequently and include such additional information as
the MSA name where the hospital is located, the applicable inflation
adjustment factors, and the MSA to which each hospital has been
reclassified by the MGCRB, if applicable.
Response: The wage data file is currently updated twice a year, in
mid-March and mid-August, in conjunction with the issuances of the
proposed and final rules for the hospital inpatient prospective payment
systems. This effort is very labor intensive, and since hospitals are
able to submit cost reports throughout the year, it is impractical to
update the wage data file more frequently. In addition, we would point
out that the intent of making these data available is primarily to
provide hospitals the opportunity to verify the data used in the
calculation of their wage index. Updating this file more frequently is
not necessary to fulfill this primary objective.
Regarding the suggestion to include additional information on the
wage data file that we make available to the public, we note that the
suggested data elements are not necessary for the purpose of allowing
an opportunity for providers to verify the accuracy of their wage data.
We note that we publish the MSA names and inflation adjustment factors
in the proposed and final rules, and the MSAs to which hospitals are
reclassified can be found on the PPS Payment Impact Public Use File,
available shortly after publication of the proposed and final rules.
D. Contract Labor--Costs Included in the Hospital Wage Index
Our policy concerning inclusion of contract labor costs for
purposes of calculating the wage index has evolved over the past
several years. Primarily, this has occurred as we recognized the role
of contract labor in meeting special personnel needs of many hospitals.
In addition, improvements in the wage data have allowed us to more
accurately identify contract labor costs and hours. As a result,
effective with the FY 1994 wage index, we included the costs of direct
patient care contract services in the wage index calculation. Effective
with the FY 1999 wage index, which will use data from FY 1995 cost
reports, we will begin to include the costs and hours of certain
management contract services.
In the proposed rule, we provided a general overview of the issues
related to including contract labor costs in the wage index calculation
and solicited comments from the public regarding further expansion of
the types of contract labor costs included in the wage index. We also
listed nine specific issues on which we were seeking public comment.
The following background material is identical to the overview included
in the proposed rule, but we believe it is useful as a reference for
responding to many of the comments we received.
1. Background
In the May 9, 1990 proposed rule (55 FR 19442), we reported the
results of the 1988 wage index survey which collected, among other
information, data on the costs and hours associated with direct patient
care contract labor. All prospective payment hospitals completed the
wage survey for their cost reporting periods ending in calendar year
1988. The survey data indicated that hospitals had difficulty in
tracking and recording the actual hours worked associated with the
contract labor. In addition, there were reporting inconsistencies. For
example, some hospitals inappropriately reported patient care services
furnished directly by physicians, which are not included in the wage
data because they are paid under Medicare Part B rather than Part A.
In the May 9, 1990 proposed rule, we also discussed public comments
we received in response to issues we raised related to including
contract labor costs in the wage index. Specifically, in the May 8,
1989 proposed rule (54 FR 19647), we requested comment on the following
issues:
Should the wage index include data on contract labor?
Should the definition of contract services in the wage
index survey be expanded to include services indirectly related to
patient care, such as billing or housekeeping services?
A majority of the commenters supported the inclusion of contract
services, and many argued for the expansion of contract labor services
to include indirect patient care services. Those opposed to including
contract services, in addition to some commenters who supported
including contract service costs, were concerned about the difficulty
of accurately tracking and recording hours worked for all types of
contract labor. Other commenters were also concerned that if a hospital
contracts for services from outside its labor market area, the contract
wages could artificially increase or decrease the hospital's area wage
index. Based on the comments and the overall poor quality of the 1988
survey data, we decided to exclude all contract labor from the FY 1991
wage index.
We stated that we would continue our analysis of contract labor. In
addition, we announced that we would develop a new wage index survey
with improved
[[Page 46181]]
instructions and auditing criteria to facilitate the inclusion of
contract labor in future wage index updates. The new survey, Worksheet
S-3, Part II, was included in the hospital cost report effective with
cost reporting periods beginning on or after October 1, 1989.
The Worksheet S-3, Part II consists of detailed information for use
in the hospital wage index including contract labor for direct patient
care services. In the instructions for completing this worksheet,
contract labor costs and hours were limited to labor-related payments
and hours attributable to direct patient care contract services, such
as nursing services. Specifically, we instructed hospitals to exclude
indirect patient care contract services (for example, management and
housekeeping services), nonlabor-related expenses (for example,
equipment and supplies), and any contract services for which labor-
related payments and hours could not be accurately determined.
In the September 4, 1990 final rule (55 FR 36036), we discussed
additional comments we received on the contract labor issue. Those
commenters who supported the inclusion of contract labor stated that
some hospitals, especially rural hospitals, are dependent on contract
labor for nursing services, and it would be unfair not to include these
wage data. Other commenters requested that the definition of contract
labor be expanded to include indirect patient care services.
We also received several comments requesting that we continue to
exclude contract labor from the wage index. These commenters stated
that the contract labor data are not reliable because of the difficulty
in tracking and reporting hours and the lack of consistency in the
reporting of contract labor. In addition, inclusion of nonlabor
contract costs would inappropriately drive up labor costs, and contract
labor brought in from outside the labor market area would artificially
increase or decrease the area wage index value. Finally, commenters
were concerned that contract labor costs are too variable, temporary,
and not reflective of true wage costs. Therefore, some suggested that
contract labor should not be included in the wage index.
The FY 1994 wage index, which was based on the data collected on
the Worksheet S-3, Part II, was the first to include direct patient
care contract labor costs. In making the decision to include these
costs, we analyzed hospitals' FY 1990 data to determine if it was
sufficiently complete for inclusion in the wage index calculation (see
the May 26, 1993 proposed rule (58 FR 30236)). We noted that, in most
labor market areas, including contract labor in the wage index
computation had little effect on the average hourly wage. We further
stated that, based on our analysis of the data, including direct
patient care contract labor would more accurately and fairly reflect
wage levels across hospitals and MSAs. In the September 1, 1993 final
rule, we also responded to comments from the hospital industry
expressing concern that we did not recognize the costs of certain
contract management services (58 FR 46296). In particular, many rural
hospitals stated they were either unable to recruit or afford top
managers such as hospital administrators and must contract for these
services.
In the September 1, 1994 final rule (59 FR 45355), we expanded the
definition of contract labor for purposes of determining the hospital
wage index to include the personnel costs and hours associated with
certain contract management personnel. Contract management services
would be limited to individuals working in the top four positions in
the hospital: the Chief Executive Officer/Hospital Administrator, Chief
Operating Officer, Chief Financial Officer, and Nursing Administrator.
We noted that while exact titles may vary, individuals should be
performing essentially the same duties as customarily assigned these
management positions.
We further noted that, since the cost report did not provide at
that time for the collection of management contract data, this revised
definition would not be effective until cost reporting periods
beginning on or after October 1, 1994 (FY 1995). Hospitals were
instructed to continue to exclude all management contract costs and
hours until the FY 1995 data were reported (these data will be used to
compute the FY 1999 wage index). In addition, we began requiring
hospitals to provide descriptions and aggregate totals for all
management contracts and complete details on all direct patient care
contracts on the Form HCFA-339 (the Provider Cost Report Reimbursement
Questionnaire). A hospital must file this form with its corresponding
cost report.
We continue to receive requests that we expand our contract labor
definition to include more types of contract services in the wage
index. In particular, we have been asked to include the costs for
pharmacy and laboratory services on the basis that these services are
consistent with our definition of direct patient care (see the
September 1, 1995 final rule (60 FR 45792)). Others have asked that we
expand our definition to include all contracted services, both direct
and indirect patient care services, in order to more appropriately
calculate relative hospital wage costs.
We have limited the contract services that are included in the wage
index to direct patient care services and specific management services
for several reasons. First, hospitals reported difficulty in accurately
tracking the hours associated with contract services, especially for
off-site facilities that serve more than one hospital. Second, we are
concerned about the contractor's ability to separate nonlabor costs
from labor costs. We believe that the generally higher costs for
contract labor compared to salaried labor, due at least in part to the
added costs of overhead and supplies not separately identified in most
contracts, may distort the wage index. Finally, we are concerned that
it is difficult to remove the costs and hours for services such as
legal and accounting from total management contracts.
Our goal is to ensure that our wage index policy continues to be
responsive to the changing need for contract labor, allowing those
hospitals that must depend on contract labor to supply needed services
to reflect those costs in their wage data. At the same time, however,
we wish to avoid providing an opportunity for hospitals to inflate
their average hourly wage inappropriately by including nonlabor
contract costs. The advantage of our approach of including only
contract labor costs and hours associated with direct patient care and
specific management services is that it minimizes distortions in the
wage index that are due to a hospital's inability to identify and
exclude nonlabor costs. While changes to the wage index values are made
in a budget neutral manner and are not expected to affect aggregate
payments, we strive for policies that are equitable for all hospitals.
Finally, due to the 4-year time lag between the cost reporting
period itself and the fiscal year when data for that period are used in
calculating the wage index, it is important that we anticipate any need
to change our policy on contract labor. Therefore, in order to
formulate the most responsive and responsible policy, we solicited
comments on the following issues:
To what extent do hospitals rely on the use of contract
services?
For which services are contracts typically used?
Can hospitals accurately determine hours related to
contract services?
Can hospitals accurately isolate labor-related costs from
nonlabor- related costs?
Should the contract labor definition be expanded to
include contract
[[Page 46182]]
services indirectly related to patient care?
If contract labor remains limited to direct patient care,
what categories of services, if any, in addition to those identified
above, should be included?
Would the wage index more accurately reflect relative wage
levels if we did not limit contract labor to direct patient care
(generally high wage) services?
Would expanding the types of contract labor that are
included in the wage index provide less incentive to hospitals to keep
their labor costs low, as higher labor costs may result in a higher
wage index value for that hospital or allow it to reclassify to a labor
market with a higher wage index?
What other issues should be considered in revising the
policy for including contract labor in the wage index?
2. Discussion of Comments
We received 27 individual letters addressing the issue of contract
labor in the wage index. We appreciate the time and attention of all of
the commenters. The information provided has already increased our
understanding of the issue, and we intend to include in our future
analyses an evaluation of many of the points made by commenters. The
remainder of this section discusses the comments--first by responding
to the general comments we received and some specific policy questions,
then summarizing all of the responses we received to the questions
listed above. Although we do not respond directly to these latter
comments, they will aid us in our future consideration of this issue.
Comment: One commenter who represents a national association of
health systems noted that most of the issues raised by us in the
proposed rule were addressed by a special wage index Medicare Technical
Advisory Group (MTAG) work group. The commenter stated that ``(a)fter
considering all these issues in the MTAG work group, HCFA decided to
limit the inclusion of contract labor to direct patient care services.
This was because, in general, these services are in revenue producing
cost centers that have higher personnel costs (such as nursing
services) where the treatment of contract labor in determining the wage
index would have the greatest impact on hospitals. Also, these areas
generally have had fewer problems than contract services provided in
the overhead departments where average personnel costs are lower.
Patient care contract labor is more often billed on an hourly rate, and
because these are direct patient care services, they are generally
performed by personnel working on the hospital premises and therefore
include less indirect overhead cost from the contract organization. On
the other hand, contract labor costs related to overhead departments
normally has lower average cost, often includes more indirect overhead,
and often the related hours are not available.''
Response: We appreciate this commenter's past contributions into
the development of our contract labor policies and believe that the
commenter has presented a generally correct characterization of our
rationale for our current policy on contract labor costs. However, as
noted above, we are concerned that our policy continue to accurately
measure wage costs in a rapidly changing hospital environment and,
therefore, have solicited public input into our future policy
considerations.
Comment: Several commenters, including ProPAC, supported the
principle that all contract labor costs should be included in
calculating the wage index if they would have been included had the
contract workers been employees of the hospital; but the commenters
recognized the problems of accurately collecting contract labor costs.
The Commission suggested that, in light of the increasing importance of
adjusting payments to reflect input price variations in multiple
settings with the accelerating integration of health care delivery, a
need exists for a more comprehensive strategy for obtaining geographic
input price data. Finally, ProPAC indicated it would ``be pleased to
work with HCFA staff to develop and explore feasible approaches to a
solution.''
Response: We agree that, in principle, the wage index should
measure labor costs across hospitals without regard to who employs the
workers if such costs reflect relative wage levels and can be
identified. We also agree that, as health care delivery becomes more
integrated, so do the labor costs. Of course, we have increasingly been
concerned with this issue as we have worked to develop prospective
payment systems for various provider types. Therefore, we appreciate
ProPAC's offer of cooperation in this regard and look forward to
working together to address these issues.
Comment: Several commenters disagreed with our definition of direct
patient care contract labor, specifically, the exclusion of the costs
of contracted laboratory and pharmacy services. One commenter stated
that a preferable definition would include services that are directly
identifiable and billable to individual patients. Laboratory and
pharmacy services would be included in this definition. Another
commenter called our exclusion discriminatory toward rural hospitals as
rural hospitals are more likely to contract for a pharmacist than are
urban facilities. This commenter stated that pharmacists do have direct
patient care contact, noting that they dispense drugs to patients,
provide patient education, and are required to participate on
``interdisciplinary patient care'' teams.
Response: While there may be some direct patient care contact in
providing laboratory and pharmacy services, the amount varies across
hospitals and is only a portion of the total time spent providing
service to a hospital. As we noted in the proposed rule, one of the
reasons we have limited the types of contract services included in the
wage index calculation is that hospitals reported difficulty tracking
the hours associated with off-site facilities that serve more than one
hospital. Our experience and other comments we received indicate this
is also the case for contracted laboratory and pharmacy services. For
example, it is possible that a contracted pharmacist would spend part
of an hour preparing medications for patients in more than one
hospital.
We recognize the necessity for many hospitals, particularly small
and rural hospitals, to contract for pharmacy and laboratory services,
which are likely to be relatively costly. In fact, this is one of the
issues that led us to solicit public input into how our contract labor
policy may be improved. We believe that the insight from the comments
we received, as well as continuing communication with the hospital
industry, will ultimately help to resolve these difficult issues.
Comment: Several commenters representing hospital associations
recommended that we reinstitute an MTAG to ``assist in developing the
materials and definitions needed to implement these changes in
collecting contract labor data * * *'' Other commenters recommended the
initiation of a pilot study in selected regions to determine whether
``using (contract labor) costs in the wage index methodology are worth
the collection effort.''
Response: Again, we appreciate the volume of the responses we
received. Over the next few weeks, we will review our options for
pursuing the reinstitution of an MTAG to evaluate the need to revise
our policy on contract labor. We will also contact many of the national
and State hospital associations that responded to our solicitation for
further input.
[[Page 46183]]
Comment: Several commenters pointed to the need for greater clarity
regarding our definition of contract labor. There was a call for a
``universal model and criteria'' for fiscal intermediaries to follow in
determining allowable contract labor costs. One commenter submitted an
example of what such a model could look like.
Response: We have provided more detailed cost report instructions
for reporting contract labor in periods beginning on or after October
1, 1995. We will also include these more detailed instructions in the
desk reviews of the FY 1995 cost reports. In addition, on FORM HCFA-339
(the Provider Cost Report Reimbursement Questionnaire), we require
hospitals to provide detailed information on contract labor costs
currently included in the wage index calculation. This information
consists of descriptions and aggregate costs and hours for top
management contracts and costs and hours for each type of direct
patient care contract.
We will, however, continue to pursue opportunities for policy
improvement. In that regard, we welcome the suggestions we received in
response to the proposed rule, and encourage further input from
interested parties in the future.
Below, we summarize the comments we received in response to the
specific questions listed in the proposed rule. Again, we note that
while we are not responding to these comments here, we intend to take
them into consideration in our future analysis of this issue.
To what extent do hospitals rely on the use of contract
services?
According to the comments received, hospitals, particularly those
in rural areas and smaller cities, rely on contract labor for a variety
of services. In general, hospitals have begun to reduce ongoing labor
costs by employing contract personnel in many operational areas.
Because of fluctuating patient volumes, contract labor is a more cost
effective alternative to direct hiring. Furthermore, some States
prohibit the direct hiring of certain health care personnel; thus,
these positions must be contracted. Hospitals located in areas
experiencing shortages in health care personnel such as nurses and
pharmacists also rely heavily on contract labor.
For which services are contracts typically used? Virtually
all of those who commented stated that hospitals contract for nursing
and therapy (occupational, physical, respiratory, speech) services.
Most commenters mentioned the following as services for which hospitals
contract: radiology (including mammography and ultrasound); anesthesia;
dietary (including therapeutic); psychological and social; pharmacy;
laboratory and pathology; emergency room; medical records;
housekeeping, laundry, and central supply; clerical; legal; accounting
and audit; facility and equipment maintenance; and environmental. The
following services were also mentioned by at least one commenter:
surgery (technicians); air ambulance; management (e.g., medical
director); information systems management; education; and biomedical
engineering. Based on these comments, hospitals contract for every
category of labor.
Can hospitals accurately determine hours related to
contract services?
Most commenters stated that hospitals could accurately determine
hours related to contract services, particularly for contracts billed
on an hourly basis and for services such as laboratory, pharmacy, and
management. Some commenters explained that their hospitals have
established methods for tracking hours, such as time sheets maintained
for hourly workers, or invoices that include the hours worked and the
hourly rate. Others commented that, if necessary, systems to track
hours (for example, log-in sheets) could easily be instituted. Several
others suggested that hospitals could more accurately report hours
associated with contract services if HCFA clarified the contract labor
definition, developed acceptable methods for tracking hours and
associated costs, and developed a universal model and criteria for the
fiscal intermediaries to follow in auditing contract labor costs and
hours.
A few commenters stated concerns that hospitals may not be able to
accurately report contract labor hours. One suggested there may be
difficulty in reporting hours in situations where the contractor serves
more than one client. One hospital explained that for some services, it
does not report hours, or it relies on the contractor to supply the
hours. For services such as physical therapy, this hospital pays
contractors based on a percentage of revenue generated. One hospital
association stated that hospitals may not be able to accurately
determine the hours for services such as laundry, dietary,
housekeeping, and maintenance. Another association explained that,
while hospitals in its area are required to report contract hourly
rates and hours for nonpatient care cost centers, evidence suggests
that the data for many hospitals may not be completely accurate,
reflecting the difficulty of capturing such detailed information.
Can hospitals accurately isolate labor-related costs from
nonlabor-related costs?
Several commenters stated that hospitals can accurately isolate
labor-related costs from nonlabor-related costs using invoices. One
commenter explained that for services with little or no nonlabor costs,
such as laboratory, pharmacy, and management, there is no need to
identify and isolate these costs.
On the other hand, one commenter suggested there may be difficulty
in reporting hours in situations where the contractor serves more than
one client. One hospital stated that it does not separate labor and
nonlabor costs. One association stated that contracts for services such
as laundry, dietary, housekeeping, and maintenance may include more
nonlabor costs and may be more difficult for hospitals to isolate
nonlabor costs. Another association believes that intermediaries are
inconsistent in handling nonlabor costs and that HCFA needs to develop
better guidelines.
Should the contract labor definition be expanded to
include contract services indirectly related to patient care?
The majority of the commenters support expanding the definition of
contract labor to include services indirectly related to patient care.
Two commenters stated that, in principle, all contract labor costs and
hours should be included if they would have been included had the
workers been employed by the hospital. Two commenters responded that
excluding contract labor services understates the cost of providing
patient services and puts hospitals at a disadvantage. Two others
commented that HCFA's definition of direct patient care is too
restrictive and should be revised to include services that can be
identified and billed separately and are not included in the routine
care charge. One commenter, although in support of including indirect
patient care contract services, recognized that considerable review
would be necessary to determine which labor costs should be included as
contract labor. Another commenter noted that reporting additional types
of contract labor should not be considered an unnecessary burden. Two
associations expressed concern that excluding large labor expenses, for
services such as dietary and housekeeping, may create inconsistencies
across labor market areas. Some commenters also suggested that we
include the following services (that we consider indirectly related to
patient care) in the definition of contract labor: pharmacy, dietary,
clerical,
[[Page 46184]]
housekeeping and environmental, accounting and audit, legal,
consultant, and medical director.
Some commenters, including five large hospital associations,
expressed concern over expanding the definition of contract labor to
include indirect patient care services. Two commented it would add
considerably to the complexity of tracking costs and determining which
services should be included or excluded. One commenter added that,
based on its analyses, it would be difficult to collect reliable data
and that including contracted indirect patient care costs would have
only a minor impact on the wage index. Another commented that problems
that exist with contract labor data are more prevalent in nonrevenue
producing areas.
If contract labor remains limited to direct patient care,
what categories of services, if any, in addition to those identified
above, should be included?
Commenters named the following services as those that should be
included in the direct patient care definition of contract labor:
dietary, anesthesia, social, pharmacy, laboratory, pathology, medical
records, equipment maintenance, environmental management, central
supply, and all clinical services.
Would the wage index more accurately reflect relative wage
levels if we did not limit contract labor to direct patient care
(generally high wage services)?
Five hospitals and ProPAC commented that the wage index would more
accurately reflect relative wage levels if we did not limit contract
labor to direct patient care. One stated that failure to include all
contract labor could result in major biases in the wage index because
contract services may vary substantially among types of hospitals and
across labor market areas. Two rural hospitals argued that the current
policy discriminates against rural hospitals because they are more
likely to have to contract pharmacists and other personnel because of
employee shortages in their wage areas.
Three associations and a hospital commented that the wage index
would not more accurately reflect relative wage levels if we did not
limit contract labor to direct patient care. One explained that the
results would not be more accurate by adding or subtracting categories
of care; rather, the key to an accurate calculation is that the
components are consistent for all hospitals, not how many components
are included. Another added that, based on its analyses, including
contracted indirect patient care costs would have only a minor impact
on the wage index. A third commenter expressed concern that the time
necessary at the hospital level to obtain this information and the time
necessary for the intermediary to review such information would not be
cost effective.
Would expanding the types of contract labor that are
included in the wage index provide less incentive to hospitals to keep
their labor costs low, as higher labor costs may result in a higher
wage index value for that hospital or allow it to reclassify to a labor
market with a higher wage index?
Commenters were unanimous in their belief that expanding the types
of contract labor that are included in the wage index would not provide
less incentive to hospitals to keep their labor costs low. Several
commenters explained that hospitals in today's environment have every
incentive to keep their costs down. Because Medicare is only one payer,
allowing labor costs to increase for improved Medicare payment would
put hospitals in an uncompetitive position as far as other payers are
concerned. Also, it would take 4 years for those costs to be reflected
in the wage index. One of them added that it is difficult to conceive
of any situation in which a hospital would benefit from paying higher
labor rates than necessary.
What other issues should be considered in revising the
policy for including contract labor in the wage index?
An association, located in a mostly rural State, suggested that
changes to expand contract labor should be made as soon as possible to
provide a more accurate and equitable wage index for all hospitals.
E. Puerto Rico Wage Index Values
For several years, hospitals in Puerto Rico have experienced large
swings in their wage index values. We recognize that large shifts in
the wage index values can cause shifts in the payment levels for a
particular MSA. Because three of the six MSAs in Puerto Rico
(Aguadilla, Arecibo, and Caguas) as well as the rural area have four or
fewer hospitals, a large change in one hospital's wage data can cause a
large increase or decrease in the wage index value for the entire MSA.
One possible method to limit these annual swings in wage index values
would be to create a single labor market area encompassing all the
hospitals in Puerto Rico. That is, the six MSAs and the rural area
could be combined into one area with one wage index value. A single
labor market area would create a much larger set of hospitals to
develop aggregate wage amounts and would mitigate situations where a
change in the wage data of a single hospital has a large effect on the
wage index of an MSA.
If we created a single labor market area for Puerto Rico, we would
do so in a budget neutral manner; therefore, the effect would be to
raise wage index values for some hospitals in Puerto Rico and to lower
the values for others. Because of the negative effect on some
hospitals, rather than propose such a change, we solicited comment on
this approach for mitigating the fluctuations in wage index values for
hospitals in Puerto Rico. We noted that the potential change would have
no impact on hospitals outside Puerto Rico. We received five comments
in response to our solicitation. These comments and our responses are
set forth below.
Comment: All of the commenters expressed grave concern regarding
the creation of a single MSA in Puerto Rico for purposes of the wage
index. Most commenters objected to the negative impact this proposal
would have on the wage index values of high wage areas. One commenter
protested the elimination of large urban status for the San Juan MSA.
Two commenters were concerned about the effect this change would have
on hospitals that are able to reclassify through the MGCRB. One
commenter noted that HCFA relies on OMB for MSA designations and OMB
has not approved this change. Finally, a commenter stated that a single
labor market area would not recognize the difference between tertiary
and secondary hospitals.
Response: We solicited comment on consolidating Puerto Rico into
one labor market area because it was one method for addressing swings
in wage index values within Puerto Rico without adversely affecting
hospitals outside Puerto Rico. Since commenters do not favor this
approach, we will not pursue the option. We note that this approach
would not have eliminated large urban status of the San Juan MSA for
standardized amount purposes. Puerto Rico would have been treated as
one labor market area solely for wage index purposes.
We have recently met with representatives of the Puerto Rico
Hospital Association to explore other solutions to the problems faced
by hospitals in the Commonwealth. In reviewing the latest Medicare cost
report data available, we find that hospitals in Puerto Rico continue
to demonstrate average Medicare operating margins comparable to all
other prospective payment hospitals.
Comment: One commenter urged an add-on adjustment of not less than
7
[[Page 46185]]
percent to the Puerto Rico standardized amounts to account for the
penalty resulting from the use of temporary cost allocation methods by
government hospitals with a noncharge structure in Puerto Rico.
Response: We do not believe it is appropriate to adjust the
standardized amounts of Puerto Rico for those government hospitals with
a noncharge structure when we have not adjusted the national
standardized amounts applicable to all other hospitals to account for
government hospitals with noncharge structures that are located in the
50 States and the District of Columbia. We believe the prospective
payment system should be fair and equitable to all hospitals, no matter
where they are located.
Comment: A commenter requested that we establish a wage index floor
for the labor market areas in Puerto Rico.
Response: The wage index measures relative wage levels across labor
market areas. Since Puerto Rico labor market areas have not increased
wages at the same average rate as all other hospitals, their wage index
values have decreased accordingly. If we were to create a floor, it
would improperly benefit labor market areas whose wages are not in line
with the national experience. The hospitals receiving the floor wage
index would receive artificially high DRG payments.
In addition, we note that, if such a change were to ever be
adopted, it would be implemented in a budget neutral manner. Thus, a
wage index floor for hospitals in Puerto Rico would result in lower
payments to other hospitals.
Comment: Two commenters suggested that we eliminate the Puerto Rico
rural area classification and classify those hospitals to the nearest
MSA.
Response: We do not believe it is appropriate to offer special
treatment to hospitals located in the rural area of Puerto Rico. While
we acknowledge certain limitations in the current geographic
classification system, we have yet to find a system that is
demonstrably better. (See the discussion on labor market area research
in the June 2, 1995 proposed rule (60 FR 29218).) Unless we decide to
adopt a new method for defining labor market areas, we will continue to
use rural areas for hospitals in counties that are not designated as
part of MSAs. We note that rural hospitals in Puerto Rico may apply for
geographic redesignation under the same criteria as all other hospitals
and that some hospitals in rural Puerto Rico have been approved for
reclassification.
Comment: One commenter suggested that OMB review the San Juan MSA
for possible redesignation of certain San Juan municipalities to other
urban areas.
Response: As acknowledged by the commenter, it is OMB that makes
the determination of which municipalities are included in a particular
MSA. We believe that OMB uses the same criteria to create the San Juan
MSA as it does for all other MSAs. We urge the commenter to forward any
suggestions directly to OMB for its consideration.
F. Changes to the MGCRB Composition and Criteria
Under section 1886(d)(10) of the Act, the MGCRB considers
applications by hospitals for geographic reclassification for purposes
of payment under the prospective payment system. Guidelines concerning
the criteria and conditions for hospital reclassification are located
at Secs. 412.230 through 412.236. The purpose of these criteria is to
provide direction, to both the MGCRB and those hospitals seeking
geographic reclassification, with respect to the situations that merit
an exception to the rules governing the geographic classification of
hospitals under the prospective payment system. The composition of the
MGCRB and the procedures it follows in making reclassification
determinations are set forth in Secs. 412.246 through 412.280.
In the May 31, 1996 proposed rule, we proposed one change to the
MGCRB regulations. In addition, we requested comments on sources of
data that could be used to identify the occupational mix in a given
MSA.
1. MGCRB Composition (Sec. 412.246)
Section 1886(d)(10)(B)(i) of the Act provides that the MGCRB is
composed of five members appointed by the Secretary. This provision is
implemented in regulations at Sec. 412.246(a). Two of the members must
be representative of the concerns of rural hospitals and at least one
member must be knowledgeable in the field of analyzing costs of
providing inpatient hospital services. Under current Sec. 412.246(b),
the term of office for an MGCRB member is 3 years, and appointments are
limited to two consecutive 3-year terms. This section further provides
that to permit staggered terms of office, initial appointments may be
for shorter terms. Finally, the Secretary is permitted to terminate a
member's tenure before his or her full term has expired.
In the proposed rule, in order to allow the Secretary maximum
flexibility to recruit and retain qualified Board members, we proposed
to eliminate the current requirement at Sec. 412.246(b) that a Board
member can serve for only two consecutive 3-year terms and to provide
that an appointment to the MGCRB may be for any term not to exceed 3
years.
Under the proposed revisions, the Secretary would continue to be
able to terminate a member's tenure before his or her full term has
expired.
We received no comments on this proposal, and we have incorporated
it as final in this document.
2. Occupational Mix Adjustment
Section 1886(d)(10)(D)(i) of the Act requires the Secretary to
publish guidelines to be used by the MGCRB in rendering decisions on
applications submi
FR Doc. 96-22145 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1997 Rates
tted for geographic reclassification. Those are to
include guidelines for ``comparing wages, taking into account (to the
extent the Secretary determines appropriate) occupational mix, in the
area in which the hospital is classified and the area in which the
hospital is applying to be classified.''
Section 412.230(e) describes the criteria for hospital
reclassification for purposes of the wage index. One of the criteria
relates to the relationship between the hospital's wages and those of
the area to which it seeks reclassification. Specifically,
Sec. 412.230(e)(1)(iv) provides that the hospital must demonstrate that
its wages are at least 84 percent of the average hourly wage of
hospitals in the area to which it seeks reclassification, or that the
hospital's average hourly wage weighted for occupational mix is at
least 90 percent of the average hourly wage of hospitals in the area to
which it seeks reclassification. Under Secs. 412.232(c) and 412.234(b),
a group of hospitals seeking to reclassify must demonstrate that its
aggregate average hourly wage is at least 85 percent of the average
hourly wage of the hospitals in the area to which it seeks
reclassification. These sections also provide that the threshold for
occupational-mix adjusted hourly wage for hospital groups is the same
as that for a single hospital, that is, 90 percent.
In the September 6, 1990 interim final rule (55 FR 36760), we
stated that the acceptable sources for occupational mix data were the
American Hospital Association (AHA) or the Bureau of Labor Statistics.
Since publication of that document, the Bureau of Labor has
discontinued its hospital wage surveys. Thus, the only currently
acceptable occupational mix data source is the AHA Survey Data. We have
been informed by the AHA that the survey for 1993 will be the last
survey to collect information on the Hospital Personnel by Occupational
Category. Therefore,
[[Page 46186]]
requests filed on or before October 1, 1996 for FY 1998
reclassification, which use FY 1993 wage data, may be the last for
which we have an appropriate source of occupational mix data.
As we stated in the June 4, 1991 final rule with comment period (56
FR 25458), the reclassification process requires the use of
occupational mix data that are comparable across areas and can be
consistently applied. We are unaware of any sources other than the AHA
data that meet these criteria.
As noted in the proposed rule (61 FR 27459), we did not propose
collecting occupational mix data ourselves in light of past experience.
Instead, we solicited suggestions about any occupational mix data
sources that are available on a national basis. In addition, we
indicated that we were willing to consider suggestions about other
methods that would account for occupational mix in the wage index
reclassification process.
Comment: We received three comments on this issue. One commenter
believes that collection of the occupational mix data is burdensome,
that the data are unreliable, and that we should therefore eliminate
the use of such data. One commenter urged that the AHA continue to
collect the data for HCFA. The final commenter suggested that we
consider using the Geographic Reference Report to obtain occupational
mix information. That commenter noted, however, that this collection
effort would have to be expanded for our use.
Response: The AHA has notified us that it does not have enough
demand for these data to warrant continued collection. Generally, the
AHA, as well as HCFA, have found that hospitals do not want to provide
occupational breakdowns in a survey format. The Geographic Reference
Report would have to be expanded and tailored to fit our needs, which
means that it would be unavailable for at least several years as a data
source for this purpose. As there is no readily available data source
that can be used immediately to represent occupational mix data for the
purposes of reclassification applications, it appears that we will be
unable to continue to use such data as an alternative for hospital
reclassification applications. However, since the 1993 AHA data are
available for reclassification requests for FY 1998, we will not make a
final decision in this rule. If a suitable source of occupational mix
data becomes available in the next year, we will consider using it
beginning with reclassifications for FY 1999.
Comment: We received one comment from a hospital that was concerned
that it might not qualify for reclassification for purposes of using
the wage index of a proximate area because it could not meet the 108
percent qualifying criteria. This commenter noted that the hospital is
located in an area where it materially influences the average hourly
wage in its area, but it does not dominate the area. The commenter
believes that the current criteria disadvantages such a hospital,
because it can no longer meet the 108 percent threshold for
reclassification.
Response: We have addressed similar comments a number of times. The
purpose of the reclassification wage criteria is to identify situations
in which a hospital would receive more appropriate payments if it were
redesignated to another area. The 108 percent criterion in particular
is designed to identify situations in which a hospital is significantly
disadvantaged by its current geographic classification. If a hospital's
wages are less than 8 percent higher than the average hourly wage in
the hospital's labor market area, we believe the hospital is not
significantly disadvantaged by the payments it would receive and,
therefore, geographic reclassification is not appropriate.
Comment: One commenter requested confirmation of the process by
which a group of hospitals withdraw its application for
reclassification. The commenter believes that all the hospitals must be
a party to the withdrawal request.
Response: The commenter is correct. The regulations at
Sec. 412.273(b) clearly state that all hospitals that are party to the
application must request the withdrawal in writing. Therefore, a
request to withdraw an approved application by the MGCRB must be agreed
upon and requested in writing by the entire group.
IV. Rebasing and Revising of the Hospital Market Baskets
A. Operating Costs
1. Background
Effective for cost reporting periods beginning on or after July 1,
1979, we developed and adopted a hospital input price index (that is,
the hospital ``market basket'') for operating costs. Although ``market
basket'' technically describes the mix of goods and services used to
produce hospital care, this term is also commonly used to denote the
input price index (that is, cost category weights and price proxies
combined) derived from that market basket. Accordingly, the term
``market basket'' as used in this document refers to the hospital input
price index.
The percentage change in the market basket reflects the average
change in the price of goods and services hospitals purchase in order
to furnish inpatient care. We first used the market basket to adjust
hospital cost limits by an amount that reflected the average increase
in the prices of the goods and services used to furnish hospital
inpatient care. This approach linked the increase in the cost limits to
the efficient utilization of resources.
With the inception of the hospital inpatient prospective payment
system on October 1, 1983, we continued to use the hospital market
basket to update each hospital's 1981 inpatient operating cost per
discharge used in establishing the FY 1984 standardized payment
amounts. In addition, the projected change in the hospital market
basket has been the integral component of the update factor by which
the prospective payment rates are updated every year. Under section
1886(b)(3)(B)(i)(XII) of the Act, the prospective payment rates will be
updated in FY 1997 by the projected increase in the hospital market
basket minus 0.5 percentage points. A detailed explanation of the
hospital market basket used to develop the prospective payment rates
was published in the Federal Register on September 3, 1986 (51 FR
31461). For additional background information on general development of
hospital input price indexes, we refer the reader to the article by
Freeland, Anderson, and Schendler, ``National Hospital Input Price
Index,'' Health Care Financing Review, Summer 1979, pp 37-61. We also
refer the reader to the September 4, 1990 Federal Register (55 FR
35990) in which we discussed the previous rebasing of the hospital
input price index.
The hospital market basket is a fixed-weight, Laspeyres-type price
index that is constructed in three steps. First, a base period is
selected and total base period expenditures are estimated for 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/wage variable, referred to as a price proxy. These
price proxies are price levels derived from a publicly available
statistical series published on a consistent schedule, preferably at
least on a quarterly basis. Third and finally, the price level for each
spending category is multiplied by the expenditure weight for that
category. The sum of these products (that is, the
[[Page 46187]]
expenditure weights multiplied by the price levels) for all cost
categories yields the composite index level in the market basket in a
given year. Repeating this step for other years produces a series of
market basket index levels over time. Dividing one index level by an
earlier index level produces rates of growth in the input price index.
The 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 that was purchased in the
base period. The effects on total expenditures resulting from changes
in the quantity or mix of goods and services purchased subsequent to
the base period are not considered. For example, shifting a
traditionally inpatient type of care to an outpatient setting might
affect the volume of inpatient goods and services purchased by the
hospital, but would not be factored into the price change measured by a
fixed weight hospital market basket.
We believe that it is desirable to rebase the market basket
periodically so the cost weights reflect changes in the mix of goods
and services that hospitals purchase (hospital inputs) in furnishing
inpatient care. We last rebased the hospital market basket cost weights
effective for FY 1991. This market basket, still used through FY 1996,
reflected base year data from FY 1987 in the construction of the cost
weights.
In its April 1, 1985 report to the Secretary (Appendix C of the
June 10, 1985 proposed rule (50 FR 24446)), ProPAC supported HCFA's
position on periodic rebasing, stating that the market basket cost
weights should be recalculated or ``rebased'' at least every 5 years,
or more frequently if significant changes in the weights occur. We note
that there are separate market baskets for prospective payment
hospitals and hospitals and hospital units excluded from the
prospective payment system. The separate, excluded hospital market
basket is set forth in section IV.A.5 of this preamble.
2. Rebasing and Revising the Hospital Market Basket
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,
we are moving the base year cost structure from FY 1987 to FY 1992).
Revising means changing data sources, cost categories, or price proxies
used in the input price index.
We are adopting a rebased and revised hospital market basket in
developing the FY 1997 update factor for the prospective payment rates.
The new market basket has been rebased to reflect 1992, rather than
1987, cost data.
In developing the rebased and revised market basket, we reviewed
hospital operating expenditure data for the market basket cost
categories. In a change from the previous methodology, we relied
primarily on Medicare hospital cost report data for the rebasing. For
the rebased market baskets, we used data on hospital expenditures for
four major expense categories (wages and salaries, employee benefits,
pharmaceuticals, and a residual ``all other'') from hospital cost
reporting periods beginning in FY 1992 (that is, periods beginning on
or after October 1, 1991 and before October 1, 1992). We refer to these
as PPS-9 cost reports (the 9th year of the prospective payment system
(PPS)). The market basket was previously based on 1987 expense data
from the 1988 American Hospital Association (AHA) Annual Survey.
Expenses for wages and salaries, employee benefits, and
pharmaceuticals were determined using data from PPS-9 cost reports as
reported in the Hospital Cost Report Information System (HCRIS) files.
We determined total professional fees using AHA Annual Survey data.
Total professional fees include medical and nonmedical professional
fees. Since the medical professional fees included in the compensation
of provider-based physicians are paid under Medicare Part B, we
analyzed HCRIS data to determine the professional component of
provider-based physician compensation and subtracted it from total
professional fees to obtain an estimate of nonmedical professional
fees. Malpractice insurance costs were determined using the cost share
for PPS-6 (cost reporting periods beginning in FY 1989), the last year
these costs had to be treated separately from all other administrative
and general costs, trended forward to 1992 based on the relative
importance of malpractice costs found in the previous market basket.
The All Other Expenses category was calculated in two steps. First,
from PPS-9 cost reports, total operating expenses were tabulated by
subtracting capital-related expenses, direct medical education
expenses, and the medical professional fees from total expenses.
Second, we subtracted the total of the five cost category expenses
already determined from total operating expenses to obtain the All
Other Expenses category.
After totals for these main cost categories (wages and salaries,
employee benefits, professional fees, pharmaceuticals, malpractice
insurance, and all other expenses) were calculated, we then determined
the proportion each category represents of the total costs. These
proportions represent the major rebased market basket weights. The
differences between the six major categories for the 1992-based index
and the previous 1987-based index are summarized in Table 1 below.
Table 1.--Comparison of 1992 and 1987 Prospective Payment Hospital
Operating Cost Categories and Weights
------------------------------------------------------------------------
Rebased 1987-
1992 based
Expense categories hospital hospital
market market
basket basket
------------------------------------------------------------------------
Wages and salaries................................ 50.244 52.2
Employee benefits................................. 11.146 9.5
Nonmedical professional fees...................... 2.127 1.6
Malpractice insurance............................. 1.189 1.4
Pharmaceuticals................................... 4.162 3.9
All other......................................... 31.132 31.4
---------------------
Total......................................... 100.000 100.0
------------------------------------------------------------------------
Note: Although we rounded the weights to the tenths decimal position in
the 1987-based market basket as published in the September 4, 1990
final rule, we are presenting the 1992 weights in greater specificity.
Table 2 sets forth the market basket cost categories, weights, and
price proxies. Weights for the ``Utilities'' and the ``All Other'' cost
categories, as well as the subcategories, were determined using the
1987 Department of Commerce's Bureau of Economic Analysis (BEA) Input-
Output Table, from which data for the hospital industry were extracted.
The BEA Input-Output database, which is updated at 5-year intervals,
was most recently described in the Survey of Current Business,
``Benchmark Input-Output Accounts for the U.S. Economy, 1987'' (April
1994). To date, the Department of Commerce has not released final 1992
cost data. Therefore, we plan to incorporate these data into the FY
1998 proposed rule.
We aged the 1987 cost shares to 1992 using historical price changes
between 1987 and 1992 for each category. The aged shares were
normalized to be consistent with the 1992 hospital cost report data.
Relative weights for the new base year were then calculated for various
expenditure categories. This work resulted in the identification of 26
separate cost categories in the rebased hospital market basket, two
fewer categories than were included in the 1987-based market basket.
Detailed
[[Page 46188]]
descriptions of each category and respective price proxy are provided
in Appendix C to this final rule.
Table 2.--1992-Based Prospective Payment Hospital Operating Cost
Categories, Weights, and Price Proxies
------------------------------------------------------------------------
Rebased
1992
Expense categories hospital Price proxy
market
basket
------------------------------------------------------------------------
1. Compensation..................... 61.390 .......................
A. Wages and salaries*.......... 50.244 HCFA occupational wage
index.
B. Employee benefits*........... 11.146 HCFA occupational
benefits index
2. Professional fees*............... 2.127 ECI--compensation for
professional,
specialty and
technical.
3. Utilities........................ 2.469 .......................
A. Fuel, oil, and gasoline...... 0.345 PPI refined petroleum
products.
B. Electricity.................. 1.349 PPI commercial electric
power.
C. Natural gas.................. 0.670 PPI commercial natural
gas.
D. Water and sewerage........... 0.106 CPI-U water and
sewerage maintenance.
4. Professional liability insurance. 1.189 HCFA professional
liability insurance
premium index.
5. All other........................ 32.824 .......................
A. All other products........... 24.033 .......................
(1.) Pharmaceuticals........ 4.162 PPI ethical
(prescription) drugs.
(2.) Food................... 3.459 .......................
a. Direct purchase........ 2.363 PPI processed foods and
feeds.
b. Contract service....... 1.096 CPI-U food away from
home.
(3.) Chemicals.............. 3.795 PPI industrial
chemicals.
(4.) Medical instruments.... 3.128 PPI medical instruments
and equipment.
(5.) Photographic supplies.. 0.399 PPI photographic
supplies
(6.) Rubber and plastics.... 4.868 PPI rubber and plastic
products.
(7.) Paper products......... 2.062 PPI converted paper and
paperboard products.
(8.) Apparel................ 0.875 PPI apparel.
(9.) Machinery and equipment 0.211 PPI machinery and
equipment.
(10.) Miscellaneous products 1.074 PPI finished goods.
B. All other services........... 8.792 .......................
(1.) Business services*..... 3.823 ECI--compensation for
private workers in
business services.
(2.) Computer services*..... 1.927 AHE computer and data
processing services.
(3.) Transportation services 0.188 CPI-U transportation.
(4.) Telephone services..... 0.531 CPI-U telephone
services.
(5.) Postage*............... 0.272 CPI-U postage.
(6.) All other: labor 1.707 ECI--compensation for
intensive*. private service
occupations.
(7.) All other: nonlabor 0.344 CPI-U all items.
intensive.
-----------
Total..................... 100.000 .......................
------------------------------------------------------------------------
* Labor-related.
Note: Due to rounding, weights may not sum to total.
The 1987-based market basket included a separate Blood Services
cost category. In the 1992-based market basket, Blood Services is
contained within the Chemicals cost category. In addition, the 1987-
based cost category for Fuel Oil, Coal, etc. has been combined with the
1987-based Motor Gasoline cost category to form the 1992-based Fuel,
Oil and Gasoline cost category. Both of these changes are based on
revised cost categories from BEA. For comparison purposes, the 1987-
based cost categories are set forth in Table 3.
Table 3.--1987-Based Prospective Payment Hospital Operating Cost
Categories, Weights, and Price Proxies
------------------------------------------------------------------------
1987
hospital
Expense categories market Price proxy
basket
------------------------------------------------------------------------
1. Compensation..................... 61.7 .......................
A. Wages and salaries *......... 52.2 HCFA occupational wage
index.
B. Employee benefits *.......... 9.5 HCFA occupational
benefits index.
2. Professional fees *.............. 1.6 ECI--wages and salaries
for professional,
specialty and
technical.
3. Utilities........................ 2.4 .......................
A. fuel, oil, coal, etc......... 0.6 WPI light fuel oils.
B. Electricity.................. 1.1 WPI industrial power.
C. Natural gas.................. 0.3 WPI natural gas.
[[Page 46189]]
D. Motor gasoline............... 0.2 WPI gasoline.
E. Water and sewerage........... 0.0 CPI-U water and
sewerage maintenance.
4. Professional liability insurance. 1.4 HCFA professional
liability insurance
premiums.
5. All other........................ 32.8 .......................
A. All other products........... 21.8 .......................
(1.) Pharmaceuticals........ 3.9 WPI prescription drugs.
(2.) Food................... 3.3 .......................
a. Direct purchase........ 2.1 WPI processed foods.
b. Contract service....... 1.2 CPI-U food away from
home.
(3.) Chemicals.............. 3.1 WPI industrial
chemicals.
(4.) Medical instruments.... 2.7 WPI medical instruments
and equipment.
(5.) Photographic supplies.. 2.6 WPI photographic
supplies.
(6.) rubber and plastics.... 2.3 WPI rubber and plastic
products.
(7.) Paper products......... 1.4 PPI converted paper and
paperboard products.
(8.) Apparel................ 1.1 WPI textile house
furnishings.
(9.) machinery and equipment 0.4 WPI machinery and
equipment.
(10.) Miscellaneous products 0.8 WPI finished goods.
B. All other services........... 11.1 .......................
(1.) Business services *.... 3.8 AHE business services.
(2.) Computer services *.... 2.0 AHE computer and data
processing services.
(3.) Transportation services 1.2 CPI-U transportation.
(4.) Telephone services..... 1.0 CPI-U telephone
services.
(5.) Blood services *....... 0.6 WPI blood and
derivatives.
(6.) Postage *.............. 0.4 CPI-U postage.
(7.) All other: labor 1.2 ECI--wages and salaries
intensive *. for private service
occupations.
(8.) All other: nonlabor 0.8 CPI-U all items.
intensive.
-----------
Total................... 100.0
------------------------------------------------------------------------
* Labor-related.4700
Note: Due to rounding, weights may not sum to total.
In the September 4, 1990 final rule, for purposes of determining
the labor-related portion of the standardized amounts, we summed the
percentages of the labor-related items (that is, wages and salaries,
employee benefits, professional fees, business services, computer and
data processing, blood services, postage, and all other labor-intensive
services) in the hospital market basket. This summation resulted in a
labor-related portion of the hospital market basket of 71.4 percent and
nonlabor-related portion of 28.6 percent. Under sections 1886 (d)(2)(H)
and (d)(3)(E) of the Act, in making payments under the prospective
payment system, the Secretary estimates from time to time the
proportion of payments that are labor-related. Since October 1, 1990,
then, we have considered 71.4 percent of costs to be labor-related for
purposes of the prospective payment system.
In connection with the rebasing of the hospital market basket, we
have reestimated the labor-related share of the standardized amounts.
Based on the relative weights of the 1992-based prospective payment
hospital market basket, as described in Table 2, the labor-related
portion that is subject to hospital wage index adjustments (based on
wages and salaries, employee benefits, professional fees, business
services, computer and data processing, postage, and all other labor-
intensive services) is 71.246 percent and the nonlabor-related portion
is 28.754 percent. To implement this change, effective with discharges
occurring on or after October 1, 1996, we recomputed the labor-related
and nonlabor-related shares of the large urban and other areas'
standardized amounts used to establish the prospective payment rates.
The amounts in Table 4 reflect the revised labor-related and
nonlabor-related portions. Due to the Bureau of Economic Analysis'
reclassification of Blood Services to Chemicals, we now allocate Blood
Services to a nonlabor cost category. We note that, although there are
revisions of the labor and nonlabor portions, due to both weight
changes and the Blood Services category change, the labor-related
portions of the rates published in Table 4 have remained essentially
the same. The labor-related portion has decreased by 0.146 percentage
points.
Table 4.--Labor-Related Share
------------------------------------------------------------------------
Cost category Weight
------------------------------------------------------------------------
Wages and salaries........................................... 50.244
Employee benefits............................................ 11.146
Professional fees............................................ 2.127
Business services............................................ 3.823
Computer services............................................ 1.927
Postal services.............................................. 0.272
All other labor intensive.................................... 1.707
----------
Total labor related...................................... 71.246
----------
Total nonlabor related................................... 28.754
------------------------------------------------------------------------
Comment: Several commenters noted that because the prospective
payment system hospital input price index directly measures changes in
the price of labor for the overall economy as well as the changes in
the prices of goods and services purchased by hospitals, if legislation
is passed increasing the minimum wage in the United States the market
basket update should be revised to reflect this change.
Response: The commenters are correct in asserting that an increase
in the minimum wage should be appropriately reflected in the
prospective payment system hospital input price index. The structure of
the prospective payment
[[Page 46190]]
system hospital input price index is designed to track the historical
increases in compensation for workers comparable to those employed in
the hospital sector (as well as the prices of goods and services
comparable to those purchased by hospitals). The blend of occupational
data represents a composite of the types of labor that hospitals employ
in the production of their services. The proxies selected by HCFA to
represent these inputs are Employment Cost Indexes (ECIs) compiled by
the Bureau of Labor Statistics for the relevant occupational
categories. When the historical data for the period of the minimum wage
increase becomes available, the ECIs automatically reflect the impacts
of increases in the minimum wage. These proxies will therefore reflect
any increases in wages and benefits associated with the legislated
increase in the minimum wage.
The second quarter 1996 DRI/McGraw-Hill forecast of the prospective
payment system hospital input price index, which is included in this
final rule, reflects an anticipated increase in the minimum wage.
In the first quarter of 1996, HCFA commissioned DRI/McGraw-Hill to
consider the effects of an increase in the minimum wage on the HCFA
input price indexes. In its analysis, DRI/McGraw-Hill stated that the
critical factor in determining the relative impact on each of HCFA's
input price indexes in comparison with the economy-wide impact is the
distribution of minimum wage workers associated with the occupational
mix within each health sector. Data from the 1990, 5-percent Public Use
Micro Data Survey (scaled for consistency with the nonfarm aggregate
from the 1994 Current Population Survey) indicate that the share of all
hourly workers at or below the minimum wage is approximately 3.3
percent for the health sector as a whole, versus an economy wide share
of 3.6 percent. There is a wide variation in the importance of minimum
wage workers across health industry sectors as well, ranging from a low
of 2.0 percent for the workforce in hospitals, to a high of 9.3 percent
for nursing-care related facilities. For the key wage proxies in the
prospective payment system hospital input price index (ECI Civilian
Hospital workers and the ECI for Professional-Technical workers) the
share of minimum wage workers is negligible. The expected increase in
minimum wage will likely affect the annual rates of increase in the
prospective payment system hospital input price index in the range of
about 0.1 percent.
Comment: One commenter noted that there are few who can afford to
spend the time necessary to study the proposal to rebase and revise the
hospital market baskets in its present form or hire an economist for an
interpretation. The commenter suggests that HCFA could save valuable
resources and, at the same time, simplify a process that is extremely
complicated by using the overall cost data from the cost reports as a
means of simplifying and arriving at an accurate market basket.
Response: The Medicare cost report is designed to track hospitals'
costs for services that are covered by Medicare. Expenditures or costs
are determined by the price of inputs for a particular good or service
times the quantity of that input good or service that is used. An
increase in costs could result from input price growth (inflation) or
growth in the quantity of services used. It is essential to
understanding the growth in Medicare program costs to have a rigorous
framework for distinguishing the effects of input price growth from the
effects of increases in the quantity of inputs. A measure based upon
overall cost data from the cost reports, while appearing to simplify
the process, would not separate input price changes from changes in the
quantity of inputs and consequently would not serve the needs of
government or industry.
We do appropriately use Medicare cost report data in developing
weights for the Medicare input price indexes. The 1992 base year
weights for the four core operating categories (wages and salaries,
employee benefits, pharmaceuticals, and all other) were derived from
Medicare cost report data on hospitals' relative shares of costs in
these four categories in 1992. By holding the weights constant at their
1992 relative values, and applying proxies to measure price change over
time, it is possible to estimate the effect of pure input price
inflation while holding quantity and quality of inputs constant. This
is the purpose of the prospective payment system hospital input price
index.
Comment: A commenter stated that, in rebasing the market basket,
HCFA has chosen to put malpractice costs into a separate category. In
doing so, this cost was taken from 1989 cost reports and ``trended''
forward. The commenter suggested that, because this cost cannot be
taken from cost reports in future years, it would be better to
consolidate malpractice cost within an ``all other'' category.
Response: Malpractice has appropriately been a separate cost
category since the inception of the prospective payment system hospital
input price index. We are modifying the Medicare cost report to again
include relevant malpractice cost questions, so that we will not have
to estimate the malpractice share of costs.
3. Selection of Price Proxies
After computing the 1992 cost weights for the rebased hospital
market basket, it was necessary to select appropriate wage and price
proxies to monitor the rate of increase for each expenditure category.
Most of the indicators 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. For
example, we used the PPI for ethical drugs, rather than the Consumer
Price Index (CPI) for prescription drugs. PPIs are preferable price
proxies for goods that hospitals purchase as inputs in producing their
outputs. The PPIs we used 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 the
producer, the consumer price indexes were used if no appropriate PPI
was available, or if the expenditure was more similar to that of retail
consumers in general rather than a purchase at the wholesale level. For
example, the CPI for food purchased away from home was 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. They are not affected by shifts in employment mix.
Average Hourly Earnings--Average Hourly Earnings (AHEs)
measure the rate of change of hourly earnings for various occupations
within a given industry, and, therefore, reflect a weighted
occupational mix within a particular industry. The AHE series is
calculated by dividing gross payrolls by total hours and measures
actual earnings rather than pure wage rates. It is a current-weight
series rather than a fixed-weight index and thus reflects shifts in
employment mix. An AHE rather than an ECI is used when there is no
corresponding ECI category that is an appropriate measure of growth for
a
[[Page 46191]]
given labor category or when the ECI does not have sufficient length of
history to be useful for our purpose.
Our price proxies for the rebased prospective payment hospital
market basket are shown in Table 2 above and are summarized in Appendix
C to this final rule.
Comment: One commenter believes that the most recent available
Medicare cost report and other data should be used to establish the
cost weights, particularly because the hospital industry and its cost
structure are changing so rapidly.
Response: The prospective payment system hospital input price index
was designed to be rebased at 5-year intervals, consistent with the
scheduled release of the Commerce Department data on detailed cost
structure by industrial sector of the U.S. economy. The Gross Domestic
Product (GDP) and other related government statistics are on the same
schedule of 5-year intervals between updates. Therefore, when planning
for rebasing, HCFA adopted a base year that was 5 years from the most
recent previous base year, 1987. We note that the Department of
Commerce has not yet made its planned release of the 1992 detailed data
on cost structure by industrial sector of the U.S. economy. However, in
the proposed rule for FY 1998, we intend to modify the input price
indexes for both the prospective payment system and excluded hospitals
by incorporating the 1992 detailed cost structure data.
Comment: One commenter requested that we provide a more complete
rationale in the final rule concerning the proposed price-proxy
changes.
Response: The following discussion is offered to further explain
our rationale for the price proxy changes we are adopting.
a. Nonmedical professional fees: The ECI for Compensation for
Professional and Technical Workers replaced the ECI for Wages and
Salaries for Professional and Technical Workers. The new index measures
the growth in input prices associated with employee benefits as well as
wages and salaries. Since the nonmedical professional fees category
represents the hospital costs associated with obtaining these services,
a price measure that accounts for aggregate compensation costs is
preferable to one that measures only the wages and salaries component.
When the ECI was first collected, it measured only growth in wages and
salaries (not employee benefits). We changed the price proxy to reflect
the improved data from the Bureau of Labor Statistics (BLS).
b. In an effort to improve the general accuracy and validity of the
index's measurement of price growth, we made four minor producer price
index changes:
Fuel Oil and Gasoline: In the 1992-based index, the Fuel
Oil and Gasoline category represents a combination of the Fuel Oil and
Coal category and the Motor Gasoline category from the 1987-based
index. The weight for motor gasoline was too small to keep it as a
separate category. The price proxy used for the combined group in the
1992-based index, the Producer Price Index for Refined Petroleum
Products, encompasses both PPIs used in the 1987-based index.
Electricity: The PPI for Industrial Power was replaced
with the PPI for Commercial Electrical Power to reflect information
from the hospital industry and utility industry that commercial rates
of change for utility costs are generally more appropriate than
industrial rates.
Paper Products: The weighted average of the percentage
change in the price of converted paper and paperboard products and the
percentage change in the price of paper excluding newsprint and
packaging paper was replaced by the PPI for converted paper and
paperboard products to better reflect the composition of costs in
hospitals.
Apparel: The PPI for textile house furnishings was
replaced by the PPI for Apparel to better reflect the composition of
costs in hospitals.
c. Business Services: The Average Hourly Earnings (AHE) for
Business Services (AHE73NS) was replaced by the ECI for Compensation
for Business Services. Compensation, which reflects both fringe
benefits and wages, more appropriately measures the cost of business
services. In addition, the ECI measurement holds the skill mix
constant, measuring just the change in the cost of compensation,
whereas a change in the AHE for Business Services can reflect a change
in skill mix as well as a change in earnings. At the time of
publication of the 1987-based index, the ECI for Business Services was
not available.
d. All Other Services, Labor Intensive: The ECI Wages and Salaries
for Private Service workers was replaced by the ECI Compensation for
Private Service workers. A compensation price proxy reflects both a
change in the price of benefits as well as a change in the price of
wages and salaries.
4. The HCFA Blended Compensation Index
Compensation includes the two largest categories of the rebased
market basket: wages and salaries, and employee benefits. Wages and
salaries account for 50.244 percent and employee benefits account for
11.146 percent of the total weight in the prospective payment hospital
market basket.
The HCFA Blended Compensation Index groups hospital occupations
into nine broad categories. For eight of those occupational groups, we
believe that hospitals compete for labor generally with employers
outside the health care sector. Accordingly, we use economy-wide
employment cost indexes (ECI) as price proxies for these eight
occupational groups. In the case of compensation for nurses, as well as
for certain other health care technicians and professionals, the
hospital labor market may be predominant. However, hospitals do compete
with other industries to obtain certain skilled professional and
technical staff (for example, computer programmers). Therefore, for
professional and technical workers, we believe a price proxy that
reflects an equal blend of internal and external compensation variables
is appropriate.
Similar to the methodology used for the previous rebasing, the
weights for the nine cost categories in the occupational blend index
were derived from the 1992 Current Population Survey (CPS) produced by
BLS. Using the CPS, private hospital workers were classified into the
nine occupational categories. Private hospitals better reflect the mix
of occupations used to produce acute care services for the prospective
payment system hospital input price index. Government hospitals were
excluded because their occupational mix reflects the subset of nonacute
care hospitals. Once private hospital workers were sorted by occupation
into one of the nine occupational groups, weights were estimated using
the share of wages and salaries for each of the nine occupations. These
shares formed the basis of the weights that were used for the market
basket of occupational categories.
An additional adjustment was made for contract labor costs. Rather
than treat contract labor as a distinct noncompensation cost category,
it was integrated into the occupational blend as a component of
hospitals' compensation costs for purposes of the market basket index.
Thus, contract labor is treated the same as other labor expenses.
Contract labor was allocated to the professional and technical and
service occupation categories. After adjusting the professional and
technical and service workers' shares to account for contract labor,
the weights for the
[[Page 46192]]
nine occupational blend categories were renormalized to equal 100.00
percent. The weights and proxies for the nine cost categories of the
HCFA Blended Wages and Salaries Index are shown in Table 5.
Table 5.--HCFA Blended Wages and Salaries Index (Wages and Salaries
Component of the 1992-Based Market Basket)
------------------------------------------------------------------------
Cost category Weight Price proxy
------------------------------------------------------------------------
Professional and technical.......... 65.729 Equal blend of ECI for
wages and salaries of
civilian hospital
workers and ECI for
wages and salaries of
professional,
specialty and
technical workers.
Managers and administrators......... 9.554 ECI for wages and
salaries for
executive,
administrative and
managerial workers.
Sales............................... 0.402 ECI for wages and
salaries for sales
workers.
Clerical workers.................... 12.379 ECI for wages and
salaries for
administrative support
including clerical
workers.
Craft and kindred................... 1.689 ECI for wages and
salaries for precision
production, craft and
repair workers.
Operatives except transport......... 0.437 ECI for wages and
salaries for machine
operators, assemblers
and inspectors.
Transport equipment operatives...... 0.122 ECI for wages and
salaries for
transportation and
material moving
workers.
Nonfarm laborers.................... 0.084 ECI for wages and
salaries for handlers,
equipment cleaners,
helpers and laborers.
Service workers..................... 9.606 ECI for wages and
salaries for service
occupations.
Total wages and salaries............ 100.000 Total weight for wages
and salaries is 50.2.
------------------------------------------------------------------------
Note: Due to rounding, weights may not sum to total.
Comment: One commenter suggested that the manner in which hospital-
specific wages and benefits price proxies are incorporated into the
market basket should be changed, so that the internal hospital industry
wage and benefit price proxies represent more of the compensation
weights in the market basket. The ECI for hospital workers should be
blended 50-50 for all labor cost categories, not just the professional
and technical worker cost group. Although nonprofessional and technical
workers may be employed in other settings, many of these workers have
skills that are specific to the hospital industry.
Response: The blended compensation index of nine broad occupational
groups with the ECI for Hospital Workers that is included in the
prospective payment system hospital input price index reflects HCFA's
judgment that, except for the professional and technical occupational
category, hospitals compete primarily in the economy-wide labor market.
Accordingly, HCFA uses Employment Cost Indexes (ECIs) for the private
sector of the economy for eight of the nine occupation groups. For one
broad occupational group, professional and technical workers, HCFA has
recognized that certain subcategory occupations, such as registered
nurses and physical therapists, are so specialized that hospitals are
the predominant employers. Other types of professional and technical
workers such as computer programers and biological researchers are
distributed more evenly throughout the private sector economy.
Therefore, a blend of the ECI for ``Private Professional Specialty and
Technical Workers'' and the ECI for Civilian Hospital workers is used
to measure growth in compensation prices for professional and
technical. Since none of the other eight occupational categories are
likely to use substantial proportions of hospital specific occupations,
extending the blend to other labor categories is not appropriate.
As a practical matter, there is virtually no difference in the
overall hospital input price index that results from using only a 50-50
blend of the ECI for Professional-Technical Workers and the ECI for
Hospital Workers versus using a 50-50 blend for each of the nine ECI
occupation groups with the ECI for Civilian Hospital Workers. The
following table illustrates this point:
Difference in the Rate of Increase in the Hospital Index 50-50 Blend of
Professional-Technical Workers Versus 50-50 Blend of All Occupations
Federal Fiscal Year Percent Change
------------------------------------------------------------------------
1997 1998 1999
------------------------------------------------------------------------
50-50 blend of ECI P&T and ECI civilian hospital
workers........................................ 2.5 2.9 3.1
50-50 blend of all nine occupations and ECI
civilian hospital workers...................... 2.5 2.8 3.1
------------------------------------------------------------------------
The latest forecast of the rate of increase in the hospital input
price index indicates that there is no difference for the FY 1997
update. For FY 1998, the current forecasts have a 0.1 percent
difference. For FY 1999, the forecasts are identical. We will continue
to monitor the effect on the hospital input price index that results
from the alternative construction of the compensation sub-index. If a
material difference develops between the two versions, we will
reevaluate our position on the construction of the compensation sub-
index.
Comment: One commenter, noting Table 5, ``HCFA Blended Wages and
Salaries Index (Wages and Salaries Component of the 1992-Based Market
Basket) (61 FR 27463), which lists the nine occupational categories,
stated that HCFA is of the opinion that hospitals compete with the
general labor market with the first category entitled ``Professional
and Technical.'' The commenter questioned how HCFA arrives at this
conclusion. The commenter recommended that, unless there is evidence
that ``Professional and Technical'' workers provide an accurate proxy
for wages in the hospital industry, the ``blend'' be dropped and be
replaced by a hospital industry measure.
Response: The professional and technical workers category includes
computer programmers, computer systems analysts, social workers,
accountants, scientists, and lawyers. To varying degrees, hospitals
employ each of these types of personnel. As noted in the previous
comment and response, these occupations are also in significant demand
outside the hospital industry, and hospitals must compete with
employers in other industries as well as with other hospitals. For
these types of occupations, competitive market forces that affect the
compensation levels paid to workers in the nonhospital sector directly
influence the compensation that prudent buyer hospitals pay. In order
to account for this, it is appropriate to use the ECI Compensation for
Private Professional-Technical Workers.
Hospitals are also major employers of other types of workers such
as physical therapists, respiratory therapists, and registered nurses.
Because hospitals demand substantial proportions of these types of
workers, it is appropriate to reflect, at least in part, hospital
industry-specific compensation.
[[Page 46193]]
The blend of professional-technical workers with the hospital
industry specific compensation ECI is also used mitigate the effect of
potential labor market imperfections in the hospital industry.
Licensure requirements and the existence of third party insurance are
believed by some to have enabled certain occupations to command
compensation premiums that are above what can be explained by
traditional predictors such as education, skill, experience, and
location. Because certain professional and technical workers tend to
have licensure restrictions that are more limiting than other
occupations in the health care industry, there is some reason to
believe that workers with the strictest licensure requirements are most
able to realize a compensation premium. A blend provides a reasonable
way to recognize that hospital compensation of professional and
technical workers is influenced by both economy-wide and hospital
sector-specific forces and that licensure requirements may influence
compensation in ways different from a competitive market.
The advent of managed care may have diminished the ability of
certain health sector labor occupations to achieve compensation
premiums. This is suggested by the fact that recently the rate of
increase in the ECI for Hospital workers has declined relative to the
ECI for economy-wide professional-technical workers while in earlier
periods the reverse held. Since FY 1992, the ECI for Hospital Workers
has grown at a slower rate than the ECI for Private Professional and
Technical workers. We will continue to monitor the ECIs and other data
to detect changes in the market dynamics for the types of workers that
hospitals employ.
Employment Cost Index Hospital Industry Workers Versus Economywide
Professional and Technical Occupations
Federal Fiscal Year Percent Change
------------------------------------------------------------------------
1992 1993 1994 1995
------------------------------------------------------------------------
ECI civilian hospital industry workers.. 4.3 3.7 3.1 2.5
ECI private P&T occupations............. 4.5 4.0 3.2 2.6
------------------------------------------------------------------------
Comment: One commenter believed that the hospital industry does not
compete with the general labor market for the cost category entitled
``Managers and Administrators.'' Therefore, the price proxy for this
category should be the ECI for hospital workers, a hospital sector-
specific proxy.
Response: Occupations in this category require a knowledge of and
the capability to put into effect management principles, practices and
techniques. The skills that these personnel possess are in demand in
the overall economy as well as the hospital sector.
Since FY 1994, the ECI Compensation for Hospital Workers has grown
at a slower rate than the ECI Compensation for Private Executive
Administrative and Managerial Workers. Recent projections of these
price proxies by DRI/McGraw-Hill suggest that this trend will continue.
Comment: One commenter suggested that, as an alternative to using
the ECI for Hospital Industry Workers as a price proxy for all nine
occupational categories, HCFA could use the data base it has developed
over the last few years dealing with hospital wages.
Response: We assume that the commenter's reference to the data base
that HCFA has developed over the last few years refers to the Hospital
Area Wage Index. This index was developed pursuant to a statutory
requirement that the Secretary adjust the standardized amounts for area
differences in hospital wage levels. This index is designed to measure
geographic differences in wage levels, not changes in wages over time.
Also, because the area wage index is computed using total adjusted
compensation divided by the sum total hours worked in a labor market
(see section III of this preamble), it does not hold constant the
skill-mix of employees from year to year. Therefore, any year-to-year
index based upon the area wage index would include both price and
quantity effects. The hospital input price index is appropriately
designed to measure pure price inflation.
5. Separate Market Basket for Hospitals and Hospital Units Excluded
from the Prospective Payment System
In its March 1, 1990 report, ProPAC recommended that we establish a
separate market basket for hospitals and hospital units excluded from
the prospective payment system. Effective with FY 1991, HCFA adopted
ProPAC's recommendation to implement separate market baskets. (See the
September 4, 1990 final rule (55 FR 36044).) Prospective payment and
excluded hospitals tend to have different case mixes, practice
patterns, and composition of inputs. The fact that these hospitals are
not included under the prospective payment system in part reflects
these differences.
Studies completed by HCFA, ProPAC, and the hospital industry have
documented different weights for excluded hospitals and prospective
payment hospitals. Table 7 compares major weights in the rebased 1992
market basket for excluded hospitals with weights in the rebased 1992
market basket for prospective payment system hospitals. Wages and
salaries are 52.152 percent of total operating costs for excluded
hospitals compared to 50.244 percent for prospective payment hospitals.
Employee benefits are 11.569 percent for excluded hospitals compared to
11.146 percent for prospective payment hospitals. As a result,
compensation costs (wages and salaries plus employee benefits) for
excluded hospitals are 63.721 percent of costs compared to 61.390
percent for prospective payment hospitals. Noncompensation costs are
36.279 percent for excluded hospitals and 38.610 of costs for
prospective payment hospitals.
Two significant differences in the category weights occur in
Pharmaceuticals and Business Services. Pharmaceuticals represent 4.162
percent of costs for prospective payment hospitals and 3.070 percent
for excluded hospitals. Business services represent 3.823 percent of
costs for prospective payment hospitals and 2.337 percent for excluded
hospitals. The weights for the excluded hospital market basket were
derived using the same data sources and methods as for the prospective
payment market basket (see Appendix C to this final rule).
Differences in weights between the excluded hospital and
prospective payment hospital market baskets do not necessarily lead to
significant differences in the rate of price growth for the two market
baskets. If the individual wages and prices move at the approximately
same annual rate, both market baskets may have about the same price
growth even though weights may differ substantially because both market
baskets use the same wages and prices. Also, offsetting price increases
for various cost components can result in similar composite price
growth in both market baskets.
The wage and price proxies are the same for the excluded hospital
and prospective payment hospital market baskets. As discussed in
section IV.A.2 of this preamble, all of the cost expenditure weights
for both the prospective payment and excluded hospital market baskets
are subject to refinement when the U.S. Department of Commerce 1992
data are released, analyzed by HCFA, and incorporated in
[[Page 46194]]
the PPS and exempt final market baskets.
The excluded hospital market basket is a composite set of weights
for Medicare participating psychiatric, long-term care, rehabilitation,
and children's hospitals. We are using cost report data for excluded
hospitals and units whose average length of stay for Medicare patients
is within 15 percent (that is, 15 percent higher or lower) of the
facility average length of stay for all patients. This is a change from
the 1987-based market basket, for which data for all excluded hospitals
and units were used. We believe that limiting our sample to hospitals
with a Medicare average length of stay within 15 percent of the total
facility average length of stay provides a more accurate reflection of
the structure of costs for Medicare. We note that the forecast for FY
1997 differs by only 0.1 percent when we included all excluded
hospitals in the calculation of weights. The forecast for the limited
index was 2.5 percent, while the forecast for the full set of excluded
hospitals was 2.6 percent.
Table 6.--Comparison of Significant Weights for 1992-Based Excluded
Hospital and Prospective Payment Hospital Market Baskets
------------------------------------------------------------------------
Prospective
Category Excluded payment
hospitals hospitals
------------------------------------------------------------------------
Wages and salaries.............................. 52.152 50.244
Employee benefits............................... 11.569 11.146
Professional fees............................... 2.098 2.127
Pharmaceuticals................................. 3.070 4.162
All other....................................... 31.111 32.321
Total....................................... 100.000 100.000
------------------------------------------------------------------------
Table 7.--1992-Based Excluded Hospital Operating Cost Categories,
Weights, and Price Proxies
------------------------------------------------------------------------
Rebased
1992
excluded
Expense categories hospital Price proxy
market
basket
------------------------------------------------------------------------
1. Compensation..................... 63.721 .......................
A. Wages and salaries........... 52.152 HCFA occupational wage
index.
B. Employee benefits............ 11.569 HCFA occupational
benefits index.
2. Professional fees............ 2.098 ECI--Compensation for
professional,
specialty and
technical.
3. Utilities........................ 2.557 .......................
A. Fuel, oil, and gasoline..... 0.357 PPI refined petroleum
products.
B. Electricity.................. 1.396 PPI commercial electric
power.
C. Natural gas.................. 0.694 PPI commercial natural
gas.
D. Water and sewerage........... 0.110 CPI-U water and
sewerage maintenance.
4. Professional liability insurance. 1.081 HCFA professional
liability insurance
premiums index.
5. All other........................ 30.543 .......................
A. All other products........... 23.642 .......................
(1.) Pharmaceuticals........ 3.070 PPI ethical
(prescription) drugs.
(2.) Food................... 3.581 .......................
a. Direct purchase........ 2.446 PPI processed foods and
feeds.
b. Contract service....... 1.135 CPI-U food away from
home.
(3.) Chemicals.............. 3.929 PPI industrial
chemicals.
(4.) Medical instruments.... 3.238 PPI medical instruments
and equipment.
(5.) Photographic supplies.. 0.413 PPI photographic
supplies.
(6.) Rubber and plastics.... 5.039 PPI rubber and plastic
products.
(7.) Paper products......... 2.134 PPI converted paper and
paperboard products.
(8.) Apparel................ 0.906 PPI apparel.
(9.) Machinery and equipment 0.218 PPI machinery and
equipment.
(10.) Miscellaneous products 1.112 PPI finished goods.
B. All other services........... 6.901 .......................
(1.) Business services...... 2.337 ECI--compensation for
private workers in
business services.
(2.) Computer services...... 1.415 AHE computer and data
processing services.
(3.) Transportation services 0.195 CPI-U transportation.
(4.) Telephone services..... 0.549 CPI-U telephone
services.
(5.) Postage................ 0.282 CPI-U postage.
(6.) All other: labor 1.767 ECI--compensation for
intensive. private service
occupations.
(7.) All other: nonlabor 0.356 CPI-U all items.
intensive.
Total..................... 100.000
------------------------------------------------------------------------
Note: Due to rounding, weights may not sum to total.
Table 8, below, shows what the
excluded hospital weights would be
if cost data for all excluded
hospitals had been used.
[[Page 46195]]
Table 8.--1992 Excluded Hospital Operating Cost Categories, Weights, and
Proxies using Data from all Excluded Hospitals
------------------------------------------------------------------------
Rebased
1992
excluded
Expense categories hospital Price proxy
market
basket
------------------------------------------------------------------------
1. Compensation..................... 68.074 .......................
A. Wages and salaries........... 55.714 HCFA occupational wage
index.
B. Employee benefits............ 12.360 HCFA occupational
benefits index.
2. Professional fees................ 2.073 ECI--compensation for
professional,
specialty and
technical.
3. Utilities........................ 2.191 .......................
A. Fuel, oil, and gasoline...... 0.306 PPI refined petroleum
products.
B. Electricity.................. 1.196 PPI commercial electric
power.
C. Natural gas.................. 0.595 PPI commercial natural
gas.
D. Water and sewerage........... 0.094 CPI-U water and
sewerage maintenance.
4. Professional liability insurance. 1.081 HCFA professional
liability insurance
premiums index.
5. All other........................ 26.582 .......................
A. All other products........... 20.333
FR Doc. 96-22145 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1997 Rates
.......................
(1.) Pharmaceuticals........ 2.704 PPI ethical
(prescription) drugs.
(2.) Food................... 3.069 .......................
a. Direct purchase........ 2.096 PPI processed foods and
feeds.
b. Contract Service....... 0.973 CPI-U food away from
home.
(3.) Chemicals.............. 3.367 PPI industrial
chemicals.
(4.) Medical instruments.... 2.775 PPI medical instruments
and equipment.
(5.) Photographic supplies.. 0.354 PPI photographic
supplies.
(6.) Rubber and plastics.... 4.319 PPI rubber and plastic
products.
(7.) Paper products......... 1.829 PPI converted paper and
paperboard products.
(8.) Apparel................ 0.777 PPI apparel.
(9.) Machinery and equipment 0.187 PPI machinery and
equipment.
(10.) Miscellaneous products 0.953 PPI finished goods.
B. All other services........... 6.248 .......................
(1.) Business services...... 2.337 ECI--compensation for
private workers in
business services.
(2.) Computer services...... 1.213 AHE computer and data
processing services.
(3.) Transportation services 0.167 CPI-U transportation.
(4.) Telephone Services..... 0.471 CPI-U telephone
services.
(5.) Postage................ 0.242 CPI-U postage.
(6.) All Other: Labor 1.514 ECI--compensation for
Intensive. private service
occupations.
(7.) All Other: Nonlabor 0.305 CPI-U all items.
Intensive.
Total..................... 100.000 .......................
------------------------------------------------------------------------
The relatively small differences in weights between the excluded
hospital market basket data from excluded hospitals that have a
Medicare length of stay within 15 percent of the total facility average
length of stay and the excluded hospital market basket using data from
all excluded hospitals do not lead to significant changes in the rate
of price growth for these two market baskets. If all individual wages
and prices move at about the same annual rate, both market baskets
could have about the same price growth even if weights are somewhat
different. Also, offsetting price increases for various costs
components can result in the price growth being the same.
To examine the sensitivity of the change to the limited set of
excluded hospitals, we developed a comparison for the period 1988-1998.
Using historical data and forecasts for the market baskets, we compared
limited and full sets of excluded hospitals.
Table 9.--A Comparison of the Excluded Hospital Market Basket and the
Excluded Hospital Market Basket Rebased Using All Excluded Hospitals,
Percent Change, 1988-1998
------------------------------------------------------------------------
Excluded (+/- Excluded
15%) hospital market
hospital basket using
Federal fiscal year market all excluded Difference
basket--1992 hospitals--1992
base base
------------------------------------------------------------------------
Historical: 1988............. 4.9 4.8 0.1
1989......................... 5.6 5.5 0.1
1990......................... 4.6 4.7 (0.1)
1991......................... 4.3 4.4 (0.1)
[[Page 46196]]
1992......................... 3.0 3.2 (0.2)
1993......................... 3.1 3.1 (0.0)
1994......................... 2.6 2.7 (0.1)
1995......................... 3.3 3.2 0.1
Forecasted: 1996............. 2.5 2.7 (0.2)
1997......................... 2.5 2.6 (0.1)
1998......................... 2.8 2.9 (0.1)
Historical average: 1988-1995 3.9 4.0 (0.1)
Forecasted average: 1996-1998 2.6 2.7 (0.1)
------------------------------------------------------------------------
Note that the historical average rate of growth from 1988 to 1995
for the excluded hospital market basket including only excluded
hospitals with Medicare average length of stay within 15 percent of
total facility average length of stay is virtually identical to that
for the excluded hospital market basket with all excluded hospitals.
The rates of growth using the two methodologies are within 0.1 percent
for FY 1996, 1997, and 1998.
Comment: A commenter requested a more detailed explanation about
the rationale for dropping from the calculation of the excluded
facility market basket those excluded hospitals and units with Medicare
average lengths of stay that vary by more than 15 percent from the
facility's overall average length of stay. The commenter stated that
there is no description of the hospitals being dropped or their
characteristics (e.g., if these facilities have low Medicare shares, it
may be appropriate to exclude them). More information is needed before
the appropriateness of the 15-percent screen can be assessed.
Response: To the extent possible, we used total reimbursable
facility costs to determine the weights for Medicare costs. If the
patterns of practice for Medicare patients differ significantly from
the overall patient population, we believe that total facility costs
for facilities with high shares of Medicare patients are more
representative of the Medicare population. We chose to compare the
average length of stay for all patients to that of Medicare
beneficiaries as the test of the similarity of the practice patterns
for non-Medicare patients versus Medicare patients. Our method results
in retaining hospitals that had a share of patient days attributable to
Medicare that was approximately three times that of hospitals that were
excluded. Our goal is to measure cost shares that are reflective of
case mix and practice patterns associated with providing services to
Medicare beneficiaries.
Comment: A commenter questioned whether there will be a need for a
separate market basket for each type of excluded hospital once
prospective payment systems are developed for psychiatric and
rehabilitation hospitals and units. The commenter recommended that HCFA
consider whether it would be beneficial to begin identifying a separate
market basket for each type of excluded hospital.
Response: We agree with the commenter that HCFA will have to
consider whether to use separate market baskets for each type of
excluded hospital once prospective payment systems are developed for
psychiatric and rehabilitation hospitals. However, until those systems
are designed we believe it is premature to develop separate market
baskets.
B. Capital Costs
Rebasing the Capital Input Price Index
1. Background
Effective for cost reporting periods beginning on or after October
1, 1995, the Capital Input Price Index (CIPI) is used to determine the
price increase associated with prospective payment hospital capital-
related expenses. Capital-related expenses are defined as depreciation
expenses, capital-related interest expenses, and other capital-related
expenses, such as insurance and taxes. The CIPI measures the input
price change of these capital-related expenses, and is included in the
capital prospective payment update framework to determine a rate of
increase in capital prospective payments.
Like the prospective payment hospital operating input price index,
the CIPI is a fixed-weight price index. A fixed-weight price index
measures how much it would cost at a later date to purchase the same
mix of goods and services purchased in the base period. For the
prospective payment hospital operating and capital input price indexes,
the base period is selected and cost category weights are determined
using available data on hospitals. Next, appropriate price proxy
indexes are chosen for each cost category. Then a price proxy index
level for each expenditure category is multiplied by the comparable
cost category weight. The sum of these products (that is, weights
multiplied by price proxy index levels) for all cost categories yields
the composite index level of the market basket for a given year.
Repeating the step for other years produces a time series of composite
market basket index levels. Dividing an index level by a later index
level produces a rate of growth in the input price index. Since the
percent change is computed for the fixed mix of total capital inputs
with a 1992 base, the index is called fixed-weight.
Like the operating input price index, the CIPI measures the price
changes associated with costs during a given year. In order to do so,
the CIPI must differ from the operating input price index in one
important aspect. The CIPI must reflect the vintage nature of capital,
which is the acquisition and use of capital over time. Capital expenses
in any given year are determined by the stock of capital in that year
(that is, capital that remains on hand from all current and prior
capital acquisitions).
[[Page 46197]]
An index measuring capital price changes needs to reflect this vintage
nature of capital. Therefore, the CIPI was developed to capture the
vintage nature of capital by using a weighted-average of past capital
purchase prices up to and including the current year. Using Medicare
cost reports, AHA data, and Securities Data Corporation data, a
vintage-weighted price index was developed to measure price increases
associated with capital expenses.
Comment: A commenter suggested that HCFA's model is overly
complicated and relies excessively on assumptions given that capital
costs make up approximately 10 percent of total hospital costs. The
commenter recommended that HCFA adopt a simpler approach to update the
Federal rate for capital-related costs for hospital inpatient services.
Response: Capital payments for prospective payment hospitals are
expected to be about $8.6 billion in FY 1997, a significant amount that
warrants an appropriate input price index. It would not be appropriate
to use a simpler index if it does not accurately reflect the price
increases associated with capital costs. Capital costs are inherently
complicated and are determined by complex capital purchasing decisions
over time, which are based on such factors as interest rates and debt
financing decisions. Also, capital is depreciated over periods of time
instead of being consumed in the same period it is purchased. The CIPI
accurately reflects the annual price increases associated with capital
costs, and is a useful simplification of the actual capital
accumulation process. By appropriately accounting for the vintage
nature of capital in the CIPI, HCFA is able to provide an accurate,
stable annual measure of price increases. Annual, non-vintage price
changes for capital are highly unstable due to the volatility of
interest rate changes. These unstable annual price changes do not
reflect the actual annual price changes for Medicare capital-related
costs. The HCFA CIPI reflects the underlying stability of the capital
acquisition process and provides hospitals with the ability to plan for
changes in capital payments.
The most recent discussion on the CIPI and methodological
background was published in the May 31, 1996 proposed rule (61 FR
27466). The following Federal Register documents describe development
and revisions of the methodology involved with the construction of the
CIPI: September 1, 1992 (57 FR 40016), May 26, 1993 (58 FR 30448),
September 1, 1993 (58 FR 46490), May 27, 1994 (59 FR 27876), September
1, 1994 (59 FR 45517), June 2, 1995 (60 FR 29229), and September 1,
1995 (60 FR 45815).
We periodically update the base year for the operating and capital
input prices to reflect the changing composition of inputs for
operating and capital expenses. Previously, both the operating input
price index and the CIPI are based to FY 1987. We are updating the base
year cost structure to FY 1992, the most recent year with relatively
complete data for purposes of rebasing. We explain the process of
rebasing the cost structure weights for the CIPI below.
2. Rebasing the Capital Input Price Index
We are using a rebased capital input price index (CIPI) in
developing the FY 1997 capital update factor for capital prospective
payment rates. The new CIPI is rebased to reflect the 1992, rather than
the 1987, structure of capital costs. In developing the rebased CIPI,
we reviewed hospital capital expenditure data for capital cost
categories (depreciation, interest, and other). Two sets of weights had
to be developed in order to compute the rebased CIPI: (1) cost category
weights which identify the proportion of total hospital capital
expenditures attributable to each capital expenditure category, and (2)
relative vintage weights for depreciation and interest which identify
the proportion of capital expenditures within a cost category that are
attributable to each year over the life of capital assets in that
category. Because capital expense data in the Medicare Cost Reports is
not available prior to 1980 for use in computing vintage weights, the
two sets of weights are measured using the best data sources available
as explained below and in Appendix C to this final rule. The
computations involved with rebasing the CIPI are explained for each of
these sets of weights.
a. Capital Cost Category Weights. The capital cost category weights
in Table 10 below were computed using a combination of the FY 1992
Medicare Cost Reports and 1992 AHA Annual Survey data. FY 1992 marked
the first year for expanded capital data available in the Medicare Cost
Reports. After reviewing the data, we determined that much of the data
had been reclassified into different expense categories. Therefore, we
removed prospective payment hospital reports that appeared to have
reclassified data, and matched the remaining reports to the
corresponding reports in the AHA Annual Survey data set. These
remaining 2724 prospective payment hospital reports were used to
compute capital cost category weights and the expected life of capital,
which is used in determining vintage weights for depreciation and
interest.
In reviewing the data, we determined that the Medicare Cost Reports
provided accurate data for depreciation and other capital expenses, but
had reclassified interest data. We determined that AHA Annual Survey
data more accurately reflected interest expense, based on past trends
in interest rates. Therefore, we used the AHA Annual Survey interest
levels along with the Medicare Cost Report levels for depreciation and
other capital expenses to develop a more robust capital cost data base.
After removing depreciation, interest, and other capital expenses
from total capital expenses, the remainder constitutes lease expenses.
Lease expenses are not a separate cost category in the CIPI. They are
distributed to the other cost categories (depreciation, interest,
other), reflecting an assumption that the underlying cost structure of
leases is similar to capital costs in general. We assigned 10 percent
of lease expenses to the other capital expenses cost category as
overhead, and 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. (We base this
assignment of 10 percent of lease expenses to overhead on the common
assumption that overhead is 10 percent of costs.)
We also used the 1992 Medicare cost reports to determine weights
for the building and fixed equipment category and the movable equipment
category. Expenses for building and fixed equipment and for movable
equipment were determined using the same sample of prospective payment
hospital reports as was used to compute the major cost category
weights. The split between building and fixed equipment and movable
equipment was also used to compute the vintage weights described below.
Table 10 presents a comparison of the rebased 1992 capital cost weights
and the 1987 capital cost weights.
We only used those hospital reports which we considered to have
capital data that was not reclassified. Because we did not use all
hospital reports, we were concerned that the hospitals used may not be
representative of the universe. Therefore, we compared the distribution
of costs for the hospitals used with the data re-weighted to reflect
the characteristics of the total universe of hospitals. From this
analysis we validated that the cost weights derived from the subset we
used were
[[Page 46198]]
representative of the cost weights for the entire universe of
hospitals.
Table 10.--Comparison of 1987 and 1992 Cost Category Weights
------------------------------------------------------------------------
Rebased
Expense categories FY 1987 FY 1992 Price proxy
------------------------------------------------------------------------
1. Building and fixed equipment 0.3054 0.3009 Boeckh
depreciation. Institutional
Construction
Index--vintage
weighted (22 yrs)
2. Movable equipment 0.3456 0.3475 PPI for machinery
depreciation. and equipment--
vintage weighted
(10 yrs)
Total interest.............. 0.3274 0.3184
1. Government/nonprofit interest 0.2783 0.2706 Average yield on
domestic
municipal bonds
(bond buyer 20
bonds)--vintage
weighted (22 yrs)
2. For-profit interest.......... 0.0491 0.0478 Average yield on
Moody's Aaa
Bonds--vintage
weighted (22 yrs)
Other........................... 0.0216 0.0332 CPI(U) for
residential rent
Total....................... 1.0000 1.0000
Total depreciation........ 0.6510 0.6484
------------------------------------------------------------------------
Source: 1992 Medicare Cost Reports, PPS year 9; 1992 AHA Annual Survey.
Note: Due to rounding, weights may not sum to totals.
Comment: The price proxy for ``for-profit interest'' was listed in
Table 10 of the May 31, 1996 Federal Register (61 FR 27468) as the
Average Yield on Moody's AAA Corporate Bonds. A commenter pointed out
that Moody's highest ratings is Aaa instead of AAA.
Response: As the commenter pointed out, the correct Moody's rating
is Aaa. While publications other than Moody's may not be as precise in
their presentation of Moody's ratings, HCFA will use the more precise
definition of Aaa and refer to the price proxy for for-profit interest
as the Average Yield on Moody's Aaa Corporate Bonds throughout this
final rule.
We had planned to incorporate the 1992 data from the Department of
Commerce for developing capital cost category weights. However, these
data are not available for inclusion in this final rule.
b. Relative Vintage Weights for Prices. As we have explained in
previous Federal Register documents (most recently the September 1,
1995 final rule at 60 FR 45817), the CIPI was developed to capture the
vintage nature of capital; that is, because capital is acquired and
consumed over time, the capital expenses in any given year are
determined by past and current purchases of physical and financial
capital. Therefore, a vintage-weighted CIPI was developed which used
vintage weights for depreciation (physical capital) and interest
(financial capital) to capture the long-term consumption of capital.
These vintage weights reflect the purchase patterns of building and
fixed equipment and movable equipment over time. Because depreciation
and interest expenses are determined by the amount of past and current
capital purchases, we use the vintage weights to compute vintage-
weighted price changes associated with depreciation and interest
expense, which is the purpose of the CIPI.
To compute the vintage weights for depreciation and interest
expenses, we used 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 Medicare cost reports
did not have sufficient capital data to meet this need. The AHA Panel
Survey provides a consistent database back to 1963. While the AHA Panel
Survey data does not provide annual capital purchases, it does provide
a time series of depreciation and interest expenses, which can be used
to infer capital purchases over time. The process of using the AHA data
to estimate a time series of capital purchases, and eventually vintage
weights, is explained in detail below.
In order to estimate capital purchases from AHA data on
depreciation and interest expenses, the expected life for building and
fixed equipment, for movable equipment, and for debt instruments is
needed. The expected life is used in the calculation of vintage weights
for building and fixed equipment, movable equipment, and debt
instruments as we explain below.
We used the same sample of prospective payment hospitals from FY
1992 Medicare cost reports and the 1992 AHA Annual Survey explained
above in computing cost category weights to compute the expected life
of building and fixed equipment and movable equipment. (The AHA Panel
Survey is a monthly survey of a sample of hospitals, while the AHA
Annual Survey is a more detailed survey of all hospitals.) The expected
life of any piece of equipment can be determined by dividing the
historical asset cost (excluding fully depreciated assets) by the
current year depreciation amount. This calculation yields the estimated
useful life of an asset if depreciation continued at current year
levels, assuming straight-line depreciation, which is the only
depreciation method allowed under Medicare. From the FY 1992 costs
reports, the expected life of building and fixed equipment was
determined to be 22 years, and the expected life of movable equipment
was determined to be 10 years. By comparison, the expected life using
FY 1987 data was 25 years for building and fixed equipment and 10 years
for movable equipment.
It was also necessary to compute the expected life of debt
instruments held by hospitals. As in prior exercises, we used hospital
issuances of municipal and commercial bonds from Securities Data
Corporation to determine the expected life of hospital debt
instruments, which is used in the estimation of vintage weights for
interest expense. This data source produced a weighted average life for
the two types of bonds of 22 years for FY 1992, the same expected life
as was computed for the 1987-based CIPI.
An annual series of total expenses and depreciation expenses was
obtained from the AHA Panel Survey. For the calculation of vintage
weights, this expense data was needed back to 1963. However, the
depreciation expense data in the AHA Panel survey was available only
back to 1976. We noticed an increasing trend in depreciation expenses
as a percentage of total expenses. We performed a regression on this
percentage, and used the regression
[[Page 46199]]
equation to estimate depreciation expenses back to 1963. We then used
the fixed and movable weights derived from the FY 1992 Medicare cost
reports to partition the AHA Panel Survey depreciation expenses into
annual amounts of building and fixed depreciation and movable
depreciation.
Multiplying the annual depreciation amounts by the expected life
calculations from the FY 1992 Medicare cost reports, year-end asset
costs for building and fixed equipment and movable equipment were
determined. Then by subtracting the previous year asset costs from the
current year asset costs, annual purchases of building and fixed
equipment and movable equipment were estimated back to 1963. This
capital purchase time series is then used to compute the vintage
weights for building and fixed equipment, movable equipment, and debt
instruments. Each of these sets of vintage weights is explained in
detail below.
For 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. Because building and fixed
equipment has an expected life of 22 years, the vintage weights for
building and fixed equipment were deemed to represent the average
purchase pattern of building and fixed equipment over 22-year periods.
With real building and fixed equipment purchase estimates available
back to 1963, nine 22-year periods could be averaged to determine the
average vintage weights for building and fixed equipment. Averaging
different periods produces vintage weights that are representative of
average building and fixed equipment purchase patterns over time.
Vintage weights for each 22-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 22-year period. For example, for
the 22-year period of 1964-1985, the vintage weight for year 1 is
calculated by dividing the real annual capital purchase amount of
building and fixed equipment in 1964 into the total amount of real
annual capital purchases of building and fixed equipment over the
entire 1964-1985 period. This calculation is done for each year in the
22-year period, and for each of the nine 22-year periods. An average is
taken of the nine 22-year periods to determine the FY 1992 average
building and fixed equipment vintage weights, presented in Table 11
with the FY 1987 vintage weights.
For movable equipment vintage weights, the real annual capital
purchase amounts for movable 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 price inflation.
This real annual purchase amount for movable equipment was produced by
deflating the nominal annual purchase amount by the movable equipment
price proxy, the Producer Price Index for machinery and equipment.
Because movable equipment has an expected life of 10 years, the vintage
weights for movable equipment were deemed to represent the average
purchase pattern of movable equipment over 10-year periods. With real
movable equipment purchase estimates available back to 1963, 21 10-year
periods could be averaged to determine the average vintage weights for
movable equipment. Averaging different periods produces vintage weights
which are representative of average movable equipment purchase patterns
over time. Vintage weights for each 10-year period are calculated by
dividing the real movable capital purchase amount for any given year by
the total amount of purchases in the 10-year period. For example, for
the 10-year period of 1976-1985, the vintage weight for year 1 is
calculated by dividing the real annual capital purchase amount of
movable equipment in 1976 into the total amount of real annual capital
purchases of movable equipment over the entire 1976-1985 period. This
calculation is done for each year in the 10-year period, and for each
of the 21 10-year periods. The average of the 21 10-year periods is
used to determine the FY 1992 average movable equipment vintage
weights, presented in Table 11 with the FY 1987 vintage weights.
For interest vintage weights, the nominal annual capital purchase
amounts for total equipment (building and fixed, and movable) derived
from the AHA Panel Survey were used. Nominal annual purchase amounts
were used to capture the value of the debt instrument. Because debt
instruments have an expected life of 22 years, the vintage weights for
interest were deemed to represent the average purchase pattern of total
equipment over 22-year periods. With nominal total equipment purchase
estimates available back to 1963, nine 22-year periods could be
averaged to determine the average vintage weights for interest.
Averaging different periods produces vintage weights which are
representative of average capital purchase patterns over time. Vintage
weights for each 22-year period are calculated by dividing the nominal
total capital purchase amount for any given year by the total amount of
purchases in the 22-year period. For example, for the 22-year period of
1964-1985, the vintage weight for year 1 is calculated by dividing the
nominal annual capital purchase amount of total equipment in 1964 into
the total amount of nominal annual capital purchases of total equipment
over the entire 1964-1985 period. This calculation is done for each
year in the 22-year period, and for each of the nine 22-year periods.
The average of the nine 22-year periods is used to determine the FY
1992 average interest vintage weights, presented in Table 11 with the
FY 1987 weights.
[[Page 46200]]
Table 11.--Vintage Weights for Capital-Related Price Proxies
----------------------------------------------------------------------------------------------------------------
Building and fixed Movable equipment Interest
equipment ---------------------------------------------------
--------------------------
Year Rebased Fiscal Year Rebased Fiscal Year Rebased
Fiscal Year Fiscal Year 1987 10 Fiscal Year 1987 22 Fiscal Year
1987 25 1992 22 yrs 1992 10 yrs 1992 22
yrs yrs yrs yrs
----------------------------------------------------------------------------------------------------------------
1................................. 0.015 0.019 0.064 0.069 0.007 0.007
2................................. 0.019 0.020 0.072 0.075 0.009 0.008
3................................. 0.022 0.023 0.077 0.083 0.010 0.010
4................................. 0.024 0.026 0.085 0.091 0.011 0.012
5................................. 0.023 0.028 0.095 0.097 0.013 0.014
6................................. 0.022 0.030 0.101 0.103 0.015 0.016
7................................. 0.020 0.031 0.109 0.109 0.017 0.018
8................................. 0.021 0.032 0.122 0.115 0.020 0.021
9................................. 0.025 0.036 0.132 0.124 0.023 0.024
10................................ 0.030 0.039 0.142 0.133 0.027 0.029
11................................ 0.033 0.043 ........... ........... 0.032 0.035
12................................ 0.034 0.047 ........... ........... 0.038 0.041
13................................ 0.034 0.050 ........... ........... 0.043 0.047
14................................ 0.035 0.052 ........... ........... 0.050 0.052
15................................ 0.038 0.055 ........... ........... 0.057 0.059
16................................ 0.043 0.059 ........... ........... 0.064 0.067
17................................ 0.049 0.062 ........... ........... 0.074 0.074
18................................ 0.053 0.065 ........... ........... 0.083 0.081
19................................ 0.056 0.067 ........... ........... 0.090 0.088
20................................ 0.057 0.069 ........... ........... 0.098 0.093
21................................ 0.060 0.072 ........... ........... 0.105 0.099
22................................ 0.066 0.073 ........... ........... 0.114 0.103
23................................ 0.071 ........... ........... ........... ........... ...........
24................................ 0.075 ........... ........... ........... ........... ...........
25................................ 0.077 ........... ........... ........... ........... ...........
-----------------------------------------------------------------------------
Total......................... 1.000 1.000 1.000 1.000 1.000 1.000
----------------------------------------------------------------------------------------------------------------
Sources: AHA Panel Survey, 1963-1993; 1992 Medicare Cost Reports; Securities Data Corporation.
[[Page 46201]]
Comment: ProPAC again commented that HCFA's capital update
framework could be improved, and that ProPAC's capital update framework
is similar to the operating update framework. The ProPAC framework also
includes a discretionary financing policy adjustment for use in
extended periods of unusually high or low interest rates.
Response: The HCFA CIPI measures the annual price increase
associated with vintage-weighted capital expenses, making it consistent
with the HCFA operating input price index, which measures the annual
price increase associated with operating expenses. The ProPAC market
basket reflects the price increase of capital purchases from one year
to the next, and does not capture the vintage nature of capital that is
captured by the HCFA CIPI. Therefore, we believe the HCFA CIPI
accurately measures annual price increases in capital expenses, as we
stated before in the May 26, 1993 (58 FR 30451), September 1, 1993 (58
FR 46492), May 27, 1994 (59 FR 27889), September 1, 1994 (59 FR 45521),
June 2, 1995 (60 FR 29233), and the September 1, 1995 (60 FR 45823)
Federal Registers. ProPAC has presented no criteria (objective or
subjective) for determining when a discretionary financing policy
adjustment would be appropriate. HCFA believes that interest rates are
intrinsic to a technically sound and fair measure of price increases in
capital expenses (which are defined as depreciation, interest, and
lease expenses, and insurance and taxes), just as all expense
components are appropriately included in the HCFA operating input price
index.
3. Selection of Price Proxies
After the 1992 capital cost category weights were computed, it was
necessary to select appropriate price proxies to monitor the rate of
increase for each expenditure category. Our price proxies for the FY
1992 based CIPI are the same as those for the FY 1987 based CIPI. The
rationale for selecting the price proxies is explained in the June 2,
1995 proposed rule (60 FR 29227) and the September 1, 1995 final rule
(60 FR 45817). The price proxies are presented in Table 10.
Comment: A commenter contended the average yield on bonds rated Aaa
is not representative of the bond rating the for-profit hospital
industry is obtaining. The commenter examined the bond rating of some
of its member companies and found them to range from A3 (highest) to B1
(lowest). The commenter recommended the selection of a price proxy that
better reflects interest costs of taxpaying hospitals.
Response: The commenter is correct that the average yield on lower-
rated corporate bonds is different from the average yield on higher-
rated corporate bonds, and that some for-profit hospitals have lower
ratings than Aaa. However, the interest component for for-profit
hospitals in the HCFA CIPI is based on percent changes in yields and
not the yields themselves. We analyzed the percent change in the yield
for two bond ratings: Aaa and Baa. Despite the yields for the two bond
ratings being significantly different for the 15 years between 1981-
1995, the percent changes in the yields for the two bond ratings were
nearly identical. We used the percent changes in both yields to
calculate the CIPI and determined the impact of the different yields on
the overall CIPI was essentially zero. Because our analysis did not
reveal any significant difference in the percent change in yields for
corporate bonds with different ratings, we believe the average yield
for Moody's Aaa corporate bonds is an appropriate price proxy for for-
profit interest expense.
4. Forecast of the CIPI for Federal Fiscal Year 1997
DRI forecasts a 1.3 percent increase in the rebased 1992 CIPI for
FY 1997, as indicated in Table 12. This is the outcome of a 2.4 percent
increase in projected depreciation prices (building and fixed
equipment, and movable equipment) and a 2.2 percent increase in other
capital expense prices in FY 1997, partially offset by a 1.8 percent
decline in vintage-weighted interest rates in FY 1997.
[[Page 46202]]
Table 12.--HCFA Capital Input Price Index Percent Changes, Total and Components, Fiscal Years 1979 to 2000
----------------------------------------------------------------------------------------------------------------
Depreciation
---------------------------------------
Fiscal year Total Building Interest Other
Total and fixed Movable
equipment equipment
----------------------------------------------------------------------------------------------------------------
Weights (fiscal year 1992)........ 1.0000 0.6484 0.3009 0.3475 0.3184 0.0332
----------------------------------------------------------------------------------------------------------------
VINTAGE-WEIGHTED PRICE CHANGES
----------------------------------------------------------------------------------------------------------------
1979.............................. 5.4 7.4 7.0 7.7 2.7 7.1
1980.............................. 6.9 8.0 7.3 8.5 5.4 8.6
1981.............................. 8.7 8.5 7.7 9.1 9.1 8.8
1982.............................. 9.2 8.5 8.0 9.0 10.2 8.0
1983.............................. 6.7 8.1 7.9 8.2 4.8 6.3
1984.............................. 6.3 7.3 7.6 7.1 4.9 5.0
1985.............................. 5.2 6.3 7.0 5.8 3.5 5.9
1986.............................. 3.7 5.7 6.4 5.1 0.7 6.2
1987.............................. 3.1 5.1 5.9 4.5 -0.1 4.5
1988.............................. 3.0 4.6 5.4 4.0 0.3 3.8
1989.............................. 2.6 4.4 5.2 3.7 -0.5 3.8
1990.............................. 2.3 4.0 4.9 3.2 -0.7 4.2
1991.............................. 2.0 3.6 4.6 2.7 -1.1 3.9
1992.............................. 1.5 3.2 4.4 2.1 -2.0 2.6
1993.............................. 1.1 2.9 4.1 1.8 -2.8 2.4
1994.............................. 1.1 2.7 3.9 1.7 -2.7 2.3
1995.............................. 1.3 2.6 3.8 1.6 -2.0 2.5
1996.............................. 1.1 2.5 3.6 1.5 -2.4 2.4
1997.............................. 1.3 2.4 3.5 1.5 -1.8 2.2
1998.............................. 1.2 2.4 3.3 1.5 -2.2 3.1
1999.............................. 1.2 2.4 3.3 1.5 -2.2 2.2
2000.............................. 1.3 2.4 3.3 1.5 -2.3 3.1
----------------------------------------------------------------------------------------------------------------
[[Page 46203]]
5. Comparison of Percent Changes in the FY 1992-Based CIPI and the FY
1987-Based CIPI
Rebasing the CIPI from 1987 to 1992 decreased the percent change in
the FY 1997 forecast by only 0.2 percentage points, from 1.5 to 1.3 as
indicated in Table 13. The effect of rebasing is analyzed by comparing
the 1992-based CIPI forecasted percent changes to the 1987-based CIPI
forecasted percent changes using the same DRI forecast of component
prices. As shown in Table 13, there is only a 0.2 percentage point
difference between the percent changes in the 1992-based CIPI and the
1987-based CIPI using the second quarter 1996 forecast. The difference
reflects changes to: (1) cost category weights, (2) expected life, and
(3) vintage weights. The changes to cost category weights coupled with
the wide disparity in price changes between the different cost
categories contributed to lowering the CIPI percent change in the FY
1997 forecast. This was the case with fixed depreciation, which has
faster price growth than the other cost categories and now has a lower
weight by nearly one-half of a percentage point because of rebasing to
1992. Also contributing to the 0.2 percentage point difference in FY
1997 forecast is the change in the expected life of building and fixed
equipment and the change in the vintage weights for all three
components: building and fixed equipment, movable equipment, and
interest. The shorter expected life (22 years in 1992 versus 25 years
in 1987) of building and fixed equipment slightly decreased the FY 1997
forecast CIPI percent change because years with higher price increases
were not included as they had been before. The change in vintage
weights also tended to decrease the FY 1997 CIPI percent change because
vintage weights in all cases changed to be spread more evenly over the
life of the asset, decreasing the weight of more recent years and
increasing the weight of past years. In the years around FY 1997,
prices for depreciation and interest are projected to increase slightly
faster than prices in earlier years.
Table 13.--Comparison of 1987 and 1992 Based Capital Input Price Index
Using the Same DRI Forecast, Percent Change, 1979-1997
------------------------------------------------------------------------
CIPI
---------------------
Federal fiscal year Rebased
1987 1992
------------------------------------------------------------------------
1979.............................................. 5.6 5.4
1980.............................................. 7.1 6.9
1981.............................................. 8.8 8.7
1982.............................................. 9.3 9.2
1983.............................................. 6.7 6.7
1984.............................................. 6.3 6.3
1985.............................................. 5.1 5.2
1986.............................................. 3.7 3.7
1987.............................................. 3.1 3.1
1988.............................................. 3.0 3.0
1989.............................................. 2.7 2.6
1990.............................................. 2.4 2.3
1991.............................................. 2.1 2.0
1992.............................................. 1.7 1.5
1993.............................................. 1.3 1.1
1994.............................................. 1.3 1.1
1995.............................................. 1.5 1.3
1996.............................................. 1.4 1.1
1997.............................................. 1.5 1.3
------------------------------------------------------------------------
V. Other Decisions and Changes to the Prospective Payment System
for Inpatient Operating Costs
A. Sole Community Hospital Criteria (Sec. 412.92)
Under the prospective payment system, special payment protections
are provided to hospitals that, by reason of factors such as isolated
location, weather conditions, travel conditions, or absence of other
hospitals, are the sole source of hospital inpatient services
reasonably available to Medicare beneficiaries. The criteria a hospital
must meet to be classified as a sole community hospital (SCH) as well
as the special payment adjustments available are set forth in the
regulations at Sec. 412.92.
One of the ways in which a hospital can qualify for sole community
status is to be located between 25 and 35 miles from other like
hospitals and prove that no more than 25 percent of residents who
become inpatients or no more than 25 percent of the Medicare
beneficiaries who become inpatients in the hospital's ``service area''
are admitted to other like hospitals located within a 35-mile radius of
the hospital (or its service area, if larger).
In the final rule published on September 30, 1988, we stated: ``A
hospital may delineate its service area by identifying the zip codes of
all its inpatients for the cost reporting period ending before the date
it applies for SCH status. The lowest number of zip codes accounting
for at least 75 percent of its inpatients would then constitute its
service area.'' (53 FR 35810).
In March 1990, we issued a revised manual which inadvertently
reflected policy prior to October 1, 1988; specifically, section 2810
A.2.c of the Medicare Provider Reimbursement Manual, Part 1 (HCFA Pub.
15-1) stated, ``A hospital may define its service area as the lowest
number of contiguous zip codes from which the hospital draws at least
75 percent of its inpatients.'' (Emphasis added.) As discussed in the
proposed rule, some hospitals have raised questions about the
definition of service area. Therefore, we clarified that our definition
of ``service area'' for purposes of determining SCH status does not
require contiguous zip code areas. We have applied this definition
since October 1, 1988 (the effective date of the September 30, 1988
final rule). We also indicated that we intended to revise the current
manual accordingly at our earliest opportunity.
Comment: Two commenters responded to our clarification on the use
of zip codes to determine a hospital's service area for SCH purposes.
One commenter did not object to the policy clarification, but requested
that we also clarify whether use of zip codes and use of a statewide
health planning agency are the only two methods of defining a service
area. The other commenter believes our current policy may lead to
unfair results for some hospitals in sparsely populated areas. The
commenter requested that we permit a hospital to use either the lowest
number of zip codes or the lowest number of contiguous zip codes to
determine its service area.
Response: We discussed the definition of a hospital's service area
for SCH purposes at some length in the preamble of the September 30,
1988 final rule (53 FR 38511). In that document, we stated that a
hospital's service area is the area from which it draws at least 75
percent of its inpatients for the 12-month cost reporting period ending
before it applies for SCH classification.
We noted that not all States have Statewide health planning
commissions that identify hospitals' service areas and we offered the
zip code methodology as one alternative. We also noted that ``(t)he
important consideration is that a hospital be able to define its
service area as the area from which it draws 75 percent of its
inpatient admissions, as stated in the regulations text at
Sec. 412.92(c)(3).''
We have not restricted a hospital's source of data for defining its
service area to the use of zip codes or to Statewide planning
commissions. These are merely the two most common methods and, thus,
are the two we have
[[Page 46204]]
discussed in detail. There have been instances where a State hospital
association has been the source of data used to define the hospital's
service area. If a hospital does not wish to use the zip code
methodology to define its service area, we will review data from any
independent source that can supply documented data to identify the
hospital's service area. The important consideration is that we must be
able to verify supportable evidence that a hospital drew at least 75
percent of its inpatients from the defined service area.
In regard to the commenter who requested that a hospital be
permitted to define its service area using either the lowest number of
zip codes or the lowest number of contiguous zip codes, we do not
agree. Since October 1, 1988, any hospital choosing to define its
service area using the zip code methodology has been required to use
the lowest number of zip codes from which it drew at least 75 percent
of its inpatients during its most recently completed cost reporting
period.
We have not permitted any hospital to define its service area using
the lowest number of contiguous zip codes because we do not believe
this method presents as accurate a picture of a hospital's true service
area as does the actual lowest number of zip codes. Although the
commenter presented an elaborate example of how a hospital might meet
the market share test if its service area is based on contiguous zip
codes, but not meet the market share test when service area is defined
strictly as the lowest number of zip codes, we do not believe such a
scenario is likely to occur with any frequency. And, as noted above, a
hospital is not required to use the zip code methodology to define its
service area. If a hospital does not qualify using the lowest number of
zip codes, it can look to other sources such as a State hospital
association, Statewide planning commission, or any other independent
body that can present documentable data to verify that at least 75
percent of its inpatients came from the identified area.
Comment: One commenter was concerned about the interim payments
that sole community hospitals receive during the year. Specifically,
the commenter was troubled by the method we use to account for outlier
payments. Because our pricing methodology assumes that all sole
community hospitals will receive ``average ''outlier payments, the
aggregate interim payments for a hospital with few outliers are less
than the amount ultimately due the hospital. Although the difference is
paid to the hospital during its cost report settlement, the commenter
claimed that the delay in receiving the money due the hospital has
caused dire financial consequences.
Response: One of the difficulties in making interim payments during
the year for sole community hospitals is not knowing precisely the
amount of outlier payments the hospital is going to receive. Currently,
we simply use the overall national expected rate of approximately 5.1
percent to adjust the Federal payment rate. That is, we take the
hospital's Federal payment rate, already adjusted for the wage index,
indirect medical education factor, and disproportionate share factor,
and further adjust the rate by assuming that the hospital's outlier
payments will be 5.1 percent of its total DRG payments. Then, we
compare this amount to the hospital-specific amount and, if the
hospital-specific amount is higher, we make the difference an add-on to
the Federal payment rate in making interim payments.
Some sole community hospitals, however, actually receive much less
in outlier payments than the national average of 5.1 percent. This
causes our estimate of their outlier-adjusted Federal payments to be
higher than is really the case. Therefore, the hospital does not
receive all of its add-on payments during the year, because the
difference between the hospital-specific rate and the estimated
adjusted Federal payment rate is understated. The effect is a
potentially large payment to the hospital at the time of settlement. We
note that for sole community hospitals with higher than average outlier
payments, the opposite problem results. That is, the hospitals are
overpaid during the year and must repay monies to the Federal
Government at cost report settlement.
We believe an assumption based on the expected percentage of
overall national outlier payments is reasonable, but we will explore
this problem in more detail during the next year and try to determine
if use of a hospital-specific outlier adjustment factor for this
limited purpose would be more appropriate, as well as feasible.
B. Rural Referral Centers (Sec. 412.96)
Under the authority of section 1886(d)(5)(C)(i) of the Act,
Sec. 412.96 sets forth the criteria a hospital must meet in order to
receive special treatment under the prospective payment system as a
rural referral center. For discharges occurring before October 1, 1994,
rural referral centers received the benefit of payment based on the
other urban rather than the rural standardized amount. As of that date,
the other urban and rural standardized amounts are the same. However,
rural referral centers continue to receive special treatment under both
the disproportionate share hospital payment adjustment and the criteria
for geographic reclassification.
One of the criteria under which a rural hospital may qualify as a
referral center is to have 275 or more beds available for use. A rural
hospital that does not meet the bed size criterion can qualify as a
rural referral center if the hospital meets two mandatory criteria
(number of discharges and case-mix index) and at least one of three
optional criteria (medical staff, source of inpatients, or volume of
referrals). With respect to the two mandatory criteria, a hospital may
be classified as a rural referral center if its--
Case-mix index is at least equal to the lower of the
median case-mix index for urban hospitals in its census region,
excluding hospitals with approved teaching programs, or the median
case-mix index for all urban hospitals nationally; and
Number of discharges is at least 5,000 discharges per year
or, if fewer, the median number of discharges for urban hospitals in
the census region in which the hospital is located. (The number of
discharges criterion for an osteopathic hospital is at least 3,000
discharges per year.)
1. Case-Mix Index
Section 412.96(c)(1) provides that HCFA will establish updated
national and regional case-mix index values in each year's annual
notice of prospective payment rates for purposes of determining rural
referral center status. In determining the proposed national and
regional case-mix index values, we follow the same methodology we used
in the November 24, 1986 final rule, as set forth in regulations at
Sec. 412.96(c)(1)(ii). Therefore, the proposed national case-mix index
value included all urban hospitals nationwide, and the proposed
regional values were the median values of urban hospitals within each
census region, excluding those with approved teaching programs (that
is, those hospitals receiving indirect medical education payments as
provided in Sec. 412.105).
The values in the proposed rule were based on discharges occurring
during FY 1995 (October 1, 1994 through September 30, 1995) and
included bills posted to HCFA's records through December 1995.
Therefore, in addition to meeting other criteria, we proposed that to
qualify for initial rural referral center status or to meet the
triennial review standards for cost reporting periods beginning on or
after October 1,
[[Page 46205]]
1996, a hospital's case-mix index value for FY 1995 would have to be at
least--
1.3332; or
Equal to the median case-mix index value for urban
hospitals (excluding hospitals with approved teaching programs as
identified in Sec. 412.105) calculated by HCFA for the census region in
which the hospital is located. (See the table set forth in the May 31,
1996 proposed rule at 61 FR 27472.)
Based on the latest data available (FY 1995 bills received through
June 1996), the final national case-mix value is 1.3347 and the median
case-mix values by region are set forth in the table below:
------------------------------------------------------------------------
Case-mix
Region index value
------------------------------------------------------------------------
1. New England (CT, ME, MA, NH, RI, VT).................... 1.2249
2. Middle Atlantic (PA, NJ, NY)............................ 1.2230
3. South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV)..... 1.3396
4. East North Central (IL, IN, MI, OH, WI)................. 1.2471
5. East South Central (AL, KY, MS, TN)..................... 1.2933
6. West North Central (IA, KS, MN, MO, NE, ND, SD)......... 1.2125
7. West South Central (AR, LA, OK, TX)..................... 1.3116
8. Mountain (AZ, CO, ID, MT, NV, NM, UT, WY)............... 1.3339
9. Pacific (AK, CA, HI, OR, WA)............................ 1.3303
------------------------------------------------------------------------
For the benefit of hospitals seeking to qualify as referral centers
or those wishing to know how their case-mix index value compares to the
criteria, we are publishing each hospital's FY 1995 case-mix index
value in Table 3C in section V of the Addendum to this final rule. In
keeping with our policy on discharges, these case-mix index values are
computed based on all Medicare patient discharges subject to DRG-based
payment.
2. Discharges
Section 412.96(c)(2)(i) provides that HCFA will set forth the
national and regional numbers of discharges in each year's annual
notice of prospective payment rates for purposes of determining
referral center status. As specified in section 1886(d)(5)(C)(ii) of
the Act, the national standard is set at 5,000 discharges. However, we
proposed to update the regional standards. The proposed regional
standards were based on discharges for urban hospitals' cost reporting
periods that began during FY 1994 (that is, October 1, 1993 through
September 30, 1994). That is the latest year for which we have complete
discharge data available.
Therefore, in addition to meeting other criteria, we proposed that
to qualify for initial rural referral center status or to meet the
triennial review standards for cost reporting periods beginning on or
after October 1, 1996, the number of discharges a hospital must have
for its cost reporting period that began during FY 1995 would have to
be at least--
5,000; or
Equal to the median number of discharges for urban
hospitals in the census region in which the hospital is located. (See
the table set forth in the June 2, 1996 proposed rule at 61 FR 27472.)
Based on the latest discharge data available, the final median
numbers of discharges for urban hospitals by census regions are as
follows:
------------------------------------------------------------------------
Number of
Region discharges
------------------------------------------------------------------------
1. New England (CT, ME, MA, NH, RI, VT).................... 6771
2. Middle Atlantic (PA, NJ, NY)............................ 8486
3. South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV)..... 7504
4. East North Central (IL, IN, MI, OH, WI)................. 7384
5. East South Central (AL, KY, MS, TN)..................... 6386
6. West North Central (IA, KS, MN, MO, NE, ND, SD)......... 5794
7. West South Central (AR, LA, OK, TX)..................... 4806
8. Mountain (AZ, CO, ID, MT, NV, NM, UT, WY)............... 7553
9. Pacific (AK, CA, HI, OR, WA)............................ 5617
------------------------------------------------------------------------
We reiterate that, to qualify for rural referral center status for
cost reporting periods beginning on or after October 1, 1996, an
osteopathic hospital's number of discharges for its cost reporting
period that began during FY 1995 must be at least 3,000.
3. Retention of Referral Center Status
Section 412.96(f) states that each hospital receiving the referral
center adjustment is reviewed every 3 years to determine if the
hospital continues to meet the criteria for referral center status. To
retain status as a referral center, a hospital must meet the criteria
for classification as a referral center specified in Sec. 412.96 (b)(1)
or (b)(2) or (c) for 2 of the last 3 years, or for the current year. A
hospital may meet any one of the three sets of criteria for individual
years during the 3-year period or the current year. For example, a
hospital may meet the two mandatory requirements in Sec. 412.96 (c)(1)
(case-mix index) and (c)(2) (number of discharges) and the optional
criterion in paragraph (c)(3) (medical staff) during the first year.
During the second or third year, the hospital may meet the criteria
under Sec. 412.96(b)(1) (rural location and appropriate bed size).
A hospital must meet all of the criteria within any one of these
three sections of the regulations in order to meet the retention
requirement for a given year. That is, it will have to meet all the
criteria of Sec. 412.96(b)(1) or Sec. 412.96(b)(2) or Sec. 412.96(c).
For example, if a hospital meets the case-mix index standards in
Sec. 412.96(c)(1) in years 1 and 3 and the number of discharge
standards in Sec. 412.96(c)(2) in years 2 and 3, it will not meet the
retention criteria. All of the standards would have to be met in the
same year.
In accordance with Sec. 412.96(f)(2), the review process is limited
to the hospital's compliance during the last 3 years. Thus, if a
hospital meets the criteria in effect for at least 2 of the last 3
years or if it meets the criteria in effect for the current year (that
is, the criteria for FY 1997 outlined above in this section of the
preamble), it will retain its status for another 3 years. We have
constructed the following chart and example to aid hospitals that
qualify as referral centers under the criteria in Sec. 412.96(c) in
projecting whether they will retain their status as a referral center.
Under Sec. 412.96(f), to qualify for a 3-year extension effective
with cost reporting periods beginning in FY 1997, a hospital must meet
the criteria in Sec. 412.96(c) for FY 1997 or it must meet the criteria
for 2 of the last 3 years as follows:
------------------------------------------------------------------------
For the cost Use the discharges Use numerical
reporting Use hospital's for the hospital's standards as
period case-mix index for cost reporting published in the
beginning FY period beginning Federal Register
during FY during FY on
------------------------------------------------------------------------
1996 1994.............. 1994.............. September 1, 1995.
1995 1993.............. 1993.............. September 1, 1994.
1994 1992.............. 1992.............. September 1, 1993.
------------------------------------------------------------------------
Example: A hospital with a cost reporting period beginning July 1
qualified as a referral center effective July 1, 1994. The hospital has
fewer than 275 beds. Its 3-year status as a referral center is
protected through June 30, 1997 (the end of its cost reporting period
beginning July 1, 1996). To determine if the hospital should retain its
status as a referral center for an
[[Page 46206]]
additional 3-year period, we will review its compliance with the
applicable criteria for its cost reporting periods beginning July 1,
1994, July 1, 1995, and July 1, 1996. The hospital must meet the
criteria in effect either for its cost reporting period beginning July
1, 1997, or for two out of the three past periods. For example, to be
found to have met the criteria at Sec. 412.96(c) for its cost reporting
period beginning July 1, 1995, the hospital's case-mix index value
during FY 1993 must have equaled or exceeded the lower of the national
or the appropriate regional standard as published in the September 1,
1994 final rule with comment period. The hospital's total number of
discharges during its cost reporting year beginning July 1, 1993, must
have equaled or exceeded 5,000 or the regional standard as published in
the September 1, 1994 final rule with comment period.
For those hospitals that seek to retain referral center status by
meeting the criteria of Sec. 412.96(b)(1) (i) and (ii) (that is, rural
location and at least 275 beds), we will look at the number of beds
shown for indirect medical education purposes (as defined at
Sec. 412.105(b)) on the hospital's cost report for the appropriate
year. We will consider only full cost reporting periods when
determining a hospital's status under Sec. 412.96(b)(1)(ii). This
definition varies from the number of beds criterion used to determine a
hospital's initial status as a referral center because we believe it is
important for a hospital to demonstrate that it has maintained at least
275 beds throughout its entire cost reporting period, not just for a
particular portion of the year. We received no comments on the rural
referral center criteria.
C. Disproportionate Share Adjustment (Sec. 412.106)
Section 1886(d)(5)(F) of the Act provides for additional payments
for hospitals that serve a disproportionate share of low income
patients. The disproportionate share adjustment, which was added to the
prospective payment system by section 9105 of the Consolidated Omnibus
Budget Reconciliation Act of 1985 (Public Law 99-272), was intended to
address the higher Medicare costs associated with treating a large
number of low-income patients. Under this provision, patients who are
eligible for Medicaid and Supplemental Security Income (SSI) benefits
were used as a proxy measure of the proportion of low-income patients.
A hospital's disproportionate share adjustment is generally
determined by calculating the sum of two patient percentages (Medicare
Part A/Supplemental Security Income (SSI) covered days to total
Medicare Part A covered days, and Medicaid but not Medicare Part A
covered days to total inpatient hospital days). Based on the location
and size of the hospital, a formula determines if the hospital's
patient percentage qualifies the hospital for an adjustment and how
much that adjustment will be. There is also a limited exception
providing for disproportionate share adjustments for large urban
hospitals that receive substantial state and local revenues for
indigent (non-Medicare, non-Medicaid) care.
With respect to the Medicare-SSI calculation, hospitals have
expressed dissatisfaction with these proxy measures, and have
challenged HCFA's implementation of them in recent litigation. Since
SSI beneficiary information is confidential, hospitals do not have
access to lists of patients who are eligible for both Medicare Part A
and SSI benefits. Hospitals are increasingly frustrated by their
inability to monitor these data.
With respect to the Medicaid fraction, hospitals have complained
that, because of Medicaid coverage restrictions, Medicaid covered days
may not be a consistent measure of indigent care across States.
Medicaid reforms under consideration by the President and Congress may
further interfere with the utility of Medicaid covered days as a
measure of the proportion of low-income patients.
Because of these concerns, we have been examining alternative
measures of indigent care. Some of the measures we have explored using
are estimates of patient income in a hospital's service area, hospital
levels of bad debt, and proportion of emergency room admissions in a
hospital. Because of data and other limitations, however, we have yet
to find an alternative that appears promising as a replacement to the
present measure. Therefore, in the proposed rule, we solicited comments
from the industry on better and more direct measures of indigent care
than the present measure that relies on SSI and Medicaid data. We also
discussed ProPAC's recommendations concerning DSH payments (61 FR
27474).
Comment: A large number of commenters responded to our request for
input on the Medicare disproportionate share adjustment calculation and
the SSI and Medicaid data that go into its development. Some commenters
believe that the current method of identifying disproportionate share
hospitals is acceptable. Other commenters stated that we should
implement a revised formula only if it captures the current base of
eligible hospitals as well as additional facilities. Finally, several
commenters believe that the current calculation is flawed beyond repair
and that we should reevaluate the current base of hospitals that are
eligible for payments under the disproportionate share adjustment and
revise the formula dramatically. The suggestions we received follow:
Use the current formula, but expand Medicaid days to
include all days that a person eligible for Title XIX spends in the
hospital, whether or not Medicaid paid. Further, in the case of States
that have replaced traditional Medicaid programs with alternate health
care programs for their low-income population, include all days that a
person who is covered by the State's program spends in the hospital,
whether or not that person would have been eligible for Title XIX
benefits.
Use the current formula and include outpatient data as
well as inpatient data.
Use data fro
FR Doc. 96-22145 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1997 Rates
m the Department of Commerce based on income
levels and zip code information to determine median income levels
within designated service areas. These data can then be compared to
Federal poverty guidelines to establish the appropriate level of
disbursement of disproportionate share payments.
Combine charity care and bad debts as reported on the
hospital's financial statements and multiply by the hospital's overall
cost-to-charge ratio. Then, divide these costs by the hospital's net
patient revenue excluding Medicare, Medicaid, Medicare health
maintenance organization (HMO), and Medicaid (HMO) data. This method is
similar to the current qualifying criteria for an exception under the
disproportionate share adjustment calculation set forth at
Sec. 412.106(c)(2).
Use the low-income utilization rate that is currently used
in the administration of Medicaid disproportionate share adjustments.
This is a combination of a hospital's Medicaid revenues and its State
and local subsidies divided by its total revenues and its inpatient
charity care charges minus its State and local inpatient subsidies
divided by total charges.
Some of the commenters referred to the decisions in court cases in
the 6th and the 8th Circuits that require the inclusion of days that
would have been paid by Medicaid but for a State day limitation in the
disproportionate share calculation. These commenters encouraged HCFA to
implement the Court's ruling at the national level. Other commenters
were concerned
[[Page 46207]]
about the inclusion of HMO and other managed care utilization data in
the calculation. Many of these commenters suggested that HCFA should
require States to more accurately identify the Medicaid enrollees who
receive services under a waiver program, possibly by providing these
enrollees with encrypted insurance cards to reflect Title XIX
eligibility.
Several commenters believe that the adjusted average per capita
cost (AAPCC) payment rate for Medicare managed care plans should be
revised to exclude any adjustment for disproportionate share and that
those payments should be made directly to the eligible hospitals.
Several commenters offered to work with HCFA on this issue.
Response: We appreciate the responses that we received on the
disproportionate share adjustment issue. Members of the hospital
industry and its representatives carefully considered the question of
data sources, targeted hospitals, and the indigent population. In
general, commenters believe that compensation for hospitals that treat
a disproportionate share of the indigent population is valid. However,
as noted above, there are conflicting ideas about how to target that
set of hospitals.
Although many of these comments will require further analysis, we
will address some suggestions here. First, in the current formula, we
believe that Medicaid covered days is the correct measure and the
correct interpretation of Congressional intent as we have outlined on
numerous previous occasions, most notably in the September 1, 1986
final rule (54 FR 31460-31461). Given the current statute, we believe
it is not reasonable to include days that a person spent in the
hospital while that person was not eligible for Medicaid under any
circumstances. The statute clearly states that title XIX eligibility is
a requirement under any circumstances. If a State chooses to adopt some
sort of a waiver program and elects to cover people who would not have
otherwise been eligible for care, those persons will not be included as
Medicaid days in the current formula. Further, inpatient data are used
in the Medicare disproportionate share adjustment calculation because
the payment add-on is applied to the Medicare inpatient payment. It is
not designed to reflect either Medicaid shortfalls or outpatient data,
since there is a separate Medicaid disproportionate share adjustment,
and payment for outpatient services is not made through a prospective
payment system.
Data from the Department of Commerce based on the U.S. Census are
collected only during decennial census periods. Thus, while the data
look promising on first analysis, they become increasingly
unrepresentative of the population's income trends as they relate to
geographic areas as the years pass from the base year for which the
data are collected. We also have a problem with any data that may be
reported on a hospital's financial statements but that are not reported
on its annual Medicare cost report. The Medicare cost report data are
collected annually and subject to a settlement process. The financial
statements of hospitals vary from facility to facility, are audited on
an erratic schedule, and are not currently collected by Medicare for
evaluation.
Finally, we would not want to duplicate the procedure by which the
Medicaid disproportionate share adjustment is determined since the
Medicaid program already pays hospitals an adjustment under Medicaid
based on these criteria.
Regarding commenters' concerns on HMO days, currently we collect
data on HMO utilization for use in the disproportionate share
adjustment calculation. However, it is up to the hospital, in securing
the contract with the HMO, to obtain an agreement from the HMO that
allows the hospital to be able to distinguish those Medicare and
Medicaid patients that are utilizing services so that it may report
those days to the fiscal intermediary. We note that the President's FY
1997 budget includes a provision that would mandate the removal of
disproportionate share payments from the AAPCC calculation and allow
these payments to be made directly to the eligible hospital.
While there appears to be no easy or quick solution to improving
the disproportionate share payment adjustment, we appreciate the
comments that the hospital industry provided on this issue. Our concern
is that Medicaid data will continue to vary more and more from State to
State and SSI data will continue to be protected from the hospital
industry's examination by the Privacy Act. Therefore, we will continue
to examine the inconsistencies in the current Medicare disproportionate
share adjustment calculation and ways to improve the data and the
calculation to better target those hospitals that treat a
disproportionate share of the indigent population.
D. Direct Graduate Medical Education (Sec. 413.86)
1. Initial Residency Period Limitations
As discussed in the proposed rule, we are updating the Initial
Residency Period Limitations for direct graduate medical education
(GME), originally published in the Federal Register on September 29,
1989 (54 FR 40286). The regulations in Sec. 413.86(g)(1) state that,
``[e]ffective July 1, 1995, an initial residency period is defined as
the minimum number of years required for board eligibility.''
The update reflects the following:
Effective July 1, 1995, section 1886(h)(5)(F) of the Act,
as amended by Public Law 103-66, defines an initial residency period as
the minimum number of years required for initial board eligibility.
Previously, this period had been defined as minimum number of years
``plus one.'' The prior listing had included the additional year, not
to exceed five years.
Changes in curriculum requirements regarding the number of
years needed for board eligibility for previously approved programs.
Addition of newly approved graduate medical education
programs.
The table of initial residency periods published in the proposed
rule (61 FR 27475) did not constitute a proposal in the usual
rulemaking sense because we were simply updating the tables in
accordance with current policy. Nevertheless, we received many comments
that reflected a misunderstanding of the meaning of ``initial residency
period'' in general. The initial residency period, as that term is used
in section 1886(h)(5) (F) and (G) of the Act and in Sec. 413.86 refers
to the minimum number of years necessary to satisfy the requirements
for initial board eligibility in a specialty. During the initial
residency period, each full-time resident is weighted at 1.0 full-time
equivalent (FTE) for purposes of determining GME payments. Once the
resident has worked the minimum number of years required for board
eligibility in a specialty, any subsequent training in an approved
program is weighted at 0.5 FTE.
The comments on the updated listing also brought to our attention
information that has resulted in changes in the table of initial
residency periods. We have added allopathic allergy and immunology with
an initial residency period of 3 years, osteopathic preventive
medicine/aerospace medicine with an initial residency of 4 years, and
osteopathic combined programs in internal medicine/emergency medicine
and internal medicine/pediatrics with
[[Page 46208]]
an initial residency period of 4 years. We have also modified the table
by listing pathology/anatomic and pathology/clinical with respective
initial residency periods of 3 years and pathology/anatomic and
clinical with an initial residency period of 4 years. Finally, in the
proposed rule, emergency medicine was listed with an initial residency
period of 3/4 years due to our understanding that these programs have
been approved for both 3 and 4 years. However, since the Accreditation
Council for Graduate Medical Education (ACGME) has approved 3-year
programs, the minimum number of years of training to become board
eligible in emergency medicine is actually 3 years. Accordingly, we are
including the appropriate initial residency period limitation of 3
years in the table in this final rule.
Initial Residency Period Limitations
------------------------------------------------------------------------
Initial residency
Residency type period limitation
(No. of years)
------------------------------------------------------------------------
ALLOPATHY
ALLERGY AND IMMUNOLOGY............................... 3
ANESTHESIOLOGY....................................... 4
Critical Care Medicine........................... 4
Pain Management.................................. 4
COLON AND RECTAL SURGERY............................. 5
DERMATOLOGY.......................................... 4
Dermatopathology................................. 4
Clinical & Laboratory Dermatological Immunology.. 4
EMERGENCY MEDICINE................................... 3
Sports Medicine.................................. 3
FAMILY PRACTICE...................................... 3
Geriatric Medicine............................... 5
Sports Medicine.................................. 3
INTERNAL MEDICINE.................................... 3
Adolescent Medicine.............................. 3
Cardiovascular Disease........................... 3
Clinical Cardiac Electrophysiology............... 3
Clinic & Laboratory Immunology................... 3
Critical Care Medicine........................... 3
Endocrinology, Diabetes, and Metabolism.......... 3
Gastroenterology................................. 3
Geriatric Medicine............................... 5
Hematology....................................... 3
Hematology and Oncology.......................... 3
Infectious Disease............................... 3
Medical Oncology................................. 3
Nephrology....................................... 3
Pulmonary Disease................................ 3
Pulmonary Disease and Critical Care Medicine..... 3
Rheumatology..................................... 3
Sports Medicine.................................. 3
MEDICAL GENETICS..................................... 4
NEUROLOGICAL SURGERY................................. 5
Pediatric Neurological Surgery................... 5
NEUROLOGY............................................ 4
Child Neurology.................................. 4
Clinical Neurophysiology......................... 4
NUCLEAR MEDICINE..................................... 3
OBSTETRICS AND GYNECOLOGY............................ 4
Critical Care Medicine........................... 4
Gynecological Oncology........................... 4
Maternal and Fetal Medicine...................... 4
Reproductive Endocrinology....................... 4
OPHTHALMOLOGY........................................ 4
ORTHOPAEDIC SURGERY.................................. 5
Adult Reconstructive Orthopaedics................ 5
Foot and Ankle Orthopaedics...................... 5
Hand Surgery..................................... 5
Musculoskeletal Oncology......................... 5
Pediatric Orthopaedics........................... 5
Spinal Cord Injury............................... 5
Sports Medicine.................................. 5
OTOLARYNGOLOGY....................................... 5
Neurotology/Otolaryngology....................... 5
Pediatric Otolaryngology......................... 5
PATHOLOGY, ANATOMIC.................................. 3
PATHOLOGY, CLINICAL.................................. 3
PATHOLOGY, ANATOMIC AND CLINICAL..................... 4
Blood Banking/Transfusion Medicine............... 4
Chemical Pathology............................... 4
[[Page 46209]]
Cytopathology.................................... 4
Dermatopathology................................. 4
Forensic Pathology............................... 4
Hematology....................................... 4
Immunopathology.................................. 4
Medical Microbiology............................. 4
Neuropathology................................... 4
Pediatric Pathology.............................. 4
PEDIATRICS........................................... 3
Adolescent Medicine.............................. 3
Clinical and Laboratory Immunology............... 3
Neonatal-Perinatal Medicine...................... 3
Pediatric Cardiology............................. 3
Pediatric Critical Care Medicine................. 3
Pediatric Emergency Medicine..................... 3
Pediatric Endocrinology.......................... 3
Pediatric Gastroenterology....................... 3
Pediatric Hematology/Oncology.................... 3
Pediatric Infectious Disease..................... 3
Pediatric Nephrology............................. 3
Pediatric Opthamology............................ 3
Pediatric Pulmonology............................ 3
Pediatric Rheumatology........................... 3
Pediatric Sports Medicine........................ 3
PHYSICAL MEDICINE AND REHABILITATION................. 4
PLASTIC SURGERY...................................... 5
Hand Surgery..................................... 5
PREVENTIVE MEDICINE.................................. 3
Aerospace Medicine............................... 3
Medical Toxicology............................... 3
Occupational Medicine............................ 3
Public Health & General Preventive Medicine...... 3
PSYCHIATRY........................................... 4
Addiction Medicine............................... 4
Child & Adolescent Psychiatry.................... 4
Forensic Psychiatry.............................. 4
Geriatric Psychiatry............................. 5
RADIOLOGY, DIAGNOSTIC................................ 4
Neuroradiology................................... 4
Nuclear Radiology................................ 4
Pediatric Radiology.............................. 4
Vascular and Interventional Radiology............ 4
Radiation Oncology............................... 4
SURGERY, GENERAL..................................... 5
Critical Care Medicine........................... 5
Hand Surgery..................................... 5
Pediatric Surgery................................ 5
Thoracic Surgery................................. 5
Vascular Surgery................................. 5
UROLOGY.............................................. 5
Pediatric Urology................................ 5
OSTEOPATHY
ANESTHESIOLOGY....................................... 4
Critical Care Medicine........................... 4
DERMATOLOGY.......................................... 4
Dermatopathology................................. 4
MOHS Micrographic Surgery........................ 4
EMERGENCY MEDICINE................................... 4
Sports Medicine.................................. 4
FAMILY PRACTICE...................................... 3
Adolescent and Young Adult Medicine.............. 3
Geriatrics....................................... 5
Sports Medicine.................................. 3
INTERNAL MEDICINE.................................... 4
Clinical Allergy and Immunology.................. 4
Cardiology....................................... 4
Endocrinology.................................... 4
Gastroenterology................................. 4
Hematology....................................... 4
Infectious Diseases.............................. 4
[[Page 46210]]
Nephrology....................................... 4
ONCOLOGY............................................. 4
Pulmonary Diseases............................... 4
Rheumatology..................................... 4
Clinical Cardiac Electrophysiology............... 4
Critical Care Medicine........................... 4
Geriatrics....................................... 6
Sports Medicine.................................. 4
NUCLEAR MEDICINE..................................... 4
In-Vivo and In-Vitro Nuclear Medicine............ 4
Nuclear Cardiology............................... 4
Nuclear Imaging and Therapy...................... 4
NEUROLOGY............................................ 4
Child Neurology.................................. 4
PSYCHIATRY........................................... 4
Child Psychiatry................................. 4
OBSTETRICS/GYNECOLOGY................................ 5
Maternal and Fetal Medicine...................... 5
Gynecological Oncology........................... 5
Reproductive Endocrinology....................... 5
FACIAL PLASTIC SURGERY............................... 5
OPHTHALMOLOGY........................................ 4
OTORHINO/FACIAL PLASTIC SURGERY...................... 5
OTORHINOLARYNGOLOGY.................................. 5
ORTHOPEDIC SURGERY................................... 5
PATHOLOGY, ANATOMIC.................................. 4
PATHOLOGY, ANATOMIC/LABORATORY MEDICINE.............. 5
PATHOLOGY, LABORATORY MEDICINE....................... 4
Forensic Pathology............................... 5
Blood Banking/Transfusion Medicine............... 5
Chemical Pathology............................... 5
Cytopathology.................................... 5
Dermatopathology................................. 5
Hematology....................................... 5
Immunopathology.................................. 5
Medical Microbiology............................. 5
Neuropathology................................... 5
PEDIATRICS........................................... 3
Adolescent and Young Adult Medicine.............. 3
Neonatal Medicine................................ 3
Pediatric Allergy/Immunology..................... 3
Pediatric Cardiology............................. 3
Pediatric Hematology/Oncology.................... 3
Pediatric Infectious Diseases.................... 3
Pediatric Intensive Care......................... 3
Pediatric Nephrology............................. 3
Pediatric Pulmonology............................ 3
Pediatric Sports Medicine........................ 3
PREVENTIVE MEDICINE.................................. 4
PREVENTIVE/AEROSPACE MEDICINE........................ 4
PROCTOLOGY........................................... 3
RADIATION ONCOLOGY................................... 4
RADIOLOGY, DIAGNOSTIC................................ 5
Angiography and Interventional Radiology......... 5
Diagnostic Ultrasound............................ 5
Neuroradiology................................... 5
Nuclear Radiology................................ 5
Radiological Imaging............................. 5
Pediatric Radiology.............................. 5
REHABILITATION MEDICINE.............................. 4
Sports Medicine.................................. 4
GENERAL SURGERY...................................... 5
NEUROSURGERY......................................... 5
PLASTIC AND RECONSTRUCTIVE SURGERY................... 5
THORACIC CARDIOVASCULAR SURGERY...................... 5
UROLOGICAL SURGERY................................... 5
GENERAL VASCULAR SURGERY............................. 5
CRITICAL CARE SURGERY................................ 5
OSTEOPATHIC MANIPULATIVE MEDICINE.................... 3
PODIATRY
ROTATING PODIATRIC RESIDENCY(PRIMARY CARE)........... 2
[[Page 46211]]
PODIATRIC ORTHOPEDIC RESIDENCY....................... 2
PODIATRIC SURGICAL RESIDENCY......................... 2
DENTISTRY
DENTAL PUBLIC HEALTH................................. 1
ENDODONTICS.......................................... 2
ORAL PATHOLOGY....................................... 3
ORAL AND MAXILLOFACIAL SURGERY....................... 4
ORTHODONTICS......................................... 2
PEDIATRIC DENTISTRY.................................. 2
PERIODONTICS......................................... 3
PROSTHODONTICS....................................... 3
PROSTHODONTICS/MAXILLOFACIAL......................... 3
GENERAL DENTISTRY.................................... 1
ADVANCED GENERAL DENTISTRY........................... 2
ALLOPATHY COMBINED PROGRAMS*
FAMILY PRACTICE(3) AND PSYCHIATRY(4)................. 4
INTERNAL MEDICINE(3) & EMERGENCY MEDICINE(3)......... 3
INTERNAL MEDICINE(3) & FAMILY PRACTICE(3)............ 3
INTERNAL MEDICINE(3) & NEUROLOGY(4).................. 4
INTERNAL MEDICINE(3) & PEDIATRICS(3)................. 3
INTERNAL MED(3) & PHYS MED & REHABILITATION(4)....... 4
INTERNAL MEDICINE(3) & PREVENTIVE MEDICINE(5)........ 5
INTERNAL MEDICINE(3) & PSYCHIATRY(4)................. 4
NEUROLOGY(4) & PHYS MEDICINE AND REHAB(4)............ 4
PEDIATRICS(3) & EMERGENCY MEDICINE(3)................ 3
PEDIATRICS(3) & PHYSICAL MEDICINE AND REHAB(4)....... 4
PEDIATRICS(3)/PSYCHIATRY(4)/CHILD&ADOL PSYCH(4)...... 4
PSYCHIATRY(4) AND NEUROLOGY(4)....................... 4
OSTEOPATHY COMBINED PROGRAMS*
INTERNAL MEDICINE/EMERGENCY MEDICINE................. 4
INTERNAL MEDICINE/PEDIATRICS......................... 4
------------------------------------------------------------------------
* For residents participating in combined programs, Medicare limits the
initial residency period to the time required for individual
certification in the longer of the two programs.
2. Combined Residency Programs
As discussed in the proposed rule, when we updated the listing of
the Initial Residency Period Limitations for GME, we noted many new
programs that were combined specialty residency programs. The combined
programs run concurrently for a period of time that is longer than the
required time for certification in either specialty, but shorter than
would be required if the programs were taken sequentially. Residents
completing these programs are eligible for board certification in both
specialties.
We use the Internal Medicine and Pediatrics combined program as an
example: Taken individually, Internal Medicine is a 3-year program and
Pediatrics is also a 3-year program. However, taken as a combined
program, Internal Medicine and Pediatrics is a 4-year program, with
eligibility for certification in both specialties.
Currently, we are aware of 13 allopathic and 2 osteopathic combined
programs, including Internal Medicine/Pediatrics, Pediatrics/Emergency
Medicine, Family Practice/Psychiatry, and Neurology/Physical Medicine
and Rehabilitation. Due to the increasing prevalence of combined
residency programs since our September 29, 1989 final rule, we proposed
to clarify how the definition of initial residency period applies in
such cases. As discussed in detail in the proposed rule (61 FR 27477),
we proposed to clarify the definition of the initial residency period
for combined programs as the time required for individual certification
in the longer of the two programs. Continuing to use Internal Medicine
and Pediatrics as an example, we would define the initial residency for
Internal Medicine and Pediatrics as 3 years. The remaining year of the
combined program would be treated as 0.5 FTE, in accordance with
Sec. 413.86(g)(3). We received numerous comments on this policy, and
the issues raised by the commenters are discussed below.
Comment: Many commenters disagreed with our clarification
concerning initial residency periods for combined programs. These
commenters stated that residents in combined programs are not board
eligible in either specialty until they have completed the entire
combined program. Some commenters asserted that we did not understand
that training in combined programs does not occur sequentially. One
commenter noted that the Graduate Medical Education Directory states
that ``applicants may not appear for certifying examinations until all
training has been completed.'' Many commenters stated that the law
states that a resident is to be counted as a 1.0 FTE during the
resident's initial residency period, which is defined as the ``period
of board eligibility'' in section 1886(h)(5)(F) of the Act. These
commenters do not believe we have the authority to establish an initial
residency period that is shorter than the length of the combined
program, because Medicare will not be paying for residents at 1.0 FTE
for the period of initial board eligibility.
Several commenters noted that a resident enrolled in a combined
program is enrolling in one program and receives a single certificate
upon completion. One commenter stated that the directors of combined
programs have not sought to independently certify their graduates with
a single examination administered by a single
[[Page 46212]]
board. This commenter added that similar to family practice, combined
programs are not a composite of separate specialties and should be
recognized as a single discipline. Other commenters noted that training
in combined internal medicine/pediatrics programs is more intensive
than family practice and the initial residency period should recognize
this superior training in adult and pediatric medicine. Some commenters
believe our proposal implies that training in a second specialty is
``superfluous, nonessential or less important.''
Response: We have always recognized that the training in combined
programs does not occur sequentially, and we acknowledge that residents
participating in combined programs are not board eligible in either
specialty until they have completed all of their training requirements.
We agree that combined training is more intensive than training in each
specialty taken separately, and we never stated or meant to imply that
training in a second specialty is unimportant or superfluous. Our
intent is simply to establish a reasonable policy, consistent with the
statute, that provides for full Medicare payment for training in one
speciality.
We believe our policy is consistent with section 1886(h)(5)(F) of
the Act, which defines ``initial residency period'' as ``the period of
board eligibility.'' Section 1886(h)(5)(G) defines the ``period of
board eligibility'' as ``the minimum number of years of formal training
necessary to satisfy the requirements for initial board eligibility in
the particular specialty for which the resident is training.''
(Emphasis added.)
The statute does not address how to count the initial residency
period in combined programs, perhaps because such programs were not
contemplated at the time the statute was enacted. We believe the
statutory scheme indicates congressional intent to allow ``full''
Medicare payment only for the minimum period required to train in one
specialty. Contrary to the suggestion of the commenters, it is clear
that the statute does not require Medicare to apply a weighting factor
of 1.0 for a resident until the resident actually becomes board
eligible. Rather, the statute requires a weighting factor of 1.0 only
for the ``minimum number of years necessary to satisfy the requirements
for initial board eligibility''; for time beyond the ``minimum''
period, the statute provides that the weighting factor is 0.5. Thus,
the statute contemplates Medicare payments for the costs of graduate
medical education, but it does not impose an open-ended obligation for
Medicare to pay full costs until a resident becomes board eligible.
The statute defines the initial residency period as the ``minimum
number of years'' necessary to satisfy the requirements for the
``particular specialty'' for which the resident is training. Based on
the public comments we received, we are not persuaded that combined
residency programs are ``particular specialties'' in and of themselves.
As we understand it, graduates of these combined residency programs are
not certified by a single examination by a single board. Rather, they
must take each board's examination separately. Thus, these residents
can become board eligible for each distinct specialty (for example,
Internal Medicine and Pediatrics). It appears that combined programs
simply combine training in separate specialties (whose requirements may
overlap). As always, we are willing to consider further information on
this issue.
We believe our policy on combined programs is reasonable. Residents
in combined programs complete all of the training requirements for two
specialties, but the minimum number of years required to become board
eligible in either specialty is less than the length of the combined
program. We believe it is reasonable to define the initial residency
period for combined programs as the longer of the initial residency
periods for the two specialties. Our policy is consistent with the
manner in which Medicare payment would be made if the resident trained
in two specialties in a sequential manner. In such cases, the resident
would be counted as a full 1.0 FTE during the training for the first
specialty, and as 0.5 FTE for later years.
Comment: Many commenters stated that Congress established the
initial residency period limitation with the intent of discouraging
subspecialty training and increasing the primary care work force. These
commenters do not believe that Congress intended to limit training in
combined programs consisting of two primary care specialties.
Similarly, other commenters noted that graduates of combined programs
are more likely to enter primary care practice in rural and medically
underserved areas than are graduates of other programs. These
commenters said that our proposal conflicts with Congress' goal to
provide medical care to rural and medically underserved areas.
Response: The initial residency period limitation on full Medicare
payment applies to all types of programs, both primary care and non-
primary care, and is not intended to discourage primary care practice.
We agree with these commenters that in general Federal policy should
encourage more training in primary care and that programs designed to
encourage practice in rural and medically underserved areas should
continue to be an important component of Federal health policy.
However, we believe that these concerns are more properly addressed in
other contexts. We note that section 1886(h)(2)(D) of the Act provides
updates to the per resident amounts for primary care residents, but the
statute does not distinguish between primary and non-primary care
specialties for purposes of determining the initial residency period.
Comment: Some commenters were concerned that our policy
clarification would lead to the dismantling of combined residency
programs.
Response: As we have stated, we believe this policy clarification
is necessary to avoid full Medicare payments, beyond the time required
to train in one specialty. We note that hospitals will continue to be
paid for residents in combined programs beyond their initial residency
period, with the residents weighted at 0.5 FTE.
Comment: Several commenters were concerned that HCFA developed this
policy, in part, to control Medicare's graduate medical education
payments. These commenters noted that there are few of these programs
in existence with only a small number of graduates who will be
affected. Accordingly, Medicare savings resulting from this policy
clarification will be small.
Response: This policy clarification is based on considerations
concerning the appropriate application of the statute and does not
arise solely from a goal of limiting payments. However, we acknowledge
that Medicare's payment liabilities will be less under this policy than
if hospitals were allowed to weight residents as 1.0 FTE throughout the
entire training period in the combined program. We believe that
combined training programs may have grown in recent years as physicians
seek additional qualifications in a competitive job market. Our
understanding is that there are more than 1,400 students in combined
programs. Given that only a portion of these students are beyond the
initial residency period under this clarification, we agree that any
budgetary impact is small relative to the total number of residents
participating in approved programs.
Comment: One commenter noted that osteopathic residency programs
allow 4 years for internal medicine but that allopathic residency
programs allow 3
[[Page 46213]]
years. This commenter suggested that if we modified the initial
residency periods so that both were of the same duration, the 4-year
combined residency could be accommodated.
Response: Allopathic and osteopathic specialty boards set different
requirements for board certification. The first year of postgraduate
osteopathic training consists of a rotating internship which is
followed by subsequent specialty training. Most allopathic training
programs do not require similar training. In the September 29, 1989 GME
regulation published in the Federal Register (54 FR 40293), we stated
that the osteopathic rotating internship, like the transitional year
required by some allopathic medical residency programs, would not count
as an additional year beyond initial board eligibility.
Comment: One commenter questioned the limitation on the number of
years noted on the table for geriatric psychiatry. The listing of the
initial residency periods permits an additional year for training in
geriatric medicine as a subspecialty of internal medicine and family
practice but not as a subspecialty of psychiatry. This commenter noted
that there is a minimum requirement of 4 years of training in
psychiatry and requested that the initial residency period be extended
to 5 years for training in geriatric psychiatry. Another commenter
noted that section 1886(h)(5)(F) of the Act provides that a 2-year
geriatric residency or fellowship program is treated as part of the
initial residency period, ``but shall not be counted against any
limitation on the initial residency period.'' This commenter stated
that the law clearly provides that geriatric psychiatry programs should
be eligible for full funding under the special geriatric medical
education provision described in the law. Other commenters noted that
the Accreditation Council for Graduate Medical Education (ACGME) only
accredited geriatric subspecialty programs in family and internal
medicine when the 1989 regulations were published but now recognizes
geriatric subspecialty programs in psychiatry.
Response: We agree that the initial residency period for geriatric
psychiatry programs should be revised. When the September 29, 1989
regulation (54 FR 40286) was published, the ACGME was in the process of
approving training programs in geriatrics as a subspecialty of internal
medicine and family practice. At that time, we proposed to consider
expanding the exception to the initial residency period limitation to
fellowships in other programs when the appropriate national
organizations establish criteria for approving these programs.
Subsequently, the ACGME established criteria for accrediting 12-month
programs in geriatric psychiatry, and the American Board of Psychiatry
and Neurology recognizes applicants with the required training for
certification in geriatric psychiatry. Accordingly, we are including
geriatric psychiatry in the table above with an initial residency
period of 5 years, which includes a 1-year exception to the 4-year
initial residency period for psychiatry. We are also modifying the
definition of ``approved geriatric program'' in Sec. 413.86(b) to
reflect that the ACGME is accrediting, and boards are recognizing,
training in geriatric medicine in specialties other than internal
medicine and family practice.
3. Statutory Provision Regarding Prohibition on Abortion-Related
Discrimination in Training and Licensing of Physicians
(Secs. 412.105(g) and 413.86(b))
Congress recently enacted a statutory provision that prohibits
certain abortion-related discrimination by the Federal Government and
State and local governments. In section 515 of the Departments of
Labor, Health and Human Services, and Education, and Related Agencies
Appropriations Act of 1996 (see section 101(d) of the Omnibus
Consolidated Rescissions and Appropriations Act of 1996, Pub. L. No.
104-134), enacted April 26, 1996, Congress added a new section 245 to
the Public Health Service Act to provide that:
``The Federal Government, and any State or local government that
receives Federal financial assistance, may not subject any health
care entity to discrimination on the basis that--
(1) the entity refuses to undergo training in the performance of
induced abortions, to require or provide such training, to perform
such abortions, or to provide referrals for such training or such
abortions;
(2) the entity refuses to make arrangements for any of the
activities specified in paragraph (1); or
(3) the entity attends (or attended) a post-graduate physician
training program, or any other program of training in the health
professions, that does not (or did not) perform induced abortions or
require, provide or refer for training in the performance of induced
abortions, or make arrangements for the provision of such
training.''
For purposes of section 245, the statute defines ``financial
assistance'' to include ``governmental payments provided as
reimbursement for carrying out health-related activities,'' and defines
``health care entity'' to include individual physicians, postgraduate
physician training programs (which includes residency training
programs), and participants in a program of training in the health
professions.
The new section also addresses accreditation of postgraduate
physician training programs. Specifically, the statute provides that:
``In determining whether to grant a legal status to a health
care entity (including a license or certificate) or to provide such
entity with financial assistance, services or other benefits, the
Federal government, or any State or local government that receives
Federal financial assistance, shall deem accredited any postgraduate
physician training program that would be accredited but for the
accrediting agency's reliance upon an accreditation standard that
requires an entity to perform an induced abortion or require,
provide, or refer for training in the performance of induced
abortions, or make arrangements for such training, regardless of
whether such accreditation standard provides exceptions or
exemptions.''
The statute further requires that the government involved ``shall
formulate such regulations or other mechanisms, or enter into such
agreements with accrediting agencies, as are necessary to comply with
this subsection.''
Under the terms of the statute, the provisions of section 245 shall
not ``prevent any health care entity from voluntarily electing to be
trained, to train, or to arrange for training in the performance of, to
perform, or to make referrals for induced abortions.'' Similarly, the
provisions of section 245 shall not ``prevent an accrediting agency or
a Federal, State or local government from establishing standards of
medical competency applicable only to those individuals who have
voluntarily elected to perform abortions.''
In this document, we are making conforming changes to the
regulations at Sec. 412.105(g) and Sec. 413.86(b) to reflect the
accreditation provisions of section 245. These technical changes merely
conform the regulations text to the express requirements of the
statute, and do not involve an exercise of discretion by the agency.
E. Distribution of an ``Important Message from Medicare'' (Sec. 489.27)
Under Sec. 489.27 of our provider agreement regulations, all
hospitals that participate in Medicare (including those not paid under
the prospective payment system) must agree to furnish each Medicare
beneficiary with a notice, at or about the time of admission, that
explains the patient's discharge rights. This statement, entitled ``An
Important Message from Medicare,'' advises a beneficiary of his or her
rights to be fully informed about decisions affecting
[[Page 46214]]
Medicare coverage or payment and about his or her appeal rights in
response to any hospital's notice to the effect that Medicare will no
longer cover the patient's care. The ``Important Message'' also advises
the patient of what to do when he or she receives such a hospital
statement and how to elicit more information.
In November 1993, the Medicare Technical Advisory Group (M-TAG)
established the Beneficiary Protection and Documentation Issues Task
Force. The task force consists of HCFA staff as well as representatives
from health care industry organizations, beneficiary advocate groups,
fiscal ntermediaries, and peer review organizations (PROs). The task
force was charged with reviewing various issues that impact
beneficiaries and the health care community, including how to improve
the effectiveness of ``An Important Message from Medicare.''
We proposed to adopt a recommendation of this task force that would
respond to numerous requests for clarification on the timing of the
written notice of discharge rights that must be given to hospital
inpatients. As noted above, existing Sec. 489.27 specifies that a
hospital must distribute the statement ``at or about the time of
admission.'' We understand that for monitoring purposes some PROs have
interpreted this requirement to mean ``within 24 hours preceding or
following the admission.'' However, we agree with the task force's
determination that the PRO's interpretation is unnecessarily narrow. We
believe that during the first 24 hours of a patient's admission, the
hospital is primarily concerned with ensuring appropriate treatment of
the patient's illness or injury. Therefore, we proposed to change
Sec. 489.27 to specify that the hospital must provide timely notice
during the course of the hospital stay.
For purposes of this requirement, we would consider the course of
the hospital stay to begin when the hospital provides the individual
with a package of information regarding scheduled preadmission testing
and registration for a planned hospital admission. This would give
hospitals more flexibility in meeting the requirement, as well as
encourage the distribution of the ``Important Message'' at a time when
the beneficiary is better able to receive and more likely to understand
its contents. In complying with the requirement to provide timely
notice during the course of the patient's hospital stay, the hospital
must give the patient the ``Important Message'' far enough in advance
of the hospital's written notice regarding continued stay to provide
the beneficiary time to appeal the hospital's decision. Finally,
``timely notice'' would also include adherence to any State
requirements on the provision of patient rights notices.
We received only one comment on this proposal.
Comment: One commenter agreed with the proposal to permit hospitals
to provide timely notice during the course of the hospital stay.
However, the commenter stated that the ``Important Message'' is
currently ineffective in meeting its intended purpose, regardless of
the timing, because people are too sick and frightened to comprehend
the information at the point of hospitalization. The commenter
suggested instead using mass mailings to Medicare beneficiaries when
they are healthy and have no immediate plans to be hospitalized.
Response: While we agree that making this information available to
the Medicare beneficiary prior to hospitalization may enhance
comprehension, we believe that the ``Important Message'' may be ignored
during a mass mailing because the information would not be considered
needed at the time. Moreover, it is a statutory requirement that the
``Important Message'' be provided during an individual's
hospitalization; therefore, we cannot accept the commenter's
suggestion. Furthermore, in our proposal, while we did not intend to
address the effectiveness or the content of the ``Important Message''
in this regulation, we recognize the need to review its contents.
Therefore, an internal HCFA workgroup has begun the process to revise
the ``Important Message,'' including further consideration of the
recommendations for revision made by the Beneficiary Protection and
Documentation Issues Task Force of the Medicare Technical Advisory
Group (M-TAG). The goals of the Workgroup are to improve clarity for
increased comprehension and to improve efficiency of its distribution
to Medicare beneficiaries. Comments on the revision will be solicited
from selected outside parties in the near future.
VI. Changes and Clarifications to the Prospective Payment System
for Capital-Related Costs
A. Consistent Cost Finding During the Capital Transition Period
(Sec. 412.302(d))
Section 412.302(d) requires that during the transition period to
full prospective payment for capital-related costs, a hospital must
follow consistent cost-finding methods for classifying and allocating
capital-related costs. Specifically, the regulation requires that
unless there is a change of ownership, a hospital must continue the
same cost-finding methods for old capital costs, including its
practices for direct assignment of costs and its cost-allocation bases,
that were in effect in the hospital's last cost-reporting period before
becoming subject to payment under the capital prospective payment
transition system. A hospital may request a change in its cost-finding
methods for new capital, provided that the request is made in a timely
fashion as provided in the regulation, the hospital provides
justification for the change, and the intermediary determines that the
justification is reasonable.
It is important to note that, while the regulation does permit
changes in cost-finding methods for new capital, such changes are only
permitted where they do not involve any changes in cost-finding for old
capital. In practice, this means that if a hospital claims any old
capital, the intermediary cannot permit a change in any of the
allocation bases on Worksheet B-1 of the cost report from the bases
used in the last cost reporting period prior to the capital prospective
payment system transition period. Otherwise, the consistency rule
governing old capital cost-finding would be violated.
In response to concerns expressed by the hospital industry about
the costs of the recordkeeping required under the cost-reporting rules,
HCFA has developed new cost reporting instructions, which will be
released later this year, that permit hospitals to voluntarily adopt a
simplified cost allocation methodology. This methodology reduces the
number of statistical bases that a hospital is required to maintain.
Under the new instructions for HCFA Form 2552-96 (the cost report
instructions for FY 1996 cost reporting periods), hospitals may request
the simplified cost allocation methodology. However, hospitals that
elect this methodology must employ a prescribed list of statistical
bases with no deviations. Hospitals may not pick and choose among the
prescribed statistics for the combination that is most advantageous.
The election of the simplified method cannot be used to shift costs
inappropriately. Furthermore, a hospital that elects the simplified
methodology must continue to use it for at least 3 years, unless a
change of ownership occurs. In the proposed rule (61 FR 27478), we
proposed to add a new paragraph (d)(4) to Sec. 412.302, to provide that
hospitals may elect to adopt the simplified cost allocation
[[Page 46215]]
methodology, as will be provided in the instructions for HCFA Form
2552-96.
Comment: One commenter agreed with our proposal to revise
Sec. 412.302(d)(4) to allow for a simplified cost allocation
methodology, but suggested that we make a technical change to existing
Sec. 412.302(d)(1) to reflect the availability of the simplified
methodology option.
Response: We are adopting the commenter's recommended change to the
regulations. Section 412.302(d)(1) will now read: ``For cost reporting
periods beginning on or after October 1, 1991 and before October 1,
2001, the hospital must follow consistent cost finding methods for
classifying and allocating capital-related costs, except as otherwise
provided in paragraph (d)(4) of this section.''
Comment: In response to our proposal on the simplified cost
allocation methodology, one commenter argued that the general capital
consistency rule is flawed. The commenter stated that a provider should
be able to request that the fiscal intermediary reassign capital costs
from the acute care hospital portion of a facility to exempt areas of
the facility if the provider is using the space differently than it was
used during the capital base year, such as using the space as a skilled
nursing facility or a rehabilitation unit.
Response: This comment concerns the underlying intent of the
capital consistency rule itself rather than the subject of our May 31,
1995 proposed rule. In the August 30, 1991 final rule that implemented
the capital prospective payment system (56 FR 43396), we explained the
rationale for the capital consistency rule. We explained that the
capital consistency rule is necessary: (1) to prevent cost shifting to
outpatient departments through changes in cost finding methods, and (2)
to provide consistency with the determination of the hospital-specific
rate used in the base year. For these reasons, it is important that the
hospital continue the same bases of cost allocation for old capital
throughout the transition.
Throughout the transition to a fully prospective payment system for
capital, the provider must continue to allocate any space that was part
of the acute care hospital in the base year in the same way. However,
if the provider opens a new section of the facility as a skilled
nursing facility or excluded unit, capital costs in those areas could
be allocated directly to those areas.
B. Possible Adjustments to the Capital Prospective Payment System
Federal Rate and Hospital-Specific Rates (Secs. 412.308(b) and 412.328)
In the proposed and final rules for FY 1996 (60 FR 29238-29239 and
60 FR 45830-45831), we discussed the effects of the expiration of the
statutory budget neutrality provision on rates and aggregate payments
under the capital prospective payment system. Under the budget
neutrality provision, we set the capital-prospective payment system
rates during FY 1992 through FY 1995 so that payments were projected to
equal 90 percent of Medicare payments that would have been made on a
reasonable cost basis for each fiscal year. As a result of the
provision's expiration in FY 1996, the capital-prospective payment
system rates and payments under the transition system increased
significantly. The FY 1996 Federal rate is 22.59 percent higher than
the FY 1995 Federal rate. We now estimate that aggregate capital
payments will increase 27.5 percent in FY 1996 relative to FY 1995, and
that payments will exceed capital costs by 8.8 percent in FY 1996.
Under current law and regulations, we estimate that aggregate payments
will further increase by 6.8 percent in FY 1997, for an increase of
36.1 percent over 2 years. We also estimate that payments will exceed
capital costs by 7.5 percent in FY 1997.
In the May 31, 1996 proposed rule, we stated that we continue to
believe that such large increases in capital payments are neither
necessary nor warranted. We identified several possible approaches for
establishing a more appropriate level for the rates and discussed the
options we considered in developing the proposed rule (61 FR 27479).
These options included freezing the inflation updates for the rates in
FY 1997 or making downward adjustments in the base rates, as discussed
below:
Reduce the standard Federal rate by 7.38 percent and the
hospital-specific rates by 9.48 percent to reflect revised data on base
year costs used to determine the rates.
Implement the provision contained in the Administration's
budget plan to reduce the base Federal and hospital-specific rates by
15.7 percent.
As discussed in detail in the proposed rule, the rationale for
reducing the base rate derives from an analysis of current data
compared to data on which the rate was originally based. Under
Sec. 412.308, HCFA determined the standard Federal rate, which is used
to determine the Federal rate for each fiscal year, on the basis of an
estimate of the FY 1992 national average Medicare capital cost per
discharge. The FY 1992 national average Medicare capital cost per
discharge was estimated by updating the FY 1989 national average
Medicare capital cost per discharge by the estimated increase in
Medicare inpatient capital cost per discharge.
Section 13501(a)(3) of Public Law 103-66 amended section
1886(g)(1)(A) of the Social Security Act to require that, for
discharges occurring after September 30, 1993, the unadjusted standard
Federal rate be reduced by 7.4 percent. The purpose of that reduction
was to reflect revised inflation estimates as of May 1993, for the
increases in Medicare capital costs per discharge during FY 1989
through FY 1992. We now have extensive cost report data for FY 1992
that shows an audit-adjusted FY 1992 Medicare inpatient capital cost
per discharge that is an additional 7.38 percent lower that the
estimate on which the Federal rate is currently based. Accordingly, the
rate could be reduced to reflect accurate FY 1992 capital cost per
discharge data.
Under Sec. 412.328, HCFA determined the FY 1992 hospital-specific
rate by using a process similar to the process for determining the FY
1992 Federal rate. The intermediary determined each hospital's
allowable Medicare inpatient capital cost per discharge for the
hospital's latest cost reporting period ending on or before December
31, 1990. The intermediary then updated each hospital's FY 1990
allowable Medicare capital cost per discharge to FY 1992 based on the
estimated increase in Medicare inpatient capital cost per case. As with
the Federal rate updates, current data demonstrate that the estimates
used to update the hospital specific rates from FY 1990 to FY 1992 were
overstated. In order to adjust the hospital-specific rate to reflect
actual FY 1992 data, the rates must be reduced by 9.48 percent.
The reduction reflected in the President's budget plan is based on
a different consideration. That reduction would build the budget
neutrality adjustment for FY 1995 (0.8432, or -15.68 percent)
permanently into the base rates, effectively using the FY 1995 base
payment rate as the base for future years. The actual payment rates for
future years would then be determined by applying the analytical update
framework that we adopted in the final rule for FY 1996 (60 FR 45815-
45829). Our last analysis (60 FR 45826-45829) suggested that the
estimated FY 1992 capital costs used to set the Federal and hospital-
specific capital rates exceeded by approximately 28 percent the level
that could be accounted for by known factors. This unaccounted for
difference
[[Page 46216]]
in the rates justifies a 15.7 percent reduction to the rates.
We seriously considered proposing one of these options in the
proposed rule, and we invited public comment on their merits and on the
advisability of implementing one or the other in the final rule, in the
absence of legislative action.
We received many comments on our discussion of possible adjustments
to the capital Federal rate, and these comments and our responses are
presented below. Although we continue to believe that any of these
options is justified on the basis of current data and analysis, we are
not implementing any freeze or reduction to the capital Federal rates
in this final rule. The President's budget bill includes numerous
proposals to reform the Medicare program, including a reduction to the
capital prospective payment rate. At this time, we believe it would be
more appropriate to adopt a change to the rate in the context of more
global changes to the Medicare program than to implement this one
specific provision of the President's budget through regulation.
Therefore, we are not implementing any of the possible reductions to
the capital Federal rate that were discussed in the proposed rule but
instead are updating the capital rates in accordance with the capital
update framework, as discussed in section III of the addendum to this
final rule.
In general, commenters opposed freezing or reducing the capital
Federal rate as suggested in the proposed rule. Commenters cited
various reasons why the suggested changes were inappropriate or
unnecessary. One commenter, ProPAC, agreed that continued significant
increases in capital payments are unjustified and supported reductions
to the capital rate. ProPAC suggested several options for our
consideration, such as using the FY 1995 rates as the base for future
years, or rebasing the FY 1992 capital payment rates and updating them
to the current year using an analytic framework. As explained earlier,
although we agree with ProPAC that a reduction in the rates is
warranted, we have decided not to proceed with reducing the rates by
regulation at this time. We discuss the comments on the possible
changes in more detail below.
Comment: Some commenters contended that it would be illegal for
HCFA to implement any of the identified reductions to the rates
(including an efficiency adjustment) because HCFA does not have the
authority to rebase the capital payment rate. Two commenters
characterized the rate reduction options as thinly disguised attempts
to rebase hospitals' base year capital costs, and asserted that
Congress has not given the Secretary of Health and Human Services the
authority to rebase hospital capital costs. One commenter stated that
the rate revisions discussed in the proposed rule would violate a
fundamental principle of prospective payment: that the system provide
certain and predictable payment rates. Another commenter opposed any
reduction in the capital Federal rate undertaken without legislative
direction.
Finally, one commenter noted that when Congress specified the 7.4
percent reduction in the Federal rate as part of OBRA 93, Congress
referenced the capital Federal rate ``as described in
Sec. 412.308(c).'' That regulation describes the methodology for
defining the Federal rate. The commenter believes that the regulation
does not contemplate the substitution of actual cost data for periods
in which estimated data were used initially. The commenter believes
that because Congress cited this section of the regulations, it
implicitly approved the continued use of estimated data for setting the
rates rather than the use of actual data.
Response: Section 1886(g) of the Act states that ``the Secretary
shall, for hospital cost reporting periods beginning on or after
October 1, 1991, provide for payments for [capital-related] costs in
accordance with a prospective payment system established by the
Secretary.'' The statute gives the Secretary wide discretion in
determining the particular features of the prospective payment system
for capital-related costs, including the appropriate level of payment
rates.
We believe that, consistent with this broad authority, it is
appropriate to make prospective adjustments to the capital rates. We
believe that any rate revision implemented prospectively would satisfy
the principle of certainty and predictability under a prospective
system. We have never contemplated a retroactive adjustment to payment
rates used in prior years.
The provision of OBRA 93 cited by the commenter does not indicate
that we cannot make other adjustments to the capital Federal rate in
future years. Section 412.308(c) describes the process for determining
the Federal rate by adjusting the standard Federal rate by an update
factor each year. We believe that Congress cited this section solely to
identify the rate to which we applied the 7.4 percent reduction.
Since the inception of the capital prospective payment system,
rates have been set on the basis of FY 1992 capital costs. Since we set
initially set rates before FY 1992 started, we necessarily had to
project capital costs for FY 1992. We used FY 1989 costs as the basis
for projecting FY 1992 costs because they were the latest cost report
data available at that time. (Even the FY 1989 data required an
estimated adjustment for the effect of audits not yet performed.) We
applied estimated adjustment factors to the FY 1989 data to derive
estimated FY 1992 capital costs. We used this estimated FY 1992 cost
level to set rates beginning in FY 1992.
When Congress legislated that the unadjusted standard Federal rate
be reduced by 7.4 percent in 1993, the size of the adjustment was based
on more recent data on FY 1992 costs available at that time. The latest
available data now indicate an additional 7.36 percent reduction is
appropriate. Again, although we are not implementing this adjustment,
we believe that we have the authority to do so and that it would
represent a logical extension of our policy of basing the capital
Federal rate on FY 1992 capital costs.
Comment: Several commenters stated that the discussion in the
proposed rule of the possibility of implementing reductions to the
capital Federal rate through the final rule did not constitute
sufficient notice to the public of proposed regulatory changes. The
commenters asserted that before implementing a reduction in the capital
payment rates, HCFA was obligated to provide ``formal'' public notice
and time for the public to respond.
Response: As noted above, we do not intend to implement any
reduction to the capital Federal rate at this time. However, we believe
that the discussion in the proposed rule would have satisfied the
requirements of the Administrative Procedure Act by (1) describing in
some detail three potential options for cutting the capital rate, (2)
informing the public that we might implement one of these options if
Congress and the Administration did not act to cut the rate, and (3)
soliciting public comment on the possible options. We stated that it
was our intention to consider all of the options in light of the
comments received. Moreover, in the FY 1996 proposed rule (60 FR
29238), we discussed in some detail and invited comments on two options
for adjusting the Federal and hospital specific rate, to account for
the overestimation of the FY 1992 Medicare inpatient capital cost per
discharge, and to compensate for the effects of the expiration of
budget neutrality. Finally, since FY 1992 we have printed seven
discussions of the efficiency issue, and providers have long known that
we
[[Page 46217]]
might make an adjustment in the rate to account for possible
inefficiency.
Comment: Some commenters stated that we should not adjust the
Federal rate to reflect the actual level of FY 1992 capital spending
because the FY 1992 level is lower than was projected. The commenters
asserted that FY 1992 capital cost levels are lower than projected
because hospitals responded in FY 1992 to the incentives of the
prospective payment system and modified their capital spending
behavior. Some commenters argued that hospitals responded to the
possible implementation of a capital prospective payment system even
prior to FY 1992. These commenters asserted that in order to get a true
sense of the impact of the capital prospective payment system on
hospital capital expenditure behavior, one must look further back to
when hospitals believed implementation of such a system was imminent.
One commenter explained that one reason actual increases in capital
costs in FY 1992 were less than projected was because lengthy
certificate of need (CON) approval processes prevented hospitals from
beginning building projects as planned. The commenter also stated that
if rates were reduced, hospitals in States with strict CON processes
should not be subjected to the same rate reductions as hospitals in
States without such processes. The commenter asserted that facilities
in the commenter's State are undercapitalized relative to facilities in
the rest of the country.
Finally, some commenters believe that the overestimation of FY 1992
capital costs (discussed above) stems not from a forecast error in the
FY 1992 capital cost per case but from a change in the treatment of
allowable interest that was implemented in the first capital
prospective payment system final rule published on August 30, 1991.
Thus, they believe the overestimation resulted from a change in the
rules regarding capital and that the proposed reduction based on a
revised FY 1992 capital cost data is not justified.
Response: Since the inception of the capital prospective payment
system, we have based capital rates on FY 1992 cost levels. We believe
it is appropriate for the rate to reflect actual FY 1992 capital
spending, even if hospitals had modified capital spending behavior
before the current system was implemented.
We agree that the prospective payment system provides an incentive
for hospitals to modify their capital spending behavior, and that it is
likely that hospitals have done so. However, we do not believe that the
magnitude of the difference between the projection for FY 1992 capital
costs and the latest measurement of FY 1992 capital costs can be
completely explained by changes in capital spending behavior caused by
the incentives of the prospective payment system. First, most of the
capital costs in FY 1992 would be attributable to capital acquired
before FY 1992 that was still being depreciated. Second, most capital
acquired in FY 1992 would have been planned and committed prior to FY
1992. Thus, only a small proportion of FY 1992 capital spending would
have been impacted by the implementation of the capital prospective
payment system. Consequently, the implementation of the prospective
payment system would have had little, if any, effect on capital growth
in FY 1992. Moreover, the anticipated onset of the prospective payment
system for capital-related costs may have encouraged some hospitals to
limit spending, but we are aware of several situations in which
hospitals actually hastened building projects in order to qualify for
possible old capital protections.
We recognize that CON processes may well delay hospital building
projects. However, the commenter does not explain why these effects
would have been greater in FY 1992 than in previous years. Our data on
the cumulative percentage change in capital-related cost per case,
which we presented in the September 1, 1995 final rule (60 FR 45828),
demonstrate that the growth of capital costs has slowed considerably in
recent years, from a high of 19.9 percent per year in 1986 to a low of
2.9 percent per year in 1992. The most recent FY 1992 HCRIS data
available show that hospitals' actual FY 1992 capital costs per
discharge are an additional 7.36 percent lower than the estimate on
which the capital Federal rate is currently based (taking into
consideration the adjustment mandated by Public Law 103-66). We believe
it is appropriate for the rate to reflect actual costs.
In designing the prospective payment system for capital costs, we
recognized the unique position of hospitals in States with CON programs
by developing special rules with regard to obligated capital. Those
special rules (see Sec. 412.302(c)(2), ``Lengthy certificate-of-need
process'') are designed to ensure that hospitals in States with CON
programs receive equitable treatment in terms of recognition ``old
capital costs.'' Essentially, this provision permits certain obligated
capital costs in CON States to be tr
FR Doc. 96-22145 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1997 Rates
eated in the same manner as actual
capital expenditures in non-CON States. We believe these provisions
adequately address the concerns of hospitals in states with CON
processes.
Finally, we do not agree that the August 30, 1991 final rule
implemented any change in the treatment of allowable interest. Section
412.302(b)(2)(v), which defines old capital costs for purposes of the
prospective payment system for capital-related costs, states that
``Investment income, excluding income from funded depreciation
accounts, is used to reduce old capital interest expense based on the
ratio of total old capital interest expense to total allowable interest
expense in each cost reporting period. ''(Emphasis added.) The
commenter apparently believes that this statement reflects a change in
the treatment of allowable interest because Sec. 413.130(g)(2), which
defines capital-related interest expense net of investment income
(under our reasonable cost reimbursement rules), provides that in
determining the proportion of investment income to be offset, the ratio
is to be based on capital-related interest to total interest. However,
Sec. 413.130(g) derives from Sec. 413.130(a)(7), and Sec. 413.130(a)(7)
addresses only ``allowable interest expense'' (that is, interest
expense as determined under Sec. 413.153), so the ratio expressed in
Sec. 413.130(g) is reasonably interpreted to refer to ``total allowable
interest expense.''
Comment: Commenters also addressed the possible adjustment based in
part on an efficiency analysis. A few commenters stated that higher
than expected capital costs per case for FY 1992 were not the result of
inefficient use of capital resources, but rather a reaction to pent-up
demand in States that had restrictive certificate of need (CON)
policies. Another commenter argued that no overexpansion of health
facilities has occurred in the commenter's State, because it is highly
regulated, and that the average age of hospitals' physical plants in
the State is among the oldest in the country. This commenter too
believes that it is inappropriate to apply a rate reduction equally in
all States.
Some commenters agreed with our statement that economic theory
would suggest incentives for the overuse of capital during a period in
which capital was paid on a cost basis while operating costs were paid
on the basis of a prospective rate. However, the commenters contended
that economic theory would also suggest that, if hospitals over
purchased capital, they conversely had to under employ operating
inputs. Thus, the commenters believe that reductions to the capital
Federal rate to account for the
[[Page 46218]]
inefficient overuse of capital should be matched by increases in the
operating rates to account for inefficient underutilization of
operating inputs.
Finally, one commenter suggested that we obtain an independent
evaluation of HCFA's capital model and the factors that account for the
known increase in costs per case, such as the inflation in capital
input prices, quality enhancing intensity increases, and real case-mix
growth, as well as the factors that may be responsible for the
unexplained growth in capital costs per case.
Response: As noted in our September 1, 1995 final rule in response
to a similar comment (60 FR 45829), we agree that the conjunction of
rate-based payment for operating costs and cost-based payment for
capital costs encouraged hospitals to substitute capital inputs for
labor and other operating inputs. However, we do not agree that an
inefficiently high level of capital inputs under those conditions
necessarily implies an inefficiently low level of operating inputs.
Rather, the conjunction of rate-based payment for operating costs and
cost-based payment for capital could also lead to the substitution of
inefficient capital inputs for inefficient operating inputs. Indeed,
our previous analysis of efficient operating costs for hospitals during
FY 1985 through FY 1991 (57 FR 40014) indicates that operating
prospective payments during that period were sufficient for the
efficient and cost-effective delivery of quality care. In conjunction
with the analysis of capital spending during FY 1985 to FY 1992, these
results suggest that hospitals may indeed have responded to the
existing incentives by substituting an inefficiently high level of
capital inputs for inefficient operating inputs. Under these
circumstances, it would not be appropriate to increase operating rates
in conjunction with a decrease in capital rates. Decreased capital
rates, along with the existing level of operating rates, would provide
the appropriate incentives for hospitals to achieve efficient levels of
both capital and operating inputs.
As we stated in our September 1, 1995 final rule in response to a
similar comment (60 FR 45828), our analysis suggests a significant
measure of inefficiency in capital costs, and was based on national
figures. Therefore, since we are evaluating an efficiency adjustment in
the national Federal rate, our analysis does not consider regional
differences, such as the existence of CON requirements in some States.
The national Federal rate is based on an average; thus, we recognize
that some States will have higher costs than the average and other
States will have lower costs. We note, however, that although we did
not make adjustments for CON policies for purposes of this particular
analysis, Sec. 412.302(c)(2) does provide for differential treatment of
hospitals in CON States in terms of the recognition of obligated
capital (as discussed in more detail above).
In response to the commenter's suggestion that a group of
independent economists should evaluate the capital model and our theory
about the possible cause of the unexplained growth in capital costs per
case, we note that ProPAC has also analyzed the current capital rate
and has discussed possible reductions to the capital rate, implicitly
endorsing a reduction to the capital rate in the order of magnitude
that we discussed in the proposed rule.
Comment: A number of commenters contended that the reductions
discussed in the proposed rule would jeopardize the ability of many
hospitals to meet current obligations and reduce their ability to meet
future capital needs.
Response: Our data indicate that there is ample room to cut the
capital rate without a major adverse affect on facilities in any
region. Before the implementation of the prospective payment system for
capital-related costs, facilities were paid only 85 percent of their
capital costs. In the proposed rule, we estimated that payments would
exceed capital costs by 9.6 percent in FY 1996 (61 FR 27479). We now
estimate that capital payments will exceed capital costs by 8.8 percent
in FY 1996 and 7.5 percent in FY 1997.
C. Possible Adjustment to Capital Prospective Payment System Minimum
Payment Levels
Section 412.348(b) of the regulations provides that, during the
capital prospective payment system transition period, a hospital may
receive an additional payment under an exceptions process if its total
inpatient capital-related payments under its payment methodology (that
is, fully prospective or hold-harmless) are less than a minimum
percentage of its allowable Medicare inpatient capital-related costs.
The minimum payment levels are established by class of hospitals under
Sec. 412.348(c). The minimum payment levels for portions of cost
reporting periods occurring in FY 1996 are:
Sole community hospitals (located in either an urban or
rural area), 90 percent;
Urban hospitals with at least 100 beds and a
disproportionate share patient percentage of at least 20.2 percent and
urban hospitals with at least 100 beds that qualify for
disproportionate share payments under Sec. 412.106(c)(2), 80 percent;
and,
All other hospitals, 70 percent.
Under Sec. 412.348(d), the amount of the exceptions payment is
determined by comparing the cumulative payments made to the hospital
under the capital prospective payment system to the cumulative minimum
payment levels applicable to the hospital for each cost reporting
period subject to that system. Any amount by which the hospital's
cumulative payments for previous cost reporting periods exceed its
cumulative minimum payment is deducted from the additional payment that
would otherwise be payable for a cost reporting period.
Section 412.348(h) further provides that total estimated exceptions
payments under the exceptions process may not exceed 10 percent of the
total estimated capital prospective payments (exclusive of hold-
harmless payments for old capital) for the same fiscal year. In the
final rule implementing the prospective payment system for capital-
related costs we stated that the minimum payment levels in subsequent
transition years would be revised, if necessary, to keep the projected
percentage of payments under the exceptions process at no more than 10
percent of capital prospective payments.
In section III of the addendum to the proposed rule (61 FR 27499),
we discussed the factors and adjustments used to develop the FY 1997
Federal and hospital-specific rates. In particular, we discussed the FY
1997 exceptions payment reduction factor. This factor adjusts the
annual payment rates for the estimated percentage of additional
payments for exceptions in FY 1997. In the proposed rule, we estimated
that exceptions would equal 6.07 percent of aggregate payments based on
the Federal rate and the hospital-specific rate. We indicated that it
might be necessary to implement adjustments to the minimum payment
levels in the final rule and that it will almost certainly be necessary
to adjust the minimum payment levels for FY 1998. We therefore provided
public notification that adjustments to the minimum payment levels were
imminent, discussed our ideas on the most appropriate method for
adjusting the minimum payment levels, and solicited public comment.
We stated that, when it does become necessary to adjust the minimum
payment levels, we intended to adjust each of the existing levels (that
is, 90 percent for sole community hospitals, 80 percent for large urban
DSH hospitals, and 70 percent for all other
[[Page 46219]]
hospitals) by 5 percentage point increments until estimated exceptions
payments are within the 10 percent limit.
Current estimates indicate that we will not reach the 10 percent
exception limit in FY 1997. Therefore, we are not making adjustments to
the minimum payment levels at this time; the minimum payment levels for
exception payments will remain at the current levels.
We received several comments regarding the necessity and
methodology of adjustments to the minimum payment levels.
Comment: Some commenters objected to the proposed method for
handling necessary reductions to the minimum payment levels. One
commenter suggested that we develop a more sophisticated methodology
that would allow more refined adjustment of the minimum payment levels.
Another commenter suggested a 1 or 2 percent reduction increment,
rather than the proposed 5 percent increment.
Response: As stated above, in this final rule the minimum payment
levels for exception payments will remain at the current levels, since
our current forecasts indicate that we will not reach the 10 percent
limit in FY 1997. All comments received on this issue will be taken
under advisement and considered at such time as it becomes necessary to
make such an adjustment.
Comment: Some commenters believe that HCFA's capital acquisition
model (see appendix B to this final rule for a detailed discussion)
projects excessive growth in exception payments. These commenters
objected to any reduction in the capital minimum payment levels based
on projected rapid growth in exceptions and requested further
explanation. The commenters further stated that they could not
understand why exception payments would be so large when average
payments exceed costs.
Response: Since payments under the capital prospective payment
system are based on averages, not on an individual hospital's costs,
some hospitals may receive payments exceeding their costs, while other
hospitals may receive payments less than their costs. Even if aggregate
payments exceed aggregate costs, some hospitals may have costs so much
higher than payments that they qualify for large exceptions payments.
It is these large exceptions payments that are driving the
aggregate exception payments toward the 10 percent ceiling on exception
payments. We have reviewed the cost reports for the first 3 years under
the capital prospective payment system. The number of hospitals
receiving exceptions payments and the aggregate amount paid for
exceptions have increased each year. We expect this trend to continue
throughout the transition period, as some hospitals' payments deviate
even more from their actual costs. Our model is consistent with these
findings. The model projects, as expected, that exceptions payments
will continue to grow.
``Low cost'' hospitals are paid a blend of their hospital-specific
rate, and a higher Federal rate. ``High cost'' hospitals are paid 85
percent of their old capital plus their ratio of new capital to total
capital applied to the Federal rate. In both cases, the capital the
hospitals had at the time the capital prospective payment system was
implemented is addressed by the standard payments.
Capital prospective payment rates for FY 1992 were designed to
adequately address capital costs that existed at the time the
prospective payment system began. Since then, hospitals have acquired
additional capital, with some hospitals acquiring more than others.
With each passing year, more additional capital is accumulated. In some
cases, this additional capital is large, and the affected hospitals'
capital costs greatly exceed their standard payments. Exceptions
payments mitigate the financial impact on these hospitals.
High cost hospitals are more likely to qualify for exceptions
payments. Their old capital costs are encompassed in the hold harmless
payments, while their new capital costs are reimbursed at a fraction of
the Federal rate. If their new capital costs are high, these high cost
hospitals will need the full benefit of the exceptions process. Since
high cost hospitals will acquire more additional capital over time,
more hospitals will qualify for exceptions payments. In fact, high cost
hospitals showed rapid growth in exceptions in the first three years
under the capital prospective payment system. We expect this rapid
growth to continue.
Comment: Regarding minimum payment levels, one commenter suggested
we reconcile exceptions payments retrospectively and recoup any
overpayments on a pro rata basis by reducing future payments to
hospitals. The commenter recommends reductions in subsequent Medicare
payments to hospitals.
Response: Section 412.348(d) states that ``Total estimated payments
under the exceptions process may not exceed 10 percent of the total
estimated capital prospective payments (exclusive of hold-harmless
payments for old capital) for the same fiscal year.'' (Emphasis added.)
We believe reconciling actual exceptions payments with estimated
exceptions payments on a retroactive basis would fundamentally
undermine the prospectivity of the system. Moreover, recouping
``overpayments'' on a retroactive basis may be potentially unfair to
individual hospitals. An individual hospital that qualifies for an
exception payment in one year may not also qualify for an exception in
the later year in which a ``retroactive'' exception payment is to be
made. Hospitals would not be able to predict the effects of retroactive
adjustments to supposedly prospective payment rates.
VII. Changes for Hospitals and Units Excluded From the Prospective
Payment Systems
Application of Ceiling in Calculating Payment for Hospital Inpatient
Operating Costs (Sec. 413.40 (d) and (g))
Section 1886(b)(1)(B) of the Act provides for an additional payment
to a hospital excluded from the prospective payment system when the
hospital's reasonable operating costs exceed its target amount. The
additional payment is based on the lesser of 50 percent of the amount
by which the operating costs exceed the target amount, or 10 percent of
the target amount. The Medicare statute further provides that this
comparison is made ``after any exceptions or adjustments are made to
such target amount for any cost reporting period.'' The regulations, at
42 CFR Sec. 413.40(d)(3), state that the total payment to the hospital
for inpatient operating costs (including the additional payment
described above) is based on the lesser of the following: the ceiling
(target amount multiplied by the number of Medicare discharges) plus 50
percent of the allowable net inpatient operating costs in excess of the
ceiling, or 110 percent of the ceiling. However, the regulations do not
explicitly include the additional statutory requirement regarding the
effect of exceptions or adjustments.
As discussed in the proposed rule (61 FR 27481), we understand that
there are questions about the calculation of the additional payment
under the regulations, which require comparison of two amounts: the
``ceiling'' plus 50 percent of the difference between allowable costs
and the ceiling, and 110 percent of the ``ceiling.'' Specifically,
where a hospital has received an adjustment to the target amount under
Sec. 413.40(g), there has been confusion as to whether the ``ceiling''
used for purposes of calculating the additional payment under
Sec. 413.40(d) is the unadjusted ceiling (the amount determined without
consideration of
[[Page 46220]]
any adjustments granted to the hospital) or the adjusted ceiling.
To address any confusion about these issues, we proposed to revise
Sec. 413.40(d)(3) to indicate specifically that calculation of payments
for hospital inpatient operating costs under that provision reflects
the adjusted ceiling amount (the amount determined after an adjustment
under Sec. 413.40(g)). This would apply to all adjustments, including
adjustments based on a longer average length of stay in the hospital's
rate year as compared to the base year and adjustments for increased
routine services.
We received only two comments on this proposal. Both commenters
supported the proposal, and we will adopt as final the proposed changes
to the regulations at Sec. 413.40(d)(3).
VIII. ProPAC Recommendations
As required by law, we reviewed the March 1, 1996 report submitted
by ProPAC to Congress and gave its recommendations careful
consideration in conjunction with the proposals set forth in the
proposed rule. We also responded to the individual recommendations in
the proposed rule (61 FR 27482). The comments we received on the
treatment of the ProPAC recommendations are set forth below along with
our responses to those comments. However, if we received no comments
from the public concerning a ProPAC recommendation, we have not
repeated the recommendation and response in the discussion below. The
update factors for inpatient operating costs and the update factor for
hospitals excluded from the prospective payment system and distinct-
part units (ProPAC recommendations 10 and 12, respectively) are
discussed in Appendix E to this final rule. Capital payment rates
(recommendation 11) are discussed in section VI of this final rule.
Disproportionate share hospitals (recommendations 17 and 18) are
discussed in section V of this final rule. The remaining
recommendations on which we received comments are discussed below.
A. Discharges From Hospitals to Other Facilities (Recommendation 19)
Recommendation: Medicare payments should be modified to account for
the shift in services from acute to postacute settings. Broadening the
definition of transfer cases, however, is not an appropriate approach.
Response in the Proposed Rule: In both the September 1, 1994 and
September 1, 1995 final rules, we expressed our concern that the
current trend of declining average lengths of stay as hospitals
discharge Medicare patients into alternative health care settings
(other than acute care prospective payment hospitals) in less time may
result in a misalignment of payments and costs under our existing
payment systems (59 FR 45362; 60 FR 29221). In particular, we expressed
concern over the potential for hospitals paid under the prospective
payment system to shift costs (for which they are compensated through
the DRG payments) to alternative settings, which are in turn paid on a
cost basis. Although we solicited comments on possible solutions to
this problem, we did not propose any change in policy.
The President's FY 1997 budget includes a proposal to redefine
discharges from acute care hospitals to excluded hospitals and units
and skilled nursing facilities as transfers for payment purposes.
Currently, for cases transferred from one acute care hospital paid
under the prospective payment system to another like hospital, the
sending hospital is paid a per diem rate instead of the full DRG
amount. For cases transferred to an excluded hospital or unit or to a
skilled nursing facility (as well as cases discharged home or home with
home health care), hospitals receive the full DRG payment amount,
regardless of the length of stay in the hospital. Under the per diem
transfer payment methodology, hospitals receive a per diem amount
(doubled for the first day of the stay) until the full DRG amount is
reached. Therefore, under the President's budget proposal, hospitals
transferring patients to excluded facilities or skilled nursing
facilities prior to the geometric mean length of stay for the DRG,
minus one day (to account for the double per diem on the first day),
would receive less than the full DRG amount for that case.
The basis for ProPAC's opposition to this proposal is that it ``* *
* thinks this policy would discourage the use of postacute providers.
Moreover, it could result in longer inpatient stays, which may not be
desirable or cost effective in the long run.'' We acknowledge that the
change in the definition of a transfer is not the ultimate solution to
this health care trend. In response to immediate concerns about
overpaying hospitals for the reduced services they are providing and
the rate of increase in expenditures for postacute care services,
however, we believe this is an appropriate interim measure while we
continue to explore long-term policy alternatives that will better
integrate our payment systems for care provided to Medicare
beneficiaries across the acute and postacute care settings.
Comment: We received several comments on this response. ProPAC
repeated its concern that redefining transfers may not be the right
approach, indicating that ``(m)ore needs to be known about the
relationships among these services before implementing a policy that
assumes that hospitals are being overpaid for cases who use post-acute
care.'' Two other commenters expressed their objections to the
redefinition of transfers from acute care hospitals. Generally, both of
these commenters agreed with ProPAC's assessment that this would lead
to longer inpatient stays and discourage the use of postacute care.
Also, both commenters objected to ProPAC's suggestion that HCFA bundle
acute and postacute care payments. Finally, one commenter recommended
that ``the total Medicare funding for hospitals be reduced to recognize
the shift of patient days away from the hospital setting.''
Response: We agree with ProPAC that a better understanding of this
phenomenon is needed, and we are well aware of the improved efficiency
claims made by those who advocate even greater use of postacute care.
However, while we continue to explore potential refinements to reflect
the shift in services from acute to postacute settings, we believe it
is appropriate to concurrently explore interim measures for responding
to the undisputed trends showing continuing declining lengths of
hospital inpatient stays and increasing postacute care utilization,
particularly for certain DRGs. The present overlaps between our acute
and postacute payment methodologies demand immediate attention, given
our responsibility for preserving the Medicare Trust Fund.
We also understand the commenters' concerns about the transfer
redefinition. In evaluating any such interim measures two fundamental
questions need to be answered: Will this approach protect
beneficiaries' access to quality, effective health care and will it
adequately compensate the providers of that care for their costs? To
the extent that increasing utilization of postacute care allows
hospitals to release patients earlier, redefining transfers would
better match payments with costs, as well as eliminate some of the
potential incentive for premature discharges.
With regard to the comments we received about ProPAC's suggestion
that bundling might be a potential alternative, we intend to continue
to evaluate all potential payment approaches. For example, implementing
an offset to the hospital inpatient standardized amounts to reflect
cost
[[Page 46221]]
shifting is another approach under examination.
B. Prospective Payment for Postacute Care (Recommendation 20)
Recommendation: Prospective payment systems should be implemented
for all postacute services. The payment method for each service should
be consistent across delivery sites. The Secretary should explore
methods to control volume of postacute service use, such as bundling
services for a single payment.
Response in the Proposed Rule: We agree that HCFA should develop
prospective payment systems for all postacute services, and we have
made significant progress in this area. As we discuss in our responses
to Recommendations 22 and 23, we have developed detailed implementation
plans for interim prospective payment systems for skilled nursing
facilities (SNFs) and home health agencies (HHAs) that do not require
patient classification systems. Execution of these plans will, of
course, require legislative action.
Beyond our interim plan, we have developed a strategy for
developing a full-fledged prospective payment system for SNFs. In the
absence of legislation, we have been pursuing data that could be used
to support a case-mix prospective payment system through our Multi-
State Case Mix Demonstration Project. This demonstration project, now
in its operational phase, is collecting data on patient case mix using
a modified version of the minimum data set, the assessment tool SNFs
use in developing patient care plans. Through the course of the
demonstration, we hope to gather data on the full range of SNF
resources needed for each resource utilization group. We are proceeding
to require by regulation that all facilities provide resident
assessment data. Consolidated billing of SNF services (that is,
requiring SNFs to bill for all services furnished to their patients)
and uniform coding of SNF services are also prerequisites for a SNF
prospective payment system. Consolidated billing and uniform coding are
needed to determine the appropriate payment for the ancillary services
component of SNF services and to provide useful data on the range of
services SNFs furnish.
We have also been working on a strategy to develop a full-fledged
prospective payment system for HHAs. We have funded a project to
develop outcome measures for home care that can be used for an outcome-
based quality improvement system. These measures will be based largely
on a core standard assessment data set that includes items measuring
sociodemographic, environmental, support system, health status,
functional status, and health service utilization characteristics of
patients. Many of the data items included in the core standard
assessment data set are not only essential for assessing patient
outcomes but are also critical for designing an adequate case-mix
system for payment purposes. To test and refine Medicare's approach to
outcome based quality improvement for home health care, HCFA is
currently sponsoring the Medicare Quality Assurance and Improvement
Demonstration, which uses this instrument. We plan to publish
regulations identifying the required data elements and addressing the
collection of information from the core standard assessment data set.
We also plan to sponsor additional research that would lead to an
appropriate case mix adjuster that can be used in a national
prospective payment system.
In addition to the developmental work underway on SNF and HHA
prospective payment systems, we have begun work on the preliminary
steps necessary for the development of a prospective payment system for
hospital inpatient rehabilitation services. The biggest obstacle we
have faced in this effort is the lack of appropriate patient
classification systems for the types of patients treated by
rehabilitation hospitals. We have recently contracted with the Rand
Corporation to evaluate a rehabilitation coding system known as the
Functional Independence Measure (FIM), which is a scoring system that
measures the degree of functional independence of rehabilitation
patients. These researchers will also evaluate the patient
classification system known as function related groups (FRGs), which
are based on the FIM, as a possible basis for a Medicare prospective
payment system for rehabilitation services. If the research confirms
functional status measures can be used to develop an appropriate
patient classification system, we will begin the additional work
necessary to put a prospective payment system into place. This would
require collecting patient assessment data from Medicare rehabilitation
hospitals and units and developing all the necessary components of the
new payment system. It will take at least 3 years to design and
implement such a system. To facilitate implementation, we are
considering initiating collection of patient assessment data in advance
of legislation establishing a prospective payment system. We will be
seeking public input on whether to proceed with a requirement for
patient assessment data in the absence of legislation and what data
elements should be included in a core data set that could be used not
only as the basis for a patient classification system but also to
assess outcomes.
We recognize that there are advantages to a coordinated approach in
developing prospective payment systems for postacute services and we
will be evaluating how to make them as consistent as possible. We also
recognize that the demand for implementation of prospective payment
systems for postacute services is sufficiently immediate so that there
may not be time for the broad study, data collection, and research
needed to develop a ``unified'' system using similar resource grouping
principles. Most of the current legislative proposals, including the
Administration's proposals, would require implementation dates within
the next several years. It may not be feasible to develop a ``unified''
system within the time frames contemplated by the current legislative
proposals. Trade-offs may be required between continuation of the
interim payment systems versus the prospective payment systems on one
hand, and the separate versus ``unified'' prospective payment systems
on the other hand.
Comment: One commenter strongly supported adoption of a prospective
payment system for inpatient rehabilitation and believes that the RAND
research project will likely produce such a system. The commenter noted
that we are considering initiating the collection of patient assessment
data in advance of legislation establishing a prospective payment
system and urged us to begin collecting the data at the earliest
possible date. The commenter believes that imposition of a reporting
requirement based on the FIM should not be a great burden on the
industry since rehabilitation hospitals and units are already using the
FIM or similar patient evaluation measures. Systematizing collection of
such data would expedite introduction of a prospective payment system
based on FRGs and would considerably reduce the 3-year minimum
implementation period suggested in HCFA's response in the proposed
rule. The commenter also urged, as a means toward developing a payment
system that is consistent across payment sites based on patient
characteristics, that HCFA expand the RAND research project to
determine the feasibility of using an FRG-based payment system for
rehabilitation patients in skilled nursing facilities.
[[Page 46222]]
Response: Since the collection of patient assessment data in
advance of legislation establishing a prospective payment system would
expedite implementation of the system, we are exploring whether we can
initiate the collection of data from rehabilitation facilities without
legislative action. Our estimate of 3 years to design and implement a
payment system includes beginning data collection at the earliest
possible time and continuing the collection over a period sufficient to
ensure the validity and stability of the components of a payment
system, such as payment rates, relative weights of patient groups,
outlier payments, and facility payment adjustments, in addition to
ensuring the validity of coding within and across hospitals.
We agree with the commenter that, as a step toward developing a
payment system that is consistent across delivery sites, it would be
desirable to explore the usefulness of FRGs in a payment system for
rehabilitation services in skilled nursing facilities. We will,
therefore, evaluate our ability to expand the RAND project given the
limits of available resources. We note that we are also engaged in
research on other case-mix measures for SNF and home health services
and we will investigate the suitability of these measures for
rehabilitation hospital services.
C. Case-Mix Measures for Postacute Services (Recommendation 21)
Recommendation: Reliable case-mix measurement is important in
prospective payment systems to account for resource use and to analyze
treatment patterns and costs across sites. The Secretary should
coordinate case-mix research across postacute care settings, using
consistent methods for measuring patient acuity and resource use.
Response in the Proposed Rule: We are attempting to coordinate our
work on case-mix adjustment for home health care, long-term and SNF
care, and rehabilitative services. To develop a case-mix adjustment
system for SNF care, time studies were conducted in order to measure
resource utilization. Similarly, as noted above in response to
Recommendation 20, we have funded a new home health case-mix study.
In addition, in the case-mix work to date for both home health care
and SNF care, dependence in activities of daily living is the biggest
predictor of resource utilization. Some of the other predictors differ
across SNF care and home health care due to differences in the
treatment settings and the availability of information for a
classification system.
As also noted in the preceding response, researchers at the
University of Pennsylvania have developed a classification system based
on FIMs called Function Related Groups (FIM-FRGs). This system appears
promising for use in a case-mix adjusted prospective payment system for
rehabilitation and long-term care facilities, and we are working with
the Rand Corporation on a research project to evaluate the suitability
of FIM-FRGs for this purpose.
We agree that a compatible cross-provider measure of resource use
would be the best multiplier in any universal postacute system. We also
believe that such measures do not now exist and to produce them would
require the program to incur significant costs and impose significant
data reporting and collection requirements on providers. We would
prefer to obtain explicit legislative direction before we incur these
costs and impose these burdens. Even so, we believe several years would
be required to gather the data and develop the case-mix measures. For
these reasons, we believe that interim prospective payment systems of
the types contained in the President's FY 1997 budget should be put in
place.
Comment: One commenter agreed with ProPAC's recommendation to
develop a unified case-mix prospective payment system for postacute
care, but expressed concern that such a prospective payment system
based on ICD-9-CM codes will require the development of uniform coding
guidelines that do not currently exist.
Response: We have not yet decided whether it would be appropriate
to use ICD-9-CM codes in connection with a postacute prospective
payment system. We will keep the overall concern of uniform coding
guidelines in mind as we progress in our evaluation of postacute
prospective payment.
D. Update to the Composite Rate for Dialysis Services (Recommendation
24)
Recommendation: The Secretary should develop methods to control
total Medicare per capita expenditures for end stage renal disease
(ESRD) beneficiaries. In the meantime, the composite rate should be
updated by 2.7 percent for hospital-based dialysis facilities and by
2.0 percent for freestanding facilities for fiscal year 1997. The
Secretary should also develop reliable measures of patient severity and
outcomes to analyze the relationships among treatment processes,
patient outcomes, and costs. These factors should be considered in
evaluating the need for and the level of future payment updates.
Response in the Proposed Rule: One of ProPAC's suggestions is that
HCFA consider opening enrollment for ESRD beneficiaries to participate
in Medicare risk programs. The reason for this recommendation is the
rapid growth in total Medicare spending for ESRD beneficiaries. A large
part of this increase is attributable to the expanding ESRD population,
especially older patients who require more services. These
beneficiaries are using more acute inpatient, skilled nursing and other
dialysis-related services than ever before. ProPAC suggests that to
control these expenditures, Medicare examine the possibility of
adopting a capitation payment system for ESRD services, since
capitation rates have been successful in controlling expenditure growth
for other populations. At a minimum, they are recommending that
utilization review or other managed care techniques be used to control
the total volume of services provided to ESRD beneficiaries across all
sites of care.
Section 1876(d) of the Act currently prevents an individual with
ESRD from enrolling in an HMO or a competitive medical plan. However,
an individual who is enrolled in a prepaid health plan when he or she
is determined to have ESRD may continue enrollment in that plan. A
prepaid health plan may only disenroll a beneficiary as provided by
regulations at Sec. 417.460.
Congress addressed the issue of paying for ESRD services in a
capitation setting in legislation. Section 13567(b) of the Omnibus
Budget Reconciliation Act of 1993 (Pub. L. 103-66) (August 10, 1993)
amended section 2355 of Public Law 98-369 by requiring the Secretary to
include the integration of acute and chronic care management for
patients with ESRD through expanded community care case management
services in a social health maintenance organization (SHMO). Initial
legislation required the Secretary to grant demonstration waivers for
SHMOs that provide for the integration of health and social services at
a fixed annual prepaid capitation rate. In the January 26, 1996 Federal
Register, we published a notice informing interested parties of the
opportunity to apply for funds for a cooperative agreement to operate
an ESRD Managed Care Demonstration (61 FR 2516). Two of the
demonstration's purposes would be to test whether ESRD beneficiaries
can and should be given access to HMOs during open enrollment and
whether the statewide capitation rate can and should be adjusted. The
demonstration would adjust rates for treatment status (such as
dialysis, transplant, or a functioning graft), age groups and the cause
of renal
[[Page 46223]]
failure (for example, diabetes). As the legislation requires, rates
would be based on 100 percent of the adjusted average per capita costs
(AAPCC); additional non-Medicare-covered benefits would be offered by
the provider to justify the additional 5 percent beyond the 95 percent
of the AAPCC paid to Medicare risk-contracting HMOs on behalf of ESRD
enrollees. Based on the results of this demonstration, we would make
recommendations to Congress concerning the appropriateness of paying
for dialysis services in a capitation setting.
To improve the quality of care ESRD patients are receiving, we are
in the process of developing proposed rules for ESRD conditions for
coverage. The essence of the regulation is patient-centered and
outcome-oriented. The proposed conditions for coverage will focus on
facilities achieving an optimal level of health and well-being for all
dialysis patients. The proposed rules will be published in Spring 1996
with expected implementation in late fiscal year 1997.
While we share ProPAC's concern that payment rates be sufficient to
assure quality care for ESRD patients, we do not believe there is
sufficient evidence at this point to conclude that more money is needed
to provide appropriate care. Currently, the University of Michigan, as
part of a National Institute of Health grant, is examining the
relationship between facilities' costs and the level of KT/V. Also the
National Institute of Diabetes and Digestive and Kidney Diseases is
sponsoring a study on the impact of increasing dialysis as measured by
KT/V and the use of high-flux-dialysis on ESRD patients. The results of
these studies should help us analyze the relationship between patient
outcomes and costs, and thus provide us with a basis for recommending
an appropriate payment rate increase.
While we acknowledge that an increase in the composite rate may be
appropriate in the next few years, we believe that any rate increase
should be linked to implementation of the revised conditions for
coverage. Moreover, any ESRD rate increase must be considered within
the context of Medicare budgetary concerns and should have a direct
link to improved patient outcomes. We will continue to monitor ESRD
facility costs, and, if appropriate, we may recommend an update to the
ESRD composite rate for FY 1998.
We note that ProPAC's recommendation provides for an across-the-
board rate increase for all renal facilities. However, data show that
high volume independent facilities (over 6,000 treatments per year)
account for about 85 percent of independent dialysis treatments. These
high volume facilities report margins between Medicare payments and
costs that are higher than average. Therefore, in proposing a future
rate increase, we would want to examine the need to adjust payment
increases for volume. In addition, we believe that any update to the
composite rate should include an update to the wage index currently
used to adjust the labor portion of the rate. We are currently using an
outdated wage index which is a blend of 1980 Bureau of Labor Statistics
(BLS) and 1984 prospective payment system wage data and does not
reflect the MSA revisions resulting from the 1990 census.
The Commission's final recommendation is that the Secretary closely
monitor treatment patterns and patient outcomes to ensure that
facilities use the payment increase to improve quality of care. The
proposed ESRD conditions for coverage should address this issue. We
expect the proposed rule to be published in the Federal Register before
Summer 1996. Between the publication of the proposed and final rules,
HCFA is planning to meet with the renal community to develop complete
clinical data sets to monitor patient outcomes and medical conditions.
These data will then be used to evaluate the quality of dialysis
services furnished by individual facilities. Of course, this is a long-
term project. In the short term, we are exploring the possibility of
collecting limited patient outcome data such as KT/V and URR.
Comment: One commenter and the Commission reiterated that ProPAC's
recommended update framework was appropriate. According to ProPAC, its
analysis suggests that input costs are rising and large productivity
gains may no longer be possible. Consequently, renal facilities may be
unable to continue to provide quality dialysis without some payment
increase.
Response: As discussed above, we recognize that an increase in the
composite payment rate may be appropriate in the future, but we believe
that any rate increase should be linked to implementation of the
revised conditions for coverage for ESRD facilities. Until such
implementation, we will continue to monitor facility costs and other
factors to determine if it is appropriate to recommend a payment rate
increase. At this time, the composite payment rate is set by statute.
IX. Other Required Information
A. Paperwork Reduction Act
The Paperwork Reduction Act of 1995 provides for notice and comment
when a collection of information requirement is submitted to the Office
of Management and Budget (OMB) for review and approval. In order to
fairly evaluate whether an information collection should be approved by
OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995
requires that we solicit comment on the following issues:
Whether the information collection is necessary and useful
to carry out the proper functions of the agency;
The accuracy of the agency's estimate of the information
collection burden;
The quality, utility, and clarity of the information to be
collected; and
Recommendations to minimize the information collection
burden on the affected public, including automated collection
techniques.
Therefore, in the proposed rule, we solicited public comment on each of
these issues for the information collection requirement discussed
below.
The only information collection or paperwork burden item contained
in the FY 1997 proposed or final rules involves the requirement under
Sec. 489.27 that a hospital furnish each Medicare beneficiary with a
notice of discharge rights supplied by HCFA, that is, ``An Important
Message from Medicare.''
As discussed in section V of this preamble, we are revising the
current requirement that a hospital must distribute the ``Important
Message'' to each Medicare beneficiary at or about the time of
admission. In order to permit hospitals more flexibility, but still
ensure that beneficiaries are aware of their discharge rights, we are
revising Sec. 489.27 to specify that a hospital must provide the notice
of discharge rights ``during the course of the hospital stay.'' We
estimated that the paperwork burden associated with the requirement
that hospital personnel distribute the ``Important Message'' to each
Medicare beneficiary is approximately 1 minute per admission. Based on
our most recent available data (1995 Data Compendium, HCFA Pub. No.
03364), there are approximately 11 million Medicare beneficiaries
admitted to hospitals each year, resulting in an annual burden of
approximately 183,000 hours.
This paperwork burden is not effective until it has been approved
by OMB. A notice will be published in the Federal Register when
approval is obtained.
[[Page 46224]]
B. Requests for Data From the Public
In order to respond promptly to public requests for data related to
the prospective payment system, we have set up a process under which
commenters can gain access to the raw data on an expedited basis.
Generally, the data are available in computer tape format or
cartridges; however, some files are available on diskette, and on the
internet at HTTP://WWW.HCFA.GOV/STATS/PUBFILES.HTML. In our May 31,
1996 proposed rule, we published a list of data sets that are available
for purchase (61 FR 27490).
C. Waiver of Notice of Proposed Rulemaking
We ordinarily publish a notice of proposed rulemaking for a rule to
provide a period for public comment. However, we may waive that
procedure if we find good cause that prior notice and comment are
impracticable, unnecessary, or contrary to public interest.
Most provisions of this final rule were directly addressed in the
May 31, 1996 proposed rule (61 FR 27444) or were made in response to
comments on that proposed rule. The only issue raised in this final
rule for which we have not provided an opportunity for notice and
comment concerns a recently enacted statutory provision. On April 26,
1996, Congress enacted the Omnibus Consolidated Rescissions and
Appropriations Act of 1996. Among other things, the new statute
requires that, for certain purposes, the Federal Government ``shall
deem accredited any postgraduate physician training program that would
be accredited but for the accrediting agency's reliance upon an
accreditation standard that requires an entity to perform an induced
abortion or require, provide, or refer for training in the performance
of induced abortions, or make arrangements for such training,
regardless of whether such standard provides exceptions or
exemptions.''
In this final rule, we are revising the regulations at Sec. 412.105
and Sec. 413.86 to conform the regulations to the new statutory
provision. We find good cause to waive the procedure for notice and
comment with respect to these conforming changes. We find that the
procedure for notice and comment is unnecessary because these technical
changes merely conform the regulations text to the express requirements
of the statute and do not involve an exercise of agency discretion;
moreover, delaying these technical changes would be contrary to the
public interest because any perceived discrepancy between the
regulations and the statute might cause confusion.
List of Subjects
42 CFR Part 412
Administrative practice and procedure, Health facilities, Medicare,
Puerto Rico, Reporting and recordkeeping requirements.
42 CFR Part 413
Health facilities, Kidney diseases, Medicare, Puerto Rico,
Reporting and recordkeeping requirements.
42 CFR Part 489
Health facilities, Medicare.
42 CFR chapter IV is amended as set forth below:
A. Part 412 is amended as follows:
PART 412--PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL
SERVICES
1. The authority citation for part 412 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
Subpart D--Basic Methodology for Determining Prospective Payment
Federal Rates for Inpatient Operating Costs
2. In Sec. 412.63(s)(1), a new sentence is added at the end to read
as follows:
Sec. 412.63 Federal rates for inpatient operating costs for fiscal
years after Federal fiscal year 1984.
* * * * *
(s) * * *
(1) * * * The wage index is updated annually.
* * * * *
Subpart G--Special Treatment of Certain Facilities Under the
Prospective Payment System for Inpatient Operating Costs
3. In Sec. 412.105, the introductory text of both paragraph (g)(1)
and paragraph (g)(1)(i) is republished and a new paragraph (g)(1)(i)(D)
is added to read as follows:
Sec. 412.105 Special treatment: Hospitals that incur indirect costs for
graduate medical education programs.
* * * * *
(g) Determining the total number of full-time equivalent residents
for cost reporting periods beginning on or after July 1, 1991.
(1) For cost reporting periods beginning on or after July 1, 1991,
the count of full-time equivalent residents for the purpose of
determining the indirect medical education adjustment is determined as
follows:
(i) The resident must be enrolled in an approved teaching program.
An approved teaching program is one that meets one of the following
requirements:
* * * * *
(D) Is a program that would be accredited except for the
accrediting agency's reliance upon an accreditation standard that
requires an entity to perform an induced abortion or require, provide,
or refer for training in the performance of induced abortions, or make
arrangements for such training, regardless of whether the standard
provides exceptions or exemptions.
* * * * *
Subpart L--The Medicare Geographic Classification Review Board
4. In Sec. 412.246, paragraph (b) is revised to read as follows:
Sec. 412.246 MGCRB members.
* * * * *
(b) Term of office. The term of office for an MGCRB member may not
exceed 3 years. A member may serve more than one term. The Secretary
may terminate a member's tenure prior to its full term.
Subpart M--Prospective Payment System for Inpatient Hospital
Capital Costs
5. In Sec. 412.302, paragraph (d)(1) is revised and a new paragraph
(d)(4) is added to read as follows:
Sec. 412.302 Introduction to capital costs.
* * * * *
(d) Consistency in cost reporting--(1) General rule. For cost
reporting periods beginning on or after October 1, 1991, and before
October 1, 2001, the hospital must follow consistent cost finding
methods for classifying and allocating capital-related costs, except as
otherwise provided in paragraph (d)(4) of this section.
* * * * *
(4) Hospitals may elect the simplified cost allocation methodology
under the terms and conditions provided in the instructions for HCFA
Form 2552.
B. Part 413 is amended as follows:
[[Page 46225]]
PART 413--PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR
END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED
PAYMENT RATES FOR SKILLED NURSING FACILITIES
1. The authority citation for part 413 continues to read as
follows:
Authority: Secs. 1102, 1861(v)(1)(A), and 1871 of the Social
Security Act (42 U.S.C. 1302, 1395x(v)(1)(A), and 1395hh).
Subpart C--Limits on Cost Reimbursement
2. In Sec. 413.40, paragraph (d)(3) is revised to read as follows:
Sec. 413.40 Ceiling on the rate of increase in hospital inpatient
costs.
* * * * *
(d) * * *
(3) Net inpatient operating costs are greater than the ceiling. For
cost reporting periods beginning on or after October 1, 1991, if a
hospital's allowable net inpatient operating costs exceed the
hospital's ceiling (or the adjusted ceiling, if applicable), payment
will be based on the lower of the--
(i) Ceiling (or the adjusted ceiling, if applicable) plus 50
percent of the allowable net inpatient operating costs in excess of the
ceiling (or the adjusted ceiling, if applicable); or
(ii) One hundred-ten percent of the ceiling (or the adjusted
ceiling, if applicable).
* * * * *
Subpart F--Specific Categories of Costs
3. In Sec. 413.86, under paragraph (b), the definition of
``Approved geriatric program'' is revised and a new paragraph (4) is
added to the definition of ``Approved medical residency program'' and a
new sentence is added at the end of paragraph (g)(1) introductory text
to read as follows:
Sec. 413.86 Direct graduate medical education payments.
* * * * *
(b) Definitions.
* * * * *
Approved geriatric program means a fellowship program of one or
more years in length that is approved by the Accreditation Council for
Graduate Medical Education (ACGME) under the ACGME's criteria for
geriatric fellowship programs.
Approved medical residency program * * *
(4) Is a program that would be accredited except for the
accrediting agency's reliance upon an accreditation standard that
requires an entity to perform an induced abortion or require, provide,
or refer for training in the performance of induced abortions, or make
arrangements for such training, regardless of whether the standard
provides exceptions or exemptions.
* * * * *
(g) * * *
(1) * * * For combined residency programs, an initial residency
period is defined as the time required for individual certification in
the longer of the programs.
* * * * *
C. Part 489 would be amended as follows:
PART 489--PROVIDER AGREEMENTS AND SUPPLIER APPROVAL
1. The authority citation for part 489 continues to read as
follows:
Authority: Secs. 1102, and 1871 of the Social Security Act (42
U.S.C. 1302, and 1395hh).
Subpart B--Essentials of Provider Agreements
2. Section 489.27 is revised to read as follows:
Sec. 489.27 Beneficiary notice of discharge rights.
A hospital that participates in the Medicare program must furnish
each Medicare beneficiary, or an individual acting on his or her
behalf, the notice of discharge rights HCFA supplies to the hospital to
implement section 1886(a)(1)(M) of the Act. The hospital must provide
timely notice during the course of the hospital stay. For purposes of
this paragraph, the course of the hospital stay may begin with the
provision of a package of information regarding scheduled preadmission
testing and registration for a planned hospital admission. The hospital
must be able to demonstrate compliance with this requirement.
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: August 23, 1996.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
Dated: August 23, 1996.
Donna E. Shalala,
Secretary.
[Note: The following addendum and appendixes will not appear in the
Code of Federal Regulations.]
Addendum--Schedule of Standardized Amounts Effective With
Discharges On or After October 1, 1996 and Update Factors and Rate-
of-Increase Percentages Effective With Cost Reporting Periods
Beginning On or After October 1, 1996
I. Summary and Background
In this addendum, we are setting forth the amounts and factors for
determining prospective payment rates for Medicare inpatient operating
costs and Medicare inpatient capital-related costs. We are also setting
forth rate-of-increase percentages for updating the target amounts for
hospitals and hospital units excluded from the prospective payment
system.
For discharges occurring on or after October 1, 1996, except for
sole community hospitals and hospitals located in Puerto Rico, each
hospital's payment per discharge under the prospective payment system
will be based on 100 percent of the Federal national rate.
Sole community hospitals are paid based on whichever of the
following rates yields the greatest aggregate payment: the Federal
national rate, the updated hospital-specific rate based on FY 1982 cost
per discharge, or the updated hospital-specific rate based on FY 1987
cost per discharge. For hospitals in Puerto Rico, the payment per
discharge is based on the sum of 75 percent of a Puerto Rico rate and
25 percent of a national rate (section 1886(d)(9)(A) of the Act).
As discussed below in section II, we are making changes in the
determination of the prospective payment rates for Medicare inpatient
operating costs. The changes, to be applied prospectively, will affect
the calculation of the Federal rates. In section III, we discuss
changes we are making in determining the prospective payment rates for
Medicare inpatient capital-related costs. Section IV sets forth our
changes for determining the rate-of-increase limits for hospitals
excluded from the prospective payment system. The tables to which we
refer in the preamble to this final rule are presented at the end of
this addendum in section V.
II. Changes to Prospective Payment Rates for Inpatient Operating
Costs for FY 1997
The basic methodology for determining prospective payment rates for
inpatient operating costs is set forth at Sec. 412.63 for hospitals
located outside of Puerto Rico. The basic methodology for determining
the prospective payment rates for inpatient operating
[[Page 46226]]
costs for hospitals located in Puerto Rico is set forth at
Secs. 412.210 and 412.212. Below, we discuss the manner in which we are
changing some of the factors used for determining the prospective
payment rates. The Federal and Puerto Rico rate changes are effective
with discharges occurring on or after October 1, 1996. As required by
section 1886(d)(4)(C) of the Act, we must also adjust the DRG
classifications and weighting factors for discharges in FY 1997.
In summary, the standardized amounts set forth in Tables 1a and 1c
of section V of this addendum reflect--
Updates of 2.0 percent for all areas (that is, the market
basket percentage increase of 2.5 percent minus 0.5 percentage points);
An adjustment to ensure budget neutrality as provided for
in sections 1886(d)(4)(C)(iii) and (d)(3)(E) of the Act by applying new
budget neutrality adjustment factors to the large urban and other
standardized amounts;
An adjustment to ensure budget neutrality as provided for
in section 1886(d)(8)(D) of the Act by removing the FY 1996 budget
neutrality factor and applying a revised factor; and
An adjustment to apply the revised outlier offset by
removing the FY 1996 outlier offsets and applying a new offset.
A. Calculation of Adjusted Standardized Amounts
1. Standardization of Base-Year Costs or Target Amounts
Section 1886(d)(2)(A) of the Act required the establishment of
base-year cost data containing allowable operating costs per discharge
of inpatient hospital services for each hospital. The preamble to the
September 1, 1983 interim final rule (48 FR 39763) contains a detailed
explanation of how base-year cost data were established in the initial
development of standardized amounts for the prospective payment system
and how they are used in computing the Federal rates.
Section 1886(d)(9)(B)(i) of the Act required that Medicare target
amounts be determined for each hospital located in Puerto Rico for its
cost reporting period beginning in FY 1987. The September 1, 1987 final
rule contains a detailed explanation of how the target amounts were
determined and how they are used in computing the Puerto Rico rates (52
FR 33043, 33066).
The standardized amounts are based on per discharge averages of
adjusted hospital costs from a base period or, for Puerto Rico,
adjusted target amounts from a base period, updated and otherwise
adjusted in accordance with the provisions of section 1886(d) of the
Act. Sections 1886(d)(2)(C) and (d)(9)(B)(ii) of the Act required that
the updated base-year per discharge costs and, for Puerto Rico, the
updated target amounts, respectively, be standardized in order to
remove from the cost data the effects of certain sources of variation
in cost among hospitals. These include case mix, differences in area
wage levels, cost of living adjustments for Alaska and Hawaii, indirect
medical education costs, and payments to hospitals serving a
disproportionate share of low-income patients.
Since the standardized amounts have already been adjusted for
differences in case mix, wages, cost-of-living, indirect medical
education costs, and payments to hospitals serving a disproportionate
share of low-income patients, no additional adjustments for these
factors for FY 1997 were made. That is, the standardization adjustments
reflected in the FY 1997 standardized amounts are the same as those
reflected in the FY 1996 standardized amounts.
Under sections 1886(d)(2)(H) and (d)(3)(E) of the Act, in making
payments under the prospective payment system, the Secretary estimates
from time to time the proportion of costs that are wages and wage-
related costs. Since October 1, 1990, when the market basket was last
rebased, we have considered 71.4 percent of costs to be labor-related
for purposes of the prospective payment system. As discussed in section
IV of the preamble, we are using a rebased market basket effective for
FY 1997. Based on the rebased market basket, we are revising the labor
and nonlabor proportions of the standardized amounts. Effective with
discharges occurring on or after October 1, 1996, we are establishing a
labor-related proportion of 71.2 percent and a nonlabor- related
proportion of 28.8 percent. The standardized amounts in Table 1a of
section V of this addendum have been recomputed to reflect the revised
labor-related and nonlabor-related proportions. (We are revising the
Puerto Rico standardized amounts by the average labor share in Puerto
Rico of 82.8 percent. We are also revising the discharged-weighted
national standardized amount to reflect the proportion of discharges in
large urban and other areas from the FY 1995 MedPAR file.)
2. Computing Large Urban and Other Averages Within Geographic Areas
Section 1886(d)(3) of the Act requires the Secretary to compute two
average standardized amounts for discharges occurring in a fiscal year:
one for hospitals located in large urban areas and one for hospitals
located in other areas. In addition, under sections 1886(d)(9)(B)(iii)
and (C)(i) of the Act, the average standardized amount per discharge
must be determined for hospitals located in urban and other areas in
Puerto Rico. Hospitals in Puerto Rico are paid a blend of 75 percent of
the applicable Puerto Rico standardized amount and 25 percent of a
national standardized payment amount.
Section 1886(d)(2)(D) of the Act defines ``urban areas'' as those
areas within a Metropolitan Statistical Area (MSA). A ``large urban
area'' is defined as an urban area with a population of more than
1,000,000. In addition, section 4009(i) of Public Law 100-203 provides
that a New England County Metropolitan Area (NECMA) with a population
of more than 970,000 is classified as a large urban area. As required
by section 1886(d)(2)(D) of the Act, population size is determined by
the Secretary based on the latest population data published by the
Bureau of the Census. Urban areas that do not meet the definition of a
``large urban area'' are referred to as ``other urban areas.'' Areas
that are not included in MSAs are considered ``rural areas'' under
section 1886(d)(2)(D). Payment for discharges from hospitals located in
large urban areas will be based on the large urban standardized amount.
Payment for discharges from hospitals located in other urban and rural
areas will be based on the other standardized amount.
Based on 1995 population estimates published by the Bureau of the
Census, 56 areas meet the criteria to be defined as large urban areas
for FY 1997. These areas are identified by an asterisk in Table 4a.
Table 1a contains the two national standardized amounts that are
applicable to all hospitals, except for sole community hospitals and
hospitals in Puerto Rico. For a number of years, Table 1b had been used
to set forth the 18 regional standardized amounts applicable for
hospitals located in census areas subject to the regional floor.
However, as provided in section 1886(d)(1)(A)(iii)(II) of the Act, the
regional floor expires effective with discharges occurring on or after
October 1, 1996. Therefore, all hospitals (except sole community
hospitals and hospitals in Puerto Rico) will be paid solely on the
basis of the national standardized amounts. Under section
1886(d)(9)(A)(ii) of the Act, the national standardized payment amount
applicable to hospitals in Puerto Rico consists of the discharge-
weighted average of the national large urban standardized amount and
the national
[[Page 46227]]
other standardized amount (as set forth in Table 1a). The national
average standardized amount for Puerto Rico is set forth in Table 1c.
This table also includes the two standardized amounts that will be
applicable to most hospitals in Puerto Rico.
We note that on June 28, 1996, the Office of Management and Budget
announced the designation of the Pocatello, Idaho MSA and the
Jonesboro, Arkansas MSA. In addition, Chester County was added to the
Jackson, Tennessee MSA. We have incorporated these changes in this
final rule.
3. Updating the Average Standardized Amounts
In accordance with section 1886(d)(3)(A)(iv) of the Act, we are
updating the large urban and the other areas average standardized
amounts for FY 1997 using the applicable percentage increases specified
in section 1886(b)(3)(B)(i) of the Act. Section 1886(b)(3)(B)(i)(XII)
of the Act specifies that, for hospitals in all areas, the update
factor for the standardized amounts for FY 1997 is the market basket
percentage increase minus 0.5 percentage points.
The percentage change in the market basket reflects the average
change in the price of goods and services purchased by hospitals to
furnish inpatient care. The most recent forecast of the rebased
hospital market basket increase for FY 1997 is 2.5 percent. For FY
1997, this yields an update to the average standardized amounts of 2.0
percent (2.5 percent minus 0.5 percent). (See section IV of the
preamble to this final rule for a discussion of the market basket
rebasing.)
As in the past, we are adjusting the FY 1996 standardized amounts
to remove the effects of the FY 1996 geographic reclassifications and
outlier payments before applying the FY 1997 updates. That is, we are
increasing the standardized amounts to restore the reductions that were
made for the effects of geographic reclassification and outliers. After
including the FY 1997 offsets to the standardized amounts for outliers
and geographic reclassification, we estimate that there will be an
actual increase of 1.8 percent to the large urban and other area
standardized amounts.
We note that the FY 1996 standardized amounts reflected a budget
neutrality factor of 0.997575 to account for the change in transfer
payment policy implemented in FY 1996. See 60 FR 45854. In the proposed
rule we stated that ``there will be no need for a further budget
neutrality adjustment'' (61 FR 27573), but we incorrectly suggested
that the FY 1996 budget neutrality adjustment for transfers should be
removed in setting the FY 1997 rates. The budget neutrality adjustment
for the transfer policy is built permanently into the unadjusted rates.
Although the update factor for FY 1997 is set by law, we were
required by section 1886(e)(3)(B) of the Act to report to Congress on
our initial recommendation of update factors for FY 1997 for both
prospective payment hospitals and hospitals excluded from the
prospective payment system. For general information purposes, we
published the report to Congress as Appendix D to the proposed rule.
That recommendation was based on an earlier forecast of the market
basket increase. Our final recommendation on the update factors (which
is required by sections 1886(e)(4)(A) and (e)(5)(A) of the Act) is set
forth as Appendix D to this final rule.
4. Other Adjustments to the Average Standardized Amounts
a. Recalibration of DRG Weights and Updated Wage Index--Budget
Neutrality Adjustment.--Section 1886(d)(4)(C)(iii) of the Act specifies
that beginning in FY 1991, the annual DRG reclassification and
recalibration of the relative weights must be made in a manner that
ensures that aggregate payments to hospitals are not affected. As
discussed in section II of the preamble, we normalized the recalibrated
DRG weights by an adjustment factor, so that the average case weight
after recalibration is equal to the average case weight prior to
recalibration.
Section 1886(d)(3)(E) of the Act specifies that the hospital wage
index must be updated on an annual basis beginning October 1, 1993.
This provision also requires that any updates or adjustments to the
wage index must be made in a manner that ensures that aggregate
payments to hospitals are not affected by the change in the wage index.
To comply with the requirement of section 1886(d)(4)(C)(iii) of the
Act that DRG reclassification and recalibration of the relative weights
be budget neutral, and the requirement in section 1886(d)(3)(E) of the
Act that the updated wage index be budget neutral, we compared
aggregate payments using the FY 1996 relative weights and wage index to
aggregate payments using the FY 1997 relative weights and wage index.
The same methodology was used for the FY 1996 budget neutrality
adjustment. (See the discussion in the September 1, 1992 final rule (57
FR 39832).) Based on this comparison, we computed a proposed budget
neutrality adjustment factor equal to 0.998509. Based on the final FY
1997 relative weights and wage index, the final budget neutrality
adjustment factor is 0.998703. This budget neutrality adjustment factor
is applied to the standardized amounts without removing the effects of
the FY 1996 budget neutrality adjustment. We do not remove the prior
budget neutrality adjustment because estimated aggregate payments after
the changes in the DRG relative weights and wage index should equal
estimated aggregate payments prior to the changes. If we removed the
prior year adjustment, we would not satisfy this condition.
In addition, we will continue to apply the same FY 1997 adjustment
factor to the hospital-specific rates that are effective for cost
reporting periods beginning on or after October 1, 1996, in order to
ensure that we meet the statutory requirement that aggregate payments
neither increase nor decrease as a result of the implementation of the
FY 1997 DRG weights and updated wage index. (See the discussion in the
September 4, 1990 final rule (55 FR 36073).)
b. Reclassified Hospitals--Budget Neutrality Adjustment.--Section
1886(d)(8)(B) of the Act provides that certain rural hospitals are
deemed urban effective with discharges occurring on or after October 1,
1988. In addition, section 1886(d)(10) of the Act provides for the
reclassification of hospitals based on determinations by the Medicare
Geographic Classification Review Board (MGCRB). Under section
1886(d)(10) of the Act, a hospital may be reclassified for purposes of
the standardized amount or the wage index, or both.
Under section 1886(d)(8)(D) of the Act, the Secretary is required
to adjust the standardized amounts so as to ensure that total aggregate
payments under the prospective payment system after implementation of
the provisions of sections 1886(d)(8) (B) and (C) and 1886(d)(10) of
the Act are equal to the aggregate prospective payments that would have
been made absent these provis
FR Doc. 96-22145 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1997 Rates
ions. To calculate this budget neutrality
factor, we used historical discharge data to simulate payments, and
compared total prospective payments (including indirect medical
education and disproportionate share payments) prior to any
reclassifications to total prospective payments after
reclassifications. In the proposed rule, we applied an adjustment
factor of 0.994059 to ensure that the effects of reclassification are
budget neutral. The
[[Page 46228]]
final budget neutrality adjustment factor is 0.993514.
The adjustment factor is applied to the standardized amounts after
removing the effects of the FY 1996 budget neutrality adjustment
factor. We note that the proposed FY 1997 adjustment reflected wage
index and standardized amount reclassifications approved by the MGCRB
or the Administrator as of March 14, 1996. The final budget neutrality
adjustment factor reflects the effects of all reclassification changes
resulting from appeals and reviews of the MGCRB decisions for FY 1997
or from a hospital's request for the withdrawal of a reclassification
request.
c. Outliers.--Section 1886(d)(5)(A) of the Act provides for
payments in addition to the basic prospective payments for ``outlier''
cases, cases involving extraordinarily high costs (cost outliers) or
long lengths of stay (day outliers). Section 1886(d)(3)(B) of the Act
requires the Secretary to adjust both the large urban and other area
national standardized amounts by the same factor to account for the
estimated proportion of total DRG payments made to outlier cases.
Similarly, section 1886(d)(9)(B)(iv) of the Act requires the Secretary
to adjust the large urban and other standardized amounts applicable to
hospitals in Puerto Rico by the same factor to account for the
estimated proportion of total DRG payments made to outlier cases.
Furthermore, under section 1886(d)(5)(A)(iv) of the Act, outlier
payments for any year must be projected to be not less than 5 percent
nor more than 6 percent of total payments based on DRG prospective
payment rates.
Beginning with FY 1995, section 1886(d)(5)(A) of the Act requires
the Secretary to phase out payments for day outliers (correspondingly,
payments for cost outliers would increase). Under the requirements of
section 1886(d)(5)(A)(v), the proportion of day outlier payments to
total outlier payments is reduced from FY 1994 levels as follows: 75
percent of FY 1994 levels in FY 1995, 50 percent of FY 1994 levels in
FY 1996, and 25 percent of FY 1994 levels in FY 1997. We estimated the
FY 1994 proportion of day outlier payments to total outlier payments at
31.3 percent in our September 1, 1993 final rule (58 FR 46348). Thus,
the proportion of day outlier payments to total outlier payments in FY
1997 will be approximately 8 percent (25 percent of 31.3 percent). For
discharges occurring after September 30, 1997, the Secretary will no
longer pay for day outliers under the provisions of section
1886(d)(5)(A)(I) of the Act.
i. FY 1997 Outlier Payment Policies, Including Outlier Thresholds
For FY 1996, the day outlier threshold is the geometric mean length
of stay for each DRG plus the lesser of 23 days or 3.0 standard
deviations. The marginal cost factor for day outliers (the percent of
Medicare's average per diem payment paid for each outlier day) is 44
percent for FY 1996. The fixed loss cost outlier threshold is equal to
the prospective payment for the DRG plus $15,150 ($13,800 for hospitals
that have not yet entered the prospective payment system for capital-
related costs). The marginal cost factor for cost outliers (the percent
of costs paid after costs for the case exceed the threshold) is 80
percent. We applied an outlier adjustment to the FY 1996 standardized
amounts of 0.949054 for the large urban and other areas rates and
0.9526 for the capital Federal rate.
For FY 1997, we proposed to set the day outlier threshold at the
geometric mean length of stay for each DRG plus the lesser of 24 days
or 3.0 standard deviations. Section 1886(d)(5)(A)(iii) of the Act, as
amended by section 13501(c)(3) of Public Law 103-66, provides that
additional payments for day outlier cases may be reduced below the
marginal cost of care to meet the requirements of section
1886(d)(5)(A)(v) of the Act. We also proposed to reduce the marginal
cost factor for each outlier day from 44 percent to 35 percent in FY
1997. The thresholds that we are establishing in this final rule will
be the geometric mean length of stay for each DRG plus the lesser of 24
days or 3.0 standard deviations. Based on updated simulations, we are
establishing in this final rule a marginal cost factor of 33 percent
for each outlier day in FY 1997. We estimate that these policies will
reduce the proportion of outlier payments paid to day outliers to
approximately 8 percent, in accordance with section 1886(d)(5)(A) of
the Act.
In the proposed rule, we proposed to maintain the marginal cost
factor for cost outliers at 80 percent and proposed a fixed loss cost
outlier threshold in FY 1997 equal to the prospective payment rate for
the DRG plus $11,050 ($10,075 for hospitals that have not yet entered
the prospective payment system for capital-related costs). In this
final rule, based on simulations using updated data and a revised cost
inflation factor (discussed below), we are establishing a fixed loss
cost outlier threshold in FY 1997 equal to the prospective payment rate
for the DRG plus $9,700 ($8,850 for hospitals that have not yet entered
the prospective payment system for capital-related costs). We are also
establishing a marginal cost factor for cost outliers of 80 percent, as
proposed. We note that the FY 1997 cost outlier calculations are to be
completed using the revised labor/nonlabor shares discussed above in
section II.A.1 in this Addendum.
The final FY 1997 cost outlier threshold reflects a revised cost
inflation factor. As explained in the proposed rule, in setting the
proposed FY 1997 cost outlier threshold, we used a cost inflation
factor of 0.0 percent to simulate payments using FY 1995 hospital bills
(61 FR 27497). That is, to determine when a case should qualify for
cost outlier payments in FY 1997, we calculated FY 1997 ``costs'' for
each bill in the FY 1995 MedPAR file by applying a cost inflation
factor of 0.0 percent. We indicated that we would reevaluate this
factor in developing the final rule.
The latest available Medicare cost reports indicate that hospital
cost per case decreased from FY 1993 to FY 1994 as well as from FY 1994
to FY 1995. Cost report data for 4,600 hospitals for cost reporting
periods beginning in FYs 1993 and 1994 show that cost per case
decreased 1.906 percent from FY 1993 to FY 1994. Preliminary data for
cost reports beginning in FY 1995, which were unavailable when we
developed the proposed rule, show that cost per case decreased 2.392
percent from FY 1994 to FY 1995. The latter figure is preliminary to
the extent that it reflects only 1,800 hospitals and also reflects ``as
submitted'' cost reports. Nevertheless, it suggests a continued trend
in cost deflation. Accordingly, based on the more complete data for
hospital cost reporting periods beginning in FYs 1993 and 1994, we have
decided to use a cost inflation factor of minus 1.906 percent (a cost
per case decrease of 1.906 percent) for purposes of setting the final
FY 1997 outlier thresholds (as compared with our proposed FY 1997 cost
inflation factor of 0.0 percent). We note that this is the first time
we have deflated costs in making the outlier projection.
The use of a negative cost inflation factor results in lower FY
1997 ``costs'' for the set of cases analyzed. For example, if a bill in
the FY 1995 MedPAR file reflects FY 1995 ``costs'' of $1,000, the FY
1997 ``costs'' will be
$1,000 x (1-0.01906) x (1-0.01906)
(reflecting 2 years of cost deflation), or $962.24. These lower costs,
in turn, result in a lower cost outlier threshold relative to a
methodology using a positive or zero cost inflation factor (other
things being equal). As stated above, the final FY 1997 cost outlier
threshold is the DRG amount plus $9,700, rather than $11,050 as
indicated in the proposed rule.
[[Page 46229]]
In accordance with section 1886(d)(5)(A)(iv) of the Act, we
calculated outlier thresholds so that outlier payments are projected to
equal 5.1 percent of total payments based on DRG prospective payment
rates. In accordance with section 1886(d)(3)(E), we reduced the FY 1997
standardized amounts by the same percentage to account for the
projected proportion of payments paid to outliers.
As stated in the September 1, 1993 final rule (58 FR 46348), we
establish outlier thresholds that are applicable to both inpatient
operating costs and inpatient capital-related costs. When we modeled
the combined operating and capital outlier payments, we found that
using a common set of thresholds resulted in a higher percentage of
outlier payments for capital-related costs than for operating costs. We
project that the thresholds for FY 1997 will result in outlier payments
equal to 5.1 percent of operating DRG payments and 5.2 percent of
capital payments based on the Federal rate.
The proposed outlier adjustment factors applied to the standardized
amounts and the capital Federal rate for FY 1997 were as follows:
------------------------------------------------------------------------
Operating standardized amounts Capital Federal rate
------------------------------------------------------------------------
0.948968.................................. 0.9476
------------------------------------------------------------------------
The final outlier adjustment factors applied to the standardized
amounts and the capital Federal rate for FY 1997 are as follows:
------------------------------------------------------------------------
Operating standardized amounts Capital Federal rate
------------------------------------------------------------------------
0.948766.................................. 0.9481
------------------------------------------------------------------------
As in the proposed rule, we apply the final outlier adjustment
factors after removing the effects of the FY 1996 outlier adjustment
factors on the standardized amounts and the capital Federal rate.
ii. Other Changes Concerning Outliers
Table 5 of section V of this addendum contains the DRG relative
weights, geometric and arithmetic mean lengths of stay, as well as the
day outlier threshold for each DRG. When we recalibrate DRG weights, we
set a threshold of 10 cases as the minimum number of cases required to
compute a reasonable weight and geometric mean length of stay. DRGs
that do not have at least 10 cases are considered to be low volume
DRGs. For the low volume DRGs, we use the original geometric mean
lengths of stay, because no arithmetic mean length of stay was
calculated based on the original data.
Table 8a in section V of this addendum contains the updated
Statewide average operating cost-to-charge ratios for urban hospitals
and for rural hospitals to be used in calculating cost outlier payments
for those hospitals for which the intermediary is unable to compute a
reasonable hospital-specific cost-to-charge ratio. These Statewide
average ratios will replace the ratios published in the September 1,
1995 final rule (60 FR 45922), effective October 1, 1996. Table 8b
contains comparable Statewide average capital cost-to-charge ratios.
These average ratios will be used to calculate cost outlier payments
for those hospitals for which the intermediary computes operating cost-
to-charge ratios lower than 0.24265 or greater than 1.28879 and capital
cost-to-charge ratios lower than 0.013243 or greater than 0.19730. This
range represents 3.0 standard deviations (plus or minus) from the mean
of the log distribution of cost-to-charge ratios for all hospitals. We
note that the cost-to-charge ratios in Tables 8a and 8b will be used
for all cost reports settled during FY 1997 (regardless of the actual
cost reporting period) when hospital-specific cost-to-charge ratios are
either not available or outside the three standard deviations range.
iii. FY 1995 and FY 1996 Outlier Payments
In the proposed rule, we estimated that actual outlier payments for
FY 1995 were approximately 3.7 percent of actual total DRG payments
(lower than the 5.1 percent we projected in setting outlier policies
for FY 1995). This percentage was computed by simulating payments using
actual FY 1995 bill data available at the time of the proposed rule.
Our current estimate is that actual outlier payments for FY 1995 were
approximately 3.8 percent of actual total DRG payments. These estimates
are based on simulations using the July 1996 update of the provider-
specific file and the June 1996 update of the FY 1995 MedPAR file.
In the proposed rule, we estimated that actual outlier payments for
FY 1996 would be approximately 4.2 percent of actual total DRG payments
(lower than the 5.1 percent we projected in setting outlier policies
for FY 1996). We currently estimate that FY 1996 outlier payments will
approximate 4.0 percent of total DRG payments. This current estimate is
based on simulations using the July 1996 update of the provider-
specific file and the June 1996 update of the FY 1995 MedPAR file. We
used these data to calculate an estimate of the actual outlier
percentage for FY 1996 by applying FY 1996 rates and policies to the FY
1995 bills.
In the proposed rule, we discussed in detail our methodology for
setting outlier thresholds, our periodic refinements to that
methodology, and some possible explanations for the recent differences
between projected and actual outlier percentages (61 FR 27496). We
invited comments and suggestions for further refinements to the
methodology. The comments on our outlier policies and methodology and
our responses are set forth below.
Comment: A number of commenters are concerned that the percentages
of actual outlier payments for FYs 1995 and 1996 are lower than we
projected when we set the respective thresholds for those years. Some
commenters requested that we monitor outlier payments during a fiscal
year, so that we can change the thresholds in the middle of the year in
the event that projected actual outlier payments are not between 5 and
6 percent of projected actual total DRG payments. Other commenters
requested that any difference between outlier payments and the amount
set aside be used to offset the amount required in the next year. One
commenter argued that it is fundamentally inequitable, even assuming
that it is not illegal, not to make additional outlier payments after
the end of the fiscal year to assure that we meet our 5.1 percent goal.
The commenter cited historical figures on outlier payments from a
pending court case in the United States District Court for the District
of Columbia, County of Los Angeles v. Shalala, C.A. No. 93-0146 SSH
(D.D.C).
Response: We have responded to similar comments a number of times,
including the final rules for FY 1993 (57 FR 39784), FY 1994 (58 FR
46347), FY 1995 (59 FR 45408), and FY 1996 (60 FR 45856). As we have
explained before and as explained below, we believe our outlier
policies are consistent with the statute and the goals of the
prospective payment system and are not inequitable.
In accordance with section 1886(d)(5)(A)(iv) of the Act, we set
outlier thresholds before a fiscal year so that outlier payments for
the fiscal year are projected to be 5.1 percent of total DRG payments.
In doing so, we use the best available Medicare discharge data and
hospital-specific data.
Many of the factors used to set prospective payment amounts for a
given fiscal year are based on estimates. These factors include not
only the outlier thresholds, but also the market basket rate of
increase used to establish
[[Page 46230]]
the update factors, the recalibration of the DRG weights, and the
various required budget neutrality provisions. We do not believe that
Congress intended for us to revise these factors in midyear. Similarly,
we do not believe that Congress intended that the standardized amounts
for a given fiscal year should be adjusted (upward or downward) to
reflect any difference between projected and actual outlier payments
for a past fiscal year. Payments for a given discharge in a given
fiscal year are generally intended to reflect or address the average
costs of that discharge in that year; that goal would be undermined if
we adjusted prospective payment system payments to account for
``underpayments'' or ``overpayments'' in other years.
Moreover, the midyear or retroactive adjustments contemplated by
the commenters would be extremely difficult or impracticable (if not
impossible) to administer. Hospital bill data with respect to a given
fiscal year continues to be added to the MedPAR file for some time
after the end of the fiscal year. (We update the MedPAR file for 2 full
years after the end of the respective fiscal year.) Therefore, precise
figures on actual outlier payments for a given fiscal year cannot be
determined until well after that fiscal year ends. We do publish
estimates of ``actual'' outlier payments for recent fiscal years, but
those estimates are based on available bills (and sometimes based on
simulations using bills for a previous year, adjusted for estimates of
inflation).
In short, we believe our outlier policies are consistent with the
statute and the goals of the prospective payment system. In a recent
court decision, the United States District Court for the Central
District of California upheld the agency's interpretation of the
statute as reasonable, writing in part that ``[a]ny retroactive
adjustment would be inconsistent with [prospective payment system]
because the incentives for cost reduction and efficiency would be
eliminated.'' Alvarado Community Hospital v. Shalala, Case No. CV 94-
0972 RMT (Ex) (C.D. Cal May 6, 1996), appeal filed, No. 96-55967 (9th
Cir.). (There is pending litigation on the same issues in the U.S.
District Court for the District of Columbia.)
Finally, we do not agree that our outlier policies are
fundamentally inequitable. As we discussed in the proposed rule, we
believe that one reason outlier payments have been lower than expected
is that hospital costs are not increasing at the rate we expected, and
costs may even be decreasing. Available data show that, beginning in FY
1994, for the first time since the inception of the prospective payment
system, hospitals are experiencing actual decreases in cost per case
from one year to the next. This information is confirmed by ProPAC in
its June 1996 Report to Congress ``Medicare and the American Health
Care System'' (Table 3-3, Annual Change in PPS Operating Costs and
Payments, First 11 Years of PPS, p. 65). These actual decreases in cost
per case follow a period of several years in which the rate of increase
in operating cost per case declined from one year to the next.
The thresholds for a given fiscal year reflect a certain level of
costs, so if hospitals are generally holding costs down, then fewer
cases qualify for outlier payments and outlier payments are lower than
expected. But if lower hospital costs result in lower than expected
outlier payments, it also results in higher than expected ``profits''
(at least with respect to nonoutlier cases). Hospital, Medicare profit
margins have rebounded to levels not seen since the middle of the
1980s. In the June 1996 report, ProPAC found the aggregate prospective
payment system operating margin to be 6.0 percent for FY 1994 (Figure
3-2, Aggregate PPS Operating Margin, First 13 Years of PPS p. 68).
ProPAC believes that aggregate prospective payment system margins are
even higher for FYs 1995 and 1996.
Therefore, we believe that ``underpayments'' for outliers are not
fundamentally inequitable because one factor contributing to this
result--lower hospital costs--results in ``overpayments'' with respect
to the standard DRG payments. We do not make retroactive adjustments to
the standard DRG payments to account for the effect of actual costs
being lower than expected; similarly, we do not make retroactive
adjustments to outlier payments.
As we have stated previously, we believe the more appropriate
action for addressing outlier payments is to continue to examine the
outlier policy and try to refine our estimation methodology.
Comment: Two commenters stated that, after modeling the outlier
payments, they were able to replicate HCFA's result of 5.1 percent for
operating outlier payments, but that their analysis yielded only 4.8
percent for capital outlier payments as compared with HCFA's result of
5.2 percent.
Response: We have determined that the methodology used by the
commenters contained several technical errors.
Comment: Two commenters requested that we develop an econometric
hospital cost model to help us predict the cost inflation factors used
for purposes of setting outlier thresholds.
Response: Currently, we calculate the cost inflation factor used to
set outlier thresholds by analyzing hospital cost report data on cost
per case for recent cost reporting periods. The nature of the
econometric cost model contemplated by the commenters is not entirely
clear to us, but we are interested in exploring such an approach and
welcome specific suggestions for developing an econometric model. We
believe such an approach might be helpful if the model could analyze
data that are more recent than the data available in hospital cost
reports.
We did not receive any specific suggestions for refinements to our
outlier estimation methodology. We note that one commenter believes
that the 0.0 percent cost inflation factor reflected in the proposed
rule is warranted. As explained above, in this final rule, we are using
a cost inflation factor of minus 1.906 percent to further reflect the
decreases in cost per case.
B. Adjustments for Area Wage Levels and Cost of Living
The adjusted standardized amounts are divided into labor and
nonlabor portions. Tables 1a and 1c, as set forth in this addendum,
contain the actual labor-related and nonlabor-related shares that will
be used to calculate the prospective payment rates for hospitals
located in the 50 States, the District of Columbia, and Puerto Rico.
This section addresses two types of adjustments to the standardized
amounts that are made in determining the prospective payment rates as
described in this addendum.
1. Adjustment for Area Wage Levels
Sections 1886(d)(3)(E) and 1886(d)(9)(C)(iv) of the Act require
that an adjustment be made to the labor-related portion of the
prospective payment rates to account for area differences in hospital
wage levels. This adjustment is made by multiplying the labor-related
portion of the adjusted standardized amounts by the appropriate wage
index for the area in which the hospital is located. In section III of
the preamble, we discuss certain revisions we are making to the wage
index. This index is set forth in Tables 4a through 4e of this
addendum.
[[Page 46231]]
2. Adjustment for Cost of Living in Alaska and Hawaii
Section 1886(d)(5)(H) of the Act authorizes an adjustment to take
into account the unique circumstances of hospitals in Alaska and
Hawaii. Higher labor-related costs for these two States are taken into
account in the adjustment for area wages described above. For FY 1997,
we are adjusting the payments for hospitals in Alaska and Hawaii by
multiplying the nonlabor portion of the standardized amounts by the
appropriate adjustment factor contained in the table below.
Table of Cost-of-Living Adjustment Factors, Alaska and Hawaii Hospitals
------------------------------------------------------------------------
Alaska--All areas............................................. 1.25
Hawaii:
County of Honolulu........................................ 1.225
County of Hawaii.......................................... 1.15
County of Kauai........................................... 1.20
County of Maui............................................ 1.225
County of Kalawao......................................... 1.225
------------------------------------------------------------------------
(The above factors are based on data obtained from the U.S. Office of
Personnel Management.)
C. DRG Relative Weights
As discussed in section II of the preamble, we have developed a
classification system for all hospital discharges, assigning them into
DRGs, and have developed relative weights for each DRG that reflect the
resource utilization of cases in each DRG relative to Medicare cases in
other DRGs. Table 5 of section V of this addendum contains the relative
weights that we will use for discharges occurring in FY 1997. These
factors have been recalibrated as explained in section II of the
preamble.
D. Calculation of Prospective Payment Rates for FY 1997
General Formula for Calculation of Prospective Payment Rates for FY
1997
Prospective payment rate for all hospitals located outside Puerto
Rico except sole community hospitals = Federal rate.
Prospective payment rate for sole community hospitals = Whichever
of the following rates yields the greatest aggregate payment: 100
percent of the Federal rate, 100 percent of the updated FY 1982
hospital-specific rate, or 100 percent of the updated FY 1987 hospital-
specific rate.
Prospective payment rate for Puerto Rico = 75 percent of the Puerto
Rico rate + 25 percent of a discharge-weighted average of the national
large urban standardized amount and the national other standardized
amount.
1. Federal Rate
For discharges occurring on or after October 1, 1996 and before
October 1, 1997, except for sole community hospitals and hospitals in
Puerto Rico, the hospital's payment is based exclusively on the Federal
national rate. Section 1866(d)(1)(A)(iii) of the Act provides that the
Federal rate is comprised of 100 percent of the Federal national rate.
The payment amount is determined as follows:
Step 1--Select the appropriate national standardized amount
considering the type of hospital and designation of the hospital as
large urban or other (see Tables 1a, section V of this addendum).
Step 2--Multiply the labor-related portion of the standardized
amount by the applicable wage index for the geographic area in which
the hospital is located (see Tables 4a, 4b, and 4c, section V of this
addendum).
Step 3--For hospitals in Alaska and Hawaii, multiply the nonlabor-
related portion of the standardized amount by the appropriate cost-of-
living adjustment factor.
Step 4--Add the amount from Step 2 and the nonlabor-related portion
of the standardized amount (adjusted if appropriate under Step 3).
Step 5--Multiply the final amount from Step 4 by the relative
weight corresponding to the appropriate DRG (see Table 5, section V of
this addendum).
2. Hospital-Specific Rate (Applicable Only to Sole Community Hospitals)
Sections 1886(d)(5)(D)(i) and (b)(3)(C) of the Act provide that
sole community hospitals are paid based on whichever of the following
rates yields the greatest aggregate payment: the Federal rate, the
updated hospital-specific rate based on FY 1982 cost per discharge, or
the updated hospital-specific rate based on FY 1987 cost per discharge.
Hospital-specific rates have been determined for each of these
hospitals based on both the FY 1982 cost per discharge and the FY 1987
cost per discharge. For a more detailed discussion of the calculation
of the FY 1982 hospital-specific rate and the FY 1987 hospital-specific
rate, we refer the reader to the September 1, 1983 interim final rule
(48 FR 39772); the April 20, 1990 final rule with comment (55 FR
15150); and the September 4, 1990 final rule (55 FR 35994).
a. Updating the FY 1982 and FY 1987 Hospital-Specific Rates for FY
1997.--We are increasing the hospital-specific rates by 2.0 percent
(the hospital market basket percentage increase of 2.5 percent minus
0.5 percentage points) for sole community hospitals located in all
areas in FY 1997. Section 1886(b)(3)(C)(ii) of the Act provides that
the update factor applicable to the hospital-specific rates for sole
community hospitals equals the update factor provided under section
1886(b)(3)(B)(ii) of the Act, which, for FY 1997, is the market basket
rate of increase minus 0.5 percentage points.
b. Calculation of Hospital-Specific Rate.--For sole community
hospitals, the applicable FY 1997 hospital-specific rate will be
calculated by multiplying a hospital's hospital-specific rate for the
preceding fiscal year by the applicable update factor (2.0 percent),
which is the same as the update for all prospective payment hospitals.
In addition, the hospital-specific rate will be adjusted by the budget
neutrality adjustment factor (that is, 0.998703) as discussed in
section II.A.4.a of this addendum. This resulting rate will be used in
determining under which rate a sole community hospital is paid for its
discharges beginning on or after October 1, 1996, based on the formula
set forth above.
3. General Formula for Calculation of Prospective Payment Rates for
Hospitals Located in Puerto Rico Beginning On or After October 1, 1996
and Before October 1, 1997
a. Puerto Rico Rate.--The Puerto Rico prospective payment rate is
determined as follows:
Step 1--Select the appropriate adjusted average standardized amount
considering the large urban or other designation of the hospital (see
Table 1c, section V of the addendum).
Step 2--Multiply the labor-related portion of the standardized
amount by the appropriate wage index (see Tables 4a and 4b, section V
of the addendum).
Step 3--Add the amount from Step 2 and the nonlabor-related portion
of the standardized amount.
Step 4--Multiply the result in Step 3 by 75 percent.
Step 5--Multiply the amount from Step 4 by the appropriate DRG
relative weight (see Table 5, section V of the addendum).
b. National Rate.--The national prospective payment rate is
determined as follows:
Step 1--Multiply the labor-related portion of the national average
standardized amount (see Table 1c, section V of the addendum) by the
appropriate wage index.
[[Page 46232]]
Step 2--Add the amount from Step 1 and the nonlabor-related portion
of the national average standardized amount.
Step 3--Multiply the result in Step 2 by 25 percent.
Step 4--Multiply the amount from Step 3 by the appropriate DRG
relative weight (see Table 5, section V of the addendum).
The sum of the Puerto Rico rate and the national rate computed
above equals the prospective payment for a given discharge for a
hospital located in Puerto Rico.
III. Changes to Payment Rates for Inpatient Capital-Related Costs
for FY 1997
The prospective payment system for hospital inpatient capital-
related costs was implemented for cost reporting periods beginning on
or after October 1, 1991. Effective with that cost reporting period and
during a 10-year transition period extending through FY 2001, hospital
inpatient capital-related costs are paid based on an increasing
proportion of the capital prospective payment system Federal rate and a
decreasing proportion of the hospital's historical costs for capital.
The basic methodology for determining Federal capital prospective
rates is set forth at Secs. 412.308 through 412.352. Below we discuss
the factors that we used to determine the Federal rate and the
hospital-specific rates for FY 1997. The rates will be effective for
discharges occurring on or after October 1, 1996.
For FY 1992, we computed the standard Federal payment rate for
capital-related costs under the prospective payment system by updating
the FY 1989 Medicare inpatient capital cost per case by an actuarial
estimate of the increase in Medicare inpatient capital costs per case.
Each year after FY 1992 we update the standard Federal rate, as
provided in Sec. 412.308(c)(1), to account for capital input price
increases and other factors. Also, Sec. 412.308(c)(2) provides that the
Federal rate is adjusted annually by a factor equal to the estimated
additional payments under the Federal rate for outlier cases,
determined as a proportion of total capital payments under the Federal
rate. Section 412.308(c)(3) further requires that the Federal rate be
reduced by an adjustment factor equal to the estimated additional
payments made for exceptions under Sec. 412.348, and
Sec. 412.308(c)(4)(ii) requires that the Federal rate be adjusted so
that the annual DRG reclassification and the recalibration of DRG
weights and changes in the geographic adjustment factor are budget
neutral. For FY 1992 through FY 1995, Sec. 412.352 required that the
Federal rate also be adjusted by a budget neutrality factor so that
estimated aggregate payments for inpatient hospital capital costs were
projected to equal 90 percent of the estimated payments that would have
been made for capital-related costs on a reasonable cost basis during
the fiscal year. That provision expired in FY 1996.
The hospital-specific rate for each hospital was calculated by
dividing the hospital's Medicare inpatient capital-related costs for a
specified base year by its Medicare discharges (adjusted for
transfers), and dividing the result by the hospital's case mix index
(also adjusted for transfers). The resulting case-mix adjusted average
cost per discharge was then updated to FY 1992 based on the national
average increase in Medicare's inpatient capital cost per discharge and
adjusted by the exceptions payment adjustment factor and the budget
neutrality adjustment factor to yield the FY 1992 hospital-specific
rate. The hospital-specific rate is updated each year after FY 1992 for
inflation and for changes in the exceptions payment adjustment factor.
For FY 1992 through FY 1995, the hospital-specific rate was also
adjusted by a budget neutrality adjustment factor.
To determine the appropriate budget neutrality adjustment factors
and the exceptions payment adjustment factor, we developed a dynamic
model of Medicare inpatient capital-related costs, that is, a model
that projects changes in Medicare inpatient capital-related costs over
time. With the expiration of the budget neutrality provision, the model
is still used to estimate the exceptions payment adjustment and other
factors. The model and its application are described more fully in
Appendix B.
In accordance with section 1886(d)(9)(A) of the Act, under the
prospective payment system for inpatient operating costs, hospitals
located in Puerto Rico are paid for operating costs under a special
payment formula. These hospitals are paid a blended rate that consists
of 75 percent of the applicable standardized amount specific to Puerto
Rico hospitals and 25 percent of the applicable national average
standardized amount. Section 412.374 provides for this blended payment
system for payments to Puerto Rico hospitals under the prospective
payment system for inpatient capital-related costs. Accordingly, for
capital-related costs we compute a separate payment rate specific to
Puerto Rico hospitals using the same methodology used to compute the
national Federal rate for capital. Hospitals in Puerto Rico are paid
based on 75 percent of the Puerto Rico rate and 25 percent of the
Federal rate.
A. Determination of Federal Inpatient Capital-Related Prospective
Payment Rate Update
For FY 1996, the Federal rate was $461.96. In the proposed rule, we
stated that the proposed FY 1997 Federal rate was $441.84. In this
final rule, we are establishing an FY 1997 Federal rate of $438.92.
In the discussion that follows, we explain the factors that were
used to determine the FY 1997 Federal rate. In particular, we explain
why the FY 1997 Federal rate has decreased 4.99 percent compared to the
FY 1996 Federal rate. We also explain that capital payments per case
are estimated to increase by 3.92 percent. Taking into account the
effects of increases in projected discharges, we estimate that
aggregate capital payments will increase 6.77 percent.
The major factor contributing to the decrease in the FY 1997 rate
in comparison to FY 1996 is the change in the exceptions reduction
factor. We have expected the number and amount of exceptions payments
generally to increase throughout the transition period.
Total payments to hospitals under the prospective payment system
are relatively insensitive to changes in the capital prospective
payments. Since capital payments are about 10 percent of hospital
payments, a 1 percent change in the capital Federal rate yields only
about 0.1 percent change in actual payments to hospitals. Aggregate
payments under the capital prospective payment transition system are
estimated to increase in FY 1997 compared to FY 1996. Specifically, we
estimate that aggregate payments in FY 1997 will be 6.77 percent higher
than they were in FY 1996. Changes in aggregate payments include
changes in capital payments per discharge and changes in the number of
discharges. Under the prospective payment system for capital-related
costs, payments per discharge (or case) are estimated to increase 3.92
percent in FY 1997 compared to FY 1996.
1. Standard Federal Rate Update
Section 412.308(c)(1)(ii) has provided that the standard Federal
rate is updated based on an analytical framework that takes into
account changes in a capital input price index and other factors. The
update framework consists of a capital input price index and several
policy adjustment factors. Specifically, we have adjusted the projected
CIPI rate of increase as appropriate each year for
[[Page 46233]]
case-mix index related changes, for intensity, and for errors in
previous CIPI forecasts. The proposed rule reflected an update factor
of 1.0 percent, based on the data available at the time. The final
update factor for FY 1997 under that framework is 0.7 percent. This
update factor is based on a projected 1.3 percent increase in the CIPI,
and on policy adjustment factors of -0.6 percent. We explain the basis
for the FY 1997 CIPI projection in section IV.B of the preamble to this
final rule. Here we describe the policy adjustments that have been
applied.
The case-mix index (CMI) is the measure of the average DRG weight
for cases paid under the prospective payment system. Because the DRG
weight determines the prospective payment for each case, any percentage
increase in the CMI corresponds to an equal percentage increase in
hospital payments.
The CMI can change for any of several reasons: because the average
resource use of Medicare patients changes (``real'' case-mix change);
because changes in hospital coding of patient records result in higher
weight DRG assignments (``coding effects''); and because the annual DRG
reclassification and recalibration changes may not be budget neutral
(``reclassification effect''). We define real case-mix change as actual
changes in the mix (and resource requirements) of Medicare patients as
opposed to changes in coding behavior that result in assignment of
cases to higher-weighted DRGs but do not reflect higher resource
requirements. In the update framework for the prospective payment
system for operating costs, we adjust the update upwards to allow for
real case-mix change, but remove the effects of coding changes on the
CMI. We also remove the effect on total payments of prior changes to
the DRG classifications and relative weights, in order to retain budget
neutrality for all CMI-related changes other than patient severity.
(For example, we adjusted for the effects of the FY 1992 DRG
reclassification and recalibration as part of our FY 1994 update
recommendation.) The operating adjustment consists of a reduction for
total observed case-mix change, an increase for the portion of case-mix
change that we determine is due to real case-mix change rather than
coding modifications, and an adjustment for the effect of prior DRG
reclassification and recalibration changes. We have adopted this CMI
adjustment in the capital update framework as well.
For FY 1997, we are projecting a 1.6 percent increase in the case-
mix index. We now estimate that real case-mix increase will be 1.0
percent in FY 1997. In previous years, we have assumed that real case
mix will increase at about 1.0 percent per year. We expect this pattern
to continue. The final net adjustment for case-mix change in FY 1997 is
therefore 0.6 percentage points.
We estimate that DRG reclassification and recalibration resulted in
a 0.0 percent change in the case mix when compared with the case-mix
index that would have resulted if we had not made the reclassification
and recalibration changes to the DRGs.
The current operating update framework contains an adjustment for
forecast error. The input price index forecast is based on historical
trends and relationships ascertainable at the time the update factor is
established for the upcoming year. In any given year there may be
unanticipated price fluctuations that may result in differences between
the actual increase in prices faced by hospitals and the forecast used
in calculating the update factors. In setting a prospective payment
rate under the proposed framework, we make an adjustment for forecast
error only if our estimate of the capital input price index rate of
increase for any year is off by 0.25 percentage points or more. There
is a 2-year lag between the forecast and the measurement of the
forecast error. Thus, for example, we would adjust for a forecast error
made in FY 1996 through an adjustment to the FY 1998 update. Because we
only introduced this analytical framework in FY 1996, FY 1998 is the
first year in which a forecast error adjustment could be required.
Under the capital prospective payment system framework, we also
make an adjustment for changes in intensity. We calculate this
adjustment using the same methodology and data as in the framework for
the operating prospective payment system. The intensity factor for the
operating update framework reflects how hospital services are utilized
to produce the final product, that is, the discharge. This component
accounts for changes in the use of quality-enhancing services, changes
in within-DRG severity, and expected modification of practice patterns
to remove cost-ineffective services.
We calculate case-mix constant intensity as the change in total
charges per admission, adjusted for price level changes (the CPI
hospital component) and changes in real case mix. The use of total
charges in the calculation of the proposed intensity factor makes it a
total intensity factor, that is, charges for capital services are
already built into the calculation of the factor. We have therefore
incorporated the intensity adjustment from the operating update
framework into the capital update framework. Without reliable estimates
of the proportions of the overall annual intensity increases that are
due, respectively, to ineffective practice patterns and to the
combination of quality-enhancing new technologies and within-DRG
complexity, we assume, as in the revised operating update framework,
that one-half of the annual increase is due to each of these factors.
The capital update framework thus provides an add-on to the input price
index rate of increase of one-half of the estimated annual increase in
intensity to allow for within-DRG severity increases and the adoption
of quality-enhancing technology.
For FY 1997, we have developed a Medicare-specific intensity
measure based on a 5-year average using FY 1991-1995. In determining
case-mix constant intensity, we found that observed case-mix increase
was 2.8 percent in FY 1991, 1.8 percent in FY 1992, 0.9 percent in FY
1993, 0.8 percent in FY 1994, and 1.6 percent in FY 1995. For FY 1991,
FY 1992 and FY 1995, we estimate that real case-mix increase was 1.0 to
1.4 percent each year. The estimate for those years is supported by
past studies of case-mix change by the RAND Corporation. The most
recent study was ``Has DRG Creep Crept Up? Decomposing the Case Mix
Index Change Between 1987 and 1988'' by G.M. Carter, J.P. Newhouse, and
D.A. Relles, R-4098-HCFA/ProPAC (1991). The study suggested that real
case-mix change was not dependent on total change, but was rather a
fairly steady 1.0 to 1.5 percent per year. We use 1.4 percent as the
upper bound because the RAND study did not take into account that
hospitals may have induced doctors to document medical records more
completely in order to improve payment. Following that study, we
consider up to 1.4 percent of observed case-mix change as real for FY
1991 through FY 1995.
Given estimates of real case-mix increase of 1.0 percent for FY
1991 and FY 1992, 0.9 percent for FY 1993, 0.8 percent for FY 1994, and
1.0 percent for FY 1995, we estimate that case-mix constant intensity
declined by an average 1.1 percent during FY 1991 through FY 1995, for
a cumulative decrease of 5.3 percent. If we assume that real case-mix
increase was 1.4 percent for FY 1991 and FY 1992, 0.9 percent for FY
1993, 0.8 percent for FY 1994, and 1.4 percent for FY 1995, we estimate
that case-mix constant intensity declined by an average 1.2 percent
during FY 1991 through FY
[[Page 46234]]
1995, for a cumulative decrease of 5.8 percent. Since we estimate that
intensity has declined during that period, we are recommending a 0.0
percent intensity adjustment for FY 1997.
2. Outlier Payment Adjustment Factor
Section 412.312(c) establishes a unified outlier methodology for
inpatient operating and inpatient capital-related costs. A single set
of thresholds is used to identify outlier cases for both inpatient
operating and inpatient capital-related payments. Outlier payments are
made only on the portion of the Federal rate used to calculate the
hospital's inpatient capital-related payments (for example, 60 percent
for cost reporting periods beginning in FY 1997 for hospitals paid
under the fully prospective methodology). Section 412.308(c)(2)
provides that the standard Federal rate for inpatient capital-related
costs be reduced by an adjustment factor equal to the estimated
additional payments under the Federal rate for outlier cases,
determined as a proportion of inpatient capital-related payments under
the Federal rate. The outlier thresholds are set so that estimated
outlier payments are 5.1 percent of estimated total DRG payments. The
inpatient capital-related outlier reduction factor is then set
according to the estimated inpatient capital-related outlier payments
that would be made if all hospitals were paid according to 100 percent
of the Federal rate. For purposes of calculating the outlier thresholds
and the outlier reduction factor, we model all hospitals as if paid 100
percent of the Federal rate because, as explained above, outlier
payments are made only on the portion of the Federal rate that is
included in the hospital's inpatient capital-related payments.
In the September 1, 1995 final rule, we estimated that outlier
payments for capital in FY 1996 would equal 4.64 percent of inpatient
capital-related payments based on the Federal rate. Accordingly, we
applied an outlier adjustment factor of 0.9536 to the Federal rate.
Based on the thresholds as set forth in section II.A.4.d of the
addendum, we estimate that outlier payments will equal 5.19 percent of
inpatient capital-related payments based on the Federal rate in FY
1997. We are, therefore, applying an outlier adjustment factor of
0.9481 to the Federal rate. Thus, estimated capital outlier payments
for FY 1997 represent a higher percentage of total capital payments
than in FY 1996.
The outlier reduction factors are not built permanently into the
rates; that is, they are not applied cumulatively in determining the
Federal rate. Therefore, the net change in the outlier adjustment to
the Federal rate for FY 1997 is 0.9942 (.9481/.9536). Thus, the outlier
adjustment decreases the FY 1997 Federal rate by 0.58 percent (1-
0.9942) compared with the FY 1996 outlier adjustment.
3. Budget Neutrality Adjustment Factor for Changes in DRG
Classifications and Weights and the Geographic Adjustment Factor
Section 412.308(c)(4)(ii) requires that the Federal rate be
adjusted so that estimated aggregate payments for the fiscal year based
on the Federal rate after any changes resulting from the annual DRG
reclassification and recalibration and changes in the geographic
adjustment factor equal estimated aggregate payments that would have
been made based on the Federal rate without such changes. We use the
actuarial model described in Appendix B to estimate the aggregate
payments that would have been made on the basis of the Federal rate
without changes in the DRG classifications and weights and in the
geographic adjustment factor. We also use the model to estimate
aggregate payments that would be made on the basis of the Federal rate
as a result of those changes. We then use these figures to compute the
adjustment required to maintain budget neutrality for changes in DRG
weights and in the geographic adjustment factor.
For FY 1996, we calculated a GAF/DRG budget neutrality factor of
0.9994. In the proposed rule for FY 1997, we proposed a GAF/DRG budget
neutrality factor of 0.9992. In this final rule, based on calculations
using updated data, we are applying a factor of 0.9987 to meet this
requirement. The GAF/DRG budget neutrality factors are built
permanently into the rates; that is, they are applied cumulatively in
determining the Federal rate. This follows from the requirement that
estimated aggregate payments each year be no more than they would have
been in the absence of the annual DRG reclassification and
recalibration and changes in the geographic adjustment factor. The
incremental change in the adjustment from FY 1996 to FY 1997 is 0.9987.
The cumulative change in the rate due to this adjustment is 1.0012 (the
product of the incremental factors for FY 1993, FY 1994, FY 1995, FY
1996, and FY 1997: 0.9980 x 1.0053 x 0.9998 x 0.9994 x 0.9987 =
1.0012).
This factor accounts for DRG reclassifications and recalibration
and for changes in the geographic adjustment factor. It also
incorporates the effects on the geographic adjustment factor of FY 1997
geographic reclassification decisions made by the MGCRB compared to FY
1996 decisions. However, it does not account for changes in payments
due to changes in the disproportionate share and indirect medical
education adjustment factors or in the large urban add-on.
4. Exceptions Payment Adjustment Factor
Section 412.308(c)(3) requires that the standard Federal rate for
inpatient capital-related costs be reduced by an adjustment factor
equal to the estimated additional payments for exceptions under
Sec. 412.348 determined as a proportion of total payments under the
hospital-specific rate and Federal rate. We use the model originally
developed for determining the budget neutrality adjustment factor to
estimate payments under the exceptions payment process and to determine
the exceptions payment adjustment factor. We describe that model in
Appendix B to this final rule.
For FY 1996, we estimated that exceptions payments would equal 1.51
percent of aggregate payments based on the Federal rate and the
hospital-specific rate. Therefore, we applied an exceptions reduction
factor of 0.9849 (1-.0151) in determining the Federal rate. For FY
1997, we estimated in the May 31, 1996, proposed rule that exceptions
payments would equal 6.07 percent of aggregate payments based on the
Federal rate and the hospital-specific rate. Therefore, we proposed to
apply an exceptions reduction factor of 0.9393 (1-0.0607) to determine
the FY 1997 Federal rate. For this final rule, we estimate that
exceptions payments for FY 1997 will equal 6.42 percent of aggregate
payments based on the Federal rate and the hospital-specific rate. We
are, therefore, applying an exceptions payment reduction factor of
0.9358 to the Federal rate for FY 1997.
The final exceptions reduction factor for FY 1997 is thus 4.99
percent lower than the factor for FY 1996, and 0.37 percent lower than
the factor in the FY 1997 proposed rule. As we have stated before, we
have expected the number and amount of exceptions payments generally to
increase throughout the transition period.
The exceptions reduction factors are not built permanently into the
rates; that is, the factors are not applied cumulatively in determining
the Federal rate. Therefore, the net adjustment to the FY 1997 Federal
rate is 0.9358/0.9849, or 0.9501.
[[Page 46235]]
5. Standard Capital Federal Rate for FY 1997
For FY 1996, the capital Federal rate was $461.96. With the changes
we proposed to the factors used to establish the Federal rate, we
proposed that the FY 1997 Federal rate would be $441.84. In this final
rule, we are establishing an FY 1997 Federal rate of $438.92. The final
Federal rate for FY 1997 was calculated as follows:
The FY 1997 update factor is 1.0070, that is, the update
is 0.70 percent.
The FY 1997 outlier adjustment factor is 0.9481.
The FY 1997 budget neutrality adjustment factor applied to
the standard Federal payment rate for changes in the DRG relative
weights and in the geographic adjustment factor is 0.9987.
The FY 1997 exceptions payments adjustment factor is
0.9358.
Since the Federal rate has already been adjusted for differences in
case mix, wages, cost of living, indirect medical education costs, and
payments to hospitals serving a disproportionate share of low-income
patients, we are making no additional adjustments in the standard
Federal rate for these factors other than the budget neutrality factor
for changes in the DRG relative weights and the geographic adjustment
factor.
We are providing a chart that shows how each of the factors and
adjustments for FY 1997 affected the computation of the final FY 1997
Federal rate in comparison to the FY 1996 Federal rate. The final FY
1997 update factor increases the Federal rate 0.70 percent compared to
the rate in FY 1996, while the final geographic and DRG budget
neutrality factor decreases the Federal rate by 0.13 percent. The final
FY 1997 outlier adjustment factor decreases the Federal rate by 0.58
percent compared to FY 1996. The final FY 1997 exceptions reduction
factor decreases the Federal rate by 4.99 percent compared to the
exceptions reduction for FY 1996. The combined effect of all the
changes is to decrease the Federal rate by 4.99 percent compared to the
Federal rate for FY 1996.
Comparison of Factors and Adjustments: FY 1996 Federal Rate and FY 1997 Federal Rate
----------------------------------------------------------------------------------------------------------------
Change Percent change
----------------------------------------------------------------------------------------------------------------
Update factor \1\:
FY 1996............................................ 1.0120 ................. .................
FY 1997............................................ 1.0070 1.0070 0.70
GAF/DRG adjustment factor \1\:
FY 1996............................................ 0.9994 ................. .................
FY 1997............................................ 0.9987 0.9987 -0.13
Outlier adjustment factor \2\:
FY 1996............................................ 0.9536 ................. .................
FY 1997............................................ 0.9481 0.9942 -0.58
Exceptions adjustment factor \2\:
FY 1996............................................ 0.9849 ................. .................
FY 1997............................................ 0.9358 0.9501 -4.99
Federal Rate:
FY 1996............................................ $461.96 ................. .................
FY 1997............................................ $438.92 0.9501 -4.99
----------------------------------------------------------------------------------------------------------------
\1\ The update factor and the GAF/DRG budget neutrality factors are built permanently into the rates. Thus, for
example, the incremental change from FY 1996 to FY 1997 resulting from the application of the 0.9987 GAF/DRG
budget neutrality factor for FY 1997 is 0.9987.
\2\ The outlier reduction factor and the exceptions reduction factor are not built permanently into the rates;
that is, these factors are not applied cumulatively in determining the rates. Thus, for example, the net
change resulting from the application of the FY 1997 exceptions reduction factor is 0.9358/0.9849, or 0.9501.
We are also providing a chart that shows how the final FY 1997
Federal rate differs from the proposed FY 1997 Federal rate.
This chart shows the factors that contributed to the 0.66 percent
decrease in the rate since the proposed rule. The update factor
decreased 0.30 percent since the proposed rule. Another change since
the proposed rule is seen in the exceptions reduction factor,
decreasing 0.37 percent from the earlier estimate. The GAF/DRG
reduction factor decreased only 0.05 percent since the proposed rule
and the outlier reduction factor increased 0.05 percent since the
proposed estimate.
Comparison of Factors and Adjustments: Proposed FY 1997 Federal Rate and Final FY 1997 Federal Rate
----------------------------------------------------------------------------------------------------------------
Net adjustment Percent change
----------------------------------------------------------------------------------------------------------------
Update factor:
Proposed FY 1997................................... 1.0100 ................. .................
Final FY 1997...................................... 1.0070 0.9970 -0.30
Outlier reduction factor:
Proposed FY 1997................................... 0.9476 ................. .................
Final FY 1997...................................... 0.9481 1.0005 0.05
GAF/DRG reduction factor:
Proposed FY 1997................................... 0.9992 ................. .................
Final FY 1997...................................... 0.9987 0.9995 -0.05
Exceptions reduction factor:
Proposed FY 1997................................... 0.9393 ................. .................
Final FY 1997...................................... 0.9358 0.9963 -0.37
Federal rate:
Proposed FY 1997................................... $441.84 ................. .................
Final FY 1997...................................... $438.92 0.9934 -0.66
----------------------------------------------------------------------------------------------------------------
[[Page 46236]]
6. Special Rate for Puerto Rico Hospitals
For FY 1996, the special rate for Puerto Rico hospitals was
$355.35. With the changes we proposed to the factors used to determine
the rate, the proposed FY 1997 special rate for Puerto Rico was
$339.87. In this final rule, the FY 1997 capital rate for Puerto Rico
is $337.63.
B. Determination of Hospital-Specific Rate Update
Section 412.328(e) of the regulations provides that the hospital-
specific rate for FY 1997 be determined by adjusting the FY 1996
hospital-specific rate by the following factors:
1. Hospital-Specific Rate Update Factor
The hospital-specific rate is updated in accordance with the update
factor for the standard Federal rate determined under
Sec. 412.308(c)(1). For FY 1997, the hospital-specific rate will be
updated by a factor of 1.0070.
2. Exceptions Payment Adjustment Factor
For FY 1992 through FY 2001, the updated hospital-specific rate is
multiplied by an adjustment factor to account for estimated exceptions
payments for capital-related costs under Sec. 412.348, determined as a
proportion of the total amount of payments under the hospital-specific
rate and the Federal rate. For FY 1997, we estimated in the proposed
rule that exceptions payments would be 6.07 percent of aggregate
payments based on the Federal rate and the hospital-specific rate. We
therefore proposed that the updated hospital-specific rate be reduced
by a factor of 0.9393. In this final rule, we estimate that exceptions
payments will be 6.42 percent of aggregate payments based on the
Federal rate and the hospital-specific rate. We are therefore applying
an exceptions reduction factor of 0.9358 to the hospital-specific rate.
The exceptions reduction factors are not built permanently into the
rates; that is, the factors are not applied cumulatively in determining
the hospital-specific rate. Therefore, the net adjustment to the FY
1997 hospital-specific rate is 0.9358/0.9849, or 0.9501.
3. Net Change to Hospital-Specific Rate
We are providing a chart to show the net change to the hospital-
specific rate. The chart shows the factors for FY 1996 and FY 1997 and
the net adjustment for each factor. It also shows that the cumulative
net adjustment from FY 1996 to FY 1997 is 0.9568, which represents a
decrease of 4.32 percent to the hospital-specific rate. The FY 1997
hospital-specific rate for each hospital is determined by multiplying
the FY 1996 hospital-specific rate by the cumulative net adjustment of
0.9568.
FY 1997 Update and Adjustments to Hospital-Specific Rates
----------------------------------------------------------------------------------------------------------------
Net adjustment Percent change
----------------------------------------------------------------------------------------------------------------
Update factor:
FY 1996............................................ 1.0100 ................. .................
FY 1997............................................ 1.0070 1.0070 0.70
Exceptions payment adjustment factor:
FY 1996............................................ 0.9849 ................. .................
FY 1997............................................ 0.9358 0.9501 -4.99
Cumulative adjustments:
FY 1996............................................ 0.9947 ................. .................
FY 1997............................................ 0.9518 0.9568 -4.32
----------------------------------------------------------------------------------------------------------------
Note: The update factor for the hospital-specific rate is applied cumulatively in determining the rates. Thus,
the incremental increase in the update factor from FY 1996 to FY 1997 is 1.0070. In contrast, the exceptions
payment adjustment factor and the budget neutrality factor are not applied cumulatively. Thus, for example,
the incremental increase in the exceptions reduction factor from FY 1996 to FY 1997 is 0.9358/0.9849, or
0.9501.
C. Calculation of Inpatient Capital-Related Prospective Payments for FY
1997
During the capital prospective payment system transition period, a
hospital is paid for inpatient capital-related costs under one of two
alternative payment methodologies: the fully prospective payment
methodology or the hold-harmless methodology. The payment methodology
applicable to a particular hospital is determined when a hospital comes
under the prospective payment system for capital-related costs by
comparing its hospital-specific rate to the Federal rate applicable to
the hospital's first cost reporting period under the prospective
payment system. The applicable Federal rate is determined by adjusting:
For outliers by dividing the standard Federal rate by the
outlier reduction factor for that fiscal year; and,
For the payment adjustment factors applicable to the
hospital (that is, the hospital's geographic adjustment factor, the
disproportionate share adjustment factor, and the indirect medical
education adjustment factor, when appropriate).
If the hospital-specific rate is above the applicable Federal rate,
the hospital is paid under the hold-harmless methodology. If the
hospital-specific rate is below the applicable Federal rate, the
hospital is paid under the fully prospective methodology.
For purposes of calculating payments for each discharge under both
the hold-harmless payment methodology and the fully prospective payment
methodology, the standard Federal rate is adjusted as follows:
(Standard Federal Rate) x (DRG weight) x (Geographic Adjustment
Factor) x (Large Urban Add-on, if applicable) x (COLA adjustment
for hospitals located in Alaska and Hawaii) x (1 + Disproportionate
Share Adjustment Factor + Indirect Medical Education Adjustment Factor,
if applicable).
The result is termed the adjusted Federal rate.
Payments under the hold-harmless methodology are determined under
one of two formulas. A hold-harmless hospital is paid the higher of:
100 percent of the adjusted Federal rate for each
discharge; or
An old capital payment equal to 85 percent (100 percent
for sole community hospitals) of the hospital's allowable Medicare
inpatient old capital costs per discharge for the cost reporting period
plus a new capital payment based on a percentage of the adjusted
Federal rate for each discharge. The percentage of the adjusted Federal
rate equals the ratio of the hospital's allowable Medicare new capital
costs to its total Medicare inpatient capital-related costs in the cost
reporting period.
Once a hospital receives payment based on 100 percent of the
adjusted Federal rate in a cost reporting period beginning on or after
October 1, 1994 (or the first cost reporting period after
[[Page 46237]]
obligated capital that is recognized as old capital under
Sec. 412.302(c) is put in use for patient care, if later), the hospital
continues to receive capital prospective payment system payments on
that basis for the remainder of the transition period.
Payment for each discharge under the fully prospective methodology
is the sum of:
The hospital-specific rate multiplied by the DRG relative
weight for the discharge and by the applicable hospital-specific
transition blend percentage for the cost reporting period; and
The adjusted Federal rate multiplied by the Federal
transition blend percentage.
The blend percentages for cost reporting periods beginning in FY
1997 are 60 percent of the adjusted Federal rate and 40 percent of the
hospital-specific rate.
Hospitals may also receive outlier payments for those cases that
qualify under the thresholds established for each fiscal year. Section
412.312(c) provides for a single set of thresholds to identify outlier
cases for both inpatient operating and inpatient capital-related
payments. Outlier payments are made only on that portion of the
hospital's inpatient capital-related payments that is based on the
Federal rate. For fully prospective hospitals, that portion is 60
percent Federal rate for discharges occurring in cost reporting periods
beginning during FY 1997. Thus, a fully prospective hospital will
receive 60 percent of the capital-related outlier payment calculated
for the case for discharges occurring in cost reporting periods
beginning in FY 1997. For hold-harmless hospitals paid 85 percent of
their reasonable costs for old inpatient capital, the portion of the
Federal rate that is included in the hospital's outlier payments is
based on the hospital's ratio of Medicare inpatient costs for new
capital to total Medicare inpatient capital costs. For hold-harmless
hospitals that are paid based on 100 percent of the Federal rate, 100
percent of the Federal rate is included in the hospital's outlier
payments.
The outlier thresholds for FY 1997 are published in section
II.A.4.c of this addendum. For FY 1997, a case qualifies as a cost
outlier if the cost for the case (after standardization for the
indirect teaching adjustment and disproportionate share adjustment) is
greater than the prospective payment rate for the DRG plus $9,700. A
case qualifies as a day outlier for FY 1997 if the length of stay is
greater than the geometric mean length of stay for the DRG plus the
lesser of 3 standard deviations of the length of stay or 24 days.
During the capital prospective payment system transition period, a
hospital may also receive an additional payment under an exceptions
process if its total inpatient capital-related payments are less than a
minimum percentage of its allowable Medicare inpatient capital-related
costs. The minimum payment level is established by class of hospital
under Sec. 412.348. The minimum payment levels for portions of cost
reporting periods occurring in FY 1997 are:
Sole community hospitals (located in either an urban or
rural area), 90 percent;
Urban hospitals with at least 100 beds and a
disproportionate share patient percentage of at least 20.2 percent and
urban hospitals with at least 100 beds that qualify for
disproportionate share payments under Sec. 412.106(c)(2), 80 percent;
and,
All other hospitals, 70 percent.
Under Sec. 412.348(d), the amount of the exceptions payment is
determined by comparing the cumulative payments made to the hospital
under the capital prospective payment system to the cumulative minimum
payment levels applicable to the hospital for each cost reporting
period subject to that system. Any amount by which the hospital's
cumulative payments exceed its cumulative minimum payment is deducted
from the additional payment that would otherwise be payable for a cost
reporting period.
New hospitals are exempted from the capital prospective payment
system for their first 2 years of operation and are paid 85 percent of
their reasonable costs during that period. A new hospital's old capital
costs are its allowable costs for capital assets that were put in use
for patient care on or before the later of December 31, 1990 or the
last day of the hospital's base year cost reporting period, and are
subject to the rules pertaining to old capital and obligated capital as
of the applicable date. Effective with the third year of operation, we
will pay the hospital under either the fully prospective methodology,
using the appropriate transition blend in that Federal fiscal year, or
the hold-harmless methodology. If the hold-harmless methodology is
applicable, the hold-harmless payment for assets in use during the base
period would extend for 8 years, even if the hold-harmless payments
extend beyond the normal transition period.
IV. Changes to Payment Rates for Excluded Hospitals and Hospital
Units
A. Rate-of-Increase Percentages for Excluded Hospitals and Hospital
Units
The inpatient operating costs of hospitals and hospital units
excluded from the prospective payment system are subject to rate-of-
increase limits established under the authority of section 1886(b) of
the Act, which is implemented in Sec. 413.40 of the regulations. Under
these limits, an annual target amount (expressed in terms of the
inpatient operating cost per discharge) is set for each hospital, based
on the hospital's own historical cost experience trended forward by the
applicable rate-of-increase percentages (update factors). The target
amount is multiplied by the number of Medicare discharges in a
hospital's cost reporting period, yielding the ceiling on aggregate
Medicare inpatient operating costs for the cost reporting period.
Effective
FR Doc. 96-22145 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1997 Rates
with cost reporting periods beginning on or after October
1, 1991, a hospital that has Medicare inpatient operating costs in
excess of its ceiling is paid its ceiling plus 50 percent of its costs
in excess of the ceiling. Total payment may not exceed 110 percent of
the ceiling. A hospital that has inpatient operating costs less than
its ceiling is paid its costs plus the lower of--
Fifty percent of the difference between the allowable
inpatient operating costs and the ceiling; or
Five percent of the ceiling.
Each hospital's target amount is adjusted annually, at the
beginning of its cost reporting period, by an applicable rate-of-
increase percentage. Section 1886(b)(3)(B) of the Act provides that for
cost reporting periods beginning on or after October 1, 1993 and before
October 1, 1994, the applicable rate-of-increase percentage is the
market basket percentage increase minus the lesser of 1 percentage
point or the percentage point difference between 10 percent and the
hospital's ``update adjustment percentage'' except for hospitals with
an ``update adjustment percentage'' of at least 10 percent. The rate-
of-increase percentage for hospitals in the latter case is the market
basket percentage increase. The ``update adjustment percentage'' is the
percentage by which a hospital's allowable inpatient operating costs
exceeds the hospital's ceiling for the cost reporting period beginning
in FY 1990. For cost reporting periods beginning on or after October 1,
1994 and before October 1, 1997, the update adjustment percentage is
the update adjustment percentage from the previous year plus the
previous year's
[[Page 46238]]
applicable reduction. The applicable reduction and applicable rate of
increase percentage are then determined in the same manner as for FY
1994. The most recent forecast of the market basket increase for FY
1997 for hospitals and hospital units excluded from the prospective
payment system is 2.5 percent.
B. Wage Index Exceptions for Excluded Hospitals and Units
In the August 30, 1991 final rule (56 FR 43232), we set forth our
policy for target amount adjustments for significant wage increases.
Effective with cost reporting periods beginning on or after April 1,
1990, significant increases in wages since the base period are
recognized as a basis for an adjustment in the target amount under
Sec. 413.40(g).
To qualify for an adjustment, the excluded hospital or hospital
unit must be located in a labor market area for which the average
hourly wage increased significantly more than the national average
hourly wage between the hospital's base period and the period subject
to the ceiling. We use the hospital wage index for prospective payment
hospitals to determine the rate of increase in the average hourly wage
in the labor market area. For a hospital to qualify for an adjustment,
the wage index value for the cost reporting period subject to the
ceiling must be at least 8 percent higher than the wage index based on
wage survey data collected for the base year cost reporting period. If
survey data are not available for one (or both) of the cost reporting
periods used in the comparison, the wage index based on the latest
available survey data collected before that cost reporting period will
be used. For example, to make the comparison between a 1983 base period
and a hospital's cost reporting period beginning in FY 1994, we would
use the rate of increase between the wage index based on 1982 wage data
and the wage index based on the FY 1993 data, since the FY 1993 data
are the most recent data currently available. Further, the comparison
is made without regard to geographic reclassifications made by the
MGCRB under sections 1886(d) (8) and (10) of the Act. Therefore, the
comparison is made based on the wage index value of the labor market
area in which the hospital is actually located.
We determine the amount of the adjustment for wage increases by
considering three factors for the time between the base period and the
period for which an adjustment is requested: the rate of increase in
the hospital's average hourly wage; the rate of increase in the average
hourly wage in the labor market area in which the hospital is located;
and, the rate of increase in the national average hourly wage for
hospital workers. The adjustment is limited to the amount by which the
lower of the hospital's or the labor market area's rate of increase in
average hourly wages significantly exceeds the national increase (that
is, exceeds the national rate of increase by more than 8 percent). For
purposes of computing the adjustment, the relative rate of increase in
the average hourly wage for the labor market area is assumed to have
been the same over each of the intervening years between the wage
surveys.
To determine the rate of increase in the national average hourly
wage, we use the average hourly earnings (AHE) component of the wages
and salaries portion of the market basket. This measure is derived from
the 1982-based market basket since the 1987-based market basket uses
the employment cost index (ECI) for hospital workers as the price proxy
for this component. Unlike the AHE, the ECI for hospital workers can be
measured historically only back to 1986. In addition, the ECI does not
adjust for skill-mix shifts and, therefore, measures only the change in
wage rates per hour.
The average hourly earnings for hospital workers as measured by the
market basket show the following increases:
1992 = 4.8 percent
1993 = 3.6 percent
1994 = 2.7 percent
1995 = 3.3 percent
1996 = 3.3 percent
1997 = 3.2 percent
We note that this section merely provides updated information with
respect to areas that would qualify for the wage index adjustment under
Sec. 413.30(g). This information was calculated in accordance with
established policy and does not reflect any change in that policy. The
geographic areas in which the percentage difference in wage indexes was
sufficient to qualify for a wage index adjustment are listed in Table
10 of section V of the addendum to this final rule. The table is
constructed with old MSAs instead of the revised MSAs effective October
1, 1993 because current adjustment requests are for years prior to FY
1995.
V. Tables
This section contains the tables referred to throughout the
preamble to this final rule and in this Addendum. For purposes of this
final rule, and to avoid confusion, we have retained the designations
of Tables 1 through 5 that were first used in the September 1, 1983
initial prospective payment final rule (48 FR 39844). Tables 1A, 1C,
1D, 3C, 4a, 4b, 4c, 4d, 4e, 5, 6A, 6B, 6C, 6D, 6E, 6F, 6G, 6H, 7A, 7B,
8A, 8B, and 10 are presented below. The tables presented below are as
follows:
Table 1A--National Adjusted Operating Standardized Amounts, Labor/
Nonlabor
Table 1C--Adjusted Operating Standardized Amounts for Puerto Rico,
Labor/Nonlabor
Table 1D--Capital Standard Federal Payment Rate
Table 3C--Hospital Case Mix Indexes for Discharges Occurring in Federal
Fiscal Year 1995 and Hospital Average Hourly Wage for Federal Fiscal
Year 1997 Wage Index
Table 4a--Wage Index and Capital Geographic Adjustment Factor (GAF) for
Urban Areas
Table 4b--Wage Index and Capital Geographic Adjustment Factor (GAF) for
Rural Areas
Table 4c--Wage Index and Capital Geographic Adjustment Factor (GAF) for
Hospitals That Are Reclassified
Table 4d--Average Hourly Wage for Urban Areas
Table 4e--Average Hourly Wage for Rural Areas
Table 5--List of Diagnosis Related Groups (DRGs), Relative Weighting
Factors, Geometric Mean Length of Stay, and Length of Stay Outlier
Cutoff Points Used in the Prospective Payment System
Table 6A--New Diagnosis Codes
Table 6B--New Procedure Codes
Table 6C--Invalid Diagnosis Codes
Table 6D--Invalid Procedure Codes
Table 6E--Revised Diagnosis Code Titles
Table 6F--Revised Procedure Code Titles
Table 6G--Additions to the CC Exclusions List
Table 6H--Deletions to the CC Exclusions List
Table 7A--Medicare Prospective Payment System Selected Percentile
Lengths of Stay FY 95 MEDPAR Update 06/95 GROUPER V13.0
Table 7B--Medicare Prospective Payment System Selected Percentile
Lengths of Stay FY 95 MEDPAR Update 06/95 GROUPER V14.0
Table 8A--Statewide Average Operating Cost-to-Charge Ratios for Urban
and Rural Hospitals (Case Weighted) August 1996
Table 8B--Statewide Average Capital Cost-to-Charge Ratios for Urban and
Rural Hospitals (Case Weighted) August 1996
[[Page 46239]]
Table 10--Percentage Difference in Wage Indexes for Areas that Qualify
for a Wage Index Exception for Excluded Hospitals and Units
Table 1A.--National Adjusted Operating Standardized Amounts, Labor/
Nonlabor
------------------------------------------------------------------------
Large urban areas Other areas
------------------------------------------------------------------------
Nonlabor- Labor- Nonlabor-
Labor-related related related related
------------------------------------------------------------------------
$2,782.84........................... $1,125.64 $2,738.79 $1,107.83
------------------------------------------------------------------------
Table 1C.--Adjusted Operating Standardized Amounts for Puerto Rico, Labor/Nonlabor
----------------------------------------------------------------------------------------------------------------
Large urban areas Other areas
---------------------------------------------------------------------------
Labor Nonlabor Labor Nonlabor
----------------------------------------------------------------------------------------------------------------
National............................ $2,759.22 $1,116.09 $2,759.22 $1,116.09
Puerto Rico......................... 2,488.70 518.65 2,449.31 510.446
----------------------------------------------------------------------------------------------------------------
Table 1D.--Capital Standard Federal Payment Rate
------------------------------------------------------------------------
Rate
------------------------------------------------------------------------
National................................................... $438.92
Puerto Rico................................................ 337.63
------------------------------------------------------------------------
[[Page 46240]]
Table 3c.--Hospital Case Mix Indexes for Discharges Occurring in Federal Fiscal Year 1995
Page 1 of 16
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Case Avg. Case Avg. Case Avg. Case Avg. Case Avg.
Provider mix hour Provider mix hour Provider mix hour Provider mix hour Provider mix hour
index wage index wage index wage index wage index wage
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
010001....................... 01.4404 14.82 010095.......... 00.9193 11.25 030004......... 01.0049 13.48 040003......... 01.0725 13.23 040106......... 01.2549 12.84
010004....................... 00.9693 11.10 010097.......... 00.9352 15.20 030006......... 01.5554 17.52 040004......... 01.4587 14.83 040107......... 01.1909 14.95
010005....................... 01.1626 15.40 010098.......... 01.1820 11.02 030007......... 01.3159 16.41 040005......... 01.0378 11.59 040109......... 01.1653 12.69
010006....................... 01.4724 15.23 010099.......... 01.1144 15.49 030008......... 02.0954 20.42 040007......... 01.8743 18.12 040114......... 01.8503 16.64
010007....................... 01.1025 13.12 010100.......... 01.1699 14.77 030009......... 01.2852 15.58 040008......... 01.0326 10.77 040116......... 01.3868 19.25
010008....................... 01.1344 09.54 010101.......... 01.1120 14.21 030010......... 01.4117 17.75 040010......... 01.2297 13.78 040118......... 01.1263 14.29
010009....................... 01.1393 14.82 010102.......... 00.9570 13.63 030011......... 01.5040 17.66 040011......... 00.9313 10.75 040119......... 01.0928 14.34
010010....................... 01.1289 14.33 010103.......... 01.7657 17.15 030012......... 01.2238 15.81 040014......... 01.1951 16.07 040124......... 01.2159 14.30
010011....................... 01.6182 18.94 010104.......... 01.6869 17.90 030013......... 01.2435 18.99 040015......... 01.1979 12.12 040126......... 00.9606 11.74
010012....................... 01.2658 16.27 010108.......... 01.1476 13.68 030014......... 01.4395 17.86 040016......... 01.7360 16.43 050002......... 01.5608 25.91
010015....................... 01.0576 15.63 010109.......... 01.0643 11.48 030016......... 01.2487 17.09 040017......... 01.2593 11.68 050006......... 01.3917 19.15
010016....................... 01.2642 16.76 010110.......... 01.0158 13.44 030017......... 01.5214 18.98 040018......... 01.1718 16.66 050007......... 01.5863 25.29
010018....................... 00.9019 16.19 010112.......... 01.1218 14.09 030018......... 01.7970 19.57 040019......... 01.1544 13.52 050008......... 01.5106 25.48
010019....................... 01.2853 14.99 010113.......... 01.6345 13.69 030019......... 01.2020 19.31 040020......... 01.5961 14.08 050009......... 01.7160 31.63
010021....................... 01.2330 12.20 010114.......... 01.3192 15.37 030022......... 01.5026 17.41 040021......... 01.2317 14.69 050013......... 01.8083 22.05
010022....................... 01.0214 16.89 010115.......... 00.8472 11.98 030023......... 01.2631 17.64 040022......... 01.6987 14.73 050014......... 01.1762 22.55
010023....................... 01.4798 14.71 010117.......... 00.8122 13.54 030024......... 01.7885 21.04 040024......... 01.1694 12.16 050015......... 01.3901 22.18
010024....................... 01.4003 15.62 010118.......... 01.2505 15.07 030025......... 01.1635 12.76 040025......... 00.9192 11.81 050016......... 01.1490 18.51
010025....................... 01.4321 13.16 010119.......... 01.4921 16.36 030027......... 01.0796 14.69 040026......... 01.5567 16.35 050017......... 02.0442 24.39
010027....................... 00.8360 13.55 010120.......... 00.9671 14.32 030030......... 01.6610 18.19 040027......... 01.2885 12.56 050018......... 01.3313 18.49
010029....................... 01.4936 14.84 010121.......... 01.2282 12.92 030033......... 01.2472 16.40 040028......... 01.0910 11.40 050021......... 01.4226 23.40
010031....................... 01.1845 14.58 010123.......... 01.2531 16.95 030034......... 01.0470 15.89 040029......... 01.2512 14.12 050022......... 01.4532 22.63
010032....................... 00.9480 12.45 010124.......... 01.2853 16.15 030035......... 01.3434 20.77 040030......... 00.8948 11.09 050024......... 01.3916 21.31
010033....................... 01.9155 17.61 010125.......... 01.0231 12.86 030036......... 01.1448 18.23 040032......... 01.0009 11.18 050025......... 01.7849 21.97
010034....................... 01.0754 13.48 010126.......... 01.1654 13.13 030037......... 02.0251 19.60 040035......... 01.0269 10.24 050026......... 01.4559 21.79
010035....................... 01.2416 15.13 010127.......... 01.2974 16.29 030038......... 01.6224 18.82 040036......... 01.4885 16.45 050028......... 01.4384 15.33
010036....................... 01.1248 15.34 010128.......... 00.9619 12.34 030040......... 01.1863 15.88 040037......... 01.1075 11.55 050029......... 01.3835 25.55
010038....................... 01.3476 16.70 010129.......... 01.0826 13.29 030041......... 00.9847 13.68 040039......... 01.2413 12.23 050030......... 01.3340 19.24
010039....................... 01.7027 16.14 010130.......... 01.0405 15.28 030043......... 01.1901 18.25 040040......... 01.0021 15.73 050032......... 01.2750 22.76
010040....................... 01.5324 18.21 010131.......... 01.3555 17.75 030044......... 01.0338 13.19 040041......... 01.3902 13.95 050033......... 01.4227 25.47
010043....................... 01.1075 10.35 010134.......... 00.9077 13.36 030046......... 00.9532 16.38 040042......... 01.2961 12.03 050036......... 01.6184 18.61
010044....................... 01.0952 11.01 010137.......... 01.2701 16.36 030047......... 00.9496 19.91 040044......... 00.9581 10.04 050038......... 01.4467 29.05
010045....................... 01.2215 10.79 010138.......... 00.9454 09.85 030049......... 00.9747 17.30 040045......... 01.0339 14.28 050039......... 01.6003 21.04
010046....................... 01.5270 15.51 010139.......... 01.6545 19.67 030054......... 00.8681 12.63 040047......... 01.0992 14.78 050040......... 01.0789 22.92
010047....................... 01.0203 10.05 010143.......... 01.1818 15.83 030055......... 01.2107 16.85 040048......... 01.2128 13.48 050041......... 02.8307 22.21
010049....................... 01.1130 15.66 010144.......... 01.3065 18.42 030059......... 01.2755 19.95 040050......... 01.1009 11.66 050042......... 01.3156 20.20
010050....................... 01.0631 13.48 010145.......... 01.3277 14.59 030060......... 01.2055 13.90 040051......... 01.0953 12.64 050043......... 01.5742 30.15
010051....................... 00.8526 10.24 010146.......... 01.1731 15.59 030061......... 01.6515 16.75 040053......... 01.1051 11.67 050045......... 01.2631 17.44
010052....................... 00.9891 12.78 010148.......... 00.9991 12.83 030062......... 01.2298 15.56 040054......... 01.0313 12.44 050046......... 01.1948 23.81
010053....................... 01.0623 12.67 010149.......... 01.3548 16.86 030064......... 01.6287 17.31 040055......... 01.4492 14.51 050047......... 01.6384 29.15
010054....................... 01.1715 16.17 010150.......... 01.0458 16.29 030065......... 01.6550 18.87 040058......... 01.0595 13.61 050051......... 01.1150 16.63
010055....................... 01.4799 16.35 010152.......... 01.5001 16.29 030067......... 01.0493 15.92 040060......... 00.9905 09.85 050054......... 01.1945 20.55
010056....................... 01.3958 17.99 010155.......... 01.0155 09.42 030068......... 00.9533 14.04 040062......... 01.6183 16.66 050055......... 01.3688 27.48
010058....................... 01.0940 12.96 020001.......... 01.4893 25.53 030069......... 01.3387 19.11 040063......... 01.4690 15.67 050056......... 01.3269 25.23
010059....................... 01.0172 14.17 020002.......... 01.0275 24.16 030071......... 00.9564 ....... 040064......... 01.0568 10.49 050057......... 01.4831 20.22
010061....................... 01.0121 14.70 020004.......... 01.1018 25.46 030072......... 00.8597 ....... 040066......... 01.1450 14.63 050058......... 01.4657 22.78
010062....................... 01.0056 13.45 020005.......... 00.9023 28.36 030073......... 00.9795 ....... 040067......... 01.0823 11.34 050060......... 01.5871 24.25
010064....................... 01.8006 17.85 020006.......... 01.1404 23.19 030074......... 00.8590 ....... 040069......... 01.1002 14.90 050061......... 01.4278 22.12
010065....................... 01.3671 14.30 020007.......... 00.8988 21.82 030075......... 00.8591 ....... 040070......... 00.9422 14.98 050063......... 01.4169 21.44
010066....................... 00.9765 10.87 020008.......... 01.1004 26.45 030076......... 00.9802 ....... 040071......... 01.5971 15.42 050065......... 01.6154 22.37
010068....................... 01.2347 18.82 020009.......... 00.9164 21.29 030077......... 00.8769 ....... 040072......... 01.0869 13.39 050066......... 01.2719 24.33
010069....................... 01.1593 13.06 020010.......... 00.9035 22.13 030078......... 01.0972 ....... 040074......... 01.2491 14.51 050067......... 01.3827 21.09
010072....................... 01.2165 12.72 020011.......... 01.0329 22.27 030079......... 00.7727 ....... 040075......... 01.0588 11.57 050068......... 01.0946 19.05
010073....................... 00.9681 09.66 020012.......... 01.3114 23.99 030080......... 01.6582 20.82 040076......... 01.0307 14.71 050069......... 01.6194 23.15
010078....................... 01.1765 15.50 020013.......... 01.0331 24.03 030083......... 01.3074 21.70 040077......... 00.9164 10.72 050070......... 01.2861 30.65
010079....................... 01.2797 13.72 020014.......... 01.0795 24.52 030084......... 00.9397 ....... 040078......... 01.4848 17.29 050071......... 01.3190 30.60
010080....................... 01.0410 12.99 020017.......... 01.5155 26.83 030085......... 01.5017 20.21 040080......... 01.0736 15.45 050072......... 01.3045 30.90
010081....................... 01.9870 16.16 020018.......... 00.8963 ....... 030086......... 01.3255 18.76 040081......... 00.9292 09.91 050073......... 01.3242 31.28
010083....................... 01.0482 13.25 020019.......... 00.8718 ....... 030087......... 01.6136 18.77 040082......... 01.2135 13.69 050074......... 01.2333 33.23
010084....................... 01.4758 16.64 020020.......... 00.8462 ....... 030088......... 01.3530 19.90 040084......... 01.0970 14.83 050075......... 01.4037 30.63
010085....................... 01.3193 17.11 020021.......... 00.8338 ....... 030089......... 01.5845 18.66 040085......... 01.2469 15.18 050076......... 01.7727 29.53
010086....................... 01.0497 13.54 020024.......... 01.0892 22.64 030092......... 01.5679 20.62 040088......... 01.3050 13.73 050077......... 01.6129 22.83
010087....................... 01.6125 16.88 020025.......... 01.0122 24.44 030093......... 01.3720 18.08 040090......... 00.8995 13.78 050078......... 01.3591 24.44
010089....................... 01.1896 15.13 020026.......... 01.3245 ....... 030094......... 01.2482 18.57 040091......... 01.2939 18.25 050079......... 01.5793 28.30
010090....................... 01.5738 16.40 020027.......... 01.0132 ....... 030095......... 01.2170 13.09 040093......... 00.9710 10.98 050080......... 01.2370 16.56
010091....................... 00.9216 13.43 030001.......... 01.3125 19.28 030098......... 00.9899 ....... 040095......... 00.9117 10.56 050081......... 01.6631 24.01
010092....................... 01.4203 15.35 030002.......... 01.8022 20.25 040001......... 01.1237 12.37 040100......... 01.2420 12.81 050082......... 01.5000 21.34
010094....................... 01.1427 16.76 030003.......... 01.8995 21.05 040002......... 01.1641 13.07 040105......... 01.0034 11.90 050084......... 01.5602 22.33
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
[[Page 46241]]
Page 2 of 16
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Case Avg. Case Avg. Case Avg. Case Avg. Case Avg.
Provider mix hour Provider mix hour Provider mix hour Provider mix hour Provider mix hour
index wage index wage index wage index wage index wage
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
050088....................... 01.1393 21.94 050188.......... 01.3477 25.25 050295......... 01.4128 20.86 050419......... 01.3115 18.88 050542......... 01.2233 13.79
050089....................... 01.3622 19.92 050189.......... 00.9734 21.50 050296......... 01.2084 22.69 050420......... 01.4349 25.15 050543......... 00.9225 21.68
050090....................... 01.2815 21.75 050191.......... 01.5035 20.64 050298......... 01.2991 20.77 050421......... 01.4202 24.62 050545......... 00.8302 20.39
050091....................... 01.2000 24.42 050192.......... 01.1398 18.74 050299......... 01.3639 22.49 050423......... 00.9862 19.25 050546......... 00.7201 21.10
050092....................... 00.8597 16.12 050193.......... 01.3513 22.56 050300......... 01.3143 18.87 050424......... 01.8327 22.16 050547......... 00.9283 20.65
050093....................... 01.5911 22.35 050194.......... 01.2422 25.03 050301......... 01.3882 21.54 050425......... 01.2730 30.30 050549......... 01.7151 25.86
050096....................... 01.1293 12.95 050195.......... 01.5895 31.26 050302......... 01.4072 24.31 050426......... 01.3016 23.89 050550......... 02.3039 23.34
050097....................... 01.4914 18.40 050196.......... 01.4171 16.40 050305......... 01.5823 29.82 050427......... 00.9243 18.44 050551......... 01.3441 24.20
050099....................... 01.4623 22.91 050197.......... 01.8264 29.07 050307......... 01.4384 20.51 050430......... 00.9414 15.94 050552......... 01.1681 22.44
050100....................... 01.7458 29.38 050199.......... 00.8980 19.48 050308......... 01.5751 29.77 050431......... 01.0690 22.58 050557......... 01.4977 21.08
050101....................... 01.4057 25.12 050204.......... 01.5012 23.12 050309......... 01.3320 23.63 050432......... 01.5759 23.69 050559......... 01.3565 24.18
050102....................... 01.4495 22.34 050205.......... 01.4071 19.99 050310......... 01.2559 22.24 050433......... 01.0471 17.37 050560......... 01.1958 ......
050103....................... 01.6149 26.74 050207.......... 01.2968 20.58 050312......... 01.9778 23.66 050434......... 01.1429 18.08 050561......... 01.2258 30.34
050104....................... 01.3954 21.73 050208.......... 00.9598 27.60 050313......... 01.1978 20.90 050435......... 01.2450 18.98 050564......... 01.2054 24.02
050107....................... 01.4293 22.92 050211.......... 01.3146 29.60 050315......... 01.1780 20.82 050436......... 01.0070 15.77 050565......... 01.1520 21.26
050108....................... 01.5836 22.79 050213.......... 01.3874 21.12 050317......... 01.3273 20.90 050438......... 01.6314 23.33 050566......... 00.8825 19.75
050109....................... 02.3476 24.68 050214.......... 01.4375 21.76 050320......... 01.3287 27.27 050440......... 01.3954 19.93 050567......... 01.6587 23.01
050110....................... 01.2507 18.72 050215.......... 01.5190 27.75 050324......... 01.8319 25.93 050441......... 01.9149 28.55 050568......... 01.4204 18.28
050111....................... 01.3798 18.81 050217.......... 01.3643 18.44 050325......... 01.2523 20.87 050443......... 00.9587 15.95 050569......... 01.3542 22.93
050112....................... 01.5220 22.15 050219.......... 01.3321 20.37 050327......... 01.6010 21.00 050444......... 01.3523 22.19 050570......... 01.6980 24.91
050113....................... 01.2853 28.23 050222.......... 01.5922 24.56 050328......... 01.4495 32.92 050446......... 00.8940 17.25 050571......... 01.4204 22.37
050114....................... 01.3991 21.65 050224.......... 01.5653 22.17 050329......... 01.3164 20.34 050447......... 01.0844 18.59 050573......... 01.6397 23.66
050115....................... 01.5990 21.11 050225.......... 01.3294 20.67 050331......... 01.4127 27.08 050448......... 01.1051 19.82 050575......... 01.2273 ......
050116....................... 01.4567 22.73 050226.......... 01.3370 22.58 050333......... 00.9784 18.66 050449......... 01.3604 21.99 050577......... 01.3597 20.32
050117....................... 01.2834 20.93 050228.......... 01.3736 29.90 050334......... 01.7734 28.22 050454......... 01.8370 26.64 050578......... 01.1992 23.70
050118....................... 01.2808 23.24 050230.......... 01.2918 26.22 050335......... 01.2452 19.62 050455......... 01.9214 22.89 050579......... 01.5677 26.94
050121....................... 01.4021 19.96 050231.......... 01.6412 24.14 050336......... 01.3479 21.04 050456......... 01.1402 20.24 050580......... 01.3586 23.47
050122....................... 01.7000 22.90 050232.......... 01.7744 24.17 050337......... 01.1692 23.87 050457......... 01.9338 28.66 050581......... 01.4202 24.63
050124....................... 01.2720 19.72 050233.......... 01.2916 30.88 050342......... 01.3725 17.55 050459......... 01.1867 28.20 050583......... 01.5832 23.08
050125....................... 01.3165 25.98 050234.......... 01.3192 22.00 050343......... 01.0360 18.56 050464......... 01.8999 22.62 050584......... 01.2104 22.39
050126....................... 01.4674 23.23 050235.......... 01.5083 25.00 050348......... 01.5885 22.83 050468......... 01.3992 16.26 050585......... 01.2578 23.70
050127....................... 01.2913 22.89 050236.......... 01.6581 24.28 050349......... 00.9126 14.28 050469......... 01.0927 17.33 050586......... 01.3811 21.76
050128....................... 01.5432 20.97 050238.......... 01.4934 22.95 050350......... 01.3885 22.68 050470......... 01.1184 21.29 050588......... 01.3856 26.55
050129....................... 01.5533 22.11 050239.......... 01.5043 21.24 050351......... 01.4758 24.81 050471......... 01.7401 24.07 050589......... 01.3208 25.37
050131....................... 01.2667 27.78 050240.......... 01.3972 22.82 050352......... 01.2909 23.35 050476......... 01.3455 19.12 050590......... 01.4063 23.00
050132....................... 01.4398 24.55 050241.......... 01.2317 25.78 050353......... 01.5639 21.45 050477......... 01.5165 24.50 050591......... 01.2961 22.97
050133....................... 01.3529 20.16 050242.......... 01.4661 27.10 050355......... 00.9639 15.53 050478......... 00.9231 21.73 050592......... 01.3448 20.34
050135....................... 01.3822 26.86 050243.......... 01.5339 21.58 050357......... 01.7182 23.17 050481......... 01.4226 24.85 050593......... 01.5312 24.40
050136....................... 01.3787 21.89 050245.......... 01.3997 21.74 050359......... 01.2130 18.78 050482......... 00.9467 14.55 050594......... 02.0186 23.81
050137....................... 01.3809 31.46 050248.......... 01.2055 24.50 050360......... 01.4693 30.15 050483......... 01.1688 23.89 050597......... 01.2823 21.91
050138....................... 01.8792 32.07 050251.......... 01.0803 17.68 050366......... 01.3068 20.47 050485......... 01.6321 22.34 050598......... 01.4008 26.87
050139....................... 01.3410 31.14 050253.......... 00.7756 18.87 050367......... 01.2858 27.02 050486......... 01.4321 24.94 050599......... 01.6761 22.70
050140....................... 01.4209 30.76 050254.......... 01.1917 22.13 050369......... 01.3286 23.30 050488......... 01.3939 30.41 050601......... 01.3057 29.03
050144....................... 01.5867 26.03 050256.......... 01.7682 19.70 050373......... 01.4241 23.83 050489......... 00.9463 27.10 050603......... 01.4202 23.50
050145....................... 01.3536 27.67 050257.......... 01.0737 20.65 050376......... 01.3722 25.86 050491......... 01.2864 23.76 050604......... 01.5879 29.45
050146....................... 01.3368 ....... 050260.......... 01.0937 21.96 050377......... 00.9038 15.01 050492......... 01.2453 23.05 050607......... 01.2965 21.79
050147....................... 00.6982 20.55 050261.......... 01.1916 17.91 050378......... 01.1132 22.45 050494......... 01.1689 24.95 050608......... 01.3088 15.23
050148....................... 01.1363 19.62 050262.......... 01.9314 26.89 050379......... 01.0922 19.04 050496......... 01.7816 31.64 050609......... 01.4337 31.39
050149....................... 01.4384 21.97 050263.......... 01.2879 24.44 050380......... 01.6730 28.31 050497......... 00.7940 ....... 050613......... 01.1371 22.70
050150....................... 01.2549 23.23 050264.......... 01.3787 26.01 050382......... 01.4475 20.97 050498......... 01.2605 22.42 050615......... 01.7184 23.31
050152....................... 01.4365 24.60 050267.......... 01.5206 24.88 050385......... 01.3946 24.83 050502......... 01.6552 23.61 050616......... 01.3002 20.68
050153....................... 01.6526 30.53 050270.......... 01.2597 23.60 050388......... 00.9121 14.19 050503......... 01.3025 23.01 050618......... 01.0773 19.37
050155....................... 01.1138 23.60 050272.......... 01.3290 19.69 050390......... 01.2239 20.80 050506......... 01.4050 25.57 050623......... 01.1535 24.40
050158....................... 01.6868 27.88 050274.......... 00.9762 18.36 050391......... 01.2734 21.61 050510......... 01.3660 30.46 050624......... 01.3672 25.95
050159....................... 01.2594 22.01 050276.......... 01.2209 26.99 050392......... 00.9526 17.49 050512......... 01.4632 31.27 050625......... 01.5887 24.00
050167....................... 01.4435 21.67 050277.......... 01.3813 21.30 050393......... 01.4172 21.56 050515......... 01.3623 30.78 050630......... 01.3492 21.26
050168....................... 01.6111 24.83 050278.......... 01.5176 23.01 050394......... 01.5474 20.71 050516......... 01.6598 24.33 050633......... 01.2939 21.76
050169....................... 01.5874 24.53 050279.......... 01.2425 20.58 050396......... 01.6173 21.89 050517......... 01.2778 19.15 050635......... 01.4086 31.06
050170....................... 01.5243 21.58 050280.......... 01.6603 22.80 050397......... 01.0096 19.97 050522......... 01.3194 30.40 050636......... 01.4306 20.37
050172....................... 01.2559 19.96 050281.......... 01.4482 22.74 050401......... 01.1146 19.09 050523......... 01.2674 27.65 050638......... 01.0967 24.28
050173....................... 01.2322 23.70 050282.......... 01.3406 21.42 050404......... 01.1459 16.51 050526......... 01.3671 24.28 050641......... 01.2440 12.26
050174....................... 01.6918 27.89 050283.......... 01.1645 27.24 050406......... 01.1157 15.29 050528......... 01.3348 16.46 050643......... 00.7692 ......
050175....................... 01.3877 21.97 050286.......... 01.0345 17.99 050407......... 01.3194 27.06 050531......... 01.3097 23.60 050644......... 00.9068 26.86
050177....................... 01.2949 18.76 050289.......... 01.7959 27.38 050410......... 01.0758 17.45 050534......... 01.3868 23.83 050660......... 01.3466 ......
050179....................... 01.2634 17.29 050290.......... 01.6280 32.31 050411......... 01.4012 29.35 050535......... 01.3837 22.46 050661......... 00.8839 20.21
050180....................... 01.5556 30.12 050291.......... 01.2616 24.46 050414......... 01.2883 24.32 050537......... 01.2702 21.30 050662......... 00.8598 21.17
050183....................... 01.1975 19.09 050292.......... 01.0830 21.20 050417......... 01.3024 21.14 050539......... 01.2222 21.90 050663......... 01.0612 23.51
050186....................... 01.2894 24.12 050293.......... 01.0595 19.93 050418......... 01.4205 24.24 050541......... 01.5919 30.97 050666......... 00.7408 22.84
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[[Page 46242]]
Page 3 of 16
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Case Avg. Case Avg. Case Avg. Case Avg. Case Avg.
Provider mix hour Provider mix hour Provider mix hour Provider mix hour Provider mix hour
index wage index wage index wage index wage index wage
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
050667....................... 01.1376 24.88 060043.......... 00.9469 11.78 080003......... 01.3117 19.32 100069......... 01.3695 17.29 100165......... 01.3116 13.45
050668....................... 01.1691 28.20 060044.......... 01.2667 17.32 080004......... 01.2876 17.59 100070......... 01.4431 17.56 100166......... 01.4649 20.31
050670....................... 00.7582 20.12 060046.......... 01.1210 16.56 080005......... 01.3302 16.82 100071......... 01.2985 16.98 100167......... 01.3941 20.54
050672....................... 00.6286 23.77 060047.......... 00.9812 11.40 080006......... 01.3946 20.49 100072......... 01.2499 17.24 100168......... 01.3762 19.35
050674....................... 01.2103 29.09 060049.......... 01.3584 17.47 080007......... 01.3608 17.99 100073......... 01.7985 20.61 100169......... 01.8614 18.29
050675....................... 01.7287 16.32 060050.......... 01.1733 13.77 090001......... 01.4141 19.64 100075......... 01.6343 17.85 100170......... 01.5053 16.56
050676....................... 01.0181 13.83 060052.......... 01.1025 12.56 090002......... 01.2979 20.51 100076......... 01.3934 17.15 100172......... 01.3679 13.38
050677....................... 01.4291 32.99 060053.......... 00.9924 13.73 090003......... 01.3037 24.74 100077......... 01.3130 17.25 100173......... 01.6821 16.33
050678....................... 01.0695 24.07 060054.......... 01.3339 16.80 090004......... 01.7183 23.49 100078......... 01.1660 15.14 100174......... 01.5414 18.20
050680....................... 01.2184 26.13 060056.......... 00.9638 13.37 090005......... 01.3403 27.07 100079......... 01.8349 16.01 100175......... 01.2188 16.18
050682....................... 00.8554 14.98 060057.......... 01.0526 21.45 090006......... 01.3699 19.52 100080......... 01.6185 19.40 100176......... 02.0480 21.95
050684....................... 01.2032 21.30 060058.......... 00.9353 12.54 090007......... 01.4082 19.58 100081......... 01.1190 13.33 100177......... 01.3381 18.55
050685....................... 01.2265 26.94 060060.......... 00.9689 12.21 090008......... 01.5337 24.06 100082......... 01.5411 17.93 100179......... 01.6547 19.03
050686....................... 01.3481 30.96 060062.......... 00.9518 15.85 090010......... 00.9987 21.70 100083......... 01.3214 17.50 100180......... 01.4234 17.67
050688....................... 01.2759 27.89 060063.......... 01.0378 11.12 090011......... 01.9774 24.77 100084......... 01.5306 16.53 100181......... 01.2716 17.59
050689....................... 01.4006 29.12 060064.......... 01.4255 20.21 090015......... 01.1679 ....... 100085......... 01.4393 19.50 100183......... 01.3672 19.33
050690....................... 01.4317 30.29 060065.......... 01.3431 19.98 100001......... 01.5420 18.86 100086......... 01.3389 21.32 100186......... 01.4766 16.70
050693....................... 01.9223 28.80 060066.......... 00.9927 13.10 100002......... 01.4781 19.71 100087......... 01.8063 20.83 100187......... 01.4519 18.35
050694....................... 01.3722 21.20 060068.......... 01.2574 14.00 100004......... 01.0281 11.81 100088......... 01.6818 17.41 100189......... 01.3788 23.13
050695....................... 01.1715 24.30 060070.......... 01.0379 14.99 100005......... 01.0125 16.26 100090......... 01.4281 16.49 100191......... 01.3328 19.19
050696....................... 02.0081 27.85 060071.......... 01.2272 14.69 100006......... 01.5475 18.99 100092......... 01.4493 16.91 100199......... 01.4386 21.91
050697....................... 01.1596 17.93 060073.......... 00.9804 14.32 100007......... 01.8482 19.61 100093......... 01.5191 14.28 100200......... 01.3968 21.35
050698....................... 01.1420 22.83 060075.......... 01.3519 20.27 100008......... 01.7482 19.80 100098......... 01.1444 17.43 100203......... 01.2655 19.34
050699....................... 00.5836 23.13 060076.......... 01.3688 15.97 100009......... 01.5619 18.17 100099......... 01.2518 13.09 100204......... 01.6212 19.95
050700....................... 01.4316 32.46 060085.......... 00.9849 10.28 100010......... 01.5539 20.58 100102......... 01.1013 16.44 100206......... 01.3436 19.47
050701....................... 01.3067 27.13 060087.......... 01.6543 18.67 100012......... 01.6867 16.73 100103......... 01.1795 14.46 100207......... 01.4708 19.86
050702....................... 00.8621 16.98 060088.......... 01.0424 15.38 100014......... 01.4263 18.57 100105......... 01.4672 18.08 100208......... 01.6280 21.86
050704....................... 01.2122 20.48 060090.......... 00.9635 14.23 100015......... 01.2474 17.60 100106......... 01.0473 15.46 100209......... 01.6581 22.39
050706....................... 00.9234 16.16 060096.......... 01.0000 21.70 100017......... 01.6490 17.18 100107......... 01.4657 18.26 100210......... 01.6673 16.51
050707....................... 01.1851 25.62 060100.......... 01.4179 20.95 100018......... 01.2838 19.94 100108......... 01.1057 15.45 100211......... 01.3452 19.17
050708....................... 00.9454 15.13 060103.......... 01.2446 21.10 100019......... 01.4953 18.81 100109......... 01.3492 16.81 100212......... 01.6712 18.54
050709....................... 01.3089 ....... 060104.......... 01.3185 20.32 100020......... 01.3391 18.31 100110......... 01.4144 18.91 100213......... 01.5487 20.00
050710....................... 01.4032 ....... 070001.......... 01.7660 24.78 100022......... 01.8412 23.05 100112......... 00.9727 10.84 100217......... 01.2995 17.06
050711....................... 02.3704 ....... 070002.......... 01.8658 24.78 100023......... 01.3492 15.88 100113......... 02.0782 18.19 100220......... 01.9605 19.66
050712....................... 02.1009 ....... 070003.......... 01.1262 24.50 100024......... 01.3428 19.54 100114......... 01.4899 17.73 100221......... 01.5710 20.68
060001....................... 01.5508 18.95 070004.......... 01.1725 23.70 100025......... 01.8824 16.22 100117......... 01.3400 18.32 100222......... 01.3999 18.80
060003....................... 01.2948 16.17 070005.......... 01.3749 25.45 100026......... 01.6407 15.52 100118......... 01.2643 16.03 100223......... 01.4871 18.53
060004....................... 01.2527 19.46 070006.......... 01.3549 26.73 100027......... 00.9771 11.53 100121......... 01.3066 15.44 100224......... 01.4719 19.83
060006....................... 01.1975 16.19 070007.......... 01.3479 24.08 100028......... 01.2652 16.38 100122......... 01.4506 16.39 100225......... 01.3254 19.52
060007....................... 01.2004 13.06 070008.......... 01.3150 23.47 100029......... 01.4199 18.94 100124......... 01.3626 19.41 100226......... 01.3465 16.58
060008....................... 01.0187 14.31 070009.......... 01.2763 25.01 100030......... 01.2742 18.25 100125......... 01.1588 17.77 100228......... 01.3104 21.73
060009....................... 01.4655 19.88 070010.......... 01.5525 22.46 100032......... 01.9211 17.39 100126......... 01.4979 18.74 100229......... 01.3245 16.27
060010....................... 01.5260 20.98 070011.......... 01.3234 22.80 100034......... 01.7396 18.34 100127......... 01.6887 17.42 100230......... 01.5387 18.97
060011....................... 01.3370 20.75 070012.......... 01.2507 23.38 100035......... 01.6148 16.60 100128......... 02.2486 20.13 100231......... 01.6719 17.53
060012....................... 01.3930 15.79 070013.......... 01.2967 24.01 100038......... 01.6027 21.18 100129......... 01.2547 17.45 100232......... 01.2671 17.95
060013....................... 01.2675 18.83 070015.......... 01.3575 23.82 100039......... 01.7141 21.15 100130......... 01.2030 17.45 100234......... 01.5302 19.03
060014....................... 01.7036 20.52 070016.......... 01.3214 25.46 100040......... 01.6660 17.04 100131......... 01.3906 20.00 100235......... 01.4767 17.51
060015....................... 01.5654 19.33 070017.......... 01.3822 23.54 100043......... 01.4572 17.78 100132......... 01.4161 15.67 100236......... 01.4469 17.14
060016....................... 01.0899 11.42 070018.......... 01.3711 27.83 100044......... 01.5020 19.01 100134......... 01.0905 14.50 100237......... 02.1542 22.65
060018....................... 01.2065 16.36 070019.......... 01.2155 24.04 100045......... 01.4043 17.12 100135......... 01.5238 16.11 100238......... 01.4815 18.68
060020....................... 01.5157 16.73 070020.......... 01.3663 24.32 100046......... 01.5110 18.53 100137......... 01.3214 18.42 100239......... 01.4625 19.34
060022....................... 01.6703 17.89 070021.......... 01.3063 25.47 100047......... 01.9063 18.62 100138......... 00.9490 13.00 100240......... 00.8493 15.06
060023....................... 01.6452 16.65 070022.......... 01.7748 24.30 100048......... 01.0049 11.69 100139......... 01.0446 14.54 100241......... 00.9419 12.47
060024....................... 01.8238 21.86 070024.......... 01.3565 23.81 100049......... 01.3205 18.04 100140......... 01.2494 16.91 100242......... 01.4130 16.29
060026....................... 01.4257 19.44 070025.......... 01.7832 24.06 100050......... 01.2217 15.06 100142......... 01.1996 16.68 100243......... 01.4202 18.82
060027....................... 01.6710 19.41 070026.......... 01.2095 23.07 100051......... 01.1641 16.60 100144......... 01.1391 13.65 100244......... 01.4365 17.32
060028....................... 01.4813 21.26 070027.......... 01.2527 24.31 100052......... 01.3742 15.60 100145......... 01.3457 14.87 100246......... 01.3480 20.92
060029....................... 00.9561 13.93 070028.......... 01.4842 24.67 100053......... 01.2969 17.36 100146......... 01.2636 14.27 100248......... 01.7029 17.88
060030....................... 01.3302 20.36 070029.......... 01.3530 21.65 100054......... 01.2845 17.74 100147......... 01.1046 13.43 100249......... 01.3523 18.87
060031....................... 01.6125 18.60 070030.......... 01.3017 24.71 100055......... 01.3733 17.47 100150......... 01.3716 18.64 100252......... 01.2487 19.21
060032....................... 01.5798 19.35 070031.......... 01.2736 22.24 100056......... 01.4638 19.83 100151......... 01.8558 18.63 100253......... 01.4795 20.60
060033....................... 01.1592 11.96 070033.......... 01.2828 28.25 100057......... 01.3486 16.78 100154......... 01.5652 17.95 100254......... 01.5994 17.50
060034....................... 01.4918 15.10 070034.......... 01.3756 24.74 100060......... 01.8574 17.64 100156......... 01.2197 18.65 100255......... 01.3326 19.11
060036....................... 01.1876 14.12 070035.......... 01.3457 24.31 100061......... 01.5097 20.88 100157......... 01.6104 19.31 100256......... 01.8928 19.32
060037....................... 01.0382 13.22 070036.......... 01.4357 26.98 100062......... 01.7312 17.34 100159......... 00.9792 12.76 100258......... 01.6487 21.12
060038....................... 01.0165 12.25 070039.......... 00.9163 ....... 100063......... 01.3440 16.12 100160......... 01.1077 18.07 100259......... 01.4550 16.36
060041....................... 00.9131 16.53 080001.......... 01.6108 23.66 100067......... 01.4273 16.38 100161......... 01.5218 19.76 100260......... 01.4008 20.44
060042....................... 01.0563 15.65 080002.......... 01.1901 17.34 100068......... 01.3898 17.42 100162......... 01.3906 14.53 100262......... 01.4078 19.32
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[[Page 46243]]
Page 4 of 16
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Case Avg. Case Avg. Case Avg. Case Avg. Case Avg.
Provider mix hour Provider mix hour Provider mix hour Provider mix hour Provider mix hour
index wage index wage index wage index wage index wage
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
100263....................... 01.3780 15.44 110061.......... 01.0125 10.61 110154......... 00.8337 12.68 130009......... 00.9607 14.78 140042......... 01.0485 13.30
100264....................... 01.3927 18.24 110062.......... 00.9133 09.73 110155......... 01.2457 12.27 130010......... 00.9378 15.04 140043......... 01.1788 16.37
100265....................... 01.3736 17.47 110063.......... 01.0733 11.44 110156......... 01.0063 12.68 130011......... 01.2462 16.74 140045......... 01.0658 14.21
100266....................... 01.2340 15.64 110064.......... 01.2886 15.87 110161......... 01.3364 20.79 130012......... 01.0306 18.53 140046......... 01.3024 14.83
100267....................... 01.3054 16.39 110065.......... 01.0226 12.00 110162......... 00.8869 ....... 130013......... 01.2406 17.21 140047......... 01.1337 13.20
100268....................... 01.1963 22.00 110066.......... 01.4492 15.93 110163......... 01.4519 18.52 130014......... 01.3064 16.43 140048......... 01.2661 21.68
100269....................... 01.3576 19.07 110069.......... 01.1724 15.22 110164......... 01.4148 19.63 130015......... 00.8651 12.43 140049......... 01.5736 19.35
100270....................... 00.8215 12.95 110070.......... 01.1711 11.37 110165......... 01.3220 17.47 130016......... 00.9236 16.18 140051......... 01.4909 19.14
100271....................... 01.6484 19.22 110071.......... 01.0312 10.29 110166......... 01.4938 16.67 130017......... 01.3329 13.03 140052......... 01.3125 17.02
100273....................... 00.5356 19.72 110072.......... 01.0247 11.53 110168......... 01.6565 19.22 130018......... 01.6907 17.60 140053......... 01.8943 17.53
100275....................... 01.4323 21.96 110073.......... 01.2039 12.67 110169......... 00.7217 19.70 130019......... 01.1299 13.74 140054......... 01.3596 ......
100276....................... 01.3023 21.94 110074.......... 01.4766 18.11 110171......... 01.4568 21.21 130021......... 01.0465 11.96 140055......... 00.9522 13.00
100277....................... 01.0092 12.71 110075.......... 01.2078 15.29 110172......... 01.3364 22.83 130022......... 01.1801 15.79 140058......... 01.2417 15.26
100279....................... 01.3749 18.35 110076.......... 01.3901 18.01 110174......... 01.0421 17.57 130024......... 01.0502 15.25 140059......... 01.1373 13.52
100280....................... 01.3702 16.93 110078.......... 01.6719 20.46 110176......... 01.1237 19.42 130025......... 01.1504 15.21 140061......... 01.0923 13.80
100281....................... 01.2549 20.85 110079.......... 01.3994 21.08 110177......... 01.4754 19.21 130026......... 01.1837 17.88 140062......... 01.2440 23.10
100282....................... 01.0458 16.99 110080.......... 01.1584 17.55 110178......... 01.3367 16.78 130027......... 00.9547 17.18 140063......... 01.4167 22.48
100283....................... 01.5652 ....... 110082.......... 02.0181 20.36 110179......... 01.2418 21.56 130028......... 01.2487 16.08 140064......... 01.3103 16.15
110001....................... 01.2981 17.40 110083.......... 01.7259 20.66 110181......... 00.9808 12.59 130029......... 01.0228 17.07 140065......... 01.4933 23.68
110002....................... 01.2392 15.22 110086.......... 01.2202 13.76 110183......... 01.3677 17.07 130030......... 01.0169 16.20 140066......... 01.3703 13.39
110003....................... 01.3058 15.41 110087.......... 01.3382 19.17 110184......... 01.1756 17.58 130031......... 01.0188 13.26 140067......... 01.8244 18.24
110004....................... 01.3077 16.17 110088.......... 00.9695 11.17 110185......... 01.0884 12.23 130034......... 01.0391 16.38 140068......... 01.3717 19.00
110005....................... 01.1844 21.40 110089.......... 01.2124 15.37 110186......... 01.3073 15.75 130035......... 01.0662 15.37 140069......... 01.0074 14.23
110006....................... 01.3576 18.87 110091.......... 01.3396 19.15 110187......... 01.2468 17.19 130036......... 01.2648 12.50 140070......... 01.2760 16.18
110007....................... 01.4531 16.31 110092.......... 01.1806 12.55 110188......... 01.4230 18.00 130037......... 01.2740 14.58 140074......... 00.9717 14.60
110008....................... 01.2394 15.47 110093.......... 01.0117 09.81 110189......... 01.1532 19.78 130043......... 00.9512 14.61 140075......... 01.4676 21.53
110009....................... 01.0428 15.71 110094.......... 00.9605 12.06 110190......... 01.0880 14.41 130044......... 01.1521 12.37 140077......... 01.1406 17.05
110010....................... 02.1537 21.39 110095.......... 01.2790 13.86 110191......... 01.3522 18.06 130045......... 01.0312 12.15 140079......... 01.2381 20.90
110011....................... 01.2831 16.01 110096.......... 01.1394 14.30 110192......... 01.3947 22.17 130048......... 01.0694 11.90 140080......... 01.5767 19.60
110013....................... 01.1303 14.36 110097.......... 01.0211 15.58 110193......... 01.2332 16.16 130049......... 01.2951 17.55 140081......... 01.0786 13.92
110014....................... 01.0358 14.48 110098.......... 01.0943 11.76 110194......... 00.9677 11.77 130054......... 00.9652 17.12 140082......... 01.5017 22.10
110015....................... 01.3568 16.52 110100.......... 01.0953 12.27 110195......... 01.0807 10.50 130056......... 00.8422 09.45 140083......... 01.2513 16.51
110016....................... 01.2935 14.21 110101.......... 01.0963 09.24 110198......... 01.3335 22.58 130058......... 00.9768 12.87 140084......... 01.2323 17.94
110017....................... 00.8913 11.01 110103.......... 00.9600 10.35 110200......... 01.9391 15.79 130060......... 01.1395 18.38 140086......... 01.1440 13.93
110018....................... 01.1312 17.20 110104.......... 01.1190 13.28 110201......... 01.4569 16.13 130061......... 00.9484 ....... 140087......... 01.3815 17.10
110020....................... 01.2347 17.30 110105.......... 01.1311 15.17 110203......... 00.9715 14.94 140001......... 01.2991 14.63 140088......... 01.6591 23.33
110023....................... 01.2424 17.53 110107.......... 01.8265 17.61 110204......... 00.8135 13.48 140002......... 01.2823 17.06 140089......... 01.2280 15.85
110024....................... 01.4719 16.51 110108.......... 00.9766 11.27 110205......... 01.1045 11.84 140003......... 01.0185 13.14 140090......... 01.5067 23.62
110025....................... 01.4105 16.85 110109.......... 01.1048 12.14 110207......... 01.0934 15.59 140004......... 01.0772 13.75 140091......... 01.8655 17.70
110026....................... 01.1893 14.02 110111.......... 01.1951 15.43 110208......... 00.9744 14.94 140005......... 00.9515 09.98 140093......... 01.1958 17.17
110027....................... 01.1003 14.56 110112.......... 01.1526 16.19 110209......... 00.8260 ....... 140007......... 01.4661 20.56 140094......... 01.2893 18.81
110028....................... 01.6029 17.75 110113.......... 01.1372 12.86 120001......... 01.7306 24.22 140008......... 01.4816 20.57 140095......... 01.4253 ......
110029....................... 01.3446 17.71 110114.......... 01.0725 13.75 120002......... 01.1982 21.46 140010......... 01.3912 22.14 140097......... 00.9264 14.15
110030....................... 01.2789 16.60 110115.......... 01.6206 21.82 120003......... 01.1664 21.82 140011......... 01.1461 15.31 140100......... 01.2257 17.62
110031....................... 01.3373 19.59 110118.......... 01.0282 13.18 120004......... 01.2809 20.56 140012......... 01.2854 17.59 140101......... 01.2060 18.04
110032....................... 01.2263 15.31 110120.......... 01.0844 13.35 120005......... 01.2640 18.34 140013......... 01.6583 16.49 140102......... 01.0399 14.09
110033....................... 01.5143 20.32 110121.......... 01.1813 11.84 120006......... 01.2131 22.75 140014......... 01.0788 16.53 140103......... 01.3225 16.66
110034....................... 01.5234 16.64 110122.......... 01.3572 16.03 120007......... 01.6283 20.27 140015......... 01.2919 13.45 140105......... 01.3087 18.25
110035....................... 01.4060 18.53 110124.......... 01.0707 15.32 120009......... 00.9840 18.05 140016......... 00.9315 11.59 140107......... 01.0822 11.63
110036....................... 01.6813 ....... 110125.......... 01.2239 15.97 120010......... 01.8462 22.11 140018......... 01.4546 18.85 140108......... 01.3622 20.00
110037....................... 01.0852 10.18 110127.......... 00.9150 14.43 120011......... 01.2509 30.31 140019......... 00.9900 11.80 140109......... 01.1367 12.95
110038....................... 01.4649 15.04 110128.......... 01.2059 17.54 120012......... 00.9944 20.30 140024......... 01.0188 13.59 140110......... 01.2343 14.51
110039....................... 01.3761 17.93 110129.......... 01.6793 14.06 120014......... 01.3609 21.25 140025......... 01.0804 15.88 140112......... 01.1043 13.55
110040....................... 01.0393 16.26 110130.......... 01.0709 10.57 120015......... 00.8375 21.01 140026......... 01.1408 15.58 140113......... 01.4630 19.21
110041....................... 01.2212 16.43 110132.......... 01.1522 12.87 120016......... 00.8646 21.94 140027......... 01.3210 15.96 140114......... 01.3392 18.95
110042....................... 01.2049 14.63 110134.......... 00.8920 11.65 120018......... 01.0071 21.16 140029......... 01.3790 19.62 140115......... 01.2253 19.32
110043....................... 01.7109 15.17 110135.......... 01.1993 13.83 120019......... 01.1783 19.48 140030......... 01.6766 21.46 140116......... 01.2899 19.68
110044....................... 01.0952 14.31 110136.......... 01.1192 13.74 120021......... 01.0173 19.68 140031......... 01.1664 13.02 140117......... 01.4908 17.63
110045....................... 01.2460 22.04 110140.......... 00.8194 15.03 120022......... 01.7340 17.83 140032......... 01.2528 16.44 140118......... 01.6836 23.01
110046....................... 01.1964 15.07 110141.......... 00.9075 11.65 120026......... 01.2870 22.30 140033......... 01.2626 19.10 140119......... 01.6901 19.58
110048....................... 01.3156 12.97 110142.......... 00.9799 11.15 120027......... 01.5254 21.16 140034......... 01.1754 16.74 140120......... 01.5071 14.72
110049....................... 01.0670 13.71 110143.......... 01.4049 18.27 130001......... 01.0518 17.21 140035......... 01.0183 10.70 140121......... 01.5259 10.91
110050....................... 01.0687 14.00 110144.......... 01.1632 16.44 130002......... 01.3744 14.66 140036......... 01.2342 15.03 140122......... 01.5567 21.02
110051....................... 00.9846 16.35 110146.......... 01.0267 09.43 130003......... 01.3166 18.11 140037......... 00.9837 12.24 140124......... 01.1235 23.06
110052....................... 00.9986 09.11 110149.......... 01.1280 12.17 130005......... 01.4466 18.49 140038......... 01.1512 15.00 140125......... 01.3444 15.60
110054....................... 01.2820 16.57 110150.......... 01.3562 16.56 130006......... 01.9033 18.19 140039......... 00.9224 11.51 140127......... 01.3521 17.11
110056....................... 00.9698 12.61 110152.......... 01.1389 13.06 130007......... 01.6435 19.45 140040......... 01.3038 14.34 140128......... 01.0617 16.10
110059....................... 01.2862 14.39 110153.......... 01.0201 15.49 130008......... 00.9993 10.28 140041......... 01.2502 15.01 140129......... 01.0511 13.18
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Case Avg. Case Avg. Case Avg. Case Avg. Case Avg.
Provider mix hour Provider mix hour Provider mix hour Provider mix hour Provider mix hour
index wage index wage index wage index wage index wage
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
140130....................... 01.2732 21.67 140224.......... 01.3678 22.10 150039......... 01.0056 14.51 150125......... 01.4257 18.17 160068......... 01.1088 13.30
140132....................... 01.4192 18.58 140228.......... 01.7080 17.36 150042......... 01.2901 15.47 150126......... 01.5188 19.24 160069......... 01.4027 16.05
140133....................... 01.3737 19.77 140230.......... 00.9428 15.48 150043......... 01.0529 16.65 150127......... 01.0449 14.34 160070......... 01.0379 13.84
140135....................... 01.3086 14.29 140231.......... 01.6699 19.79 150044......... 01.2628 17.63 150128......... 01.2306 18.59 160072......... 01.0673 12.08
140137....................... 01.0318 13.61 140233.......... 01.7418 16.57 150045......... 01.0901 15.00 150129......... 01.2088 20.35 160073......... 01.0129 11.50
140138....................... 00.9633 12.15 140234.......... 01.1961 16.03 150046......... 01.5910 16.06 150130......... 01.1433 16.23 160074......... 01.1103 12.98
140139....................... 01.0713 13.46 140236.......... 01.0474 12.82 150047......... 01.6262 17.74 150132......... 01.3406 19.17 160075......... 01.1107 13.84
140140....................... 01.1363 13.05 140239.......... 01.5891 18.81 150048......... 01.1670 16.18 150133......... 01.2048 14.96 160076......... 01.0695 16.33
140141....................... 00.9005 13.30 140240.......... 01.5057 20.90 150049......... 01.0814 13.72 150134......... 01.3003 16.53 160077......... 01.1355 10.97
140143....................... 01.0710 15.95 140242.......... 01.5840 22.51 150050......... 01.1857 14.50 150136......... 00.9384 18.69 160079......... 01.4258 15.22
140144....................... 00.9814 16.57 140245.......... 01.1287 13.55 150051......... 01.3842 16.92 150138......... 01.1552 ....... 160080......... 01.2094 15.46
140145....................... 01.1986 14.80 140246.......... 01.0547 12.03 150052......... 01.0656 12.93 150139......... 01.5412 ....... 160081......... 01.0669 14.36
140146....................... 00.9645 14.85 140250.......... 01.3128 21.35 150053......... 01.0612 16.69 150141......... 01.1063 ....... 160082......... 01.7526 17.09
140147....................... 01.1905 13.32 140251.......... 01.3100 18.25 150054......... 01.1373 12.39 150142......... 02.4300 ....... 160083......... 01.5750 17.49
140148....................... 01.7984 16.51 140252.......... 01.4282 21.53 150056......... 01.7052 21.58 160001......... 01.2713 16.39 160085......... 01.0913 12.79
140150....................... 01.5793 26.00 140253.......... 01.4398 ....... 150057......... 02.3094 15.06 160002......... 01.1942 13.14 160086......... 01.0153 12.88
140151....................... 01.1069 17.61 140258.......... 01.5311 20.98 150058......... 01.6859 18.64 160003......... 01.0183 11.87 160088......... 01.0346 13.10
140152....................... 01.0701 22.68 140271.......... 01.0187 13.54 150059......... 01.3219 18.93 160005......... 01.1028 12.93 160089......... 01.1654 14.12
140155....................... 01.1892 16.91 140275.......... 01.2297 18.20 150060......... 01.1301 12.79 160007......... 01.0097 12.02 160090......... 01.0018 13.98
140158....................... 01.2623 21.41 140276.......... 01.9808 20.48 150061......... 01.3042 15.86 160008......... 01.1070 13.93 160091......... 01.1032 10.56
140160....................... 01.2330 15.34 140280.......... 01.2730 16.16 150062......... 01.0694 15.20 160009......... 01.1682 13.54 160092......... 00.9729 12.93
140161....................... 01.1376 17.05 140281.......... 01.6371 20.19 150063......... 01.0497 18.88 160012......... 01.0622 14.05 160093......... 01.1433 15.20
140162....................... 01.7733 18.38 140285.......... 01.1995 14.75 150064......... 01.2128 16.48 160013......... 01.2233 16.64 160094......... 01.2151 14.79
140164....................... 01.2955 16.01 140286.......... 01.1484 17.59 150065......... 01.1479 15.94 160014......... 01.0356 12.21 160095......... 01.0295 12.30
140165....................... 01.1122 1
FR Doc. 96-22145 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1997 Rates
3.06 140288.......... 01.7729 22.68 150066......... 01.0006 12.89 160016......... 01.2891 15.68 160097......... 01.0918 13.47
140166....................... 01.2945 16.62 140289.......... 01.3068 15.73 150067......... 01.1174 14.35 160018......... 00.9441 13.19 160098......... 01.0813 13.90
140167....................... 01.1593 14.64 140290.......... 01.3353 19.21 150069......... 01.2347 16.53 160020......... 01.0854 12.11 160099......... 00.9773 12.80
140168....................... 01.1855 15.02 140291.......... 01.2791 22.84 150070......... 01.0425 16.70 160021......... 01.0514 13.85 160101......... 01.1119 17.71
140170....................... 01.1292 12.39 140292.......... 01.1677 19.04 150071......... 01.1521 12.69 160023......... 01.1553 13.66 160102......... 01.3846 15.69
140171....................... 00.9125 12.53 140294.......... 01.1871 16.10 150072......... 01.1943 15.32 160024......... 01.5685 17.39 160103......... 01.0159 12.95
140172....................... 01.5367 18.29 140297.......... 01.2576 21.42 150073......... 01.0179 15.49 160026......... 01.0997 15.21 160104......... 01.2441 19.21
140173....................... 00.9787 13.11 140300.......... 01.6558 24.90 150074......... 01.5921 18.63 160027......... 01.1632 13.22 160106......... 01.0809 14.18
140174....................... 01.4289 18.89 150001.......... 01.0902 16.95 150075......... 01.2189 13.82 160028......... 01.3375 17.78 160107......... 01.1459 13.78
140176....................... 01.2609 18.83 150002.......... 01.4428 19.23 150076......... 01.1446 19.89 160029......... 01.4982 17.46 160108......... 01.1575 14.09
140177....................... 01.2794 16.44 150003.......... 01.7127 18.32 150077......... 01.2631 16.21 160030......... 01.2329 16.67 160109......... 01.1710 12.01
140179....................... 01.3313 19.51 150004.......... 01.4240 20.15 150078......... 01.0858 17.20 160031......... 01.1857 13.26 160110......... 01.5051 17.76
140180....................... 01.5279 20.22 150005.......... 01.1897 17.17 150079......... 01.1456 13.01 160032......... 01.1518 14.66 160111......... 01.1008 10.75
140181....................... 01.3085 18.82 150006.......... 01.2020 16.72 150082......... 01.4952 18.38 160033......... 01.7266 15.82 160112......... 01.4058 14.48
140182....................... 01.3245 19.11 150007.......... 01.2261 17.95 150084......... 01.8742 21.80 160034......... 01.0638 13.81 160113......... 00.9632 11.39
140184....................... 01.1998 14.20 150008.......... 01.3450 18.38 150086......... 01.3003 15.76 160035......... 00.9589 11.91 160114......... 01.0691 14.13
140185....................... 01.4563 16.35 150009.......... 01.3279 16.97 150088......... 01.1875 16.71 160036......... 01.0735 12.83 160115......... 01.0315 13.87
140186....................... 01.3197 18.48 150010.......... 01.2026 16.10 150089......... 01.4010 18.99 160037......... 01.1648 14.80 160116......... 01.1763 15.46
140187....................... 01.4891 16.33 150011.......... 01.2227 16.76 150090......... 01.2547 19.34 160039......... 01.0629 15.23 160117......... 01.3429 15.52
140188....................... 00.9624 10.54 150012.......... 01.6885 20.57 150091......... 01.0744 15.66 160040......... 01.3465 16.04 160118......... 01.0327 12.42
140189....................... 01.1723 15.74 150013.......... 01.1612 13.09 150092......... 01.0659 12.44 160041......... 01.0613 12.88 160120......... 01.0161 09.94
140190....................... 01.1204 13.36 150014.......... 01.4250 18.85 150094......... 00.9984 16.65 160043......... 01.0335 13.38 160122......... 01.1556 14.96
140191....................... 01.3847 23.16 150015.......... 01.2351 17.85 150095......... 01.1097 15.78 160044......... 01.1566 13.36 160123......... 01.1606 12.18
140192....................... 01.1887 16.51 150017.......... 01.8496 17.26 150096......... 01.1003 17.15 160045......... 01.6893 17.48 160124......... 01.2587 15.35
140193....................... 01.0150 12.24 150018.......... 01.2888 17.47 150097......... 01.1268 16.64 160046......... 01.0357 11.92 160126......... 01.1485 13.82
140197....................... 01.2770 16.05 150019.......... 01.1204 13.82 150098......... 01.1387 11.81 160047......... 01.3555 15.87 160129......... 01.0397 13.07
140199....................... 01.0179 15.13 150020.......... 01.1507 13.19 150099......... 01.2979 17.10 160048......... 01.0230 11.76 160130......... 01.1619 13.04
140200....................... 01.4263 20.12 150021.......... 01.6805 18.22 150100......... 01.6831 18.15 160049......... 00.9816 12.04 160131......... 01.0980 12.63
140202....................... 01.3108 20.09 150022.......... 01.1445 17.62 150101......... 01.0919 14.46 160050......... 01.0242 14.12 160134......... 00.9706 11.37
140203....................... 01.1567 19.02 150023.......... 01.4993 17.81 150102......... 01.0920 14.61 160051......... 00.9990 12.90 160135......... 01.0543 13.24
140205....................... 00.9105 13.88 150024.......... 01.4398 16.96 150103......... 01.0356 17.63 160052......... 01.0599 14.80 160138......... 01.0612 13.48
140206....................... 01.0979 19.58 150025.......... 01.4540 16.32 150104......... 01.1461 15.09 160054......... 01.0268 10.82 160140......... 01.0940 14.86
140207....................... 01.3773 26.85 150026.......... 01.1855 16.69 150105......... 01.4058 16.61 160055......... 01.0383 11.48 160142......... 01.0318 13.60
140208....................... 01.6155 23.94 150027.......... 01.0681 16.04 150106......... 01.1387 15.58 160056......... 01.0434 12.84 160143......... 01.1292 13.03
140209....................... 01.7014 17.46 150029.......... 01.2766 20.57 150109......... 01.4513 16.04 160057......... 01.3212 15.92 160145......... 01.0839 13.74
140210....................... 01.0830 12.87 150030.......... 01.1946 16.20 150110......... 00.9917 14.72 160058......... 01.6811 18.42 160146......... 01.4188 15.32
140211....................... 01.2257 20.44 150031.......... 01.0622 15.93 150111......... 01.2066 12.88 160060......... 01.0858 13.82 160147......... 01.2744 15.02
140212....................... 01.2970 22.65 150032.......... 01.7930 18.85 150112......... 01.2228 16.84 160061......... 01.0104 14.19 160151......... 01.0694 12.75
140213....................... 01.2892 20.44 150033.......... 01.6075 20.07 150113......... 01.1843 16.78 160062......... 00.9605 11.95 160152......... 01.0169 13.30
140215....................... 01.1640 13.22 150034.......... 01.4013 18.15 150114......... 01.0253 13.44 160063......... 01.2810 14.24 160153......... 01.7061 17.05
140217....................... 01.2388 21.09 150035.......... 01.4004 17.90 150115......... 01.4004 17.31 160064......... 01.6369 16.41 170001......... 01.2005 15.90
140218....................... 01.0502 13.64 150036.......... 01.0404 17.35 150122......... 01.1415 17.55 160065......... 01.0755 14.51 170004......... 01.0839 13.18
140220....................... 01.1066 14.22 150037.......... 01.2647 17.06 150123......... 01.1703 12.81 160066......... 01.1226 14.06 170006......... 01.1973 13.48
140223....................... 01.5408 25.37 150038.......... 01.2712 16.65 150124......... 01.1239 15.00 160067......... 01.3756 16.70 170008......... 00.9787 13.35
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[[Page 46245]]
Page 6 of 16
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Case Avg. Case Avg. Case Avg. Case Avg. Case Avg.
Provider mix hour Provider mix hour Provider mix hour Provider mix hour Provider mix hour
index wage index wage index wage index wage index wage
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
170009....................... 01.1209 16.81 170089.......... 00.9887 14.21 180011......... 01.1747 15.71 180103......... 02.0746 17.85 190060......... 01.4965 16.51
170010....................... 01.2604 16.38 170090.......... 01.0970 09.58 180012......... 01.3355 17.14 180104......... 01.5020 16.55 190064......... 01.5617 17.46
170011....................... 01.4042 14.59 170092.......... 00.8625 11.45 180013......... 01.5057 17.38 180105......... 00.9303 12.23 190065......... 01.4781 15.75
170012....................... 01.4938 15.48 170093.......... 00.9308 11.58 180014......... 01.6061 19.67 180106......... 00.9112 12.65 190071......... 00.8601 11.38
170013....................... 01.3148 13.27 170094.......... 01.0437 12.81 180015......... 01.2422 14.91 180108......... 00.8502 12.49 190077......... 00.9184 13.41
170014....................... 01.0357 15.18 170095.......... 01.0793 13.80 180016......... 01.3158 14.91 180115......... 01.0276 14.18 190078......... 01.1344 11.21
170015....................... 00.9779 13.74 170097.......... 01.0290 13.42 180017......... 01.2736 13.52 180116......... 01.3708 14.92 190079......... 01.2606 13.61
170016....................... 01.6634 21.80 170098.......... 01.0823 16.21 180018......... 01.2225 15.73 180117......... 01.1829 16.14 190081......... 00.8818 09.70
170017....................... 01.1668 16.76 170099.......... 01.3430 11.00 180019......... 01.3412 17.22 180118......... 01.0472 11.72 190083......... 00.9480 12.45
170018....................... 01.0636 12.23 170100.......... 00.9977 14.63 180020......... 01.0343 15.37 180120......... 01.0465 12.49 190086......... 01.3623 14.02
170019....................... 01.1792 15.13 170101.......... 00.9112 14.13 180021......... 01.1778 13.25 180121......... 01.2193 13.09 190088......... 01.1960 16.01
170020....................... 01.3277 14.54 170102.......... 01.0195 12.78 180023......... 00.8339 11.27 180122......... 01.0457 14.47 190089......... 01.1207 09.60
170022....................... 01.1643 14.15 170103.......... 01.2461 15.28 180024......... 01.3934 15.69 180123......... 01.4536 19.34 190090......... 01.0617 15.75
170023....................... 01.4219 15.57 170104.......... 01.4212 19.52 180025......... 01.1240 16.18 180124......... 01.4782 16.00 190092......... 01.3320 20.14
170024....................... 01.1563 12.71 170105.......... 01.0263 14.45 180026......... 01.1079 13.66 180125......... 00.9495 16.23 190095......... 00.9953 14.04
170025....................... 01.1622 18.37 170106.......... 00.8380 12.54 180027......... 01.2747 14.17 180126......... 01.1697 11.90 190098......... 01.5422 17.56
170026....................... 01.0141 16.38 170108.......... 00.9468 10.88 180028......... 00.9964 16.19 180127......... 01.2380 16.63 190099......... 01.1497 17.31
170027....................... 01.3730 15.02 170109.......... 01.0494 14.67 180029......... 01.2190 15.99 180128......... 01.1870 15.40 190102......... 01.5854 16.15
170030....................... 01.0399 13.61 170110.......... 01.0197 13.62 180030......... 01.1777 12.89 180129......... 01.0306 13.93 190103......... 00.8408 09.66
170031....................... 00.9163 12.36 170112.......... 00.9254 13.44 180031......... 01.0461 12.38 180130......... 01.4219 17.87 190106......... 01.1388 17.27
170032....................... 01.1121 14.18 170113.......... 01.1501 13.43 180032......... 00.9926 15.30 180132......... 01.2453 15.43 190109......... 01.1894 14.20
170033....................... 01.3417 14.08 170114.......... 00.9540 12.96 180033......... 01.1325 12.57 180133......... 01.2455 18.31 190110......... 00.9431 11.96
170034....................... 00.9579 13.74 170115.......... 00.9905 11.01 180034......... 01.0720 13.61 180134......... 01.0124 13.71 190111......... 01.5456 17.24
170035....................... 00.9370 12.37 170116.......... 01.0367 13.94 180035......... 01.5668 18.26 180136......... 01.5752 16.63 190112......... 01.5143 20.35
170036....................... 00.8755 12.31 170117.......... 00.9947 12.63 180036......... 01.2433 17.36 180137......... 01.6637 17.00 190113......... 01.3748 17.85
170037....................... 01.1197 15.02 170119.......... 00.9470 11.32 180037......... 01.2824 20.29 180138......... 01.2089 17.02 190114......... 01.0043 11.51
170038....................... 00.9180 10.94 170120.......... 01.2814 14.66 180038......... 01.4336 14.73 180139......... 01.0714 16.41 190115......... 01.2409 16.75
170039....................... 01.1372 11.69 170122.......... 01.9013 19.69 180040......... 02.0237 19.04 180140......... 01.0106 ....... 190116......... 01.2969 14.97
170040....................... 01.5594 18.21 170123.......... 01.7740 17.69 180041......... 01.0904 13.03 190001......... 00.9354 16.67 190118......... 01.0464 11.87
170041....................... 00.9886 11.41 170124.......... 00.9495 12.10 180042......... 01.1215 13.43 190002......... 01.6389 16.28 190120......... 00.9281 12.89
170043....................... 00.9329 13.41 170126.......... 00.9261 11.07 180043......... 01.0168 15.31 190003......... 01.4461 17.16 190122......... 01.2732 12.96
170044....................... 01.1174 14.73 170128.......... 01.0762 14.31 180044......... 01.0336 14.68 190004......... 01.3781 14.81 190124......... 01.5748 18.80
170045....................... 01.0311 13.54 170131.......... 01.0910 10.54 180045......... 01.2089 16.86 190005......... 01.6913 14.94 190125......... 01.5826 16.74
170049....................... 01.3345 18.05 170133.......... 01.1401 14.09 180046......... 01.2073 16.81 190006......... 01.2839 14.07 190128......... 01.2172 17.04
170050....................... 00.8380 09.63 170134.......... 00.9226 12.10 180047......... 01.0087 13.79 190007......... 01.0054 12.79 190130......... 00.9983 11.74
170051....................... 00.9591 13.31 170137.......... 01.1832 16.81 180048......... 01.1345 15.53 190008......... 01.6481 17.79 190131......... 01.2691 17.33
170052....................... 01.0675 13.31 170139.......... 00.9838 11.66 180049......... 01.3619 14.47 190009......... 01.1897 13.40 190133......... 01.0518 15.09
170053....................... 01.0064 13.09 170140.......... 00.9990 11.17 180050......... 01.2650 15.58 190010......... 01.1104 15.31 190134......... 00.9992 12.16
170054....................... 01.0821 12.86 170142.......... 01.2590 16.10 180051......... 01.4236 14.35 190011......... 01.1162 14.08 190135......... 01.4027 17.70
170055....................... 01.0629 17.05 170143.......... 01.1201 12.53 180053......... 01.1138 14.22 190013......... 01.4152 15.27 190136......... 01.1264 10.66
170056....................... 00.9457 10.99 170144.......... 01.6225 18.74 180054......... 01.1573 14.02 190014......... 01.0568 15.36 190138......... 00.7080 15.62
170057....................... 01.0529 13.75 170145.......... 01.1678 17.02 180055......... 01.0383 13.61 190015......... 01.2394 16.38 190140......... 00.9434 11.60
170058....................... 01.1738 17.54 170146.......... 01.4164 17.58 180056......... 01.1035 16.68 190017......... 01.3740 17.22 190142......... 00.9384 12.20
170060....................... 01.1254 12.73 170147.......... 01.2279 18.33 180058......... 01.0125 12.85 190018......... 01.1705 13.78 190144......... 01.2227 18.82
170061....................... 01.1532 12.59 170148.......... 01.4736 18.35 180059......... 00.9719 11.98 190019......... 01.5074 17.57 190145......... 00.9867 13.77
170062....................... 00.9501 10.45 170150.......... 01.0772 13.13 180060......... 00.7427 13.48 190020......... 01.1936 15.83 190146......... 01.5911 18.99
170063....................... 00.8993 09.30 170151.......... 00.9962 11.69 180063......... 00.9643 10.28 190025......... 01.2979 12.36 190147......... 00.9929 13.30
170064....................... 00.9472 11.38 170152.......... 00.9812 13.27 180064......... 01.3019 14.40 190026......... 01.4497 15.65 190148......... 00.8949 11.81
170066....................... 00.9901 12.26 170160.......... 01.0305 11.25 180065......... 00.9850 09.05 190027......... 01.4805 15.62 190149......... 00.9972 11.02
170067....................... 01.0335 11.05 170164.......... 01.0288 13.87 180066......... 01.2107 16.87 190029......... 01.1364 14.09 190151......... 01.1567 12.30
170068....................... 01.3864 14.01 170166.......... 01.1446 13.49 180067......... 01.8972 15.96 190033......... 00.9673 09.64 190152......... 01.4477 20.50
170069....................... 01.1712 13.20 170168.......... 00.9486 09.97 180069......... 01.0363 16.08 190034......... 01.2482 14.93 190155......... 00.9246 10.54
170070....................... 01.0193 11.83 170171.......... 01.0923 11.15 180070......... 01.0919 14.86 190035......... 01.4173 20.27 190156......... 00.8872 11.89
170072....................... 00.9565 11.53 170172.......... 00.9841 11.07 180072......... 01.0544 13.80 190036......... 01.6581 21.15 190158......... 01.2399 20.36
170073....................... 01.1115 12.66 170174.......... 01.0916 11.58 180075......... 00.9745 13.08 190037......... 00.9667 11.05 190160......... 01.2163 15.56
170074....................... 01.1546 12.86 170175.......... 01.2906 16.30 180078......... 01.1237 17.35 190039......... 01.4275 16.41 190161......... 01.0457 12.98
170075....................... 00.8688 10.55 170176.......... 01.5023 18.40 180079......... 01.2461 13.75 190040......... 01.3850 19.03 190162......... 01.1677 21.04
170076....................... 01.0722 11.15 170181.......... 01.0745 ....... 180080......... 01.0640 15.16 190041......... 01.4986 19.72 190164......... 01.2267 16.86
170077....................... 00.9683 11.12 170182.......... 00.8647 ....... 180085......... 01.2920 17.49 190043......... 01.1369 12.38 190166......... 01.0709 14.81
170079....................... 01.0838 11.81 170183.......... 02.1585 ....... 180087......... 01.0844 13.72 190044......... 01.1725 18.27 190167......... 01.2039 16.09
170080....................... 00.9559 11.05 180001.......... 01.2298 16.16 180088......... 01.5754 19.42 190045......... 01.3644 19.09 190170......... 00.9613 12.34
170081....................... 00.9254 10.42 180002.......... 01.0070 17.16 180092......... 01.0511 14.43 190046......... 01.4846 16.87 190173......... 01.4516 19.47
170082....................... 01.0572 10.60 180004.......... 01.0887 13.54 180093......... 01.3575 14.76 190048......... 01.0651 14.55 190175......... 01.2790 ......
170084....................... 00.9830 11.06 180005.......... 01.0375 17.40 180094......... 01.0158 11.93 190049......... 00.9679 14.74 190176......... 01.7076 18.06
170085....................... 00.9074 12.01 180006.......... 00.9157 08.63 180095......... 01.1597 12.78 190050......... 01.0446 13.90 190177......... 01.6056 22.02
170086....................... 01.7241 18.04 180007.......... 01.5430 14.17 180099......... 01.2008 11.72 190053......... 01.0575 11.98 190178......... 00.9842 11.20
170087....................... 01.4580 18.87 180009.......... 01.3358 17.70 180101......... 01.3403 18.84 190054......... 01.4118 13.67 190182......... 01.1627 20.12
170088....................... 00.9068 10.59 180010.......... 01.8318 16.91 180102......... 01.5134 16.31 190059......... 00.9449 13.58 190183......... 01.1310 13.81
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Case Avg. Case Avg. Case Avg. Case Avg. Case Avg.
Provider mix hour Provider mix hour Provider mix hour Provider mix hour Provider mix hour
index wage index wage index wage index wage index wage
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
190184....................... 01.0574 12.13 210002.......... 01.9575 16.84 220028......... 01.4667 22.45 220162......... 01.0805 ....... 230102......... 01.1047 ......
190185....................... 01.3141 19.03 210003.......... 01.5314 22.97 220029......... 01.1906 22.25 220163......... 02.0697 24.73 230103......... 01.0214 17.37
190186....................... 00.9515 11.69 210004.......... 01.3228 20.30 220030......... 01.0842 16.42 220171......... 01.6908 22.55 230104......... 01.6223 20.32
190187....................... 00.7862 14.05 210005.......... 01.2352 17.70 220031......... 02.0234 27.21 230001......... 01.2061 15.98 230105......... 01.6171 19.46
190189....................... 00.9439 14.54 210006.......... 01.1253 16.84 220033......... 01.3931 19.40 230002......... 01.2210 19.28 230106......... 01.1730 18.07
190190....................... 00.9294 18.74 210007.......... 01.6144 18.82 220035......... 01.2748 19.72 230003......... 01.0891 18.07 230107......... 00.8972 12.56
190191....................... 01.3146 18.47 210008.......... 01.3145 21.21 220036......... 01.6198 23.26 230004......... 01.6087 20.95 230108......... 01.2387 16.64
190194....................... 01.1471 19.16 210009.......... 01.7113 18.57 220038......... 01.2797 21.85 230005......... 01.2812 18.02 230110......... 01.3356 17.10
190196....................... 00.9064 16.46 210010.......... 01.2016 17.00 220041......... 01.2446 20.87 230006......... 01.1331 16.19 230111......... 00.9762 15.13
190197....................... 01.2631 19.05 210011.......... 01.2066 20.12 220042......... 01.2043 24.10 230007......... 01.0869 16.51 230113......... 00.9500 17.66
190199....................... 01.3557 12.82 210012.......... 01.4880 21.27 220046......... 01.3991 21.48 230013......... 01.2823 20.70 230114......... 00.6368 23.27
190200....................... 01.5122 21.33 210013.......... 01.2755 20.65 220049......... 01.2668 21.58 230015......... 01.1305 18.28 230115......... 01.0218 15.14
190201....................... 01.2417 18.24 210015.......... 01.2700 18.48 220050......... 01.0856 17.45 230017......... 01.5161 20.40 230116......... 00.9079 15.58
190202....................... 01.4412 18.34 210016.......... 01.7323 20.37 220051......... 01.2701 19.70 230019......... 01.5116 20.50 230117......... 01.9633 23.81
190203....................... 01.5963 19.50 210017.......... 01.1297 15.35 220052......... 01.2969 22.76 230020......... 01.7218 21.17 230118......... 01.2381 17.25
190204....................... 01.5211 20.12 210018.......... 01.2426 20.93 220053......... 01.2476 18.86 230021......... 01.5949 17.25 230119......... 01.3182 21.13
190205....................... 01.8559 17.63 210019.......... 01.3992 17.42 220055......... 01.3472 20.61 230022......... 01.2454 17.62 230120......... 01.2209 19.00
190206....................... 01.4848 21.17 210022.......... 01.4541 20.07 220057......... 01.4402 20.91 230024......... 01.4230 21.79 230121......... 01.2308 19.67
190207....................... 01.1759 19.43 210023.......... 01.2870 20.31 220058......... 01.0628 17.55 230027......... 01.0568 16.25 230122......... 01.3310 18.32
190208....................... 00.8210 10.20 210024.......... 01.5093 18.06 220060......... 01.2567 24.78 230029......... 01.5980 20.91 230124......... 01.1514 16.49
190218....................... 01.1418 15.05 210025.......... 01.3259 17.84 220062......... 00.6041 19.30 230030......... 01.2372 16.55 230125......... 01.3587 13.01
190223....................... 00.4998 12.04 210026.......... 01.3221 24.54 220063......... 01.2982 18.42 230031......... 01.4622 18.32 230128......... 01.3795 19.33
190227....................... 00.8050 30.01 210027.......... 01.2047 17.47 220064......... 01.2108 20.66 230032......... 01.7401 18.97 230129......... 01.8851 19.07
190230....................... 00.8511 ....... 210028.......... 01.2362 16.66 220065......... 01.2162 20.00 230034......... 01.1936 16.64 230130......... 01.6896 22.37
190231....................... 01.3052 ....... 210029.......... 01.3022 20.04 220066......... 01.2825 19.39 230035......... 01.1374 15.84 230132......... 01.5360 22.92
190232....................... 01.6623 ....... 210030.......... 01.0938 15.77 220067......... 01.2910 22.82 230036......... 01.2859 19.78 230133......... 01.2321 14.06
190233....................... 01.1753 ....... 210031.......... 01.6379 16.97 220068......... 00.5210 15.95 230037......... 01.1680 16.96 230134......... 01.1066 15.87
190234....................... 01.0977 ....... 210032.......... 01.2064 18.42 220070......... 01.2693 17.77 230038......... 01.6453 21.18 230135......... 01.2023 19.88
200001....................... 01.2668 15.74 210033.......... 01.1813 17.38 220071......... 01.8550 24.38 230040......... 01.1967 18.35 230137......... 01.1665 17.78
200002....................... 01.0219 16.15 210034.......... 01.3999 20.29 220073......... 01.3821 25.34 230041......... 01.2106 19.17 230141......... 01.6842 20.84
200003....................... 01.1282 15.90 210035.......... 01.1950 17.25 220074......... 01.2579 21.18 230042......... 01.1517 19.03 230142......... 01.2118 18.71
200006....................... 01.0627 14.95 210037.......... 01.2862 16.14 220075......... 01.3235 20.09 230046......... 01.8323 24.65 230143......... 01.1404 15.23
200007....................... 01.0052 16.86 210038.......... 01.3397 19.90 220076......... 01.1791 22.47 230047......... 01.3036 19.61 230144......... 01.1171 21.06
200008....................... 01.2463 18.34 210039.......... 01.1588 15.25 220077......... 01.7205 22.32 230053......... 01.5335 23.82 230145......... 01.1817 15.41
200009....................... 01.7644 19.84 210040.......... 01.2948 20.32 220079......... 01.1871 21.28 230054......... 01.8245 19.74 230146......... 01.2933 19.49
200012....................... 01.1610 16.11 210043.......... 01.2538 20.04 220080......... 01.2723 17.77 230055......... 01.1799 17.36 230147......... 01.4832 19.34
200013....................... 01.1360 15.32 210044.......... 01.2025 20.28 220081......... 00.9625 23.55 230056......... 00.9745 14.17 230149......... 01.2487 14.92
200015....................... 01.2341 17.15 210045.......... 01.0197 11.73 220082......... 01.2932 19.28 230058......... 01.0807 17.42 230151......... 01.3634 21.32
200016....................... 01.0283 16.10 210046.......... 01.1047 12.34 220083......... 01.1845 19.80 230059......... 01.4913 19.00 230153......... 01.1245 15.61
200017....................... 01.2444 16.86 210048.......... 01.1780 22.47 220084......... 01.2361 22.24 230060......... 01.2802 16.90 230154......... 00.9519 12.09
200018....................... 01.1671 14.27 210049.......... 01.1482 16.57 220086......... 01.5481 24.60 230062......... 01.0313 13.61 230155......... 00.9759 13.80
200019....................... 01.2445 18.01 210051.......... 01.4488 13.94 220088......... 01.5772 21.76 230063......... 01.3188 18.41 230156......... 01.7043 21.57
200020....................... 01.1821 19.86 210054.......... 01.2726 20.17 220089......... 01.3301 22.99 230065......... 01.5013 18.63 230157......... 01.2036 19.67
200021....................... 01.1844 17.66 210055.......... 01.2866 22.48 220090......... 01.2380 20.78 230066......... 01.3628 18.72 230159......... 01.3967 18.93
200023....................... 00.8848 14.61 210056.......... 01.4106 16.51 220092......... 01.2548 20.86 230068......... 01.4399 22.29 230162......... 00.9885 13.73
200024....................... 01.2892 19.16 210057.......... 01.3623 ....... 220094......... 01.2795 19.76 230069......... 01.1716 18.86 230165......... 01.8687 20.92
200025....................... 01.2698 18.81 210058.......... 01.6823 18.09 220095......... 01.2220 17.77 230070......... 01.4873 19.30 230167......... 01.3648 19.18
200026....................... 01.0913 15.20 210059.......... 01.2586 21.91 220098......... 01.2874 19.81 230071......... 01.1375 20.78 230169......... 01.4359 21.16
200027....................... 01.1419 16.51 210060.......... 01.1661 25.28 220099......... 01.1836 15.97 230072......... 01.2839 18.87 230171......... 00.9842 14.18
200028....................... 00.9343 14.83 210061.......... 01.0947 14.25 220100......... 01.2742 23.48 230075......... 01.5188 19.29 230172......... 01.3154 17.85
200031....................... 01.2955 14.96 220001.......... 01.1632 20.98 220101......... 01.5044 22.58 230076......... 01.3263 21.53 230174......... 01.2896 19.11
200032....................... 01.3528 17.72 220002.......... 01.5425 21.62 220104......... 01.2488 23.12 230077......... 01.9786 18.44 230175......... 04.1740 14.83
200033....................... 01.7115 19.57 220003.......... 01.0771 16.92 220105......... 01.2188 21.97 230078......... 01.0937 14.82 230176......... 01.2350 20.89
200034....................... 01.1951 17.19 220004.......... 01.1778 18.85 220106......... 01.2489 21.83 230080......... 01.1934 20.41 230178......... 01.0502 16.02
200037....................... 01.2200 15.53 220006.......... 01.4287 21.79 220107......... 01.1695 18.46 230081......... 01.2169 16.55 230180......... 01.0710 15.03
200038....................... 01.1115 17.66 220008.......... 01.2538 19.26 220108......... 01.1491 20.96 230082......... 01.1611 14.88 230184......... 01.2276 16.99
200039....................... 01.2513 18.06 220010.......... 01.2956 20.94 220110......... 01.9412 30.07 230085......... 01.1161 17.10 230186......... 01.3686 15.81
200040....................... 01.0917 16.48 220011.......... 01.1550 27.95 220111......... 01.2575 21.21 230086......... 00.9918 14.03 230188......... 01.1727 15.49
200041....................... 01.2221 17.37 220012.......... 01.3665 27.84 220116......... 01.9442 23.95 230087......... 01.0641 13.65 230189......... 00.8937 14.50
200043....................... 00.5614 16.96 220015.......... 01.1777 20.35 220118......... 02.0524 26.47 230089......... 01.3393 21.55 230190......... 01.0395 22.66
200050....................... 01.1978 16.71 220016.......... 01.3747 20.16 220119......... 01.3288 24.40 230092......... 01.3264 17.77 230191......... 00.8900 14.99
200051....................... 00.9723 17.70 220017.......... 01.4278 23.78 220123......... 01.0371 23.85 230093......... 01.2267 17.37 230193......... 01.2471 16.03
200052....................... 00.9716 13.07 220019.......... 01.1780 17.06 220126......... 01.3041 19.39 230095......... 01.2357 15.53 230194......... 01.2111 14.37
200055....................... 01.1557 14.56 220020.......... 01.2189 18.47 220128......... 01.1441 20.85 230096......... 01.1957 19.85 230195......... 01.2822 19.80
200062....................... 00.9198 14.64 220021.......... 01.3862 23.21 220133......... 00.8406 30.53 230097......... 01.5406 17.75 230197......... 01.2640 22.00
200063....................... 01.1662 16.63 220023.......... 01.1469 19.37 220135......... 01.2559 23.97 230099......... 01.2173 19.06 230199......... 01.1553 17.72
200066....................... 01.1689 14.34 220024.......... 01.1752 20.14 220153......... 01.0402 19.74 230100......... 01.1533 15.19 230201......... 01.2138 14.02
210001....................... 01.4102 17.94 220025.......... 01.1894 18.87 220154......... 00.9268 18.96 230101......... 01.0658 16.79 230204......... 01.3660 19.78
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[[Page 46247]]
Page 8 of 16
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Case Avg. Case Avg. Case Avg. Case Avg. Case Avg.
Provider mix hour Provider mix hour Provider mix hour Provider mix hour Provider mix hour
index wage index wage index wage index wage index wage
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
230205....................... 01.0570 14.54 240044.......... 01.2004 16.02 240129......... 01.0159 12.18 250032......... 01.2599 15.70 250134......... 00.9882 12.70
230207....................... 01.2586 19.85 240045.......... 01.0731 18.49 240130......... 01.0112 14.54 250033......... 00.9948 11.57 250136......... 00.7904 16.84
230208....................... 01.1857 16.10 240047.......... 01.5172 18.27 240132......... 01.2360 21.80 250034......... 01.5348 12.99 250138......... 01.3513 16.94
230211....................... 00.9823 13.86 240048.......... 01.2728 20.43 240133......... 01.1709 16.16 250035......... 00.9044 11.82 250140......... 00.9213 09.37
230212....................... 01.0970 21.13 240049.......... 01.7768 20.33 240135......... 00.8166 11.38 250036......... 00.9786 11.34 250141......... 01.2098 15.50
230213....................... 01.0251 12.69 240050.......... 01.1319 19.89 240137......... 01.2521 15.40 250037......... 00.8704 09.53 250144......... 00.9384 11.18
230216....................... 01.5269 17.91 240051.......... 00.9956 15.97 240138......... 00.8994 13.09 250038......... 00.9851 12.52 250145......... 00.9432 ......
230217....................... 01.2172 18.06 240052.......... 01.2612 17.21 240139......... 00.9643 14.24 250039......... 01.0021 11.71 250146......... 01.0011 13.25
230219....................... 01.0186 15.18 240053.......... 01.5152 19.67 240141......... 01.0919 19.12 250040......... 01.2981 15.65 250148......... 01.1518 ......
230221....................... 01.1845 18.15 240056.......... 01.2438 20.13 240142......... 01.1289 15.16 250042......... 01.1494 13.78 250149......... 00.9174 ......
230222....................... 01.3604 18.98 240057.......... 01.7426 22.04 240143......... 01.0597 12.48 250043......... 01.0352 10.49 260001......... 01.6549 16.08
230223....................... 01.3187 19.85 240058.......... 00.9668 09.64 240144......... 00.9459 13.39 250044......... 00.9822 13.98 260002......... 01.4877 20.05
230227....................... 01.5187 22.00 240059.......... 01.0942 17.98 240145......... 00.9654 12.37 250045......... 01.1477 17.17 260003......... 00.9457 12.45
230228....................... 01.2121 17.29 240061.......... 01.7512 20.93 240146......... 00.9209 17.20 250047......... 00.9674 09.12 260004......... 01.0314 11.86
230230....................... 01.5400 20.38 240063.......... 01.4674 20.88 240148......... 00.9490 11.34 250048......... 01.4542 13.51 260005......... 01.6146 19.68
230232....................... 01.0356 15.87 240064.......... 01.2630 18.13 240150......... 00.8906 11.72 250049......... 00.9037 09.93 260006......... 01.5247 16.72
230235....................... 01.1038 14.65 240065.......... 01.1600 11.14 240152......... 01.0128 17.85 250050......... 01.2407 12.30 260007......... 01.4679 16.03
230236....................... 01.3542 21.07 240066.......... 01.4040 19.08 240153......... 01.0199 14.30 250051......... 00.8548 09.44 260008......... 01.2220 15.65
230239....................... 01.1770 16.07 240069.......... 01.1629 18.35 240154......... 01.0158 13.15 250057......... 01.1806 14.06 260009......... 01.2407 15.63
230241....................... 01.1553 17.08 240071.......... 01.1200 18.05 240155......... 00.9827 14.39 250058......... 01.1385 13.65 260011......... 01.6765 16.87
230244....................... 01.3134 20.14 240072.......... 01.0257 16.08 240157......... 01.1226 13.92 250059......... 01.0304 12.16 260012......... 01.0472 11.96
230253....................... 01.0735 17.39 240073.......... 00.9213 15.13 240160......... 01.0116 14.65 250060......... 00.8121 12.19 260013......... 01.1520 14.02
230254....................... 01.2785 22.64 240075.......... 01.2132 18.79 240161......... 00.9351 14.56 250061......... 00.8654 10.75 260014......... 01.7769 17.84
230257....................... 01.1031 19.01 240076.......... 01.1434 19.94 240162......... 00.9629 15.28 250063......... 00.8615 12.68 260015......... 01.2698 13.16
230259....................... 01.1967 19.06 240077.......... 01.0646 14.15 240163......... 00.9381 14.10 250065......... 00.8878 11.72 260017......... 01.2272 13.94
230264....................... 00.9614 16.74 240078.......... 01.4510 21.46 240166......... 01.1661 14.67 250066......... 00.9422 12.17 260018......... 00.9658 09.56
230269....................... 01.3062 21.71 240079.......... 01.0143 12.57 240169......... 00.9528 15.25 250067......... 01.1241 14.14 260019......... 00.9862 12.63
230270....................... 01.2238 20.08 240080.......... 01.3766 20.87 240170......... 01.1518 14.42 250068......... 00.8546 11.19 260020......... 01.7312 19.29
230273....................... 01.6568 22.11 240082.......... 01.1233 14.55 240171......... 00.9973 14.02 250069......... 01.1820 13.42 260021......... 01.5117 18.47
230275....................... 00.5764 16.53 240083.......... 01.3779 16.60 240172......... 01.0856 14.50 250071......... 00.9499 08.06 260022......... 01.3423 18.69
230276....................... 00.8113 16.23 240084.......... 01.3446 17.20 240173......... 00.9609 14.82 250072......... 01.2933 17.40 260023......... 01.2569 15.58
230277....................... 01.2440 21.76 240085.......... 00.9356 14.90 240179......... 00.9990 14.30 250076......... 00.9378 10.32 260024......... 01.0179 12.28
230278....................... 02.1143 19.50 240086.......... 01.0496 15.23 240180......... 01.0157 10.51 250077......... 00.9481 11.08 260025......... 01.3240 13.61
230279....................... 00.7080 ....... 240087.......... 01.1088 15.69 240184......... 01.0352 11.31 250078......... 01.4504 14.21 260027......... 01.5963 18.92
230280....................... 01.0737 ....... 240088.......... 01.4423 18.10 240187......... 01.2576 16.56 250079......... 00.8573 15.12 260029......... 01.1241 15.76
230281....................... 01.8228 ....... 240089.......... 00.9966 15.23 240193......... 01.0505 14.73 250081......... 01.3046 15.19 260030......... 01.0922 09.73
240001....................... 01.5705 21.24 240090.......... 01.0889 13.57 240196......... 00.6134 22.50 250082......... 01.2852 12.30 260031......... 01.5029 18.49
240002....................... 01.6951 19.40 240093.......... 01.3149 16.49 240200......... 00.8945 13.34 250083......... 01.0297 11.01 260032......... 01.5899 17.59
240004....................... 01.4733 20.16 240094.......... 01.0470 17.26 240205......... 00.9066 ....... 250084......... 01.0930 13.92 260034......... 00.9820 14.22
240005....................... 00.9911 13.49 240096.......... 01.0126 14.12 240206......... 00.8405 ....... 250085......... 01.0146 11.42 260035......... 01.0725 11.44
240006....................... 01.1243 19.75 240097.......... 01.1262 17.05 240207......... 01.2516 21.47 250088......... 00.9555 15.43 260036......... 01.0697 15.72
240007....................... 01.1114 15.15 240098.......... 00.9639 16.41 240210......... 01.2558 21.44 250089......... 01.0349 11.77 260037......... 01.3946 15.17
240008....................... 01.0447 15.22 240099.......... 01.1186 11.00 240211......... 00.9295 11.18 250093......... 01.1144 12.17 260039......... 01.1393 11.17
240009....................... 00.9722 14.18 240100.......... 01.3180 19.58 240212......... 01.9942 ....... 250094......... 01.2380 14.41 260040......... 01.6081 14.92
240010....................... 01.9804 20.17 240101.......... 01.1585 17.32 250001......... 01.6860 15.91 250095......... 00.9763 13.57 260042......... 01.4179 15.65
240011....................... 01.1378 15.69 240102.......... 00.8877 12.27 250002......... 00.7948 13.34 250096......... 01.3058 16.49 260044......... 01.0453 14.29
240013....................... 01.3077 15.90 240103.......... 01.0788 14.10 250003......... 01.0260 14.13 250097......... 01.1879 13.83 260047......... 01.3608 14.19
240014....................... 01.0825 17.79 240104.......... 01.2317 21.71 250004......... 01.4695 15.12 250098......... 00.8668 13.73 260048......... 01.2801 18.05
240016....................... 01.3045 15.46 240105.......... 01.0024 12.70 250005......... 00.9707 09.15 250099......... 01.2736 12.73 260050......... 01.0896 14.71
240017....................... 01.1365 15.15 240106.......... 01.3351 23.68 250006......... 00.9603 12.27 250100......... 01.2423 14.53 260052......... 01.3429 15.95
240018....................... 01.2985 15.82 240107.......... 00.9779 15.07 250007......... 01.2699 16.88 250101......... 00.9416 09.89 260053......... 01.1239 09.46
240019....................... 01.2259 19.58 240108.......... 00.9570 11.64 250008......... 00.9041 11.36 250102......... 01.5340 14.80 260054......... 01.3205 16.08
240020....................... 01.1410 18.11 240109.......... 00.9926 13.59 250009......... 01.1772 15.04 250104......... 01.3615 15.58 260055......... 01.0344 13.67
240021....................... 00.9545 12.49 240110.......... 01.0347 15.18 250010......... 01.0374 11.07 250105......... 00.9185 13.13 260057......... 01.1563 13.85
240022....................... 01.1265 17.33 240111.......... 00.9806 13.06 250012......... 00.9543 13.77 250107......... 00.9101 14.16 260059......... 01.1218 14.17
240023....................... 01.0070 15.86 240112.......... 01.0585 13.30 250015......... 01.0921 09.75 250109......... 00.9351 11.54 260061......... 01.1737 10.87
240025....................... 01.1710 15.02 240114.......... 00.9961 11.13 250017......... 01.0049 13.77 250112......... 00.9915 14.22 260062......... 01.1677 19.89
240027....................... 00.9990 12.60 240115.......... 01.6186 22.30 250018......... 00.9576 09.81 250117......... 01.0706 13.28 260063......... 01.1867 14.82
240028....................... 01.1340 16.50 240116.......... 00.9450 12.43 250019......... 01.4239 17.43 250119......... 01.2057 10.80 260064......... 01.3241 15.40
240029....................... 01.1619 15.70 240117.......... 01.0688 16.21 250020......... 01.0024 10.78 250120......... 01.0683 12.04 260065......... 01.7807 15.31
240030....................... 01.2995 16.78 240119.......... 00.8459 16.93 250021......... 00.8612 07.74 250122......... 01.2814 15.87 260066......... 01.0907 12.78
240031....................... 00.9285 13.50 240121.......... 00.8986 17.10 250023......... 00.8655 11.22 250123......... 01.3253 17.72 260067......... 00.9812 10.43
240036....................... 01.5566 19.05 240122.......... 01.0462 16.80 250024......... 00.9845 08.25 250124......... 00.9123 10.69 260068......... 01.6696 18.49
240037....................... 01.0463 16.40 240123.......... 01.0518 13.30 250025......... 01.1440 13.58 250125......... 01.3189 18.35 260070......... 01.0868 11.09
240038....................... 01.4513 22.50 240124.......... 01.0123 15.71 250027......... 01.0290 10.40 250126......... 00.9867 10.22 260073......... 00.9754 11.58
240040....................... 01.2271 17.67 240125.......... 00.9399 10.75 250029......... 00.8857 11.87 250127......... 00.7659 ....... 260074......... 01.2444 11.49
240041....................... 01.3105 14.43 240127.......... 01.0272 12.51 250030......... 00.9703 11.39 250128......... 01.0941 12.64 260077......... 01.7237 16.30
240043....................... 01.2029 16.83 240128.......... 01.1234 14.55 250031......... 01.3147 17.20 250131......... 01.0545 09.36 260078......... 01.1752 12.39
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[[Page 46248]]
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Case Avg. Case Avg. Case Avg. Case Avg. Case Avg.
Provider mix hour Provider mix hour Provider mix hour Provider mix hour Provider mix hour
index wage index wage index wage index wage index wage
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
260079....................... 00.9808 11.78 270002.......... 01.1914 13.92 280024......... 01.0190 13.22 280111......... 01.2501 16.06 310014......... 01.7262 23.69
260080....................... 00.9748 09.77 270003.......... 01.2463 18.65 280025......... 00.9834 11.07 280114......... 00.9302 10.26 310015......... 01.7788 24.34
260081....................... 01.4994 16.44 270004.......... 01.6543 17.33 280026......... 01.1268 12.80 280115......... 00.9762 13.59 310016......... 01.2218 22.93
260082....................... 01.1249 13.50 270006.......... 01.0348 18.67 280028......... 01.0603 13.64 280117......... 01.2367 14.48 310017......... 01.3316 21.95
260085....................... 01.5653 18.92 270007.......... 00.9630 12.26 280029......... 01.0513 12.62 280118......... 00.9917 13.47 310018......... 01.2149 21.06
260086....................... 01.0538 12.67 270009.......... 01.0369 14.91 280030......... 01.7482 23.06 280119......... 00.8442 ....... 310019......... 01.6444 20.84
260089....................... 00.9595 13.31 270011.......... 01.1240 16.46 280031......... 01.0457 12.48 280123......... 00.7968 ....... 310020......... 01.1914 19.66
260091....................... 01.6036 18.96 270012.......... 01.5997 17.10 280032......... 01.3205 15.11 290001......... 01.6296 22.35 310021......... 01.3482 21.15
260094....................... 01.1818 15.98 270013.......... 01.2868 16.78 280033......... 00.9881 13.62 290002......... 00.9009 17.99 310022......... 01.2391 19.38
260095....................... 01.4416 16.05 270014.......... 01.7155 15.97 280034......... 01.2104 13.41 290003......... 01.6155 21.15 310024......... 01.2539 22.60
260096....................... 01.5553 21.52 270016.......... 00.8195 11.51 280035......... 00.9439 11.75 290005......... 01.4321 19.66 310025......... 01.2317 21.92
260097....................... 01.1803 15.82 270017.......... 01.2264 18.32 280037......... 01.0150 13.55 290006......... 01.2223 16.54 310026......... 01.2770 21.91
260100....................... 00.9672 13.12 270019.......... 01.0747 13.34 280038......... 01.0733 13.39 290007......... 01.9023 25.07 310027......... 01.3756 18.17
260102....................... 01.0113 16.75 270021.......... 01.1036 15.55 280039......... 01.1841 14.24 290008......... 01.2244 17.14 310028......... 01.1453 20.46
260103....................... 01.3826 16.73 270023.......... 01.2906 18.76 280040......... 01.5869 18.30 290009......... 01.6096 21.07 310029......... 01.8972 20.69
260104....................... 01.6337 19.57 270024.......... 00.9931 11.15 280041......... 00.9988 10.95 290010......... 01.2116 19.33 310031......... 02.6282 24.14
260105....................... 01.8722 19.18 270026.......... 00.8677 11.95 280042......... 01.0970 13.22 290011......... 00.8854 14.39 310032......... 01.2962 20.00
260107....................... 01.3844 18.55 270027.......... 01.0389 12.69 280043......... 01.1235 12.75 290012......... 01.4484 19.97 310034......... 01.2537 19.14
260108....................... 01.8056 18.26 270028.......... 01.0735 14.91 280045......... 01.1409 13.48 290013......... 01.0180 14.85 310036......... 01.2137 18.44
260109....................... 00.9922 11.92 270029.......... 00.9056 14.51 280046......... 01.0729 11.09 290014......... 01.0424 16.52 310037......... 01.3032 25.43
260110....................... 01.6069 14.16 270031.......... 00.8747 09.71 280047......... 01.1632 15.70 290015......... 00.9691 15.38 310038......... 01.9189 22.82
260111....................... 00.9994 08.04 270032.......... 01.1776 16.46 280048......... 01.0813 11.17 290016......... 01.1476 18.71 310039......... 01.2906 20.51
260112....................... 01.4123 17.47 270033.......... 00.8822 11.39 280049......... 01.0363 13.82 290019......... 01.2779 17.92 310040......... 01.2680 23.12
260113....................... 01.1111 14.05 270035.......... 01.0294 15.87 280050......... 00.9263 13.11 290020......... 01.0783 17.65 310041......... 01.3192 22.90
260115....................... 01.2400 14.92 270036.......... 00.9483 10.42 280051......... 01.0572 13.72 290021......... 01.5602 19.17 310042......... 01.2513 21.74
260116....................... 01.1317 13.70 270039.......... 01.0661 11.99 280052......... 01.0352 11.85 290022......... 01.7398 22.47 310043......... 01.2027 20.60
260119....................... 01.1592 15.01 270040.......... 01.0819 17.60 280054......... 01.2613 15.54 290027......... 00.9516 14.68 310044......... 01.2981 20.16
260120....................... 01.1606 15.72 270041.......... 01.0700 11.14 280055......... 00.9274 11.63 290029......... 00.9400 ....... 310045......... 01.3866 25.76
260122....................... 01.1407 13.12 270044.......... 01.1997 13.40 280056......... 00.9925 10.99 290032......... 01.4088 18.66 310047......... 01.3405 23.05
260123....................... 01.0309 11.17 270046.......... 00.9328 13.50 280057......... 01.0060 14.48 290036......... 01.4927 ....... 310048......... 01.1853 20.69
260127....................... 00.9517 13.71 270048.......... 01.0968 13.30 280058......... 01.3349 13.75 290038......... 01.1066 ....... 310049......... 01.3247 23.54
260128....................... 00.9877 08.95 270049.......... 01.8369 18.19 280060......... 01.5930 18.38 300001......... 01.3969 20.70 310050......... 01.2623 20.88
260129....................... 01.2126 13.51 270050.......... 01.0374 15.96 280061......... 01.4692 14.76 300003......... 01.8661 20.92 310051......... 01.3232 24.26
260131....................... 01.3183 16.32 270051.......... 01.2969 18.02 280062......... 01.2236 11.92 300005......... 01.2669 18.65 310052......... 01.2516 20.53
260134....................... 01.1485 13.87 270052.......... 01.0663 18.02 280064......... 01.0732 12.61 300006......... 01.1225 16.24 310054......... 01.2937 23.19
260137....................... 01.2635 13.71 270053.......... 00.8716 09.53 280065......... 01.2934 16.22 300007......... 01.1477 16.76 310056......... 01.1800 20.11
260138....................... 01.9683 20.66 270057.......... 01.1700 17.35 280066......... 01.0101 11.38 300008......... 01.2465 16.95 310057......... 01.2906 20.10
260141....................... 01.8935 16.53 270058.......... 00.9419 11.20 280068......... 00.9716 09.31 300009......... 01.1071 17.45 310058......... 01.1047 25.35
260142....................... 01.1604 14.50 270059.......... 00.8676 19.21 280070......... 01.0712 10.75 300010......... 01.2380 17.80 310060......... 01.2112 17.55
260143....................... 00.9437 10.52 270060.......... 00.9653 11.92 280073......... 01.0399 12.78 300011......... 01.3508 21.36 310061......... 01.2156 19.85
260147....................... 01.0490 12.81 270063.......... 00.8933 12.94 280074......... 01.0981 12.87 300012......... 01.2779 21.64 310062......... 01.2941 23.90
260148....................... 00.9639 09.33 270068.......... 00.8629 12.38 280075......... 01.2063 12.90 300013......... 01.2250 16.87 310063......... 01.3515 20.78
260158....................... 01.1355 11.80 270072.......... 00.8526 14.88 280076......... 01.0602 12.54 300014......... 01.2336 18.41 310064......... 01.2988 21.35
260159....................... 01.2962 18.17 270073.......... 01.0764 11.06 280077......... 01.3589 17.36 300015......... 01.1776 17.37 310067......... 01.3199 21.14
260160....................... 01.0683 14.07 270074.......... 00.8861 ....... 280079......... 01.0649 09.40 300016......... 01.3172 17.41 310069......... 01.1308 18.19
260162....................... 01.6912 17.70 270075.......... 00.8706 ....... 280080......... 01.0842 11.34 300017......... 01.2081 20.49 310070......... 01.3980 22.16
260163....................... 01.3188 14.11 270076.......... 00.8386 ....... 280081......... 01.5683 17.24 300018......... 01.2333 18.85 310072......... 01.2980 20.74
260164....................... 00.9955 12.07 270079.......... 00.9563 13.36 280082......... 01.1154 13.03 300019......... 01.2621 18.43 310073......... 01.5552 22.31
260166....................... 01.2126 21.51 270080.......... 01.1536 14.27 280083......... 01.0646 15.64 300020......... 01.2622 19.78 310074......... 01.4149 21.08
260172....................... 01.0128 12.07 270081.......... 01.0790 09.77 280084......... 01.0366 10.92 300021......... 01.1644 15.69 310075......... 01.2933 21.67
260173....................... 00.9588 11.15 270082.......... 01.0039 16.10 280085......... 00.7201 14.02 300022......... 01.1031 17.08 310076......... 01.3854 28.16
260175....................... 01.1310 14.60 270083.......... 01.1160 10.96 280088......... 01.8032 18.12 300023......... 01.3278 20.13 310077......... 01.5172 23.09
260176....................... 01.6716 19.26 270084.......... 00.9034 12.77 280089......... 01.0548 13.79 300024......... 01.2736 16.56 310078......... 01.3568 22.70
260177....................... 01.3854 19.46 280001.......... 01.0830 14.11 280090......... 00.9850 11.70 300028......... 01.2674 15.52 310081......... 01.2644 20.80
260178....................... 01.4707 19.06 280003.......... 01.9484 18.11 280091......... 01.1370 13.17 300029......... 01.3084 21.29 310083......... 01.2592 22.20
260179....................... 01.5633 18.48 280005.......... 01.3783 16.64 280092......... 00.8990 11.63 300033......... 01.1012 13.70 310084......... 01.2622 20.43
260180....................... 01.6919 18.45 280009.......... 01.7335 16.70 280094......... 01.1464 13.32 300034......... 01.9356 21.31 310086......... 01.1738 20.89
260183....................... 01.6448 16.51 280011.......... 00.9513 11.56 280097......... 01.0552 12.56 310001......... 01.7775 24.91 310087......... 01.2345 18.95
260186....................... 01.2538 15.20 280012.......... 01.2413 14.88 280098......... 01.0077 09.68 310002......... 01.7278 25.68 310088......... 01.2566 19.57
260188....................... 01.2759 15.70 280013.......... 02.0235 19.71 280101......... 01.1173 10.92 310003......... 01.2230 23.16 310090......... 01.1884 22.86
260189....................... 00.9409 11.23 280014.......... 00.9990 10.78 280102......... 01.1321 11.77 310005......... 01.2257 19.20 310091......... 01.2193 21.35
260190....................... 01.2003 18.46 280015.......... 01.0254 13.78 280104......... 00.9599 09.88 310006......... 01.2209 19.02 310092......... 01.3080 20.52
260191....................... 01.1725 19.44 280017.......... 01.1524 13.42 280105......... 01.2988 16.46 310008......... 01.2785 21.23 310093......... 01.2193 19.52
260193....................... 01.2262 19.13 280018.......... 01.1939 12.25 280106......... 00.9481 13.23 310009......... 01.2877 21.35 310096......... 01.9014 21.19
260195....................... 01.1678 ....... 280020.......... 01.5198 18.97 280107......... 01.0284 12.36 310010......... 01.2966 21.05 310105......... 01.1914 22.41
260197....................... 01.3273 20.38 280021.......... 01.3322 14.01 280108......... 01.1433 13.26 310011......... 01.3050 21.71 310108......... 01.3940 21.08
260198....................... 01.2292 14.98 280022.......... 00.9740 11.07 280109......... 00.9424 10.61 310012......... 01.5915 23.53 310110......... 01.2108 19.69
260200....................... 01.3542 19.14 280023.......... 01.3802 13.73 280110......... 01.0201 10.88 310013......... 01.2813 19.91 310111......... 01.2536 19.70
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[[Page 46249]]
Page 10 of 16
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Case Avg. Case Avg. Case Avg. Case Avg. Case Avg.
Provider mix hour Provider mix hour Provider mix hour Provider mix hour Provider mix hour
index wage index wage index wage index wage index wage
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
310112....................... 01.2441 20.58 330024.......... 01.9152 30.03 330126......... 01.2229 20.35 330230......... 01.5076 26.44 330396......... 01.2740 25.30
310113....................... 01.2115 20.70 330025.......... 01.1879 13.80 330127......... 01.3974 25.01 330231......... 01.1364 27.57 330397......... 01.3146 26.82
310115....................... 01.1954 19.78 330027.......... 01.4751 28.56 330128......... 01.3390 25.26 330232......... 01.2180 15.46 330398......... 01.2362 26.59
310116....................... 01.2905 21.67 330028.......... 01.3453 23.76 330132......... 01.1636 13.74 330233......... 01.5344 29.08 330399......... 01.3284 29.65
310118....................... 01.1883 21.86 330029.......... 01.1091 17.36 330133......... 01.3525 28.31 330234......... 02.1947 24.17 340001......... 01.4939 19.54
310119....................... 01.5440 27.27 330030.......... 01.2330 15.20 330135......... 01.2522 16.25 330235......... 01.1384 17.37 340002......... 01.8814 18.53
310120....................... 01.0653 17.24 330033.......... 01.2702 13.46 330136......... 01.2620 20.45 330236......... 01.3965 26.57 340003......... 01.1186 16.56
310121....................... 01.0416 16.61 330034.......... 00.7745 36.61 330140......... 01.7171 17.19 330238......... 01.1734 14.53 340004......... 01.4952 17.21
320001....................... 01.4645 16.76 330036.......... 01.3260 21.00 330141......... 01.3544 23.17 330239......... 01.2034 15.44 340005......... 01.2172 14.57
320002....................... 01.4190 21.55 330037.......... 01.1403 15.17 330144......... 00.9809 13.27 330240......... 01.3472 26.47 340006......... 01.2315 14.56
320003....................... 01.1694 15.57 330038.......... 01.2154 14.91 330148......... 01.0806 14.39 330241......... 01.8842 20.92 340007......... 01.1793 14.81
320004....................... 01.2647 17.86 330039.......... 00.8474 13.18 330151......... 01.0508 13.77 330242......... 01.3486 22.98 340008......... 01.1505 16.90
320005....................... 01.3207 17.86 330041.......... 01.3957 27.81 330152......... 01.4256 27.77 330245......... 01.2684 17.15 340009......... 01.3744 19.12
320006....................... 01.3742 15.20 330043.......... 01.2516 26.92 330153......... 01.6484 17.44 330246......... 01.2600 22.99 340010......... 01.3111 16.41
320009....................... 01.5332 16.49 330044.......... 01.2413 17.05 330154......... 01.5904 ....... 330247......... 00.7043 26.49 340011......... 01.1105 13.98
320011....................... 00.9883 17.79 330045.......... 01.4206 24.83 330157......... 01.3111 18.41 330249......... 01.2271 15.89 340012......... 01.2599 15.82
320012....................... 01.0365 16.57 330046.......... 01.5166 30.08 330158......... 01.3798 24.33 330250......... 01.3148 16.01 340013......... 01.2783 16.58
320013....................... 01.2196 18.28 330047.......... 01.2282 16.63 330159......... 01.3217 17.55 330252......... 00.9107 15.40 340014......... 01.5898 22.15
320014....................... 01.0172 13.13 330048.......... 01.3029 16.10 330160......... 01.4707 26.09 330254......... 01.0280 15.94 340015......... 01.2409 16.44
320016....................... 01.1611 12.00 330049.......... 01.2452 17.52 330161......... 00.7237 16.00 330258......... 01.4226 25.28 340016......... 01.2062 15.18
320017....................... 01.2209 17.34 330053.......... 01.1285 14.39 330162......... 01.2663 26.18 330259......... 01.4498 21.99 340017......... 01.2587 15.96
320018....................... 01.4884 16.61 330055.......... 01.5084 29.02 330163......... 01.2137 17.75 330261......... 01.2244 24.35 340018......... 01.1282 14.78
320019....................... 01.4863 19.01 330056.......... 01.4474 28.37 330164......... 01.3963 18.96 330263......... 00.9929 17.00 340019......... 01.0519 13.69
320021....................... 01.7092 20.62 330057.......... 01.7158 16.48 330166......... 00.9723 14.11 330264......... 01.2681 20.00 340020......... 01.1686 17.33
320022....................... 01.1787 16.34 330058.......... 01.3270 15.85 330167......... 01.6440 27.45 330265......... 01.3105 15.78 340021......... 01.2198 15.08
320023....................... 01.0348 13.29 330059.......... 01.6224 29.66 330169......... 01.4303 31.95 330267......... 01.2786 22.78 340022......... 01.0527 14.56
320030....................... 00.9822 16.54 330061.......... 01.2977 23.38 330171......... 01.2804 22.28 330268......... 00.9740 15.79 340023......... 01.3923 18.44
320031....................... 00.9008 14.78 330062.......... 01.1779 14.99 330175......... 01.1255 14.11 330270......... 01.9655 30.33 340024......... 01.2228 15.49
320032....................... 00.9936 16.66 330064.......... 01.3752 28.38 330177......... 01.0208 12.46 330273......... 01.2942 21.36 340025......... 01.1893 14.38
320033....................... 01.1484 19.23 330065.......... 01.1890 17.14 330179......... 00.8617 14.09 330275......... 01.2178 18.34 340027......... 01.1954 15.46
320035....................... 01.0033 14.82 330066.......... 01.2343 17.26 330180......... 01.1952 16.36 330276......... 01.1877 16.61 340028......... 01.5380 17.48
320037....................... 01.2052 15.17 330067.......... 01.3770 19.68 330181......... 01.3076 28.32 330277......... 01.1372 16.35 340030......... 02.0110 19.06
320038....................... 01.1660 15.62 330072.......... 01.3458 26.89 330182......... 02.5837 26.92 330279......... 01.2893 17.24 340031......... 00.9808 12.56
320046....................... 01.1839 18.23 330073.......... 01.1820 14.32 330183......... 01.4389 18.88 330285......... 01.8218 21.81 340032......... 01.3999 17.87
320048....................... 01.3187 13.90 330074.......... 01.1874 17.35 330184......... 01.3396 25.83 330286......... 01.3203 22.59 340035......... 01.1695 14.97
320056....................... 00.9819 ....... 330075.......... 01.0879 16.48 330185......... 01.2256 24.23 330290......... 01.7578 28.28 340036......... 01.1713 17.04
320057....................... 01.0573 ....... 330078.......... 01.4454 16.90 330186......... 00.9205 18.79 330293......... 01.1689 13.72 340037......... 01.1725 15.50
320058....................... 00.9038 ....... 330079...
FR Doc. 96-22145 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1997 Rates
....... 01.3130 16.60 330188......... 01.1850 17.75 330304......... 01.2689 25.52 340038......... 01.1103 14.52
320059....................... 00.9778 ....... 330080.......... 01.4167 24.95 330189......... 01.3177 16.20 330306......... 01.4522 26.59 340039......... 01.2748 19.18
320060....................... 00.9187 ....... 330082.......... 01.1199 16.29 330191......... 01.2688 17.18 330307......... 01.2171 18.33 340040......... 01.7746 17.75
320061....................... 01.1051 ....... 330084.......... 00.9919 15.59 330193......... 01.3086 27.34 330308......... 01.1772 28.68 340041......... 01.2471 15.99
320062....................... 00.9353 ....... 330085.......... 01.3266 18.66 330194......... 01.8119 26.07 330309......... 01.2334 24.67 340042......... 01.1864 13.80
320063....................... 01.3272 15.84 330086.......... 01.2540 24.13 330195......... 01.6272 29.02 330314......... 01.3526 21.07 340044......... 01.1056 13.26
320065....................... 01.2822 16.76 330088.......... 01.1094 24.41 330196......... 01.3367 25.53 330315......... 01.2558 24.58 340045......... 01.0365 10.95
320067....................... 00.8203 09.19 330090.......... 01.5534 16.86 330197......... 01.0945 14.43 330316......... 01.3037 26.23 340047......... 01.9028 17.98
320068....................... 00.9119 17.98 330091.......... 01.3842 17.64 330198......... 01.3399 22.17 330327......... 00.9253 15.30 340048......... 00.9055 09.39
320069....................... 01.0454 09.08 330092.......... 01.1025 13.64 330199......... 01.4635 24.80 330331......... 01.2220 27.78 340049......... 00.6394 15.10
320070....................... 01.0243 ....... 330094.......... 01.2299 15.78 330201......... 01.5377 27.83 330332......... 01.2606 24.30 340050......... 01.1904 14.69
320074....................... 01.1107 17.15 330095.......... 01.2598 16.49 330202......... 01.4872 25.07 330333......... 01.3624 22.00 340051......... 01.2639 16.23
320079....................... 01.2049 17.41 330096.......... 01.0679 14.88 330203......... 01.3994 19.16 330336......... 01.3438 27.39 340052......... 01.0447 18.62
330001....................... 01.1955 24.84 330097.......... 01.1652 14.63 330204......... 01.4236 24.90 330338......... 01.1329 22.52 340053......... 01.6969 18.96
330002....................... 01.4938 24.26 330100.......... 00.6895 25.95 330205......... 01.1568 19.46 330339......... 00.8034 18.09 340054......... 01.0901 12.68
330003....................... 01.3393 19.29 330101.......... 01.8031 33.09 330208......... 01.2061 23.16 330340......... 01.2081 23.91 340055......... 01.2079 16.69
330004....................... 01.2785 19.10 330102.......... 01.3004 16.32 330209......... 01.1871 21.17 330350......... 01.8138 27.96 340060......... 01.1390 16.38
330005....................... 01.8133 19.53 330103.......... 01.2486 15.94 330211......... 01.2093 16.31 330353......... 01.3975 27.49 340061......... 01.7128 19.20
330006....................... 01.3128 24.11 330104.......... 01.3604 25.44 330212......... 01.1755 20.25 330354......... 01.3898 ....... 340063......... 01.0555 13.01
330007....................... 01.3289 17.43 330106.......... 01.5666 33.04 330213......... 01.1241 16.19 330357......... 01.3757 32.07 340064......... 01.2278 17.24
330008....................... 01.1187 15.77 330107.......... 01.2590 24.38 330214......... 01.7379 28.90 330359......... 00.9471 23.70 340065......... 01.3129 12.82
330009....................... 01.3480 28.08 330108.......... 01.2119 15.85 330215......... 01.2197 15.65 330372......... 01.2689 22.53 340067......... 01.1907 12.84
330010....................... 01.1648 15.34 330111.......... 01.0877 14.62 330218......... 01.1661 17.16 330381......... 01.1945 27.09 340068......... 01.2333 14.21
330011....................... 01.2464 17.22 330114.......... 00.8876 15.48 330219......... 01.6358 18.39 330385......... 01.1735 29.27 340069......... 01.7159 18.31
330012....................... 01.6173 27.84 330115.......... 01.2008 14.46 330221......... 01.3421 26.57 330386......... 01.1478 20.82 340070......... 01.3795 16.78
330013....................... 02.0611 16.93 330116.......... 00.9149 13.82 330222......... 01.2611 15.28 330387......... 00.8589 23.28 340071......... 01.0726 14.30
330014....................... 01.3852 27.12 330118.......... 01.6360 18.19 330223......... 01.0811 15.10 330389......... 01.8045 29.95 340072......... 01.1400 13.86
330016....................... 01.0249 14.55 330119.......... 01.7390 29.88 330224......... 01.2647 18.85 330390......... 01.2567 28.38 340073......... 01.4546 20.50
330019....................... 01.1339 23.60 330121.......... 01.0050 14.35 330225......... 01.1856 23.23 330393......... 01.7319 25.24 340075......... 01.1558 15.98
330020....................... 01.0573 14.25 330122.......... 01.2081 20.92 330226......... 01.2808 16.83 330394......... 01.5114 17.27 340080......... 01.1240 13.55
330023....................... 01.2492 22.80 330125.......... 01.8059 19.91 330229......... 01.3242 14.92 330395......... 01.3557 30.16 340084......... 01.0689 14.51
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Case Avg. Case Avg. Case Avg. Case Avg. Case Avg.
Provider mix hour Provider mix hour Provider mix hour Provider mix hour Provider mix hour
index wage index wage index wage index wage index wage
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
340085....................... 01.2597 15.46 350008.......... 01.0366 15.15 360032......... 01.0867 16.18 360108......... 01.0267 15.08 360197......... 01.2031 16.76
340087....................... 01.1439 16.80 350009.......... 01.1592 15.74 360034......... 01.1593 13.30 360109......... 01.0942 17.43 360200......... 01.0011 13.48
340088....................... 01.1199 16.46 350010.......... 01.1821 12.30 360035......... 01.5736 19.90 360112......... 01.7563 21.61 360203......... 01.1469 15.55
340089....................... 00.9632 12.28 350011.......... 01.9090 17.37 360036......... 01.3217 17.31 360113......... 01.3031 18.24 360204......... 01.2935 16.96
340090....................... 01.1321 16.30 350012.......... 01.1445 12.36 360037......... 02.1462 20.14 360114......... 01.1423 16.05 360210......... 01.2312 19.23
340091....................... 01.6457 18.32 350013.......... 01.0749 14.58 360038......... 01.5947 18.31 360115......... 01.3193 18.08 360211......... 01.2323 17.25
340093....................... 01.0600 11.60 350014.......... 01.0459 14.29 360039......... 01.2539 15.34 360116......... 01.1312 16.04 360212......... 01.3976 20.25
340094....................... 01.3349 16.83 350015.......... 01.7084 15.42 360040......... 01.3179 17.72 360118......... 01.3243 17.37 360213......... 01.1708 15.77
340096....................... 01.2029 17.18 350016.......... 01.0584 10.35 360041......... 01.3771 18.25 360121......... 01.2823 16.74 360218......... 01.2976 16.21
340097....................... 01.1577 16.04 350017.......... 01.4608 14.88 360042......... 01.1043 16.74 360122......... 01.3977 17.77 360230......... 01.3323 20.27
340098....................... 01.6813 19.05 350018.......... 01.1656 10.67 360044......... 01.1490 15.84 360123......... 01.2541 17.50 360231......... 01.1369 12.45
340099....................... 01.1020 13.36 350019.......... 01.6065 18.69 360045......... 01.4935 19.25 360124......... 01.2534 17.08 360234......... 01.3572 17.90
340101....................... 01.0289 11.11 350020.......... 01.4956 18.57 360046......... 01.1278 18.52 360125......... 01.1047 16.87 360236......... 01.1905 18.56
340104....................... 00.9432 10.60 350021.......... 01.0704 10.94 360047......... 01.2351 13.85 360126......... 01.2042 18.97 360239......... 01.2400 18.70
340105....................... 01.3861 17.75 350023.......... 00.8923 15.59 360048......... 01.7480 21.00 360127......... 01.1566 16.28 360241......... 00.5347 17.69
340106....................... 01.1062 17.79 350024.......... 01.1031 13.69 360049......... 01.2653 17.36 360128......... 01.1287 13.85 360242......... 01.7176 ......
340107....................... 01.3146 16.17 350025.......... 01.0558 12.60 360050......... 01.1666 12.43 360129......... 01.0400 14.06 360243......... 00.7473 14.35
340109....................... 01.3269 15.91 350027.......... 00.9712 12.57 360051......... 01.5445 21.82 360130......... 01.1366 15.16 360244......... 00.7208 16.77
340111....................... 01.1675 13.78 350029.......... 01.0062 12.34 360052......... 01.7086 17.88 360131......... 01.4162 16.27 360245......... 00.8023 12.10
340112....................... 01.2839 14.03 350030.......... 01.0917 15.42 360054......... 01.2621 15.55 360132......... 01.2311 20.78 360246......... 00.8798 15.05
340113....................... 02.0160 19.50 350033.......... 00.9596 13.23 360055......... 01.2391 18.92 360133......... 01.4596 17.61 360247......... 00.4357 ......
340114....................... 01.5131 19.16 350034.......... 01.0571 13.58 360056......... 01.3529 16.92 360134......... 01.5973 18.25 370001......... 01.6944 18.41
340115....................... 01.5532 17.23 350035.......... 00.9015 10.11 360057......... 01.0445 13.04 360135......... 01.1672 17.12 370002......... 01.2462 13.60
340116....................... 01.9191 20.30 350038.......... 01.0538 13.26 360058......... 01.2628 15.35 360136......... 01.0528 14.73 370004......... 01.2787 15.30
340119....................... 01.2839 15.21 350039.......... 00.9705 13.53 360059......... 01.5433 20.00 360137......... 01.5604 18.98 370005......... 01.0273 14.12
340120....................... 01.1296 12.33 350041.......... 01.0446 13.05 360062......... 01.4697 18.40 360140......... 01.0178 15.47 370006......... 01.3096 14.88
340121....................... 01.0450 14.52 350042.......... 01.0504 12.39 360063......... 01.1243 17.19 360141......... 01.4412 19.84 370007......... 01.1404 12.80
340122....................... 00.9921 10.30 350043.......... 01.6433 16.58 360064......... 01.5567 19.65 360142......... 01.0184 14.99 370008......... 01.4080 16.02
340123....................... 01.1293 14.07 350044.......... 00.9113 10.01 360065......... 01.2287 16.97 360143......... 01.2979 17.74 370011......... 01.0616 12.47
340124....................... 01.0275 12.27 350047.......... 01.2204 16.64 360066......... 01.3889 17.16 360144......... 01.3148 20.19 370012......... 00.8457 10.05
340125....................... 01.4145 16.94 350049.......... 01.2419 10.38 360067......... 01.2670 12.11 360145......... 01.6244 16.84 370013......... 01.7611 18.61
340126....................... 01.4353 16.23 350050.......... 00.9371 10.24 360068......... 01.6576 21.91 360147......... 01.2662 ....... 370014......... 01.3196 17.14
340127....................... 01.3099 16.30 350051.......... 00.9466 14.13 360069......... 01.1437 16.38 360148......... 01.0715 16.50 370015......... 01.2617 13.84
340129....................... 01.3429 18.65 350053.......... 01.0767 09.58 360070......... 01.6677 16.57 360149......... 01.1450 20.33 370016......... 01.3790 14.25
340130....................... 01.3332 16.03 350055.......... 00.9216 11.50 360071......... 01.2655 15.42 360150......... 01.2825 17.70 370017......... 01.1042 12.14
340131....................... 01.4267 16.05 350056.......... 00.9601 12.92 360072......... 01.1448 16.29 360151......... 01.3167 16.55 370018......... 01.2647 14.06
340132....................... 01.3222 12.41 350058.......... 00.9495 12.18 360074......... 01.3535 19.15 360152......... 01.4765 17.73 370019......... 01.3066 11.91
340133....................... 01.0518 13.87 350060.......... 00.7458 08.17 360075......... 01.4875 20.80 360153......... 01.1500 13.64 370020......... 01.2884 12.53
340136....................... 00.7885 24.45 350061.......... 01.0625 13.77 360076......... 01.3060 18.84 360154......... 01.0235 12.39 370021......... 00.9781 10.01
340137....................... 01.2154 12.68 350063.......... 00.8969 ....... 360077......... 01.4820 18.59 360155......... 01.3290 18.75 370022......... 01.2741 15.13
340138....................... 01.1811 17.60 350064.......... 00.9840 ....... 360078......... 01.2766 18.97 360156......... 01.3403 16.47 370023......... 01.3301 14.95
340141....................... 01.6320 18.27 350066.......... 00.7996 ....... 360079......... 01.7539 19.31 360159......... 01.1943 18.50 370025......... 01.4024 15.37
340142....................... 01.1998 14.94 360001.......... 01.3171 17.88 360080......... 01.1169 14.39 360161......... 01.2798 18.78 370026......... 01.4279 16.08
340143....................... 01.3874 18.50 360002.......... 01.2012 15.33 360081......... 01.3564 17.96 360162......... 01.2593 17.27 370028......... 01.8659 17.67
340144....................... 01.4263 14.85 360003.......... 01.7460 20.67 360082......... 01.3158 19.81 360163......... 01.8617 19.87 370029......... 01.2335 12.79
340145....................... 01.3230 16.80 360006.......... 01.7465 19.53 360083......... 01.2516 15.77 360164......... 00.8576 13.98 370030......... 01.2425 12.05
340146....................... 01.0175 15.42 360007.......... 01.0523 15.41 360084......... 01.6097 18.16 360165......... 01.2134 14.31 370032......... 01.5284 14.28
340147....................... 01.2925 17.80 360008.......... 01.2955 16.20 360085......... 01.8261 19.63 360166......... 01.1750 15.83 370033......... 01.0754 11.23
340148....................... 01.4427 18.28 360009.......... 01.3969 17.35 360086......... 01.4494 16.75 360169......... 00.9859 16.99 370034......... 01.2609 12.79
340151....................... 01.1215 14.05 360010.......... 01.2298 15.38 360087......... 01.4106 17.32 360170......... 01.2826 15.68 370035......... 01.6338 15.21
340153....................... 01.9740 21.08 360011.......... 01.2267 17.83 360088......... 01.2136 15.48 360172......... 01.3727 16.62 370036......... 01.0298 09.22
340155....................... 01.3941 20.91 360012.......... 01.2961 17.61 360089......... 01.1654 16.92 360174......... 01.2295 19.24 370037......... 01.7224 16.37
340156....................... 00.8042 ....... 360013.......... 01.0861 16.71 360090......... 01.2325 17.90 360175......... 01.2416 17.61 370038......... 00.9103 12.01
340158....................... 01.1785 15.94 360014.......... 01.1236 17.57 360091......... 01.2653 18.90 360176......... 01.1811 15.62 370039......... 01.4595 17.22
340159....................... 01.1571 16.88 360016.......... 01.5986 17.81 360092......... 01.2754 17.85 360177......... 01.2619 16.30 370040......... 01.1036 10.89
340160....................... 01.0888 12.88 360017.......... 01.7484 19.82 360093......... 01.2219 16.66 360178......... 01.2206 15.58 370041......... 01.0290 13.52
340162....................... 01.2211 17.78 360018.......... 01.5417 18.51 360094......... 01.3012 20.27 360179......... 01.2895 19.01 370042......... 00.8626 11.22
340164....................... 01.4594 18.17 360019.......... 01.2939 18.22 360095......... 01.3299 16.68 360180......... 02.0595 22.07 370043......... 00.9753 12.91
340166....................... 01.4192 18.51 360020.......... 01.4334 20.05 360096......... 01.1102 16.20 360184......... 00.4913 17.11 370045......... 01.1501 10.20
340168....................... 00.5028 14.78 360021.......... 01.2759 18.04 360098......... 01.3988 18.00 360185......... 01.2472 17.09 370046......... 00.9820 09.22
340171....................... 01.1220 ....... 360024.......... 01.4300 17.76 360099......... 01.1087 16.91 360186......... 01.1741 15.04 370047......... 01.3236 15.40
350001....................... 01.0070 11.08 360025.......... 01.2331 17.66 360100......... 01.3108 15.63 360187......... 01.2880 16.00 370048......... 01.1790 13.46
350002....................... 01.7570 16.04 360026.......... 01.1939 15.59 360101......... 01.7511 19.71 360188......... 01.0028 14.77 370049......... 01.3544 16.07
350003....................... 01.1983 15.67 360027.......... 01.5318 19.06 360102......... 01.2675 19.68 360189......... 01.0113 15.40 370051......... 00.9604 13.31
350004....................... 01.9399 17.94 360028.......... 01.4723 15.28 360103......... 01.3274 18.70 360192......... 01.2451 19.28 370054......... 01.3882 14.79
350005....................... 01.0794 13.14 360029.......... 01.1573 16.41 360104......... 01.9146 20.28 360193......... 01.3171 16.77 370056......... 01.5659 15.41
350006....................... 01.3898 16.16 360030.......... 01.1350 14.82 360106......... 01.0557 13.89 360194......... 01.1176 16.14 370057......... 01.1762 15.05
350007....................... 00.9506 12.20 360031.......... 01.3576 18.42 360107......... 01.2429 16.98 360195......... 01.1297 17.72 370059......... 01.1142 13.53
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[[Page 46251]]
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Case Avg. Case Avg. Case Avg. Case Avg. Case Avg.
Provider mix hour Provider mix hour Provider mix hour Provider mix hour Provider mix hour
index wage index wage index wage index wage index wage
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
370060....................... 01.0828 12.88 370190.......... 01.6289 17.49 390002......... 01.3694 17.03 390078......... 01.0673 15.98 390164......... 01.9539 19.14
370063....................... 01.0959 13.12 370192.......... 01.1353 ....... 390003......... 01.2550 15.57 390079......... 01.7078 16.83 390166......... 01.1034 17.40
370064....................... 00.9954 10.14 370194.......... 02.0879 ....... 390004......... 01.3802 16.70 390080......... 01.2568 18.66 390167......... 01.2653 20.71
370065....................... 01.0424 14.76 370195.......... 02.4526 ....... 390005......... 01.0808 14.82 390081......... 01.3530 20.23 390168......... 01.2043 17.54
370071....................... 01.0343 10.18 380001.......... 01.3214 19.27 390006......... 01.7350 17.39 390083......... 01.2270 20.87 390169......... 01.2058 18.63
370072....................... 00.9116 11.67 380002.......... 01.2073 22.74 390007......... 01.1796 21.33 390084......... 01.2421 15.29 390170......... 01.8570 22.43
370076....................... 01.3116 12.42 380003.......... 01.1475 18.75 390008......... 01.1300 15.08 390086......... 01.1340 16.87 390173......... 01.1954 17.08
370077....................... 01.2139 16.30 380004.......... 01.8006 22.89 390009......... 01.6087 18.07 390088......... 01.3283 18.42 390174......... 01.7088 24.17
370078....................... 01.7084 14.58 380005.......... 01.1861 19.47 390010......... 01.1790 16.58 390090......... 01.8006 19.41 390176......... 01.1460 16.79
370079....................... 00.9678 11.98 380006.......... 01.3890 18.29 390011......... 01.2467 16.49 390091......... 01.1700 17.09 390178......... 01.2822 17.74
370080....................... 00.9908 11.12 380007.......... 01.5689 22.66 390012......... 01.1943 19.15 390093......... 01.1538 15.20 390179......... 01.2710 22.80
370082....................... 00.9103 12.48 380008.......... 01.0706 18.69 390013......... 01.2311 16.77 390095......... 01.1758 13.95 390180......... 01.5397 22.83
370083....................... 00.9505 10.95 380009.......... 01.8307 22.17 390014......... 01.6424 16.42 390096......... 01.2633 16.88 390181......... 01.0583 17.80
370084....................... 01.0351 08.88 380010.......... 01.0879 24.15 390015......... 01.2054 13.06 390097......... 01.3262 20.91 390183......... 01.1883 17.16
370085....................... 00.8092 12.94 380011.......... 01.1042 14.95 390016......... 01.2233 15.58 390098......... 01.7539 20.06 390184......... 01.1032 17.69
370086....................... 01.1831 09.89 380013.......... 01.2681 21.54 390017......... 01.1747 14.20 390100......... 01.6285 19.30 390185......... 01.2281 16.12
370089....................... 01.2759 14.01 380014.......... 01.4266 18.89 390018......... 01.2261 19.47 390101......... 01.2027 15.70 390189......... 01.0384 18.41
370091....................... 01.6816 16.13 380017.......... 01.7014 21.77 390019......... 01.1185 14.53 390102......... 01.3635 20.34 390191......... 01.0441 13.91
370092....................... 01.0706 12.73 380018.......... 01.8329 19.21 390022......... 01.3887 21.81 390103......... 01.0941 17.17 390192......... 01.1158 17.15
370093....................... 01.8716 18.67 380019.......... 01.2061 18.88 390023......... 01.2485 19.71 390104......... 01.0526 15.15 390193......... 01.1854 15.39
370094....................... 01.4235 16.67 380020.......... 01.4312 20.06 390024......... 00.8664 22.60 390106......... 01.0134 14.85 390194......... 01.1543 18.97
370095....................... 00.9189 11.62 380021.......... 01.2831 19.10 390025......... 00.6470 16.64 390107......... 01.2490 18.66 390195......... 01.8317 22.08
370097....................... 01.3652 18.99 380022.......... 01.1731 19.92 390026......... 01.2710 20.58 390108......... 01.4094 19.97 390196......... 01.3947 ......
370099....................... 01.1641 12.91 380023.......... 01.2312 17.76 390027......... 01.9535 23.48 390109......... 01.1447 14.44 390197......... 01.3094 18.40
370100....................... 01.0343 13.02 380025.......... 01.2677 21.90 390028......... 01.7850 18.54 390110......... 01.6460 17.36 390198......... 01.1948 15.21
370103....................... 00.9027 11.77 380026.......... 01.1914 16.87 390029......... 01.9570 18.73 390111......... 01.8484 26.22 390199......... 01.2026 14.89
370105....................... 02.0050 17.06 380027.......... 01.2567 20.25 390030......... 01.2446 16.29 390112......... 01.1485 12.16 390200......... 01.0202 14.67
370106....................... 01.5501 16.96 380029.......... 01.1523 17.29 390031......... 01.1536 16.93 390113......... 01.2135 16.04 390201......... 01.2674 18.75
370108....................... 01.0589 10.82 380031.......... 01.0334 15.92 390032......... 01.2594 17.80 390114......... 01.1068 21.07 390203......... 01.3159 20.45
370112....................... 01.0733 12.33 380033.......... 01.7873 22.97 390035......... 01.2733 17.28 390115......... 01.3311 21.40 390204......... 01.2627 20.05
370113....................... 01.1633 12.33 380035.......... 01.3604 18.58 390036......... 01.3360 17.63 390116......... 01.2395 19.91 390205......... 01.3650 22.42
370114....................... 01.6326 14.69 380036.......... 01.1184 17.27 390037......... 01.3511 18.49 390117......... 01.1590 15.65 390206......... 01.3418 19.91
370121....................... 01.1757 15.78 380037.......... 01.2075 18.24 390039......... 01.0973 15.60 390118......... 01.1514 16.34 390209......... 01.0388 15.48
370122....................... 01.1255 09.78 380038.......... 01.3358 21.15 390040......... 01.0015 12.71 390119......... 01.3484 17.17 390211......... 01.1864 17.10
370123....................... 01.2080 14.12 380039.......... 01.3285 18.89 390041......... 01.2556 16.82 390121......... 01.3362 18.95 390213......... 00.9413 14.55
370125....................... 01.0313 11.90 380040.......... 01.2529 19.23 390042......... 01.4303 21.35 390122......... 01.0707 16.06 390215......... 01.1567 20.69
370126....................... 00.9473 10.66 380042.......... 01.1547 18.06 390043......... 01.1059 15.65 390123......... 01.3002 20.58 390217......... 01.2820 17.92
370131....................... 01.0515 12.93 380047.......... 01.6980 19.84 390044......... 01.6035 18.80 390125......... 01.2243 15.08 390219......... 01.3126 18.57
370133....................... 01.1108 09.82 380048.......... 01.0877 13.92 390045......... 01.7250 17.35 390126......... 01.3270 20.07 390220......... 01.2051 19.33
370138....................... 01.1139 14.40 380050.......... 01.3535 16.37 390046......... 01.5479 18.49 390127......... 01.2341 20.26 390222......... 01.3047 20.42
370139....................... 01.0952 10.62 380051.......... 01.5153 19.13 390047......... 01.6934 23.83 390128......... 01.2022 17.96 390223......... 01.6436 23.15
370140....................... 00.9914 11.71 380052.......... 01.1886 16.70 390048......... 01.1867 16.26 390130......... 01.1400 16.62 390224......... 00.9380 13.04
370141....................... 01.3994 19.17 380055.......... 01.2332 23.88 390049......... 01.5481 19.82 390131......... 01.2704 16.24 390225......... 01.2136 15.42
370146....................... 01.0334 12.03 380056.......... 01.0805 15.78 390050......... 02.1410 21.21 390132......... 01.2472 20.25 390226......... 01.7849 23.22
370148....................... 01.5867 19.01 380060.......... 01.5427 21.51 390051......... 02.1789 24.98 390133......... 01.7840 20.57 390228......... 01.2097 18.67
370149....................... 01.2406 15.19 380061.......... 01.5190 21.85 390052......... 01.1942 16.68 390135......... 01.2903 19.73 390231......... 01.3073 21.89
370153....................... 01.0980 13.17 380062.......... 01.1022 15.07 390054......... 01.2238 14.56 390136......... 01.2304 15.66 390233......... 01.3224 16.71
370154....................... 01.0184 12.31 380063.......... 01.3291 19.90 390055......... 01.7758 21.82 390137......... 01.3205 17.80 390235......... 01.5737 23.94
370156....................... 01.0910 13.37 380064.......... 01.4379 18.47 390056......... 01.1158 15.73 390138......... 01.3335 17.41 390236......... 01.1730 15.90
370158....................... 01.0520 12.08 380065.......... 01.0522 19.24 390057......... 01.3213 18.94 390139......... 01.5034 23.50 390237......... 01.6110 20.17
370159....................... 01.3498 13.95 380066.......... 01.3198 17.60 390058......... 01.3256 17.46 390142......... 01.6703 22.64 390238......... 01.3009 16.12
370163....................... 00.8598 10.99 380068.......... 01.0572 19.31 390060......... 01.1441 16.68 390145......... 01.3568 18.64 390242......... 01.2706 18.69
370165....................... 01.0906 11.74 380069.......... 01.1302 17.51 390061......... 01.4388 20.47 390146......... 01.3133 16.19 390244......... 00.9314 13.32
370166....................... 01.0846 15.48 380070.......... 01.3936 21.21 390062......... 01.1400 15.76 390147......... 01.2593 19.22 390245......... 01.3505 23.15
370169....................... 01.1130 10.66 380071.......... 01.2923 18.06 390063......... 01.7390 19.30 390149......... 01.2546 19.59 390246......... 01.2343 15.91
370170....................... 00.9813 ....... 380072.......... 00.9776 14.15 390064......... 01.5536 16.30 390150......... 01.1045 17.50 390247......... 01.0532 17.11
370171....................... 01.0235 ....... 380075.......... 01.4343 20.90 390065......... 01.2840 18.85 390151......... 01.2950 18.26 390249......... 01.0339 10.81
370172....................... 00.8846 ....... 380078.......... 01.1630 16.95 390066......... 01.2949 17.15 390152......... 01.0397 17.07 390256......... 01.7863 23.51
370173....................... 01.2880 ....... 380081.......... 01.1420 17.66 390067......... 01.8124 18.03 390153......... 01.2439 21.93 390258......... 01.2630 19.78
370174....................... 00.9656 ....... 380082.......... 01.2830 20.35 390068......... 01.3206 18.13 390154......... 01.1846 13.93 390260......... 01.1752 20.02
370176....................... 01.1460 16.48 380083.......... 01.2473 18.93 390069......... 01.3149 19.23 390155......... 01.2947 20.56 390262......... 01.9683 17.25
370177....................... 00.9746 10.10 380084.......... 01.2083 20.61 390070......... 01.2872 19.49 390156......... 01.4292 22.61 390263......... 01.4329 18.66
370178....................... 01.0093 12.17 380087.......... 01.0126 12.30 390071......... 01.1143 13.36 390157......... 01.3465 17.97 390265......... 01.3177 17.72
370179....................... 00.8839 14.28 380088.......... 01.0041 15.71 390072......... 01.1098 15.76 390158......... 01.5904 ....... 390266......... 01.2130 16.69
370180....................... 01.0671 ....... 380089.......... 01.2966 21.87 390073......... 01.5899 18.94 390160......... 01.2106 17.51 390267......... 01.2925 18.93
370183....................... 01.0923 14.00 380090.......... 01.3003 24.41 390074......... 01.2338 16.26 390161......... 01.0926 14.87 390268......... 01.3885 19.94
370186....................... 01.0180 12.72 380091.......... 01.2100 23.79 390075......... 01.2463 15.92 390162......... 01.4285 19.03 390270......... 01.3067 15.89
370189....................... 00.9704 10.13 390001.......... 01.3711 18.16 390076......... 01.3156 20.45 390163......... 01.2240 16.55 390272......... 00.4528 ......
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Case Avg. Case Avg. Case Avg. Case Avg. Case Avg.
Provider mix hour Provider mix hour Provider mix hour Provider mix hour Provider mix hour
index wage index wage index wage index wage index wage
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
390277....................... 00.5603 20.34 420002.......... 01.3814 18.80 430011......... 01.3374 14.33 440024......... 01.3270 16.22 440146......... 00.9338 11.08
390278....................... 00.7678 17.52 420004.......... 01.8677 18.35 430012......... 01.3054 14.99 440025......... 01.1364 13.01 440147......... 01.1985 17.06
390279....................... 01.0751 13.63 420005.......... 01.2065 14.35 430013......... 01.2411 15.06 440029......... 01.2900 16.30 440148......... 01.1378 14.37
390281....................... 03.2278 ....... 420006.......... 01.2691 18.90 430014......... 01.2803 16.77 440030......... 01.2038 13.21 440149......... 01.2007 15.19
400001....................... 01.2220 08.25 420007.......... 01.5104 16.31 430015......... 01.1797 14.41 440031......... 00.9661 12.29 440150......... 01.2814 19.58
400002....................... 01.4856 10.96 420009.......... 01.2122 15.70 430016......... 01.8135 17.59 440032......... 01.0524 12.65 440151......... 01.3711 15.86
400003....................... 01.2332 08.92 420010.......... 01.1103 14.35 430018......... 00.9842 14.06 440033......... 01.0675 14.84 440152......... 01.5691 16.91
400004....................... 01.1483 07.59 420011.......... 01.0948 14.89 430022......... 00.9711 10.91 440034......... 01.5752 16.64 440153......... 01.2623 15.10
400005....................... 01.1206 06.10 420014.......... 01.1243 14.11 430023......... 00.9247 09.95 440035......... 01.3207 15.65 440156......... 01.5611 18.85
400006....................... 01.2016 08.16 420015.......... 01.3249 15.96 430024......... 00.9133 12.28 440039......... 01.6370 16.76 440157......... 01.0908 13.64
400007....................... 01.2693 07.55 420016.......... 01.0738 14.39 430026......... 01.0802 11.36 440040......... 00.9724 17.03 440159......... 01.2247 14.83
400009....................... 01.0262 07.68 420018.......... 01.7297 18.63 430027......... 01.8126 16.64 440041......... 01.0380 12.35 440161......... 01.6915 20.63
400010....................... 00.9203 07.94 420019.......... 01.2334 14.90 430028......... 01.0919 13.68 440046......... 01.3297 13.59 440166......... 01.4435 17.80
400011....................... 00.9992 08.65 420020.......... 01.3863 15.98 430029......... 00.9945 13.10 440047......... 00.9562 15.31 440168......... 01.0268 13.03
400012....................... 01.2240 07.45 420023.......... 01.4196 18.07 430031......... 00.9633 11.31 440048......... 01.7952 16.64 440173......... 01.5203 16.91
400013....................... 01.3026 07.90 420026.......... 01.9243 18.05 430033......... 01.0190 11.90 440049......... 01.6599 15.62 440174......... 00.9800 13.30
400014....................... 01.3669 07.72 420027.......... 01.3766 15.51 430034......... 01.0691 11.58 440050......... 01.2144 16.03 440175......... 01.2313 18.06
400015....................... 01.2460 10.88 420030.......... 01.3136 15.83 430036......... 01.0403 10.11 440051......... 00.9274 13.29 440176......... 01.2943 18.36
400016....................... 01.3669 10.57 420031.......... 00.9596 12.15 430037......... 00.9746 12.89 440052......... 01.2208 14.25 440178......... 01.1828 20.20
400017....................... 01.2323 06.27 420033.......... 01.2169 19.24 430038......... 01.0102 10.77 440053......... 01.3082 15.64 440180......... 01.1590 16.68
400018....................... 01.3497 09.15 420035.......... 00.8201 12.43 430039......... 01.0851 11.53 440054......... 01.2219 12.82 440181......... 01.0247 11.75
400019....................... 01.6713 09.52 420036.......... 01.2109 15.61 430040......... 00.9125 12.17 440056......... 01.0837 13.45 440182......... 00.9496 15.33
400021....................... 01.4363 07.63 420037.......... 01.2790 19.65 430041......... 00.9368 11.91 440057......... 01.0173 10.77 440183......... 01.5317 15.06
400022....................... 01.3221 09.94 420038.......... 01.3043 14.43 430042......... 00.9807 10.63 440058......... 01.3195 14.95 440184......... 01.3454 18.63
400024....................... 01.0278 08.62 420039.......... 01.1575 14.52 430043......... 01.1884 12.02 440059......... 01.3263 15.63 440185......... 01.1231 14.24
400026....................... 00.9518 05.90 420042.......... 01.2023 12.15 430044......... 00.9113 13.17 440060......... 01.1970 14.76 440186......... 01.1936 16.21
400027....................... 01.1389 08.01 420043.......... 01.1809 18.82 430047......... 01.1401 12.24 440061......... 01.2086 15.46 440187......... 01.2024 14.85
400028....................... 01.0186 07.77 420048.......... 01.1316 14.26 430048......... 01.2003 15.01 440063......... 01.6128 17.43 440189......... 01.4803 18.81
400029....................... 01.1282 06.64 420049.......... 01.1758 14.55 430049......... 00.9292 12.66 440064......... 01.1917 15.05 440192......... 01.1477 14.18
400031....................... 01.1362 08.00 420051.......... 01.5589 17.99 430051......... 01.0196 13.48 440065......... 01.2342 16.18 440193......... 01.2835 17.88
400032....................... 01.1227 07.75 420053.......... 01.1416 14.03 430054......... 01.0137 13.13 440067......... 01.1944 15.54 440194......... 01.4255 16.89
400044....................... 01.2346 09.09 420054.......... 01.3673 16.39 430056......... 00.8553 08.93 440068......... 01.2212 16.43 440196......... 00.9505 13.32
400048....................... 01.1349 07.30 420055.......... 01.0608 12.51 430057......... 00.9283 10.47 440069......... 01.1286 14.17 440197......... 01.4034 19.15
400061....................... 01.6729 11.80 420056.......... 01.1544 13.41 430060......... 01.1566 08.46 440070......... 01.1243 12.52 440200......... 01.1971 15.41
400079....................... 01.2619 08.43 420057.......... 01.1466 14.96 430062......... 00.8743 10.31 440071......... 01.3952 14.87 440203......... 00.9399 13.17
400087....................... 01.3682 07.87 420059.......... 00.9934 13.96 430064......... 01.1303 11.89 440072......... 01.5223 13.92 440205......... 01.0953 14.15
400094....................... 01.0449 07.49 420061.......... 01.1508 16.16 430065......... 00.9479 09.93 440073......... 01.3496 16.96 440206......... 01.0265 13.82
400098....................... 01.2488 07.50 420062.......... 01.4491 15.65 430066......... 00.9678 10.93 440078......... 01.0256 13.28 440208......... 01.8205 ......
400102....................... 01.1685 08.67 420064.......... 01.1139 13.45 430073......... 01.0704 ....... 440081......... 01.1542 15.31 450002......... 01.4659 19.35
400103....................... 01.3822 08.80 420065.......... 01.3039 16.72 430076......... 00.9751 09.41 440082......... 01.9853 20.54 450004......... 01.1678 12.38
400104....................... 01.3757 08.97 420066.......... 00.9103 14.40 430077......... 01.5817 16.53 440083......... 01.1097 10.96 450005......... 01.1514 13.79
400105....................... 01.1767 08.37 420067.......... 01.2427 16.24 430079......... 00.9610 11.47 440084......... 01.1791 11.41 450007......... 01.2393 13.73
400106....................... 01.2375 08.39 420068.......... 01.2907 16.08 430080......... 01.1317 08.89 440087......... 00.9425 14.44 450008......... 01.3554 14.96
400109....................... 01.5324 09.13 420069.......... 01.1030 13.71 430081......... 01.0291 ....... 440090......... 00.9368 13.29 450010......... 01.3345 15.37
400110....................... 01.1163 07.65 420070.......... 01.2642 15.05 430082......... 00.8067 ....... 440091......... 01.5497 16.53 450011......... 01.5020 17.43
400111....................... 01.1523 07.98 420071.......... 01.3101 16.13 430083......... 00.8649 ....... 440100......... 01.0343 12.82 450014......... 01.0617 13.84
400112....................... 01.2541 06.01 420072.......... 01.0775 10.64 430084......... 00.9278 ....... 440102......... 01.0720 12.26 450015......... 01.5403 15.15
400113....................... 01.2466 08.20 420073.......... 01.3072 18.13 430085......... 00.9194 ....... 440103......... 01.2317 17.24 450016......... 01.6194 17.57
400114....................... 01.0452 06.50 420074.......... 00.9037 11.72 430087......... 00.9027 09.29 440104......... 01.6500 17.68 450018......... 01.6073 21.75
400115....................... 01.0096 07.56 420075.......... 00.9694 12.66 440001......... 01.1291 12.18 440105......... 01.3509 16.69 450020......... 01.0239 15.47
400117....................... 01.1759 09.23 420078.......... 01.8104 18.59 440002......... 01.6019 15.73 440109......... 01.1368 12.28 450021......... 01.8149 21.11
400118....................... 01.1868 08.61 420079.......... 01.5628 16.94 440003......... 01.0727 15.23 440110......... 00.9697 16.06 450023......... 01.4758 15.45
400120....................... 01.3057 09.14 420080.......... 01.2627 19.18 440006......... 01.6333 17.55 440111......... 01.3691 18.00 450024......... 01.3739 16.45
400121....................... 01.0090 05.80 420082.......... 01.3944 19.13 440007......... 01.0099 11.83 440114......... 01.0453 12.68 450025......... 01.5088 16.23
400122....................... 00.9993 05.88 420083.......... 01.1937 18.36 440008......... 00.9877 13.50 440115......... 01.1184 14.66 450028......... 01.6360 17.17
400123....................... 01.1685 08.24 420084.......... 00.7413 13.56 440009......... 01.1773 13.22 440120......... 01.5405 16.14 450029......... 01.3996 12.98
400124....................... 02.6681 09.27 420085.......... 01.3941 16.86 440010......... 00.9181 08.75 440125......... 01.4435 16.09 450031......... 01.5825 18.72
410001....................... 01.3237 23.02 420086.......... 01.3585 16.90 440011......... 01.2884 16.28 440130......... 01.1725 14.16 450032......... 01.2733 13.63
410004....................... 01.3672 21.15 420087.......... 01.5958 16.53 440012......... 01.4781 17.72 440131......... 01.1390 13.44 450033......... 01.6352 16.84
410005....................... 01.3477 21.90 420088.......... 01.1487 15.05 440014......... 01.0633 09.06 440132......... 01.1117 14.01 450034......... 01.6414 16.28
410006....................... 01.2581 21.40 420089.......... 01.2296 19.40 440015......... 01.6236 16.42 440133......... 01.5475 17.78 450035......... 01.4498 18.91
410007....................... 01.6598 20.37 420091.......... 01.2145 13.16 440016......... 01.0124 11.35 440135......... 01.3052 17.20 450037......... 01.6198 17.78
410008....................... 01.1681 21.05 430004.......... 01.0941 17.25 440017......... 01.6214 18.42 440137......... 00.9781 12.14 450039......... 01.3536 18.70
410009....................... 01.2979 20.66 430005.......... 01.3166 14.06 440018......... 01.4781 16.10 440141......... 01.0780 13.59 450040......... 01.5551 17.75
410010....................... 01.0163 25.40 430007.......... 01.0466 12.56 440019......... 01.6255 19.06 440142......... 01.0334 10.75 450042......... 01.6664 15.75
410011....................... 01.2082 22.25 430008.......... 01.1342 14.01 440020......... 01.2332 15.43 440143......... 01.1007 17.21 450043......... 01.4465 20.40
410012....................... 01.7245 19.51 430009.......... 01.0881 11.86 440022......... 01.2045 13.72 440144......... 01.3344 18.35 450044......... 01.6233 20.51
410013....................... 01.3149 24.63 430010.......... 01.1233 09.23 440023......... 01.0084 11.58 440145......... 01.0427 10.99 450046......... 01.3659 14.67
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[[Page 46253]]
Page 14 of 16
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Case Avg. Case Avg. Case Avg. Case Avg. Case Avg.
Provider mix hour Provider mix hour Provider mix hour Provider mix hour Provider mix hour
index wage index wage index wage index wage index wage
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
450047....................... 01.1220 13.43 450152.......... 01.2584 16.04 450292......... 01.2041 20.69 450473......... 01.0025 17.83 450648......... 01.0330 11.36
450050....................... 01.0646 16.00 450153.......... 01.5850 17.97 450293......... 00.9718 13.55 450475......... 01.1382 14.13 450649......... 01.0760 14.64
450051....................... 01.5938 18.22 450154.......... 01.1993 12.23 450296......... 01.3113 16.46 450484......... 01.4918 18.53 450651......... 01.8202 21.97
450052....................... 01.0170 13.18 450155.......... 01.0180 12.61 450297......... 01.0190 12.01 450488......... 01.2564 15.04 450652......... 00.9227 13.44
450053....................... 01.1454 13.11 450157.......... 01.0065 12.97 450299......... 01.3347 17.02 450489......... 00.9782 11.56 450653......... 01.2431 18.84
450054....................... 01.7192 21.32 450160.......... 00.9923 17.50 450303......... 00.9406 09.97 450497......... 01.1271 12.05 450654......... 01.0022 11.11
450055....................... 01.1447 12.92 450162.......... 01.1938 16.77 450306......... 01.0853 12.50 450498......... 01.2476 13.88 450656......... 01.4892 16.48
450056....................... 01.6156 18.26 450163.......... 01.0440 15.34 450307......... 00.8981 13.62 450508......... 01.5513 16.37 450658......... 00.9782 14.01
450058....................... 01.5801 14.76 450164.......... 01.0742 12.56 450309......... 01.0640 12.74 450514......... 01.2130 18.78 450659......... 01.5709 21.98
450059....................... 01.2524 13.14 450165.......... 00.9592 14.34 450315......... 01.1187 19.65 450517......... 00.9987 10.94 450660......... 01.5676 21.85
450060....................... 01.3645 22.17 450166.......... 00.9684 10.06 450320......... 01.3390 18.20 450518......... 01.5354 16.84 450661......... 01.1458 19.26
450063....................... 00.9796 11.51 450169.......... 00.9080 13.82 450321......... 00.9595 12.45 450523......... 01.5274 21.38 450662......... 01.6776 16.53
450064....................... 01.5134 15.34 450170.......... 00.9791 11.32 450322......... 00.7151 15.40 450530......... 01.4471 21.64 450665......... 00.9352 11.45
450065....................... 01.1489 14.75 450176.......... 01.2251 15.23 450324......... 01.6544 15.19 450534......... 00.9729 20.29 450666......... 01.2706 19.71
450068....................... 01.7905 20.31 450177.......... 01.0924 13.18 450325......... 01.2253 11.93 450535......... 01.2548 14.12 450668......... 01.5402 18.90
450070....................... 01.2681 15.46 450178.......... 01.0088 14.65 450327......... 00.9860 12.11 450537......... 01.3601 17.80 450669......... 01.2864 19.10
450072....................... 01.2416 18.19 450181.......... 01.0019 15.15 450330......... 01.2227 16.86 450538......... 01.3999 21.17 450670......... 01.3009 19.44
450073....................... 01.1264 12.84 450184.......... 01.5407 23.27 450334......... 01.0534 11.65 450539......... 01.2984 13.27 450672......... 01.6541 19.75
450076....................... 01.5782 ....... 450185.......... 01.1327 08.47 450337......... 01.2371 17.14 450544......... 01.4369 22.65 450673......... 01.1436 11.38
450078....................... 00.9932 11.17 450187.......... 01.2814 16.44 450340......... 01.3187 14.54 450545......... 01.2718 14.13 450674......... 01.0111 22.09
450079....................... 01.4322 19.03 450188.......... 01.0119 12.46 450341......... 01.0248 16.26 450546......... 01.8222 18.37 450675......... 01.5087 17.94
450080....................... 01.2955 15.79 450190.......... 01.1860 19.53 450346......... 01.3451 16.27 450547......... 01.1713 15.09 450677......... 01.4313 19.18
450081....................... 01.0995 12.87 450191.......... 01.0888 15.75 450347......... 01.1474 15.48 450550......... 00.9808 17.01 450678......... 01.4822 20.45
450082....................... 00.9666 12.75 450192.......... 01.2364 16.25 450348......... 01.0026 10.99 450551......... 01.1921 13.75 450681......... 03.0551 17.29
450083....................... 01.7113 17.42 450193.......... 02.0587 21.32 450351......... 01.1755 18.65 450558......... 01.7741 17.17 450683......... 01.3220 20.22
450085....................... 01.0883 14.38 450194.......... 01.2395 18.11 450352......... 01.1091 16.21 450559......... 00.9492 12.75 450684......... 01.2741 18.53
450087....................... 01.4225 19.35 450196.......... 01.5055 17.58 450353......... 01.3200 17.98 450561......... 01.6456 17.65 450686......... 01.5540 14.30
450090....................... 01.2033 12.40 450197.......... 01.0524 19.66 450355......... 01.1377 11.18 450563......... 01.2363 21.98 450688......... 01.2881 18.65
450092....................... 01.2143 13.12 450200.......... 01.3821 16.35 450358......... 02.0797 20.57 450565......... 01.3067 15.63 450690......... 01.4332 20.17
450094....................... 01.2606 19.39 450201.......... 01.0166 15.38 450362......... 01.1880 18.62 450570......... 01.0343 11.74 450691......... 01.0990 14.91
450096....................... 01.5374 19.25 450203.......... 01.1911 16.13 450369......... 01.0899 10.21 450571......... 01.4975 14.52 450694......... 01.2392 15.91
450097....................... 01.4459 18.33 450209.......... 01.5470 16.62 450370......... 01.1322 13.02 450573......... 01.0043 13.58 450696......... 01.6532 23.37
450098....................... 01.1700 13.75 450210.......... 01.1942 12.03 450371......... 01.1439 11.02 450574......... 00.9401 13.41 450697......... 01.5296 16.28
450099....................... 01.2845 17.70 450211.......... 01.3875 15.53 450372......... 01.2685 20.49 450575......... 01.0588 16.98 450698......... 00.9741 11.66
450101....................... 01.4874 15.03 450213.......... 01.5135 16.27 450373......... 01.1458 13.68 450578......... 00.9188 12.94 450700......... 00.9361 12.68
450102....................... 01.7024 21.87 450214.......... 01.3724 18.61 450374......... 00.9606 12.20 450580......... 01.1043 12.59 450702......... 01.6116 17.58
450104....................... 01.2215 13.74 450217.......... 01.0493 12.61 450376......... 01.5130 16.26 450583......... 01.0101 12.24 450703......... 01.5347 22.71
450107....................... 01.6114 18.75 450219.......... 01.1376 14.22 450378......... 01.0872 21.56 450584......... 01.2252 12.86 450704......... 01.3685 17.86
450108....................... 00.9951 14.49 450221.......... 01.0919 14.05 450379......... 01.5119 21.28 450586......... 00.9990 11.26 450705......... 01.0325 16.80
450109....................... 00.9937 15.36 450222.......... 01.6583 17.32 450381......... 01.0501 12.56 450587......... 01.2284 16.93 450706......... 01.2203 21.90
450110....................... 01.2581 19.34 450224.......... 01.3804 16.16 450388......... 01.7618 17.41 450591......... 01.1443 16.28 450709......... 01.2258 20.05
450111....................... 01.2467 19.56 450229.......... 01.5720 15.17 450389......... 01.2091 16.74 450596......... 01.3111 17.29 450711......... 01.6445 17.90
450112....................... 01.3458 13.87 450231.......... 01.5952 18.09 450393......... 01.3286 20.94 450597......... 01.0558 14.23 450712......... 00.7326 15.03
450113....................... 01.2354 16.99 450234.......... 00.9894 11.27 450395......... 01.0373 14.68 450603......... 00.8313 16.27 450713......... 01.4795 18.10
450118....................... 01.5684 21.60 450235.......... 01.0641 13.47 450399......... 00.9972 13.37 450604......... 01.3843 13.57 450715......... 01.4608 19.89
450119....................... 01.2883 16.37 450236.......... 01.0680 14.17 450400......... 01.1529 13.70 450605......... 01.4572 17.91 450716......... 01.2763 19.64
450121....................... 01.4394 18.70 450237.......... 01.5497 16.60 450403......... 01.3695 19.91 450609......... 00.8873 12.25 450717......... 01.3876 22.95
450123....................... 01.1501 17.47 450239.......... 01.2041 12.35 450411......... 00.9528 11.46 450610......... 01.4525 16.09 450718......... 01.2410 20.52
450124....................... 01.5911 19.48 450241.......... 01.0376 15.67 450417......... 01.0520 12.95 450614......... 01.0500 12.43 450723......... 01.3595 18.17
450126....................... 01.3790 11.95 450243.......... 00.8397 11.57 450418......... 01.3231 17.42 450615......... 01.0751 11.70 450724......... 01.2949 16.59
450128....................... 01.2417 14.78 450246.......... 00.9745 15.02 450419......... 01.2764 22.40 450617......... 01.2951 20.82 450725......... 01.0238 20.88
450130....................... 01.5026 16.34 450249.......... 00.9682 10.70 450422......... 00.8069 23.47 450620......... 01.0721 12.48 450726......... 00.8634 14.54
450131....................... 01.3704 21.35 450250.......... 00.9525 09.93 450423......... 01.4345 21.03 450623......... 01.1422 17.62 450727......... 00.9554 09.78
450132....................... 01.6500 16.45 450253.......... 01.3238 13.51 450424......... 01.2052 16.33 450626......... 01.0899 14.09 450728......... 00.9742 14.31
450133....................... 01.5434 16.49 450258.......... 01.0987 11.17 450429......... 01.1218 13.35 450628......... 00.9432 15.48 450730......... 01.3596 21.14
450135....................... 01.7232 21.81 450259.......... 01.2053 17.44 450431......... 01.6621 17.30 450630......... 01.6460 20.60 450733......... 01.3642 16.91
450137....................... 01.5052 24.28 450264.......... 00.8888 11.94 450438......... 01.1814 14.39 450631......... 01.7443 18.24 450735......... 00.8814 12.70
450140....................... 00.8514 16.46 450269.......... 01.1527 12.62 450446......... 00.8552 13.07 450632......... 01.0135 11.17 450742......... 01.3392 21.43
450142....................... 01.4322 19.50 450270.......... 01.1746 10.16 450447......... 01.3578 17.69 450633......... 01.5955 19.99 450743......... 01.4512 18.56
450143....................... 01.0933 12.23 450271.......... 01.2705 14.41 450450......... 01.0892 16.43 450634......... 01.6915 21.57 450746......... 01.0348 13.39
450144....................... 01.1100 16.23 450272.......... 01.2918 16.29 450451......... 01.1189 20.23 450637......... 01.3801 18.24 450747......... 01.3596 16.51
450145....................... 00.8715 12.46 450276.......... 01.1012 10.44 450457......... 01.7888 17.14 450638......... 01.5960 22.52 450749......... 01.0066 12.35
450146....................... 01.0002 16.53 450278.......... 00.8518 18.12 450460......... 01.0391 12.06 450639......... 01.4075 21.41 450750......... 01.0207 11.86
450147....................... 01.4238 17.66 450280.......... 01.5267 20.58 450462......... 01.8388 19.89 450641......... 01.0270 12.60 450751......... 01.3180 21.80
450148....................... 01.3128 19.02 450283.......... 01.0534 12.09 450464......... 00.9829 13.41 450643......... 01.2616 17.57 450754......... 00.8914 13.19
450149....................... 01.3535 19.71 450286.......... 01.0404 14.54 450465......... 01.3156 14.66 450644......... 01.4772 20.30 450755......... 01.1576 13.66
450150....................... 00.8833 13.62 450288.......... 01.2198 12.58 450467......... 00.9614 14.39 450646......... 01.6091 19.59 450757......... 00.9791 13.32
450151....................... 01.1042 13.27 450289.......... 01.4806 17.37 450469......... 01.3754 16.94 450647......... 02.0177 20.35 450758......... 01.2161 13.21
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Case Avg. Case Avg. Case Avg. Case Avg. Case Avg.
Provider mix hour Provider mix hour Provider mix hour Provider mix hour Provider mix hour
index wage index wage index wage index wage index wage
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
450760....................... 01.1995 16.97 460047.......... 01.7910 19.49 490067......... 01.2066 14.95 500028......... 01.0863 14.76 500139......... 01.4752 21.33
450761....................... 01.0624 09.63 460049.......... 01.9373 17.36 490069......... 01.4041 15.74 500029......... 00.9240 14.30 500141......... 01.3369 21.93
450763....................... 01.0137 16.27 460050.......... 01.3229 20.35 490071......... 01.4437 17.56 500030......... 01.4741 22.13 500143......... 00.7548 14.92
450766....................... 02.3026 21.39 460051.......... 01.1889 ....... 490073......... 01.3572 21.49 500031......... 01.2908 20.19 500146......... 01.0356 ......
450769....................... 01.0302 13.28 470001.......... 01.2042 17.11 490074......... 01.3267 16.06 500033......... 01.2023 18.05 510001......... 01.7170 17.08
450770....................... 00.9569 13.59 470003.......... 01.8185 20.22 490075......... 01.3350 16.62 500036......... 01.3243 19.11 510002......... 01.2698 16.31
450771....................... 01.9684 19.76 470004.......... 01.1082 14.18 490077......... 01.1612 16.87 500037......... 01.1182 17.63 510004......... 00.9340 12.62
450774....................... 00.9029 23.99 470005.......... 01.2621 18.71 490079......... 01.3172 14.30 500039......... 01.3816 21.32 510005......... 00.9906 13.71
450775....................... 01.2195 19.26 470006.......... 01.1890 17.05 490083......... 00.6451 14.63 500041......... 01.2847 22.09 510006......... 01.2547 17.08
450776....................... 00.9203 ....... 470008.......... 01.2515 15.41 490084......... 01.2474 15.96 500042......... 01.3841 20.95 510007......... 01.4719 17.81
450777....................... 01.0133 15.01 470010.......... 01.1785 18.58 490085......... 01.2069 13.36 500043......... 01.2790 16.56 510008......... 01.1392 15.33
450779....................... 01.3433 20.59 470011.......... 01.1576 19.30 490088......... 01.2040 13.97 500044......... 01.8929 20.56 510012......... 01.0689 14.26
450780....................... 01.6395 19.78 470012.......... 01.2641 17.52 490089......... 01.0777 14.37 500045......... 01.1206 20.65 510013......... 01.1401 15.10
450781....................... 01.5121 16.23 470013.......... 01.1730 18.38 490090......... 01.1910 14.25 500048......... 00.9121 16.01 510015......... 00.9645 12.51
450785....................... 01.0081 26.08 470015.......... 01.0821 16.29 490091......... 01.2048 20.14 500049......... 01.4662 19.34 510016......... 00.9894 11.27
450788....................... 01.4240 ....... 470018.......... 01.1960 17.37 490092......... 01.2073 14.32 500050......... 01.4048 20.41 510018......... 01.1325 14.40
450793....................... 01.6623 ....... 470020.......... 00.9790 14.50 490093......... 01.2886 15.31 500051......... 01.6400 22.71 510020......... 01.0439 10.16
450794....................... 01.4607 ....... 470023.......... 01.3025 17.20 490094......... 01.0703 14.57 500052......... 01.2844 ....... 510022......... 01.8032 19.52
450795....................... 00.8583 ....... 470024.......... 01.1065 17.08 490095......... 01.4704 16.32 500053......... 01.2764 20.10 510023......... 01.1453 15.14
450797....................... 00.6907 ....... 490001.......... 01.0855 19.41 490097......... 01.1309 13.69 500054......... 01.8765 20.41 510024......... 01.4123 17.94
450798....................... 00.8914 ....... 490002.......... 01.0634 13.61 490098......... 01.3117 11.69 500055......... 01.0919 20.32 510026......... 00.9431 12.19
450799....................... 01.4105 ....... 490003.......... 00.6013 17.55 490099......... 00.9354 15.29 500057......... 01.3473 16.24 510027......... 00.9624 13.86
450800....................... 01.3490 ....... 490004.......... 01.2275 16.67 490100......... 01.3718 16.69 500058......... 01.5008 19.82 510028......... 01.0722 14.90
450801....................... 01.4785 ....... 490005.......... 01.5365 16.10 490101......... 01.1892 23.64 500059......... 01.1568 20.02 510029......... 01.2911 16.69
450802....................... 01.0743 ....... 490006.......... 01.1550 13.27 490104......... 00.8927 14.46 500060......... 01.4852 20.70 510030......... 01.1024 14.87
450803....................... 00.8537 ....... 490007.......... 02.0173 17.19 490105......... 00.7368 16.55 500061......... 00.9874 17.95 510031......... 01.3462 16.27
450804....................... 01.5317 ....... 490009.......... 01.8300 18.08 490106......... 00.8894 14.86 500062......... 01.0881 17.16 510033......... 01.2683 14.42
450805....................... 01.1690 ....... 490010.......... 01.0896 17.08 490107......... 01.3168 22.65 500064......... 01.5317 21.69 510035......... 01.1333 16.46
450807....................... 00.9104 ....... 490011.......... 01.4141 17.03 490108......... 00.8692 13.78 500065......... 01.2988 17.67 510036......... 01.0124 09.34
450809....................... 01.6695 ....... 490012.......... 01.2074 15.55 490109......... 00.9193 14.09 500068......... 01.0249 17.17 510038......... 01.1602 13.71
460001....................... 01.7915 19.82 490013.......... 01.2459 14.82 490110......... 01.3951 15.90 500069......... 01.1604 18.62 510039......... 01.3713 15.02
460003....................... 01.7205 18.38 490014.......... 01.3674 21.04 490111......... 01.2384 16.79 500071......... 01.3704 19.46 510043......... 00.9246 11.33
460004....................... 01.7759 20.68 490015.......... 01.4613 17.30 490112......... 01.7317 19.07 500072......... 01.1955 21.19 510046......... 01.2634 15.26
460005....................... 01.5560 18.80 490017.......... 01.3610 16.58 490113......... 01.2998 20.96 500073......... 01.0893 16.85 510047......... 01.2119 17.26
460006....................... 01.4316 18.71 490018.......... 01.2531 16.88 490114......... 01.1055 15.00 500074......... 01.1764 14.80 510048......... 01.0836 17.39
460007....................... 01.5439 19.27 490019.......... 01.2029 15.60 490115......... 01.2378 14.25 500075......... 03.7376 20.25 510050......... 01.4644 15.34
460008....................... 01.3622 16.02 490020.......... 01.1532 14.16 490116......... 01.2262 15.61 500077......... 01.3928 21.63 510053......... 01.0373 13.50
460009....................... 01.8858 18.11 490021.......... 01.1440 17.12 490117......... 01.1727 13.62 500079......... 01.4051 19.87 510055......... 01.2326 19.41
460010....................... 01.9311 20.15 490022.......... 01.4164 17.59 490118......... 01.7640 21.32 500080......... 00.8347 11.56 510058......... 01.1980 16.23
460011....................... 01.3873 16.16 490023.......... 01.2222 17.03 490119......... 01.3430 16.41 500084......... 01.1384 20.05 510059......... 01.2369 13.65
460013....................... 01.5121 18.54 490024.......... 01.7777 17.06 490120......... 01.3210 16.90 500085......... 01.0600 17.19 510060......... 01.1653 15.36
460014....................... 01.0302 15.38 490027.......... 01.1366 13.11 490122......... 01.5068 20.86 500086......... 01.4233 18.48 510061......... 01.0684 12.59
460015....................... 01.2578 19.75 490028.......... 01.3505 18.42 490123......... 01.1433 14.80 500088......... 01.3681 22.86 510062......... 01.2001 15.38
460016....................... 00.8956 13.54 490030.......... 01.0966 11.16 490124......... 01.1494 16.99 500089......... 00.9699 13.99 510063......... 01.0086 10.63
460017....................... 01.4587 16.52 490031.......... 01.1399 12.61 490126......... 01.3829 14.72 500090......... 00.9942 12.60 510065......... 01.0057 12.04
460018....................... 00.9760 13.59 490032.......... 01.7447 19.08 490127......... 01.0153 14.44 500092......... 01.0866 15.65 510066......... 01.1328 12.02
460019....................... 01.1474 12.90 490033.......... 01.1930 15.58 490129......... 01.4271 17.98 500094......... 00.9216 15.53 510067......... 01.2442 15.91
460020....................... 01.0550 14.21 490035.......... 01.2134 09.64 490130......... 01.3112 16.58 500096......... 01.0818 17.13 510068......... 01.1194 14.01
460021....................... 01.3930 19.20 490037.......... 01.1236 13.27 490131......... 01.0313 14.06 500097......... 01.1361 16.12 510070......... 01.2176 16.05
460022....................... 00.9379 19.41 490038.......... 01.2160 12.54 500001......... 01.3320 20.92 500098......... 00.9259 13.66 510071......... 01.2805 14.49
460023....................... 01.1852 20.75 490040.......... 01.412
FR Doc. 96-22145 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1997 Rates
6 21.19 500002......... 01.4806 18.75 500101......... 01.0231 17.84 510072......... 01.0631 13.50
460024....................... 00.8925 13.88 490041.......... 01.3528 16.82 500003......... 01.4107 21.28 500102......... 00.9438 18.43 510077......... 01.1112 14.36
460025....................... 00.8072 12.63 490042.......... 01.3424 15.18 500005......... 01.8423 22.52 500104......... 01.2581 18.71 510080......... 01.1526 09.35
460026....................... 01.0894 16.98 490043.......... 01.3567 16.74 500007......... 01.4103 20.14 500106......... 00.9357 15.53 510081......... 01.0273 13.19
460027....................... 00.9427 18.71 490044.......... 01.3652 16.65 500008......... 01.8538 22.88 500107......... 01.1326 15.58 510082......... 01.0492 12.08
460029....................... 01.0225 15.71 490045.......... 01.1326 18.60 500009......... 01.2784 21.07 500108......... 01.6728 21.40 510084......... 00.9917 13.25
460030....................... 01.2159 15.78 490046.......... 01.4684 17.24 500011......... 01.3857 21.44 500110......... 01.2764 18.75 510085......... 01.2369 17.99
460032....................... 01.0099 19.00 490047.......... 01.0719 16.34 500012......... 01.5255 20.94 500118......... 01.1356 20.88 510086......... 01.0561 15.65
460033....................... 00.9544 18.22 490048.......... 01.4849 17.53 500014......... 01.5705 22.36 500119......... 01.3328 20.48 520002......... 01.2922 17.24
460035....................... 00.9610 11.43 490050.......... 01.4304 20.06 500015......... 01.3611 20.92 500122......... 01.1907 20.27 520003......... 01.1620 15.19
460036....................... 00.9397 19.41 490052.......... 01.6110 15.34 500016......... 01.4832 22.76 500123......... 00.8533 14.78 520004......... 01.1559 16.53
460037....................... 01.0591 15.92 490053.......... 01.2500 14.14 500019......... 01.3350 19.82 500124......... 01.3275 22.39 520006......... 01.0574 18.05
460039....................... 01.0976 21.08 490054.......... 01.1202 13.91 500021......... 01.5313 20.77 500125......... 00.9883 10.72 520007......... 01.2421 14.14
460041....................... 01.2170 18.29 490057.......... 01.5395 17.05 500023......... 01.1880 19.09 500129......... 01.7287 22.41 520008......... 01.5505 20.54
460042....................... 01.4763 16.14 490059.......... 01.5677 18.24 500024......... 01.6344 21.06 500132......... 00.9951 19.79 520009......... 01.5958 16.88
460043....................... 00.9968 20.44 490060.......... 01.0692 16.72 500025......... 01.8629 21.69 500134......... 00.8092 15.75 520010......... 01.1719 19.34
460044....................... 01.2081 19.41 490063.......... 01.6593 22.34 500026......... 01.4296 22.42 500137......... 00.7050 19.99 520011......... 01.2046 16.46
460046....................... 00.7432 10.23 490066.......... 01.2205 17.58 500027......... 01.5358 23.68 500138......... 03.4209 ....... 520013......... 01.2869 17.88
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[[Page 46255]]
Page 16 of 16
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Case Avg. Case Avg. Case Avg. Case Avg. Case Avg.
Provider mix hour Provider mix hour Provider mix hour Provider mix hour Provider mix hour
index wage index wage index wage index wage index wage
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
520014....................... 01.2027 15.55 520103.......... 01.3253 17.70 530025......... 01.3617 17.99
520015....................... 01.1208 16.65 520107.......... 01.2590 17.46 530026......... 01.0549 14.63
520016....................... 01.0905 12.75 520109.......... 00.9991 17.25 530027......... 00.8298 09.56
520017....................... 01.1856 16.87 520110.......... 01.1737 16.47 530029......... 00.9607 13.49
520018....................... 01.0817 15.88 520111.......... 00.9881 14.44 530031......... 00.8790 10.95
520019....................... 01.2831 16.65 520112.......... 01.0774 18.15 530032......... 01.1497 17.34
520021....................... 01.3589 19.16 520113.......... 01.1649 17.80
520024....................... 01.0340 13.33 520114.......... 01.1065 12.61
520025....................... 01.1366 15.19 520115.......... 01.3241 15.89
520026....................... 01.0973 17.48 520116.......... 01.2614 17.66
520027....................... 01.2310 19.22 520117.......... 01.0328 15.40
520028....................... 01.3213 17.60 520118.......... 00.9426 10.95
520029....................... 00.9672 16.70 520120.......... 00.8716 11.95
520030....................... 01.6756 20.19 520121.......... 00.9752 14.18
520031....................... 01.1149 16.11 520122.......... 00.9991 13.96
520032....................... 01.1627 14.56 520123.......... 01.1304 16.55
520033....................... 01.1838 15.91 520124.......... 01.1231 14.34
520034....................... 01.1326 17.17 520130.......... 01.0848 12.60
520035....................... 01.2520 14.67 520131.......... 01.0608 15.82
520037....................... 01.6526 18.23 520132.......... 01.1759 14.31
520038....................... 01.4892 17.14 520134.......... 01.0288 15.14
520039....................... 01.0077 16.24 520135.......... 00.9463 13.84
520040....................... 01.4307 20.05 520136.......... 01.4791 18.87
520041....................... 01.1426 14.54 520138.......... 01.8806 18.18
520042....................... 01.0710 16.25 520139.......... 01.2886 18.50
520044....................... 01.3714 16.09 520140.......... 01.6140 19.31
520045....................... 01.6919 17.97 520141.......... 01.1169 15.63
520047....................... 01.0188 14.50 520142.......... 00.9147 12.48
520048....................... 01.4400 17.67 520144.......... 01.0393 16.10
520049....................... 01.9950 17.97 520145.......... 00.9143 16.57
520051....................... 02.0353 19.41 520146.......... 01.0746 13.71
520053....................... 01.0992 14.78 520148.......... 01.1623 15.34
520054....................... 01.0858 16.40 520149.......... 00.9555 13.31
520056....................... 01.3107 17.77 520151.......... 01.0897 14.43
520057....................... 01.1288 16.08 520152.......... 01.1331 16.38
520058....................... 01.0509 17.87 520153.......... 00.9798 13.19
520059....................... 01.3228 18.17 520154.......... 01.1472 16.15
520060....................... 01.2997 15.15 520156.......... 01.1203 16.37
520062....................... 01.2655 16.18 520157.......... 00.9424 13.70
520063....................... 01.2607 17.61 520159.......... 00.9388 16.25
520064....................... 01.7082 18.60 520160.......... 01.7678 17.77
520066....................... 01.4098 17.73 520161.......... 01.0250 14.76
520068....................... 00.8915 15.82 520170.......... 01.2443 18.51
520069....................... 01.1870 16.75 520171.......... 00.9943 13.69
520070....................... 01.5908 16.93 520173.......... 01.1567 17.36
520071....................... 01.1171 17.71 520174.......... 01.4333 20.57
520074....................... 01.0987 14.96 520177.......... 01.6449 20.33
520075....................... 01.4698 17.44 520178.......... 01.0559 14.61
520076....................... 01.1236 14.40 520186.......... 02.5906 .......
520077....................... 01.0257 14.50 530002.......... 01.1980 18.07
520078....................... 01.5135 17.89 530003.......... 00.9289 12.59
520082....................... 01.3440 15.25 530004.......... 01.0252 13.17
520083....................... 01.5917 21.59 530005.......... 01.1380 13.19
520084....................... 01.0815 15.73 530006.......... 01.1263 16.83
520087....................... 01.6157 17.16 530007.......... 01.0519 11.52
520088....................... 01.2441 17.56 530008.......... 01.2819 17.75
520089....................... 01.5181 18.76 530009.......... 00.9693 20.60
520090....................... 01.2798 16.16 530010.......... 01.2110 16.30
520091....................... 01.3653 17.25 530011.......... 01.0901 15.27
520092....................... 01.1109 15.11 530012.......... 01.5887 17.25
520094....................... 01.0028 16.07 530014.......... 01.3344 15.01
520095....................... 01.3845 18.56 530015.......... 01.1465 19.22
520096....................... 01.4966 17.78 530016.......... 01.2083 11.87
520097....................... 01.3301 17.90 530017.......... 00.9927 16.09
520098....................... 01.7373 19.40 530018.......... 01.0650 14.57
520100....................... 01.2315 15.91 530019.......... 00.9451 14.32
520101....................... 01.1002 15.75 530022.......... 01.1165 15.94
520102....................... 01.2175 19.00 530023.......... 00.8533 17.76
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Note: Case mix indexes do not include discharges from PPS-exempt units. Case mix indexes include cases received in HCFA central office through June 1996.
[[Page 46256]]
Table 4a.--Wage Index and Capital Geographic Adjustment Factor (GAF) for
Urban Areas
------------------------------------------------------------------------
Urban area (constituent counties or county Wage
equivalents) index GAF
------------------------------------------------------------------------
0040 Abilene, TX................................... 0.8147 0.8691
Taylor, TX
0060 Aguadilla, PR................................. 0.4237 0.5554
Aguada, PR
Aguadilla, PR
Moca, PR
0080 Akron, OH..................................... 0.9853 0.9899
Portage, OH
Summit, OH
0120 Albany, GA.................................... 0.8597 0.9017
Dougherty, GA
Lee, GA
0160 Albany-Schenectady-Troy, NY................... 0.8624 0.9036
Albany, NY
Montgomery, NY
Rensselaer, NY
Saratoga, NY
Schenectady, NY
Schoharie, NY
0200 Albuquerque, NM............................... 0.9350 0.9550
Bernalillo, NM
Sandoval, NM
Valencia, NM
0220 Alexandria, LA................................ 0.8194 0.8725
Rapides, LA
0240 Allentown-Bethlehem-Easton, PA................ 0.9992 0.9995
Carbon, PA
Lehigh, PA
Northampton, PA
0280 Altoona, PA................................... 0.9510 0.9662
Blair, PA
0320 Amarillo, TX..................................
Potter, TX 0.8730 0.9112
Randall, TX
0380 Anchorage, AK................................. 1.3255 1.2128
Anchorage, AK
0440 Ann Arbor, MI................................. 1.1662 1.1110
Lenawee, MI
Livingston, MI
Washtenaw, MI
0450 Anniston, AL.................................. 0.8023 0.8600
Calhoun, AL
0460 Appleton-Oshkosh-Neenah, WI................... 0.8890 0.9226
Calumet, WI
Outagamie, WI
Winnebago, WI
0470 Arecibo, PR................................... 0.4397 0.5697
Arecibo, PR
Camuy, PR
Hatillo, PR
0480 Asheville, NC................................. 0.9344 0.9546
Buncombe, NC
Madison, NC
0500 Athens, GA.................................... 0.9408 0.9591
Clarke, GA
Madison, GA
Oconee, GA
0520 *Atlanta, GA.................................. 1.0033 1.0023
Barrow, GA
Bartow, GA
Carroll, GA
Cherokee, GA
Clayton, GA
Cobb, GA
Coweta, GA
DeKalb, GA
Douglas, GA
Fayette, GA
Forsyth, GA
Fulton, GA
Gwinnett, GA
Henry, GA
Newton, GA
Paulding, GA
Pickens, GA
Rockdale, GA
Spalding, GA
Walton, GA
0560 Atlantic-Cape May, NJ......................... 1.1077 1.0726
Atlantic, NJ
Cape May, NJ
0600 Augusta-Aiken, GA-SC.......................... 0.8836 0.9187
Columbia, GA
McDuffie, GA
Richmond, GA
Aiken, SC
Edgefield, SC
0640 Austin-San Marcos, TX......................... 0.9254 0.9483
Bastrop, TX
Caldwell, TX
Hays, TX
Travis, TX
Williamson, TX
0680 Bakersfield, CA............................... 1.0189 1.0129
Kern, CA
0720 *Baltimore, MD................................ 0.9798 0.9861
Anne Arundel, MD
Baltimore, MD
Baltimore City, MD
Carroll, MD
Harford, MD
Howard, MD
Queen Anne's, MD
0733 Bangor, ME.................................... 0.9391 0.9579
Penobscot, ME
0743 Barnstable-Yarmouth, MA....................... 1.3651 1.2375
Barnstable, MA
0760 Baton Rouge, LA............................... 0.8433 0.8898
Ascension, LA
East Baton Rouge, LA
Livingston, LA
West Baton Rouge, LA
0840 Beaumont-Port Arthur, TX...................... 0.8576 0.9001
Hardin, TX
Jefferson, TX
Orange, TX
0860 Bellingham, WA................................ 1.1317 1.0884
Whatcom, WA
0870 Benton Harbor, MI............................. 0.8550 0.8983
Berrien, MI
0875 *Bergen-Passaic, NJ........................... 1.1785 1.1190
Bergen, NJ
Passaic, NJ
0880 Billings, MT.................................. 0.9086 0.9365
Yellowstone, MT
0920 Biloxi-Gulfport-Pascagoula, MS................ 0.8554 0.8986
Hancock, MS
Harrison, MS
Jackson, MS
0960 Binghamton, NY................................ 0.8822 0.9178
Broome, NY
Tioga, NY
1000 Birmingham, AL................................ 0.9036 0.9329
Blount, AL
Jefferson, AL
St. Clair, AL
Shelby, AL
1010 Bismarck, ND.................................. 0.8074 0.8637
Burleigh, ND
Morton, ND
1020 Bloomington, IN............................... 0.8652 0.9056
Monroe, IN
1040 Bloomington-Normal, IL........................ 0.8990 0.9297
McLean, IL
1080 Boise City, ID................................ 0.9383 0.9573
Ada, ID
Canyon, ID
1123 *Boston-Worcester-Lawrence-Lowell-Brockton, MA-
NH................................................. 1.1613 1.1078
Bristol, MA
Essex, MA
Middlesex, MA
Norfolk, MA
Plymouth, MA
Suffolk, MA
Worcester, MA
Hillsborough, NH
Merrimack, NH
Rockingham, NH
Strafford, NH
1125 Boulder-Longmont, CO.......................... 0.9522 0.9670
Boulder, CO
1145 Brazoria, TX.................................. 0.8845 0.9194
Brazoria, TX
1150 Bremerton, WA................................. 1.0901 1.0609
Kitsap, WA
1240 Brownsville-Harlingen-San Benito, TX.......... 0.8542 0.8977
Cameron, TX
1260 Bryan-College Station, TX..................... 0.8851 0.9198
Brazos, TX
1280 *Buffalo-Niagara Falls, NY.................... 0.9107 0.9380
Erie, NY
Niagara, NY
1303 Burlington, VT................................ 1.0068 1.0047
Chittenden, VT
Franklin, VT
Grand Isle, VT
1310 Caguas, PR.................................... 0.4589 0.5866
Caguas, PR
Cayey, PR
Cidra, PR
Gurabo, PR
San Lorenzo, PR
[[Page 46257]]
1320 Canton-Massillon, OH.......................... 0.8648 0.9053
Carroll, OH
Stark, OH
1350 Casper, WY.................................... 0.8821 0.9177
Natrona, WY
1360 Cedar Rapids, IA.............................. 0.8458 0.8916
Linn, IA
1400 Champaign-Urbana, IL.......................... 0.9391 0.9579
Champaign, IL
1440 Charleston-North Charleston, SC............... 0.8963 0.9278
Berkeley, SC
Charleston, SC
Dorchester, SC
1480 Charleston, WV................................ 0.9526 0.9673
Kanawha, WV
Putnam, WV
1520 *Charlotte-Gastonia-Rock Hill, NC-SC.......... 0.9620 0.9738
Cabarrus, NC
Gaston, NC
Lincoln, NC
Mecklenburg, NC
Rowan, NC
Union, NC
York, SC
1540 Charlottesville, VA........................... 0.9155 0.9413
Albemarle, VA
Charlottesville City, VA
Fluvanna, VA
Greene, VA
1560 Chattanooga, TN-GA............................ 0.8847 0.9195
Catoosa, GA
Dade, GA
Walker, GA
Hamilton, TN
Marion, TN
1580 Cheyenne, WY.................................. 0.7678 0.8345
Laramie, WY
1600 *Chicago, IL.................................. 1.0760 1.0514
Cook, IL
DeKalb, IL
DuPage, IL
Grundy, IL
Kane, IL
Kendall, IL
Lake, IL
McHenry, IL
Will, IL
1620 Chico-Paradise, CA............................ 1.0417 1.0284
Butte, CA
1640 *Cincinnati, OH-KY-IN......................... 0.9568 0.9702
Dearborn, IN
Ohio, IN
Boone, KY
Campbell, KY
Gallatin, KY
Grant, KY
Kenton, KY
Pendleton, KY
Brown, OH
Clermont, OH
Hamilton, OH
Warren, OH
1660 Clarksville-Hopkinsville, TN-KY............... 0.7716 0.8373
Christian, KY
Montgomery, TN
1680 *Cleveland-Lorain-Elyria, OH.................. 0.9886 0.9922
Ashtabula, OH
Cuyahoga, OH
Geauga, OH
Lake, OH
Lorain, OH
Medina, OH
1720 Colorado Springs, CO.......................... 0.9341 0.9544
El Paso, CO
1740 Columbia, MO.................................. 0.8904 0.9236
Boone, MO
1760 Columbia, SC.................................. 0.9160 0.9417
Lexington, SC
Richland, SC
1800 Columbus, GA-AL...............................
Russell, AL 0.7779 0.8420
Chattanoochee, GA
Harris, GA
Muscogee, GA
1840 *Columbus, OH................................. 0.9681 0.9780
Delaware, OH
Fairfield, OH
Franklin, OH
Licking, OH
Madison, OH
Pickaway, OH
1880 Corpus Christi, TX............................ 0.8881 0.9219
Nueces, TX
San Patricio, TX
1900 Cumberland, MD-WV............................. 0.8671 0.9070
Allegany, MD
Mineral, WV
1920 *Dallas, TX................................... 0.9729 0.9814
Collin, TX
Dallas, TX
Denton, TX
Ellis, TX
Henderson, TX
Hunt, TX
Kaufman, TX
Rockwall, TX
1950 Danville, VA.................................. 0.8497 0.8945
Danville City, VA
Pittsylvania, VA
1960 Davenport-Moline-Rock Island, IA-IL........... 0.8388 0.8866
Scott, IA
Henry, IL
Rock Island, IL
2000 Dayton-Springfield, OH........................ 0.9559 0.9696
Clark, OH
Greene, OH
Miami, OH
Montgomery, OH
2020 Daytona Beach, FL............................. 0.8871 0.9212
Flagler, FL
Volusia, FL
2030 Decatur, AL................................... 0.8384 0.8863
Lawrence, AL
Morgan, AL
2040 Decatur, IL................................... 0.7848 0.8471
Macon, IL
2080 *Denver, CO................................... 1.0166 1.0113
Adams, CO
Arapahoe, CO
Denver, CO
Douglas, CO
Jefferson, CO
2120 Des Moines, IA................................ 0.8815 0.9173
Dallas, IA
Polk, IA
Warren, IA
2160 *Detroit, MI.................................. 1.0724 1.0490
Lapeer, MI
Macomb, MI
Monroe, MI
Oakland, MI
St. Clair, MI
Wayne, MI
2180 Dothan, AL.................................... 0.7740 0.8391
Dale, AL
Houston, AL
2190 Dover, DE..................................... 0.8997 0.9302
Kent, DE
2200 Dubuque, IA................................... 0.8112 0.8665
Dubuque, IA
2240 Duluth-Superior, MN-WI........................ 0.9416 0.9596
St. Louis, MN
Douglas, WI
2281 Dutchess County, NY........................... 1.0589 1.0400
Dutchess, NY
2290 Eau Claire, WI................................ 0.8678 0.9075
Chippewa, WI
Eau Claire, WI
2320 El Paso, TX................................... 0.9464 0.9630
El Paso, TX
2330 Elkhart-Goshen, IN............................ 0.8801 0.9163
Elkhart, IN
2335 Elmira, NY.................................... 0.8417 0.8887
Chemung, NY
2340 Enid, OK...................................... 0.7862 0.8481
Garfield, OK
2360 Erie, PA...................................... 0.9159 0.9416
Erie, PA
2400 Eugene-Springfield, OR........................ 1.1477 1.0989
Lane, OR
2440 Evansville-Henderson, IN-KY................... 0.8983 0.9292
Posey, IN
Vanderburgh, IN
Warrick, IN
Henderson, KY
2520 Fargo-Moorhead, ND-MN......................... 0.9045 0.9336
[[Page 46258]]
Clay, MN
Cass, ND
2560 Fayetteville, NC.............................. 0.9007 0.9309
Cumberland, NC
2580 Fayetteville-Springdale-Rogers, AR............ 0.7220 0.8001
Benton, AR
Washington, AR
2620 Flagstaff, AZ-UT.............................. 0.9019 0.9317
Coconino, AZ
Kane, UT
2640 Flint, MI..................................... 1.1248 1.0839
Genesee, MI
2650 Florence, AL.................................. 0.8111 0.8664
Colbert, AL
Lauderdale, AL
2655 Florence, SC.................................. 0.8594 0.9014
Florence, SC
2670 Fort Collins-Loveland, CO..................... 1.0562 1.0382
Larimer, CO
2680 *Ft. Lauderdale, FL........................... 1.0586 1.0398
Broward, FL
2700 Fort Myers-Cape Coral, FL..................... 0.9032 0.9327
Lee, FL
2710 Fort Pierce-Port St. Lucie, FL................ 1.0169 1.0115
Martin, FL
St. Lucie, FL
2720 Fort Smith, AR-OK............................. 0.7867 0.8485
Crawford, AR
Sebastian, AR
Sequoyah, OK
2750 Fort Walton Beach, FL......................... 0.9192 0.9439
Okaloosa, FL
2760 Fort Wayne, IN................................ 0.8800 0.9162
Adams, IN
Allen, IN
DeKalb, IN
Huntington, IN
Wells, IN
Whitley, IN
2800 *Forth Worth-Arlington, TX.................... 1.0153 1.0105
Hood, TX
Johnson, TX
Parker, TX
Tarrant, TX
2840 Fresno, CA.................................... 1.1177 1.0792
Fresno, CA
Madera, CA
2880 Gadsden, AL................................... 0.8881 0.9219
Etowah, AL
2900 Gainesville, FL............................... 0.9434 0.9609
Alachua, FL
2920 Galveston-Texas City, TX...................... 1.0997 1.0672
Galveston, TX
2960 Gary, IN...................................... 0.9155 0.9413
Lake, IN
Porter, IN
2975 Glens Falls, NY............................... 0.8562 0.8991
Warren, NY
Washington, NY
2980 Goldsboro, NC................................. 0.8393 0.8869
Wayne, NC
2985 Grand Forks, ND-MN............................ 0.9207 0.9450
Polk, MN
Grand Forks, ND
2995 Grand Junction, CO............................ 0.8825 0.9180
Mesa, CO
3000 Grand Rapids-Muskegon-Holland, MI............. 1.0119 1.0081
Allegan, MI
Kent, MI
Muskegon, MI
Ottawa, MI
3040 Great Falls, MT............................... 0.9015 0.9315
Cascade, MT
3060 Greeley, CO................................... 0.9690 0.9787
Weld, CO
3080 Green Bay, WI................................. 0.9366 0.9561
Brown, WI
3120 *Greensboro-Winston-Salem-High Point, NC...... 0.9314 0.9525
Alamance, NC
Davidson, NC
Davie, NC
Forsyth, NC
Guilford, NC
Randolph, NC
Stokes, NC
Yadkin, NC
3150 Greenville, NC................................ 0.9078 0.9359
Pitt, NC
3160 Greenville-Spartanburg-Anderson, SC........... 0.8927 0.9252
Anderson, SC
Cherokee, SC
Greenville, SC
Pickens, SC
Spartanburg, SC
3180 Hagerstown, MD................................ 0.9175 0.9427
Washington, MD
3200 Hamilton-Middletown, OH....................... 0.9490 0.9648
Butler, OH
3240 Harrisburg-Lebanon-Carlisle, PA............... 1.0158 1.0108
Cumberland, PA
Dauphin, PA
Lebanon, PA
Perry, PA
3283 *Hartford, CT................................. 1.2367 1.1566
Hartford, CT
Litchfield, CT
Middlesex, CT
Tolland, CT
3285 Hattiesburg, MS............................... 0.7252 0.8025
Forrest, MS
Lamar, MS
3290 Hickory-Morganton-Lenoir, NC.................. 0.7953 0.8548
Alexander, NC
Burke, NC
Caldwell, NC
Catawba, NC
3320 Honolulu, HI.................................. 1.1461 1.0979
Honolulu, HI
3350 Houma, LA..................................... 0.7853 0.8475
Lafourche, LA
Terrebonne, LA
3360 *Houston, TX.................................. 1.0000 1.0000
Chambers, TX
Fort Bend, TX
Harris, TX
Liberty, TX
Montgomery, TX
Waller, TX
3400 Huntington-Ashland, WV-KY-OH.................. 0.9174 0.9427
Boyd, KY
Carter, KY
Greenup, KY
Lawrence, OH
Cabell, WV
Wayne, WV
3440 Huntsville, AL................................ 0.8206 0.8734
Limestone, AL
Madison, AL
3480 *Indianapolis, IN............................. 0.9903 0.9933
Boone, IN
Hamilton, IN
Hancock, IN
Hendricks, IN
Johnson, IN
Madison, IN
Marion, IN
Morgan, IN
Shelby, IN
3500 Iowa City, IA................................. 0.9361 0.9558
Johnson, IA
3520 Jackson, MI................................... 0.9045 0.9336
Jackson, MI
3560 Jackson, MS................................... 0.7928 0.8530
Hinds, MS
Madison, MS
Rankin, MS
3580 Jackson, TN................................... 0.8288 0.8793
Chester, TN
Madison, TN
3600 Jacksonville, FL.............................. 0.9089 0.9367
Clay, FL
Duval, FL
Nassau, FL
St. Johns, FL
3605 Jacksonville, NC.............................. 0.7055 0.7875
Onslow, NC
3610 Jamestown, NY................................. 0.7670 0.8339
Chautaqua, NY
3620 Janesville-Beloit, WI......................... 0.8645 0.9051
Rock, WI
3640 Jersey City, NJ............................... 1.1382 1.0927
Hudson, NJ
3660 Johnson City-Kingsport-Bristol, TN-VA......... 0.8901 0.9234
Carter, TN
Hawkins, TN
Sullivan, TN
Unicoi, TN
[[Page 46259]]
Washington, TN
Bristol City, VA
Scott, VA
Washington, VA
3680 Johnstown, PA................................. 0.8398 0.8873
Cambria, PA
Somerset, PA
3700 Jonesboro, AR................................. 0.7220 0.8001
Craighead, AR
3710 Joplin, MO.................................... 0.7659 0.8331
Jasper, MO
Newton, MO
3720 Kalamazoo-Battlecreek, MI..................... 1.0542 1.0368
Calhoun, MI
Kalamazoo, MI
Van Buren, MI
3740 Kankakee, IL.................................. 0.9115 0.9385
Kankakee, IL
3760 *Kansas City, KS-MO........................... 0.9478 0.9640
Johnson, KS
Leavenworth, KS
Miami, KS
Wyandotte, KS
Cass, MO
Clay, MO
Clinton, MO
Jackson, MO
Lafayette, MO
Platte, MO
Ray, MO
3800 Kenosha, WI................................... 0.9145 0.9406
Kenosha, WI
3810 Killeen-Temple, TX............................ 1.0392 1.0267
Bell, TX
Coryell, TX
3840 Knoxville, TN................................. 0.8502 0.8948
Anderson, TN
Blount, TN
Knox, TN
Loudon, TN
Sevier, TN
Union, TN
3850 Kokomo, IN.................................... 0.8590 0.9012
Howard, IN
Tipton, IN
3870 La Crosse, WI-MN.............................. 0.8618 0.9032
Houston, MN
La Crosse, WI
3880 Lafayette, LA................................. 0.8165 0.8704
Acadia, LA
Lafayette, LA
St. Landry, LA
St. Martin, LA
3920 Lafayette, IN................................. 0.8804 0.9165
Clinton, IN
Tippecanoe, IN
3960 Lake Charles, LA.............................. 0.8034 0.8608
Calcasieu, LA
3980 Lakeland-Winter Haven, FL..................... 0.8668 0.9067
Polk, FL
4000 Lancaster, PA................................. 0.9583 0.9713
Lancaster, PA
4040 Lansing-East Lansing, MI...................... 1.0010 1.0007
Clinton, MI
Eaton, MI
Ingham, MI
4080 Laredo, TX.................................... 0.7073 0.7889
Webb, TX
4100 Las Cruces, NM................................ 0.8497 0.8945
Dona Ana, NM
4120 *Las Vegas, NV-AZ............................. 1.0870 1.0588
Mohave, AZ
Clark, NV
Nye, NV
4150 Lawrence, KS.................................. 0.8597 0.9017
Douglas, KS
4200 Lawton, OK.................................... 0.8365 0.8849
Comanche, OK
4243 Lewiston-Auburn, ME........................... 0.9410 0.9592
Androscoggin, ME
4280 Lexington, KY................................. 0.8303 0.8804
Bourbon, KY
Clark, KY
Fayette, KY
Jessamine, KY
Madison, KY
Scott, KY
Woodford, KY
4320 Lima, OH...................................... 0.8732 0.9113
Allen, OH
Auglaize, OH
4360 Lincoln, NE................................... 0.9161 0.9418
Lancaster, NE
4400 Little Rock-North Little Rock, AR............. 0.8597 0.9017
Faulkner, AR
Lonoke, AR
Pulaski, AR
Saline, AR
4420 Longview-Marshall, TX......................... 0.8645 0.9051
Gregg, TX
Harrison, TX
Upshur, TX
4480 *Los Angeles-Long Beach, CA................... 1.2382 1.1576
Los Angeles, CA
4520 Louisville, KY-IN............................. 0.9447 0.9618
Clark, IN
Floyd, IN
Harrison, IN
Scott, IN
Bullitt, KY
Jefferson, KY
Oldham, KY
4600 Lubbock, TX................................... 0.8510 0.8954
Lubbock, TX
4640 Lynchburg, VA................................. 0.8052 0.8621
Amherst, VA
Bedford, VA
Bedford City, VA
Campbell, VA
Lynchburg City, VA
4680 Macon, GA..................................... 0.8824 0.9179
Bibb, GA
Houston, GA
Jones, GA
Peach, GA
Twiggs, GA
4720 Madison, WI................................... 1.0021 1.0014
Dane, WI
4800 Mansfield, OH................................. 0.8524 0.8964
Crawford, OH
Richland, OH
4840 Mayaguez, PR.................................. 0.4215 0.5534
Anasco, PR
Cabo Rojo, PR
Hormigueros, PR
Mayaguez, PR
Sabana Grande, PR
San German, PR
4880 McAllen-Edinburg-Mission, TX.................. 0.8485 0.8936
Hidalgo, TX
4890 Medford-Ashland, OR........................... 1.0082 1.0056
Jackson, OR
4900 Melbourne-Titusville-Palm Bay, FL............. 0.9068 0.9352
Brevard, FL
4920 *Memphis, TN-AR-MS............................ 0.8166 0.8705
Crittenden, AR
DeSoto, MS
Fayette, TN
Shelby, TN
Tipton, TN
4940 Merced, CA.................................... 1.0660 1.0447
Merced, CA
5000 *Miami, FL.................................... 0.9938 0.9958
Dade, FL
5015 *Middlesex-Somerset-Hunterdon, NJ............. 1.0688 1.0466
Hunterdon, NJ
Middlesex, NJ
Somerset, NJ
5080 *Milwaukee-Waukesha, WI....................... 0.9645 0.9756
Milwaukee, WI
Ozaukee, WI
Washington, WI
Waukesha, WI
5120 *Minneapolis-St. Paul, MN-WI.................. 1.0777 1.0526
Anoka, MN
Carver, MN
Chisago, MN
Dakota, MN
Hennepin, MN
Isanti, MN
Ramsey, MN
Scott, MN
Sherburne, MN
Washington, MN
Wright, MN
Pierce, WI
St. Croix, WI
5160 Mobile, AL.................................... 0.7981 0.8569
Baldwin, AL
Mobile, AL
5170 Modesto, CA................................... 1.0112 1.0077
Stanislaus, CA
[[Page 46260]]
5190 *Monmouth-Ocean, NJ........................... 1.0996 1.0672
Monmouth, NJ
Ocean, NJ
5200 Monroe, LA.................................... 0.8211 0.8737
Ouachita, LA
5240 Montgomery, AL................................ 0.7876 0.8492
Autauga, AL
Elmore, AL
Montgomery, AL
5280 Muncie, IN.................................... 0.9714 0.9803
Delaware, IN
5330 Myrtle Beach, SC.............................. 0.7790 0.8428
Horry, SC
5345 Naples, FL.................................... 1.0199 1.0136
Collier, FL
5360 *Nashville, TN................................ 0.9081 0.9361
Cheatham, TN
Davidson, TN
Dickson, TN
Robertson, TN
Rutherford, TN
Sumner, TN
Williamson, TN
Wilson, TN
5380 *Nassau-Suffolk, NY........................... 1.3547 1.2311
Nassau, NY
Suffolk, NY
5483 *New Haven-Bridgeport-Stamford-Waterbury-..... 1.2750 1.1810
Danbury, CT
Fairfield, CT
New Haven, CT
5523 New London-Norwich, CT........................ 1.2317 1.1534
New London, CT
5560 *New Orleans, LA.............................. 0.9294 0.9511
Jefferson, LA
Orleans, LA
Plaquemines, LA
St. Bernard, LA
St. Charles, LA
St. James, LA
St. John The Baptist, LA
St. Tammany, LA
5600 *New York, NY................................. 1.4154 1.2686
Bronx, NY
Kings, NY
New York, NY
Putnam, NY
Queens, NY
FR Doc. 96-22145 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1997 Rates
Richmond, NY
Rockland, NY
Westchester, NY
5640 *Newark, NJ................................... 1.1036 1.0698
Essex, NJ
Morris, NJ
Sussex, NJ
Union, NJ
Warren, NJ
5660 Newburgh, NY-PA............................... 1.0803 1.0543
Orange, NY
Pike, PA
5720 *Norfolk-Virginia Beach-Newport News, VA-NC... 0.8348 0.8837
Currituck, NC
Chesapeake City, VA
Gloucester, VA
Hampton City, VA
Isle of Wight, VA
James City, VA
Mathews, VA
Newport News City, VA
Norfolk City, VA
Poquoson City, VA
Portsmouth City, VA
Suffolk City, VA
Virginia Beach City, VA
Williamsburg City, VA
York, VA
5775 *Oakland, CA.................................. 1.5069 1.3242
Alameda, CA
Contra Costa, CA
5790 Ocala, FL..................................... 0.9105 0.9378
Marion, FL
5800 Odessa-Midland, TX............................ 0.8566 0.8994
Ector, TX
Midland, TX
5880 *Oklahoma City, OK............................ 0.8371 0.8854
Canadian, OK
Cleveland, OK
Logan, OK
McClain, OK
Oklahoma, OK
Pottawatomie, OK
5910 Olympia, WA................................... 1.0689 1.0467
Thurston, WA
5920 Omaha, NE-IA.................................. 0.9480 0.9641
Pottawattamie, IA
Cass, NE
Douglas, NE
Sarpy, NE
Washington, NE
5945 *Orange County, CA............................ 1.1902 1.1266
Orange, CA
5960 *Orlando, FL.................................. 0.9470 0.9634
Lake, FL
Orange, FL
Osceola, FL
Seminole, FL
5990 Owensboro, KY................................. 0.7575 0.8268
Daviess, KY
6015 Panama City, FL............................... 0.8061 0.8628
Bay, FL
6020 Parkersburg-Marietta, WV-OH................... 0.7877 0.8492
Washington, OH
Wood, WV
6080 Pensacola, FL................................. 0.8202 0.8731
Escambia, FL
Santa Rosa, FL
6120 Peoria-Pekin, IL.............................. 0.8905 0.9237
Peoria, IL
Tazewell, IL
Woodford, IL
6160 *Philadelphia, PA-NJ.......................... 1.1237 1.0831
Burlington, NJ
Camden, NJ
Gloucester, NJ
Salem, NJ
Bucks, PA
Chester, PA
Delaware, PA
Montgomery, PA
Philadelphia, PA
6200 *Phoenix-Mesa, AZ............................. 0.9810 0.9870
Maricopa, AZ
Pinal, AZ
6240 Pine Bluff, AR................................ 0.7886 0.8499
Jefferson, AR
6280 *Pittsburgh, PA............................... 0.9701 0.9794
Allegheny, PA
Beaver, PA
Butler, PA
Fayette, PA
Washington, PA
Westmoreland, PA
6323 Pittsfield, MA................................ 1.0552 1.0375
Berkshire, MA
6340 Pocatello, ID................................. 0.8784 0.9150
Bannock, ID
6360 Ponce, PR..................................... 0.4685 0.5950
Guayanilla, PR
Juana Diaz, PR
Penuelas, PR
Ponce, PR
Villalba, PR
Yauco, PR
6403 Portland, ME.................................. 0.9619 0.9738
Cumberland, ME
Sagadahoc, ME
York, ME
6440 *Portland-Vancouver, OR-WA.................... 1.1235 1.0830
Clackamas, OR
Columbia, OR
Multnomah, OR
Washington, OR
Yamhill, OR
Clark, WA
6483 Providence-Warwick-Pawtucket, RI.............. 1.1092 1.0736
Bristol, RI
Kent, RI
Newport, RI
Providence, RI
Washington, RI
6520 Provo-Orem, UT................................ 1.0116 1.0079
Utah, UT
6560 Pueblo, CO.................................... 0.8284 0.8790
Pueblo, CO
6580 Punta Gorda, FL............................... 0.8353 0.8841
Charlotte, FL
6600 Racine, WI.................................... 0.8835 0.9187
Racine, WI
6640 Raleigh-Durham-Chapel Hill, NC................ 0.9728 0.9813
[[Page 46261]]
Chatham, NC
Durham, NC
Franklin, NC
Johnston, NC
Orange, NC
Wake, NC
6660 Rapid City, SD................................ 0.8458 0.8916
Pennington, SD
6680 Reading, PA................................... 0.9445 0.9617
Berks, PA
6690 Redding, CA................................... 1.1605 1.1073
Shasta, CA
6720 Reno, NV...................................... 1.1018 1.0686
Washoe, NV
6740 Richland-Kennewick-Pasco, WA.................. 0.9970 0.9979
Benton, WA
Franklin, WA
6760 Richmond-Petersburg, VA....................... 0.9194 0.9441
Charles City County, VA
Chesterfield, VA
Colonial Heights City, VA
Dinwiddie, VA
Goochland, VA
Hanover, VA
Henrico, VA
Hopewell City, VA
New Kent, VA
Petersburg City, VA
Powhatan, VA
Prince George, VA
Richmond City, VA
6780 *Riverside-San Bernardino, CA................. 1.1234 1.0829
Riverside, CA
San Bernardino, CA
6800 Roanoke, VA................................... 0.8702 0.9092
Botetourt, VA
Roanoke, VA
Roanoke City, VA
Salem City, VA
6820 Rochester, MN................................. 1.0428 1.0291
Olmsted, MN
6840 *Rochester, NY................................ 0.9649 0.9758
Genesee, NY
Livingston, NY
Monroe, NY
Ontario, NY
Orleans, NY
Wayne, NY
6880 Rockford, IL.................................. 0.8994 0.9300
Boone, IL
Ogle, IL
Winnebago, IL
6895 Rocky Mount, NC............................... 0.8955 0.9272
Edgecombe, NC
Nash, NC
6920 *Sacramento, CA............................... 1.2351 1.1556
El Dorado, CA
Placer, CA
Sacramento, CA
6960 Saginaw-Bay City-Midland, MI.................. 0.9667 0.9771
Bay, MI
Midland, MI
Saginaw, MI
6980 St. Cloud, MN................................. 0.9457 0.9625
Benton, MN
Stearns, MN
7000 St. Joseph, MO................................ 0.8551 0.8983
Andrews, MO
Buchanan, MO
7040 *St. Louis, MO-IL............................. 0.9022 0.9319
Clinton, IL
Jersey, IL
Madison, IL
Monroe, IL
St. Clair, IL
Franklin, MO
Jefferson, MO
Lincoln, MO
St. Charles, MO
St. Louis, MO
St. Louis City, MO
Warren, MO
7080 Salem, OR..................................... 0.9728 0.9813
Marion, OR
Polk, OR
7120 Salinas, CA................................... 1.3803 1.2470
Monterey, CA
7160 *Salt Lake City-Ogden, UT..................... 0.9677 0.9778
Davis, UT
Salt Lake, UT
Weber, UT
7200 San Angelo, TX................................ 0.7577 0.8270
Tom Green, TX
7240 *San Antonio, TX.............................. 0.8390 0.8867
Bexar, TX
Comal, TX
Guadalupe, TX
Wilson, TX
7320 *San Diego, CA................................ 1.2154 1.1429
San Diego, CA
7360 *San Francisco, CA............................ 1.4211 1.2721
Marin, CA
San Francisco, CA
San Mateo, CA
7400 *San Jose, CA................................. 1.4455 1.2870
Santa Clara, CA
7440 *San Juan-Bayamon, PR......................... 0.4506 0.5793
Aguas Buenas, PR
Barceloneta, PR
Bayamon, PR
Canovanas, PR
Carolina, PR
Catano, PR
Ceiba, PR
Comerio, PR
Corozal, PR
Dorado, PR
Fajardo, PR
Florida, PR
Guaynabo, PR
Humacao, PR
Juncos, PR
Los Piedras, PR
Loiza, PR
Luguillo, PR
Manati, PR
Morovis, PR
Naguabo, PR
Naranjito, PR
Rio Grande, PR
San Juan, PR
Toa Alta, PR
Toa Baja, PR
Trujillo Alto, PR
Vega Alta, PR
Vega Baja, PR
Yabucoa, PR
7460 San Luis Obispo-Atascadero-Paso Robles, CA.... 1.1561 1.1044
San Luis Obispo, CA
7480 Santa Barbara-Santa Maria-Lompoc, CA.......... 1.1242 1.0835
Santa Barbara, CA
7485 Santa Cruz-Watsonville, CA.................... 1.3520 1.2294
Santa Cruz, CA
7490 Santa Fe, NM.................................. 1.0823 1.0557
Los Alamos, NM
Santa Fe, NM
7500 Santa Rosa, CA................................ 1.2487 1.1643
Sonoma, CA
7510 Sarasota-Bradenton, FL........................ 0.9789 0.9855
Manatee, FL
Sarasota, FL
7520 Savannah, GA.................................. 0.9649 0.9758
Bryan, GA
Chatham, GA
Effingham, GA
7560 Scranton--Wilkes-Barre--Hazleton, PA.......... 0.8752 0.9128
Columbia, PA
Lackawanna, PA
Luzerne, PA
Wyoming, PA
7600 *Seattle-Bellevue-Everett, WA................. 1.1384 1.0928
Island, WA
King, WA
Snohomish, WA
7610 Sharon, PA.................................... 0.8885 0.9222
Mercer, PA
7620 Sheboygan, WI................................. 0.7764 0.8409
Sheboygan, WI
7640 Sherman-Denison, TX........................... 0.8631 0.9041
Grayson, TX
7680 Shreveport-Bossier City, LA................... 0.9359 0.9556
Bossier, LA
Caddo, LA
Webster, LA
7720 Sioux City, IA-NE............................. 0.8313 0.8812
Woodbury, IA
[[Page 46262]]
Dakota, NE
7760 Sioux Falls, SD............................... 0.8620 0.9033
Lincoln, SD
Minnehaha, SD
7800 South Bend, IN................................ 0.9934 0.9955
St. Joseph, IN
7840 Spokane, WA................................... 1.0524 1.0356
Spokane, WA
7880 Springfield, IL............................... 0.8671 0.9070
Menard, IL
Sangamon, IL
7920 Springfield, MO............................... 0.7842 0.8466
Christian, MO
Greene, MO
Webster, MO
8003 Springfield, MA............................... 1.0586 1.0398
Hampden, MA
Hampshire, MA
8050 State College, PA............................. 0.9538 0.9681
Centre, PA
8080 Steubenville-Weirton, OH-WV................... 0.8266 0.8777
Jefferson, OH
Brooke, WV
Hancock, WV
8120 Stockton-Lodi, CA............................. 1.1391 1.0933
San Joaquin, CA
8140 Sumter, SC.................................... 0.7699 0.8360
Sumter, SC
8160 Syracuse, NY.................................. 0.9396 0.9582
Cayuga, NY
Madison, NY
Onondaga, NY
Oswego, NY
8200 Tacoma, WA.................................... 1.0866 1.0585
Pierce, WA
8240 Tallahassee, FL............................... 0.8313 0.8812
Gadsden, FL
Leon, FL
8280 *Tampa-St. Petersburg-Clearwater, FL.......... 0.9302 0.9517
Hernando, FL
Hillsborough, FL
Pasco, FL
Pinellas, FL
8320 Terre Haute, IN............................... 0.8591 0.9012
Clay, IN
Vermillion, IN
Vigo, IN
8360 Texarkana, AR-Texarkana, TX................... 0.8509 0.8953
Miller, AR
Bowie, TX
8400 Toledo, OH.................................... 1.0361 1.0246
Fulton, OH
Lucas, OH
Wood, OH
8440 Topeka, KS.................................... 1.0086 1.0059
Shawnee, KS
8480 Trenton, NJ................................... 1.0549 1.0373
Mercer, NJ
8520 Tucson, AZ.................................... 0.9075 0.9357
Pima, AZ
8560 Tulsa, OK..................................... 0.8095 0.8653
Creek, OK
Osage, OK
Rogers, OK
Tulsa, OK
Wagoner, OK
8600 Tuscaloosa, AL................................ 0.7784 0.8424
Tuscaloosa, AL
8640 Tyler, TX..................................... 0.9996 0.9997
Smith, TX
8680 Utica-Rome, NY................................ 0.8413 0.8884
Herkimer, NY
Oneida, NY
8720 Vallejo-Fairfield-Napa, CA.................... 1.3452 1.2252
Napa, CA
Solano, CA
8735 Ventura, CA................................... 1.1052 1.0709
Ventura, CA
8750 Victoria, TX.................................. 0.8393 0.8869
Victoria, TX
8760 Vineland-Millville-Bridgeton, NJ.............. 0.9993 0.9995
Cumberland, NJ
8780 Visalia-Tulare-Porterville, CA................ 1.0151 1.0103
Tulare, CA
8800 Waco, TX...................................... 0.7772 0.8415
McLennan, TX
8840 *Washington, DC-MD-VA-WV...................... 1.0823 1.0557
District of Columbia, DC
Calvert, MD
Charles, MD
Frederick, MD
Montgomery, MD
Prince Georges, MD
Alexandria City, VA
Arlington, VA
Clarke, VA
Culpepper, VA
Fairfax, VA
Fairfax City, VA
Falls Church City, VA
Fauquier, VA
Fredericksburg City, VA
King George, VA
Loudoun, VA
Manassas City, VA
Manassas Park City, VA
Prince William, VA
Spotsylvania, VA
Stafford, VA
Warren, VA
Berkeley, WV
Jefferson, WV
8920 Waterloo-Cedar Falls, IA...................... 0.8705 0.9094
Black Hawk, IA
8940 Wausau, WI.................................... 1.0323 1.0220
Marathon, WI
8960 West Palm Beach-Boca Raton, FL................ 1.0002 1.0001
Palm Beach, FL
9000 Wheeling, OH-WV............................... 0.7563 0.8259
Belmont, OH
Marshall, WV
Ohio, WV
9040 Wichita, KS................................... 0.9369 0.9563
Butler, KS
Harvey, KS
Sedgwick, KS
9080 Wichita Falls, TX............................. 0.8041 0.8613
Archer, TX
Wichita, TX
9140 Williamsport, PA.............................. 0.8467 0.8923
Lycoming, PA
9160 Wilmington-Newark, DE-MD...................... 1.1315 1.0883
New Castle, DE
Cecil, MD
9200 Wilmington, NC................................ 0.9046 0.9336
New Hanover, NC
Brunswick, NC
9260 Yakima, WA.................................... 1.0026 1.0018
Yakima, WA
9270 Yolo, CA...................................... 1.1444 1.0968
Yolo, CA
9280 York, PA...................................... 0.9104 0.9377
York, PA
9320 Youngstown-Warren, OH......................... 0.9742 0.9823
Columbiana, OH
Mahoning, OH
Trumbull, OH
9340 Yuba City, CA................................. 1.0414 1.0282
Sutter, CA
Yuba, CA
9360 Yuma, AZ...................................... 0.9497 0.9653
Yuma, AZ
------------------------------------------------------------------------
*Large Urban Area
Table 4b.--Wage Index and Capital Geographic Adjustment Factor (GAF) for
Rural Areas
------------------------------------------------------------------------
Wage
Nonurban area index GAF
------------------------------------------------------------------------
Alabama............................................. 0.7150 0.7947
Alaska.............................................. 1.2444 1.1615
Arizona............................................. 0.7928 0.8530
Arkansas............................................ 0.6954 0.7798
California.......................................... 1.0002 1.0001
Colorado............................................ 0.8092 0.8650
Connecticut......................................... 1.2759 1.1816
Delaware............................................ 0.9447 0.9618
Florida............................................. 0.8668 0.9067
Georgia............................................. 0.7653 0.8326
Hawaii.............................................. 1.0245 1.0167
Idaho............................................... 0.8277 0.8785
Illinois............................................ 0.7553 0.8252
Indiana............................................. 0.8124 0.8674
Iowa................................................ 0.7366 0.8111
Kansas.............................................. 0.7107 0.7915
Kentucky............................................ 0.7753 0.8401
Louisiana........................................... 0.7253 0.8026
Maine............................................... 0.8317 0.8814
[[Page 46263]]
Maryland............................................ 0.8427 0.8894
Massachusetts....................................... 1.0770 1.0521
Michigan............................................ 0.8836 0.9187
Minnesota........................................... 0.8144 0.8688
Mississippi......................................... 0.6793 0.7674
Missouri............................................ 0.7261 0.8032
Montana............................................. 0.8128 0.8677
Nebraska............................................ 0.7214 0.7996
Nevada.............................................. 0.8775 0.9144
New Hampshire....................................... 0.9751 0.9829
New Jersey \1\...................................... ........ ........
New Mexico.......................................... 0.8000 0.8583
New York............................................ 0.8558 0.8989
North Carolina...................................... 0.7953 0.8548
North Dakota........................................ 0.7358 0.8105
Ohio................................................ 0.8332 0.8825
Oklahoma............................................ 0.6942 0.7788
Oregon.............................................. 0.9664 0.9769
Pennsylvania........................................ 0.8459 0.8917
Puerto Rico......................................... 0.4026 0.5363
Rhode Island \1\.................................... ........ ........
South Carolina...................................... 0.7668 0.8337
South Dakota........................................ 0.7063 0.7881
Tennessee........................................... 0.7341 0.8092
Texas............................................... 0.7462 0.8183
Utah................................................ 0.8848 0.9196
Vermont............................................. 0.8921 0.9248
Virginia............................................ 0.7729 0.8383
Washington.......................................... 0.9933 0.9954
West Virginia....................................... 0.7923 0.8526
Wisconsin........................................... 0.8430 0.8896
Wyoming............................................. 0.8177 0.8713
------------------------------------------------------------------------
\1\ All counties within the State are classified as urban.
Table 4c.--Wage Index and Capital Geographic Adjustment Factor (GAF) for
Hospitals that are Reclassified
------------------------------------------------------------------------
Wage
Area reclassified to index GAF
------------------------------------------------------------------------
Abilene, TX......................................... 0.8147 0.8691
Albuquerque, NM..................................... 0.9350 0.9550
Alexandria, LA...................................... 0.8194 0.8725
Allentown-Bethlehem-Easton, PA...................... 0.9992 0.9995
Amarillo, TX........................................ 0.8730 0.9112
Anchorage, AK....................................... 1.3255 1.2128
Asheville, NC....................................... 0.9344 0.9546
Atlanta, GA......................................... 1.0033 1.0023
Bangor, ME.......................................... 0.9391 0.9579
Baton Rouge, LA..................................... 0.8433 0.8898
Benton Harbor, MI................................... 0.8550 0.8983
Benton Harbor, MI (Rural Michigan Hosp.)............ 0.8836 0.9187
Billings, MT........................................ 0.9086 0.9365
Birmingham, AL...................................... 0.9036 0.9329
Bismarck, ND........................................ 0.8074 0.8637
Boise City, ID...................................... 0.9383 0.9573
Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH.... 1.1613 1.1078
Caguas, PR.......................................... 0.4589 0.5866
Champaign-Urbana, IL................................ 0.8978 0.9288
Charleston-North Charleston, SC..................... 0.8963 0.9278
Charlotte-Gastonia-Rock Hill, NC-SC................. 0.9620 0.9738
Charlottesville, VA................................. 0.8990 0.9297
Chattanooga, TN-GA.................................. 0.8847 0.9195
Chicago, IL......................................... 1.0658 1.0446
Cincinnati, OH-KY-IN................................ 0.9568 0.9702
Cleveland-Lorain-Elyria, OH......................... 0.9886 0.9922
Columbia, MO........................................ 0.8904 0.9236
Columbus, OH........................................ 0.9681 0.9780
Dallas, TX.......................................... 0.9729 0.9814
Davenport-Moline-Rock Island, IA-IL................. 0.8388 0.8866
Denver, CO.......................................... 1.0166 1.0113
Des Moines, IA...................................... 0.8714 0.9100
Duluth-Superior, MN-WI.............................. 0.9416 0.9596
Dutchess County, NY................................. 1.0291 1.0198
Elkhart-Goshen, IN.................................. 0.8801 0.9163
Eugene-Springfield, OR.............................. 1.1477 1.0989
Fargo-Moorhead, ND-MN............................... 0.8879 0.9218
Fayetteville, NC.................................... 0.8640 0.9047
Flagstaff, AR-UT.................................... 0.8828 0.9182
Flint, MI........................................... 1.1248 1.0839
Florence, AL........................................ 0.8111 0.8664
Florence, SC........................................ 0.8594 0.9014
Fort Lauderdale, FL................................. 1.0586 1.0398
Fort Pierce-Port St. Lucie, FL...................... 1.0027 1.0018
Fort Smith, AR-OK................................... 0.7867 0.8485
Fort Walton Beach, FL............................... 0.8980 0.9290
Fort Worth-Arlington, TX............................ 1.0153 1.0105
Gadsden, AL......................................... 0.8881 0.9219
Gary, IN............................................ 0.9155 0.9413
Grand Forks, ND-MN.................................. 0.9207 0.9450
Grand Junction, CO.................................. 0.8825 0.9180
Grand Rapids-Muskegon-Holland, MI................... 1.0119 1.0081
Great Falls, MT..................................... 0.9015 0.9315
Greeley, CO......................................... 0.9388 0.9577
Green Bay, WI....................................... 0.9366 0.9561
Greensboro-Winston-Salem-High Point, NC............. 0.9314 0.9525
Greenville-Spartanburg-Anderson, SC................. 0.8927 0.9252
Hartford, CT........................................ 1.2191 1.1453
Honolulu, HI........................................ 1.1461 1.0979
Houston, TX......................................... 1.0000 1.0000
Huntington-Ashland, WV-KY-OH........................ 0.9174 0.9427
Huntsville, AL...................................... 0.8081 0.8642
Indianapolis, IN.................................... 0.9796 0.9860
Jackson, MS......................................... 0.7928 0.8530
Jacksonville, FL.................................... 0.9089 0.9367
Johnson City-Kingsport-Bristol, TN-VA............... 0.8901 0.9234
Joplin, MO.......................................... 0.7659 0.8331
Kalamazoo-Battlecreek, MI........................... 1.0542 1.0368
Kansas City, KS-MO.................................. 0.9478 0.9640
Knoxville, TN....................................... 0.8502 0.8948
Lafayette, LA....................................... 0.8165 0.8704
Lansing-East Lansing, MI............................ 1.0010 1.0007
Las Vegas, NV-AZ.................................... 1.0870 1.0588
Lexington, KY....................................... 0.8303 0.8804
Lima, OH............................................ 0.8732 0.9113
Lincoln, NE......................................... 0.9030 0.9325
Little Rock-North Little Rock, AR................... 0.8597 0.9017
Longview-Marshall, TX............................... 0.8504 0.8950
Los Angeles-Long Beach, CA.......................... 1.2382 1.1576
Louisville, KY-IN................................... 0.9447 0.9618
Macon, GA........................................... 0.8468 0.8924
Madison, WI......................................... 1.0021 1.0014
Mansfield, OH....................................... 0.8524 0.8964
Medford-Ashland, OR................................. 1.0082 1.0056
Memphis, TN-AR-MS................................... 0.8166 0.8705
Middlesex-Somerset-Hunterdon, NJ.................... 1.0688 1.0466
Milwaukee-Waukesha, WI.............................. 0.9645 0.9756
Minneapolis-St. Paul, MN-WI......................... 1.0777 1.0526
Modesto, CA......................................... 1.0112 1.0077
Monmouth-Ocean, NJ.................................. 1.0764 1.0517
Montgomery, AL...................................... 0.7876 0.8492
Nashville, TN....................................... 0.9081 0.9361
New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT. 1.2750 1.1810
New London-Norwich, CT.............................. 1.2317 1.1534
New Orleans, LA..................................... 0.9294 0.9511
New York, NY........................................ 1.4010 1.2597
Newark, NJ.......................................... 1.1036 1.0698
Oakland, CA......................................... 1.5069 1.3242
Odessa-Midland, TX.................................. 0.8566 0.8994
Oklahoma City, OK................................... 0.8371 0.8854
Omaha, NE-IA........................................ 0.9480 0.9641
Orange County, CA................................... 1.1902 1.1266
Peoria-Pekin, IL.................................... 0.8905 0.9237
Philadelphia, PA-NJ................................. 1.1237 1.0831
Pittsburgh, PA...................................... 0.9539 0.9682
Portland, ME........................................ 0.9619 0.9738
Portland-Vancouver, OR-WA........................... 1.1235 1.0830
Provo-Orem, UT...................................... 1.0116 1.0079
Raleigh-Durham-Chapel Hill, NC...................... 0.9602 0.9726
Rapid City, SD...................................... 0.8458 0.8916
Roanoke, VA......................................... 0.8702 0.9092
Rochester, MN....................................... 1.0428 1.0291
Rockford, IL........................................ 0.8994 0.9300
Sacramento, CA...................................... 1.2351 1.1556
Saginaw-Bay City-Midland, MI........................ 0.9667 0.9771
St. Cloud, MN....................................... 0.9457 0.9625
St. Louis, MO-IL.................................... 0.9022 0.9319
Salt Lake City-Ogden, UT............................ 0.9677 0.9778
San Diego, CA....................................... 1.2154 1.1429
San Francisco, CA................................... 1.4211 1.2721
San Jose, CA........................................ 1.4455 1.2870
Santa Rosa, CA...................................... 1.2363 1.1563
Sarasota-Bradenton, FL.............................. 0.9789 0.9855
Seattle-Bellevue-Everett, WA........................ 1.1384 1.0928
Sharon, PA.......................................... 0.8885 0.9222
Sherman-Denison, TX................................. 0.8631 0.9041
[[Page 46264]]
Sioux Falls, SD..................................... 0.8620 0.9033
South Bend, IN...................................... 0.9934 0.9955
Springfield, IL..................................... 0.8671 0.9070
Springfield, MO..................................... 0.7842 0.8466
Stockton-Lodi, CA................................... 1.1391 1.0933
Syracuse, NY........................................ 0.9396 0.9582
Tacoma, WA.......................................... 1.0866 1.0585
Tampa-St. Petersburg-Clearwater, FL................. 0.9302 0.9517
Texarkana, AR-Texarkana, TX......................... 0.8509 0.8953
Toledo, OH.......................................... 1.0361 1.0246
Topeka, KS.......................................... 0.9795 0.9859
Tucson, AZ.......................................... 0.9075 0.9357
Tulsa, OK........................................... 0.8095 0.8653
Tyler, TX........................................... 0.9605 0.9728
Victoria, TX........................................ 0.8185 0.8718
Washington, DC-MD-VA-WV............................. 1.0823 1.0557
Waterloo-Cedar Falls, IA............................ 0.8591 0.9012
Wausau, WI.......................................... 0.9698 0.9792
Wichita, KS......................................... 0.9211 0.9453
Rural Alabama....................................... 0.7150 0.7947
Rural Florida....................................... 0.8668 0.9067
Rural Kentucky...................................... 0.7753 0.8401
Rural Louisiana..................................... 0.7253 0.8026
Rural Michigan...................................... 0.8836 0.9187
Rural Minnesota..................................... 0.8144 0.8688
Rural New Hampshire................................. 0.9751 0.9829
Rural North Carolina................................ 0.7953 0.8548
Rural Virginia...................................... 0.7729 0.8383
Rural Virginia (Rural Kentucky Hosp.)............... 0.7753 0.8401
Rural Washington.................................... 0.9933 0.9954
Rural West Virginia................................. 0.7923 0.8526
Rural Wyoming....................................... 0.8177 0.8713
------------------------------------------------------------------------
Table 4d.--Average Hourly Wage for Urban Areas
------------------------------------------------------------------------
Average
Urban area hourly
wage
------------------------------------------------------------------------
Abilene, TX.................................................. 15.7361
Aguadilla, PR................................................ 8.2856
Akron, OH.................................................... 19.2662
Albany, GA................................................... 16.8101
Albany-Schenectady-Troy, NY.................................. 16.8634
Albuquerque, NM.............................................. 18.2712
Alexandria, LA............................................... 15.8746
Allentown-Bethlehem-Easton, PA............................... 19.5376
Altoona, PA.................................................. 18.5951
Amarillo, TX................................................. 17.0704
Anchorage, AK................................................ 25.8567
Ann Arbor, MI................................................ 22.8035
Anniston, AL................................................. 15.6871
Appleton-Oshkosh-Neenah, WI.................................. 17.3835
Arecibo, PR.................................................. 8.5979
Asheville, NC................................................ 18.2517
Athens, GA................................................... 18.3967
Atlanta, GA.................................................. 19.6186
Atlantic-Cape May, NJ........................................ 21.6594
Augusta-Aiken, GA-SC......................................... 17.2764
Austin-San Marcos, TX........................................ 18.0941
Bakersfield, CA.............................................. 19.9230
Baltimore, MD................................................ 19.1581
Bangor, ME................................................... 18.3630
Barnstable-Yarmouth, MA...................................... 26.6928
Baton Rouge, LA.............................................. 16.4888
Beaumont-Port Arthur, TX..................................... 16.7698
Bellingham, WA............................................... 22.1285
Benton Harbor, MI............................................ 16.6319
Bergen-Passaic, NJ........................................... 23.0426
Billings, MT................................................. 17.7662
Biloxi-Gulfport-Pascagoula, MS............................... 16.7252
Binghamton, NY............................................... 17.2505
Birmingham, AL............................................... 17.6684
Bismarck, ND................................................. 15.4928
Bloomington, IN.............................................. 16.9184
Bloomington-Normal, IL....................................... 17.5793
Boise City, ID............................................... 18.3461
Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH............. 22.7074
Boulder-Longmont, CO......................................... 18.6194
Brazoria, TX................................................. 17.9908
Bremerton, WA................................................ 21.3152
Brownsville-Harlingen-San Benito, TX......................... 16.7030
Bryan-College Station, TX.................................... 17.3076
Buffalo-Niagara Falls, NY.................................... 17.8073
Burlington, VT............................................... 19.6864
Caguas, PR................................................... 8.9423
Canton-Massillon, OH......................................... 16.9098
Casper, WY................................................... 17.2484
Cedar Rapids, IA............................................. 16.5386
Champaign-Urbana, IL......................................... 18.3634
Charleston-North Charleston, SC.............................. 17.5265
Charleston, WV............................................... 18.6261
Charlotte-Gastonia-Rock Hill, NC-SC.......................... 18.8112
Charlottesville, VA.......................................... 17.9005
Chattanooga, TN-GA........................................... 17.2991
Cheyenne, WY................................................. 15.0126
Chicago, IL.................................................. 21.0400
Chico-Paradise, CA........................................... 20.3689
Cincinnati, OH-KY-IN......................................... 18.7085
Clarksville-Hopkinsville, TN-KY.............................. 15.0873
Cleveland-Lorain-Elyria, OH.................................. 19.3308
Colorado Springs, CO......................................... 18.2642
Columbia, MO................................................. 17.4002
Columbia, SC................................................. 17.9118
Columbus, GA-AL.............................................. 15.2114
Columbus, OH................................................. 18.9295
Corpus Christi, TX........................................... 17.3648
Cumberland, MD-WV............................................ 16.9547
Dallas, TX................................................... 19.0236
Danville, VA................................................. 16.6152
Davenport-Moline-Rock Island, IA-IL.......................... 16.4021
Dayton-Springfield, OH....................................... 18.6913
Daytona Beach, FL............................................ 17.3459
Decatur, AL.................................................. 16.3934
Decatur, IL.................................................. 15.3452
Denver, CO................................................... 19.8786
Des Moines, IA............................................... 17.2370
Detroit, MI.................................................. 20.9694
Dothan, AL................................................... 15.1351
Dover, DE.................................................... 17.5916
Dubuque, IA.................................................. 15.8624
Duluth-Superior, MN-WI....................................... 18.4105
Dutchess County, NY.......................................... 20.7053
Eau Claire, WI............................................... 16.9692
El Paso, TX.................................................. 18.5059
Elkhart-Goshen, IN........................................... 17.2083
Elmira, NY................................................... 16.4576
Enid, OK..................................................... 15.3724
Erie, PA..................................................... 17.9082
Eugene-Springfield, OR....................................... 22.0384
Evansville, Henderson, IN-KY................................. 17.5644
Fargo-Moorhead, ND-MN........................................ 17.6861
Fayetteville, NC............................................. 17.6113
Fayetteville-Springdale-Rogers, AR........................... 14.1177
Flagstaff, AZ-UT............................................. 17.6344
Flint, MI.................................................... 21.9933
Florence, AL................................................. 15.5219
Florence, SC................................................. 16.8047
Fort Collins-Loveland, CO.................................... 20.6529
Fort Lauderdale, FL.......................................... 20.6250
Fort Myers-Cape Coral, FL.................................... 17.6607
Fort Pierce-Port St. Lucie, FL............................... 19.8836
Fort Smith, AR-OK............................................ 15.3772
Fort Walton Beach, FL........................................ 17.9727
Fort Wayne, IN............................................... 17.2067
Fort Worth-Arlington, TX..................................... 19.8533
Fresno, CA................................................... 21.8549
Gadsden, AL.................................................. 17.3656
Gainesville, FL.............................................. 18.4465
Galveston-Texas City, TX..................................... 21.5032
Gary, IN..................................................... 18.8504
Glens Falls, NY.............................................. 16.7411
Goldsboro, NC................................................ 16.4109
Grand Forks, ND-MN........................................... 17.6200
Grand Junction, CO........................................... 16.2997
Grand Rapids-Muskegon-Holland, MI............................ 19.7853
Great Falls, MT.............................................. 16.9748
Greeley, CO.................................................. 18.9481
Green Bay, WI................................................ 17.6730
Greensboro-Winston-Salem-High Point, NC...................... 18.2112
Greenville, NC............................................... 17.7503
Greenville-Spartanburg-Anderson, SC.......................... 17.4559
Hagerstown, MD............................................... 17.9394
Hamilton-Middletown, OH...................................... 18.5562
Harrisburg-Lebanon-Carlisle, PA.............................. 19.8630
Hartford, CT................................................. 24.1823
Hattiesburg, MS.............................................. 14.1809
Hickory-Morganton-Lenoir, NC................................. 16.8672
Honolulu, HI................................................. 22.4099
Houma, LA.................................................... 15.3561
Houston, TX.................................................. 19.5534
Huntington-Ashland, WV-KY-OH................................. 17.9378
Huntsville, AL............................................... 16.0449
Indianapolis, IN............................................. 19.3630
Iowa City, IA................................................ 18.3037
Jackson, MI.................................................. 17.6864
Jackson, MS.................................................. 15.4167
Jackson, TN.................................................. 16.2068
Jacksonville, FL............................................. 17.7663
Jacksonville, NC............................................. 13.7955
Jamestown, NY................................................ 14.9979
Janesville-Beloit, WI........................................ 16.9030
Jersey City, NJ.............................................. 22.2562
Johnson City-Kingsport-Bristol, TN-VA........................ 17.3717
Johnstown, PA................................................ 16.4213
Jonesboro, AR................................................ 14.1168
Joplin, MO................................................... 14.9353
Kalamazoo-Battlecreek, MI.................................... 20.6127
Kankakee, IL................................................. 17.8236
Kansas City, KS-MO........................................... 18.5333
Kenosha, WI.................................................. 17.8819
[[Page 46265]]
Killeen-Temple, TX........................................... 20.3189
Knoxville, TN................................................ 16.6250
Kokomo, IN................................................... 16.7962
La Crosse, WI-MN............................................. 16.8513
Lafayette, LA................................................ 15.9607
Lafayette, IN................................................ 17.1690
Lake Charles, LA............................................. 15.7084
Lakeland-Winter Haven, FL.................................... 17.1559
Lancaster, PA................................................ 18.7384
Lansing-East Lansing, MI..................................... 19.5719
Laredo, TX................................................... 13.8306
Las Cruces, NM............................................... 16.6145
Las Vegas, NV-AZ............................................. 21.2545
Lawrence, KS................................................. 16.8098
Lawton, OK................................................... 16.3566
Lewiston-Auburn, ME.......................................... 18.3998
Lexington, KY................................................ 16.2159
Lima, OH..................................................... 17.0746
Lincoln, NE.................................................. 17.9136
Little Rock-North Little Rock, AR............................ 16.8095
Longview-Marshall, TX........................................ 16.9037
Los Angeles-Long Beach, CA................................... 24.1347
Louisville, KY-IN............................................ 18.4730
Lubbock, TX.................................................. 16.6400
Lynchburg, VA................................................ 15.7441
Macon, GA.................................................... 17.2534
Madison, WI.................................................. 19.5953
Mansfield, OH................................................ 16.6677
Mayaguez, PR................................................. 8.2422
McAllen-Edinburg-Mission, TX................................. 16.5901
Medford-Ashland, OR.......................................... 19.6857
Melbourne-Titusville-Palm Bay, FL............................ 17.7314
Memphis, TN-AR-MS............................................ 15.9681
Merced, CA................................................... 20.8439
Miami, FL.................................................... 19.4323
Middlesex-Somerset-Hunterdon, NJ............................. 21.2792
Milwaukee-Waukesha, WI....................................... 18.8591
Minneapolis-St. Paul, MN-WI.................................. 21.0727
Mobile, AL................................................... 15.6052
Modesto, CA.................................................. 20.7262
Monmouth-Ocean, NJ........................................... 21.1825
Monroe, LA................................................... 16.0553
Montgomery, AL............................................... 15.4009
Muncie, IN................................................... 18.9936
Myrtle Beach, SC............................................. 15.2321
Naples, FL................................................... 19.9423
Nashville, TN................................................ 17.7573
Nassau-Suffolk, NY........................................... 26.4893
New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT.......... 24.8405
New London-Norwich, CT....................................... 23.9754
New Orleans, LA.............................................. 18.1738
New York, NY................................................. 27.6763
Newark, NJ................................................... 22.9987
Newburgh, NY-PA.............................................. 21.1229
Norfolk-Virginia Beach-Newport News, VA-NC................... 16.3222
Oakland, CA.................................................. 29.3127
Ocala, FL.................................................... 17.8031
Odessa-Midland, TX........................................... 16.5854
Oklahoma City, OK............................................ 16.3683
Olympia, WA.................................................. 20.9003
Omaha, NE-IA................................................. 18.5371
Orange County, CA............................................ 23.3969
Orlando, FL.................................................. 18.5164
Owensboro, KY................................................ 14.8119
Panama City, FL.............................................. 15.7629
Parkersburg-Marietta, WV-OH.................................. 15.4018
Pensacola, FL................................................ 16.0371
Peoria-Pekin, IL............................................. 17.4120
Philadelphia, PA-NJ.......................................... 21.9722
Phoenix-Mesa, AZ............................................. 19.1821
Pine Bluff, AR............................................... 15.4205
Pittsburgh, PA............................................... 18.9688
Pittsfield, MA............................................... 20.6334
Pocatello, ID................................................ 17.1752
Ponce, PR.................................................... 9.1599
Portland, ME................................................. 18.8079
Portland-Vancouver, OR-WA.................................... 21.9679
Providence-Warwick, RI....................................... 21.6876
Provo-Orem, UT............................................... 19.7809
Pueblo, CO................................................... 16.1970
Punta Gorda, FL.............................................. 16.3323
Racine, WI................................................... 17.2751
Raleigh-Durham-Chapel Hill, NC............................... 19.0221
Rapid City, SD............................................... 16.5325
Reading, PA.................................................. 18.4690
Redding, CA.................................................. 22.6922
Reno, NV..................................................... 21.5443
Richland-Kennewick-Pasco, WA................................. 19.4956
Richmond-Petersburg, VA...................................... 17.9776
Riverside-San Bernardino, CA................................. 22.2475
Roanoke, VA.................................................. 17.0151
Rochester, MN................................................ 20.3908
Rochester, NY................................................ 18.8662
Rockford, IL................................................. 17.5872
Rocky Mount, NC.............................................. 17.5097
Sacramento, CA............................................... 24.1510
Saginaw-Bay City-Midland, MI................................. 18.7939
St. Cloud, MN................................................ 18.4907
St. Joseph, MO............................................... 16.7196
St. Louis, MO-IL............................................. 17.6400
Salem, OR.................................................... 19.0205
Salinas, CA.................................................. 26.9904
Salt Lake City-Ogden, UT..................................... 18.9211
San Angelo, TX............................................... 14.8158
San Antonio, TX.............................................. 16.4044
San Diego, CA................................................ 23.7268
San Francisco, CA............................................ 27.8836
San Jose, CA................................................. 28.3887
San Juan-Bayamon, PR......................................... 8.8111
San Luis Obispo-Atascadero-Paso Robles, CA................... 22.6053
Santa Barbara-Santa Maria-Lompoc, CA......................... 21.9816
Santa Cruz-Watsonville, CA................................... 26.4364
Santa Fe, NM................................................. 21.1622
Santa Rosa, CA............................................... 24.4155
Sarasota-Bradenton, FL....................................... 19.1406
Savannah, GA................................................. 18.8663
Scranton-Wilkes Barre-Hazleton, PA........................... 17.1121
Seattle-Bellevue-Everett, WA................................. 22.2595
Sharon, PA................................................... 17.3726
Sheboygan, WI................................................ 15.1817
Sherman-Denison, TX.......................................... 16.8423
Shreveport-Bossier City, LA.................................. 18.2999
Sioux City, IA-NE............................................ 16.2539
Sioux Falls, SD.............................................. 16.8540
South Bend, IN............................................... 19.4248
Spokane, WA.................................................. 20.5788
Springfield, IL.............................................. 16.9538
Springfield, MO.............................................. 15.2957
Springfield, MA.............................................. 20.6983
State College, PA............................................ 18.6507
Steubenville-Weirton, OH-WV.................................. 16.1632
Stockton-Lodi, CA............................................ 22.1532
Sumter, SC................................................... 15.0540
Syracuse, NY................................................. 18.3703
Tacoma, WA................................................... 21.2354
Tallahassee, FL.............................................. 16.2555
Tampa-St. Petersburg-Clearwater, FL.......................... 18.0859
Terre Haute, IN.............................................. 16.7989
Texarkana, AR-Texarkana, TX.................................. 16.6266
Toledo, OH................................................... 20.2601
Topeka, KS................................................... 19.7210
Trenton, NJ.................................................. 20.6259
Tucson, AZ................................................... 17.7311
Tulsa, OK.................................................... 15.8281
Tuscaloosa, AL............................................... 15.2197
Tyler, TX.................................................... 19.5462
Utica-Rome, NY............................................... 16.4509
Vallejo-Fairfield-Napa, CA................................... 27.2708
Ventura, CA.................................................. 22.3964
Victoria, TX................................................. 16.4116
Vineland-Millville-Bridgeton, NJ............................. 19.5394
Visalia-Tulare-Porterville, CA............................... 19.8483
Waco, TX..................................................... 15.1959
Washington, DC-MD-VA-WV...................................... 21.1632
Waterloo-Cedar Falls, IA..................................... 17.0208
Wausau, WI................................................... 20.1856
West Palm Beach-Boca Raton, FL............................... 19.9482
Wheeling, OH-WV.............................................. 14.7877
Wichita, KS.................................................. 18.3188
Wichita Falls, TX............................................ 15.7237
Williamsport, PA............................................. 16.5567
Wilmington-Newark, DE-MD..................................... 22.1249
Wilmington, NC............................................... 17.6887
Yakima, WA................................................... 19.6049
Yolo, CA..................................................... 22.3769
York, PA..................................................... 17.8006
Youngstown-Warren, OH........................................ 19.0484
Yuba City, CA................................................ 20.3622
Yuma, AZ..................................................... 18.5693
------------------------------------------------------------------------
Table 4e.--Average Hourly Wage for Rural Areas
------------------------------------------------------------------------
Average
Nonurban area hourly
wage
------------------------------------------------------------------------
Alabama...................................................... 13.9255
Alaska....................................................... 2
FR Doc. 96-22145 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1997 Rates
4.3314
Arizona...................................................... 15.5012
Arkansas..................................................... 13.5966
California................................................... 19.5577
Colorado..................................................... 15.8231
Connecticut.................................................. 24.9480
Delaware..................................................... 18.4711
Florida...................................................... 16.9485
Georgia...................................................... 14.9642
Hawaii....................................................... 20.0330
Idaho........................................................ 16.1848
Illinois..................................................... 14.7683
Indiana...................................................... 15.8851
Iowa......................................................... 14.4039
Kansas....................................................... 13.8962
Kentucky..................................................... 15.1598
Louisiana.................................................... 14.1417
Maine........................................................ 16.2618
Maryland..................................................... 16.4777
Massachusetts................................................ 21.0582
Michigan..................................................... 17.2651
[[Page 46266]]
Minnesota.................................................... 15.9249
Mississippi.................................................. 13.2829
Missouri..................................................... 14.1978
Montana...................................................... 15.8928
Nebraska..................................................... 14.1063
Nevada....................................................... 17.1588
New Hampshire................................................ 19.0549
New Jersey \1\............................................... .........
New Mexico................................................... 15.6424
New York..................................................... 16.7329
North Carolina............................................... 15.5456
North Dakota................................................. 14.3865
Ohio......................................................... 16.2910
Oklahoma..................................................... 13.5735
Oregon....................................................... 18.8958
Pennsylvania................................................. 16.5277
Puerto Rico.................................................. 7.8716
Rhode Island \1\............................................. .........
South Carolina............................................... 14.9937
South Dakota................................................. 13.8107
Tennessee.................................................... 14.3532
Texas........................................................ 14.5903
Utah......................................................... 17.3014
Vermont...................................................... 17.4440
Virginia..................................................... 15.0809
Washington................................................... 19.4229
West Virginia................................................ 15.4544
Wisconsin.................................................... 16.4842
Wyoming...................................................... 15.9886
------------------------------------------------------------------------
\1\ All counties within the State are classified as urban.
Table 5.--List of Diagnosis Related Groups (DRGS), Relative Weighting Factors, Geometric Mean Length of Stay,
and Length of Stay Outlier Cutoff Points Used in the Prospective Payment System
----------------------------------------------------------------------------------------------------------------
Relative Geometric Arithmetic Outlier
weights mean LOS mean LOS threshold
----------------------------------------------------------------------------------------------------------------
1........... 01 SURG CRANIOTOMY AGE >17 3.0486 7.7 11.1 32
EXCEPT FOR TRAUMA.
2........... 01 SURG CRANIOTOMY FOR TRAUMA 3.0134 8.4 11.6 32
AGE >17.
3........... 01 SURG *CRANIOTOMY AGE 0-17... 1.9167 12.7 12.7 37
4........... 01 SURG SPINAL PROCEDURES...... 2.3399 5.9 9.1 30
5........... 01 SURG EXTRACRANIAL VASCULAR 1.5143 3.4 4.4 26
PROCEDURES.
6........... 01 SURG CARPAL TUNNEL RELEASE.. .7419 2.4 3.4 26
7........... 01 SURG PERIPH & CRANIAL NERVE 2.4886 8.1 12.6 32
& OTHER NERV SYST PROC
W CC.
8........... 01 SURG PERIPH & CRANIAL NERVE 1.0962 2.6 3.9 27
& OTHER NERV SYST PROC
W/O CC.
9........... 01 MED SPINAL DISORDERS & 1.2677 5.4 7.8 29
INJURIES.
10.......... 01 MED NERVOUS SYSTEM 1.2196 5.7 8.1 30
NEOPLASMS W CC.
11.......... 01 MED NERVOUS SYSTEM .8000 3.5 5.0 28
NEOPLASMS W/O CC.
12.......... 01 MED DEGENERATIVE NERVOUS .9457 5.4 7.7 29
SYSTEM DISORDERS.
13.......... 01 MED MULTIPLE SCLEROSIS & .7770 5.0 6.2 29
CEREBELLAR ATAXIA.
14.......... 01 MED SPECIFIC 1.1999 5.5 7.5 30
CEREBROVASCULAR
DISORDERS EXCEPT TIA.
15.......... 01 MED TRANSIENT ISCHEMIC .7231 3.5 4.5 27
ATTACK & PRECEREBRAL
OCCLUSIONS.
16.......... 01 MED NONSPECIFIC 1.0371 4.9 6.6 29
CEREBROVASCULAR
DISORDERS W CC.
17.......... 01 MED NONSPECIFIC .6331 3.0 4.0 26
CEREBROVASCULAR
DISORDERS W/O CC.
18.......... 01 MED CRANIAL & PERIPHERAL .9319 4.8 6.4 29
NERVE DISORDERS W CC.
19.......... 01 MED CRANIAL & PERIPHERAL .6230 3.4 4.5 27
NERVE DISORDERS W/O CC.
20.......... 01 MED NERVOUS SYSTEM 2.4854 8.6 11.6 33
INFECTION EXCEPT VIRAL
MENINGITIS.
21.......... 01 MED VIRAL MENINGITIS....... 1.4910 5.8 7.8 30
22.......... 01 MED HYPERTENSIVE .8353 3.8 4.9 28
ENCEPHALOPATHY.
23.......... 01 MED NONTRAUMATIC STUPOR & .8089 3.6 5.1 28
COMA.
24.......... 01 MED SEIZURE & HEADACHE AGE .9694 4.2 5.8 28
>17 W CC.
25.......... 01 MED SEIZURE & HEADACHE AGE .5793 3.0 3.9 24
>17 W/O CC.
26.......... 01 MED SEIZURE & HEADACHE AGE .7387 3.3 4.6 27
0-17.
27.......... 01 MED TRAUMATIC STUPOR & 1.3060 3.6 6.3 28
COMA, COMA >1 HR.
28.......... 01 MED TRAUMATIC STUPOR & 1.2033 4.8 7.1 29
COMA, COMA <1 HR AGE
>17 W CC.
29.......... 01 MED TRAUMATIC STUPOR & .6371 3.0 4.1 27
COMA, COMA <1 HR AGE
>17 W/O CC.
30.......... 01 MED *TRAUMATIC STUPOR & .3241 2.0 2.0 17
COMA, COMA <1 HR AGE 0-
17.
31.......... 01 MED CONCUSSION AGE >17 W CC .8412 3.7 5.4 28
32.......... 01 MED CONCUSSION AGE >17 W/O .4861 2.3 3.1 20
CC.
33.......... 01 MED *CONCUSSION AGE 0-17... .2037 1.6 1.6 9
34.......... 01 MED OTHER DISORDERS OF 1.0673 4.6 6.5 29
NERVOUS SYSTEM W CC.
35.......... 01 MED OTHER DISORDERS OF .6149 3.2 4.3 27
NERVOUS SYSTEM W/O CC.
36.......... 02 SURG RETINAL PROCEDURES..... .6134 1.3 1.6 6
37.......... 02 SURG ORBITAL PROCEDURES..... .9323 2.7 4.0 27
38.......... 02 SURG PRIMARY IRIS PROCEDURES .4282 1.9 2.6 17
39.......... 02 SURG LENS PROCEDURES WITH OR .5184 1.5 2.0 10
WITHOUT VITRECTOMY.
40.......... 02 SURG EXTRAOCULAR PROCEDURES .7072 2.2 3.4 26
EXCEPT ORBIT AGE >17.
41.......... 02 SURG *EXTRAOCULAR PROCEDURES .3299 1.6 1.6 7
EXCEPT ORBIT AGE 0-17.
[[Page 46267]]
42.......... 02 SURG INTRAOCULAR PROCEDURES .5816 1.6 2.2 13
EXCEPT RETINA, IRIS &
LENS.
43.......... 02 MED HYPHEMA................ .4520 3.3 4.2 27
44.......... 02 MED ACUTE MAJOR EYE .6237 4.7 5.7 29
INFECTIONS.
45.......... 02 MED NEUROLOGICAL EYE .6525 3.1 3.8 22
DISORDERS.
46.......... 02 MED OTHER DISORDERS OF THE .7656 4.0 5.6 28
EYE AGE >17 W CC.
47.......... 02 MED OTHER DISORDERS OF THE .4664 2.8 3.8 27
EYE AGE >17 W/O CC.
48.......... 02 MED *OTHER DISORDERS OF THE .2907 2.9 2.9 27
EYE AGE 0-17.
49.......... 03 SURG MAJOR HEAD & NECK 1.7245 4.1 5.7 28
PROCEDURES.
50.......... 03 SURG SIALOADENECTOMY........ .7686 1.7 2.1 9
51.......... 03 SURG SALIVARY GLAND .7345 1.9 2.9 20
PROCEDURES EXCEPT
SIALOADENECTOMY.
52.......... 03 SURG CLEFT LIP & PALATE 1.0271 2.1 3.4 24
REPAIR.
53.......... 03 SURG SINUS & MASTOID 1.0128 2.2 3.6 26
PROCEDURES AGE >17.
54.......... 03 SURG *SINUS & MASTOID .4712 3.2 3.2 22
PROCEDURES AGE 0-17.
55.......... 03 SURG MISCELLANEOUS EAR, .7880 2.0 3.0 22
NOSE, MOUTH & THROAT
PROCEDURES.
56.......... 03 SURG RHINOPLASTY............ .8283 2.1 2.7 18
57.......... 03 SURG T&A PROC, EXCEPT .9325 2.8 4.1 27
TONSILLECTOMY &/OR
ADENOIDECTOMY ONLY,
AGE >17.
58.......... 03 SURG *T&A PROC, EXCEPT .2676 1.5 1.5 4
TONSILLECTOMY &/OR
ADENOIDECTOMY ONLY,
AGE 0-17.
59.......... 03 SURG TONSILLECTOMY &/OR .7439 2.3 3.6 26
ADENOIDECTOMY ONLY,
AGE >17.
60.......... 03 SURG *TONSILLECTOMY &/OR .2038 1.5 1.5 4
ADENOIDECTOMY ONLY,
AGE 0-17.
61.......... 03 SURG MYRINGOTOMY W TUBE 1.1960 2.7 5.1 27
INSERTION AGE >17.
62.......... 03 SURG *MYRINGOTOMY W TUBE .2885 1.3 1.3 5
INSERTION AGE 0-17.
63.......... 03 SURG OTHER EAR, NOSE, MOUTH 1.2168 3.2 4.7 27
& THROAT O.R.
PROCEDURES.
64.......... 03 MED EAR, NOSE, MOUTH & 1.1737 4.8 7.6 29
THROAT MALIGNANCY.
65.......... 03 MED DYSEQUILIBRIUM......... .5195 2.7 3.4 20
66.......... 03 MED EPISTAXIS.............. .5366 2.9 3.6 21
67.......... 03 MED EPIGLOTTITIS........... .8397 3.4 4.2 24
68.......... 03 MED OTITIS MEDIA & URI AGE .7098 3.9 4.8 27
>17 W CC.
69.......... 03 MED OTITIS MEDIA & URI AGE .5239 3.1 3.8 20
>17 W/O CC.
70.......... 03 MED OTITIS MEDIA & URI AGE .3727 2.4 2.9 15
0-17.
71.......... 03 MED LARYNGOTRACHEITIS...... .7702 3.1 4.0 27
72.......... 03 MED NASAL TRAUMA & .6532 3.1 4.4 27
DEFORMITY.
73.......... 03 MED OTHER EAR, NOSE, MOUTH .7505 3.7 5.0 28
& THROAT DIAGNOSES AGE
>17.
74.......... 03 MED *OTHER EAR, NOSE, MOUTH .3278 2.1 2.1 20
& THROAT DIAGNOSES AGE
0-17.
75.......... 04 SURG MAJOR CHEST PROCEDURES. 3.1951 8.8 11.2 33
76.......... 04 SURG OTHER RESP SYSTEM O.R. 2.6036 9.1 12.5 33
PROCEDURES W CC.
77.......... 04 SURG OTHER RESP SYSTEM O.R. 1.1593 3.8 5.5 28
PROCEDURES W/O CC.
78.......... 04 MED PULMONARY EMBOLISM..... 1.4292 7.0 8.3 31
79.......... 04 MED RESPIRATORY INFECTIONS 1.6300 7.2 9.3 31
& INFLAMMATIONS AGE
>17 W CC.
80.......... 04 MED RESPIRATORY INFECTIONS .9436 5.3 6.6 29
& INFLAMMATIONS AGE
>17 W/O CC.
81.......... 04 MED RESPIRATORY INFECTIONS 1.4845 6.3 7.8 30
& INFLAMMATIONS AGE 0-
17.
82.......... 04 MED RESPIRATORY NEOPLASMS.. 1.3319 5.7 7.9 30
83.......... 04 MED MAJOR CHEST TRAUMA W CC .9782 4.9 6.4 29
84.......... 04 MED MAJOR CHEST TRAUMA W/O .5319 2.9 3.7 23
CC.
85.......... 04 MED PLEURAL EFFUSION W CC.. 1.2200 5.6 7.4 30
86.......... 04 MED PLEURAL EFFUSION W/O CC .7117 3.4 4.5 27
87.......... 04 MED PULMONARY EDEMA & 1.3615 5.1 6.9 29
RESPIRATORY FAILURE.
88.......... 04 MED CHRONIC OBSTRUCTIVE .9846 4.9 6.1 29
PULMONARY DISEASE.
89.......... 04 MED SIMPLE PNEUMONIA & 1.1156 5.8 7.1 30
PLEURISY AGE >17 W CC.
90.......... 04 MED SIMPLE PNEUMONIA & .6978 4.3 5.1 24
PLEURISY AGE >17 W/O
CC.
91.......... 04 MED SIMPLE PNEUMONIA & .7524 3.5 4.5 27
PLEURISY AGE 0-17.
92.......... 04 MED INTERSTITIAL LUNG 1.2029 5.6 7.3 30
DISEASE W CC.
93.......... 04 MED INTERSTITIAL LUNG .7498 4.0 4.9 28
DISEASE W/O CC.
94.......... 04 MED PNEUMOTHORAX W CC...... 1.1780 5.3 7.1 29
95.......... 04 MED PNEUMOTHORAX W/O CC.... .5996 3.3 4.1 25
96.......... 04 MED BRONCHITIS & ASTHMA AGE .8272 4.5 5.5 29
>17 W CC.
97.......... 04 MED BRONCHITIS & ASTHMA AGE .6035 3.6 4.3 22
>17 W/O CC.
98.......... 04 MED BRONCHITIS & ASTHMA AGE .7807 2.9 4.3 27
0-17.
[[Page 46268]]
99.......... 04 MED RESPIRATORY SIGNS & .6869 2.7 3.5 22
SYMPTOMS W CC.
100......... 04 MED RESPIRATORY SIGNS & .5113 2.0 2.4 12
SYMPTOMS W/O CC.
101......... 04 MED OTHER RESPIRATORY .8748 3.9 5.2 28
SYSTEM DIAGNOSES W CC.
102......... 04 MED OTHER RESPIRATORY .5335 2.4 3.1 20
SYSTEM DIAGNOSES W/O
CC.
103......... 05 SURG HEART TRANSPLANT....... 15.3358 28.4 40.0 52
104......... 05 SURG CARDIAC VALVE 7.3199 12.0 14.6 36
PROCEDURES W CARDIAC
CATH.
105......... 05 SURG CARDIAC VALVE 5.5998 9.0 11.0 33
PROCEDURES W/O CARDIAC
CATH.
106......... 05 SURG CORONARY BYPASS W 5.5564 10.3 11.7 34
CARDIAC CATH.
107......... 05 SURG CORONARY BYPASS W/O 4.0685 7.8 8.8 32
CARDIAC CATH.
108......... 05 SURG OTHER CARDIOTHORACIC 5.9135 9.8 12.6 34
PROCEDURES.
109......... ................ NO LONGER VALID........ .0000 .0 .0 0
110......... 05 SURG MAJOR CARDIOVASCULAR 4.1589 8.2 10.9 32
PROCEDURES W CC.
111......... 05 SURG MAJOR CARDIOVASCULAR 2.2875 5.9 6.7 30
PROCEDURES W/O CC.
112......... 05 SURG PERCUTANEOUS 2.0946 3.5 4.7 27
CARDIOVASCULAR
PROCEDURES.
113......... 05 SURG AMPUTATION FOR CIRC 2.6935 10.6 14.4 35
SYSTEM DISORDERS
EXCEPT UPPER LIMB &
TOE.
114......... 05 SURG UPPER LIMB & TOE 1.5152 6.8 9.5 31
AMPUTATION FOR CIRC
SYSTEM DISORDERS.
115......... 05 SURG PERM CARDIAC PACEMAKER 3.6827 9.1 11.5 33
IMPLANT W AMI, HEART
FAILURE OR SHOCK.
116......... 05 SURG OTH PERM CARDIAC 2.4150 3.9 5.4 28
PACEMAKER IMPLANT OR
AICD LEAD OR GENERATOR
PROC.
117......... 05 SURG CARDIAC PACEMAKER 1.1764 2.7 4.1 27
REVISION EXCEPT DEVICE
REPLACEMENT.
118......... 05 SURG CARDIAC PACEMAKER 1.5825 2.1 3.2 25
DEVICE REPLACEMENT.
119......... 05 SURG VEIN LIGATION & 1.1435 3.3 5.5 27
STRIPPING.
120......... 05 SURG OTHER CIRCULATORY 1.9318 5.4 9.2 29
SYSTEM O.R. PROCEDURES.
121......... 05 MED CIRCULATORY DISORDERS W 1.6482 6.4 7.8 30
AMI & C.V. COMP DISCH
ALIVE.
122......... 05 MED CIRCULATORY DISORDERS W 1.1617 4.4 5.3 28
AMI W/O C.V. COMP
DISCH ALIVE.
123......... 05 MED CIRCULATORY DISORDERS W 1.4555 2.7 4.7 27
AMI, EXPIRED.
124......... 05 MED CIRCULATORY DISORDERS 1.3258 3.8 5.0 28
EXCEPT AMI, W CARD
CATH & COMPLEX DIAG.
125......... 05 MED CIRCULATORY DISORDERS .9246 2.3 3.1 20
EXCEPT AMI, W CARD
CATH W/O COMPLEX DIAG.
126......... 05 MED ACUTE & SUBACUTE 2.5379 11.0 14.3 35
ENDOCARDITIS.
127......... 05 MED HEART FAILURE & SHOCK.. 1.0265 4.8 6.2 29
128......... 05 MED DEEP VEIN .7861 5.9 6.7 27
THROMBOPHLEBITIS.
129......... 05 MED CARDIAC ARREST, 1.1316 2.0 3.5 26
UNEXPLAINED.
130......... 05 MED PERIPHERAL VASCULAR .9352 5.3 6.7 29
DISORDERS W CC.
131......... 05 MED PERIPHERAL VASCULAR .6038 4.3 5.2 28
DISORDERS W/O CC.
132......... 05 MED ATHEROSCLEROSIS W CC... .6840 2.9 3.6 20
133......... 05 MED ATHEROSCLEROSIS W/O CC. .5537 2.3 2.9 16
134......... 05 MED HYPERTENSION........... .5787 3.0 3.9 23
135......... 05 MED CARDIAC CONGENITAL & .8838 3.7 5.0 28
VALVULAR DISORDERS AGE
>17 W CC.
136......... 05 MED CARDIAC CONGENITAL & .5629 2.6 3.3 18
VALVULAR DISORDERS AGE
>17 W/O CC.
137......... 05 MED *CARDIAC CONGENITAL & .7999 3.3 3.3 27
VALVULAR DISORDERS AGE
0-17.
138......... 05 MED CARDIAC ARRHYTHMIA & .8008 3.5 4.6 27
CONDUCTION DISORDERS W
CC.
139......... 05 MED CARDIAC ARRHYTHMIA & .4971 2.4 2.9 16
CONDUCTION DISORDERS W/
O CC.
140......... 05 MED ANGINA PECTORIS........ .6205 2.8 3.5 20
141......... 05 MED SYNCOPE & COLLAPSE W CC .7128 3.4 4.5 27
142......... 05 MED SYNCOPE & COLLAPSE W/O .5288 2.5 3.2 18
CC.
143......... 05 MED CHEST PAIN............. .5223 2.1 2.6 14
144......... 05 MED OTHER CIRCULATORY 1.0857 4.1 5.7 28
SYSTEM DIAGNOSES W CC.
145......... 05 MED OTHER CIRCULATORY .6208 2.5 3.2 20
SYSTEM DIAGNOSES W/O
CC.
146......... 06 SURG RECTAL RESECTION W CC.. 2.6363 9.8 11.2 34
147......... 06 SURG RECTAL RESECTION W/O CC 1.6018 6.7 7.3 27
148......... 06 SURG MAJOR SMALL & LARGE 3.3710 11.2 13.5 35
BOWEL PROCEDURES W CC.
149......... 06 SURG MAJOR SMALL & LARGE 1.5999 7.0 7.7 25
BOWEL PROCEDURES W/O
CC.
150......... 06 SURG PERITONEAL ADHESIOLYSIS 2.6828 9.5 11.7 34
W CC.
151......... 06 SURG PERITONEAL ADHESIOLYSIS 1.2910 5.2 6.5 29
W/O CC.
152......... 06 SURG MINOR SMALL & LARGE 1.9311 7.6 9.0 32
BOWEL PROCEDURES W CC.
[[Page 46269]]
153......... 06 SURG MINOR SMALL & LARGE 1.1568 5.6 6.2 24
BOWEL PROCEDURES W/O
CC.
154......... 06 SURG *STOMACH, ESOPHAGEAL & 4.1817 11.6 15.0 36
DUODENAL PROCEDURES
AGE >17 W CC.
155......... 06 SURG STOMACH, ESOPHAGEAL & 1.4059 4.5 5.9 29
DUODENAL PROCEDURES
AGE >17 W/O CC.
156......... 06 SURG *STOMACH, ESOPHAGEAL & .8238 6.0 6.0 30
DUODENAL PROCEDURES
AGE 0-17.
157......... 06 SURG ANAL & STOMAL 1.1352 4.2 5.8 28
PROCEDURES W CC.
158......... 06 SURG ANAL & STOMAL .6077 2.3 2.9 18
PROCEDURES W/O CC.
159......... 06 SURG HERNIA PROCEDURES 1.2268 4.0 5.3 28
EXCEPT INGUINAL &
FEMORAL AGE >17 W CC.
160......... 06 SURG HERNIA PROCEDURES .7026 2.4 3.0 16
EXCEPT INGUINAL &
FEMORAL AGE >17 W/O CC.
161......... 06 SURG INGUINAL & FEMORAL 1.0066 3.0 4.4 27
HERNIA PROCEDURES AGE
>17 W CC.
162......... 06 SURG INGUINAL & FEMORAL .5707 1.7 2.2 11
HERNIA PROCEDURES AGE
>17 W/O CC.
163......... 06 SURG *HERNIA PROCEDURES AGE .7706 2.1 2.1 11
0-17.
164......... 06 SURG APPENDECTOMY W 2.3386 8.0 9.4 32
COMPLICATED PRINCIPAL
DIAG W CC.
165......... 06 SURG APPENDECTOMY W 1.2582 5.1 5.8 24
COMPLICATED PRINCIPAL
DIAG W/O CC.
166......... 06 SURG APPENDECTOMY W/O 1.4497 4.5 5.7 29
COMPLICATED PRINCIPAL
DIAG W CC.
167......... 06 SURG APPENDECTOMY W/O .8431 2.8 3.2 15
COMPLICATED PRINCIPAL
DIAG W/O CC.
168......... 03 SURG MOUTH PROCEDURES W CC.. 1.0929 3.2 5.0 27
169......... 03 SURG MOUTH PROCEDURES W/O CC .6717 2.0 2.5 15
170......... 06 SURG OTHER DIGESTIVE SYSTEM 2.7453 8.5 12.5 33
O.R. PROCEDURES W CC.
171......... 06 SURG OTHER DIGESTIVE SYSTEM 1.1202 4.0 5.4 28
O.R. PROCEDURES W/O CC.
172......... 06 MED DIGESTIVE MALIGNANCY W 1.2920 5.7 8.2 30
CC.
173......... 06 MED DIGESTIVE MALIGNANCY W/ .6769 3.0 4.4 27
O CC.
174......... 06 MED G.I. HEMORRHAGE W CC... .9952 4.4 5.6 28
175......... 06 MED G.I. HEMORRHAGE W/O CC. .5485 2.9 3.5 17
176......... 06 MED COMPLICATED PEPTIC 1.0856 4.7 6.2 29
ULCER.
177......... 06 MED UNCOMPLICATED PEPTIC .8335 4.0 5.0 28
ULCER W CC.
178......... 06 MED UNCOMPLICATED PEPTIC .6091 3.0 3.6 19
ULCER W/O CC.
179......... 06 MED INFLAMMATORY BOWEL 1.1188 5.5 7.2 30
DISEASE.
180......... 06 MED G.I. OBSTRUCTION W CC.. .9194 4.7 6.1 29
181......... 06 MED G.I. OBSTRUCTION W/O CC .5338 3.3 4.0 22
182......... 06 MED ESOPHAGITIS, GASTROENT .7789 3.8 5.0 28
& MISC DIGEST
DISORDERS AGE >17 W CC.
183......... 06 MED ESOPHAGITIS, GASTROENT .5553 2.8 3.4 20
& MISC DIGEST
DISORDERS AGE >17 W/O
CC.
184......... 06 MED ESOPHAGITIS, GASTROENT .5414 2.8 3.9 27
& MISC DIGEST
DISORDERS AGE 0-17.
185......... 03 MED DENTAL & ORAL DIS .8424 3.7 5.2 28
EXCEPT EXTRACTIONS &
RESTORATIONS, AGE >17.
186......... 03 MED *DENTAL & ORAL DIS .3140 2.9 2.9 23
EXCEPT EXTRACTIONS &
RESTORATIONS, AGE 0-17.
187......... 03 MED DENTAL EXTRACTIONS & .7104 3.1 4.2 27
RESTORATIONS.
188......... 06 MED OTHER DIGESTIVE SYSTEM 1.0591 4.5 6.1 28
DIAGNOSES AGE >17 W CC.
189......... 06 MED OTHER DIGESTIVE SYSTEM .5640 2.7 3.7 27
DIAGNOSES AGE >17 W/O
CC.
190......... 06 MED OTHER DIGESTIVE SYSTEM .8769 3.9 5.1 28
DIAGNOSES AGE 0-17.
191......... 07 SURG PANCREAS, LIVER & SHUNT 4.4543 12.1 16.3 36
PROCEDURES W CC.
192......... 07 SURG PANCREAS, LIVER & SHUNT 1.7889 6.2 7.9 30
PROCEDURES W/O CC.
193......... 07 SURG BILIARY TRACT PROC 3.2878 11.4 13.9 35
EXCEPT ONLY CHOLECYST
W OR W/O C.D.E. W CC.
194......... 07 SURG BILIARY TRACT PROC 1.7549 6.8 8.5 31
EXCEPT ONLY CHOLECYST
W OR W/O C.D.E. W/O CC.
195......... 07 SURG CHOLECYSTECTOMY W 2.6894 8.8 10.5 33
C.D.E. W CC.
196......... 07 SURG CHOLECYSTECTOMY W 1.6127 5.8 6.7 30
C.D.E. W/O CC.
197......... 07 SURG CHOLECYSTECTOMY EXCEPT 2.2679 7.5 9.2 31
BY LAPAROSCOPE W/O
C.D.E. W CC.
198......... 07 SURG CHOLECYSTECTOMY EXCEPT 1.1738 4.3 4.9 23
BY LAPAROSCOPE W/O
C.D.E. W/O CC.
[[Page 46270]]
199......... 07 SURG HEPATOBILIARY 2.3728 8.4 11.2 32
DIAGNOSTIC PROCEDURE
FOR MALIGNANCY.
200......... 07 SURG HEPATOBILIARY 3.1772 7.9 12.4 32
DIAGNOSTIC PROCEDURE
FOR NON-MALIGNANCY.
201......... 07 SURG OTHER HEPATOBILIARY OR 3.7669 12.1 16.8 36
PANCREAS O.R.
PROCEDURES.
202......... 07 MED CIRRHOSIS & ALCOHOLIC 1.3675 5.7 7.8 30
HEPATITIS.
203......... 07 MED MALIGNANCY OF 1.2486 5.5 7.7 30
HEPATOBILIARY SYSTEM
OR PANCREAS.
204......... 07 MED DISORDERS OF PANCREAS 1.2004 5.1 6.8 29
EXCEPT MALIGNANCY.
205......... 07 MED DISORDERS OF LIVER 1.2194 5.3 7.3 29
EXCEPT MALIG, CIRR,
ALC HEPA W CC.
206......... 07 MED DISORDERS OF LIVER .7159 3.6 4.7 28
EXCEPT MALIG, CIRR,
ALC HEPA W/O CC.
207......... 07 MED DISORDERS OF THE 1.0508 4.4 5.8 28
BILIARY TRACT W CC.
208......... 07 MED DISORDERS OF THE .6045 2.6 3.5 21
BILIARY TRACT W/O CC.
209......... 08 SURG MAJOR JOINT & LIMB 2.2606 5.9 6.7 23
REATTACHMENT
PROCEDURES OF LOWER
EXTREMITY.
210......... 08 SURG HIP & FEMUR PROCEDURES 1.8460 7.2 8.6 31
EXCEPT MAJOR JOINT AGE
>17 W CC.
211......... 08 SURG HIP & FEMUR PROCEDURES 1.2740 5.6 6.3 23
EXCEPT MAJOR JOINT AGE
>17 W/O CC.
212......... 08 SURG *HIP & FEMUR PROCEDURES 1.1487 11.1 11.1 35
EXCEPT MAJOR JOINT AGE
0-17.
213......... 08 SURG AMPUTATION FOR 1.7049 7.0 9.7 31
MUSCULOSKELETAL SYSTEM
& CONN TISSUE
DISORDERS.
214......... 08 SURG BACK & NECK PROCEDURES 1.9255 4.9 6.5 29
W CC.
215......... 08 SURG BACK & NECK PROCEDURES 1.1119 3.0 3.7 20
W/O CC.
216......... 08 SURG BIOPSIES OF 2.0784 7.9 11.1 32
MUSCULOSKELETAL SYSTEM
& CONNECTIVE TISSUE.
217......... 08 SURG WND DEBRID & SKN GRFT 2.8812 10.2 15.4 34
EXCEPT HAND, FOR
MUSCSKELET & CONN TISS
DIS.
218......... 08 SURG LOWER EXTREM & HUMER 1.4574 4.8 6.2 29
PROC EXCEPT HIP, FOOT,
FEMUR AGE >17 W CC.
219......... 08 SURG LOWER EXTREM & HUMER .9553 3.1 3.8 19
PROC EXCEPT HIP, FOOT,
FEMUR AGE >17 W/O CC.
220......... 08 SURG *LOWER EXTREM & HUMER .5706 5.3 5.3 29
PROC EXCEPT HIP, FOOT,
FEMUR AGE 0-17.
221......... 08 SURG KNEE PROCEDURES W CC... 1.8340 5.8 8.1 30
222......... 08 SURG KNEE PROCEDURES W/O CC. 1.0177 3.1 4.0 27
223......... 08 SURG MAJOR SHOULDER/ELBOW .8720 2.2 2.9 16
PROC, OR OTHER UPPER
EXTREMITY PROC W CC.
224......... 08 SURG SHOULDER, ELBOW OR .7417 1.9 2.3 10
FOREARM PROC, EXC
MAJOR JOINT PROC, W/O
CC.
225......... 08 SURG FOOT PROCEDURES........ 1.0020 3.3 5.0 27
226......... 08 SURG SOFT TISSUE PROCEDURES 1.3831 4.4 6.7 28
W CC.
227......... 08 SURG SOFT TISSUE PROCEDURES .7449 2.3 3.0 18
W/O CC.
228......... 08 SURG MAJOR THUMB OR JOINT .9349 2.3 3.5 26
PROC, OR OTH HAND OR
WRIST PROC W CC.
229......... 08 SURG HAND OR WRIST PROC, .6512 1.8 2.4 13
EXCEPT MAJOR JOINT
PROC, W/O CC.
230......... 08 SURG LOCAL EXCISION & 1.0567 3.3 5.2 27
REMOVAL OF INT FIX
DEVICES OF HIP & FEMUR.
231......... 08 SURG LOCAL EXCISION & 1.2263 3.3 5.1 27
REMOVAL OF INT FIX
DEVICES EXCEPT HIP &
FEMUR.
232......... 08 SURG ARTHROSCOPY............ 1.0884 2.6 4.5 27
233......... 08 SURG OTHER MUSCULOSKELET SYS 2.0170 6.4 9.1 30
& CONN TISS O.R. PROC
W CC.
234......... 08 SURG OTHER MUSCULOSKELET SYS 1.0675 3.1 4.1 27
& CONN TISS O.R. PROC
W/O CC.
235......... 08 MED FRACTURES OF FEMUR..... .8395 4.7 6.9 29
236......... 08 MED FRACTURES OF HIP & .7620 4.7 6.4 29
PELVIS.
237......... 08 MED SPRAINS, STRAINS, & .5637 3.3 4.4 27
DISLOCATIONS OF HIP,
PELVIS & THIGH.
238......... 08 MED OSTEOMYELITIS.......... 1.3796 7.6 10.1 32
239......... 08 MED PATHOLOGICAL FRACTURES 1.0115 5.8 7.6 30
& MUSCULOSKELETAL &
CONN TISS MALIGNANCY.
240......... 08 MED CONNECTIVE TISSUE 1.2112 5.5 7.5 30
DISORDERS W CC.
241......... 08 MED CONNECTIVE TISSUE .6029 3.5 4.6 28
DISORDERS W/O CC.
242......... 08 MED SEPTIC ARTHRITIS....... 1.0492 5.8 7.7 30
[[Page 46271]]
243......... 08 MED MEDICAL BACK PROBLEMS.. .7241 4.3 5.6 28
244......... 08 MED BONE DISEASES & .7279 4.3 5.8 28
SPECIFIC ARTHROPATHIES
W CC.
245......... 08 MED BONE DISEASES & .4954 3.2 4.3 27
SPECIFIC ARTHROPATHIES
W/O CC.
246......... 08 MED NON-SPECIFIC .5887 3.6 4.6 28
ARTHROPATHIES.
247......... 08 MED SIGNS & SYMPTOMS OF .5523 2.9 4.0 27
MUSCULOSKELETAL SYSTEM
& CONN TISSUE.
248......... 08 MED TENDONITIS, MYOSITIS & .7325 3.9 5.3 28
BURSITIS.
249......... 08 MED AFTERCARE, .6522 2.9 4.3 27
MUSCULOSKELETAL SYSTEM
& CONNECTIVE TISSUE.
250......... 08 MED FX, SPRN, STRN & DISL .6915 3.6 5.1 28
OF FOREARM, HAND, FOOT
AGE >17 W CC.
251......... 08 MED FX, SPRN, STRN & DISL .4640 2.5 3.3 22
OF FOREARM, HAND, FOOT
AGE >17 W/O CC.
252......... 08 MED *FX, SPRN, STRN & DISL .2479 1.8 1.8 15
OF FOREARM, HAND, FOOT
AGE 0-17.
253......... 08 MED FX, SPRN, STRN & DISL .7438 4.3 5.8 28
OF UPARM, LOWLEG EX
FOOT AGE >17 W CC.
254......... 08 MED FX, SPRN, STRN & DISL .4451 2.9 3.9 25
OF UPARM, LOWLEG EX
FOOT AGE >17 W/O CC.
255......... 08 MED *FX, SPRN, STRN & DISL .2886 2.9 2.9 27
OF UPARM, LOWLEG EX
FOOT AGE 0-17.
256......... 08 MED OTHER MUSCULOSKELETAL .7651 4.0 5.7 28
SYSTEM & CONNECTIVE
TISSUE DIAGNOSES.
257......... 09 SURG TOTAL MASTECTOMY FOR .9015 2.8 3.4 17
MALIGNANCY W CC.
258......... 09 SURG TOTAL MASTECTOMY FOR .7087 2.2 2.5 10
MALIGNANCY W/O CC.
259......... 09 SURG SUBTOTAL MASTECTOMY FOR .8640 2.3 3.5 26
MALIGNANCY W CC.
260......... 09 SURG SUBTOTAL MASTECTOMY FOR .6083 1.6 1.9 8
MALIGNANCY W/O CC.
261......... 09 SURG BREAST PROC FOR NON- .8286 1.9 2.3 12
MALIGNANCY EXCEPT
BIOPSY & LOCAL
EXCISION.
262......... 09 SURG BREAST BIOPSY & LOCAL .7695 2.7 3.9 27
EXCISION FOR NON-
MALIGNANCY.
263......... 09 SURG SKIN GRAFT &/OR DEBRID 2.1226 9.9 13.9 34
FOR SKIN ULCER OR
CELLULITIS W CC.
264......... 09 SURG SKIN GRAFT &/OR DEBRID 1.1270 6.0 8.3 30
FOR SKIN ULCER OR
CELLULITIS W/O CC.
265......... 09 SURG SKIN GRAFT &/OR DEBRID 1.4993 4.8 7.7 29
EXCEPT FOR SKIN ULCER
OR CELLULITIS W CC.
266......... 09 SURG SKIN GRAFT &/OR DEBRID .7629 2.7 3.7 27
EXCEPT FOR SKIN ULCER
OR CELLULITIS W/O CC.
267......... 09 SURG PERIANAL & PILONIDAL .8330 2.8 4.3 27
PROCEDURES.
268......... 09 SURG SKIN, SUBCUTANEOUS .9916 2.5 4.1 27
TISSUE & BREAST
PLASTIC PROCEDURES.
269......... 09 SURG OTHER SKIN, SUBCUT TISS 1.6416 6.3 9.3 30
& BREAST PROC W CC.
270......... 09 SURG OTHER SKIN, SUBCUT TISS .7003 2.4 3.4 26
& BREAST PROC W/O CC.
271......... 09 MED SKIN ULCERS............ 1.0816 6.6 8.5 31
272......... 09 MED MAJOR SKIN DISORDERS W 1.0158 5.6 7.5 30
CC.
273......... 09 MED MAJOR SKIN DISORDERS W/ .6346 4.1 5.5 28
O CC.
274......... 09 MED MALIGNANT BREAST 1.0760 5.3 7.9 29
FR Doc. 96-22145 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1997 Rates
DISORDERS W CC.
275......... 09 MED MALIGNANT BREAST .5085 2.5 3.7 27
DISORDERS W/O CC.
276......... 09 MED NON-MALIGNANT BREAST .6374 3.9 5.0 28
DISORDERS.
277......... 09 MED CELLULITIS AGE >17 W CC .8526 5.5 6.7 29
278......... 09 MED CELLULITIS AGE >17 W/O .5774 4.3 5.2 25
CC.
279......... 09 MED *CELLULITIS AGE 0-17... .7190 4.2 4.2 24
280......... 09 MED TRAUMA TO THE SKIN, .6750 3.7 5.1 28
SUBCUT TISS & BREAST
AGE >17 W CC.
281......... 09 MED TRAUMA TO THE SKIN, .4560 2.7 3.6 24
SUBCUT TISS & BREAST
AGE >17 W/O CC.
282......... 09 MED *TRAUMA TO THE SKIN, .2509 2.2 2.2 19
SUBCUT TISS & BREAST
AGE 0-17.
283......... 09 MED MINOR SKIN DISORDERS W .6990 4.1 5.5 28
CC.
284......... 09 MED MINOR SKIN DISORDERS W/ .4340 2.9 3.8 26
O CC.
285......... 10 SURG AMPUTAT OF LOWER LIMB 2.2015 9.5 13.7 34
FOR ENDOCRINE, NUTRIT,
& METABOL DISORDERS.
286......... 10 SURG ADRENAL & PITUITARY 2.3775 6.6 8.7 31
PROCEDURES.
287......... 10 SURG SKIN GRAFTS & WOUND 1.9765 9.4 13.4 33
DEBRID FOR ENDOC,
NUTRIT & METAB
DISORDERS.
288......... 10 SURG O.R. PROCEDURES FOR 2.0104 5.2 6.9 29
OBESITY.
289......... 10 SURG PARATHYROID PROCEDURES. 1.0198 2.7 4.0 27
290......... 10 SURG THYROID PROCEDURES..... .8798 2.1 2.8 15
[[Page 46272]]
291......... 10 SURG THYROGLOSSAL PROCEDURES .5189 1.4 1.8 8
292......... 10 SURG OTHER ENDOCRINE, NUTRIT 2.6450 8.4 12.8 32
& METAB O.R. PROC W CC.
293......... 10 SURG OTHER ENDOCRINE, NUTRIT 1.2671 4.6 6.8 29
& METAB O.R. PROC W/O
CC.
294......... 10 MED DIABETES AGE >35....... .7594 4.3 5.7 28
295......... 10 MED DIABETES AGE 0-35...... .7159 3.3 4.3 27
296......... 10 MED NUTRITIONAL & MISC .8929 4.7 6.4 29
METABOLIC DISORDERS
AGE >17 W CC.
297......... 10 MED NUTRITIONAL & MISC .5364 3.3 4.3 26
METABOLIC DISORDERS
AGE >17 W/O CC.
298......... 10 MED NUTRITIONAL & MISC .5221 2.5 3.4 23
METABOLIC DISORDERS
AGE 0-17.
299......... 10 MED INBORN ERRORS OF .8330 3.9 5.4 28
METABOLISM.
300......... 10 MED ENDOCRINE DISORDERS W 1.0950 5.5 7.3 30
CC.
301......... 10 MED ENDOCRINE DISORDERS W/O .6182 3.4 4.4 27
CC.
302......... 11 SURG KIDNEY TRANSPLANT...... 3.9047 10.4 12.3 34
303......... 11 SURG KIDNEY, URETER & MAJOR 2.6409 8.4 10.2 32
BLADDER PROCEDURES FOR
NEOPLASM.
304......... 11 SURG KIDNEY, URETER & MAJOR 2.3716 7.5 10.3 31
BLADDER PROC FOR NON-
NEOPL W CC.
305......... 11 SURG KIDNEY, URETER & MAJOR 1.1776 3.9 4.9 28
BLADDER PROC FOR NON-
NEOPL W/O CC.
306......... 11 SURG PROSTATECTOMY W CC..... 1.2258 4.3 6.2 28
307......... 11 SURG PROSTATECTOMY W/O CC... .6708 2.4 3.0 15
308......... 11 SURG MINOR BLADDER 1.5252 4.7 7.0 29
PROCEDURES W CC.
309......... 11 SURG MINOR BLADDER .8860 2.3 3.0 18
PROCEDURES W/O CC.
310......... 11 SURG TRANSURETHRAL 1.0015 3.2 4.6 27
PROCEDURES W CC.
311......... 11 SURG TRANSURETHRAL .5670 1.8 2.2 11
PROCEDURES W/O CC.
312......... 11 SURG URETHRAL PROCEDURES, .9124 3.2 4.8 27
AGE >17 W CC.
313......... 11 SURG URETHRAL PROCEDURES, .5223 1.8 2.3 13
AGE >17 W/O CC.
314......... 11 SURG *URETHRAL PROCEDURES, .4836 2.3 2.3 26
AGE 0-17.
315......... 11 SURG OTHER KIDNEY & URINARY 2.0574 5.3 9.3 29
TRACT O.R. PROCEDURES.
316......... 11 MED RENAL FAILURE.......... 1.3034 5.4 7.6 29
317......... 11 MED ADMIT FOR RENAL .4845 1.9 2.9 20
DIALYSIS.
318......... 11 MED KIDNEY & URINARY TRACT 1.1296 5.0 7.2 29
NEOPLASMS W CC.
319......... 11 MED KIDNEY & URINARY TRACT .5772 2.3 3.2 24
NEOPLASMS W/O CC.
320......... 11 MED KIDNEY & URINARY TRACT .9048 5.1 6.4 29
INFECTIONS AGE >17 W
CC.
321......... 11 MED KIDNEY & URINARY TRACT .6077 3.9 4.7 24
INFECTIONS AGE >17 W/O
CC.
322......... 11 MED KIDNEY & URINARY TRACT .5133 3.6 4.4 23
INFECTIONS AGE 0-17.
323......... 11 MED URINARY STONES W CC, &/ .7496 2.7 3.6 24
OR ESW LITHOTRIPSY.
324......... 11 MED URINARY STONES W/O CC.. .4159 1.7 2.1 10
325......... 11 MED KIDNEY & URINARY TRACT .6377 3.4 4.6 27
SIGNS & SYMPTOMS AGE
>17 W CC.
326......... 11 MED KIDNEY & URINARY TRACT .4320 2.4 3.4 19
SIGNS & SYMPTOMS AGE
>17 W/O CC.
327......... 11 MED *KIDNEY & URINARY TRACT .2341 3.1 3.1 27
SIGNS & SYMPTOMS AGE 0-
17.
328......... 11 MED URETHRAL STRICTURE AGE .6886 3.1 4.3 27
>17 W CC.
329......... 11 MED URETHRAL STRICTURE AGE .4567 2.1 2.8 17
>17 W/O CC.
330......... 11 MED *URETHRAL STRICTURE AGE .3115 1.6 1.6 9
0-17.
331......... 11 MED OTHER KIDNEY & URINARY .9914 4.6 6.2 29
TRACT DIAGNOSES AGE
>17 W CC.
332......... 11 MED OTHER KIDNEY & URINARY .6070 2.8 3.9 27
TRACT DIAGNOSES AGE
>17 W/O CC.
333......... 11 MED OTHER KIDNEY & URINARY .8562 4.3 5.8 28
TRACT DIAGNOSES AGE 0-
17.
334......... 12 SURG MAJOR MALE PELVIC 1.6653 5.3 6.1 23
PROCEDURES W CC.
335......... 12 SURG MAJOR MALE PELVIC 1.2610 4.2 4.6 17
PROCEDURES W/O CC.
336......... 12 SURG TRANSURETHRAL .8848 3.2 4.1 24
PROSTATECTOMY W CC.
337......... 12 SURG TRANSURETHRAL .6147 2.3 2.7 11
PROSTATECTOMY W/O CC.
338......... 12 SURG TESTES PROCEDURES, FOR 1.0499 3.5 5.3 27
MALIGNANCY.
339......... 12 SURG TESTES PROCEDURES, NON- 1.0194 3.1 5.3 27
MALIGNANCY AGE >17.
340......... 12 SURG *TESTES PROCEDURES, NON- .2769 2.4 2.4 13
MALIGNANCY AGE 0-17.
341......... 12 SURG PENIS PROCEDURES....... 1.0745 2.3 3.3 21
342......... 12 SURG CIRCUMCISION AGE >17... .7578 2.7 4.0 27
343......... 12 SURG *CIRCUMCISION AGE 0-17. .1504 1.7 1.7 6
[[Page 46273]]
344......... 12 SURG OTHER MALE REPRODUCTIVE 1.0083 2.3 3.5 25
SYSTEM O.R. PROCEDURES
FOR MALIGNANCY.
345......... 12 SURG OTHER MALE REPRODUCTIVE .8422 2.8 4.0 27
SYSTEM O.R. PROC
EXCEPT FOR MALIGNANCY.
346......... 12 MED MALIGNANCY, MALE .9559 4.8 6.8 29
REPRODUCTIVE SYSTEM, W
CC.
347......... 12 MED MALIGNANCY, MALE .5096 2.4 3.3 25
REPRODUCTIVE SYSTEM, W/
O CC.
348......... 12 MED BENIGN PROSTATIC .7107 3.6 4.9 28
HYPERTROPHY W CC.
349......... 12 MED BENIGN PROSTATIC .3974 2.2 3.0 20
HYPERTROPHY W/O CC.
350......... 12 MED INFLAMMATION OF THE .6611 3.9 4.8 24
MALE REPRODUCTIVE
SYSTEM.
351......... 12 MED *STERILIZATION, MALE... .2309 1.3 1.3 5
352......... 12 MED OTHER MALE REPRODUCTIVE .5877 2.8 3.9 27
SYSTEM DIAGNOSES.
353......... 13 SURG PELVIC EVISCERATION, 1.9174 6.7 8.3 31
RADICAL HYSTERECTOMY &
RADICAL VULVECTOMY.
354......... 13 SURG UTERINE, ADNEXA PROC 1.4643 5.2 6.3 28
FOR NON-OVARIAN/
ADNEXAL MALIG W CC.
355......... 13 SURG UTERINE, ADNEXA PROC .9056 3.6 3.9 11
FOR NON-OVARIAN/
ADNEXAL MALIG W/O CC.
356......... 13 SURG FEMALE REPRODUCTIVE .7376 2.6 3.0 12
SYSTEM RECONSTRUCTIVE
PROCEDURES.
357......... 13 SURG UTERINE & ADNEXA PROC 2.3824 8.0 9.8 32
FOR OVARIAN OR ADNEXAL
MALIGNANCY.
358......... 13 SURG UTERINE & ADNEXA PROC 1.1713 4.1 4.8 19
FOR NON-MALIGNANCY W
CC.
359......... 13 SURG UTERINE & ADNEXA PROC .8285 3.0 3.3 10
FOR NON-MALIGNANCY W/O
CC.
360......... 13 SURG VAGINA, CERVIX & VULVA .8459 2.9 3.5 17
PROCEDURES.
361......... 13 SURG LAPAROSCOPY & 1.1148 2.5 3.5 23
INCISIONAL TUBAL
INTERRUPTION.
362......... 13 SURG *ENDOSCOPIC TUBAL .2951 1.4 1.4 5
INTERRUPTION.
363......... 13 SURG D&C, CONIZATION & RADIO- .6911 2.6 3.5 21
IMPLANT, FOR
MALIGNANCY.
364......... 13 SURG D&C, CONIZATION EXCEPT .6739 2.6 3.6 27
FOR MALIGNANCY.
365......... 13 SURG OTHER FEMALE 1.7237 5.3 8.1 29
REPRODUCTIVE SYSTEM
O.R. PROCEDURES.
366......... 13 MED MALIGNANCY, FEMALE 1.1941 5.3 7.8 29
REPRODUCTIVE SYSTEM W
CC.
367......... 13 MED MALIGNANCY, FEMALE .5216 2.3 3.2 24
REPRODUCTIVE SYSTEM W/
O CC.
368......... 13 MED INFECTIONS, FEMALE 1.0230 5.3 6.9 29
REPRODUCTIVE SYSTEM.
369......... 13 MED MENSTRUAL & OTHER .5454 2.6 3.7 27
FEMALE REPRODUCTIVE
SYSTEM DISORDERS.
370......... 14 SURG CESAREAN SECTION W CC.. 1.0401 4.3 5.6 26
371......... 14 SURG CESAREAN SECTION W/O CC .6838 3.2 3.6 11
372......... 14 MED VAGINAL DELIVERY W .5439 2.4 3.4 20
COMPLICATING DIAGNOSES.
373......... 14 MED VAGINAL DELIVERY W/O .3602 1.7 1.9 7
COMPLICATING DIAGNOSES.
374......... 14 SURG VAGINAL DELIVERY W .6775 2.0 2.6 11
STERILIZATION &/OR D&C.
375......... 14 SURG *VAGINAL DELIVERY W .6698 4.4 4.4 28
O.R. PROC EXCEPT
STERIL &/OR D&C.
376......... 14 MED POSTPARTUM & POST .5638 2.3 3.4 25
ABORTION DIAGNOSES W/O
O.R. PROCEDURE.
377......... 14 SURG POSTPARTUM & POST .8188 2.1 3.3 26
ABORTION DIAGNOSES W
O.R. PROCEDURE.
378......... 14 MED ECTOPIC PREGNANCY...... .8054 2.4 2.9 15
379......... 14 MED THREATENED ABORTION.... .3591 2.0 3.0 21
380......... 14 MED ABORTION W/O D&C....... .4775 1.7 2.3 12
381......... 14 SURG ABORTION W D&C, .5151 1.7 2.3 14
ASPIRATION CURETTAGE
OR HYSTEROTOMY.
382......... 14 MED FALSE LABOR............ .2013 1.3 1.6 6
383......... 14 MED OTHER ANTEPARTUM .4655 2.8 4.1 27
DIAGNOSES W MEDICAL
COMPLICATIONS.
384......... 14 MED OTHER ANTEPARTUM .3921 1.8 3.1 22
DIAGNOSES W/O MEDICAL
COMPLICATIONS.
385......... 15 ................ *NEONATES, DIED OR 1.3443 1.8 1.8 26
TRANSFERRED TO ANOTHER
ACUTE CARE FACILITY.
386......... 15 ................ *EXTREME IMMATURITY OR 4.4329 17.9 17.9 42
RESPIRATORY DISTRESS
SYNDROME, NEONATE.
387......... 15 ................ *PREMATURITY W MAJOR 3.0276 13.3 13.3 37
PROBLEMS.
388......... 15 ................ *PREMATURITY W/O MAJOR 1.8268 8.6 8.6 33
PROBLEMS.
389......... 15 ................ FULL TERM NEONATE W 2.2451 7.9 10.7 32
MAJOR PROBLEMS.
390......... 15 ................ NEONATE W OTHER 1.2845 3.6 4.7 28
SIGNIFICANT PROBLEMS.
[[Page 46274]]
391......... 15 ................ *NORMAL NEWBORN........ .1490 3.1 3.1 11
392......... 16 SURG SPLENECTOMY AGE >17.... 3.2443 8.9 11.7 33
393......... 16 SURG *SPLENECTOMY AGE 0-17.. 1.3168 9.1 9.1 33
394......... 16 SURG OTHER O.R. PROCEDURES 1.5994 4.5 8.0 28
OF THE BLOOD AND BLOOD
FORMING ORGANS.
395......... 16 MED RED BLOOD CELL .8362 3.9 5.4 28
DISORDERS AGE >17.
396......... 16 MED RED BLOOD CELL .6966 2.7 3.8 27
DISORDERS AGE 0-17.
397......... 16 MED COAGULATION DISORDERS.. 1.2612 4.4 6.1 28
398......... 16 MED RETICULOENDOTHELIAL & 1.2106 5.2 6.6 29
IMMUNITY DISORDERS W
CC.
399......... 16 MED RETICULOENDOTHELIAL & .7030 3.5 4.4 27
IMMUNITY DISORDERS W/O
CC.
400......... 17 SURG LYMPHOMA & LEUKEMIA W 2.5572 6.7 10.4 31
MAJOR O.R. PROCEDURE.
401......... 17 SURG LYMPHOMA & NON-ACUTE 2.4834 8.5 12.4 32
LEUKEMIA W OTHER O.R.
PROC W CC.
402......... 17 SURG LYMPHOMA & NON-ACUTE 1.0255 3.1 4.7 27
LEUKEMIA W OTHER O.R.
PROC W/O CC.
403......... 17 MED LYMPHOMA & NON-ACUTE 1.6925 6.5 9.3 30
LEUKEMIA W CC.
404......... 17 MED LYMPHOMA & NON-ACUTE .8059 3.7 5.1 28
LEUKEMIA W/O CC.
405......... 17 ................ *ACUTE LEUKEMIA W/O 1.8669 4.9 4.9 29
MAJOR O.R. PROCEDURE
AGE 0-17.
406......... 17 SURG MYELOPROLIF DISORD OR 2.6841 8.1 11.3 32
POORLY DIFF NEOPL W
MAJ O.R. PROC W CC.
407......... 17 SURG MYELOPROLIF DISORD OR 1.1787 3.8 4.9 28
POORLY DIFF NEOPL W
MAJ O.R. PROC W/O CC.
408......... 17 SURG MYELOPROLIF DISORD OR 1.7393 5.0 8.2 29
POORLY DIFF NEOPL W
OTHER O.R. PROC.
409......... 17 MED RADIOTHERAPY........... .9763 4.7 6.7 29
410......... 17 MED CHEMOTHERAPY W/O ACUTE .7514 2.6 3.4 20
LEUKEMIA AS SECONDARY
DIAGNOSIS.
411......... 17 MED HISTORY OF MALIGNANCY W/ .3837 2.1 2.7 16
O ENDOSCOPY.
412......... 17 MED HISTORY OF MALIGNANCY W .4080 2.1 3.0 23
ENDOSCOPY.
413......... 17 MED OTHER MYELOPROLIF DIS 1.3257 6.0 8.4 30
OR POORLY DIFF NEOPL
DIAG W CC.
414......... 17 MED OTHER MYELOPROLIF DIS .7337 3.7 5.2 28
OR POORLY DIFF NEOPL
DIAG W/O CC.
415......... 18 SURG O.R. PROCEDURE FOR 3.4430 11.4 15.8 35
INFECTIOUS & PARASITIC
DISEASES.
416......... 18 MED SEPTICEMIA AGE >17..... 1.4838 6.2 8.3 30
417......... 18 MED SEPTICEMIA AGE 0-17.... .8089 3.7 4.6 28
418......... 18 MED POSTOPERATIVE & POST- .9697 5.4 6.8 29
TRAUMATIC INFECTIONS.
419......... 18 MED FEVER OF UNKNOWN ORIGIN .8991 4.4 5.7 28
AGE >17 W CC.
420......... 18 MED FEVER OF UNKNOWN ORIGIN .6264 3.5 4.3 24
AGE >17 W/O CC.
421......... 18 MED VIRAL ILLNESS AGE >17.. .7153 3.6 4.7 28
422......... 18 MED VIRAL ILLNESS & FEVER .5347 2.9 3.8 25
OF UNKNOWN ORIGIN AGE
0-17.
423......... 18 MED OTHER INFECTIOUS & 1.5947 6.3 8.8 30
PARASITIC DISEASES
DIAGNOSES.
424......... 19 SURG O.R. PROCEDURE W 2.3637 10.9 18.0 35
PRINCIPAL DIAGNOSES OF
MENTAL ILLNESS.
425......... 19 MED ACUTE ADJUST REACT & .7051 3.5 4.9 27
DISTURBANCES OF
PSYCHOSOCIAL
DYSFUNCTION.
426......... 19 MED DEPRESSIVE NEUROSES.... .5680 3.9 5.5 28
427......... 19 MED NEUROSES EXCEPT .5495 3.7 5.2 28
DEPRESSIVE.
428......... 19 MED DISORDERS OF .7303 5.2 8.4 29
PERSONALITY & IMPULSE
CONTROL.
429......... 19 MED ORGANIC DISTURBANCES & .9075 5.9 9.0 30
MENTAL RETARDATION.
430......... 19 MED PSYCHOSES.............. .8391 6.9 9.8 31
431......... 19 MED CHILDHOOD MENTAL .6556 4.9 7.2 29
DISORDERS.
432......... 19 MED OTHER MENTAL DISORDER .7363 3.9 6.5 28
DIAGNOSES.
433......... 20 ................ ALCOHOL/DRUG ABUSE OR .2986 2.5 3.4 25
DEPENDENCE, LEFT AMA.
434......... 20 ................ ALC/DRUG ABUSE OR .7141 4.3 5.8 28
DEPEND, DETOX OR OTH
SYMPT TREAT W CC.
435......... 20 ................ ALC/DRUG ABUSE OR .4164 3.8 4.8 28
DEPEND, DETOX OR OTH
SYMPT TREAT W/O CC.
436......... 20 ................ ALC/DRUG DEPENDENCE W .8183 12.1 14.8 36
REHABILITATION THERAPY.
437......... 20 ................ ALC/DRUG DEPENDENCE, .7657 9.2 10.9 33
COMBINED REHAB & DETOX
THERAPY.
438......... NO LONGER VALID........ .0000 .0 .0 0
439......... 21 SURG SKIN GRAFTS FOR 1.6144 5.9 8.9 30
INJURIES.
[[Page 46275]]
440......... 21 SURG W/OUND DEBRIDEMENTS FOR 1.7725 6.3 9.9 30
INJURIES.
441......... 21 SURG HAND PROCEDURES FOR .9294 2.4 4.4 26
INJURIES.
442......... 21 SURG OTHER O.R. PROCEDURES 2.1653 5.6 8.7 30
FOR INJURIES W CC.
443......... 21 SURG OTHER O.R. PROCEDURES .8849 2.5 3.6 26
FOR INJURIES W/O CC.
444......... 21 MED TRAUMATIC INJURY AGE .7312 4.0 5.3 28
>17 W CC.
445......... 21 MED TRAUMATIC INJURY AGE .4845 2.9 3.9 25
>17 W/O CC.
446......... 21 MED *TRAUMATIC INJURY AGE 0- .2894 2.4 2.4 22
17.
447......... 21 MED ALLERGIC REACTIONS AGE .4918 2.1 2.8 17
>17.
448......... 21 MED ALLERGIC REACTIONS AGE .0777 1.0 1.0 1
0-17.
449......... 21 MED POISONING & TOXIC .7902 3.0 4.5 27
EFFECTS OF DRUGS AGE
>17 W CC.
450......... 21 MED POISONING & TOXIC .4274 1.8 2.3 13
EFFECTS OF DRUGS AGE
>17 W/O CC.
451......... 21 MED *POISONING & TOXIC .2570 2.1 2.1 17
EFFECTS OF DRUGS AGE 0-
17.
452......... 21 MED COMPLICATIONS OF .9473 3.8 5.4 28
TREATMENT W CC.
453......... 21 MED COMPLICATIONS OF .4822 2.4 3.2 20
TREATMENT W/O CC.
454......... 21 MED OTHER INJURY, POISONING .8575 3.4 5.1 27
& TOXIC EFFECT DIAG W
CC.
455......... 21 MED OTHER INJURY, POISONING .4467 2.1 2.8 18
& TOXIC EFFECT DIAG W/
O CC.
456......... 22 MED BURNS, TRANSFERRED TO 1.8327 4.1 8.4 28
ANOTHER ACUTE CARE
FACILITY.
457......... 22 MED EXTENSIVE BURNS W/O 1.4657 2.4 4.8 26
O.R. PROCEDURE.
458......... 22 SURG NON-EXTENSIVE BURNS W 3.4991 11.9 16.9 36
SKIN GRAFT.
459......... 22 SURG NON-EXTENSIVE BURNS W W/ 1.6538 6.7 10.3 31
OUND DEBRIDEMENT OR
OTHER O.R. PROC.
460......... 22 MED NON-EXTENSIVE BURNS W/O .9547 4.6 6.6 29
O.R. PROCEDURE.
461......... 23 SURG O.R. PROC W DIAGNOSES .9963 2.5 4.9 27
OF OTHER CONTACT W
HEALTH SERVICES.
462......... 23 MED REHABILITATION......... 1.4298 11.0 13.9 35
463......... 23 MED SIGNS & SYMPTOMS W CC.. .7101 3.8 5.2 28
464......... 23 MED SIGNS & SYMPTOMS W/O CC .5028 2.8 3.8 24
465......... 23 MED AFTERCARE W HISTORY OF .5571 2.3 3.9 26
MALIGNANCY AS
SECONDARY DIAGNOSIS.
466......... 23 MED AFTERCARE W/O HISTORY .5905 2.5 4.8 27
OF MALIGNANCY AS
SECONDARY DIAGNOSIS.
467......... 23 MED OTHER FACTORS .4588 2.4 4.1 26
INFLUENCING HEALTH
STATUS.
468......... ................ EXTENSIVE O.R. 3.6028 10.6 15.3 35
PROCEDURE UNRELATED TO
PRINCIPAL DIAGNOSIS.
469......... ................ **PRINCIPAL DIAGNOSIS .0000 .0 .0 0
INVALID AS DISCHARGE
DIAGNOSIS.
470......... ................ **UNGROUPABLE.......... .0000 .0 .0 0
471......... 08 SURG BILATERAL OR MULTIPLE 3.5980 6.8 8.1 31
MAJOR JOINT PROCS OF
LOWER EXTREMITY.
472......... 22 SURG EXTENSIVE BURNS W O.R. 10.9989 17.0 30.2 41
PROCEDURE.
473......... 17 ................ ACUTE LEUKEMIA W/O 3.5740 8.5 14.7 33
MAJOR O.R. PROCEDURE
AGE >17.
474......... ................ NO LONGER VALID........ .0000 .0 .0 0
475......... 04 MED RESPIRATORY SYSTEM 3.6765 8.6 12.3 33
DIAGNOSIS WITH
VENTILATOR SUPPORT.
476......... SURG PROSTATIC O.R. 2.2479 10.3 13.9 34
PROCEDURE UNRELATED TO
PRINCIPAL DIAGNOSIS.
477......... SURG NON-EXTENSIVE O.R. 1.7266 5.9 9.3 30
PROCEDURE UNRELATED TO
PRINCIPAL DIAGNOSIS.
478......... 05 SURG OTHER VASCULAR 2.2883 5.6 8.3 30
PROCEDURES W CC.
479......... 05 SURG OTHER VASCULAR 1.4080 3.5 4.6 27
PROCEDURES W/O CC.
480......... SURG LIVER TRANSPLANT....... 13.9424 26.4 32.6 50
481......... SURG BONE MARROW TRANSPLANT. 11.2299 29.7 32.6 54
482......... SURG TRACHEOSTOMY FOR FACE, 3.6578 11.4 14.9 35
MOUTH & NECK DIAGNOSES.
483......... SURG TRACHEOSTOMY EXCEPT FOR 16.0413 36.0 46.4 60
FACE, MOUTH & NECK
DIAGNOSES.
484......... 24 SURG CRANIOTOMY FOR MULTIPLE 5.6821 10.6 15.9 35
SIGNIFICANT TRAUMA.
485......... 24 SURG LIMB REATTACHMENT, HIP 3.2058 9.2 11.7 33
AND FEMUR PROC FOR
MULTIPLE SIGNIFICANT
TR.
486......... 24 SURG OTHER O.R. PROCEDURES 4.7915 9.0 13.6 33
FOR MULTIPLE
SIGNIFICANT TRAUMA.
487......... 24 MED OTHER MULTIPLE 2.0305 6.2 9.1 30
SIGNIFICANT TRAUMA.
488......... 25 SURG HIV W EXTENSIVE O.R. 4.7905 14.3 20.5 38
PROCEDURE.
489......... 25 MED HIV W MAJOR RELATED 1.8141 7.2 10.7 31
CONDITION.
[[Page 46276]]
490......... 25 MED HIV W OR W/O OTHER 1.0116 4.4 6.6 28
RELATED CONDITION.
491......... 08 SURG MAJOR JOINT & LIMB 1.6308 3.6 4.3 19
REATTACHMENT
PROCEDURES OF UPPER
EXTREMITY.
492......... 17 MED CHEMOTHERAPY W ACUTE 4.0299 11.2 17.4 35
LEUKEMIA AS SECONDARY
DIAGNOSIS.
493......... 07 SURG LAPAROSCOPIC 1.7100 4.2 5.9 28
CHOLECYSTECTOMY W/O
C.D.E. W CC.
494......... 07 SURG LAPAROSCOPIC .9169 1.8 2.4 15
CHOLECYSTECTOMY W/O
C.D.E. W/O CC.
495......... SURG LUNG TRANSPLANT........ 9.2870 18.0 22.7 42
----------------------------------------------------------------------------------------------------------------
* Medicare data have been supplemented by data from 19 States for low volume DRGS.
** DRGS 469 and 470 contain cases which could not be assigned to valid DRGS.
Note: Geometric mean is used only to determine payment for transfer cases.
Note: Arithmetic mean is used only to determine payment for outlier cases.
Note: Relative weights are based on Medicare patient data and may not be appropriate for other patients.
Table 6a.--New Diagnosis Codes
----------------------------------------------------------------------------------------------------------------
Diagnosis
code Description CC MDC DRG
----------------------------------------------------------------------------------------------------------------
079.6....... Respiratory syncytial virus (RSV)... N 15 387,\1\ 389 \1\
18 421, 422
291.81...... Alcohol withdrawal.................. Y 20 434, 435, 436, 437
291.89...... Other specified alcoholic psychosis, Y 20 434, 435, 436, 437
not elsewhere classified.
293.84...... Organic anxiety syndrome............ Y 19 429
300.82...... Undifferentiated somatoform disorder N 19 427
315.32...... Receptive language disorder (mixed). N 19 431
414.04...... Coronary atherosclerosis of artery N 5 132, 133
bypass graft.
414.05...... Coronary atherosclerosis of N 5 132, 133
unspecified type of bypass graft.
466.11...... Acute bronchiolitis due to N 4 96, 97, 98
respiratory syncytial virus (RSV).
466.19...... Acute bronchiolitis due to other N 4 96, 97, 98
infectious organisms.
483.1....... Pneumonia due to Chlamydia.......... Y 4 89, 90, 91
15 387,\1\ 389 \1\
574.60...... Calculus of gallbladder and bile Y 7 207, 208
duct with acute cholecystitis
without mention of obstruction.
574.61...... Calculus of gallbladder and bile Y 7 207, 208
duct with acute cholecystitis with
obstruction.
574.70...... Calculus of gallbladder and bile Y 7 207, 208
duct with other cholecystitis
without mention of obstruction.
574.71...... Calculus of gallbladder and bile Y 7 207, 208
duct with other cholecystitis with
obstruction.
574.80...... Calculus of gallbladder and bile Y 7 207, 208
duct with acute and chronic
cholecystitis without mention of
obstruction.
574.81...... Calculus of gallbladder and bile Y 7 207, 208
duct with acute and chronic
cholecystitis with obstruction.
574.90...... Calculus of gallbladder and bile Y 7 207, 208
duct without cholecystitis without
mention of obstruction.
574.91...... Calculus of gallbladder and bile Y 7 207, 208
duct without cholecystitis with
obstruction.
575.10...... Cholecystitis, unspecified.......... N 7 207, 208
575.11...... Chronic cholecystitis............... N 7 207, 208
575.12...... Acute and chronic cholecystitis..... Y 7 207, 208
752.51...... Undescended testis.................. N 12 352
15 391 \1\
752.52...... Retractile testis................... N 12 352
15 391 \1\
752.61...... Hypospadias......................... N 12 352
752.62...... Epispadias.......................... N 12 352
752.63...... Congenital chordee.................. N 12 352
752.64...... Micropenis.......................... N 12 352
752.65...... Hidden penis........................ N 12 352
752.69...... Other penile anomalies.............. N 12 352
753.20...... Unspecified obstructive defect of N 11 331, 332, 333
renal pelvis and ureter.
753.21...... Congenital obstruction of N 11 331, 332, 333
ureteropelvic junction.
753.22...... Congenital obstruction of N 11 331, 332, 333
ureterovesical junction.
753.23...... Congenital ureterocele.............. N 11 331, 332, 333
753.29...... Obstructive defects of renal pelvis N 11 331, 332, 333
and ureter, not elsewhere classifed.
758.81...... Other conditions due to sex N 12 352
chromosome anomalies. 13 358, 359, 369
758.89...... Other conditions due to chromosome N 12 352
anomalies, not elsewhere classified. 13 358, 359, 369
922.31...... Back contusion...................... N 9 280, 281, 282
24 484, 485, 486, 487
[[Page 46277]]
922.32...... Buttock contusion................... N 9 280, 281, 282
24 484, 485, 486, 487
922.33...... Interscapular region contusion...... N 9 280, 281, 282
24 484, 485, 486, 487
995.50...... Child abuse, unspecified............ N 21 454, 455
995.51...... Child emotional/psychological abuse. N 21 454, 455
995.52...... Child neglect (nutritional)......... N 21 454, 455
995.53...... Child sexual abuse.................. N 21 454, 455
995.54...... Child physical abuse................ N 21 454, 455
995.55...... Shaken infant syndrome.............. N 21 454, 455
995.59...... Other child abuse and neglect....... N 21 454, 455
995.80...... Adult maltreatment, unspecified..... N 21 454, 455
995.82...... Adult emotional/psychological abuse. N 21 454, 455
995.83...... Adult sexual abuse.................. N 21 454, 455
995.84...... Adult neglect (nutritional)......... N 21 454, 455
995.85...... Other adult abuse and neglect....... N 21 454, 455
998.11...... Hemorrhage complicating a procedure. Y 15 387,\1\ 389 \1\
21 452, 453
998.12...... Hematoma complicating a procedure... Y 15 387,\1\ 389 \1\
21 452, 453
998.13...... Seroma complicating a procedure..... Y 15 387,\1\ 389 \1\
21 452, 453
998.51...... Infected postoperative seroma....... Y 15 387,\1\ 389 \1\
18 418
998.59...... Other postoperative infection....... Y 15 387,\1\ 389 \1\
18 418
998.83...... Non-healing surgical wound.......... Y 21 452, 453
V15.41...... History of physical abuse........... N 23 467
V15.42...... History of emotional abuse.......... N 23 467
V15.49...... Psychological trauma, not elsewhere N 23 467
classified.
V61.10...... Counseling for marital and partner N 23 467
problems, unspecified.
V61.11...... Counseling for victim of spousal and N 23 467
partner abuse.
V61.12...... Counseling for perpetrator of N 23 467
spousal and partner abuse.
V61.22...... Counseling for perpetrator of N 23 467
parental child abuse.
V62.83...... Counseling for perpetrator of N 23 467
physical/sexual abuse.
V66.7....... Encounter for palliative care....... N 23 467
----------------------------------------------------------------------------------------------------------------
\1\ Diagnosis code is classified as a ``major problem'' in these DRGs.
Table 6b.--New Procedure Codes
----------------------------------------------------------------------------------------------------------------
Procedure
code Description OR MDC DRG
----------------------------------------------------------------------------------------------------------------
36.17....... Abdominal-coronary artery Y 5 106, 107
bypass.
39.90....... Insertion of non-coronary N ..........
artery stent or stents.
47.01....... Laparoscopic appendectomy... Y 6 164, 165, 166, 167
47.09....... Other appendectomy.......... Y 6 164, 165, 166, 167
47.11....... Laparoscopic incidental Y 13 365
appendectomy. 21 442, 443
24
486
47.19....... Other incidental Y 13 365
appendectomy. 21 442, 443
24 486
51.21....... Other partial Y 7 195, 196, 197, 198
cholecystectomy.
17 400, 406,
17 407
21 442, 443
24 486
51.24....... Laparoscopic partial Y 7 195, 196, 493, 494
cholecystectomy. 17 400, 406,
17 407,
21 442, 443
24 486
52.84....... Autotransplantation of cells N ..........
of Islets of Langerhans.
52.85....... Allotransplantation of cells N ..........
of Islets of Langerhans.
FR Doc. 96-22145 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1997 Rates
52.86....... Transplantation of cells of N ..........
Islets of Langerhans, not
otherwise specified.
54.51....... Laparoscopiclysis of Y 6 150, 151
peritoneal adhesions. 7 201
13 365
[[Page 46278]]
21 442, 443
24 486
54.59....... Otherlys is of peritoneal Y 6 150, 151
adhesions. 7 201
13 365
21 442, 443
24 486
59.03....... Laparoscopic lysis of Y 11 303, 304, 305
perirenal or periureteral 12 344, 345
adhesions. 13 365
17 400
17 406, 407
21 442, 443
24 486
59.12....... Laparoscopic lysis of Y 11 308, 309
perivesical adhesions. 12 344, 345
13 365
17 400
17 406, 407
21 442, 443
24 486
65.01....... Laparoscopic oophorotomy.... Y 13 354, 355, 357, 358, 359
65.09....... Other oophorotomy........... Y 13 354, 355, 357, 358, 359
65.13....... Laparoscopic biopsy of ovary Y 13 354, 355, 357, 358, 359
65.14....... Other laparoscopic Y 13 354, 355, 357,358, 359
diagnostic procedures on
ovaries.
65.23....... Laparoscopic Y 13 354, 355, 357, 358, 359
marsupialization of ovarian
cyst.
65.24....... Laparoscopic wedge resection Y 10 292, 293
of ovary. 13 354, 355, 357, 358, 359
65.25....... Other laparoscopic local Y 13 354, 355, 357, 358, 359
excision or destruction of
ovary.
65.31....... Laparoscopic unilateral Y 13 354, 355, 357, 358, 359
oophorectomy.
65.39....... Other unilateral Y 13 354, 355, 357, 358, 359
oophorectomy.
65.41....... Laparoscopic unilateral Y 13 354, 355, 357, 358, 359
salpingo-oophorectomy.
65.49....... Other unilateral salpingo- Y 13 354, 355, 357, 358, 359
oophorectomy.
65.53....... Laparoscopic removal of both Y 9 269, 270
ovaries at same operative 13 354, 355
episode. 13 357, 358, 359
65.54....... Laparoscopic removal of Y 9 269, 270
remaining ovary. 13 354, 355,
13 357, 358, 359
65.63....... Laparoscopic removal of both Y 9 269, 270
ovaries and tubes at same 13 354, 355,
operative episode. 13 357, 358, 359
65.64....... Laparoscopic removal of Y 13 354, 355, 357, 358, 359
remaining ovary and tube.
65.74....... Laparoscopic simple suture Y 13 354, 355,
of ovary. 13 357, 358,
13 359
21 442, 443
24 486
65.75....... Laparoscopic reimplantation Y 13 354, 355,
of ovary. 13 357, 358,
13 359
21 442, 443
24 486
65.76....... Laparoscopic salpingo- Y 13 354, 355,
oophoroplasty. 13 357, 358,
13 359
21 442, 443
24 486
[[Page 46279]]
65.81....... Laparoscopic lysis of Y 13 354, 355,
adhesions of ovary and 13 357, 358,
fallopian tube.
13 359
21 442, 443
24 486
65.89....... Other lysis of adhesions of Y 13 354, 355,
ovary and fallopian tube. 13 357, 358,
13 359
21 442, 443
24 486
68.23....... Endometrial ablation........ Y 13 354, 355, 357, 358, 359
68.51....... Laparoscopically assisted Y 13 354, 355,
vaginal hysterectomy (LAVH). 13
357, 358,
13
359
14 375
22 477
68.59....... Other vaginal hysterectomy.. Y 13 354, 355,
13 357, 358,
13 359
14 375
22 477
----------------------------------------------------------------------------------------------------------------
Table 6c.--Invalid Diagnosis Codes
----------------------------------------------------------------------------------------------------------------
Diagnosis
code Description CC MDC DRG
----------------------------------------------------------------------------------------------------------------
291.8....... Other specified alcoholic Y 20 434, 435, 436, 437
psychosis.
466.1....... Acute bronchiolitis......... N 4 96, 97, 98
575.1....... Other cholecystitis......... N 7 207, 208
752.5....... Undescended testicle........ N 12 352
752.6....... Hypospadias and epispadias.. N 12 352
753.2....... Obstructive defects of renal N 11 331, 332, 333
pelvis and ureter.
758.8....... Other conditions due to sex N 12 352
chromosome anomalies. 13 358, 359, 369
922.3....... Contusion of back........... N 9 280, 281,
9 282
24 484, 485, 486, 487
995.5....... Child maltreatment syndrome. N 21 454, 455
998.1....... Hemorrhage or hematoma Y 15 387,\1\ 389 \1\
complicating a procedure. 21 452, 453
998.5....... Postoperative infection..... Y 15 387,\1\ 389 \1\
18 418
V15.4....... Psychological trauma........ N 23 467
V61.1....... Marital problems............ N 23 467
----------------------------------------------------------------------------------------------------------------
\1\ Diagnosis code is classified as a ``major problem'' in these DRGs.
Table 6d.--Invalid Procedure Codes
----------------------------------------------------------------------------------------------------------------
Procedure
code Description OR MDC DRG
----------------------------------------------------------------------------------------------------------------
47.0........ Appendectomy................ Y 6 164, 165, 166, 167
47.1........ Incidental appendectomy..... Y 13 365,
21 442, 443,
24 486
54.5........ Lysis of peritoneal Y 6 150, 151,
adhesions.
7 201
13 365
21 442, 443
24 486
59.01....... Ureterolysis with freeing or Y 11 303, 304,
repositioning of ureter for 11 305
retroperitoneal fibrosis. 12 344, 345
13 365
17 400, 406,
[[Page 46280]]
17 407
21 442, 443
24 486
65.0........ Oophorotomy................. Y 13 354, 355 357, 358, 359
65.3........ Unilateral oophorectomy..... Y 13 354, 355 357, 358, 359
65.4........ Unilateral salpingo- Y 13 354, 355, 357, 358,
oophorectomy. 359
65.8........ Lysis of adhesions of ovary Y 13 354, 355,
and fallopian tube. 13 357, 358,
13 359
21 442, 443
24 486
68.5........ Vaginal hysterectomy........ Y 13 354, 355,
13 357, 358,
13 359
14 375
22 477
----------------------------------------------------------------------------------------------------------------
Table 6e.--Revised Diagnosis Code Titles
----------------------------------------------------------------------------------------------------------------
Diagnosis
code Description CC MDC DRG
----------------------------------------------------------------------------------------------------------------
414.00...... Coronary atherosclerosis of N 5 132, 133
unspecified type of vessel,
native or graft.
995.81...... Adult physical abuse........ N 21 454, 455
997.60...... Amputation stump N 8 256
complication, unspecified
complication.
997.61...... Amputation stump N 8 256
complication, neuroma of
amputation stump.
997.62...... Amputation stump Y 8 256
complication, infection
(chronic).
997.69...... Amputation stump N 8 256
complication, not elsewhere
classified.
V61.20...... Counseling for parent-child N 23 467
problem, unspecified.
V61.21...... Counseling for victim of N 23 467
child abuse.
V67.4....... Follow-up examination, N 23 465, 466
following treatment of
healed fracture.
----------------------------------------------------------------------------------------------------------------
[[Page 46281]]
Table 6f.--Revised Procedure Code Titles
----------------------------------------------------------------------------------------------------------------
Procedure
code Description OR MDC DRG
----------------------------------------------------------------------------------------------------------------
59.11......... Other lysis of perivesical Y 11 308, 309
adhesions.
12 344, 345
13 365
17 400, 406,
17 407
21 442, 443
24 486
65.51......... Other removal of both Y 9 269, 270
ovaries at same operative 13 354, 355
episode. 13 357, 358, 359
65.52......... Other removal of remaining Y 9 269, 270
ovary.
13 354, 355
13 357, 358, 359
65.61......... Other removal of both Y 9 269, 270
ovaries and tubes at same
operative episode.
13 354, 355,
13 357, 358, 359
65.62......... Other removal of remaining Y 13 354, 355, 357, 358, 359
ovary and tube.
65.71......... Other simple suture of ovary Y 13 354, 355,
13 357, 358,
13 359
21 442, 443
24 486
65.72......... Other reimplantation of Y 13 354, 355,
ovary. 13 357, 358,
13 359
21 442, 443
24 486
65.73......... Other salpingo-oophoroplasty Y 11 308, 309,
12 344, 345
13 365
17 400, 406,
17 407
21 442, 443
24 486
----------------------------------------------------------------------------------------------------------------
[[Page 46282]]
Table 6g.--Additions to the CC Exclusions List
Page 1 of 5 Pages
CCs that are added to the list are in Table 6G--Additions to the CC
Exclusions List. Each of the principal diagnoses is shown with an
asterisk, and the revisions to the CC Exclusions List are provided in an
indented column immediately following the affected principal diagnosis.
------------------------------------------------------------------------
------------------------------------------------------------------------
*0011 00844 *00800 00844 *0085 00844 *01133 *01182
00841 00845 00841 00845 00841 00845 4831 4831
00842 00846 00842 00846 00842 00846 *01134 *01183
00843 00847 00843 00847 00843 00847 4831 4831
00844 *0061 00844 *00841 00844 *0088 *01135 *01184
00845 00841 00845 00841 00845 00841 4831 4831
00846 00842 00846 00842 00846 00842 *01136 *01185
00847 00843 00847 00843 00847 00843 4831 4831
*0020 00844 *00801 00844 *00861 00844 *01140 *01186
00841 00845 00841 00845 00841 00845 4831 4831
00842 00846 00842 00846 00842 00846 *01141 *01190
00843 00847 00843 00847 00843 00847 4831 4831
00844 *0062 00844 *00842 00844 *0090 *01142 *01191
00845 00841 00845 00841 00845 00841 4831 4831
00846 00842 00846 00842 00846 00842 *01143 *01192
00847 00843 00847 00843 00847 00843 4831 4831
*0029 00844 *00802 00844 *00862 00844 *01144 *01193
00841 00845 00841 00845 00841 00845 4831 4831
00842 00846 00842 00846 00842 00846 *01145 *01194
00843 00847 00843 00847 00843 00847 4831 4831
00844 *0069 00844 *00843 00844 *01100 *01146 *01195
00845 00841 00845 00841 00845 4831 4831 4831
00846 00842 00846 00842 00846 *01101 *01150 *01196
00847 00843 00847 00843 00847 4831 4831 4831
*0030 00844 *00803 00844 *00863 *01102 *01151 *01200
00841 00845 00841 00845 00841 4831 4831 4831
00842 00846 00842 00846 00842 *01103 *01152 *01201
00843 00847 00843 00847 00843 4831 4831 4831
00844 *0071 00844 *00844 00844 *01104 *01153 *01202
00845 00841 00845 00841 00845 4831 4831 4831
00846 00842 00846 00842 00846 *01105 *01154 *01203
00847 00843 00847 00843 00847 4831 4831 4831
*0049 00844 *00804 00844 *00864 *01106 *01155 *01204
00841 00845 00841 00845 00841 4831 4831 4831
00842 00846 00842 00846 00842 *01110 *01156 *01205
00843 00847 00843 00847 00843 4831 4831 4831
00844 *0072 00844 *00845 00844 *01111 *01160 *01206
00845 00841 00845 00841 00845 4831 4831 4831
00846 00842 00846 00842 00846 *01112 *01161 *01210
00847 00843 00847 00843 00847 4831 4831 4831
*0050 00844 *00809 00844 *00865 *01113 *01162 *01211
00841 00845 00841 00845 00841 4831 4831 4831
00842 00846 00842 00846 00842 *01114 *01163 *01212
00843 00847 00843 00847 00843 4831 4831 4831
00844 *0073 00844 *00846 00844 *01115 *01164 *01213
00845 00841 00845 00841 00845 4831 4831 4831
00846 00842 00846 00842 00846 *01116 *01165 *01214
00847 00843 00847 00843 00847 4831 4831 4831
*0051 00844 *0081 00844 *00866 *01120 *01166 *01215
00841 00845 00841 00845 00841 4831 4831 4831
00842 00846 00842 00846 00842 *01121 *01170 *01216
00843 00847 00843 00847 00843 4831 4831 4831
00844 *0078 00844 *00847 00844 *01122 *01171 *01280
00845 00841 00845 00841 00845 4831 4831 4831
00846 00842 00846 00842 00846 *01123 *01172 *01281
00847 00843 00847 00843 00847 4831 4831 4831
*0052 00844 *0082 00844 *00867 *01124 *01173 *01282
00841 00845 00841 00845 00841 4831 4831 4831
00842 00846 00842 00846 00842 *01125 *01174 *01283
00843 00847 00843 00847 00843 4831 4831 4831
00844 *0079 00844 *00849 00844 *01126 *01175 *01284
00845 00841 00845 00841 00845 4831 4831 4831
00846 00842 00846 00842 00846 *01130 *01176 *01285
00847 00843 00847 00843 00847 4831 4831 4831
*0060 00844 *0083 00844 *00869 *01131 *01180 *01286
00841 00845 00841 00845 00841 4831 4831 4831
00842 00846 00842 00846 00842 *01132 *01181 *01480
00843 00847 00843 00847 00843 4831 4831 00841
------------------------------------------------------------------------
[[Page 46283]]
Page 2 of 5 Pages
------------------------------------------------------------------------
------------------------------------------------------------------------
00842 4831 29382 29284 *29212 29383 29614 29181
00843 *11285 29383 29289 29181 29384 29634 29189
00844 00841 29384 2929 29189 7105 29644 29384
00845 00842 30300 29381 29384 *29389 29654 *30420
00846 00843 30301 29382 *2922 29181 29664 29181
00847 00844 30302 29383 29181 29189 2980 29189
*01481 00845 30390 29384 29189 29384 2983 29384
00841 00846 30391 30300 29384 *2939 2984 *30421
00842 00847 30392 30301 *29281 29181 29900 29181
00843 *11505 30400 30302 29181 29189 29910 29189
00844 4831 30401 30390 29189 29384 29980 29384
00845 *11515 30402 30391 29384 *2940 29990 *30422
00846 4831 30410 30392 *29282 29181 *30300 29181
00847 *11595 30411 30400 29181 29189 29181 29189
*01482 4831 30412 30401 29189 29384 29189 29384
00841 *1221 30420 30402 29384 *2941 29384 *30423
00842 4831 30421 30410 *29283 29181 *30301 29181
00843 *129 30411 29181 29189 29181 29189
30422
00844 00841 30440 30412 29189 29384 29189 29384
00845 00842 30441 30420 29384 *2948 29384 *30430
00846 00843 30442 30421 *29284 29181 *30302 29181
00847 00844 30450 30422 29181 29189 29181 29189
*01483 00845 30451 30440 29189 29384 29189 29384
00841 00846 30452 30441 29384 *2949 29384 *30431
00842 00847 30460 30442 *29289 29181 *30303 29181
00843 *1304 30461 30450 29181 29189 29181 29189
00844 4831 30462 30451 29189 29384 29189 29384
00845 *1363 30470 30452 29384 *30082 29384 *30432
00846 4831 30471 30460 *2929 29500 *30390 29181
00847 *2910 30472 30461 29181 29501 29181 29189
*01484 29181 30480 30462 29189 29502 29189 29384
00841 29189 30481 30470 29384 29503 29384 *30433
00842 29384 30482 30471 *2930 29504 *30391 29181
00843 *2911 30490 30472 29181 29510 29181 29189
00844 29181 30491 30480 29189 29511 29189 29384
00845 29189 30492 30481 29384 29512 29384 *30440
00846 29384 30500 30482 *2931 29513 *30392 29181
00847 *2912 30501 30490 29181 29514 29181 29189
*01485 29181 30502 30491 29189 29521 29189 29384
00841 29189 30530 30492 29384 29522 29384 *30441
00842 29384 30531 30500 *29381 29523 *30393 29181
00843 *2913 30532 30501 29181 29524 29181 29189
00844 29181 30540 30502 29189 29530 29189 29384
00845 29189 30541 30530 29384 29531 29384 *30442
00846 29384 30542 30531 *29382 29532 *30400 29181
00847 *2914 30550 30532 29181 29533 29181 29189
*01486 29181 30551 30540 29189 29534 29189 29384
00841 29189 30552 30541 29384 29540 29384 *30443
00842 29384 30560 30542 *29383 29541 *30401 29181
00843 *2915 30561 30550 29181 29542 29181 29189
00844 29181 30562 30551 29189 29543 29189 29384
00845 29189 30570 30552 29384 29544 29384 *30450
00846 29384 30571 30560 *29384 29560 *30402 29181
00847 *29181 30572 30561 2910 29561 29181 29189
*01790 2910 30590 30562 2911 29562 29189 29384
4831 2911 30591 30570 2912 29563 29384 *30451
*01791 2912 30592 30571 2913 29564 *30403 29181
4831 2913 *29189 30572 2914 29570 29181 29189
*01792 2914 2910 30590 29181 29571 29189 29384
4831 29181 2911 30591 29189 29572 29384 *30452
*01793 29189 2912 30592 2919 29573 *30410 29181
4831 2919 2913 *2919 2920 29574 29181 29189
*01794 2920 2914 29181 29211 29580 29189 29384
4831 29211 29181 29189 29212 29581 29384 *30453
*01795 29212 29189 29384 2922 29582 *30411 29181
4831 2922 2919 *2920 29281 29583 29181 29189
*01796 29281 2920 29181 29282 29584 29189 29384
4831 29282 29211 29189 29283 29590 29384 *30460
*0212 29283 29212 29384 29284 29591 *30412 29181
4831 29284 2922 *29211 29289 29592 29181 29189
*0310 29289 29281 29181 2929 29593 29189 29384
4831 2929 29282 29189 29381 29594 29384 *30461
*0391 29381 29283 29384 29382 29604 *30413 29181
------------------------------------------------------------------------
[[Page 46284]]
Page 3 of 5 Pages
------------------------------------------------------------------------
------------------------------------------------------------------------
29189 29384 *30562 29532 *48239 01180 5078 4831
29384 *30520 29181 29533 4831 01181 5080 *5062
*30462 29181 29189 29534 *4824 01182 5081 4831
29181 29189 29384 29540 4831 01183 5171 *5063
29189 29384 *30563 29541 *48281 01184 *4838 4831
29384 *30521 29181 29542 4831 01185 4831 *5064
*30463 29181 29189 29543 *48282 01186 *4841 4831
29181 29189 29384 29544 4831 01190 4831 *5069
29189 29384 *30570 29560 *48283 01191 *4843 4831
29384 *30522 29181 29561 4831 01192 4831 *5070
*30470 29181 29189 29562 *48289 01193 *4845 4831
29181 29189 29384 29563 4831 01194 4831 *5071
29189 29384 *30571 29564 *4829 01195 *4846 4831
29384 *30523 29181 29570 4831 01196 4831 *5078
*30471 29181 29189 29571 *4830 01200 *4847 4831
29181 29189 29384 29572 4831 01201 4831 *5080
29189 29384 *30572 29573 *4831 01202 *4848 4831
29384 *30530 29181 29574 01100 01203 4831 *5081
*30472 29181 29189 29580 01101 01204 *485 4831
29181 29189 29384 29581 01102 01205 4831 *5088
29189 29384 *30573 29582 01103 01206 *486 4831
29384 *30531 29181 29583 01104 01210 4831 *5089
*30473 29181 29189 29584 01105 01211 *4870 4831
29181 29189 29384 29590 01106 01212 4831 *5171
29189 29384 *30580 29591 01110 01213 *4871 4831
29384 *30532 29181 29592 01111 01214 4831 *5178
*30480 29181 29189 29593 01112 01215 *4878 4831
29181 29189 29384 29594 01113 01216 00841 *51889
29189 29384 *30581 29604 01114 0310 00842 4831
29384 *30533 29181 29614 01115 11505 00843 *5198
*30481 29181 29189 29634 01116 11515 00844 4831
29181 29189 29384 29644 01120 1304 00845 *5199
29189 29384 *30582 29654 01121 1363 00846 4831
29384 *30540 29181 29664 01122 481 00847 *53081
*30482 29181 29189 2980 01123 4820 *494
99811
29181 29189 29384 2983 01124 4821 4831 99812
29189 29384 *30583 2984 01125 4822 *4950 99813
29384 *30541 29181 29900 01126 48230 4831 *53082
*30483 29181 29189 29910 01130 48231 *4951 99811
29181 29189 29384 29980 01131 48232 4831 99812
29189 29384 *30590 29990 01132 48239 *4952 99813
29384 *30542 29181 *4560 01133 4824 4831 *53083
*30490 29181 29189 99811 01134 48281 *4953 99811
29181 29189 29384 99812 01135 48282 4831 99812
29189 29384 *30591 99813 01136 48283 *4954 99813
29384 *30543 29181 *45620 01140 48289 4831 *53089
*30491 29181 29189 99811 01141 4829 *4955 99811
29181 29189 29384 99812 01142 4830 4831 99812
29189 29384 *30592 99813 01143 4831 *4956 99813
29384 *30550 29181 *4800 01144 4838 4831 *53100
*30492 29181 29189 4831 01145 4841 *4957 99811
29181 29189 29384 *4801 01146 4843 4831 99812
29189 29384 *30593 4831 01150 4845 *4958 99813
29384 *30551 29181 *4802 01151 4846 4831 *53101
*30493 29181 29189 4831 01152 4847 *4959 99811
29181 29189 29384 *4808 01153 4848 4831 99812
29189 29384 *31532 4831 01154 485 *496
99813
29384 *30552 29500 *4809 01155 486 4831 *53120
*30500 29181 29501 4831 01156 4870 *500
99811
29181 29189 29502 *481 4950 4831 99812
01160
29189 29384 29503 4831 01161 4951 *501
99813
29384 *30553 29504 *4820 01162 4952 4831 *53121
*30501 29181 29510 4831 01163 4953 *502
99811
29181 29189 29511 *4821 01164 4954 4831 99812
29189 29384 29512 4831 01165 4955 *503
99813
29384 *30560 29513 *4822 01166 4956 4831 *53140
*30502 29181 29514 4831 01170 4957 *504
99811
29181 29189 29521 *48230 01171 4958 4831 99812
29189 29384 29522 4831 01172 4959 *505
99813
29384 *30561 29523 *48231 01173 5060 4831 *53141
*30503 29181 29524 4831 01174 5061 *5060 99811
29181 29189 29530 *48232 01175 5070 4831 99812
29189 29384 29531 4831 01176 5071 *5061 99813
------------------------------------------------------------------------
[[Page 46285]]
Page 4 of 5 Pages
------------------------------------------------------------------------
------------------------------------------------------------------------
*53160 99811 00846 00843 00844 57431 57400 57400
99811 99812 00847 00844 00845 57440 57401 57401
99812 99813 *53783 00845 00846 57441 57410 57410
99813 *53401 99811 00846 00847 57450 57411 57411
*53161 99811 99812 00847 *56202 57451 57421 57421
99811 99812 99813 *5565 99811 57460 57430 57430
99812 99813 *5550 00841 99812 57461 57431 57431
99813 *53420 00841 00842 99813 57470 57440 57440
*53200 99811 00842 00843 *56203 57471 57441 57441
99811 99812 00843 00844 99811 57490 57450 57450
99812 99813 00844 00845 99812 57491 57451 57451
99813 *53421 00845 00846 99813 5750 57470 57460
*53201 99811 00846 00847 *56212 *57461 57471 57461
99811 99812 00847 *5566 99811 57400 57480 57470
99812 99813 *5551 00841 99812 57401 57481 57471
99813 *53440 00841 00842 99813 57410 57490 57480
*53220 99811 00842 00843 *56213 57411 57491 57481
99811 99812 00843 00844 99811 57421 5750 57490
99812 99813 00844 00845 99812 57430 *57490 57491
99813 *53441 00845 00846 99813 57431 57430 5750
*53221 99811 00846 00847 *5641 57440 57431 57512
99811 99812 00847 *5568 00841 57441 57440 *57512
99812 99813 *5552 00841 00842 57450 57441 57400
99813 *53460 00841 00842 00843 57451 57450 57401
*53240 99811 00842 00843 00844 57460 57451 57410
99811 99812 00843 00844 00845 57461 57470 57411
99812 99813 00844 00845 00846 57470 57471 57421
99813 *53461 00845 00846 00847 57471 57490 57430
*53241 99811 00846 00847 *5693 57490 57491 57431
99811 99812 00847 *5569 99811 57491 *57491 57440
99812 99813 *5559 00841 99812 5750 57430 57441
99813 *53501 00841 00842 99813 *57470 57431 57450
*53260 99811 00842 00843 *56985 57430 57440 57451
99811 99812 00843 00844 99811 57431 57441 57460
99812 99813 00844 00845 99812 57440 57450 57461
99813 *53511 00845 00846 99813 57441 57451 57470
*53261 99811 00846 00847 *57430 57450 57470 57471
99811 99812 00847 *5570 57470 57451 57471 57480
99812 99813 *5560 00841 57471 57470 57490 57481
99813 *53521 00841 00842 57490 57471 57491 57490
*53300 99811 00842 00843 57491 57490 *5750 57491
99811 99812 00843 00844 *57431 57491 57460 5750
99812 99813 00844 00845 57470 *57471 57461 57512
99813 *53531 00845 00846 57471 57430 57470 *5759
*53301 99811 00846 00847 57490 57431 57471 57460
99811 99812 00847 *5571 57491 57440 57480 57461
99812 99813 *5561 00841 *57440 57441 57481 57480
99813 *53541 00841 00842 57470 57450 57490 57481
*53320 99811 00842 00843 57471 57451 57491 57512
99811 99812 00843 00844 57490 57470 57512 *5768
99812 99813 00844 00845 57491 57471 *57510 57460
99813 *53551 00845 00846 *57441 57490 57400 57461
*53321 99811 00846 00847 57470 57491 57401 57470
99811 99812 00847 *5579 57471 *57480 57410 57471
99812 99813 *5562 00841 57490 57400 57411 57480
99813 *53561 00841 00842 57491 57401 57421 57481
*53340 99811 00842 00843 *57450 57410 57430 57490
99811 99812 00843 00844 57470 57411 57431 57491
99812 99813 00844 00845 57471 57421 57440 57512
99813 *5363 00845 00846 57490 57430 57441 *5769
*53341 00841 00846 00847 57491 57431 57450 57460
99811 00842 00847 *5582 *57451 57440 57451 57461
99812 00843 *5563 00841 57470 57441 57460 57470
99813 00844 00841 00842 57471 57450 57461 57471
*53360 00845 00842 00843 57490 57451 57470 57480
99811 00846 00843 00844 57491 57470 57471 57481
99812 00847 00844 00845 *57460 57471 57480 57490
99813 *5368 00845 00846 57400 57480 57481 57491
*53361 00841 00846 00847 57401 57481 57490 57512
99811 00842 00847 *5589 57410 57490 57491 *5780
99812 00843 *5564 00841 57411 57491 5750 99811
99813 00844 00841 00842 57421 5750 57512 99812
*53400 00845 00842 00843 57430 *57481 *57511 99813
------------------------------------------------------------------------
[[Page 46286]]
Page 5 of 5 Pages
------------------------------------------------------------------------
------------------------------------------------------------------------
*5781 5996 00841 99812 9971
99811 78820 00842 99813 9972
99812 78829 00843 *99813 9973
99813 *75329 00844 9585 9974
*5789 5845 00845 9954 9975
99811 5846 00846 9980 99762
99812 5847 00847 99811 99799
99813 5849 *7758 99812 9980
*74861 585 00841 99813 9982
4831 5996 00842 *99851 9983
*75261 78820 00843 99851 9984
5970 78829 00844 99859 9986
5981 *7724 00845 *99859 9987
5982 99811 00846 99851 99883
5994 99812 00847 99859 99889
*75262 99813 *7759 *99881 9989
5970 *7750 00841 99811 *99889
5981 00841 00842 99812 99811
5982 00842 00843 99813 99812
5994 00843 00844 99851 99813
*75263 00844 00845 99859 99851
5970 00845 00846 99883 99859
5981 00846 00847 *99883 99883
5982 00847 *7775 9580 *9989
5994 *7751 00841 9581 99811
*75264 00841 00842 9582 99812
5970 00842 00843 9583 99813
5981 00843 00844 9584 99851
5982 00844 00845 9585 99859
5994 00845 00846 9587 99883
*75265 00846 00847 9954
5970 00847 *7778 99600
5981 *7752 00841 99601
5982 00841 00842 99602
5994 00842 00843 99603
*75269 00843 00844 99604
5970 00844 00845 99609
5981 00845 00846 9961
5982 00846 00847 9962
5994 00847 *7903 99630
*75320 *7753 29181 99639
5845 00841 29189 9964
5846 00842 29384 99660
5847 00843 *99791 99661
5849 00844 99811 99662
585 00845 99812 99663
5996 00846 99813 99664
78820 00847 99851 99665
78829 *7754 99859 99666
*75321 00841 99883 99667
5845 00842 *99799 99669
5846 00843 99811 99670
5847 00844 99812 99671
5849 00845 99813 99672
585 00846 99851 99673
5996 00847 99859 99674
78820 *7755 99883 99675
78829 00841 *9980 99676
*75322 00842 99811 99677
5845 00843 99812 99678
5846 00844 99813 99679
5847 00845 *99811 99690
5849 00846 9585 99691
585 00847 9954 99692
5996 *7756 9980 99693
78820 00841 99811 99694
78829 00842 99812 99695
*75323 00843 99813 99696
5845 00844 *99812 99699
5846 00845 9585 99700
5847 00846 9954 99701
5849 00847 9980 99702
585 *7757 99811 99709
------------------------------------------------------------------------
[[Page 46287]]
Table 6h.--Deletions to the CC Exclusions List
Page 1 of 1 Page
CCs that are deleted from the list are in Table 6H--Deletions to the CC
Exclusions List. Each of the principal diagnoses is shown with an
asterisk, and the revisions to the CC Exclusions List are provided in an
indented column immediately following the affected principal diagnosis.
------------------------------------------------------------------------
------------------------------------------------------------------------
*2910 30502 2918 2918 2918 9981 57421
2918 30530 *30303 *30471 *30563 *53261 57430
*2911 30531 2918 2918 2918 9981 57431
2918 30532 *30390 *30472 *30570 *53300 57440
*2912 30540 2918 2918 2918 9981 57441
2918 30541 *30391 *30473 *30571 *53301 57450
*2913 30542 2918 2918 2918 9981 57451
2918 30550 *30392 *30480 *30572 *53320 5750
*2914 30551 2918 2918 2918 9981 *5780
2918 30552 *30393 *30481 *30573 *53321 9981
*2915 30560 2918 2918 2918 9981 *5781
2918 30561 *30400 *30482 *30580 *53340 9981
*2918 30562 2918 2918 2918 9981 *5789
2910 30570 *30401 *30483 *30581 *53341 9981
2911 30571 2918 2918 2918 9981 *7526
2912 30572 *30402 *30490 *30582 *53360 5970
2913 30590 2918 2918 2918 9981 5981
2914 30591 *30403 *30491 *30583 *53361 5982
2918 30592 2918 2918 2918 9981 5994
2919 *2919 *30410 *30492 *30590 *53400 *7532
2920 2918 2918 2918 2918 9981 5845
29211 *2920 *30411 *30493 *30591 *53401 5846
29212 2918 2918 2918 2918 9981 5847
2922 *29211 *30412 *30500 *30592 *53420 5849
29281 2918 2918 2918 2918 9981 585
29282 *29212 *30413 *30501 *30593 *53421 5996
29283 2918 2918 2918 2918 9981 78820
29284 *2922 *30420 *30502 *4560 *53440 78829
29289 2918 2918 2918 9981 9981 *7724
2929 *29281 *30421 *30503 *45620 *53441 9981
29381 2918 2918 2918 9981 9981 *7903
29382 *29282 *30422 *30520 *53081 *53460 2918
29383 2918 2918 2918 9981 9981 *99791
30300 *29283 *30423 *30521 *53082 *53461 9981
30301 2918 2918 2918 9981 9981 9985
30302 *29284 *30430 *30522 *53083 *53501 *99799
30390 2918 2918 2918 9981 9981 9981
30391 *29289 *30431 *30523 *53089 *53511 9985
30392 2918 2918 2918 9981 9981 *9980
30400 *2929 *30432 *30530 *53100 *53521 9981
30401 2918 2918 2918 9981 9981 *9981
30402 *2930 *30433 *30531 *53101 *53531 9585
30410 2918 2918 2918 9981 9981 9954
30411 *2931 *30440 *30532 *53120 *53541 9980
30412 2918 2918 2918 9981 9981 9981
30420 *29381 *30441 *30533 *53121 *53551 *9985
30421 2918 2918 2918 9981 9981 9985
30422 *29382 *30442 *30540 *53140 *53561 *99881
30440 2918 2918 2918 9981 9981 9981
30441 *29383 *30443 *30541 *53141 *53783 9985
30442 2918 2918 2918 9981 9981 *99889
30450 *29389 *30450 *30542 *53160 *56202 9981
30451 2918 2918 2918 9981 9981 9985
30452 *2939 *30451 *30543 *53161 *56203 *9989
30460 2918 2918 2918 9981 9981 9981
30461 *2940 *30452 *30550 *53200 *56212 9985
30462 2918 2918 2918 9981 9981
30470 *2941 30453 *30551 *53201 *56213
30471 2918 2918 2918 9981 9981
30472 *2948 *30460 *30552 *53220 *5693
30480 2918 2918 2918 9981 9981
30481 *2949 *30461 *30553 *53221 *56985
30482 2918 2918 2918 9981 9981
30490 *30300 *30462 *30560 *53240 *5751
30491 2918 2918 2918 9981 57400
30492 *30301 *30463 *30561 *53241 57401
30500 2918 2918 2918 9981 57410
30501 *30302 *30470 *30562 *53260 57411
------------------------------------------------------------------------
[[Page 46288]]
Table 7a.--Medicare Prospective Payment System Selected Percentile Lengths of Stay
[FY95 MEDPAR Update 06/96 Grouper V13.0]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Number Arithmetic 10th 25th 50th 75th 90th
DRG discharges mean LOS percentile percentile percentile percentile percentile
--------------------------------------------------------------------------------------------------------------------------------------------------------
1....................................... 34442 11.0870 3 4 8 14 23
2....................................... 6577 11.5545 3 5 8 14 23
3....................................... 1 10.0000 10 10 10 10 10
4....................................... 6221 9.1249 2 3 6 11 20
5....................................... 100697 4.4155 2 2 3 5 9
6....................................... 464 3.4030 1 1 2 4 7
7....................................... 11182 12.6678 3 5 8 14 25
8....................................... 2377 4.1586 1 1 3 5 9
9....................................... 1768 7.6697 2 3 5 9 16
10...................................... 20201 7.9723 2 3 6 10 16
11...................................... 3044 4.9152 1 2 4 6 10
12...................................... 24534 7.6319 2 3 5 9 14
13...................................... 6348 6.2098 2 4 5 7 11
14...................................... 368912 7.4277 2 3 6 9 14
15...................................... 145736 4.4476 1 2 3 5 8
16...................................... 12479 6.5732 2 3 5 8 12
17...................................... 3377 4.0269 1 2 3 5 7
18...................................... 22488 6.3283 2 3 5 8 12
19...................................... 7265 4.5076 1 2 4 6 8
20...................................... 8354 10.1263 2 4 8 13 20
21...................................... 1176 7.8180 2 3 6 10 16
22...................................... 2753 4.8554 2 2 4 6 9
23...................................... 6038 5.0600 1 2 4 6 10
24...................................... 56498 5.8137 2 3 4 7 11
25...................................... 23104 3.8625 1 2 3 5 7
26...................................... 48 4.5625 1 2 3 6 10
27...................................... 3729 6.3130 1 1 4 7 14
28...................................... 11872 7.0601 1 3 5 8 14
29...................................... 3959 4.0354 1 2 3 5 8
31...................................... 3381 5.4590 1 2 4 6 10
32...................................... 1848 3.1483 1 1 2 4 6
34...................................... 17083 6.4969 2 3 5 8 13
35...................................... 3832 4.3072 1 2 3 5 8
36...................................... 9404 1.6325 1 1 1 2 3
37...................................... 1995 4.0551 1 1 3 5 8
38...................................... 246 2.6098 1 1 2 3 5
39...................................... 3436 1.9744 1 1 1 2 4
40...................................... 2958 3.3966 1 1 2 4 7
42...................................... 7697 2.2076 1 1 1 2 5
43...................................... 105 4.1524 1 2 3 5 8
44...................................... 1705 5.7238 2 3 5 7 10
45...................................... 2545 3.8310 1 2 3 5 7
46...................................... 3116 5.5209 1 2 4 7 10
47...................................... 1417 3.7890 1 1 3 5 7
49...................................... 2260 5.6518 1 2 4 7 11
50...................................... 3511 2.1191 1 1 2 2 3
51...................................... 323 2.9195 1 1 1 2 7
52...................................... 84 3.5357 1 1 2 3 8
53...................................... 3546 3.5491 1 1 2 4 8
54...................................... 2 4.0000 1 1 7 7 7
55...................................... 2035 2.9666 1 1 2 3 6
56...................................... 766 2.7454 1 1 2 3 6
57...................................... 677 4.0694 1 1 3 5 8
59...................................... 94 3.6064 1 1 2 4 7
60...................................... 3 1.0000 1 1 1 1 1
61...................................... 226 5.1372 1 1 2 7 14
62...................................... 1 2.0000 2 2 2 2 2
63...................................... 4238 4.6487 1 2 3 5 10
64...................................... 3550 7.5346 1 2 5 9 16
65...................................... 30917 3.4293 1 2 3 4 6
66...................................... 6878 3.5650 1 2 3 4 6
67...................................... 532 4.1992 2 2 3 5 8
68...................................... 10392 4.7941 2 3 4 6 9
69...................................... 3353 3.7739 1 2 3 5 7
70...................................... 32 2.9375 1 2 3 3 5
71...................................... 96 4.0313 1 2 3 5 8
72...................................... 612 4.4167 1 2 3 5 9
73...................................... 6332 4.9588 1 2 4 6 9
75...................................... 41590 11.1419 4 6 8 14 22
76...................................... 40960 12.4911 3 6 10 15 24
[[Page 46289]]
77...................................... 2446 5.5200 1 2 4 8 12
78...................................... 30530 8.2292 4 5 7 10 13
79...................................... 220024 9.2606 3 5 7 11 17
80...................................... 9456 6.6214 2 4 5 8 12
81...................................... 10 7.4000 1 4 6
FR Doc. 96-22145 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1997 Rates
12 15
82...................................... 72211 7.8884 2 3 6 10 16
83...................................... 7541 6.3896 2 3 5 8 12
84...................................... 1582 3.6846 1 2 3 5 7
85...................................... 19391 7.3326 2 3 6 9 14
86...................................... 1444 4.5062 1 2 4 6 9
87...................................... 62143 6.8199 1 3 6 9 13
88...................................... 368008 6.0847 2 3 5 7 11
89...................................... 442736 7.0834 3 4 6 9 12
90...................................... 43190 5.1359 2 3 4 6 9
91...................................... 53 4.4151 1 2 3 6 8
92...................................... 12548 7.2620 2 4 6 9 13
93...................................... 1332 4.9234 1 3 4 6 9
94...................................... 13242 7.0497 2 3 5 9 14
95...................................... 1458 4.1221 1 2 3 5 8
96...................................... 65710 5.5228 2 3 5 7 10
97...................................... 27798 4.2826 2 2 4 5 7
98...................................... 20 4.3000 1 1 3 6 10
99...................................... 26552 3.4947 1 2 3 4 7
100..................................... 10746 2.4205 1 1 2 3 4
101..................................... 20899 5.1925 1 2 4 7 10
102..................................... 4669 3.1371 1 1 2 4 6
103..................................... 487 39.8973 10 15 29 54 82
104..................................... 24152 14.5670 6 8 12 18 26
105..................................... 20847 10.9617 5 7 9 13 19
106..................................... 101038 11.7331 6 8 10 14 19
107..................................... 64206 8.8424 5 6 7 10 14
108..................................... 6883 12.5720 4 7 10 15 23
110..................................... 62140 10.7845 3 6 9 13 20
111..................................... 6119 6.6568 3 5 7 8 10
112..................................... 201028 4.7049 1 2 4 6 9
113..................................... 47381 14.3687 4 6 10 17 28
114..................................... 9250 9.4685 2 4 7 12 18
115..................................... 11017 11.4341 4 6 9 14 20
116..................................... 85879 5.4281 1 2 4 7 11
117..................................... 4837 4.1211 1 1 2 5 8
118..................................... 7120 3.2142 1 1 2 4 7
119..................................... 1791 5.5366 1 1 3 7 13
120..................................... 42743 9.1977 1 2 6 12 21
121..................................... 167116 7.4255 2 4 6 9 13
122..................................... 91508 5.0063 1 3 5 7 9
123..................................... 48692 4.6628 1 1 2 6 11
124..................................... 145526 4.9010 1 2 4 6 9
125..................................... 62240 3.0708 1 1 2 4 6
126..................................... 4864 14.0113 4 7 11 17 29
127..................................... 705511 6.2183 2 3 5 8 12
128..................................... 20583 6.7301 3 4 6 8 11
129..................................... 4847 3.5251 1 1 1 4 8
130..................................... 96345 6.6835 2 4 6 8 12
131..................................... 26865 5.1799 1 3 5 7 8
132..................................... 133374 3.5805 1 2 3 4 6
133..................................... 6162 2.9761 1 1 2 4 5
134..................................... 30025 3.9084 1 2 3 5 7
135..................................... 7497 4.9941 1 2 4 6 9
136..................................... 1079 3.2586 1 2 3 4 6
138..................................... 205732 4.5589 1 2 3 6 9
139..................................... 70666 2.9401 1 1 2 4 5
140..................................... 184595 3.4847 1 2 3 4 6
141..................................... 80056 4.4979 1 2 3 5 8
142..................................... 37589 3.2040 1 2 3 4 6
143..................................... 138969 2.6105 1 1 2 3 5
144..................................... 70455 5.7021 1 2 4 7 11
145..................................... 7063 3.2390 1 1 2 4 6
146..................................... 9116 11.2399 6 7 9 13 18
147..................................... 1716 7.3462 4 6 7 9 11
148..................................... 147240 13.4390 6 8 11 16 24
[[Page 46290]]
149..................................... 16479 7.7172 4 6 7 9 11
150..................................... 23661 11.7462 4 7 10 14 21
151..................................... 4727 6.4637 2 4 6 8 11
152..................................... 4681 9.0305 4 6 8 10 15
153..................................... 1810 6.1663 3 4 6 8 9
154..................................... 37523 14.9701 5 8 12 18 28
155..................................... 4800 5.8863 2 3 5 8 10
156..................................... 4 15.7500 4 4 10 22 27
157..................................... 11976 5.8075 1 2 4 7 11
158..................................... 5338 2.9039 1 1 2 4 6
159..................................... 18014 5.3347 1 2 4 7 10
160..................................... 10461 2.9524 1 1 2 4 5
161..................................... 15500 4.3536 1 2 3 5 9
162..................................... 8397 2.1870 1 1 2 3 4
163..................................... 8 3.0000 1 1 3 4 5
164..................................... 5240 9.3945 4 6 8 11 16
165..................................... 1757 5.7518 3 4 5 7 9
166..................................... 3440 5.7122 2 3 4 7 10
167..................................... 2409 3.2333 1 2 3 4 6
168..................................... 1870 4.9610 1 2 3 6 10
169..................................... 1091 2.5371 1 1 2 3 5
170..................................... 13152 12.4993 2 5 9 15 25
171..................................... 1205 5.4008 1 2 4 7 11
172..................................... 32440 8.1497 2 3 6 10 16
173..................................... 2286 4.3994 1 2 3 5 9
174..................................... 243520 5.5478 2 3 4 7 10
175..................................... 24208 3.5122 1 2 3 4 6
176..................................... 16840 6.1428 2 3 5 7 11
177..................................... 12619 4.9756 2 3 4 6 9
178..................................... 4386 3.6147 1 2 3 5 7
179..................................... 11791 7.1640 2 4 6 9 14
180..................................... 82971 6.0508 2 3 5 7 11
181..................................... 23209 3.9601 1 2 3 5 7
182..................................... 237577 4.9658 2 2 4 6 9
183..................................... 75774 3.4541 1 2 3 4 6
184..................................... 77 3.8831 1 2 2 4 7
185..................................... 4037 5.1850 1 2 4 6 10
186..................................... 2 1.5000 1 1 2 2 2
187..................................... 944 4.2108 1 2 3 6 8
188..................................... 64209 6.1263 2 3 5 8 12
189..................................... 8146 3.6866 1 1 3 5 7
190..................................... 68 5.0882 1 2 4 7 10
191..................................... 11098 16.2616 5 8 12 20 32
192..................................... 930 7.9161 2 4 7 10 14
193..................................... 8975 13.9348 5 8 11 17 25
194..................................... 847 8.4652 3 5 7 10 15
195..................................... 9686 10.4650 4 6 9 12 18
196..................................... 845 6.7136 3 4 6 8 11
197..................................... 29491 9.1586 4 5 7 11 16
198..................................... 8311 4.9344 2 3 4 6 8
199..................................... 2348 11.1661 3 5 9 14 22
200..................................... 1655 12.3329 2 4 8 15 26
201..................................... 1557 16.7534 4 7 13 21 34
202..................................... 26477 7.7437 2 3 6 10 15
203..................................... 30205 7.6570 2 3 6 10 15
204..................................... 51448 6.7152 2 3 5 8 13
205..................................... 22675 7.2389 2 3 5 9 14
206..................................... 1783 4.7196 1 2 4 6 10
207..................................... 37006 5.7262 2 3 4 7 11
208..................................... 10751 3.5105 1 2 3 4 6
209..................................... 344259 6.6642 3 4 6 7 10
210..................................... 138205 8.5738 4 5 7 10 14
211..................................... 26619 6.2716 3 4 6 7 10
212..................................... 9 5.0000 2 3 4 5 8
213..................................... 7164 9.7067 3 4 7 12 19
214..................................... 53836 6.4605 2 3 5 8 12
215..................................... 43190 3.6846 1 2 3 5 7
216..................................... 6760 11.0719 2 5 8 14 22
217..................................... 20436 15.3636 3 6 10 18 31
218..................................... 23224 6.2155 2 3 5 7 11
[[Page 46291]]
219..................................... 19076 3.7567 1 2 3 5 6
220..................................... 2 5.5000 5 5 6 6 6
221..................................... 5227 8.1037 2 4 6 10 16
222..................................... 3750 4.0496 1 2 3 5 8
223..................................... 19410 2.8704 1 1 2 3 5
224..................................... 8378 2.2731 1 1 2 3 4
225..................................... 6594 5.0059 1 2 3 6 11
226..................................... 5651 6.7383 1 2 4 8 14
227..................................... 4846 2.9610 1 1 2 4 6
228..................................... 3199 3.5261 1 1 2 4 7
229..................................... 1427 2.4043 1 1 2 3 5
230..................................... 2578 5.2002 1 2 3 6 11
231..................................... 10890 5.0626 1 2 3 6 11
232..................................... 602 4.4651 1 1 2 5 10
233..................................... 4808 9.0422 2 4 7 11 18
234..................................... 2363 4.1727 1 2 3 5 8
235..................................... 5827 6.7833 1 3 4 7 13
236..................................... 39844 6.2907 2 3 5 7 12
237..................................... 1586 4.4067 1 2 3 5 8
238..................................... 7925 10.0430 3 5 7 12 19
239..................................... 62430 7.6248 2 4 6 9 14
240..................................... 12701 7.5282 2 3 5 9 15
241..................................... 3183 4.5922 1 2 4 5 9
242..................................... 2644 7.6539 2 4 6 9 15
243..................................... 84034 5.6150 2 3 4 7 10
244..................................... 12036 5.8284 2 3 4 7 11
245..................................... 4477 4.3044 1 2 3 5 8
246..................................... 1391 4.6161 1 2 4 6 9
247..................................... 11132 3.9656 1 2 3 5 8
248..................................... 7135 5.2685 1 2 4 6 10
249..................................... 10593 4.2878 1 1 3 5 9
250..................................... 3359 5.0473 1 2 4 6 9
251..................................... 2228 3.3039 1 1 3 4 6
252..................................... 1 1.0000 1 1 1 1 1
253..................................... 18452 5.8248 2 3 4 7 11
254..................................... 9735 3.8817 1 2 3 5 7
255..................................... 1 2.0000 2 2 2 2 2
256..................................... 4819 5.6921 1 2 4 7 11
257..................................... 24829 3.4343 1 2 3 4 6
258..................................... 19718 2.4910 1 2 2 3 4
259..................................... 4225 3.5089 1 1 2 3 7
260..................................... 5083 1.8702 1 1 2 2 3
261..................................... 2489 2.3403 1 1 2 3 4
262..................................... 749 3.9439 1 1 2 5 8
263..................................... 30581 13.9228 4 6 10 16 28
264..................................... 3723 8.3503 2 4 6 10 17
265..................................... 4517 7.6810 1 3 5 9 16
266..................................... 2850 3.7140 1 1 3 5 8
267..................................... 238 4.3361 1 1 3 5 9
268..................................... 983 4.0651 1 1 2 4 9
269..................................... 10745 9.2352 2 4 7 12 19
270..................................... 3643 3.4161 1 1 2 4 8
271..................................... 22531 8.5207 3 4 7 10 15
272..................................... 6142 7.4650 2 3 6 9 14
273..................................... 1500 5.4860 2 2 4 7 11
274..................................... 2654 7.7939 2 3 5 9 16
275..................................... 258 3.6705 1 1 2 4 8
276..................................... 928 5.0151 1 2 4 6 9
277..................................... 82879 6.7243 3 4 5 8 12
278..................................... 27272 5.1610 2 3 4 6 9
279..................................... 6 4.1667 1 2 3 4 4
280..................................... 13880 5.0710 1 2 4 6 9
281..................................... 6277 3.6108 1 2 3 4 7
283..................................... 5522 5.4681 2 2 4 7 10
284..................................... 1841 3.8403 1 2 3 5 7
285..................................... 5132 13.6613 3 6 10 16 26
286..................................... 2035 8.6993 3 4 6 9 16
287..................................... 6605 13.3889 3 6 9 16 26
288..................................... 1020 6.8824 3 4 5 7 11
289..................................... 5276 3.9780 1 2 2 4 8
[[Page 46292]]
290..................................... 8909 2.8289 1 1 2 3 5
291..................................... 91 1.7692 1 1 1 2 3
292..................................... 5308 12.7491 2 5 9 16 25
293..................................... 310 6.7935 1 3 5 8 14
294..................................... 90532 5.6749 2 3 4 7 10
295..................................... 3894 4.2766 1 2 3 5 8
296..................................... 230295 6.3598 2 3 5 8 12
297..................................... 33134 4.2911 1 2 3 5 8
298..................................... 108 3.3796 1 1 2 4 6
299..................................... 927 5.4132 1 2 4 7 10
300..................................... 14815 7.2798 2 3 6 9 14
301..................................... 2247 4.3796 1 2 3 5 9
302..................................... 8314 12.3018 6 7 9 14 21
303..................................... 19404 10.2201 4 6 8 12 18
304..................................... 13543 10.2916 3 5 7 13 21
305..................................... 2681 4.9276 1 3 4 6 9
306..................................... 11853 6.2378 2 2 4 8 13
307..................................... 2696 2.9841 1 2 2 3 5
308..................................... 9573 7.0330 1 2 5 9 15
309..................................... 3563 3.0230 1 1 2 4 6
310..................................... 30025 4.6157 1 2 3 6 9
311..................................... 10221 2.1764 1 1 2 3 4
312..................................... 2120 4.8198 1 2 3 6 10
313..................................... 788 2.2855 1 1 2 3 5
314..................................... 1 5.0000 5 5 5 5 5
315..................................... 29516 9.3027 1 2 6 12 20
316..................................... 73804 7.4996 2 3 6 9 15
317..................................... 838 2.9033 1 1 2 3 6
318..................................... 6303 7.1525 2 3 5 9 14
319..................................... 522 3.2184 1 1 2 4 7
320..................................... 177322 6.4439 2 3 5 8 11
321..................................... 26732 4.7118 2 3 4 6 8
322..................................... 87 4.3333 2 2 4 5 8
323..................................... 18552 3.5564 1 2 3 4 7
324..................................... 9159 2.0887 1 1 2 3 4
325..................................... 7781 4.5729 1 2 3 5 9
326..................................... 2305 3.4265 1 1 2 4 6
327..................................... 9 3.3333 1 2 2 4 5
328..................................... 853 4.2579 1 2 3 6 8
329..................................... 113 2.7965 1 1 2 3 5
330..................................... 1 1.0000 1 1 1 1 1
331..................................... 40267 6.1796 2 3 5 8 12
332..................................... 4973 3.8520 1 2 3 5 8
333..................................... 379 5.7968 1 3 4 7 13
334..................................... 19978 6.0539 3 4 5 7 9
335..................................... 10312 4.6223 2 3 4 6 7
336..................................... 63889 4.1249 1 2 3 5 8
337..................................... 40544 2.6722 1 2 2 3 4
338..................................... 5063 5.2558 1 2 3 6 11
339..................................... 2416 5.2562 1 2 3 6 11
340..................................... 2 3.0000 1 1 5 5 5
341..................................... 6766 3.2573 1 1 2 4 6
342..................................... 231 4.0649 1 1 2 5 8
344..................................... 4022 3.4510 1 1 2 4 7
345..................................... 1428 4.0210 1 2 3 5 9
346..................................... 5626 6.7600 1 3 5 8 14
347..................................... 443 3.2889 1 1 2 4 7
348..................................... 3187 4.8892 1 2 4 6 9
349..................................... 734 2.9646 1 1 2 4 6
350..................................... 7234 4.7432 2 3 4 6 8
352..................................... 603 3.9005 1 1 3 5 8
353..................................... 2743 8.3252 3 4 6 9 15
354..................................... 10187 6.3342 3 4 5 7 11
355..................................... 5884 3.8600 2 3 4 4 6
356..................................... 30093 3.0252 1 2 3 4 5
357..................................... 6842 9.8297 4 5 8 12 18
358..................................... 28152 4.7532 2 3 4 5 8
359..................................... 28825 3.2709 2 3 3 4 5
360..................................... 17592 3.5444 1 2 3 4 6
361..................................... 655 3.4580 1 1 2 4 7
[[Page 46293]]
363..................................... 4555 3.5139 1 2 2 3 6
364..................................... 1879 3.6003 1 1 2 4 8
365..................................... 2522 8.1257 2 3 5 10 18
366..................................... 4694 7.6877 2 3 5 10 16
367..................................... 571 3.3135 1 1 2 4 7
368..................................... 2408 6.9049 2 3 5 8 13
369..................................... 2531 3.7246 1 1 3 5 7
370..................................... 1201 5.5679 3 3 4 5 9
371..................................... 1044 3.6236 2 3 3 4 5
372..................................... 872 3.3601 1 2 2 3 6
373..................................... 3961 1.9258 1 1 2 2 3
374..................................... 141 2.5957 1 2 2 3 4
375..................................... 5 2.2000 1 1 2 3 4
376..................................... 164 3.3537 1 1 2 4 7
377..................................... 27 3.2963 1 1 2 3 8
378..................................... 172 2.9186 1 2 3 3 5
379..................................... 332 3.0361 1 1 2 3 5
380..................................... 75 2.2800 1 1 2 2 4
381..................................... 209 2.2967 1 1 1 2 5
382..................................... 54 1.5741 1 1 1 1 3
383..................................... 1557 4.0873 1 2 3 5 8
384..................................... 135 3.1481 1 1 1 2 7
385..................................... 4 13.5000 1 1 1 3 49
386..................................... 1 36.0000 36 36 36 36 36
389..................................... 23 10.7391 3 4 8 10 18
390..................................... 11 4.7273 1 2 3 5 9
392..................................... 2622 11.6484 4 6 8 14 24
394..................................... 1734 7.9862 1 2 5 9 16
395..................................... 69281 5.3835 1 2 4 7 10
396..................................... 19 3.7895 1 1 3 5 8
397..................................... 16238 6.0846 2 3 5 7 12
398..................................... 17490 6.5883 2 3 5 8 12
399..................................... 1505 4.4399 1 2 4 6 8
400..................................... 7877 10.4160 2 4 7 13 23
401..................................... 6683 12.3822 2 5 9 16 25
402..................................... 1621 4.7218 1 1 3 6 10
403..................................... 36569 9.2960 2 4 7 12 19
404..................................... 4137 5.1047 1 2 4 7 10
406..................................... 3407 11.2548 3 5 8 14 23
407..................................... 761 4.9304 1 2 4 6 9
408..................................... 3100 8.1632 1 2 5 10 18
409..................................... 5931 6.7132 2 3 4 6 15
410..................................... 89997 3.3583 1 2 3 4 5
411..................................... 58 2.6724 1 1 2 3 7
412..................................... 37 2.9730 1 1 2 4 5
413..................................... 8878 8.3323 2 3 6 10 17
414..................................... 845 5.1361 1 2 4 7 11
415..................................... 40783 15.7224 4 7 12 19 31
416..................................... 201554 8.2165 2 4 7 10 15
417..................................... 54 4.5741 1 2 4 7 10
418..................................... 19614 6.7661 2 3 5 8 13
419..................................... 16484 5.6830 2 3 4 7 10
420..................................... 3023 4.3126 2 2 4 5 8
421..................................... 12216 4.6523 2 2 4 5 8
422..................................... 97 3.8041 1 2 3 4 7
423..................................... 9588 8.7110 2 4 6 10 18
424..................................... 2102 17.9139 3 6 12 20 35
425..................................... 16010 4.8731 1 2 3 6 10
426..................................... 4920 5.5150 1 2 4 7 11
427..................................... 1856 5.2333 1 2 4 6 11
428..................................... 956 8.3347 1 3 5 10 18
429..................................... 40733 8.9700 2 3 6 10 17
430..................................... 55753 9.7545 2 4 7 12 19
431..................................... 200 7.1500 1 3 5 9 13
432..................................... 457 6.5252 1 2 4 6 11
433..................................... 8283 3.4066 1 1 2 4 7
434..................................... 21933 5.8212 2 3 4 7 11
435..................................... 16378 4.8060 1 3 4 6 8
436..................................... 3128 14.3744 4 8 14 21 28
437..................................... 14927 10.8952 4 6 10 14 20
[[Page 46294]]
439..................................... 910 8.9264 2 3 6 11 18
440..................................... 5007 9.8354 2 3 6 12 21
441..................................... 648 4.4213 1 1 2 4 8
442..................................... 14653 8.7421 1 3 6 11 18
443..................................... 3469 3.5509 1 1 2 5 7
444..................................... 3543 5.2882 1 3 4 6 10
445..................................... 1415 3.9046 1 2 3 5 7
446..................................... 1 1.0000 1 1 1 1 1
447..................................... 3991 2.8013 1 1 2 3 5
448..................................... 88 1.0000 1 1 1 1 1
449..................................... 30264 4.4273 1 2 3 5 9
450..................................... 7178 2.3403 1 1 2 3 5
451..................................... 8 6.0000 2 3 4 5 7
452..................................... 20326 5.4275 1 2 4 6 11
453..................................... 3831 3.1929 1 1 2 4 6
454..................................... 5391 5.1330 1 2 3 6 10
455..................................... 1181 2.8442 1 1 2 3 5
456..................................... 213 8.3803 1 1 4 9 21
457..................................... 135 4.8222 1 1 2 5 12
458..................................... 1650 16.8358 3 7 13 22 35
459..................................... 582 10.2887 2 4 7 13 21
460..................................... 2437 6.6422 1 3 5 8 13
461..................................... 3230 4.8920 1 1 2 5 12
462..................................... 9786 13.7570 4 6 12 18 26
463..................................... 12587 5.1722 1 2 4 6 10
464..................................... 3225 3.7479 1 2 3 5 7
465..................................... 202 3.8762 1 1 2 4 7
466..................................... 1943 4.8101 1 1 2 4 10
467..................................... 1820 4.1264 1 1 2 4 8
468..................................... 62094 15.2184 3 7 12 19 30
471..................................... 9604 8.0717 4 5 6 9 14
472..................................... 159 30.1635 1 9 28 40 61
473..................................... 8650 14.3808 2 4 8 21 36
475..................................... 94974 12.1639 2 5 10 16 24
476..................................... 7275 13.8367 3 7 11 17 25
477..................................... 29790 8.9095 1 3 6 11 18
478..................................... 123960 8.3140 1 3 6 10 17
479..................................... 18606 4.5577 1 2 4 6 9
480..................................... 43 33.5581 12 16 24 39 61
481..................................... 122 36.2787 21 25 31 42 60
482..................................... 7121 14.8666 5 8 11 17 28
483..................................... 38597 45.9566 15 23 37 56 85
484..................................... 366 15.8115 2 6 12 22 32
485..................................... 3426 11.6985 4 6 9 14 22
486..................................... 2316 13.4473 1 6 11 18 28
487..................................... 4136 8.9350 1 3 7 11 18
488..................................... 1694 17.6251 5 8 13 22 35
489..................................... 18721 10.4348 2 4 7 13 22
490..................................... 5263 6.5565 1 2 4 8 14
491..................................... 9897 4.2698 2 3 3 5 7
492..................................... 2139 17.3703 3 5 10 28 37
493..................................... 54769 5.8892 1 2 5 8 11
494..................................... 28573 2.4247 1 1 2 3 5
495..................................... 131 22.7176 10 12 17 26 39
----------------
11135858
--------------------------------------------------------------------------------------------------------------------------------------------------------
Table 7b.--Medicare Prospective Payment System Selected Percentile Lengths of Stay
[FY95 MEDPAR Update 06/96 Grouper V14.0]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Number Arithmetic 10th 25th 50th 75th 90th
DRG discharges mean LOS percentile percentile percentile percentile percentile
--------------------------------------------------------------------------------------------------------------------------------------------------------
1....................................... 34442 11.0870 3 4 8 14 23
2....................................... 6577 11.5545 3 5 8 14 23
3....................................... 1 10.0000 10 10 10 10 10
4....................................... 6221 9.1249 2 3 6 11 20
5....................................... 100697 4.4155 2 2 3 5 9
6....................................... 464 3.4030 1 1 2 4 7
[[Page 46295]]
7....................................... 11326 12.5507 2 5 8 14 25
8....................................... 2651 3.8989 1 1 2 5 9
9....................................... 1768 7.6697 2 3 5 9 16
10...................................... 20201 7.9723 2 3 6 10 16
11...................................... 3044 4.9152 1 2 4 6 10
12...................................... 24534 7.6319 2 3 5 9 14
13...................................... 6348 6.2098 2 4 5 7 11
14...................................... 368912 7.4277 2 3 6 9 14
15...................................... 145736 4.4476 1 2 3 5 8
16...................................... 12480 6.5737 2 3 5 8 12
17...................................... 3376 4.0243 1 2 3 5 7
18...................................... 23963 6.3732 2 3 5 8 12
19...................................... 7792 4.5249 1 2 4 6 8
20...................................... 6352 11.2835 3 5 9 15 22
21...................................... 1176 7.8180 2 3 6 10 16
22...................................... 2753 4.8554 2 2 4 6 9
23...................................... 6038 5.0600 1 2 4 6 10
24...................................... 56509 5.8142 2 3 4 7 11
25...................................... 23093 3.8603 1 2 3 5 7
26...................................... 48 4.5625 1 2 3 6 10
27...................................... 3729 6.3130 1 1 4 7 14
28...................................... 11873 7.0603 1 3 5 8 14
29...................................... 3958 4.0341 1 2 3 5 8
31...................................... 3382 5.4595 1 2 4 6 10
32...................................... 1847 3.1462 1 1 2 4 6
34...................................... 17085 6.4968 2 3 5 8 13
35...................................... 3830 4.3065 1 2 3 5 8
36...................................... 9404 1.6325 1 1 1 2 3
37...................................... 1994 4.0341 1 1 3 5 8
38...................................... 246 2.6098 1 1 2 3 5
39...................................... 3436 1.9744 1 1 1 2 4
40...................................... 2958 3.3966 1 1 2 4 7
42...................................... 7697 2.2076 1 1 1 2 5
43...................................... 105 4.1524 1 2 3 5 8
44...................................... 1705 5.7238 2 3 5 7 10
45...................................... 2545 3.8310 1 2 3 5 7
46...................................... 3117 5.5201 1 2 4 7 10
47...................................... 1416 3.7895 1 1 3 5 7
49...................................... 2260 5.6518 1 2 4 7 11
50...................................... 3511 2.1191 1 1 2 2 3
51...................................... 323 2.9195 1 1 1 2 7
52...................................... 100 3.3600 1 1 2 3 7
53...................................... 3624 3.5566 1 1 2 4 8
54...................................... 2 4.0000 1 1 7 7 7
55...................................... 2035 2.9666 1 1 2 3 6
56...................................... 766 2.7454 1 1 2 3 6
57...................................... 637 4.1334 1 1 3 5 8
59...................................... 94 3.6064 1 1 2 4 7
60...................................... 3 1.0000 1 1 1 1 1
61...................................... 226 5.1372 1 1 2 7 14
62...................................... 1 2.0000 2 2 2 2 2
63...................................... 4238 4.6487 1 2 3 5 10
64...................................... 3550 7.5346 1 2 5 9 16
65...................................... 30917 3.4293 1 2 3 4 6
66...................................... 6878 3.5650 1 2 3 4 6
67...................................... 532 4.1992 2 2 3 5 8
68...................................... 10400 4.7953 2 3 4 6 9
69...................................... 3345 3.7677 1 2 3 5 7
70...................................... 32 2.9375 1 2 3 3 5
71...................................... 96 4.0313 1 2 3 5 8
72...................................... 612 4.4167 1 2 3 5 9
73...................................... 6332 4.9588 1 2 4 6 9
75...................................... 41590 11.1419 4 6 8 14 22
76...................................... 40962 12.4917 3 6 10 15 24
77...................................... 2444 5.5041 1 2 4 8 12
78...................................... 30530 8.2292 4 5 7 10 13
79...................................... 220099 9.2617 3 5 7 11 17
80...................................... 9381 6.5760 2 4 5 8 12
81...................................... 10 7.4000 1 4 6 12 15
82......................................
FR Doc. 96-22145 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1997 Rates
72211 7.8884 2 3 6 10 16
[[Page 46296]]
83...................................... 7541 6.3896 2 3 5 8 12
84...................................... 1582 3.6846 1 2 3 5 7
85...................................... 19393 7.3333 2 3 6 9 14
86...................................... 1442 4.4938 1 2 4 6 9
87...................................... 62143 6.8199 1 3 6 9 13
88...................................... 368008 6.0847 2 3 5 7 11
89...................................... 442908 7.0843 3 4 6 9 12
90...................................... 43018 5.1184 2 3 4 6 9
91...................................... 53 4.4151 1 2 3 6 8
92...................................... 12552 7.2631 2 4 6 9 13
93...................................... 1328 4.9059 1 3 4 6 9
94...................................... 13243 7.0498 2 3 5 9 14
95...................................... 1457 4.1187 1 2 3 5 8
96...................................... 65750 5.5233 2 3 5 7 10
97...................................... 27758 4.2796 2 2 4 5 7
98...................................... 20 4.3000 1 1 3 6 10
99...................................... 26556 3.4948 1 2 3 4 7
100..................................... 10742 2.4197 1 1 2 3 4
101..................................... 20903 5.1927 1 2 4 7 10
102..................................... 4665 3.1346 1 1 2 4 6
103..................................... 487 39.8973 10 15 29 54 82
104..................................... 24152 14.5670 6 8 12 18 26
105..................................... 20847 10.9617 5 7 9 13 19
106..................................... 101038 11.7331 6 8 10 14 19
107..................................... 64206 8.8424 5 6 7 10 14
108..................................... 6883 12.5720 4 7 10 15 23
110..................................... 62161 10.7839 3 6 9 13 20
111..................................... 6098 6.6496 3 5 6 8 10
112..................................... 201028 4.7049 1 2 4 6 9
113..................................... 47381 14.3687 4 6 10 17 28
114..................................... 9250 9.4685 2 4 7 12 18
115..................................... 11017 11.4341 4 6 9 14 20
116..................................... 85879 5.4281 1 2 4 7 11
117..................................... 4837 4.1211 1 1 2 5 8
118..................................... 7120 3.2142 1 1 2 4 7
119..................................... 1791 5.5366 1 1 3 7 13
120..................................... 42743 9.1977 1 2 6 12 21
121..................................... 167116 7.4255 2 4 6 9 13
122..................................... 91508 5.0063 1 3 5 7 9
123..................................... 48692 4.6628 1 1 2 6 11
124..................................... 145526 4.9010 1 2 4 6 9
125..................................... 62240 3.0708 1 1 2 4 6
126..................................... 4864 14.0113 4 7 11 17 29
127..................................... 705511 6.2183 2 3 5 8 12
128..................................... 20583 6.7301 3 4 6 8 11
129..................................... 4847 3.5251 1 1 1 4 8
130..................................... 96377 6.6838 2 4 6 8 12
131..................................... 26833 5.1772 1 3 5 7 8
132..................................... 133378 3.5806 1 2 3 4 6
133..................................... 6158 2.9737 1 1 2 4 5
134..................................... 30025 3.9084 1 2 3 5 7
135..................................... 7497 4.9941 1 2 4 6 9
136..................................... 1079 3.2586 1 2 3 4 6
138..................................... 205779 4.5592 1 2 3 6 9
139..................................... 70619 2.9382 1 1 2 4 5
140..................................... 184595 3.4847 1 2 3 4 6
141..................................... 80072 4.4984 1 2 3 5 8
142..................................... 37573 3.2025 1 2 3 4 6
143..................................... 138969 2.6105 1 1 2 3 5
144..................................... 70462 5.7020 1 2 4 7 11
145..................................... 7056 3.2372 1 1 2 4 6
146..................................... 9120 11.2398 6 7 9 13 18
147..................................... 1712 7.3376 4 6 7 9 11
148..................................... 147283 13.4382 6 8 11 16 24
149..................................... 16436 7.7095 4 6 7 9 11
150..................................... 23670 11.7463 4 7 10 14 21
151..................................... 4718 6.4532 2 4 6 8 11
152..................................... 4688 9.0299 4 6 8 10 15
153..................................... 1803 6.1570 3 4 6 8 9
154..................................... 37530 14.9694 5 8 12 18 28
[[Page 46297]]
155..................................... 4793 5.8782 2 3 5 8 10
156..................................... 4 15.7500 4 4 10 22 27
157..................................... 11982 5.8109 1 2 4 7 11
158..................................... 5332 2.8931 1 1 2 4 6
159..................................... 18017 5.3350 1 2 4 7 10
160..................................... 10458 2.9512 1 1 2 4 5
161..................................... 15509 4.3541 1 2 3 5 9
162..................................... 8388 2.1838 1 1 2 3 4
163..................................... 8 3.0000 1 1 3 4 5
164..................................... 5242 9.3937 4 6 8 11 16
165..................................... 1755 5.7499 3 4 5 7 9
166..................................... 3444 5.7134 2 3 4 7 10
167..................................... 2405 3.2274 1 2 3 4 5
168..................................... 1837 4.9559 1 2 3 6 10
169..................................... 1070 2.5421 1 1 2 3 5
170..................................... 13155 12.5003 2 5 9 15 25
171..................................... 1202 5.3719 1 2 4 7 11
172..................................... 32447 8.1498 2 3 6 10 16
173..................................... 2279 4.3857 1 2 3 5 9
174..................................... 243715 5.5466 2 3 4 7 10
175..................................... 24013 3.5080 1 2 3 4 6
176..................................... 16840 6.1428 2 3 5 7 11
177..................................... 12681 4.9738 2 3 4 6 9
178..................................... 4324 3.6004 1 2 3 5 7
179..................................... 11791 7.1640 2 4 6 9 14
180..................................... 83016 6.0517 2 3 5 7 11
181..................................... 23164 3.9529 1 2 3 5 7
182..................................... 237845 4.9666 2 2 4 6 9
183..................................... 75506 3.4460 1 2 3 4 6
184..................................... 77 3.8831 1 2 2 4 7
185..................................... 4037 5.1850 1 2 4 6 10
186..................................... 2 1.5000 1 1 2 2 2
187..................................... 944 4.2108 1 2 3 6 8
188..................................... 64238 6.1261 2 3 5 8 12
189..................................... 8117 3.6789 1 1 3 5 7
190..................................... 68 5.0882 1 2 4 7 10
191..................................... 11104 16.2586 5 8 12 20 32
192..................................... 924 7.8983 2 4 7 9 14
193..................................... 8979 13.9328 5 8 11 17 25
194..................................... 843 8.4603 3 5 7 10 15
195..................................... 9690 10.4638 4 6 9 12 18
196..................................... 841 6.7099 3 4 6 8 11
197..................................... 29506 9.1575 4 5 7 11 16
198..................................... 8296 4.9306 2 3 4 6 8
199..................................... 2348 11.1661 3 5 9 14 22
200..................................... 1655 12.3329 2 4 8 15 26
201..................................... 1557 16.7534 4 7 13 21 34
202..................................... 26477 7.7437 2 3 6 10 15
203..................................... 30205 7.6570 2 3 6 10 15
204..................................... 51448 6.7152 2 3 5 8 13
205..................................... 22678 7.2389 2 3 5 9 14
206..................................... 1780 4.7163 1 2 4 6 10
207..................................... 37033 5.7267 2 3 4 7 11
208..................................... 10724 3.5030 1 2 3 4 6
209..................................... 344259 6.6642 3 4 6 7 10
210..................................... 138220 8.5746 4 5 7 10 14
211..................................... 26604 6.2664 3 4 6 7 10
212..................................... 9 5.0000 2 3 4 5 8
213..................................... 7164 9.7067 3 4 7 12 19
214..................................... 53845 6.4613 2 3 5 8 12
215..................................... 43181 3.6830 1 2 3 5 7
216..................................... 6760 11.0719 2 5 8 14 22
217..................................... 20436 15.3636 3 6 10 18 31
218..................................... 23230 6.2178 2 3 5 7 11
219..................................... 19070 3.7531 1 2 3 5 6
220..................................... 2 5.5000 5 5 6 6 6
221..................................... 5230 8.1076 2 4 6 10 16
222..................................... 3747 4.0408 1 2 3 5 8
223..................................... 19412 2.8709 1 1 2 3 5
224..................................... 8377 2.2724 1 1 2 3 4
[[Page 46298]]
225..................................... 6594 5.0059 1 2 3 6 11
226..................................... 5654 6.7386 1 2 4 8 14
227..................................... 4843 2.9583 1 1 2 4 6
228..................................... 3200 3.5291 1 1 2 4 7
229..................................... 1426 2.3969 1 1 2 3 5
230..................................... 2578 5.2002 1 2 3 6 11
231..................................... 10890 5.0626 1 2 3 6 11
232..................................... 601 4.4609 1 1 2 4 10
233..................................... 4811 9.0518 2 4 7 11 18
234..................................... 2360 4.1470 1 2 3 5 8
235..................................... 5827 6.7833 1 3 4 7 13
236..................................... 39844 6.2907 2 3 5 7 12
237..................................... 1586 4.4067 1 2 3 5 8
238..................................... 7925 10.0430 3 5 7 12 19
239..................................... 62429 7.6246 2 4 6 9 14
240..................................... 12705 7.5277 2 3 5 9 15
241..................................... 3179 4.5908 1 2 4 5 9
242..................................... 2644 7.6539 2 4 6 9 15
243..................................... 84034 5.6150 2 3 4 7 10
244..................................... 12041 5.8294 2 3 4 7 11
245..................................... 4472 4.3001 1 2 3 5 8
246..................................... 1391 4.6161 1 2 4 6 9
247..................................... 11132 3.9656 1 2 3 5 8
248..................................... 7135 5.2685 1 2 4 6 10
249..................................... 10593 4.2878 1 1 3 5 9
250..................................... 3360 5.0461 1 2 3 6 9
251..................................... 2227 3.3049 1 1 3 4 6
252..................................... 1 1.0000 1 1 1 1 1
253..................................... 18457 5.8264 2 3 4 7 11
254..................................... 9730 3.8776 1 2 3 5 7
255..................................... 1 2.0000 2 2 2 2 2
256..................................... 4819 5.6921 1 2 4 7 11
257..................................... 24832 3.4341 1 2 3 4 6
258..................................... 19715 2.4910 1 2 2 3 4
259..................................... 4225 3.5089 1 1 2 3 7
260..................................... 5083 1.8702 1 1 2 2 3
261..................................... 2489 2.3403 1 1 2 3 4
262..................................... 749 3.9439 1 1 2 5 8
263..................................... 30590 13.9231 4 6 10 16 28
264..................................... 3714 8.3341 2 4 6 10 16
265..................................... 4518 7.6835 1 3 5 9 16
266..................................... 2849 3.7087 1 1 3 5 8
267..................................... 238 4.3361 1 1 3 5 9
268..................................... 983 4.0651 1 1 2 4 9
269..................................... 10750 9.2391 2 4 7 12 19
270..................................... 3638 3.3966 1 1 2 4 8
271..................................... 22531 8.5207 3 4 7 10 15
272..................................... 6144 7.4653 2 3 6 9 14
273..................................... 1498 5.4820 2 2 4 7 11
274..................................... 2654 7.7939 2 3 5 9 16
275..................................... 258 3.6705 1 1 2 4 8
276..................................... 928 5.0151 1 2 4 6 9
277..................................... 82941 6.7266 3 4 5 8 12
278..................................... 27210 5.1505 2 3 4 6 9
279..................................... 6 4.1667 1 2 3 4 4
280..................................... 13881 5.0709 1 2 4 6 9
281..................................... 6276 3.6109 1 2 3 4 7
283..................................... 5523 5.4677 2 2 4 7 10
284..................................... 1840 3.8408 1 2 3 5 7
285..................................... 5132 13.6613 3 6 10 16 26
286..................................... 2035 8.6993 3 4 6 9 16
287..................................... 6605 13.3889 3 6 9 16 26
288..................................... 1020 6.8824 3 4 5 7 11
289..................................... 5276 3.9780 1 2 2 4 8
290..................................... 8909 2.8289 1 1 2 3 5
291..................................... 91 1.7692 1 1 1 2 3
292..................................... 5308 12.7491 2 5 9 16 25
293..................................... 310 6.7935 1 3 5 8 14
294..................................... 90532 5.6749 2 3 4 7 10
295..................................... 3894 4.2766 1 2 3 5 8
[[Page 46299]]
296..................................... 230483 6.3598 2 3 5 8 12
297..................................... 32946 4.2799 1 2 3 5 8
298..................................... 108 3.3796 1 1 2 4 6
299..................................... 927 5.4132 1 2 4 7 10
300..................................... 14816 7.2798 2 3 6 9 14
301..................................... 2246 4.3780 1 2 3 5 9
302..................................... 8314 12.3018 6 7 9 14 21
303..................................... 19404 10.2201 4 6 8 12 18
304..................................... 13549 10.2932 3 5 7 13 21
305..................................... 2675 4.9073 1 3 4 6 9
306..................................... 11854 6.2386 2 2 4 8 13
307..................................... 2695 2.9796 1 2 2 3 5
308..................................... 9574 7.0326 1 2 5 9 15
309..................................... 3562 3.0230 1 1 2 4 6
310..................................... 30028 4.6161 1 2 3 6 9
311..................................... 10218 2.1747 1 1 2 3 4
312..................................... 2120 4.8198 1 2 3 6 10
313..................................... 788 2.2855 1 1 2 3 5
314..................................... 1 5.0000 5 5 5 5 5
315..................................... 29516 9.3027 1 2 6 12 20
316..................................... 73804 7.4996 2 3 6 9 15
317..................................... 838 2.9033 1 1 2 3 6
318..................................... 6305 7.1543 2 3 5 9 14
319..................................... 520 3.1808 1 1 2 4 7
320..................................... 177433 6.4459 2 3 5 8 11
321..................................... 26621 4.6916 2 3 4 6 8
322..................................... 87 4.3333 2 2 4 5 8
323..................................... 18556 3.5566 1 2 3 4 7
324..................................... 9155 2.0877 1 1 2 3 4
325..................................... 7785 4.5742 1 2 3 5 9
326..................................... 2301 3.4203 1 1 2 4 6
327..................................... 9 3.3333 1 2 2 4 5
328..................................... 853 4.2579 1 2 3 6 8
329..................................... 113 2.7965 1 1 2 3 5
330..................................... 1 1.0000 1 1 1 1 1
331..................................... 40274 6.1795 2 3 5 8 12
332..................................... 4966 3.8494 1 2 3 5 8
333..................................... 379 5.7968 1 3 4 7 13
334..................................... 19982 6.0546 3 4 5 7 9
335..................................... 10308 4.6203 2 3 4 6 7
336..................................... 63893 4.1251 1 2 3 5 8
337..................................... 40540 2.6719 1 2 2 3 4
338..................................... 5063 5.2558 1 2 3 6 11
339..................................... 2416 5.2562 1 2 3 6 11
340..................................... 2 3.0000 1 1 5 5 5
341..................................... 6766 3.2573 1 1 2 4 6
342..................................... 231 4.0649 1 1 2 5 8
344..................................... 4022 3.4510 1 1 2 4 7
345..................................... 1428 4.0210 1 2 3 5 9
346..................................... 5626 6.7600 1 3 5 8 14
347..................................... 443 3.2889 1 1 2 4 7
348..................................... 3188 4.8943 1 2 4 6 9
349..................................... 733 2.9400 1 1 2 4 6
350..................................... 7234 4.7432 2 3 4 6 8
352..................................... 603 3.9005 1 1 3 5 8
353..................................... 2743 8.3252 3 4 6 9 15
354..................................... 10191 6.3351 3 4 5 7 11
355..................................... 5880 3.8566 2 3 4 4 6
356..................................... 30093 3.0252 1 2 3 4 5
357..................................... 6842 9.8297 4 5 8 12 18
358..................................... 28157 4.7538 2 3 4 5 8
359..................................... 28820 3.2702 2 3 3 4 5
360..................................... 17592 3.5444 1 2 3 4 6
361..................................... 655 3.4580 1 1 2 4 7
363..................................... 4555 3.5139 1 2 2 3 6
364..................................... 1879 3.6003 1 1 2 4 8
365..................................... 2522 8.1257 2 3 5 10 18
366..................................... 4697 7.6915 2 3 5 10 16
367..................................... 568 3.2588 1 1 2 4 7
368..................................... 2408 6.9049 2 3 5 8 13
[[Page 46300]]
369..................................... 2531 3.7246 1 1 3 5 7
370..................................... 1201 5.5679 3 3 4 5 9
371..................................... 1044 3.6236 2 3 3 4 5
372..................................... 872 3.3601 1 2 2 3 6
373..................................... 3961 1.9258 1 1 2 2 3
374..................................... 141 2.5957 1 2 2 3 4
375..................................... 5 2.2000 1 1 2 3 4
376..................................... 164 3.3537 1 1 2 4 7
377..................................... 27 3.2963 1 1 2 3 8
378..................................... 172 2.9186 1 2 3 3 5
379..................................... 332 3.0361 1 1 2 3 5
380..................................... 75 2.2800 1 1 2 2 4
381..................................... 209 2.2967 1 1 1 2 5
382..................................... 54 1.5741 1 1 1 1 3
383..................................... 1557 4.0873 1 2 3 5 8
384..................................... 135 3.1481 1 1 1 2 7
385..................................... 4 13.5000 1 1 1 3 49
386..................................... 1 36.0000 36 36 36 36 36
389..................................... 23 10.7391 3 4 8 10 18
390..................................... 11 4.7273 1 2 3 5 9
392..................................... 2622 11.6484 4 6 8 14 24
394..................................... 1734 7.9862 1 2 5 9 16
395..................................... 69281 5.3835 1 2 4 7 10
396..................................... 19 3.7895 1 1 3 5 8
397..................................... 16238 6.0846 2 3 5 7 12
398..................................... 17498 6.5878 2 3 5 8 12
399..................................... 1496 4.4285 1 2 4 6 8
400..................................... 7875 10.4036 2 4 7 13 23
401..................................... 6682 12.3664 2 5 9 16 25
402..................................... 1619 4.7140 1 1 3 6 10
403..................................... 36528 9.2740 2 4 7 12 19
404..................................... 4124 5.0902 1 2 4 7 10
406..................................... 3407 11.2548 3 5 8 14 23
407..................................... 761 4.9304 1 2 4 6 9
408..................................... 3100 8.1632 1 2 5 10 18
409..................................... 5931 6.7132 2 3 4 6 15
410..................................... 89995 3.3580 1 2 3 4 5
411..................................... 58 2.6724 1 1 2 3 7
412..................................... 37 2.9730 1 1 2 4 5
413..................................... 8878 8.3323 2 3 6 10 17
414..................................... 845 5.1361 1 2 4 7 11
415..................................... 40783 15.7224 4 7 12 19 31
416..................................... 201554 8.2165 2 4 7 10 15
417..................................... 54 4.5741 1 2 4 7 10
418..................................... 19614 6.7661 2 3 5 8 13
419..................................... 16497 5.6833 2 3 4 7 10
420..................................... 3010 4.3050 2 2 4 5 8
421..................................... 12216 4.6523 2 2 4 5 8
422..................................... 97 3.8041 1 2 3 4 7
423..................................... 9588 8.7110 2 4 6 10 18
424..................................... 2102 17.9139 3 6 12 20 35
425..................................... 16010 4.8731 1 2 3 6 10
426..................................... 4920 5.5150 1 2 4 7 11
427..................................... 1856 5.2333 1 2 4 6 11
428..................................... 956 8.3347 1 3 5 10 18
429..................................... 40733 8.9700 2 3 6 10 17
430..................................... 55753 9.7545 2 4 7 12 19
431..................................... 200 7.1500 1 3 5 9 13
432..................................... 457 6.5252 1 2 4 6 11
433..................................... 8283 3.4066 1 1 2 4 7
434..................................... 21935 5.8210 2 3 4 7 11
435..................................... 16376 4.8062 1 3 4 6 8
436..................................... 3128 14.3744 4 8 14 21 28
437..................................... 14927 10.8952 4 6 10 14 20
439..................................... 910 8.9264 2 3 6 11 18
440..................................... 5007 9.8354 2 3 6 12 21
441..................................... 648 4.4213 1 1 2 4 8
442..................................... 14657 8.7406 1 3 6 11 18
443..................................... 3465 3.5512 1 1 2 5 7
444..................................... 3543 5.2882 1 3 4 6 10
[[Page 46301]]
445..................................... 1415 3.9046 1 2 3 5 7
446..................................... 1 1.0000 1 1 1 1 1
447..................................... 3991 2.8013 1 1 2 3 5
448..................................... 88 1.0000 1 1 1 1 1
449..................................... 30267 4.4278 1 2 3 5 9
450..................................... 7175 2.3376 1 1 2 3 5
451..................................... 8 6.0000 2 3 4 5 7
452..................................... 20338 5.4282 1 2 4 6 11
453..................................... 3819 3.1825 1 1 2 4 6
454..................................... 5391 5.1330 1 2 3 6 10
455..................................... 1181 2.8442 1 1 2 3 5
456..................................... 213 8.3803 1 1 4 9 21
457..................................... 135 4.8222 1 1 2 5 12
458..................................... 1650 16.8358 3 7 13 22 35
459..................................... 582 10.2887 2 4 7 13 21
460..................................... 2437 6.6422 1 3 5 8 13
461..................................... 3230 4.8920 1 1 2 5 12
462..................................... 9786 13.7570 4 6 12 18 26
463..................................... 12591 5.1721 1 2 4 6 10
464..................................... 3221 3.7464 1 2 3 5 7
465..................................... 202 3.8762 1 1 2 4 7
466..................................... 1943 4.8101 1 1 2 4 10
467..................................... 1820 4.1264 1 1 2 4 8
468..................................... 59655 15.3127 3 7 12 19 30
471..................................... 9604 8.0717 4 5 6 9 14
472..................................... 159 30.1635 1 9 28 40 61
473..................................... 8643 14.3722 2 4 8 21 36
475..................................... 94974 12.1639 2 5 10 16 24
476..................................... 7280 13.8379 3 7 11 17 25
477..................................... 31806 9.3027 1 3 7 12 19
478..................................... 123973 8.3143 1 3 6 10 17
479..................................... 18593 4.5529 1 2 4 6 9
480..................................... 40 32.5750 12 16 24 34 55
481..................................... 193 32.6166 19 22 28 36 53
482..................................... 7121 14.8666 5 8 11 17 28
483..................................... 38600 45.9567 15 23 37 56 85
484..................................... 366 15.8115 2 6 12 22 32
485..................................... 3426 11.6985 4 6 9 14 22
486..................................... 2316 13.4473 1 6 11 18 28
487..................................... 4136 8.9350 1 3 7 11 18
488..................................... 843 20.4152 5 8 14 25 41
489..................................... 19523 10.6298 2 4 7 13 22
490..................................... 5312 6.5849 1 2 4 8 14
491..................................... 9897 4.2698 2 3 3 5 7
492..................................... 2139 17.3703 3 5 10 28 37
493..................................... 54799 5.8913 1 2 5 8 11
494..................................... 28543 2.4171 1 1 2 3 5
495..................................... 131 22.7176 10 12 17 26 39
----------------
11135858
--------------------------------------------------------------------------------------------------------------------------------------------------------
Table 8a.--Statewide Average Operating Cost-To-Charge Ratios for Urban
and Rural Hospitals (Case Weighted) August 1996
------------------------------------------------------------------------
State Urban Rural
------------------------------------------------------------------------
ALABAMA............................................... 0.420 0.476
ALASKA................................................ 0.505 0.796
ARIZONA............................................... 0.423 0.568
ARKANSAS.............................................. 0.540 0.495
CALIFORNIA............................................ 0.405 0.540
COLORADO.............................................. 0.513 0.604
CONNECTICUT........................................... 0.553 0.551
DELAWARE.............................................. 0.503 0.500
DISTRICT OF COLUMBIA.................................. 0.525 .......
FLORIDA............................................... 0.414 0.418
GEORGIA............................................... 0.527 0.532
HAWAII................................................ 0.484 0.567
IDAHO................................................. 0.580 0.635
ILLINOIS.............................................. 0.478 0.599
INDIANA............................................... 0.564 0.613
IOWA.................................................. 0.540 0.684
KANSAS................................................ 0.449 0.649
KENTUCKY.............................................. 0.506 0.574
LOUISIANA............................................. 0.475 0.540
MAINE................................................. 0.593 0.570
MARYLAND.............................................. 0.765 0.816
MASSACHUSETTS......................................... 0.574 0.600
MICHIGAN.............................................. 0.489 0.594
MINNESOTA............................................. 0.563 0.641
MISSISSIPPI........................................... 0.525 0.527
MISSOURI.............................................. 0.459 0.529
[[Page 46302]]
MONTANA............................................... 0.513 0.615
NEBRASKA.............................................. 0.526 0.684
NEVADA................................................ 0.321 0.563
NEW HAMPSHIRE......................................... 0.591 0.611
NEW JERSEY............................................ 0.479 .......
NEW MEXICO............................................ 0.484 0.546
NEW YORK.............................................. 0.584 0.679
NORTH CAROLINA........................................ 0.539 0.498
NORTH DAKOTA.......................................... 0.651 0.694
OHIO.................................................. 0.557 0.594
OKLAHOMA.............................................. 0.489 0.558
OREGON................................................ 0.577 0.671
PENNSYLVANIA.......................................... 0.436 0.580
PUERTO RICO........................................... 0.495 0.643
RHODE ISLAND.......................................... 0.587 .......
SOUTH CAROLINA........................................ 0.477 0.501
SOUTH DAKOTA.......................................... 0.559 0.648
TENNESSEE............................................. 0.536 0.572
TEXAS................................................. 0.462 0.565
UTAH.................................................. 0.462 0.675
VERMONT............................................... 0.576 0.587
VIRGINIA.............................................. 0.499 0.536
WASHINGTON............................................ 0.634 0.688
WEST VIRGINIA......................................... 0.578 0.542
WISCONSIN............................................. 0.604 0.665
WYOMING............................................... 0.495 0.734
------------------------------------------------------------------------
Table 8b.--Statewide Average Capital Cost-To-Charge Ratios (Case
Weighted) August 1996
------------------------------------------------------------------------
State Ratio
------------------------------------------------------------------------
ALABAMA........................................................ 0.055
ALASKA......................................................... 0.077
ARIZONA........................................................ 0.050
ARKANSAS....................................................... 0.056
CALIFORNIA..................................................... 0.040
COLORADO....................................................... 0.052
CONNECTICUT.................................................... 0.037
DELAWARE....................................................... 0.054
DISTRICT OF COLUMBIA........................................... 0.042
FLORIDA........................................................ 0.051
GEORGIA........................................................ 0.052
HAWAII......................................................... 0.051
IDAHO.......................................................... 0.064
ILLINOIS....................................................... 0.044
INDIANA........................................................ 0.058
IOWA........................................................... 0.056
KANSAS......................................................... 0.055
KENTUCKY....................................................... 0.056
LOUISIANA...................................................... 0.069
MAINE.......................................................... 0.044
MARYLAND....................................................... 0.013
MASSACHUSETTS.................................................. 0.060
MICHIGAN....................................................... 0.049
MINNESOTA...................................................... 0.055
MISSISSIPPI.................................................... 0.056
MISSOURI....................................................... 0.053
MONTANA........................................................ 0.061
NEBRASKA....................................................... 0.058
NEVADA......................................................... 0.034
NEW HAMPSHIRE.................................................. 0.066
NEW JERSEY..................................................... 0.045
NEW MEXICO..................................................... 0.055
NEW YORK....................................................... 0.056
NORTH CAROLINA................................................. 0.049
NORTH DAKOTA................................................... 0.074
OHIO........................................................... 0.056
OKLAHOMA....................................................... 0.056
OREGON......................................................... 0.052
PENNSYLVANIA................................................... 0.045
PUERTO RICO.................................................... 0.090
RHODE ISLAND................................................... 0.039
SOUTH CAROLINA................................................. 0.054
SOUTH DAKOTA................................................... 0.066
TENNESSEE...................................................... 0.057
TEXAS.......................................................... 0.055
UTAH........................................................... 0.055
VERMONT........................................................ 0.049
VIRGINIA....................................................... 0.057
WASHINGTON..................................................... 0.063
WEST VIRGINIA.................................................. 0.059
WISCONSIN...................................................... 0.048
WYOMING........................................................ 0.067
------------------------------------------------------------------------
Table 10.--Percentage Difference in Wage Indexes for Areas That Qualify for a Wage Index Excluded Hospitals and
Units
----------------------------------------------------------------------------------------------------------------
1982-1993 1984-1993 1988-1993 1990-1993 1991-1993 1992-1993
Area difference difference difference difference difference difference
----------------------------------------------------------------------------------------------------------------
Rural Connecticut................. 22.9642 25.4054 ........... ........... ........... ...........
Rural Delaware.................... 8.2430 11.4258 8.2051 9.1337 ........... ...........
Rural Hawaii...................... ........... 15.9050 ........... ........... ........... ...........
Rural Massachusetts............... 20.2198 24.1342 ........... ........... ........... ...........
Rural New Hampshire............... ........... 9.8512 ........... ........... ........... ...........
Albany, GA........................ ........... 10.3581 ........... ........... ........... ...........
Anchorage, AK..................... ........... ........... ........... 8.2863 ........... ...........
Andreson, SC...................... ........... ........... 9.1948 17.8927 ........... ...........
Arecibo, PR....................... ........... ........... 11.1448 18.6084 15.7978 ...........
Athens, GA........................ 15.1448 21.0519 13.7293 13.6463 ........... ...........
Atlanta, GA....................... ........... 8.6086 ........... ........... ........... ...........
Atlantic City, NJ................. ........... 12.4784 ........... ........... ........... ...........
Bergen-Passaic, NJ................ 10.5317 12.4189 14.3717 ........... ........... ...........
Biloxi-Gulfport, MS............... ........... 11.1443 10.6209 12.4040 ........... ...........
Boise City, ID.................... ........... ........... ........... 8.3390 ........... ...........
Boston-Lowell-Brockton-Lawrence-
Salem, MA........................ ........... 9.8215 ........... ........... ........... ...........
Bremerton, WA..................... 11.9762 13.8828 14.2288 14.3007 12.7288 ...........
Bridgeport-Stamford-Norwalk-
Danbury, CT...................... 10.0485 14.3994 ........... ........... ........... ...........
Burlington, NC.................... 11.2298 14.5664 9.4207 ........... ........... ...........
Burlington, VT.................... ........... 8.8170 9.1074 ........... ........... 10.3206
Caguas, PR........................ ........... 15.1271 ........... ........... ........... ...........
Charleston, WV.................... ........... ........... 8.3229 ........... ........... ...........
Charlotte-Gastonia-Rock Hill, NC-
SC............................... ........... 14.9051 ........... ........... ........... ...........
Clarksville-Hopkinsville, TN-KY... ........... ........... 12.9537 ........... ........... ...........
Columbia, SC...................... ........... 8.4912 ........... ........... ........... ...........
Danville, VA...................... ........... 11.3907 13.1106 ........... ........... ...........
Decat
FR Doc. 96-22145 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1997 Rates
ur, AL....................... ........... 13.3721 11.9044 ........... ........... ...........
El Paso, TX....................... ........... 8.5187 ........... ........... 9.8283 ...........
Eugene-Springfield, OR............ ........... 10.5206 10.8031 18.7777 ........... ...........
Fayetteville, NC.................. 9.0029 10.4192 8.4909 ........... ........... ...........
Flint, MI......................... ........... ........... ........... ........... 9.2030 ...........
Florence, AL...................... ........... 11.9746 ........... ........... ........... ...........
Florence, SC...................... 12.7213 11.5654 ........... ........... ........... ...........
[[Page 46303]]
Fort Walton Beach, FL............. ........... 12.3564 ........... ........... ........... ...........
Fresno, CA........................ ........... ........... ........... 10.8664 9.4732 8.0939
Gadsden, AL....................... ........... ........... 8.2379 14.6656 9.8985 ...........
Galveston-Texas City, TX.......... ........... ........... 16.5166 11.3722 8.4081 ...........
Greeley, CO....................... ........... ........... ........... 11.0971 ........... ...........
Greensboro-Winston-Salem-High
Point, NC........................ 9.2662 ........... ........... ........... ........... ...........
Hamilton-Middleton, OH............ ........... ........... ........... ........... 8.1472 8.0733
Hartford-Middletown-New Britain,
CT............................... 8.7767 12.4966 3.7059 2.2400 -0.1050 -0.1775
Houma-Thibodaux, LA............... ........... ........... 9.3263 ........... ........... ...........
Jackson, TN....................... ........... 9.6429 ........... ........... ........... ...........
Jersey City, NJ................... ........... ........... 8.0391 ........... ........... ...........
Killeen-Temple, TX................ 18.3848 ........... ........... ........... ........... ...........
Lima, OH.......................... ........... ........... 8.2156 ........... ........... ...........
Macon-Warner Robins, GA........... ........... 13.0975 ........... ........... ........... ...........
McAllen-Edinburg-Mission, TX...... ........... 10.4962 9.8809 ........... ........... ...........
Medford, OR....................... ........... ........... ........... 8.0133 ........... ...........
Merced, CA........................ ........... ........... ........... ........... 8.1676 ...........
Middlesex-Somerset-Hunterdon, NJ.. ........... 9.6183 ........... ........... ........... ...........
Monmouth-Ocean, NJ................ 10.0345 15.4149 9.3349 ........... ........... ...........
Munice, IN........................ ........... ........... 20.3096 13.5593 ........... ...........
Nassau-Suffolk, NY................ ........... 11.9105 ........... ........... ........... ...........
New Bedford-Fall River-Attleboro,
MA............................... 13.7683 16.6368 10.4385 ........... ........... ...........
New Haven-West Haven-Waterbury, CT 11.8620 16.2147 ........... ........... ........... ...........
New London-Norwich, CT............ 11.3300 14.9405 ........... ........... ........... ...........
Newark, NJ........................ ........... 8.8979 ........... ........... ........... ...........
Ocala, FL......................... ........... 11.8261 ........... ........... ........... ...........
Orange County, NY................. 17.1382 21.4157 11.8518 ........... ........... ...........
Portsmouth-Dover-Rochester, NH.... 9.0870 ........... ........... ........... ........... ...........
Poughkeepsie, NY.................. ........... 8.8610 ........... ........... ........... ...........
Providence-Pawtucket-Woonsocket,
RI............................... ........... 13.9497 ........... ........... ........... ...........
Provo-Orem, UT.................... ........... 9.0782 ........... ........... ........... ...........
Redding, CA....................... ........... 17.2205 9.9157 ........... ........... ...........
Richland-Kennewick, WA............ ........... ........... ........... 8.1102 ........... ...........
Salinas-Seaside-Monterey, CA...... 10.6879 9.7202 ........... ........... ........... ...........
Santa Cruz, CA.................... 9.6319 9.7120 ........... ........... ........... ...........
Santa Fe, NM...................... 11.2207 14.0809 18.3339 8.2941 ........... ...........
Sarasota, FL...................... ........... 8.9573 ........... ........... ........... ...........
Savannah, GA...................... 9.0765 14.6762 15.7768 11.1239 ........... ...........
Topeka, KS........................ ........... ........... 8.3342 9.2849 ........... ...........
Tyler, TX......................... ........... ........... ........... 9.5202 ........... ...........
Vallejo-Fairfield-Napa, CA........ ........... 13.6478 ........... 11.7807 ........... ...........
Wilmington, DE-NJ-MD.............. ........... 8.9989 ........... ........... ........... ...........
Wilmington, NC.................... ........... 12.2020 ........... ........... ........... ...........
Worcester-Fitchburg-Leomister, MA. 10.9147 17.9463 ........... ........... ........... ...........
Yuma, AZ.......................... ........... ........... ........... ........... 9.4870 ...........
----------------------------------------------------------------------------------------------------------------
Appendix A--Regulatory Impact Analysis
I. Introduction
We generally prepare a regulatory flexibility analysis that is
consistent with the Regulatory Flexibility Act (RFA) (5 U.S.C. 601
through 612), unless the Secretary certifies that a final rule would
not have a significant economic impact on a substantial number of small
entities. For purposes of the RFA, we consider all hospitals to be
small entities.
Also, section 1102(b) of the Social Security Act (the Act) requires
the Secretary to prepare a regulatory impact analysis for any final
rule that may have a significant impact on the operations of a
substantial number of small rural hospitals. Such an analysis must
conform to the provisions of section 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 define 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). Section 601(g) of the Social Security Amendments of 1983
(Public Law 98-21) designated hospitals in certain New England counties
as belonging to the adjacent NECMA. Thus, for purposes of the
prospective payment system, we classify these hospitals as urban
hospitals.
It is clear that the changes in this document would affect both a
substantial number of small rural hospitals as well as other classes of
hospitals, and the effects on some may be significant. Therefore, the
discussion below, in combination with the rest of this final rule,
constitutes a combined regulatory impact analysis and regulatory
flexibility analysis.
II. Changes in the Final Rule
Any differences in this final rule impact analysis compared to that
in the proposed rule are the result of using more recent or more
complete hospital data. For example, a more complete FY 1995 MedPAR
file (June 1996 update) is
[[Page 46304]]
now available compared to the one available at the time of the proposed
rule. In addition, more recent hospital-specific data, including cost
reports, are used in this analysis.
Our most recent hospital market basket forecasts are: 2.5 percent
for prospective payment system hospitals and 2.5 percent for hospitals
excluded from the prospective payment system. The respective update
factors in the proposed rule were both 2.7 percent. Beyond this change
in the hospital market basket forecast, there are no operating or
capital prospective payment policy changes from those discussed in the
impact analysis in the proposed rule.
III. Limitations of Our Analysis
As has been the case in previously published regulatory impact
analyses, the following quantitative analysis presents the projected
effects of our final policy changes, as well as statutory changes
effective for FY 1997, on various hospital groups. We estimate the
effects of individual policy changes by estimating payments per case
while holding all other payment policies constant. We use the best data
available, but we do not attempt to predict behavioral responses to our
policy changes, and we do not make adjustments for future changes in
such variables as admissions, lengths of stay, or case mix.
We received no comments on the methodology used for the impact
analysis in the proposed rule.
IV. Hospitals Included In and Excluded From the Prospective Payment
System
The prospective payment systems for hospital inpatient operating
and capital-related costs encompass nearly all general, short-term,
acute care hospitals that participate in the Medicare program. There
were 46 Indian Health Service hospitals in our data base, which we
excluded from the analysis due to the special characteristics of the
prospective payment method for these hospitals. Among other short-term,
acute care hospitals, only the 50 such hospitals in Maryland remain
excluded from the prospective payment system under the waiver at
section 1814(b)(3) of the Act. Thus, we have included 5,129 hospitals
in our analysis. This represents about 82 percent of all Medicare-
participating hospitals. The majority of this impact analysis focuses
on this set of hospitals.
The remaining 18 percent are specialty hospitals that are excluded
from the prospective payment system and continue to be paid on the
basis of their reasonable costs (subject to a rate-of-increase ceiling
on their inpatient operating costs per discharge). These hospitals
include psychiatric, rehabilitation, long-term care, childrens', and
cancer hospitals. The impacts of our policy changes on these hospitals
are discussed below.
V. Impact on Excluded Hospitals and Units
As of August 1996, there were 1,125 specialty hospitals excluded
from the prospective payment system and instead paid on a reasonable
cost basis subject to the rate-of-increase ceiling under Sec. 413.40.
In addition, there were 2,315 psychiatric and rehabilitation units in
hospitals otherwise subject to the prospective payment system. These
excluded units are also paid in accordance with Sec. 413.40.
In accordance with section 1886(b)(3)(B)(ii)(V) of the Act, the
update factor applicable to the rate-of-increase limit for excluded
hospitals and units for FY 1997 is 1.5 percent (excluded hospital
market basket minus 1.0 percentage points), adjusted to account for the
relationship between the hospital's allowable operating cost per case
and its target amounts.
The impact on excluded hospitals and units of the final update in
the rate-of-increase limit depends on the cumulative cost increases
experienced by each excluded hospital and excluded unit since its
applicable base period. For excluded hospitals and units that have
maintained their cost increases at a level below the percentage
increases in the rate-of-increase limits since their base period, the
major effect will be on the level of incentive payments these hospitals
and units receive. Conversely, for excluded hospitals and units with
per-case cost increases above the cumulative update in their rate-of-
increase limit, the major effect will be the amount of excess costs
that the hospitals would have to absorb.
In this context, we note that, under Sec. 413.40(d)(3), an excluded
hospital or unit whose costs exceed the rate-of-increase limit is
allowed to receive the lower of its rate-of-increase ceiling plus 50
percent of reasonable costs in excess of the ceiling, or 110 percent of
its ceiling. In addition, under the various provisions set forth in
Sec. 413.40, excluded hospitals and units can obtain payment
adjustments for significant and justifiable increases in operating
costs that exceed the limit. At the same time, however, by generally
limiting payment increases, we continue to provide an incentive for
excluded hospitals and units to restrain the growth in their spending
for patient services.
VI. Quantitative Impact Analysis of the Final Policy Changes Under
the Prospective Payment System for Operating Costs
A. Basis and Methodology of Estimates
In this final rule, we are announcing policy changes and payment
rate updates for the prospective payment systems for operating and
capital-related costs. We have prepared separate analyses of the final
changes to each system, beginning here with changes to the operating
prospective payment system. Estimated payment impacts of final FY 1997
changes to the capital prospective payment system are discussed below
in section VII of this Appendix.
The data used in developing the quantitative analyses presented
below are taken from the FY 1995 MedPAR file and the most current
provider-specific file that is used for payment purposes. Although the
analyses of the changes to the operating prospective payment system do
not incorporate cost data, the most recently available hospital cost
report data were used to create some of the variables by which
hospitals are categorized. Our analysis has several qualifications.
First, we do not make adjustments for behavioral changes that hospitals
may adopt in response to these policy changes. Second, due to the
interdependent nature of the prospective payment system, it is very
difficult to precisely quantify the impact associated with each change.
Third, we draw upon various sources for the data used to categorize
hospitals in the tables. In some cases, particularly the number of
beds, there is a fair degree of variation in the data from different
sources. We have attempted to construct these variables with the best
available source overall. For individual hospitals, however, some
miscategorizations are possible.
Using cases in the FY 1995 MedPAR file, we simulated payments under
the operating prospective payment system given various combinations of
payment parameters. Any short-term, acute care hospitals not paid under
the general prospective payment systems (Indian Health Service
hospitals and hospitals in Maryland) are excluded from the simulations.
Payments under the capital prospective payment system, or payments for
costs other than inpatient operating costs, are not analyzed here.
The following changes are discussed separately below:
The effects of the annual reclassification of diagnoses
and procedures and the recalibration of the diagnosis-related group
(DRG) relative
[[Page 46305]]
weights required by section 1886(d)(4)(C) of the Act.
The effects of changes in hospitals' wage index values
reflecting the wage index update (FY 1993 data).
The effects of geographic reclassifications by the
Medicare Geographic Classification Review Board (MGCRB) that will be
effective in FY 1997.
The effects of phasing out payments for extraordinarily
lengthy cases (day outlier cases) with a corresponding increase in
payments for extraordinarily costly cases (cost outliers), in
accordance with section 1886(d)(5)(A)(v) of the Act.
The total change in payments based on FY 1997 policies
relative to payments based on FY 1996 policies.
To illustrate the impacts of the FY 1997 final changes, our
analysis begins with an FY 1997 baseline simulation model using: the FY
1996 GROUPER (version 13.0); the FY 1996 wage indexes (based on FY 1992
data); no MGCRB reclassifications; and current outlier policy (50
percent phase-out of day outlier payments). Outlier payments are
estimated to be 5.1 percent of total DRG payments.
Each policy change is then added incrementally to this baseline
model, finally arriving at an FY 1997 model incorporating all of the
final rule and statutory changes. This allows us to isolate the effects
of each change.
Our final comparison illustrates the percent change in payments per
case from FY 1996 to FY 1997. Four factors not displayed in the
previous five columns have significant impacts here. First is the
update to the standardized amounts for FY 1997. In accordance with
section 1886(d)(3)(A)(iv) of the Act, we are updating the large urban
and the other areas average standardized amounts for FY 1997 using the
most recently forecasted hospital market basket increase for FY 1997 of
2.5 percent, minus 0.5 percentage points. Thus, the update to the large
urban and other areas standardized amounts is 2.0 percent. Similarly,
section 1886(b)(3)(C)(ii) of the Act provides that the update factor
applicable to the hospital-specific rates for sole community hospitals
(SCHs) and essential access community hospitals (EACHs) (which are
treated as SCHs for payment purposes) is also the market basket
increase minus 0.5 percent, or 2.0 percent.
A second significant factor impacting changes in hospitals'
payments per case from FY 1996 to FY 1997 is a change in MGCRB
reclassification status from one year to the next. That is, hospitals
reclassified in FY 1996 that are no longer reclassified in FY 1997 may
have a negative payment impact going from FY 1996 to FY 1997;
conversely, hospitals not reclassified in FY 1996 that are reclassified
in FY 1997 may have a positive impact. In some cases, these impacts can
be quite substantial, so that if a relatively small number of hospitals
in a particular category lose their reclassification status, the
percentage increase in payments for the category may be below the
national mean.
A third significant factor is that we currently estimate that
actual outlier payments during FY 1996 will be 4.0 percent of actual
total DRG payments. When the FY 1996 final rule was published, we
projected FY 1996 outlier payments would be 5.1 percent of total DRG
payments, and the standardized amounts were reduced correspondingly.
The effects of the lower than expected outlier payments during FY 1996
(as discussed in the Addendum to this final rule) are reflected in the
analyses below comparing our current estimates of FY 1996 payments per
case to estimated FY 1997 payments per case.
Finally, the regional floor provision (section
1886(d)(1)(A)(iii)(II) of the Act) expires effective with discharges
occurring on or after October 1, 1996. Under this provision (applicable
during FY 1996), hospitals within any census division having a regional
standardized amount greater than the national standardized amount
(large urban or other, depending on which amount was applicable)
received a blend of 85 percent of the national amount and 15 percent of
the regional amount. Hospitals in census divisions where the regional
floor was applicable during FY 1996 will be negatively impacted by its
expiration when comparing FY 1996 to FY 1997.
Table I demonstrates the results of our analysis. This table
categorizes hospitals by various geographic and special payment
consideration groups to illustrate the varying impacts on different
types of hospitals. The top row of the table shows the overall impact
on the 5,129 hospitals included in the analysis. This is 78 fewer
hospitals than were included in the impact analysis in the FY 1996
final rule (60 FR 45924). Data for 108 hospitals that were included in
last year's analysis were not available for analysis this year;
however, data were available this year for 30 hospitals for which data
were not available last year.
The next four rows of Table I contain hospitals categorized
according to their geographic location (all urban, which is further
divided into large urban and other urban, or rural). There are 2,881
hospitals located in urban areas (MSAs or NECMAs) included in our
analysis. Among these, there are 1,596 hospitals located in large urban
areas (populations over 1 million), and 1,285 hospitals in other urban
areas (populations of 1 million or fewer). In addition, there are 2,248
hospitals in rural areas. The next two groupings are by bed size
categories, shown separately for urban and rural hospitals. The final
groupings by geographic location are by census divisions, also shown
separately for urban and rural hospitals.
The second part of Table I shows hospital groups based on
hospitals' FY 1997 payment classifications, including any
reclassifications under section 1886(d)(10) of the Act. For example,
the rows labeled urban, large urban, other urban, and rural, show the
numbers of hospitals being paid based on these categorizations (after
consideration of geographic reclassifications), are 2,981, 1,791,
1,190, and 2,148, respectively.
The next three groupings examine the impacts of the final changes
on hospitals grouped by whether or not they have residency programs
(teaching hospitals that receive an indirect medical education (IME)
adjustment), receive disproportionate share (DSH) payments, or some
combination of these two adjustments. There are 4,044 nonteaching
hospitals in our analysis, 850 teaching hospitals with fewer than 100
residents, and 235 teaching hospitals with 100 or more residents.
In the DSH categories, hospitals are grouped according to their DSH
payment status, and whether they are considered urban or rural after
MGCRB reclassifications. Hospitals in the rural DSH categories,
therefore, represent hospitals that were not reclassified for purposes
of the standardized amount. (They may, however, have been reclassified
for purposes of the wage index.) The next category groups hospitals
considered urban after geographic reclassification, in terms of whether
they receive the IME adjustment, the DSH adjustment, both, or neither.
The next four rows examine the impacts of the final changes on
rural hospitals by special payment groups (SCHs, rural referral centers
(RRCs), and EACHs), as well as rural hospitals not receiving a special
payment designation. Rural hospitals reclassified for FY 1997 for
purposes of the standardized amount are not included here.
The RRCs (90), SCH/EACHs (645), and SCH/EACH and RRCs (38) shown
here were not reclassified for purposes of the standardized amount.
There are seven EACHs included in our analysis and four EACH/RRCs.
[[Page 46306]]
There are two RRCs and three SCHs that will be reclassified for the
standardized amount in FY 1997 that, therefore, are not included in
these rows. There are significantly fewer reclassifications among these
groups than there were in FY 1996, owing to the new criterion under
Sec. 412.230(a)(5)(ii) that a hospital may not be reclassified for
purposes of the standardized amount if the area to which the hospital
seeks reclassification does not have a higher standardized amount than
that currently received by the hospital. (See the September 1, 1995
final rule (60 FR 45799).) Before this change (effective with
reclassifications for FY 1997), some rural hospitals reclassified to
other urban areas in order to qualify for urban DSH payments. For other
rural hospitals that already qualified for DSH payments, the urban
designation enabled them to qualify for a higher DSH adjustment than
they would receive as a rural hospital.
The next two groupings are based on type of ownership and the
hospital's Medicare utilization expressed as a percent of total patient
days. These data are taken primarily from the FY 1994 Medicare cost
report files, if available (otherwise FY 1993 data are used). Cost
report data needed to determine hospital ownership and to calculate
Medicare utilization percentages were unavailable for 116 hospitals.
For the most part, these are either new hospitals or hospitals filing
manual cost reports that are not yet entered into the data base.
The next series of groupings concern the geographic
reclassification status of hospitals. The first three groupings display
hospitals that were reclassified by the MGCRB for either FY 1996 or FY
1997, or for both years, by urban/rural status. The next rows
illustrate the overall number of FY 1997 reclassifications, as well as
the numbers of reclassified hospitals grouped by urban and rural
location. The final row in Table I contains hospitals located in rural
counties but deemed to be urban under section 1886(d)(8)(B) of the Act.
Table I.--Impact Analysis of Changes for FY 1997 Operating Prospective Payment System
[Percent changes in payments per case]
Combined MGCRB Day outlier
Number of DRG recali- New wage wage and reclassifi- policy All FY 97
hospitals bration \2\ data \3\ recal \4\ cation \5\ changes \6\ changes \7\
(0) (1) (2) (3) (4) (5) (6)
--------------------------------------------------------------------------------------------------------------------------------------------------------
(By Geographic Location)
--------------------------------------------------------------------------------------------------------------------------------------------------------
All hospitals............................................... 5,129 0.1 0.1 0.0 0.0 0.0 2.9
Urban hospitals............................................. 2,881 0.1 0.1 0.0 -0.4 -0.1 2.9
Large urban............................................. 1,596 0.1 0.1 0.0 -0.4 -0.1 2.9
Other urban............................................. 1,285 0.1 0.1 0.0 -0.2 0.1 3.0
Rural hospitals............................................. 2,248 0.0 0.0 -0.1 2.3 0.1 2.4
Bed size (urban):
0-99 beds............................................... 715 0.0 -0.1 -0.3 -0.5 0.1 2.7
100-199 beds............................................ 945 0.0 -0.1 -0.2 -0.4 0.1 2.6
200-299 beds............................................ 576 0.1 0.0 0.0 -0.4 0.0 2.9
300-499 beds............................................ 478 0.1 0.1 0.1 -0.4 -0.1 3.1
500 or more beds........................................ 167 0.1 0.1 0.1 -0.2 -0.2 3.1
Bed size (rural):
0-49 beds............................................... 1,177 -0.1 0.1 -0.1 0.0 0.1 2.4
50-99 beds.............................................. 657 -0.1 0.1 -0.1 1.0 0.1 2.4
100-149 beds............................................ 241 0.0 0.1 -0.1 3.1 0.1 2.6
150-199 beds............................................ 98 0.1 0.0 0.0 2.7 0.1 2.7
200 or more beds........................................ 75 0.1 -0.1 -0.1 4.9 0.1 1.9
Urban by census division:
New England............................................. 160 0.1 0.0 0.0 -0.2 -0.1 2.0
Middle Atlantic......................................... 434 0.0 0.4 0.3 -0.2 -0.7 3.3
South Atlantic.......................................... 419 0.1 -0.2 -0.2 -0.4 0.1 3.1
East North Central...................................... 483 0.1 0.4 0.4 -0.3 0.1 2.5
East South Central...................................... 163 0.1 -0.2 -0.2 -0.5 0.2 3.1
West North Central...................................... 193 0.1 0.0 0.0 -0.5 0.2 3.3
West South Central...................................... 376 0.1 0.1 0.0 -0.5 0.2 3.6
Mountain................................................ 127 0.2 -0.3 -0.3 -0.4 0.2 2.9
Pacific................................................. 478 0.1 -0.4 -0.4 -0.5 0.1 2.5
Puerto Rico............................................. 48 -0.1 -1.2 -1.4 -0.5 0.0 1.9
Rural by census division:
New England............................................. 53 0.1 -0.9 -1.0 2.0 0.2 1.2
Middle Atlantic......................................... 85 0.0 -0.5 -0.6 0.9 -0.1 1.7
South Atlantic.......................................... 297 -0.1 -0.4 -0.5 3.0 0.1 2.3
East North Central...................................... 304 0.1 0.3 0.3 2.0 0.1 2.6
East South Central...................................... 278 -0.1 0.3 0.1 2.4 0.1 1.9
West North Central...................................... 525 0.0 0.1 0.0 2.1 0.1 2.5
West South Central...................................... 349 -0.1 0.5 0.2 3.1 0.1 2.8
Mountain................................................ 211 0.1 -0.1 -0.1 0.8 0.1 2.6
Pacific................................................. 141 0.1 0.6 0.5 2.3 0.1 3.7
Puerto Rico............................................. 5 -0.2 -4.2 -4.5 3.3 0.0 1.7
--------------------------------------------------------------------------------------------------------------------------------------------------------
(By Payment Categories)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Urban hospitals............................................. 2,981 0.1 0.1 0.0 -0.3 0.0 2.9
[[Page 46307]]
Large urban............................................. 1,791 0.1 0.1 0.0 -0.2 -0.1 2.9
Other urban............................................. 1,190 0.1 0.0 0.0 -0.4 0.1 3.0
Rural hospitals............................................. 2,148 0.0 0.0 -0.1 1.9 0.1 2.2
Teaching status:
Non-teaching............................................ 4,044 0.0 0.0 -0.1 0.3 0.1 2.8
Less than 100 residents................................. 850 0.1 0.1 0.0 -0.3 0.0 3.0
100+ residents.......................................... 235 0.1 0.2 0.2 -0.2 -0.4 2.8
Disproportionate Share Hospitals (DSH):
Non-DSH................................................. 3,201 0.1 0.0 0.0 0.2 0.1 2.9
Urban DSH:
100 beds or more........................................ 1,410 0.0 0.1 0.0 -0.3 -0.1 2.9
Fewer than 100 beds..................................... 101 -0.2 -0.3 -0.6 -0.3 0.2 2.2
Rural DSH:
Sole community (SCH)................................ 156 -0.1 0.0 -0.3 0.3 0.0 3.6
Referral centers (RRC).............................. 27 0.0 0.1 -0.1 3.7 0.0 3.3
Other rural DSH hospitals:
100 beds or more.................................... 83 0.0 -0.1 -0.2 2.4 0.2 0.3
Fewer than 100 beds................................. 151 -0.2 0.0 -0.3 -0.3 0.1 2.0
Urban teaching and DSH:
Both teaching and DSH................................... 692 0.0 0.2 0.1 -0.4 -0.2 2.8
Teaching and no DSH..................................... 339 0.2 0.0 0.1 -0.1 0.0 3.0
No teaching and DSH..................................... 819 0.0 -0.1 -0.2 0.0 0.1 3.0
No teaching and no DSH.................................. 1,131 0.1 0.0 -0.1 -0.3 0.2 3.1
Rural hospital types Nonspecial status:
Hospitals............................................... 1,375 0.0 0.0 -0.1 1.7 0.1 1.6
RRC..................................................... 90 0.1 0.1 0.1 5.0 0.1 3.4
SCH/each................................................ 645 -0.1 0.0 -0.2 0.3 0.0 2.6
SCH/each and RRC........................................ 38 0.1 0.1 0.0 1.1 -0.1 2.7
Type of ownership:
Voluntary............................................... 2,951 0.1 0.1 0.1 -0.1 -0.1 2.9
Proprietary............................................. 696 0.0 -0.2 -0.4 0.3 0.2 2.9
Government.............................................. 1,366 0.0 0.0 -0.1 0.1 0.0 2.6
Unknown................................................. 116 -0.2 0.6 0.3 -0.4 -1.3 2.1
Medicare utilization as a percent of inpatient days:
0-25.................................................... 258 -0.1 -0.1 -0.3 -0.4 -0.2 2.0
25-50................................................... 1,284 0.1 0.0 0.0 -0.2 -0.1 2.9
50-65................................................... 2,097 0.1 0.1 0.0 0.2 0.0 2.9
Over 65................................................. 1,374 0.0 0.0 -0.1 0.2 0.1 2.9
Unknown................................................. 116 -0.2 0.6 0.3 -0.4 -1.3 2.1
--------------------------------------------------------------------------------------------------------------------------------------------------------
Hospitals Reclassified by the Medicare Geographic Review Board
--------------------------------------------------------------------------------------------------------------------------------------------------------
Reclassification status during FY96 and FY97:
Reclassified during both FY96 and FY97.................. 379 0.1 0.2 0.2 5.9 0.0 2.7
Urban............................................... 130 0.1 0.4 0.4 3.5 -0.1 3.0
Rural............................................... 249 0.0 0.0 -0.1 8.9 0.1 2.5
Reclassified during FY97 only........................... 98 0.2 0.3 0.3 3.8 -0.3 8.3
Urban............................................... 29 0.2 0.4 0.5 2.5 -0.5 7.6
Rural............................................... 69 0.0 -0.1 -0.1 7.1 0.1 10.2
Reclassified during FY96 only........................... 253 0.1 -0.5 -0.5 -1.2 0.1 -0.5
Urban............................................... 91 0.1 -0.8 -0.8 -1.7 0.0 0.6
Rural............................................... 162 0.0 0.0 -0.1 -0.4 0.2 -2.2
FY 97 reclassifications:
All reclassified hospitals.......................... 477 0.1 0.2 0.2 5.4 -0.1 3.8
Standard amount only................................ 119 0.1 0.1 0.1 1.7 0.0 2.8
Wage index only..................................... 272 0.1 -0.2 -0.2 8.2 -0.1 3.3
Both................................................ 86 0.1 0.9 0.9 4.7 -0.2 5.5
Nonreclassified..................................... 4,625 0.1 0.0 0.0 -0.6 0.0 2.8
All urban reclassifed................................... 159 0.1 0.4 0.4 3.3 -0.2 4.1
Standard amount only................................ 62 0.1 0.2 0.1 0.9 0.0 2.9
Wage index only..................................... 27 0.2 -0.6 -0.5 7.2 -0.4 3.7
Both................................................ 70 0.1 1.0 1.0 3.4 -0.2 5.1
[[Page 46308]]
Nonreclassified..................................... 2,722 0.1 0.0 0.0 -0.6 0.0 2.9
All rural reclassified.................................. 318 0.0 0.0 -0.1 8.6 0.1 3.5
Standard amount only................................ 57 0.1 -0.1 -0.1 4.4 0.2 2.5
Wage index only..................................... 245 0.0 0.0 -0.1 8.6 0.1 3.2
Both................................................ 16 0.1 -0.1 -0.1 18.5 0.2 9.2
Nonreclassified..................................... 1,903 0.0 0.1 -0.1 -0.4 0.1 1.9
Other reclassifed:
Hospitals (section 1886(d)(8)(B))....................... 27 0.1 0.2 0.1 1.2 0.1 2.7
\1\ Because data necessary to classify some hospitals by category were missing, the total number of hospitals in each category may not equal the
national total. Discharge data are from FY 1995, and hospital cost report data are from reporting periods beginning in FY 1993 and FY 1994.
\2\ This column displays the payment impacts of the recalibration of the DRG weights, based on FY 1995 MedPAR data and the DRG classification changes,
in accordance with section 1886(d)(4)(C) of the Act.
\3\ This column shows the payment effects of updating the data used to calculate the wage index with data from the FY 1993 cost reports.
\4\ This column displays the combined impacts of the reclassification and recalibration of the DRGs, the updated wage data used to calculate the wage
index, and the budget neutrality adjustment factor for these two changes, in accordance with sections 1886(d)(4)(C)(iii) and 1886(d)(3)(E) of the Act.
Thus, it represents the combined impacts shown in columns 1 and 2, and the FY 1997 budget neutrality factor of 0.998702.
\5\ Shown here are the combined effects of geographic reclassification by the Medicare Geographic Classification Review Board (MGCRB). The effects shown
here demonstrate the FY 1997 payment impacts of going from no reclassifications to the reclassifications scheduled to be in effect for FY 1997.
Reclassification for prior years has no bearing on the payment impacts shown here.
\6\ This column illustrates the payment impacts of phasing out day outlier payments and increasing cost outlier payments, in accordance with section
1886(d)(5) of the Act.
\7\ This column shows changes in payments from FY 1996 to FY 1997. It incorporates all of the changes displayed in columns 3 through 5 (the changes
displayed in columns 1 and 2 are included in column 3). It also displays the impacts of the updates to the FY 1997 standardized amounts, changes in
hospitals' reclassification status in FY 1997 compared to FY 1996, the expiration of the regional floor provision at section 1886(d)(1)(A)(iii)(II) of
the Act, and the difference in outlier payments from FY 1996 to FY 1997. The sum of the columns 3 through 5 plus these effects may be different from
the percentage changes shown here due to changes in hospitals' geographic reclassification status from FY 1996 to FY 1997, rounding errors and
interactive effects.
B. The Impact of the Final Changes to the DRG Classifications and
Relative Weights (Column 1)
In column 1 of Table I, we present the combined effects of the DRG
reclassifications and recalibration, as discussed in section II of the
preamble to this final rule. Section 1886(d)(4)(C)(i) of the Act
requires us each year to make appropriate classification changes and to
recalibrate the DRG weights in order to reflect changes in treatment
patterns, technology, and any other factors that may change the
relative use of hospital resources.
Consistent with the minor changes we are proposing for the FY 1997
GROUPER, the redistributional impacts across hospital groups are very
small (an increase of 0.1 for large and other urban hospitals). Among
other hospital categories, the net effects are slightly negative
changes for small (up to 99 beds) rural hospitals and slightly positive
changes for larger rural (over 150 beds) and urban (over 200 beds)
hospitals.
The largest negative effect on any of the hospital categories
examined is a 0.2 percent decrease in payments for smaller urban (100
or fewer beds) and rural hospitals that receive DSH payments, as well
as rural hospitals in Puerto Rico.
We attribute these negative changes to the increasing gap between
the relative weights for medical, diagnostic, and less complicated
surgical DRGs and the weights for the more complicated surgical DRGs.
Since the cases associated with the former DRGs tend to be treated more
often in smaller hospitals with fewer resources available, lowering the
relative weights associated with those cases would disproportionately
affect these hospitals. In general, small hospitals that serve a
disproportionate share of low-income patients and hospitals in rural
Puerto Rico fit this definition. We note, however, that these negative
impacts are relatively minor and do not result solely from the limited
DRG revisions we are making for FY 1997.
C. The Impact of Updating the Wage Data (Column 2)
Section 1886(d)(3)(E) of the Act requires that, beginning October
1, 1993, we annually update the wage data used to calculate the wage
index. In accordance with this requirement, the final wage index for FY
1997 is based on data submitted for hospital cost reporting periods
beginning on or after October 1, 1992 and before October 1, 1993. As
with the previous column, the impact of the new data on hospital
payments is isolated by holding the other payment parameters constant
in the two simulations. That is, column 2 shows the percentage changes
in payments when going from a model using the FY 1996 wage index before
geographic reclassifications based on FY 1992 wage data to a model
using the FY 1997 prereclassification wage index based on FY 1993 wage
data.
The results indicate that the new wage data do not have a
significant overall impact on hospital payments. Thus, hospitals with
significant changes in their wage indexes are not concentrated within
any particular hospital group. Some of the largest changes are found
among both urban and rural hospitals grouped by census division. Our
review of the wage data (as described below) indicates that these
changes were attributable to improved reporting, as well as relative
changes in labor costs.
Among urban hospitals in the 50 States and the District of
Columbia, the largest increases (0.4 percent) are in the Middle
Atlantic and the East North Central census divisions. Significantly,
New York City's wage index rises by over 2.4 percent (this also
contributes to the 0.2 percent increase among major
[[Page 46309]]
teaching hospitals and the 0.6 percent increase in the Unknown category
under the Type of Ownership and the Medicare Utilization rows, where a
cluster of New York City hospitals that file manual cost reports are
grouped). Last year, the Middle Atlantic experienced one of the largest
decreases (0.6 percent), which contributed to the 0.4 percent decline
among major teaching hospitals--New York City's wage index fell by
nearly 2.0 percent in FY 1996 (60 FR 45929). The largest decrease among
urban hospitals (outside of Puerto Rico, which is discussed separately
below) occurs in the Pacific census division, with a decline of 0.4
percent.
Among the rural hospitals, the largest increases are in the Pacific
census division (0.6 percent) and the West South Central census
division (0.5 percent); the largest decreases are in the census
divisions of New England (0.9 percent), the Middle Atlantic (0.5
percent) and the South Atlantic (0.4 percent). The decrease among rural
New England hospitals is primarily due to a 2.7 percent decrease in the
wage index for rural Connecticut and rural New Hampshire hospitals.
Among rural hospitals last year, the Pacific rural hospitals
experienced one of the greatest increases (0.6 percent), while the
rural West South Central hospitals experienced one of the greatest
decreases (0.4 percent).
In Puerto Rico, payments decline by 4.2 percent for the five rural
hospitals and by 1.2 percent for the urban hospitals. The average
hourly wages reported in FY 1993 by two rural Puerto Rico hospitals
fell from those reported in FY 1992 by 22.4 percent and 18.1 percent,
leading to the 4.2 percent overall decline. Also, all six urban areas
in Puerto Rico experience decreases in their wage index values. Two of
these six experience a decline of more than 5 percent. These MSAs have
relatively few hospitals (two and five), thus the decreases appear to
be the result of one hospital in each area having a decrease of more
than 5 percent in its average hourly wage.
The final FY 1997 wage index represents the fourth annual update to
the wage data, and will continue to include salaries, fringe benefits,
home office salaries, and certain contract labor costs. In the past,
updates to the wage data have resulted in significant payment shifts
among hospitals. Since the wage index is now updated annually, we
expect these payment fluctuations will continue to decrease.
This expectation is borne out by comparing the FY 1997 wage index
(after reclassifications under sections 1886(d)(8)(B) and 1886(d)(10)
of the Act) to the FY 1996 wage index. The following chart compares the
shifts in wage index values (after reclassifications) for labor markets
for FY 1997 with those from FY 1996. The majority of labor market areas
(334) experience less than a 5 percent change. Only 19 labor market
areas experience a change between 5 and 10 percent; 10 of those
experience increases. Still fewer labor markets experience a change of
more than 10 percent; one experiences an increase and three experience
decreases. For FY 1996, by comparison, 10 labor market areas
experienced an increase in their wage index value of more than 10
percent.
------------------------------------------------------------------------
Number of labor
market areas
Percentage change in area wage index values -------------------
FY 1997 FY 1996
------------------------------------------------------------------------
Increase more than 10 percent....................... 1 6
Increase between 5 and 10 percent, (inclusive)...... 10 19
Increase/decrease below 5 percent................... 334 323
Decrease between 5 and 10 percent, (inclusive)...... 9 6
Decrease more than 10 percent....................... 3 0
------------------------------------------------------------------------
Note: There are two new MSAs in FY 1997. Also, there are some MSAs that,
after geographic reclassification have no providers remaining and,
therefore, are not reflected in this table.
Under the final FY 1997 wage index, 96.6 percent of urban hospitals
and 93.9 percent of rural hospitals would experience a change in their
wage index of less than 5 percent. Approximately 2.6 percent of urban
hospitals and 1.4 percent of rural hospitals would experience a change
of between 5 and 10 percent, and 0.9 percent of urban hospitals and 4.6
percent of rural hospitals would experience a change of more than 10
percent. The following chart shows the projected impact for urban and
rural hospitals.
------------------------------------------------------------------------
Percent of
hospitals (by
Percentage change in area wage index values urban/rural)
-------------------
Urban Rural
------------------------------------------------------------------------
Increase more than 10 percent....................... 0.3 2.6
Increase between 5 and 10 percent (inclusive)....... 1.5 0.4
Increase or decrease less than 5 percent............ 96.6 93.9
Decrease between 5 and 10 percent (inclusive)....... 1.1 1.0
Decrease more than 10 percent....................... 0.6 2.0
------------------------------------------------------------------------
Note: The sum of the columns may not total to 100 due to rounding.
D. Combined Impact of DRG and Wage Index Changes--Including Budget
Neutrality Adjustment (Column 3)
The impact of DRG reclassifications and recalibration on aggregate
payments is required by section 1886(d)(4)(C)(iii) of the Act to be
budget neutral. In addition, section 1886(d)(3)(E) of the Act specifies
that any updates or adjustments to the wage index are budget neutral.
As pointed out in the Addendum to this final rule, we compared
aggregate payments using the FY 1996 DRG relative weights and wage
index to aggregate payments using the FY 1997 DRG relative weights and
wage index. Based on this comparison, we computed a wage and
recalibration budget neutrality factor of 0.998509. In Table I, the
combined overall impacts of the effects of both the DRG
reclassifications and recalibration and the updated wage index are
shown in column 3. The 0.0 percent impact for All Hospitals
demonstrates that these changes, in combination with the budget
neutrality factor, are budget neutral.
For the most part, the changes in this column are the sum of the
changes in columns 1 and 2, minus the approximately 0.2 percent
decrease attributable to the budget neutrality factor. In calculating
the total changes shown in column 6, readers should begin with this
column and add across, excluding the impacts shown in columns 1 and 2.
E. The Impact of MGCRB Reclassifications (Column 4)
Our impact analysis to this point has assumed hospitals are paid on
the basis of their actual geographic location (with the exception of
ongoing policies that provide that certain hospitals receive payments
on bases other than where they are geographically located, such as
hospitals in rural counties that are deemed urban under section
1886(d)(8)(B) of the Act). The changes in column 4 reflect the per case
payment impact of moving from this baseline to a simulation
incorporating the MGCRB decisions for FY 1997. As noted below, these
decisions affect hospitals' standardized amount and wage index area
assignments. In addition, rural
[[Page 46310]]
hospitals reclassified for purposes of receiving the large urban
standardized amount also qualify to be treated as urban for purposes of
the DSH adjustment. However, effective FY 1997, rural hospitals can no
longer be reclassified to an other urban area for purposes of the
standardized amount in order to receive a higher DSH adjustment.
By March 30 of each year, the MGCRB makes reclassification
determinations that will be effective for the next fiscal year, which
begins on October 1. The MGCRB may reclassify a hospital for the
purpose of using the other area's standardized amount, wage index
value, or both. (RRCs and SCHs are exempt from the proximity
requirement.)
This impact analysis incorporates all of the MGCRB's
reclassification decisions for FY 1997. It also reflects any decisions
made by the HCFA Administrator through the appeals and review process.
Additional changes that resulted from a request by a hospital to
withdraw its application are also reflected in this final rule.
The overall effect of geographic reclassification is required to be
budget neutral by section 1886(d)(8)(D) of the Act. Therefore, we
applied an adjustment of 0.993511 to ensure that the effects of
reclassification are budget neutral. (See section II.A.4 of the
Addendum to this final rule).
As a group, rural hospitals benefit from geographic
reclassification. Their payments rise 2.3 percent, while payments to
urban hospitals decline 0.4 percent. Large urban hospitals lose 0.4
percent because, as a group, they have the smallest percentage of
hospitals that are reclassified (fewer than 3 percent of large urban
hospitals are reclassified). There are enough hospitals in other urban
areas that are reclassified to limit the decrease in payments to these
urban hospitals stemming from the budget neutrality offset to 0.2
percent. Among urban hospital groups generally (that is, bed size,
census division, and special payment status), payments fall between 0.1
and 0.5 percent.
A positive impact is evident among all rural hospital groups except
rural hospitals with up to 49 beds, which experience a 0.0 percent
impact. The smallest effect among all rural census divisions is 0.8
percent for the Mountain division. This division has relatively few
MGCRB reclassifications. Among urban census divisions, the New England
and the Middle Atlantic display the smallest negative impact, 0.2
percent.
Among the 90 rural hospitals designated as RRCs, 50 hospitals are
reclassified for purposes of the wage index only and experience a 9.5
percent increase in payments due to MGCRB reclassification. This group
is not shown separately in the table, but this large increase is
reflected in several of the rural hospital categories. For example,
rural hospitals with 200 or more beds have a 4.9 percent increase in
payments in column 4, largely due to this effect.
Rural hospitals reclassified for FY 1996 and FY 1997 experience an
8.9 percent increase in payments, the greatest of any group in the
category. This may be due to the fact that these hospitals have the
most to gain from reclassification and have been reclassified for a
period of years. Rural hospitals reclassified for FY 1997 only
experience a 7.1 percent increase in payments while rural hospitals
reclassified for FY 1996 only experience a 0.4 decrease in payments.
This is due to the budget neutrality adjustment, since the changes in
this column reflect FY 1997 payments relative to no reclassifications,
rather than to FY 1996 reclassifications. Urban hospitals reclassified
for FY 1996 but not FY 1997 experience a 1.7 percent decline in
payments overall. This appears to be due to the combined impacts of the
budget neutrality adjustment and a number of hospitals in this category
that experience a 6 percent drop in their wage index after
reclassification. Urban hospitals reclassified for FY 1997 but not for
FY 1996 experience a 2.5 percent increase in payments.
The FY 1997 Reclassification rows of Table I show the changes in
payments per case for all FY 1997 reclassified and nonreclassified
hospitals in urban and rural locations for each of the three
reclassification categories (standardized amount only, wage index only,
or both). The table illustrates that the largest impact for
reclassified rural hospitals is for those hospitals reclassified for
both the standardized amount and the wage index. These hospitals
receive an 18.5 percent increase in payments. The number of hospitals
in this category has declined from 42 in FY 1996 to 16 in FY 1997. In
addition, 245 rural hospitals reclassified for the wage index receive
an 8.6 percent payment increase. The overall impact on reclassified
hospitals is to increase their payments per case by an average of 5.4
percent for FY 1997.
Among the 27 rural hospitals deemed to be urban under section
1886(d)(8)(B) of the Act, payments increase 1.2 percent due to MGCRB
reclassification. This is because, although these hospitals are treated
as being attached to an urban area in our baseline (their redesignation
is ongoing, rather than subject to annual review, like the MGCRB
reclassifications), they are still eligible for MGCRB reclassification.
For FY 1997, one hospital in this category reclassified to a large
urban area, resulting in a net increase due to reclassifications of 1.2
percent.
The reclassification of hospitals primarily affects payment to
nonreclassified hospitals through changes in the wage index and the
geographic reclassification budget neutrality adjustment required by
section 1886(d)(8)(D) of the Act. Among hospitals that are not
reclassified, the overall impact of hospital reclassifications is an
average decrease in payments per case of 0.6 percent, which corresponds
closely with the geographic reclassification budget neutrality factor.
Rural nonreclassified hospitals decrease slightly less, a 0.4 percent
decrease. This occurs because the wage index values in some rural areas
increase after reclassified hospitals are excluded from the calculation
of those index values.
The number of reclassifications for purposes of the standardized
amount, or for both the standardized amount and the wage index, has
declined from 358 in FY 1996 to 205 in FY 1997. This is not surprising
because of the elimination of standardized amount reclassifications
from rural to other urban areas for individual hospitals. Individual
rural (and other urban) hospitals can continue to reclassify to large
urban areas for purposes of the standardized amount. The number of wage
index only reclassifications increased slightly from 260 in FY 1996 to
272 in FY 1997.
F. Outlier Changes (Column 5)
Medicare provides extra payment in addition to the basic DRG
payment amount for extremely costly or extraordinarily lengthy cases
(cost outliers and day outliers, respectively). Section
1886(d)(5)(A)(v) of the Act requires the Secretary to phase out payment
for day outliers from FY 1994 day outlier levels in 25 percent
increments beginning in FY 1995. Day outliers in FY 1997 should account
for approximately 8 percent of total outlier payments (25 percent of FY
1994 levels). This reduction in day outlier payments will be offset by
an increase in cost outlier payments.
As discussed in the Addendum, for FY 1997, the day outlier
threshold will be equal to the geometric mean length of stay for each
DRG plus the lesser of 24 days or 3.0 standard deviations. The marginal
cost factor for day outliers is 33 percent. For FY 1997, a case would
receive cost outlier payments if its costs exceed the DRG payment plus
$9,700.
[[Page 46311]]
We are maintaining the marginal cost factor for cost outliers at 80
percent.
The payment impacts of these changes are minimal. Hospital
categories negatively affected by phasing out day outliers are
consistent with the categories negatively affected in previous years:
urban New England (0.1 percent decline); urban and rural Middle
Atlantic census divisions (0.7 percent and 0.1 percent declines,
respectively); urban hospitals with 300-499 beds and those with 500 or
more beds (0.1 and 0.2 percent declines, respectively); teaching
hospitals with 100 or more residents (0.4 percent decline); and
hospitals for which data were unavailable to calculate type of
ownership or Medicare utilization rates (1.3 percent decline). As noted
previously in the wage index discussion, this last category contains a
number of New York City hospitals because they file manual cost
reports. Because the changes to outlier policy result in a shift in
payments from cases paid as day outliers to cases paid as cost
outliers, this indicates that these categories have higher percentages
of day outliers. The largest positive impact of 0.2 percent affected
numerous hospital groups.
G. All Changes (Column 6)
Column 6 compares our estimate of payments per case incorporating
all of our changes for FY 1997 to our estimate of payments per case in
FY 1996. It also includes the effects of the 2.0 percent update to the
standardized amounts and the hospital-specific rates for SCHs and
EACHs, and the difference between the percentage of projected outlier
payments in FY 1997 (5.1 percent) and the current estimate of the
percentage of actual outlier payments in FY 1996 (4.0 percent), as
described in the introduction to this Appendix and the Addendum.
Also, column 6 includes the impacts of FY 1997 MGCRB
reclassifications compared to the payment impacts of FY 1996
reclassifications. Therefore, when comparing FY 1997 payments to FY
1996, the percent changes due to FY 1997 reclassifications shown in
column 4 are offset by the effects of reclassification on hospitals' FY
1996 payments (column 4 of Table I, September 1, 1995 final rule; 60 FR
45926). That is, column 4 of Table I shows the impacts of going from no
MGCRB reclassifications to the FY 1997 reclassifications. When
comparing FY 1996 and FY 1997 payments, hospitals similarly
reclassified during FY 1996 would not experience the full extent of the
change shown in column 4. For example, the impact of MGCRB
reclassifications on rural hospitals' FY 1996 payments was
approximately a 2.3-percent increase, equal to the 2.3-percent increase
for FY 1997. Therefore, the net increase in FY 1997 payments due to
reclassification for rural hospitals is 0.0 percent.
The FY 1996 standardized amounts were adjusted by a budget
neutrality factor of 0.997575, in accordance with section 1886(d)(5)(I)
of the Act, so that the change to the transfer payment methodology we
implemented last year (doubling the per diem payment for the first day
of a transfer) would not affect aggregate payments. As we indicated in
last year's final rule (60 FR 45854), this adjustment was applied on a
one-time basis to the FY 1996 standardized amounts. In the proposed
rule, we indicated that this was interpreted to mean that there was no
transfer budget neutrality factor applied after FY 1996, and we
estimated the impact of this to be a 0.2 percent increase in FY 1997
payments. As discussed in the Addendum to this final rule, we have
corrected this interpretation so that we will continue to apply this
budget neutrality factor of 0.997575 in FY 1997, and in the future.
In addition, eliminating the regional floor provision effective for
discharges occurring on or after October 1, 1996, results in
approximately a 0.2 percent lower average payment in FY 1997 than would
occur otherwise. This effect is attributable to particular census
divisions, as discussed below.
There may also be interactive effects among the various factors
comprising the payment system that we are not able to isolate. For
these reasons, the values in column 6 may not equal the sum of columns
3 through 5 plus the other impacts that we are able to identify. The
point should be repeated here, as well, that when comparing the percent
changes in column 6 attributable to the isolated changes in the prior
columns in this table, columns 1 and 2 are incorporated into column 3.
Therefore, just the effect in column 3 should be added into the total
change shown in column 6.
The overall payment increase from FY 1997 to FY 1996 for all
hospitals is a 2.9 percent increase. This reflects the 0.0 percent net
change in total payments due to the final changes for FY 1997 shown in
columns 3 through 5, the 2.0 percent update for FY 1997, the 1.1
percent higher outlier payments in FY 1997 compared to FY 1996, and the
0.2 overall negative effect of eliminating the regional floor.
Hospitals in urban areas experience a 2.9 percent rise in payments
per case over FY 1996. Similar to all hospitals nationally, this is
primarily due to the factors discussed above: the 2.0 percent update; a
1.1 percent impact of the higher level of outlier payments estimated
for FY 1997; and the effect of the expiration of the regional floor.
Hospitals in large and other urban areas experience 2.9 percent and
3.0 percent increases, respectively. The lower increase for hospitals
in large urban areas appears to be attributable primarily to the 0.1
percent negative impact of the continuing phase-out of day outliers.
Hospitals in rural areas experience a 2.4 percent increase. Their
FY 1997 payments are estimated to be 0.4 percent higher than for FY
1996 due to higher outlier payments, in contrast to the national
average of 1.1 percent. Like urban hospitals, the impact of geographic
reclassification in FY 1997 is offset by an identical 2.3 percent
increase in FY 1996.
Among urban bed size groups, column 6 shows changes in payments are
higher for the largest urban hospitals compared to smaller urban
hospitals. The relatively smaller increases for the smaller urban
hospitals appear to be due to the negative impacts of the new wage
data, as shown in column 2. Among rural bed size groups, the impacts
range from 2.4 percent to 2.7 percent, with the exception of rural
hospitals with 200 or more beds. Payments per case for this group of
hospitals are estimated to increase 1.9 percent during FY 1997. This
below average increase appears to be attributable primarily to a
smaller, though still significant, impact of MGCRB reclassifications
for FY 1997 compared to FY 1996. In column 4, the FY 1997 impact of
reclassification is shown to be 4.9 percent. For FY 1996, however, this
impact was 5.4 percent. Thus, the increase is 0.5 percent less for FY
1997 due to a smaller reclassification impact.
As discussed previously, effective for discharges on or after
October 1,
FR Doc. 96-22145 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1997 Rates
1996, the regional floor, which benefitted certain census
divisions, expires. The regional floor provided that, in those census
divisions where the regional standardized amount exceeded the national
standardized amount, hospitals would be paid a blend of 85 percent of
the national amount and 15 percent of the regional amount. The census
divisions affected by the regional floor during FY 1996 are New England
and East North Central. In New England, the impacts of eliminating the
regional floor are a 0.7 percent decrease for urban hospitals and a 0.6
percent decrease among rural hospitals. In the East North Central
census division, the impacts are a 1.0 percent reduction for urban
[[Page 46312]]
hospitals, and a 0.7 percent reduction for rural hospitals. The
negative impacts of losing the regional floor for urban hospitals in
the East North Central census division are largely offset by higher
estimated outlier payments in FY 1997 compared to FY 1996, the 0.4
percent higher payments due to the FY 1993 wage data (column 2), and
the 0.1 percent increase due to the phase-out of day outliers (column
5). Urban New England hospitals' higher outlier payments in FY 1997 are
also offset by the negative impacts of the expiration of the regional
floor. Rural New England hospitals also see a 0.9 percent decrease in
payments stemming from the FY 1993 wage data.
Other census divisions below the average payment increase are urban
Pacific, urban Puerto Rico, rural Middle Atlantic, rural East South
Central, and rural Puerto Rico. With the exception of the rural East
South Central, the below average overall payment impacts of these
census divisions are related to negative impacts of introducing the FY
1993 wage data. In the rural Middle Atlantic, the negative impact of
the new wage data is combined with a smaller impact stemming from MGCRB
reclassifications in FY 1997 (0.9 percent compared to 1.5 percent in FY
1996). A smaller FY 1997 reclassification impact (2.4 percent compared
to 3.7 percent in FY 1996) is also the reason for the relatively small
(1.9 percent) rate of increase in the rural East South Central census
division. In rural Puerto Rico, although hospitals experience the
greatest negative impact due to the updated wage data, this group
benefits from reclassifications by the MGCRB in FY 1997 (of the five
rural Puerto Rico hospitals, one is reclassified), with a 3.3 percent
increase compared to a 0.5 percent decrease in their FY 1996 payments
due to the reclassification budget neutrality factor.
Conversely, the urban Middle Atlantic, urban West North Central,
urban West South Central, and rural Pacific census divisions all have
overall increases at least 0.4 percent above the national average. The
urban West South Central gains from the continued phase-out of day
outliers, as well as higher estimated FY 1997 outlier payments compared
to FY 1996 (1.5 percent). As noted previously, the urban Middle
Atlantic benefits significantly from the updated wage index data. These
hospitals also have higher estimated FY 1997 outlier payments, which
offset their 0.7 percent decrease due to the phase-out of day outliers.
Rural Pacific hospitals benefit from geographic reclassification in FY
1997 (2.3 percent compared to 1.4 percent in FY 1996) and the new wage
data (0.5 percent).
The only hospital groups with negative payment impacts from FY 1996
to FY 1997 are hospitals that were reclassified for FY 1996 and are not
reclassified for FY 1997. Overall, these hospitals lose 0.5 percent.
The urban hospitals in this category actually experience a slight
payment increase over FY 1996 (0.6 percent), while the rural hospitals
lose 2.2 percent. On the other hand, hospitals reclassified for FY 1997
that were not reclassified for FY 1996 experience the greatest payment
increases: 10.2 percent for 69 rural hospitals in this category and 7.8
percent for 29 urban hospitals.
Reclassification appears to be a significant factor influencing the
payment increases for a number of rural hospital groups with above
average overall payment increases in column 6. For example, among
hospital groups identified in the discussion of the impacts of MGCRB
reclassifications for FY 1997 (column 4), all have overall increases
above the national average. This outcome highlights the redistributive
effects of reclassification decisions upon hospital payments. This
impact is illustrated even more clearly when one examines the rows
categorizing hospitals by their reclassification status for FY 1997.
All nonreclassified hospitals have an average payment increase of 2.8
percent. The average payment increase for all reclassified hospitals is
3.8 percent.
Among SCH/EACHs, the payment increase is 2.6 percent. Because these
hospital groups receive their hospital- specific rate if it exceeds the
applicable Federal amount (including outliers), there is less of an
impact due to changes in outlier payment levels, which are not applied
to the hospital-specific rate. In addition, nonspecial status rural
hospitals experience only a 1.6 percent increase. This below average
increase is largely attributable to 123 hospitals in this category that
lost their reclassification status from FY 1996 to FY 1997.
Another notably small increase appearing in this column is the 0.3
percent increase for rural DSH hospitals with 100 or more beds. This
impact is primarily due to a number of hospitals in this category that
lost their MGCRB reclassification from FY 1996 to FY 1997, stemming
from the elimination of standardized amount reclassifications solely
for higher DSH payments.
Table II.--Impact Analysis of Changes for FY 1997 Operating Prospective Payment System
[Payments per case]
Average FY Average FY
Number of 1996 1997
hospitals payment per payment per All changes
case case
(1) (2) \1\ (3) \1\ (4)
----------------------------------------------------------------------------------------------------------------
(By Geographic Location)
----------------------------------------------------------------------------------------------------------------
All hospitals............................................... 5,129 6,478 6,664 2.9
Urban hospitals............................................. 2,881 7,013 7,218 2.9
Large urban areas........................................... 1,596 7,544 7,762 2.9
Other urban areas........................................... 1,285 6,313 6,502 3.0
Rural areas................................................. 2,248 4,297 4,400 2.4
Bed size (urban):
0-99 beds............................................... 715 4,705 4,832 2.7
100-199 beds............................................ 945 5,951 6,108 2.6
200-299 beds............................................ 576 6,527 6,715 2.9
300-499 beds............................................ 478 7,444 7,674 3.1
500 or more beds........................................ 167 9,147 9,426 3.1
Bed size (rural):
0-49 Beds............................................... 1,177 3,538 3,622 2.4
50-99 beds.............................................. 657 3,992 4,090 2.4
[[Page 46313]]
100-149 beds............................................ 241 4,462 4,579 2.6
150-199 beds............................................ 98 4,594 4,716 2.7
200 or more beds........................................ 75 5,417 5,518 1.9
Urban by census div.:
New England............................................. 160 7,525 7,672 2.0
Middle Atlantic......................................... 434 7,718 7,973 3.3
South Atlantic.......................................... 419 6,682 6,889 3.1
East North Central...................................... 483 6,735 6,905 2.5
East South Central...................................... 163 6,181 6,374 3.1
West North Central...................................... 193 6,645 6,866 3.3
West South Central...................................... 376 6,508 6,743 3.6
Mountain................................................ 127 6,766 6,962 2.9
Pacific................................................. 478 8,102 8,304 2.5
Puerto Rico............................................. 48 2,595 2,644 1.9
Rural by census div.:
New England............................................. 53 5,242 5,304 1.2
Middle Atlantic......................................... 85 4,691 4,769 1.7
South Atlantic.......................................... 297 4,473 4,578 2.3
East North Central...................................... 304 4,321 4,434 2.6
East South Central...................................... 278 3,969 4,045 1.9
West North Central...................................... 525 4,004 4,105 2.5
West South Central...................................... 349 3,845 3,952 2.8
Mountain................................................ 211 4,569 4,689 2.6
Pacific................................................. 141 5,307 5,505 3.7
Puerto Rico............................................. 5 2,038 2,073 1.7
----------------------------------------------------------------------------------------------------------------
(By Payment Categories)
----------------------------------------------------------------------------------------------------------------
Urban hospitals............................................. 2,981 6,968 7,174 2.9
Large urban areas........................................... 1,791 7,370 7,586 2.9
Other urban areas........................................... 1,190 6,317 6,504 3.0
Rural areas................................................. 2,148 4,263 4,358 2.2
Teaching status:
Non-teaching............................................ 4,044 5,288 5,437 2.8
Fewer than 100 Residents................................ 850 6,895 7,099 3.0
100 or More residents................................... 235 10,565 10,865 2.8
Disproportionate share hospitals (DSH):
Non-DSH................................................. 3,201 5,595 5,755 2.9
Urban DSH:
100 beds or more.................................... 1,410 7,614 7,834 2.9
Fewer than 100 beds................................. 101 4,806 4,911 2.2
Rural DSH:
Sole community (SCH)................................ 156 4,349 4,507 3.6
Referral centers (RRC).............................. 27 5,179 5,352 3.3
Other Rural DSH hosp.:
100 beds or more.................................... 83 4,198 4,211 0.3
Fewer than 100 beds................................. 151 3,432 3,500 2.0
Urban teaching and DSH:
Both teaching and DSH................................... 692 8,587 8,832 2.8
Teaching and no DSH..................................... 339 7,095 7,310 3.0
No teaching and DSH..................................... 819 6,126 6,309 3.0
No teaching and no DSH................................. 1,131 5,438 5,605 3.1
Rural hospital types:
Nonspecial status hospitals............................. 1,375 3,895 3,958 1.6
RRC..................................................... 90 5,076 5,246 3.4
SCH/Each................................................ 645 4,405 4,519 2.6
SCH/Each and RRC........................................ 38 5,213 5,352 2.7
Type of ownership:
Voluntary............................................... 2,951 6,629 6,823 2.9
Proprietary............................................. 696 5,948 6,120 2.9
Government.............................................. 1,366 6,040 6,195 2.6
Unknown................................................. 116 7,564 7,724 2.1
Medicare Utilization as a percent of Inpatient days:
0-25.................................................... 258 8,741 8,917 2.0
25-50................................................... 1,284 7,878 8,103 2.9
50-65................................................... 2,097 5,947 6,122 2.9
[[Page 46314]]
Over 65................................................. 1,374 5,055 5,204 2.9
Unknown................................................. 116 7,564 7,724 2.1
----------------------------------------------------------------------------------------------------------------
Hospitals Reclassified by the Medicare Geographic Review Board
----------------------------------------------------------------------------------------------------------------
Reclassification status during FY96 and FY97
Reclassified during both FY96 and FY97.................. 379 5,780 5,939 2.7
Urban............................................... 130 6,606 6,802 3.0
Rural............................................... 249 5,012 5,136 2.5
Reclassified during FY97 only........................... 98 6,132 6,642 8.3
Urban............................................... 29 7,307 7,860 7.6
Rural............................................... 69 4,369 4,815 10.2
Reclassified during FY96 only........................... 253 5,893 5,861 -0.5
Urban............................................... 91 7,497 7,543 0.6
Rural............................................... 162 4,503 4,403 -2.2
FY97 Reclassifications:
All reclassified hosp............................... 477 5,845 6,069 3.8
Stand. amt. only.................................... 119 5,753 5,914 2.8
Wage index only..................................... 272 5,665 5,854 3.3
Both................................................ 86 6,254 6,600 5.5
Nonreclass.......................................... 4,625 6,563 6,744 2.8
All urban reclass....................................... 159 6,760 7,035 4.1
Stand. amt. only.................................... 62 6,218 6,398 2.9
Wage index only..................................... 27 8,949 9,282 3.7
Both................................................ 70 6,446 6,777 5.1
Nonreclass.......................................... 2,722 7,031 7,231 2.9
All Rural Reclass....................................... 318 4,916 5,088 3.5
Stand. amt. only.................................... 57 4,622 4,737 2.5
Wage index only..................................... 245 4,977 5,136 3.2
Both................................................ 16 4,904 5,354 9.2
Nonreclass.......................................... 1,903 4,051 4,127 1.9
Other reclassifed:
Hospitals (Section 1886(d)(8)(B))....................... 27 4,620 4,743 2.7
\1\ These payment amounts per case do not reflect any estimates of annual case-mix increase.
Table II presents the projected impact of the final changes for FY
1997 for urban and rural hospitals and for the different categories of
hospitals shown in Table I. It compares the projected payments per case
for FY 1997 with the average estimated per case payments for FY 1996,
as calculated under our models. Thus, this table presents, in terms of
the average dollar amounts paid per discharge, the combined effects of
the changes presented in Table I. The percentage changes shown in the
last column of Table I equal the percentage changes in average payments
from column 6 of Table I.
VII. Impact of Changes in the Capital Prospective Payment System
A. General Considerations
We now have data that were unavailable in previous impact analyses
for the capital prospective payment system. Specifically, we have cost
report data for the third year of the capital prospective payment
system (cost reports beginning in FY 1994) available through the June
1996 update of the Hospital Cost Report Information System (HCRIS). We
also have updated information on the projected aggregate amount of
obligated capital approved by the fiscal intermediaries. However, our
impact analysis of payment changes for capital-related costs is still
limited by the lack of hospital-specific data on several items. These
are the hospital's projected new capital costs for each year, its
projected old capital costs for each year, and the actual amounts of
obligated capital that will be put in use for patient care and
recognized as Medicare old capital costs in each year.
The lack of such information affects our impact analysis in several
ways. Specifically, major investment in hospital capital assets (for
example in building and major fixed equipment) occurs at irregular
intervals. As a result, there can be significant variation in the
growth rates of Medicare capital-related costs per case among
hospitals. We do not have the necessary hospital-specific budget data
to project the hospital capital growth rate for individual hospitals.
Moreover, our policy of recognizing certain obligated capital as old
capital makes it difficult to project future capital-related costs for
individual hospitals. Under Sec. 412.302(c), a hospital is required to
notify its intermediary that it has obligated capital by the later of
October 1, 1992, or 90 days after the beginning of the hospital's first
cost reporting period under the capital prospective payment system. The
intermediary must then notify the hospital of its determination whether
the criteria for recognition of obligated capital have been met by the
later of the end of the hospital's first cost reporting period subject
to the capital prospective payment system or 9 months after the receipt
of the hospital's notification. The amount that is recognized as old
capital is limited to the lesser of the actual allowable costs when the
asset is
[[Page 46315]]
put in use for patient care or the estimated costs of the capital
expenditure at the time it was obligated. We have substantial
information regarding intermediary determinations of projected
aggregate obligated capital amounts. However, we still do not know when
these projects will actually be put into use for patient care, the
actual amount that will be recognized as obligated capital when the
project is put into use, or the Medicare share of the recognized costs.
Therefore, we do not know actual obligated capital commitments for
purposes of the FY 1997 capital cost projections. We discuss in
Appendix B the assumptions and computations we employ to generate the
amount of obligated capital commitments for use in the FY 1997 capital
cost projections.
In Table III of this appendix, we present the redistributive
effects that are expected to occur between ``hold-harmless'' hospitals
and ``fully prospective'' hospitals in FY 1997. In addition, we have
integrated sufficient hospital-specific information into our actuarial
model to project the impact of the FY 1997 capital payment policies by
the standard prospective payment system hospital groupings. We caution
that while we now have actual information on the effects of the
transition payment methodology and interim payments under the capital
prospective payment system and cost report data for most hospitals, we
need to randomly generate numbers for the change in old capital costs,
new capital costs for each year, and obligated amounts that will be put
in use for patient care services and recognized as old capital each
year. We continue to be unable to predict accurately FY 1997 capital
costs for individual hospitals, but with the more recent data on the
experience to date under the capital prospective payment system, there
is adequate information to estimate the aggregate impact on most
hospital groupings.
We present the transition payment methodology by hospital grouping
in Table IV. In Table V we present the results of the cross-sectional
analysis using the results of our actuarial model. This table presents
the aggregate impact of the FY 1997 payment policies.
B. Projected Impact Based on the FY 1997 Actuarial Model
1. Assumptions
In this impact analysis, we model dynamically the impact of the
capital prospective payment system from FY 1996 to FY 1997 using a
capital acquisition model. The FY 1997 model, described in Appendix B
of this final rule, integrates actual data from individual hospitals
with randomly generated capital cost amounts. We have capital cost data
from cost reports beginning in FY 1989 through FY 1994 received through
the June 1996 update of the Hospital Cost Reporting Information System
(HCRIS), interim payment data for hospitals already receiving capital
prospective payments through PRICER, and data reported by the
intermediaries that include the hospital-specific rate determinations
that have been made through July 1, 1996 in the Provider-Specific file.
We used this data to determine the FY 1997 capital rates. However, we
do not have individual hospital data on old capital changes, new
capital formation, and actual obligated capital costs. We have data on
costs for capital in use in FY 1994, and we age that capital by a
formula described in Appendix B. We therefore need to randomly generate
only new capital acquisitions for any year after FY 1994. All Federal
rate payment parameters are assigned to the applicable hospital.
For purposes of this impact analysis, the FY 1997 actuarial model
includes the following assumptions:
Medicare inpatient capital costs per discharge will
increase at the following rates during these periods:
Average Percentage Increase in Capital
------------------------------------------------------------------------
Costs per
Fiscal year discharge
------------------------------------------------------------------------
1995....................................................... -0.53
1996....................................................... 5.06
1997....................................................... 5.21
------------------------------------------------------------------------
The Medicare case-mix index will increase by 1.4 percent
in FY 1996 and 1.6 percent in FY 1997.
The Federal capital rate as well as the hospital-specific
rate is updated in FY 1996 by an analytical framework that considers
changes in the prices associated with capital-related costs, and
adjustments to account for forecast error, changes in the case-mix
index, allowable changes in intensity, and other factors. The FY 1997
update factor is .7 percent. (see Addendum, Part III).
2. Results
We have used the actuarial model to estimate the change in payment
for capital-related costs from FY 1996 to FY 1997. Table III shows the
effect of the capital prospective payment system on low capital cost
hospitals and high capital cost hospitals. We consider a hospital to be
a low capital cost hospital if, based on a comparison of its initial
hospital-specific rate and the applicable Federal rate, it will be paid
under the fully prospective payment methodology. A high capital cost
hospital is a hospital that, based on its initial hospital-specific
rate, will be paid under the hold-harmless payment methodology. Based
on our actuarial model, the breakdown of hospitals is as follows:
Capital Transition Payment Methodology
----------------------------------------------------------------------------------------------------------------
FY 1997 FY 1997
Percent of FY 1997 percent of percent of
Type of hospital hospitals percent of capital capital
discharges costs payments
----------------------------------------------------------------------------------------------------------------
Low Cost Hospital........................................... 66 62 52 56
High Cost Hospital.......................................... 34 38 48 44
----------------------------------------------------------------------------------------------------------------
A low capital cost hospital may request to have its hospital-
specific rate redetermined based on old capital costs in the current
year, through the later of the hospital's cost reporting period
beginning in FY 1994 or the first cost reporting period beginning after
obligated capital comes into use (within the limits established in
Sec. 412.302(e) for putting obligated capital in use for patient care).
If the redetermined hospital-specific rate is greater than the adjusted
Federal rate, these hospitals will be paid under the hold-harmless
payment methodology. Regardless of whether the hospital became a hold-
harmless payment hospital as a result of a redetermination, we have
continued to show these hospitals as low capital cost hospitals in
Table III.
Assuming no behavioral changes in capital expenditures, Table III
displays the percentage change in payments from
[[Page 46316]]
FY 1996 to FY 1997 using the above described actuarial model.
Table III.--Impact of Final Changes for FY 1997 on Payments Per Discharge
FY 1996 payments per discharge
--------------------------------------------------------------------------------------------------------------------------------------------------------
Adjusted Average Hospital Hold
Number of Discharges federal federal specific harmless Exceptions Total
hospitals payment percent payment payment payment payment
--------------------------------------------------------------------------------------------------------------------------------------------------------
Low Cost Hospitals.............................. 3,363 6,868,405 $411.84 54.85 $200.68 $15.75 $18.28 $646.55
Fully Prospective........................... 1,548 3,287,821 375.12 50.00 237.10 ........... 11.40 623.62
Rebase--Fully Prospective................... 1,483 2,743,898 371.61 50.00 218.24 ........... 27.88 617.74
Rebase--100% Federal Rate................... 228 643,922 793.64 100.00 ........... ........... 0.25 793.89
Rebase--Hold Harmless....................... 104 192,764 335.30 46.49 ........... 561.32 59.11 955.72
High Cost Hospitals............................. 1,741 4,288,642 668.50 86.23 ........... 145.12 19.59 833.21
100% Federal Rate........................... 1,135 3,010,570 785.30 100.00 ........... ........... 2.23 787.53
Hold Harmless............................... 606 1,278,072 393.38 52.33 ........... 486.95 60.48 940.81
Total Hospitals......................... 5,104 11,157,046 510.50 67.15 123.54 65.48 18.78 718.30
--------------------------------------------------------------------------------------------------------------------------------------------------------
FY 1997 payments per discharge
--------------------------------------------------------------------------------------------------------------------------------------------------------
Adjusted Average Hospital Hold
Number of Discharges federal federal specific harmless Exceptions Total Percent
hospitals payment percent payment payment payment payment change
--------------------------------------------------------------------------------------------------------------------------------------------------------
Low Cost Hospitals................. 3,363 7,056,653 $471.51 63.97 $157.25 $12.43 $40.25 $681.44 5.40
Fully Prospective.............. 1,548 3,377,933 441.20 60.00 185.78 ........... 30.53 657.51 5.43
Rebase--Fully Prospective...... 1,483 2,819,103 438.15 60.00 171.01 ........... 54.23 663.39 7.39
Rebase--100% Federal Rate...... 238 677,500 778.75 100.00 ........... ........... 2.63 781.38 -1.58
Rebase--Hold Harmless.......... 94 182,117 407.13 56.47 ........... 481.80 144.04 1,032.97 8.08
High Cost Hospitals................ 1,741 4,406,184 694.20 89.74 ........... 117.32 49.69 861.21 3.36
100% Federal Rate.............. 1,173 3,160,803 779.30 100.00 ........... ........... 11.40 790.70 0.40
Hold Harmless.................. 568 1,245,382 478.21 63.00 ........... 415.08 146.89 1,040.17 10.56
Total Hospitals............ 5,104 11,462,838 557.11 74.17 96.80 52.75 43.88 750.54 4.49
--------------------------------------------------------------------------------------------------------------------------------------------------------
Under section 1886(g)(1)(A) of the Act, aggregate payments under
the capital prospective payment system for FY 1992 through 1995
respectively, were projected to equal 90 percent of payments that would
have been payable on a reasonable cost basis in each year. With the
expiration of the capital budget neutrality provision, we now estimate
that there was an aggregate 27.50 percent increase in FY 1996 Medicare
capital payments over the FY 1995 payments. We estimate aggregate
Medicare capital payments will increase by 6.77 percent in FY 1997.
We project that low capital cost hospitals paid under the fully
prospective payment methodology will experience an average increase in
payments per case of 4.75 percent, and high capital cost hospitals will
experience an average increase of 2.86 percent.
For hospitals paid under the fully prospective payment methodology,
the Federal rate payment percentage will increase from 50 percent to 60
percent and the hospital-specific rate payment percentage will decrease
from 50 to 40 percent in FY 1997. The Federal rate payment percentage
for hospitals paid under the hold-harmless payment methodology is based
on the hospital's ratio of new capital costs to total capital costs.
The average Federal rate payment percentage for hospitals receiving a
hold-harmless payment for old capital will increase from 52.33 percent
to 62.81 percent. (We estimate the percentage of hold-harmless
hospitals paid based on 100 percent of the Federal rate will increase
from 65.8 percent to 67.8 percent.)
We expect that the average hospital-specific rate payment per
discharge will decrease from $123.54 in FY 1996 to $96.10 in FY 1997.
This is partly due to the 4.32 percent decrease in the FY 1997
hospital-specific rate compared to FY 1996.
We proposed no changes in our exceptions policies for FY 1997. As a
result, the minimum payment levels will be:
90 percent for sole community hospitals;
80 percent for urban hospitals with 100 or more beds and a
disproportionate share patient percentage of 20.2 percent or more; or,
70 percent for all other hospitals.
We estimate that exceptions payments will increase from 2.61
percent of total capital payments in FY 1996 to 5.97 percent of
payments in FY 1997. The number and amount of exceptions payments is
expected to increase throughout the transition period. The projected
distribution of the payments is shown in the table below:
Estimated FY 1997 Exceptions Payments
------------------------------------------------------------------------
Percent of
Type of hospital Number of exceptions
hospitals payments
------------------------------------------------------------------------
Low Capital Cost.............................. 464 57
High Capital Cost............................. 348 43
-------------------------
Total......................................... 812 100
------------------------------------------------------------------------
C. Cross-Sectional Comparison of Capital Prospective Payment
Methodologies
Table IV presents a cross-sectional summary of hospital groupings
by capital prospective payment methodology. This distribution is
generated by our actuarial model.
[[Page 46317]]
Table IV.--Distribution by Method of Payment (Hold-Harmless/Fully Prospective) of Hospitals Receiving Capital
Payments
----------------------------------------------------------------------------------------------------------------
(2) Hold-harmless
-------------------------- (3)
(1) Total Percentage Percentage
No. of paid hold- Percentage paid fully
hospitals harmless paid fully prospective
(A) federal (B) rate
----------------------------------------------------------------------------------------------------------------
By Geographic Location:
All hospitals........................................... 5,104 13.0 27.6 59.4
Large urban areas (populations over 1 million).......... 1,584 15.3 34.8 49.9
Other urban areas (populations of 1 million or fewer)... 1,275 15.8 32.9 51.3
Rural areas............................................. 2,245 9.7 19.6 70.7
Urban hospitals......................................... 2,859 15.5 34.0 50.5
0-99 beds........................................... 697 16.4 27.4 56.2
100-199 beds........................................ 941 19.2 36.9 43.9
200-299 beds........................................ 576 14.4 36.6 49.0
300-499 beds........................................ 478 10.3 34.5 55.2
500 or more beds.................................... 167 10.2 34.1 55.7
Rural hospitals......................................... 2,245 9.7 19.6 70.7
0-49 beds........................................... 1,175 7.0 14.6 78.5
50-99 beds.......................................... 656 12.5 21.6 65.9
100-149 beds........................................ 241 13.7 30.7 55.6
150-199 beds........................................ 98 15.3 22.4 62.2
200 or more beds.................................... 75 8.0 41.3 50.7
By Region:
Urban by Region......................................... 2,859 15.5 34.0 50.5
New England......................................... 160 6.9 25.0 68.1
Middle Atlantic..................................... 434 10.1 29.7 60.1
South Atlantic...................................... 418 20.1 40.2 39.7
East North Central.................................. 480 9.6 30.0 60.4
East South Central.................................. 162 22.8 34.6 42.6
West North Central.................................. 190 18.4 27.4 54.2
West South Central.................................. 367 27.8 46.0 26.2
Mountain............................................ 126 15.9 42.1 42.1
Pacific............................................. 474 12.7 31.2 56.1
Puerto Rico......................................... 48 10.4 25.0 64.6
Rural by Region......................................... 2,245 9.7 19.6 70.7
New England......................................... 53 7.5 15.1 77.4
Middle Atlantic..................................... 84 10.7 15.5 73.8
South Atlantic...................................... 297 11.8 25.6 62.6
East North Central.................................. 304 10.2 11.8 78.0
East South Central.................................. 278 9.7 31.3 59.0
West North Central.................................. 525 7.0 15.2 77.7
West South Central.................................. 347 9.2 24.8 66.0
Mountain............................................ 211 12.3 15.2 72.5
Pacific............................................. 141 11.3 15.6 73.0
Large urban areas (populations over 1 million).......... 1,779 15.2 34.5 50.4
Other urban areas (populations over 1 million or fewer). 1,180 15.8 32.2 51.9
Rural areas............................................. 2,145 9.6 19.5 71.0
Teaching Status:
Non-teaching........................................ 4,019 13.5 26.6 59.8
Fewer than 100 Residents............................ 850 11.3 32.4 56.4
100 or more Residents............................... 235 9.4 27.7 63.0
Disproportionate share hospitals (DSH):
Non-DSH............................................. 3,178 12.3 24.0 63.7
Urban DSH:
100 or more beds................................ 1,409 15.4 36.1 48.5
Less than 100 beds.............................. 100 17.0 23.0 60.0
Rural DSH:
Sole Community (SCH/EACH)....................... 156 11.5 18.6 69.9
Referral Center (RRC/EACH)...................... 27 7.4 37.0 55.6
Other Rural:
100 or more beds............................ 83 8.4 45.8 45.8
Less than 100 beds.......................... 151 7.3 25.8 66.9
Urban teaching and DSH:
Both teaching and DSH............................... 692 11.1 32.2 56.6
Teaching and no DSH................................. 339 11.2 29.8 59.0
No teaching and DSH................................. 817 19.2 37.7 43.1
No teaching and no DSH.............................. 1,111 16.7 32.5 50.9
Rural Hospital Types:
Non special status hospitals........................ 1,372 7.7 19.5 72.8
RRC/EACH............................................ 90 10.0 34.4 55.6
SCH/EACH............................................ 645 13.3 17.2 69.5
[[Page 46318]]
SCH, RRC and EACH................................... 38 13.2 21.1 65.8
Type of Ownership:
Voluntary........................................... 2,951 12.3 27.6 60.1
Proprietary......................................... 696 23.4 46.7 29.9
Government.......................................... 1,366 8.7 17.6 73.7
Medicare Utilization as a Percent of Inpatient Days:
0-25................................................ 258 15.1 25.2 59.7
25-50............................................... 1,284 14.5 33.4 52.1
50-65............................................... 2,097 12.9 28.0 59.1
Over 65............................................. 1,374 10.8 21.6 67.5
----------------------------------------------------------------------------------------------------------------
As we explain in Appendix B, we were not able to determine a
hospital-specific rate for 25 of the 5,129 hospitals in our data base.
Consequently, the payment methodology distribution is based on 5,104
hospitals. This data should be fully representative of the payment
methodologies that will be applicable to hospitals.
The cross-sectional distribution of hospital by payment methodology
is presented by: (1) geographic location, (2) region, and (3) payment
classification. This provides an indication of the percentage of
hospitals within a particular hospital grouping that will be paid under
the fully prospective payment methodology and under the hold-harmless
methodology.
The percentage of hospitals paid fully Federal (100 percent of the
Federal rate) as hold-harmless hospitals is expected to increase to
27.5 percent in FY 1997.
Table IV indicates that 59.4 percent of hospitals are paid under
the fully prospective payment methodology. (This figure, unlike the
figure of 66 percent for low cost capital hospitals in the previous
section, takes account of the effects of redeterminations. In other
words, this figure does not include low cost hospitals that, following
a hospital-specific rate redetermination, are now paid under the hold-
harmless methodology.) As expected, a relatively higher percentage of
rural and governmental hospitals (70.7 percent and 73.7 percent,
respectively by payment classification) are being paid under the fully
prospective methodology. This is a reflection of their lower than
average capital costs per case. In contrast, only 29.9 percent of
proprietary hospitals are being paid under the fully prospective
methodology. This is a reflection of their higher than average capital
costs per case. (We found at the time of the August 30, 1991 final rule
(56 FR 43430) that 62.7 percent of proprietary hospitals had a capital
cost per case above the national average cost per case.)
D. Cross-Sectional Analysis of Changes in Aggregate Payments
We used our FY 1997 actuarial model to estimate the potential
impact of our changes for FY 1997 on total capital payments per case,
using a universe of 5,104 hospitals. The individual hospital payment
parameters are taken from the best available data, including: the July
1, 1996 update to the Provider-Specific file, cost report data, and
audit information supplied by intermediaries. Table V presents
estimates of payments per case under our model for FY 1996 and FY 1997
(columns 2 and 3). Column 4 shows the total percentage change in
payments from FY 1996 to FY 1997. Column 5 presents the percentage
change in payments that can be attributed to Federal rate changes
alone.
Federal rate changes represented in Column 5 include the 4.99
percent decrease in the Federal rate, a 1.6 percent increase in case
mix, changes in the adjustments to the Federal rate (for example, the
effect of the new hospital wage index on the geographic adjustment
factor), and reclassifications by the Medicare Geographic
Classification Review Board. Column 4 includes the effects of the
Federal rate changes represented in column 3. Column 4 also reflects
the effects of all other changes, including: the change from 50 percent
to 60 percent in the portion of the Federal rate for fully prospective
hospitals, the hospital-specific rate update, changes in the proportion
of new to total capital for hold-harmless hospitals, changes in old
capital (for example, obligated capital put in use), hospital-specific
rate redeterminations, and exceptions. The comparisons are provided by:
(1) geographic location and (2) payment classification and payment
region.
The simulation results show that, on average, capital payments per
case can be expected to increase 3.9 percent in FY 1997. The results
show that the effect of the Federal rate changes alone is to decrease
payments by 1.3 percent. The decrease attributable to the Federal rate
changes is more than offset by a 5.2 percent increase attributable to
the effects of all other changes.
Our comparison by geographic location shows that overall, urban
hospitals will gain slightly less than rural hospitals from the final
rule changes (increases of 3.8 percent and 4.7 percent, respectively).
Payments per case for urban hospitals will decrease at about the same
rate as payments per case for rural hospitals (1.2 percent and 1.7
percent, respectively) from the Federal rate changes alone. Urban
hospitals will gain slightly less than rural hospitals (5.0 percent
compared to 6.4 percent) from the effects of all other changes.
By region, there is relatively little variation compared to some
previous years. All regions are estimated to receive increases in total
capital payments per case. Changes by region vary from a low of 2.1
percent increase (rural hospitals of the West South Central region) to
a high of 15.2 percent increase (rural hospitals of the New England
region).
By type of ownership, government hospitals are projected to have
the largest rate of increase (5.1 percent, -1.5 percent due to Federal
rate changes and a 6.6 percent positive offset from the effects of all
other changes). Payments to voluntary hospitals will increase 3.8
percent (a 1.3 percent decrease due to Federal rate changes and a 5.1
percent
[[Page 46319]]
positive offset from the effects of all other changes) and payments to
proprietary hospitals will increase 3.4 percent (a 0.9 percent decrease
due to Federal rate changes and a 4.3 percent positive offset from the
effects of all other changes).
Section 1886(d)(10) of the Act established the Medicare Geographic
Classification Review Board (MGCRB). Hospitals may apply for
reclassification for purposes of the standardized amount, wage index,
or both. Although the Federal capital rate is not affected, a
hospital's geographic classification for purposes of the operating
standardized amount does affect a hospital's capital payments as a
result of the large urban adjustment factor and the disproportionate
share adjustment for urban hospitals with 100 or more beds.
Reclassification for wage index purposes affects the geographic
adjustment factor since that factor is constructed from the hospital
wage index.
To present the effects of the hospitals being reclassified for FY
1997 compared to the effects of reclassification for FY 1996, we show
the average payment percentage increase for hospitals reclassified in
each fiscal year and in total. For FY 1997 reclassifications, we
indicate those hospitals reclassified for standardized amount purposes
only, for wage index purposes only, and for both purposes. The
reclassified groups are compared to all other nonreclassified
hospitals. These categories are further identified by urban and rural
designation.
Hospitals reclassified for FY 1997 as a whole are projected to
experience a 4.5 percent increase in payments (a 0.8 percent decrease
attributable to Federal rate changes and a 5.3 percent positive offset
attributable to the effects of all other changes). Payments to
nonreclassified hospitals will increase slightly less (3.9 percent)
than reclassified hospitals (4.5 percent). Payments to nonreclassified
hospitals will decrease slightly more than reclassified hospitals from
the Federal rate changes (1.3 percent compared to 0.8 percent), but
they will gain about the same from the effects of all other changes
(5.2 percent compared to 5.3 percent).
Table V.--Comparison Of Total Payments Per Case
[FY 1996 Payments Compared to FY 1997 Payments]
----------------------------------------------------------------------------------------------------------------
Average FY Average FY Portion
Number of 1996 1997 attibutable
hospitals payments/ payments/ All changes to federal
case case rate change
----------------------------------------------------------------------------------------------------------------
By Geographic Location:
All hospitals.............................. 5,104 718 746 3.9 -1.3
Large urban areas (populations over 1
million).................................. 1,584 823 852 3.6 -1.2
Other urban areas (populations of 1 million
of fewer)................................. 1,275 715 745 4.1 -1.1
Rural areas................................ 2,245 478 501 4.7 -1.7
Urban hospitals............................ 2,859 776 806 3.8 -1.2
0-99 beds.............................. 697 566 589 4.0 -1.3
100-199 beds........................... 941 705 732 3.7 -1.3
200-299 beds........................... 576 744 774 4.0 -1.3
300-499 beds........................... 478 801 830 3.7 -1.2
500 or more beds....................... 167 944 980 3.8 -0.9
Rural hospitals............................ 2,245 478 501 4.7 -1.7
0-49 beds.............................. 1,175 367 385 5.0 -2.0
50-99 beds............................. 656 447 468 4.8 -1.6
100-149 beds........................... 241 511 532 4.2 -1.7
150-199 beds........................... 98 511 540 5.6 -1.4
200 or more beds....................... 75 612 638 4.3 -2.0
By Region:
Urban by Region............................ 2,859 776 806 3.8 -1.2
New England............................ 160 784 817 4.3 -1.9
Middle Atlantic........................ 434 813 848 4.2 -1.2
South Atlantic......................... 418 780 814 4.3 -1.1
East North Central..................... 480 727 749 3.1 -1.2
East South Central..................... 162 707 733 3.7 -0.8
West North Central..................... 190 772 809 4.8 -1.0
West South Central..................... 367 796 823 3.4 -0.4
Mountain............................... 126 775 797 2.7 -1.5
Pacific................................ 474 855 883 3.3 -1.7
Puerto Rico............................ 48 305 326 6.8 -0.4
Rural by Region............................ 2,245 478 501 4.7 -1.7
New England............................ 53 606 698 15.2 -2.3
Middle Atlantic........................ 84 497 525 5.6 -2.7
South Atlantic......................... 297 498 511 2.8 -2.0
East North Central..................... 304 482 510 5.9 -1.3
East South Central..................... 278 446 463 3.8 -1.8
West North Central..................... 525 454 477 5.2 -1.7
West South Central..................... 347 440 449 2.1 -1.3
Mountain............................... 211 504 534 6.1 -0.8
Pacific................................ 141 555 587 5.9 -1.3
By Payment Classification:
All hospitals.............................. 5,104 718 746 3.9 -1.3
Large urban areas (populations over 1
million).................................. 1,779 807 836 3.6 -1.2
Other urban areas (populations of 1 million
of fewer)................................. 1,180 715 746 4.2 -1.1
Rural areas................................ 2,145 472 494 4.7 -1.8
[[Page 46320]]
Teaching Status:
Non-teaching........................... 4,019 622 645 3.8 -1.3
Fewer than 100 Residents............... 850 757 787 3.9 -1.2
100 or more Residents.................. 235 1,034 1,079 4.3 -1.2
Urban DSH:
100 or more beds................... 1,409 813 843 3.7 -1.2
Less than 100 beds................. 100 576 607 5.4 -1.2
Rural DSH:
Sole Community (SCH/EACH).......... 156 449 486 8.1 -1.5
Referral Center (RRC/EACH)......... 27 533 541 1.5 -1.0
Other Rural:
100 or more beds............... 83 488 504 3.3 -2.5
Less than 100 beds............. 151 367 379 3.3 -2.2
Urban teaching and DSH:
Both teaching and DSH.................. 692 879 911 3.6 -1.2
Teaching and no DHS.................... 339 786 821 4.5 -1.1
No teaching and DSH........................ 817 710 737 3.9 -1.2
No teaching and no DSH..................... 1,111 673 697 3.6 -1.1
Rural Hospital Types:
Non special status hospitals............... 1,372 439 458 4.2 -2.2
RRC/EACH................................... 90 559 573 2.6 -1.1
SCH/EACH................................... 645 470 502 6.8 -1.6
SCH, RRC and EACH.......................... 38 582 6.5 5.7 -1.4
Hospitals Reclassified by the Medicare
Geographic Classification Review Board:
Reclassification Status During FY96 and
FY97:
Reclassified During Both FY96 and FY97. 379 662 685 3.5 -1.5
Reclassified During FY97 Only.............. 98 673 732 8.7 2.0
Reclassified During FY96 Only.............. 230 652 661 1.4 -3.9
FY 97 Reclassifications:
All Reclassified Hospitals............. 477 664 694 4.5 -0.8
All Nonreclassified Hospitals.......... 4,600 726 754 3.9 -1.3
All Urban Reclassified Hospitals....... 159 756 782 3.5 -1.0
Urban Nonreclassified Hospitals........ 2,700 778 808 3.8 -1.2
All Reclassified Rural Hospitals....... 318 570 604 5.9 -0.7
Rural Nonreclassified Hospitals........ 1,900 442 460 4.1 -2.2
Other Reclassified Hospitals (Section 1886
(D)(8)(B))................................ 27 541 561 3.7 -1.8
Type of Ownership:
Voluntary.................................. 2,951 731 760 3.8 -1.3
Proprietary................................ 696 751 777 3.4 -0.9
Government................................. 1,366 625 657 5.1 -1.5
Medicare Utilization as a Percent of Inpatient
Days:
0-25....................................... 258 797 830 4.1 -2.0
25-50...................................... 1,284 843 875 3.9 -1.2
50-60...................................... 2,097 676 703 4.0 -1.2
Over 65.................................... 1,374 603 627 4.0 -1.3
----------------------------------------------------------------------------------------------------------------
Appendix B: Technical Appendix on the Capital Acquisition Model and
Required Adjustments
Under section 1886(g)(1)(A) of the Act, we set capital prospective
payment rates for FY 1992 through FY 1995 so that aggregate prospective
payments for capital costs were projected to be 10 percent lower than
the amount that would have been payable on a reasonable cost basis for
capital-related costs in that year. To implement this requirement, we
developed the capital acquisition model to determine the budget
neutrality adjustment factor. Even though the budget neutrality
requirement expires effective with FY 1996, we must continue to
determine the recalibration and geographic reclassification budget
neutrality adjustment factor, and the reduction in the Federal and
hospital-specific rates for exceptions payments. We continue to use the
capital acquisition model to determine these factors.
The following data are used in the capital acquisition model for FY
1997: the June 30, 1996 update of the cost reports for PPS-IX (cost
reporting periods beginning in FY 1992), PPS-X (cost reporting periods
beginning in FY 1993) and PPS-XI (cost reporting periods beginning in
FY 1994), the July 1, 1996 update of the provider-specific file, and
the March 1994 update of the intermediary audit file. The available
data still lack certain items that were required for the determination
of budget neutrality, including each hospital's projected new capital
costs for each year, its projected old capital costs for each year, and
the projected obligated capital amounts that will be put in use for
patient care services and recognized as old capital each year.
Since hospitals under alternative payment system waivers (that is,
hospitals in Maryland) are currently excluded from the capital
prospective
[[Page 46321]]
payment system, we excluded these hospitals from our model.
We then developed FY 1992, FY 1993, FY 1994, FY 1995, and FY 1996
hospital-specific rates using the provider-specific file, the
intermediary audit file, and, when available, cost reports. (We used
the cumulative provider-specific file, which includes all updates to
each hospital's records, and chose the latest record for each fiscal
year.) We checked the consistency between the provider-specific file
and the intermediary audit file. We also ensured that the FY 1993
increase in the hospital-specific rate was at least 0.62 percent (the
net FY 1993 update), that the FY 1994 hospital-specific rate was at
least as large as the FY 1993 hospital-specific rate decreased by 2.16
percent (the net FY 1994 update), that the FY 1995 increase in the
hospital-specific rate was at least 0.05 percent (the net FY 1995
update), and that the FY 1996 increase in the hospital-specific rate
was at least 21.10 percent (the net FY 1996 update). We were able to
match hospitals to the files as shown in the following table.
------------------------------------------------------------------------
Number of
Source hospitals
------------------------------------------------------------------------
Provider-Specific File Only................................ 99
Provider-Specific and Audit File........................... 5029
Other...................................................... 1
------------
Total................................................ 5129
------------------------------------------------------------------------
Sixty-six of these hospitals had unusable or missing data. We were
able to backfill a hospital-specific rate for 41 of these hospitals
from the cost reports as shown in the following table.
------------------------------------------------------------------------
Number of
Source hospitals
------------------------------------------------------------------------
PPS-VII Cost Reports....................................... 1
PPS-VIII Cost Reports...................................... 2
PPS-IX Cost Reports........................................ 3
PPS-X Cost Reports......................................... 7
PPS-XI Cost Reports........................................ 28
------------
Total................................................ 41
------------------------------------------------------------------------
We did not have data for 25 hospitals, and had to eliminate them
from the capital analysis. These hospitals likely are new hospitals or
hospitals with very few Medicare admissions. This leaves us with 5104
hospitals and should not affect the precision of the required
adjustment factors.
Next, we determined old and new capital amounts for FY 1992 using
the PPS-IX cost reports as the first source of data. For FY 1993
amounts, we used PPS-IX and PPS-X cost reports as the first source of
data, weighting each cost report by the number of days in FY 1993. For
FY 1994 amounts, we used PPS-X and PPS-XI cost reports as the first
source of data, weighting each cost report by the number of days in FY
1994. We were able to match 5,049 PPS-IX cost reports, 5,064 PPS-X cost
reports, and 4,924 PPS-XI cost reports. In cases where cost reports
could not be matched, we used the provider-specific file for old
capital information. Even in cases where a cost report was available,
the breakout of old and new capital was not always available. In these
cases, we used the old capital amounts and new capital ratios from the
provider-specific file. If these were missing, we derived the old
capital amount from the hospital-specific rate.
Finally, we used the intermediary
FR Doc. 96-22145 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1997 Rates
audit file to develop obligated
capital amounts. Since the obligated amounts are aggregate projected
amounts, we computed a Medicare capital cost per admission associated
with these amounts. We adjusted the aggregate amounts by the following
factors:
(1) Medicare inpatient share of capital. This was derived from cost
reports and was limited to the Medicare share of total inpatient days.
It was necessary to limit the Medicare share because of data integrity
problems. Medicare share of inpatient days is a reasonably good proxy
for allocating capital. However, it may be understated if Medicare
utilization is high, and may be overstated because it does not reflect
the outpatient share of capital.
(2) Capitalization factor. This factor allocates the aggregate
amount of obligated capital to depreciation and interest amounts.
Consistent with the assumptions in the capital input price index, we
used a 25-year life for fixed capital and a 10-year life for movable
capital, and an average projected interest rate of 6.7 percent. We also
assumed that fixed capital acquisitions are about one-half of total
capital. In conjunction with the useful life and interest rate
assumptions, the resulting capitalized fixed capital is about one-half
of total capitalization. This is consistent with the allocations
between fixed and movable capital found on the cost reports. The ratio
we developed is 0.137, which produces the first year capitalization
based on the aggregate amount.
(3) A divisor of Medicare admissions to derive the capital costs
per discharge amount. Since we must project capital amounts for each
hospital, we continued to use a Monte Carlo simulation to develop these
amounts. (This model is described in detail in the August 30, 1991
final rule (56 FR 43517).) The Monte Carlo simulation is now used only
to project capital costs per discharge amounts for each hospital. We
analyzed the distributions of capital increases, and noted a slightly
negative correlation between the dollar level of capital cost per
admission, and the rate of increase in capital. To determine the rate
of increase in capital cost per admission, we multiplied the lesser of
$3,000 or the capital cost per admission by .00006 and subtracted this
result from 1.2. (Increases for capital levels over $3,000 were not
influenced by the level of capital, so this part of the calculation was
capped at $3,000.) We selected a random number from the normal
distribution, multiplied it by 0.17 (the standard deviation) and added
it to -0.04 (the mean) and then added 1 to create a multiplier. This
random result was multiplied by the previous result to assign a rate of
increase factor which was multiplied by the prior year's capital per
discharge amount to develop a capital per discharge amount for the
projected year.
To model a projected year, we used the old and new capital for the
prior year multiplied by 0.85 (aging factor). The 0.85 aging factor is
the average of changes in capital over its life due to the gradual
decrease in interest payments and the retirement of fully depreciated
capital. The aged new and old capital is subtracted from the projected
capital described in the previous paragraph. The difference represents
newly acquired capital. If the hospital has obligated capital, any
increase in ``old'' capital up to the total amount of obligated capital
in FY 1993 and FY 1994 is assigned to obligated capital. Any remaining
obligated capital is assigned to FY 1995 up to the amount of the
modeled increase in capital for FY 1995. Even though obligated capital
must be put in use for patient care by October 1, 1994, the use of the
obligated capital may have started late in FY 1994 with only part of
the ``first year'' depreciation and interest realized in FY 1994. The
remainder of the ``first year'' depreciation and interest would be
realized in FY 1995. With the exception of certain hospitals about whom
we have information to the contrary, we assume that hospitals would
meet the expiration dates provided under the obligated capital
provision. Hence, no obligated capital is assigned to years FY 1996 and
later. Once obligated capital is assigned, it is included with the
``old'' capital and is capitalized into future years as part of ``old''
capital. The on-line obligated amounts are added to old capital and
subtracted from the newly acquired capital to yield residual newly
acquired capital, which is then added to new capital. The residual
newly
[[Page 46322]]
acquired capital is never permitted to be less than zero.
Next, we computed the average total capital cost per discharge from
the capital costs that were generated by the model and compared the
results to total capital costs per discharge that we had projected
independently of the model. We adjusted the newly acquired capital
amounts proportionately, so that the total capital costs per discharge
generated by the model match the independently projected capital costs
per discharge.
Once each hospital's capital-related costs are generated, the model
projects capital payments. We use the actual payment parameters (for
example, the case-mix index and the geographic adjustment factor) that
are applicable to the specific hospital.
To project capital payments, the model first assigns the applicable
payment methodology (fully prospective or hold-harmless) to the
hospital. If available, the model uses the payment methodology
indicated in the PPS-IX cost reports or the provider-specific file.
Otherwise, the model determines the methodology by comparing the
hospital's FY 1992 hospital-specific rate to the adjusted Federal rate
applicable to the hospital. The model simulates Federal rate payments
using the assigned payment parameters and hospital-specific estimated
outlier payments. The case-mix index for a hospital is derived from the
FY 1995 MedPAR file using the FY 1997 DRG relative weights published in
this final rule. The case-mix index is increased each year after FY
1995 based on analysis of past experiences in case-mix increases.
We analyzed the case-mix increases for the recent past and found
that case-mix increases have decelerated to about 1.53 percent in FY
1992, 0.80 percent in FY 1993, and 0.75 percent in FY 1994. It appears
that the case-mix increase for FY 1995 accelerated to around 1.6
percent. Early indications show that FY 1996 case-mix is increasing at
FY 1995 level, that is, approximately 1.6 percent. Thus, it appears
that the deceleration of case-mix increases in FY 1993 and FY 1994 were
anamolous, rather than the beginning of a trend. Therefore, in the
model we are using the recent experience and have used a case-mix
increase of 1.6 percent in FY 1995 and a projected case-mix increase of
1.6 percent in both FY 1996 and FY 1997. (Since we are using FY 1995
cases for our analysis, the FY 1995 increase in case mix has no effect
on projected capital payments.)
Changes in geographic classification and revisions to the hospital
wage data used to establish the hospital wage index affect the
geographic adjustment factor. Changes in the DRG classification system
and the relative weights affect the case-mix index.
Section 1886(g)(1)(A) of the Act requires that, for discharges
occurring after September 30, 1993, the unadjusted standard Federal
rate be reduced by 7.4 percent. Consequently, the model reduces the
unadjusted standard Federal rate by 7.4 percent effective in FY 1994.
Since budget neutrality expires effective with FY 1996, this adjustment
affects the adjusted Federal rate starting in FY 1996.
Section 412.308(c)(4)(ii) requires that the estimated aggregate
payments for the fiscal year, based on the Federal rate after any
changes resulting from DRG reclassifications and recalibration and the
geographic adjustment factor, equal the estimated aggregate payments
based on the Federal rate that would have been made without such
changes. For FY 1996, the budget neutrality adjustment factor was
1.0025. To determine the factor for FY 1997, we first determined the
portion of the Federal rate that would be paid for each hospital in FY
1997 based on its applicable payment methodology. Using our model, we
then compared estimated aggregate Federal rate payments based on the FY
1996 DRG relative weights and the FY 1996 geographic adjustment factor
to estimated aggregate Federal rate payments based on the FY 1997
relative weights and the FY 1997 geographic adjustment factor. In
making the comparison, we held the FY 1997 Federal rate portion
constant and set the other budget neutrality adjustment factor and the
exceptions reduction factor to 1.00. We determined that to achieve
budget neutrality for the changes in the geographic adjustment factor
and DRG classifications and relative weights, an incremental budget
neutrality adjustment of 0.9987 for FY 1997 should be applied to the
previous cumulative FY 1996 adjustment of 1.0025 (the product of the FY
1993 incremental adjustment of 0.9980, the FY 1994 incremental
adjustment of 1.0053, the FY 1995 incremental adjustment of 0.9998, and
the FY 1996 incremental adjustment of 0.9994), yielding a cumulative
adjustment of 1.0012 through FY 1997.
The methodology used to determine the recalibration and geographic
(DRG/GAF) budget neutrality adjustment factor is similar to that used
in establishing budget neutrality adjustments under the prospective
payment system for operating costs. One difference is that under the
operating prospective payment system, the budget neutrality adjustments
for the effect of geographic reclassifications are determined
separately from the effects of other changes in the hospital wage index
and the DRG relative weights. Under the capital prospective payment
system, there is a single DRG/GAF budget neutrality adjustment factor
for changes in the geographic adjustment factor (including geographic
reclassification) and the DRG relative weights. In addition, there is
no adjustment for the effects that geographic reclassification has on
the other payment parameters, such as the payments for serving low
income patients or the large urban add-on.
In addition to computing the DRG/GAF budget neutrality adjustment
factor, we used the model to simulate total payments under the
prospective payment system.
Additional payments under the exceptions process are accounted for
through a reduction in the Federal and hospital-specific rates.
Therefore, we used the model to calculate the exceptions reduction
factor. This exceptions reduction factor ensures that aggregate
payments under the capital prospective payment system, including
exceptions payments, are projected to equal the aggregate payments that
would have been made under the capital prospective payment system
without an exceptions process. Since changes in the level of the
payment rates change the level of payments under the exceptions
process, the exceptions reduction factor must be determined through
iteration.
In the August 30, 1991 final rule (56 FR 43517), we indicated that
we would publish each year the estimated payment factors generated by
the model to determine payments for the next 5 years. The table below
provides the actual factors for FY 1992, FY 1993, FY 1994, FY 1995, FY
1996, the final FY 1997 factor, and the estimated factors that would be
applicable through FY 2001. We caution that, except with respect to FY
1992, FY 1993, FY 1994, FY 1995, FY 1996 and FY 1997, these are
estimates only, and are subject to revisions resulting from continued
methodological refinements, more recent data, and any payment policy
changes that may occur. In this regard, we note that in making these
projections we have assumed that the cumulative DRG/GAF adjustment
factor will remain at 1.0012 for FY 1997 and later because we do not
have sufficient information to estimate the change that will occur in
the factor for years after FY 1997.
The projections are as follows:
[[Page 46323]]
----------------------------------------------------------------------------------------------------------------
Federal
Update Exceptions Budget rate (after
Fiscal year factor reduction neutrality outlier)
factor factor reduction)
----------------------------------------------------------------------------------------------------------------
1992........................................................ N/A 0.9813 0.9602 415.59
1993........................................................ 6.07 .9756 .9162 \1\ 417.29
1994........................................................ 3.04 .9485 .8947 \2\ 378.34
1995........................................................ 3.44 .9734 .8432 \3\ 376.83
1996........................................................ 1.20 .9849 N/A \4\ 461.96
1997........................................................ 0.70 .9358 N/A \5\ 438.92
1998........................................................ 1.20 .9121 N/A 432.94
1999........................................................ 1.20 .9206 N/A 442.22
2000........................................................ 1.30 9148 N/A 445.15
2001........................................................ 1.30 \6\ N/A N/A 492.93
----------------------------------------------------------------------------------------------------------------
\1\ Note: Includes the DRG/GAF adjustment factor of 0.9980 and the change in the outlier adjustment from 0.9497
in FY 1992 to 0.9496 in FY 1993.
\2\ Note: Includes the 7.4 percent reduction in the unadjusted standard Federal rate. Also includes the DRG/GAF
adjustment factor of 1.0033 and the change in the outlier adjustment from 0.9496 in FY 1993 to 0.9454 in FY
1994.
\3\ Note: Includes the DRG/GAF adjustment factor of 1.0031 and the change in the outlier adjustment from 0.9454
in FY 1994 to 0.9414 in FY 1995.
\4\ Note: Includes the transfer adjustment of .9972. Also includes the DRG/GAF adjustment factor of 1.0025 and
the change in the outlier adjustment from 0.9414 in FY 1995 to 0.9536 in FY 1996.
\5\ Note: Includes the DRG/GAF adjustment factor of 1.0012 and the change in the outlier adjustment from 0.9536
in FY 1996 to 0.9481 in FY 1997. Future adjustments are, for purposes of this projection, assumed to remain at
the same level.
\6\ Note: We are unable to estimate exceptions payments for the year under the special exceptions provision
(Sec. 412.348(g) of the regulations) because the regular exceptions provision (Sec. 412.348(e)) expires.
Appendix C: Rebased Market Basket Data Sources
I. Data Sources Used to Determine the Market Basket Relative
Weights and Choice of Price Proxy Variables for the Operating
Hospital Input Price Indexes
As discussed in section IV of the preamble to this final rule, we
are rebasing and revising the hospital market baskets. This appendix
describes the technical features of the 1992-based indexes that we are
implementing in this rule. For both the prospective payment and
excluded hospital market baskets, the differences between the 1992-
based market basket and the previous 1987-based market basket are
noted. In the September 4, 1990 final rule (55 FR 36170), we discussed
in detail the 1987-based hospital market baskets.
We present this description of the hospital operating market
baskets in three steps:
A synopsis of the structural differences between the 1987-
based market baskets and the proposed 1992-based market baskets.
A description of the methodology used to develop the cost
category weights in the 1992-based market baskets, making note of the
differences from the methodology used to develop the 1987-based market
baskets.
A description of the data sources used to measure price
change for each component of the 1992-based market baskets, making note
of the differences from the price proxies used in the 1987-based
hospital market baskets.
A. Synopsis of Structural Changes Adopted in the Rebased 1992 Operating
Hospital Market Baskets.
Three major structural differences exist between the 1987-based and
the 1992-based operating hospital market baskets.
The 1992-based hospital market baskets are based on more
recent hospital expenditure data. The 1987-based market baskets
contained skeletal cost shares that were derived from the 1987 cost
data from the 1988 Annual Survey of the American Hospital Association
(AHA). The 1992-based market baskets use data from the hospital cost
reports for cost reporting periods beginning on or after October 1,
1991 and before October 1, 1992.
Some cost categories have been combined, namely Fuel, Oil,
Coal, and Other Fuel with Motor Gasoline, and Blood Services with
Chemicals. These category mergers reflect the Bureau of Economic
Analysis (BEA) reclassification decisions in the 1987 update of the BEA
Input-Output Tables.
In the 1992-based market basket, the sample of excluded
hospitals is restricted to more closely reflect the average Medicare
length of stay in excluded hospitals. We have used cost report data for
excluded hospitals from only those hospitals in which the average
length of stay of Medicare patients in the hospital is within 15
percent of the average length of stay of all patients in the hospital
to more accurately reflect the structure of costs for Medicare cases.
This is a change from the FY 1987-based market basket, for which data
from all excluded hospitals were used.
B. Methodology for Developing the Cost Category Weights.
Cost category weights for the 1992-based market baskets were
developed in four stages. First, base weights for three (Wages and
Salaries, Employee Benefits, Pharmaceuticals) of the six main
categories were derived from the 1992 Medicare cost reports for
operating costs. Second, the weight for Nonmedical Professional Fees
was developed by subtracting Medical Professional Fees reported in the
Hospital Cost Report Information System (HCRIS) file from AHA Annual
Survey Total Professional Fees to obtain Nonmedical Professional Fees,
and the weight for Professional Liability Insurance was developed using
1989 HCRIS data trended forward to 1992, using the relative importance
values in the previous market baskets. Third, the sum of Wages and
Salaries, Employee Benefits, Pharmaceuticals, Nonmedical Professional
Fees, and Professional Liability Insurance was subtracted from total
expenses to obtain All Other Expenses. Finally, the weight for All
Other Expenses was divided into subcategories using cost shares from
the 1987 Input-Output Table for the hospital industry, produced by the
U.S. Department of Commerce, Bureau of Economic Analysis, aged to 1992
using price changes. As of this writing the Department of Commerce has
not released final 1992 cost data. Therefore we plan to incorporate
these data into the FY 1998 proposed rule.
Below, we describe the source of the six main category weights and
their subcategories in the 1992-based market
[[Page 46324]]
baskets. We make note of the differences between the methodologies used
to develop the 1987-based and the 1992-based market baskets.
1. Wages and Salaries
The cost weight for the Wages and Salaries category was derived
using the 1992 Medicare cost reports. Contract Labor, which is also
derived from the 1992 Medicare cost reports, is split between the Wages
and Salaries and Employee Benefits cost categories, using the
relationship for employed workers. Examples of Contract Labor are
registered nurses and workers in hospital food service or security who
are employed and paid by firms that contract for their work with the
hospital. The Wages and Salaries cost category was disaggregated into
nine occupational subcategories (professional and technical, managers
and administration, sales, clerical, craft and kindred, operatives
excluding transport, transport equipment operatives, nonfarm laborers
and service workers) to reflect the mix of occupational inputs used by
hospitals. The Contract Labor wages and salaries component was
allocated proportionally to Professional-Technical and Service
occupations. The 1987-based weights were developed from the 1987
Current Population Survey, while the 1992-based weights were developed
from the 1992 Current Population Survey.
2. Employee Benefits
The cost weight for the employee benefits category was derived from
the 1992 cost reports. Like wages and salaries, the employee benefit
weight in each 1992-based market basket is a composite of nine labor
subcategories. The employee benefits categories in the 1987-based
market baskets were developed from the 1987 AHA Annual Survey and used
the 1987 Current Population Survey. In 1987 Contract Labor's implied
fringe benefits were allocated proportionally to Professional and
Technical occupations, while in 1992 they were allocated to
Professional-Technical and Service occupations.
3. Nonmedical Professional Fees
The cost weight for the nonmedical professional fees category was
derived from the 1992 Medicare Cost Reports and AHA Annual Survey data.
Total professional fees were split into the subcategories medical and
other (nonmedical) fees using AHA Total Professional Fees minus HCRIS
Medical Professional Fees to equal Nonmedical Professional Fees. The
1987-based nonmedical professional fees cost category was derived from
the 1987 AHA Annual Survey and American Medical Association (AMA) data.
It was split into the subcategories medical and other fees using data
derived from the American Medical Association. The medical professional
fees category is excluded from the hospital market basket since it is
paid under Medicare Part B.
4. Professional Liability Insurance
The 1987-based market baskets have weights for professional
liability insurance that were derived from the June 30 and December 31,
1987 HAS/Monitrend surveys. The cost weight for the 1992-based
professional liability insurance category was derived from 1989 HCRIS
cost shares trended to 1992 using the change in the relative importance
factor for professional liability insurance (malpractice) from the
previous 1987-based prospective payment hospital and excluded hospital
market baskets.
5. Utilities
For the 1987-based market baskets, the cost weight for utilities
was derived by extrapolating the 1985 AHA Annual Survey utilities cost
weight forward to 1987 using the rate of growth in the HAS/Monitrend
cost weight for utilities between 1985 and 1987. The 1987 Utility
subcategory weights were aged from their 1982-based index subcategory
weights using price changes from 1982 to 1987. The 1992-based market
basket cost weights for the subcategories (fuel, oil and gasoline;
electricity; natural gas; and water and sewage) were derived from the
Bureau of Economic Analysis' 1987 Input-Output table for the hospital
industry, aged forward to 1992 by price changes and summed to a weight
for utilities.
6. All Other Goods and Services
The all other goods and services category has more subcategories
than any other market basket category. Goods found in this category
include: direct service food, contract service food, pharmaceuticals,
chemicals, medical instruments, photo supplies, rubber and plastics,
paper products, apparel, machinery and equipment and miscellaneous
products. Services found in this category include: business services,
computer services, transportation and shipping, telephone, postage,
other labor-intensive services, and other nonlabor-intensive services.
The share for pharmaceuticals was derived from the 1992 Medicare cost
reports. Relative shares for the other subcategories were derived from
the 1987 Bureau of Economic Analysis' Input-Output table for the
hospital industry and were aged forward to 1992 using price changes.
C. Price Proxies Used To Measure Cost Category Growth
1. Wages and Salaries
For measuring price growth in the 1992-based market basket, 10
price proxies are applied to the 9 occupational subcategories within
the wages and salaries component. As in the 1987-based market basket,
the professional and technical subcategory was split in half. An
Employee Cost Index (ECI) for hourly wages paid to civilian hospital
workers was applied to one half. An ECI of hourly wages and salaries
paid to professional and technical workers in private industry was
applied to the other half of the professional and technical component.
The other eight occupations subcategories of the wages and salaries
component were proxied using ECIs for wages and salaries for private
industry workers in their respective occupational categories.
2. Employee Benefits
The 1992-based hospital market baskets use occupation-specific ECIs
for employee benefits. The distribution of weights and price proxies is
the same as for wages and salaries discussed above, but occupation-
specific employee benefit ECIs replace occupation-specific wages and
salaries ECIs. The components are summed into a composite index, just
as was done for the 1987-based market basket.
3. Nonmedical Professional Fees
The ECI for compensation for professional and technical workers in
private industry is applied to this category. This is a revision from
the 1987-based market basket in which the ECI for wages and salaries
for professional and technical workers in private industry was used.
4. Fuel, Oil, and Gasoline
The percentage change in the price of refined petroleum products as
measured by the Producer Price Index (PPI) (Commodity Code #057) was
applied to this component. This is a revision from the 1987-based
indexes in which the PPIs for Light Fuel Oil (Commodity Code #0573) and
Gasoline (Commodity Code #0571) were used.
5. Electricity
The percentage change in the price of commercial electric power as
measured by the PPI (Commodity Code #0542) was applied to this
component. This is a revision from the 1987-based indexes in
[[Page 46325]]
which the PPI for industrial power (Commodity Code #0543) was used.
6. Natural Gas
The percentage change in the price of gas fuels as measured by the
PPI (Commodity Code #0552) was applied to this component. This is a
revision from the 1987-based indexes in which the PPI for Natural Gas
(Commodity Code #0531) was used.
7. Water and Sewerage
The percentage change in the price of water and sewerage
maintenance as measured by the Consumer Price Index (CPI) for all urban
consumers was applied to this component. The same price measure was
used in the 1987-based market baskets.
8. Professional Liability Insurance
The percentage change in the hospital professional liability
insurance price as estimated by hospital industry professional
liability insurance premium increase was applied to this component. The
same price measure was used in the 1987-based market baskets.
9. Pharmaceuticals
The percentage change in the price of ethical preparations as
measured by the PPI (Commodity Code #0635) was applied to this
variable. The same price measure was used in the 1987-based market
baskets.
10. Food, Direct Purchases
The percentage change in the price of processed foods and feeds as
measured by the PPI (Commodity Code #02) was applied to this component.
The same price measure was used in the 1987-based market baskets.
11. Food, Contract Services
The percentage change in the price of food purchased away from home
as measured by the CPI for all urban consumers was applied to this
component. The same price measure was used in the 1987-based market
baskets.
12. Chemicals
The percentage change in the price of industrial chemical products
as measured by the PPI (Commodity Code #061) was applied to this
component. The same price measure was used in the 1987-based market
baskets.
13. Surgical and Medical Equipment
The percentage change in the price of medical and surgical
instruments as measured by the PPI (Commodity Code #1562) was applied
to this component. The same price measure was used in the 1987-based
market baskets.
14. Photographic Supplies
The percentage change in the price of photographic supplies as
measured by the PPI (Commodity Code #1542) was applied to this
component. The same price measure was used in the 1987-based market
baskets.
15. Rubber and Plastics
The percentage change in the price of rubber and plastic products
as measured by the PPI (Commodity Code #07) was applied to this
component. The same price measure was used in the 1987-based market
baskets.
16. Paper Products
The percentage change in the price of converted paper and
paperboard products as measured by the PPI (Commodity Code #0915) was
used. This is a revision from the 1987-based indexes in which a
weighted average of the percentage change in the price of converted
paper and paperboard products and the percentage change in the price of
paper excluding newsprint and packaging paper (Commodity Code #091301)
was used.
17. Apparel
The percentage change in the price of apparel as measured by the
PPI (Commodity Code #381) was applied to this component. This is a
revision from the 1987-based indexes in which the PPI for textile house
furnishings (Commodity Code #0382) was used.
18. Minor Machinery and Equipment
The percentage change in the price of machinery and equipment as
measured by the PPI (Commodity Code #11) was applied to this component.
The same price measure was used in the 1987-based market baskets.
19. Miscellaneous Products
The percentage change in the price of all finished goods as
measured by the PPI was applied to this component. The same price
measure was used in the 1987-based market baskets.
20. Business Services
The ECI for compensation for workers in the business services
industry was applied to this component. This is a revision from the
1987-based indexes in which the percentage change in the AHE for wages
and salaries for production and nonsupervisory workers in the business
services industry as measured by the Bureau of Labor Statistics (SIC
Code 73) was used.
21. Computer and Data Processing Services
The percentage change in the AHE of production and nonsupervisory
workers engaged in firms furnishing computer data processing services
(SIC Code 737) was applied to this component. The same price measure
was used in the 1987-based market baskets.
22. Transportation and Shipping
The percentage change in the transportation component of the CPI
for all urban consumers was applied to this component. The same price
measure was used in the 1987-based market baskets.
23. Telephone
The percentage change in the price of telephone services as
measured by the CPI for all urban consumers was applied to this
component. The same price measure was used in the 1987-based market
baskets.
24. Postage
The percentage change in the price of postage as measured by the
CPI for all urban consumers was applied to this component. The same
price measure was used in the 1987-based market baskets.
25. All Other Services, Labor Intensive
The percentage change in the ECI for compensation paid to service
workers employed in private industry was applied to this component.
This is a revision from the 1987-based indexes in which the ECI for
wages and salaries paid to service workers employed in private industry
was used.
26. All Other Services, Nonlabor Intensive
The percentage change in the all-items component of the CPI for all
urban consumers was applied to this component. The same price measure
was used in the 1987-based market baskets.
For further discussion of the rationale for choosing specific price
proxies, we refer the reader to the September 3, 1986 final rule (51 FR
31582).
II. Data Sources Used to Determine the Cost Category Weights and
Vintage Weights, and Choices of Price Proxy Variables for the Hospital
Capital Input Price Index
In the preamble to this final rule, we discuss the rebasing of the
capital input price index (CIPI). This appendix describes certain
technical features of the 1992-based index, as well as differences
between the 1992-based CIPI and the 1987-based CIPI. We discussed
[[Page 46326]]
the 1987-based CIPI in the September 1, 1995 final rule (60 FR 45817.)
This discussion has the following three parts:
A synopsis of the differences between the 1987-based CIPI
and the 1992-based CIPI.
A description of the methodology used to develop the cost
category weights and vintage weights in the 1992-based CIPI, making
note of the differences from the methodology used to develop the 1987-
based CIPI.
A description of the data sources used to measure price
change for each component of the 1992-based CIPI, making note of the
differences from the price proxies used in the 1987-based CIPI.
A. Synopsis of Changes Adopted in the Rebased 1992 CIPI
We made no structural changes in the 1992-based CIPI. The only
major change is the use of more recent hospital capital expenditure
data. The 1987-based CIPI contained cost category weights that were
derived from 1987 Medicare cost report data and the 1987 Annual Survey
of the AHA. The 1992-based CIPI uses data from the hospital Medicare
cost reports for cost periods beginning between October 1, 1991 and
September 30, 1992. The 1992-based CIPI also uses data from the 1992
Annual Survey of the AHA.
The 1987-based CIPI contained vintage weights that were derived
from 1987 Medicare cost report data, the 1963-1987 Panel Survey of the
AHA, and the 1980-1989 Securities Data Corporation data on hospital
bonds. The 1992-based CIPI uses data from the 1992 Medicare cost
reports, the 1963-1992 Panel Survey of the AHA, and 1980-1992
Securities Data Corporation data on hospital bonds.
B. Methodology for Developing Cost Category Weights and Vintage Weights
for the 1992-based CIPI
There are five cost categories in the CIPI: Building and fixed
equipment depreciation, movable equipment depreciation, capital-related
interest expense from government/nonprofit debt instruments, capital-
related interest expense from for-profit debt instruments, and other
capital-related expenses, such as taxes and insurance. The methodology
for developing each of these cost category weights is described below:
1. Building and Fixed Equipment Depreciation
The 1992-based cost weight for building and fixed equipment
depreciation was derived using the 1992 Medicare cost reports. The
proportion of lease expenses attributable to building and fixed
equipment was included in the cost weight based on the proportion of
overall capital expenses allocated to building and fixed equipment
depreciation. The 1987-based weight was developed from the 1987
Medicare cost reports and the 1987 AHA Annual Survey.
2. Movable Equipment Depreciation
The 1992-based cost weight for movable equipment depreciation was
derived using the 1992 Medicare Cost Reports. The proportion of lease
expenses attributable to movable equipment was included in the cost
weight based on the proportion of overall capital expenses allocated to
movable equipment depreciation. The 1987-based weight was developed
from the 1987 Medicare cost reports and the 1987 AHA Annual Survey.
3. Government/Nonprofit Interest
The 1992-based cost weight for government/nonprofit interest was
derived using the 1992 AHA Annual Survey data. The government/nonprofit
interest is 85 percent of total interest, reflecting the relative debts
of the government/nonprofit hospital sector and the for-profit hospital
sector. The proportion of lease expenses attributable to government/
nonprofit interest was included in the cost weight based on the
proportion of overall capital expenses allocated to government/non-
profit interest expense. The 1987-based weight was developed from the
1987 AHA Annual Survey.
4. For-Profit Interest
The 1992-based cost weight of for-profit interest was derived using
the 1992 AHA Annual Survey data. The for-profit interest is 15 percent
of total interest, reflecting the relative debts of the government/
nonprofit hospital sector and the for-profit hospital sector. The
proportion of lease expenses attributable to for-profit interest was
included in the cost weight based on the proportion of overall capital
expenses allocated to for-profit interest expense. The 1987-based
weight was developed from the 1987 AHA Annual Survey.
5. Other Capital-Related Expenses
The 1992-based cost weight for other capital-related expenses was
derived using 1992 Medicare cost reports. The proportion of lease
expenses attributable to other capital-related expenses was included in
the cost weight based on the proportion of overall capital expenses
allocated to other capital-related expenses. The 1987-based weight was
developed from the 1987 Medicare cost reports and the 1987 Capital
Expenditure Survey.
6. There are three sets of vintage weights in the CIPI
Building and fixed equipment depreciation, movable equipment
depreciation, and interest expense. The methodology for developing each
of these vintage weights is described below.
a. Building and Fixed Equipment: The 1992-based building and fixed
equipment vintage weights were derived from the 1992 Medicare cost
reports and the 1963-1992 AHA Panel Survey. The 1987-based weights were
developed from the 1987 Medicare cost reports and the 1963-1987 AHA
Panel Survey.
b. Movable Equipment: The 1992-based movable equipment vintage
weights were derived from the 1992 Medicare cost reports and the 1963-
1992 AHA Panel Survey. The 1987-based weights were developed from the
1987 Medicare cost reports and the 1963-1987 AHA Panel Survey.
c. Capital-Related Interest: The 1992-based movable equipment
vintage weights were derived from the 1980-1992 Securities Data
Corporation data on hospital bonds and the 1963-1992 AHA Panel Survey.
The 1987-based weights were developed from the 1980-1989 Securities
Data Corporation data on hospital bonds and the 1963-1987 AHA Panel
Survey.
C. Price Proxies Used to Measure Cost Category Growth in the CIPI
1. Building and Fixed Equipment Depreciation
The percentage change in the vintage-weighted price of building and
fixed equipment depreciation as measured by the Boeckh institutional
construction index was applied to this category in the 1992-based CIPI.
The same price proxy was used in the 1987-based CIPI.
2. Movable Equipment Depreciation
The percentage change in the vintage-weighted price of movable
equipment depreciation as measured by the Producer Price Index (PPI)
for machinery and equipment was applied to this category in the 1992-
based CIPI. The same price proxy was used in the 1987-based CIPI.
3. Government/Nonprofit Interest Expense
The percentage change in the vintage-weighted price of government/
nonprofit interest expense as measured by the Average yield on Domestic
Municipal Bonds from the Bond Buyer index of 20 bonds was applied to
this category in
[[Page 46327]]
the 1992-based CIPI. The same price proxy was used in the 1987-based
CIPI.
4. For-Profit Interest Expense
The percentage change in the vintage-weighted price of for-profit
interest expense as measured by the Average yield on Moody's Aaa Bonds
was applied to this category in the 1992-based CIPI. The same price
proxy was used in the 1987-based CIPI.
5. Other Capital-Related Expenses
The percentage change in the price of other capital-related
expenses as measured by the CPI for all urban consumers for residential
rent was applied to this category in the 1992-based CIPI. The same
price proxy was used in the 1987-based CIPI.
We provided more detailed discussion of the rationale for the
choice of these price proxies in the June 2, 1995 proposed rule (60 FR
29227) and in the September 1, 1995 final rule (60 FR 45815).
Appendix D: Recommendation of Update Factors for Operating Cost Rates
of Payment for Inpatient Hospital Services
I. Background
Several provisions of the Social Security Act (the Act) address the
setting of update factors for inpatient services furnished in FY 1997
by hospitals subject to the prospective payment system and those
excluded from the prospective payment system. Section
1886(b)(3)(B)(i)(XII) of the Act sets the FY 1997 percentage increase
in the operating cost standardized amounts equal to the rate of
increase in the hospital market basket minus 0.5 percentage points for
prospective payment hospitals in all areas. Section 1886(b)(3)(B)(iv)
of the Act sets the FY 1997 percentage increase in the hospital-
specific rates applicable to sole community hospitals equal to the rate
set forth in section 1886(b)(3)(B)(i) of the Act, that is, the same
update factor as all other hospitals subject to the prospective payment
system, or the rate of increase in the market basket minus 0.5
percentage points. Section 1886(b)(3)(B)(ii) of the Act sets the FY
1997 percentage increase in the rate of increase limits for hospitals
excluded from the prospective payment system equal to the rate of
increase in the excluded hospital market basket minus the applicable
reduction or, in the case of a hospital in a fiscal year for which the
hospital's update adjustment percentage is at least 10 percent, the
excluded hospital market basket percentage increase. Under section
1886(b)(3)(B)(v) of the Act, a hospital's update adjustment percentage
increase for FY 1997 is the percentage increase by which the hospital's
allowable operating costs of inpatient hospital services recognized
under this title for the cost reporting period beginning in FY 1990
exceed the hospital's target amount for such cost reporting period,
increased for each fiscal year (beginning with FY 1994) by the sum of
any of the hospital's applicable reductions for previous years. The
applicable reduction with respect to a hospital for FY 1997 is the
lesser of 1 percentage point or the percentage point difference between
10 percent and the hospital's update adjustment percentage for FY 1997.
In accordance with section 1886(d)(3)(A) of the Act, we are
updating the standardized amounts, the hospital-specific rates, and the
rate-of-increase limits for hospitals excluded for the prospective
payment system as provided in section 1886(b)(3)(B) of the Act. Based
on the second quarter 1996 forecast of the FY 1997 rebased market
basket increase of 2.5 percent for hospitals subject to the prospective
payment system, the updates in the standardized amounts are 2.0 percent
for hospitals in both large urban and other areas. The update in the
hospital-specific rate applicable to sole community hospitals is 2.0
percent (that is, the market basket rate of increase of 2.5 percent
minus 0.5 percentage points). The update for hospitals excluded from
the prospective payment system is based on the percentage increase in
the excluded hospital market basket (currently estimated at 2.5
percent) minus the applicable reduction factor. The applicable
reduction factor is the lesser of 1 percentage point or the percentage
point difference between 10 percent and the hospital's update
adjustment percentage. Therefore, for excluded hospitals, the hospital-
specific update can vary between 1.5 and 2.5 percent.
Sections 1886(e)(2)(A) and (3)(A) of the Act require that the
Prospective Payment Assessment Commission (ProPAC) recommend to the
Congress by March 1 of each year an update factor that takes into
account changes in the market basket rate of increase index, hospital
productivity, technological and scientific advances, the quality of
health care provided in hospitals, and long-term cost effectiveness in
the provision of inpatient hospital services.
Section 1886(e)(4) of the Act requires that the Secretary, taking
into consideration the recommendations of ProPAC, recommend update
factors for each fiscal year that take into account the amounts
necessary for the efficient and effective delivery of medically
appropriate and necessary care of high quality. Under section
1886(e)(5) of the Act, we published the FY 1996 update factors
recommended under section 1886(e)(4) of the Act as Appendix E of the
May 31, 1996 final rule (61 FR 27591).
II. Secretary's Final Recommendation for Updating the Prospective
Payment System Standardized Amounts
We did not receive any public comments concerning our proposed
recommendation. Therefore, our final recommendation will be the same as
our proposed recommendation. That is, we are recommending that the
standardized amounts be increased by an amount equal to the market
basket rate of increase minus 1.5 percentage points for hospitals
located in large urban and other areas. We are also recommending an
update of the market basket rate of increase minus 1.5 percentage
points to the hospital-specific rate for sole community hospitals.
These figures are consistent with the President's budget
recommendation.
In recommending these increases, we have followed section
1886(e)(4) of the Act, which requires that we take into account the
amounts necessary for the efficient and effective delivery of medically
appropriate and necessary care of high quality. In addition, as
required by section 1886(e)(4) of the Act, we have taken into
consideration the recommendations of ProPAC. We believe our analyses,
which measure changes in hospital productivity, scientific and
technological advances, practice pattern changes, and changes in case
mix, support our recommendations. These figures are consistent with the
President's FY 1997 budget recommendation, which continues the
reductions imposed by section 13501 of the Omnibus Budget
Reconciliation Act of 1993 (Public Law 103-66), that is, reductions in
the hospital market basket of 2.5 percentage points for FYs 1994 and
1995 and 2.0 percentage points for FY 1996. We believe these
recommended changes in the update factor would ensure that Medicare
acts as a prudent purchaser and provide incentives to hospitals for
increased efficiency, thereby contributing to the solvency of the
Medicare Part A Trust Fund. When the President's budget was submitted,
the market basket rate of increase was projected at 3.6 percent. As
noted above, our final recommendation is based on the most recent
forecast of the rebased market basket. (See section IV of the
[[Page 46328]]
preamble to this final rule for a detailed discussion of the market
basket.)
III. Secretary's Final Recommendation for Updating the Rate-of-Increase
Limits for Excluded Hospitals and Units
Our final recommendation is that hospitals and hospital units
excluded from the prospective payment system receive an update equal to
percentage increase in the rebased market basket that measures input
price increases for services furnished by excluded hospitals minus 1.5
percentage points. Thus, given the current estimate of the change in
the market basket rate of increase for excluded hospitals of 2.5
percent (compared with the earlier estimate of 2.7 percent used in the
proposed rule), our final recommendation is for an update of 1.0
percent. This recommendation is consistent with the President's budget,
acknowledging that the market basket rate of increase for these
hospitals was forecast at 3.6 percent at the time the budget was
submitted.
[FR Doc. 96-22145 Filed 8-28-96; 8:45 am]
BILLING CODE 4120-03-P
Complete official Federal Register PDF
FR Doc. 96-22141 Airworthiness Directives; Bell Helicopter Textron, A Division of Textron Canada Ltd. Model 206L, 206L-1, and 206L-3 Helicopters
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Pages 45876-45878]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22141]
=======================================================================
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DEPARTMENT OF TRANSPORTATION
Federal Aviation Administration
14 CFR Part 39
[Docket No. 96-SW-13-AD; Amendment 39-9729; AD 96-18-05]
RIN 2120-AA64
Airworthiness Directives; Bell Helicopter Textron, A Division of
Textron Canada Ltd. Model 206L, 206L-1, and 206L-3 Helicopters
AGENCY: Federal Aviation Administration, DOT.
ACTION: Final rule; request for comments.
-----------------------------------------------------------------------
SUMMARY: This amendment supersedes an existing priority letter
airworthiness directive (AD), applicable to Bell Helicopter Textron, A
Division of Textron Canada Ltd. (BHTC) Model 206L, 206L-1, and 206L-3
helicopters, that currently requires a visual inspection of the
tailboom skin in the areas around the nutplates and in the areas of the
tailboom drive shaft cover retention clips for cracks and corrosion
using a 10-power or higher magnifying glass. This amendment requires
the same actions as the existing AD, but corrects a part number that
was incorrectly stated in that AD. This amendment is prompted by a
recent accident and several reports of fatigue cracks in the tailboom
skin in the areas around the nutplates for the tail rotor fairing and
in the areas of the tail rotor drive shaft cover retention clips. The
actions specified by this AD are intended to prevent failure of the
tailboom and subsequent loss of control of the helicopter.
DATES: Effective September 16, 1996. The incorporation by reference of
certain publications listed in the regulations is approved by the
Director of the Federal Register as of September 16, 1996.
Comments for inclusion in the Rules Docket must be received on or
before October 29, 1996.
ADDRESSES: Submit comments in triplicate to the Federal Aviation
Administration (FAA), Office of the Assistant Chief Counsel, Attention:
Rules Docket No. 96-SW-13AD, 2601 Meacham Blvd., Room 663, Fort Worth,
Texas 76137.
The service information referenced in this AD may be obtained from
Bell Helicopter Textron Canada, A Division of Textron Canada Ltd.,
12,800 rue de L'Avenir, Mirabel, Quebec, Canada, JON 1LO. This
information may be examined at the FAA, Office of the Assistant Chief
Counsel, 2601 Meacham Blvd., Room 663, Fort Worth, Texas; or at the
Office of the Federal Register, 800 North Capitol Street, NW., suite
700, Washington, DC.
FOR FURTHER INFORMATION CONTACT: Mr. Tony Nguyen, Aerospace Engineer,
FAA, Rotorcraft Certification Office, Rotorcraft Directorate, 2601
Meacham Blvd., Fort Worth, Texas 76137, telephone (817) 222-5177, fax
(817) 222-5960.
SUPPLEMENTARY INFORMATION: On July 3, 1996, the FAA issued priority
letter AD 96-14-10, to require, before further flight, and thereafter
at intervals not to exceed 50 hours time-in-service (TIS), a visual
inspection of the tailboom skin in the areas around the nutplates and
in the areas of the tailboom drive shaft cover retention clips for
cracks and corrosion using a 10-power or higher magnifying glass. This
inspection interval was to be repeated until the tailboom was replaced
by part number (P/N) 206-033-004-143 or -173. That action was prompted
by a recent accident and several reports of fatigue cracks in the
tailboom skin in the areas around the nutplates for the tail rotor
fairing and in the areas of the tail rotor drive shaft cover retention
clips. That
[[Page 45877]]
condition, if not corrected, could result in failure of the tailboom
and subsequent loss of control of the helicopter.
Since the issuance of that AD, the FAA has determined that one of
the replacement tailboom's P/N should have been stated as P/N 206-033-
004-177 instead of P/N 206-033-004-173.
Since an unsafe condition has been identified that is likely to
exist or develop on other BHTC Model 206L, 206L-1, and 206L-3
helicopters of the same type design, this AD supersedes priority letter
AD 96-14-10 to require, before further flight, and thereafter at
intervals not to exceed 50 hours TIS, a visual inspection of the
tailboom skin in the areas around the nutplates and in the areas of the
tailboom drive shaft cover retention clips for cracks and corrosion
using a 10-power or higher magnifying glass. This inspection interval
will be repeated until the tailboom is replaced by P/N-206-033-004-143
or -177. The actions are required to be accomplished in accordance with
the service bulletin described previously.
Since a situation exists that requires the immediate adoption of
this regulation, it is found that notice and opportunity for prior
public comment hereon are impracticable, and that good cause exists for
making this amendment effective in less than 30 days.
Comments Invited
Although this action is in the form of a final rule that involves
requirements affecting flight safety and, thus, was not preceded by
notice and an opportunity for public comment, comments are invited on
this rule. Interested persons are invited to comment on this rule by
submitting such written data, views, or arguments as they may desire.
Communications should identify the Rules Docket number and be submitted
in triplicate to the address specified under the caption ADDRESSES. All
communications received on or before the closing date for comments will
be considered, and this rule may be amended in light of the comments
received. Factual information that supports the commenter's ideas and
suggestions is extremely helpful in evaluating the effectiveness of the
AD action and determining whether additional rulemaking action would be
needed.
Comments are specifically invited on the overall regulatory,
economic, environmental, and energy aspects of the rule that might
suggest a need to modify the rule. All comments submitted will be
available, both before and after the closing date for comments, in the
Rules Docket for examination by interested persons. A report that
summarizes each FAA-public contact concerned with the substance of this
AD will be filed in the Rules Docket.
Commenters wishing the FAA to acknowledge receipt of their comments
submitted in response to this rule must submit a self-addressed,
stamped postcard on which the following statement is made: ``Comments
to Docket No. 96-SW-13-AD.'' The postcard will be date stamped and
returned to the commenter.
The regulations adopted herein will not have substantial direct
effects on the States, on the relationship between the national
government and the States, or on the distribution of power and
responsibilities among the various levels of government. Therefore, in
accordance with Executive Order 12612, it is determined that this final
rule does not have sufficient federalism implications to warrant the
preparation of a Federalism Assessment.
The FAA has determined that this regulation is an emergency
regulation that must be issued immediately to correct an unsafe
condition in aircraft, and that it is not a ``significant regulatory
action'' under Executive Order 12866. It has been determined further
that this action involves an emergency regulation under DOT Regulatory
Policies and Procedures (44 FR 11034, February 26, 1979). If it is
determined that this emergency regulation otherwise would be
significant under DOT Regulatory Policies and Procedures, a final
regulatory evaluation will be prepared and placed in the Rules Docket.
A copy of it, if filed, may be obtained from the Rules Docket at the
location provided under the caption ADDRESSES.
List of Subjects in 14 CFR Part 39
Air transportation, Aircraft, Aviation safety, Incorporation by
reference, Safety.
Adoption of the Amendment
Accordingly, pursuant to the authority delegated to me by the
Administrator, the Federal Aviation Administration amends part 39 of
the Federal Aviation Regulations (14 CFR part 39) as follows:
PART 39--AIRWORTHINESS DIRECTIVES
1. The authority citation for part 39 continues to read as follows:
Authority: 49 U.S.C. 106(g), 40113, 44701.
Sec. 39.13 [Amended]
2. Section 39.13 is amended by adding a new airworthiness directive
(AD), Amendment 39-9729, to read as follows:
AD 96-18-05 Bell Helicopter Textron, a Division of Textron Canada
Ltd.: Amendment 39-9729. Docket No. 96-SW-13-AD. Supersedes priority
letter AD 96-14-10.
Applicability: Model 206L, 206L-1, and 206L-3 helicopters, with
tailboom, part number (P/N) 206-033-004-3, -11, -45, or -103
installed, certificated in any category.
Note 1: This AD applies to each helicopter identified in the
preceding applicability provision, regardless of whether it has been
modified, altered, or repaired in the area subject to the
requirements of this AD. For helicopters that have been modified,
altered, or repaired so that the performance of the requirements of
this AD is affected, the owner/operator must use the authority
provided in paragraph (c) to request approval from the FAA. This
approval may address either no action, if the current configuration
eliminates the unsafe condition, or different actions necessary to
address the unsafe condition described in this AD. Such a request
should include an assessment of the effect of the changed
configuration on the unsafe condition addressed by this AD. In no
case does the presence of any modification, alteration, or repair
remove any helicopter from the applicability of this AD.
Compliance: Required as indicated, unless accomplished
previously.
To prevent failure of the tailboom and subsequent loss of
control of the helicopter, accomplish the following:
(a) Before further flight, and thereafter at intervals not to
exceed 50 hours time-in-service (TIS), using a 10-power or higher
magnifying glass, inspect the tailboom for cracks or corrosion.
Perform this inspection in accordance with the inspection procedures
stated in the Accomplishment Instructions, Part II or Part III, as
applicable, of Bell Helicopter Textron Inc. Alert Service Bulletin
206L-87-47, Revision C, dated October 23, 1989. If a crack or
corrosion is detected that is beyond the limits prescribed by the
applicable maintenance manual, remove the tailboom and replace it
with an airworthy tailboom.
(b) Replacement of the tailboom with tailboom, P/N 206-033-004-
143 or -177, constitutes terminating action for the requirements of
this AD.
(c) An alternative method of compliance or adjustment of the
compliance time that provides an acceptable level of safety may be
used if approved by the Manager, Rotorcraft Certification Office,
Rotorcraft Directorate, FAA. Operators shall submit their requests
through an FAA Principal Maintenance Inspector, who may concur or
comment and then send it to the Manager, Rotorcraft Certification
Office.
Note 2: Information concerning the existence of approved
alternative methods of compliance with this AD, if any, may be
obtained from the Rotorcraft Certification Office.
(d) Special flight permits will not be issued.
(e) The inspections and replacement shall be done in accordance
with Bell Helicopter
[[Page 45878]]
Textron Inc. Alert Service Bulletin 206L-87-47, Revision C, dated
October 23, 1989. This incorporation by reference was approved by
the Director of the Federal Register in accordance with 5 U.S.C.
552(a) and 1 CFR part 51. Copies may be obtained from Bell
Helicopter Textron Canada, A Division of Textron Canada Ltd., 12,800
rue de L'Avenir, Mirabel, Quebec, Canada, JON 1LO. Copies may be
inspected at the FAA, Office of the Assistant Chief Counsel, 2601
Meacham Blvd., Room 663, Fort Worth, Texas; or at the Office of the
Federal Register, 800 North Capitol Street, NW., suite 700,
Washington, DC.
(f) This amendment becomes effective on September 16, 1996.
Issued in Fort Worth, Texas, on August 22, 1996.
Daniel P. Salvano,
Manager, Rotorcraft Directorate, Aircraft Certification Service.
[FR Doc. 96-22141 Filed 8-29-96; 8:45 am]
BILLING CODE 4910-13-U
Complete official Federal Register PDF
FR Doc. 96-22077 Identification and Mapping of Special Flood Hazard Areas, Procedures for Map Correction, and Procedures and Fees for Processing Map Changes
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Pages 46330-46333]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22077]
[[Page 46329]]
_______________________________________________________________________
Part VI
Federal Emergency Management Agency
_______________________________________________________________________
44 CFR Parts 65, 70, and 72
Flood Insurance Program: Identification and Mapping of Special Flood
Hazard Areas, Procedures for Map Correction, and Procedures and Fees
for Processing Map Changes; Interim Final Rule and Notice
Federal Register / Vol. 61, No. 170 / Friday, August 30, 1996 / Rules
and Regulations
[[Page 46330]]
FEDERAL EMERGENCY MANAGEMENT AGENCY
44 CFR Parts 65, 70, and 72
RIN 3067-AC53
Identification and Mapping of Special Flood Hazard Areas,
Procedures for Map Correction, and Procedures and Fees for Processing
Map Changes
AGENCY: Federal Emergency Management Agency (FEMA).
ACTION: Interim final rule.
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SUMMARY: This interim final rule will revise the National Flood
Insurance Program (NFIP) regulations concerning the identification and
mapping of Special Flood Hazard Areas (SFHAs) and revision of NFIP maps
by revising the fee requirements and schedule for processing certain
changes to NFIP maps. Under this interim final rule, the fees will be
adjusted periodically, but no more than once annually, to provide for
changes in the prevailing private-sector labor rate on which the fees
are predicated. Revised fees will be published in the Federal Register.
DATES: This interim final rule is effective August 30, 1996. We invite
your comments on this interim final rule. Please submit comments on or
before October 1, 1996.
ADDRESSES: Please send written comments to the Rules Docket Clerk,
Office of the General Counsel, Federal Emergency Management Agency, 500
C Street SW., Washington, DC 20472, or by facsimile at (202) 646-4536
(not a toll-free call).
FOR FURTHER INFORMATION CONTACT: Michael K. Buckley, P.E., Chief,
Hazard Identification Branch, Mitigation Directorate, 500 C Street SW.,
Washington, DC 20472; (202) 646-2756 or by facsimile at (202) 646-4596
(not toll-free calls).
SUPPLEMENTARY INFORMATION: This interim final rule will revise the
National Flood Insurance Program (NFIP) regulations concerning the
identification and mapping of Special Flood Hazard Areas (SFHAs) and
revision of NFIP maps by revising the fee requirements and schedule for
processing certain changes to NFIP maps. The current fee requirements
and schedule were established under a final rule published in the
Federal Register on June 30, 1992, 57 FR 29036.
This action will reduce expenses to the NFIP and will contribute to
the NFIP's self-support by: (1) Establishing flat user fees for most
requests for Conditional Letters of Map Amendment (CLOMAs), Letters of
Map Revision Based on Fill (LOMR-Fs), Conditional Letters of Map
Revision Based on Fill (CLOMR-Fs), Letters of Map Revision (LOMRs),
Conditional Letters of Map Revision (CLOMRs), and Physical Map
Revisions (PMRs); (2) reducing the number of user fee categories; (3)
requiring payment of user fees in full before beginning work on a
request; (4) changing the initial fee and hourly rate for LOMR, CLOMR,
and PMR requests based on structural measures on alluvial fans; (5)
limiting fee exemptions for requests involving LOMAs and requests to
correct mapping or analysis errors; and (6) replacing the mechanism for
recovering the cartographic production costs related to incorporating
map changes made by letter in Flood Insurance Rate Maps (FIRMs) and
Flood Boundary and Floodway Maps (FBFMs).
This interim final rule supersedes the fee schedules that were
established on June 30, 1992. It also expands the payment method to
include credit card payments.
Under this interim final rule, the fees will be adjusted
periodically, but no more than once annually, to provide for changes in
the prevailing private-sector labor rate on which the fees are
predicated. Revised fees will be published as a notice in the Federal
Register.
These amendments to the NFIP criteria for identification and
mapping of SFHAs are a result of the continuing reappraisal of the NFIP
for the purposes of achieving greater administrative and fiscal
effectiveness and encouraging sound floodplain management so that
reductions in the loss of life and property and in disaster-related
expenditures can be realized.
Establishment of Flat User Fees
The existing fee collection process is complex and its
administration requires time-intensive efforts on the part of FEMA. It
also increases the time required to provide requesters with the Letter
of Map Change (LOMC) product or PMR they require. The current system
requires requesters to submit an initial fee that is not intended to
cover the full review and processing costs or the cartographic
production costs. Requesters subsequently receive invoices for the
balance. The current system is further complicated by the pre-
authorized spending limits placed on each product. When FEMA determines
that these limits will be exceeded, written authorization must be
obtained before proceeding with their review. Processing the request is
delayed until the written authorization is received.
Under this interim final rule, FEMA will charge a single flat user
fee for most LOMC and PMR requests, thereby reducing the turnaround
time for preparing and issuing determination letters and reducing FEMA
costs of administering the fee-charge system. FEMA could recover more
of the actual costs than are recovered by the current system and
redistribute the overall cost of operations.
Requirement for Full Up-Front Payment
Under this interim final rule, the requester will be required to
submit the full fee payment before any work is begun on most map change
requests. This will minimize the need for follow-up invoicing and
ensure FEMA collects appropriate fees for services rendered.
Consolidation of Product Categories
Under this interim final rule, LOMC services and PMRs with similar
review and processing requirements will be consolidated into the same
fee category. As a result, the number of fee categories is reduced from
19 to 10.
Limitation of Fee Exemptions
Under current standards, requesters are exempted from paying user
fees when they submit requests for changes to (1) remove properties or
structures from the SFHA shown on the FIRM that were inadvertently
included in the SFHA because of map scale limitations. This is handled
by the LOMA process detailed in part 70 of the NFIP regulations; (2)
reflect more detailed information on flooding sources, floodways, or
topographic data; (3) correct mapping errors or errors in the effective
Flood Insurance Study analysis; or (4) reflect projects that are for
public benefit and are primarily intended for flood loss reduction to
insurable structures in identified flood hazard areas that were in
existence prior to the commencement of the projects. Such exemptions
preclude FEMA from recovering fees for a substantial volume of work.
Under this interim final rule, exemptions are maintained only for
requests for LOMAs and requests to correct mapping or analysis errors.
Maintenance of Initial Fee for Requests Based on Structural Measures on
Alluvial Fans
Under this interim final rule, the initial fee for LOMC requests
based on structural measures on alluvial fans will be maintained
because these requests are rare, the FEMA engineering review for these
requests is usually very complex, and FEMA's costs for processing these
requests can fluctuate
[[Page 46331]]
significantly. Based on a review of actual processing costs for Fiscal
Year 1995, $5,000 will be established as the initial fee for such
requests, with the remaining costs to be recovered before the LOMC is
issued, consistent with current fee-reimbursement practices. Under this
interim final rule, the hourly rate used to calculate the total fees
that must be reimbursed is increased to $50.
National Environmental Policy Act
This interim final rule is categorically excluded from the
requirements of 44 CFR part 10, Environmental Consideration. No
environmental impact assessment has been prepared.
Regulatory Flexibility Act
The Acting Associate Director, Mitigation Directorate, certifies
that this interim final rule does not have a significant economic
impact on a substantial number of small entities in accordance with the
Regulatory Flexibility Act, 5 U.S.C. 610 et seq., because it is not
expected (1) to have significant secondary or incidental effects on a
substantial number of small entities, nor (2) to create any additional
burden on small entities. A regulatory flexibility analysis has not
been prepared.
Executive Order 12612, Federalism
This interim final rule involves no policies that have federalism
implications under Executive Order 12612, Federalism, dated October 26,
1987.
Executive Order 12778, Civil Justice Reform
This interim final rule meets the applicable standards of Section
2(b)(2) of Executive Order 12778, Civil Justice Reform.
Executive Order 12866, Regulatory Planning and Review
Promulgation of this interim final rule is required by statute, 42
U.S.C. 4014(f), which also specifies the regulatory approach taken in
the interim final rule. To the extent possible under the statutory
requirements of 42 U.S.C. 4014(f), this interim final rule adheres to
the principles of regulation as set forth in Executive Order 12866,
Regulatory Planning and Review.
(Catalog of Federal Domestic Assistance No. 83.100, Flood Insurance)
List of Subjects in 44 CFR Parts 65, 70, and 72
Administrative practice and procedure, Flood insurance,
Floodplains, and Reporting and recordkeeping requirements.
Accordingly, 44 CFR Parts 65, 70, and 72 are amended as follows:
PART 65--IDENTIFICATION AND MAPPING OF SPECIAL FLOOD HAZARD AREAS
1. The authority citation for part 65 continues to read as follows:
Authority: 42 U.S.C. 4001 et seq.; Reorganization Plan No. 3 of
1978, 43 FR 41943, 3 CFR, 1978 Comp., p. 329; E.O. 12127, 44 FR
19367, 3 CFR, 1979 Comp., p. 376.
2. Section 65.4(c) is revised to read as follows:
Sec. 65.4 Right to submit new technical data.
* * * * *
(c) Requests for changes to effective Flood Insurance Rate Maps and
Flood Boundary and Floodway Maps are subject to the cost recovery
procedures described in part 72 of this subchapter. As indicated in
part 72, revisions requested to correct mapping errors or errors in the
Flood Insurance Study analysis are not subject to cost-recovery
procedures.
3. Section 65.5(d) is revised to read as follows:
Sec. 65.5 Revision to special hazard area boundaries with no change
to base flood elevation determinations.
* * * * *
(d) Submission procedures. All requests shall be submitted to the
FEMA Regional Office servicing the community's geographic area or to
the FEMA Headquarters Office in Washington, DC, and shall be
accompanied by the appropriate payment, in accordance with part 72 of
this subchapter.
4. Section 65.6(g) is revised to read as follows:
Sec. 65.6 Revision of base flood elevation determinations.
* * * * *
(g) Submission procedures. All requests shall be submitted to the
FEMA Regional Office servicing the community's geographic area or the
FEMA Headquarters Office in Washington, DC, and shall be accompanied by
the appropriate payment, in accordance with part 72 of this subchapter.
5. Section 65.8 is revised to read as follows:
Sec. 65.8 Review of proposed projects.
A community, or an individual through the community, may request
FEMA's comments on whether a proposed project will justify a map
revision, if built as proposed. FEMA's comments will be issued in the
form of a letter, termed a Conditional Letter of Map Revision, in
accordance with part 72 of this subchapter. The data required to
support such requests are the same as those required for final
revisions in accordance with Secs. 65.5, 65.6, and 65.7, except as-
built certification is not required. All such requests shall be
submitted to the FEMA Headquarters Office in Washington, DC, and shall
be accompanied by the appropriate payment, in accordance with part 72
of this subchapter.
6. Section 65.9(h) is added to read as follows:
Sec. 65.9 Review and response by the Administrator.
* * * * *
(h) The required payment, in accordance with part 72 of this
subchapter, has not been submitted, and no review will be conducted and
no determination will be issued until payment is received.
PART 70--PROCEDURE FOR MAP CORRECTION
7. The authority citation for part 70 is revised to read as
follows:
Authority: 42 U.S.C. 4001 et seq.; Reorganization Plan No. 3 of
1978, 43 FR 41943, 3 CFR, 1978 Comp., p. 329; E.O. 12127, 44 FR
19367, 3 CFR, 1979 Comp., p. 376.
8. Section 70.9 is revised to read as follows:
Sec. 70.9 Review of proposed projects.
An individual who proposes to build one or more structures on a
portion of property that may be inadvertently included in a Special
Flood Hazard Area (SFHA) may request FEMA's comments on whether the
proposed structure(s) will be in the SFHA if built as proposed. FEMA's
comments will be issued in the form of a letter, termed a Conditional
Letter of Map Amendment (CLMA). The data required to support such
requests are the same as those required for final Letters of Map
Amendment in accordance with Sec. 70.3, except as-built certification
is not required and the requests shall be accompanied by the
appropriate payment, in accordance with part 72 of this subchapter. All
such requests for CLOMAs shall be submitted to the FEMA Regional Office
servicing the community's geographic area or the FEMA Headquarters
Office in Washington, DC.
PART 72--PROCEDURES AND FEES FOR PROCESSING MAP CHANGES
9. The authority citation for part 72 is revised to read as
follows:
[[Page 46332]]
Authority: 42 U.S.C. 4001 et seq.; Reorganization Plan No. 3 of
1978, 43 FR 41943, 3 CFR, 1978 Comp., p. 329; E.O. 12127, 44 FR
19367, 3 CFR, 1979 Comp., p. 376.
10. Section 72.1 is revised to read as follows:
Sec. 72.1 Purpose of part.
The purpose of this part is to provide administrative and cost-
recovery procedures for the engineering review and administrative
processing associated with FEMA's response to requests for Conditional
Letters of Map Amendment (CLOMAs), Conditional Letters of Map Revision
(CLOMRs), Conditional Letters of Map Revision Based on Fill (CLOMR-Fs),
Letters of Map Revision Based on Fill (LOMR-Fs), Letters of Map
Revision (LOMRs), and Physical Map Revisions (PMRs). Such requests are
based on proposed or actual manmade alterations within the floodplain,
such as the placement of fill; modification of a channel; construction
or modification of a bridge, culvert, levee, or similar measure; or
construction of single or multiple residential or commercial structures
on single or multiple lots.
11. Section 72.2 is revised to read as follows:
Sec. 72.2 Definitions.
Except as otherwise provided in this part, the definitions set
forth in Part 59 of this subchapter are applicable to this part. For
the purpose of this part, the products are defined as follows:
CLOMA. A CLOMA is FEMA's comment on a proposed structure or group
of structures that upon construction, will be located on existing
natural ground above the base (1-percent annual chance) flood elevation
on a portion of a legally defined parcel of land that is partially
inundated by the base flood.
CLOMR. A CLOMR is FEMA's comment on a proposed project that upon
construction will affect the hydrologic or hydraulic characteristics of
a flooding source and thus result in the modification of the existing
effective base flood elevations, the Special Flood Hazard Area (SFHA),
or the regulatory floodway.
CLOMR-F. A CLOMR-F is FEMA's comment on a proposed project that
upon construction will result in a modification of the SFHA through the
placement of fill outside the regulatory floodway.
LOMR. A LOMR is FEMA's modification to an effective Flood Insurance
Rate Map (FIRM) or Flood Boundary and Floodway Map (FBFM), or both,
based on the implementation of physical measures that affect the
hydrologic or hydraulic characteristics of a flooding source and thus
result in the modification of the existing regulatory floodway, the
effective base flood elevations, or the SFHA. The LOMR officially
revises the FIRM or FBFM, and sometimes the Flood Insurance Study (FIS)
report, and when appropriate, includes a description of the
modifications. The LOMR is generally accompanied by an annotated copy
of the affected portions of the FIRM, FBFM, or FIS report.
LOMR-F. A LOMR-F is FEMA's modification of the SFHA shown on the
FIRM based on the placement of fill outside the regulatory floodway.
Physical Map Revision. A Physical Map Revision (PMR) is FEMA's
revision and republication of an effective FIRM, FBFM, or FIS report
based on physical measures that affect the hydrologic or hydraulic
characteristics of a flooding source and thus result in the
modification of the existing regulatory floodway, the effective base
flood elevations, or the SFHA.
12. Section 72.3 is revised to read as follows:
Sec. 72.3 Fee schedule.
(a) For requests for CLOMRs, LOMRs, and Physical Map Revisions
based on structural measures on alluvial fans, an initial fee subject
to the provisions of Sec. 72.4, shall be paid to FEMA before FEMA
begins review of the request. The initial fee represents the minimum
cost for reviewing these requests and is based on the prevailing
private-sector labor rate. A revision to this initial fee, if
necessary, will be published as a notice in the Federal Register.
(b) For requests for CLOMRs, LOMRs, and Physical Map Revisions
based on structural measures on alluvial fans, the total fee is to be
calculated based on the total hours expended by FEMA in reviewing and
processing the request multiplied by an hourly rate based on the
prevailing private-sector labor rate. The hourly rate is published as a
notice in the Federal Register. A revision to the hourly rate, if
necessary, will be published as a notice in the Federal Register.
(c) For conditional and final map revision requests for the
following categories, flat user fees, subject to the provisions of
Sec. 72.4, shall be paid to FEMA before FEMA begins review of the
request.
(1) Requests for CLOMAs, CLOMR-Fs, and LOMR-Fs for single
structures or single lots;
(2) Requests for CLOMAs for multiple structures or multiple lots;
(3) Requests for CLOMR-Fs and LOMR-Fs for multiple structures or
multiple lots;
(4) Requests for LOMRs and Physical Map Revisions based on projects
involving bridges, culverts, or channels, or combinations thereof;
(5) Requests for LOMRs and Physical Map Revisions based on projects
involving levees, berms, or other structural measures;
(6) Requests for LOMRs and Physical Map Revisions based on as-built
information for projects for which CLOMRs were issued previously by
FEMA;
(7) Requests for LOMRs and Physical Map Revisions based solely on
more detailed data;
(8) Requests for CLOMRs based on projects involving new hydrologic
information, bridges, culverts, or channels, or combinations thereof;
and
(9) Requests for CLOMRs based on projects involving levees, berms,
or other structural measures.
(d) The flat user fees for conditional and final map amendments and
map revisions are based on the actual costs for reviewing and
processing the requests. The fees for requests for LOMR-Fs, LOMRs, and
PMRs also shall include FEMA's costs for physically revising affected
FIRM and FBFM panels to reflect map changes at a later date.
(e) In addition to the flat user fees for Physical Map Revisions,
payment of a fee for FEMA's cartographic production costs, based on
actual per-panel costs, shall be required.
(f) Revisions to the fees, if necessary, will be published as a
notice in the Federal Register.
13. Section 72. 4 is revised to read as follows:
Sec. 72.4 Submittal/payment procedures and FEMA response.
(a) The initial fee shall be submitted with a request for FEMA
review and processing of CLOMRs, LOMRs, and Physical Map Revisions
based on structural measures on alluvial fans; the appropriate flat
user fee shall be submitted with all other requests for FEMA review and
processing.
(b) FEMA must receive initial and flat user fees before it will
begin any review. The fee is non-refundable when FEMA begins its
review.
(c) Following completion of FEMA's review for any CLOMR, LOMR, or
Physical Map Revision based on structural measures on alluvial fans,
FEMA shall invoice the requester at the established hourly rate for any
actual costs exceeding the initial fee incurred for review and
processing. FEMA will
[[Page 46333]]
not issue a determination letter or revised map panels until the
invoice amount is received.
(d) For all map revision requests, FEMA will bear the cost of
reprinting and distributing the revised FIRM or FBFM panels, or
combination.
(e) The entity that applies to FEMA through the local community for
review is responsible for the cost of the review. The local community
incurs no financial obligation under the reimbursement procedures set
forth in this part as a result of transmitting the application by
another party to FEMA.
(f) Requesters shall submit payments by check or money order or by
credit card. Checks or money orders, in U.S. funds, shall be made
payable to the National Flood Insurance Program.
(g) For CLOMA, CLOMR-F, LOMA, and LOMR-F requests, FEMA shall:
(1) Notify the requester and the community within 30 days as to the
adequacy of the submittal, and
(2) Provide to the requester and the community, within 60 days of
receipt of adequate information and fee, a determination letter or
other written comment in response to the request.
(h) For CLOMR, LOMR, and PMR requests, FEMA shall:
(1) Notify the requester and the community within 60 days as to the
adequacy of the submittal; and
(2) Provide to the requester and the community, within 90 days of
receipt of adequate information and fee, a CLOMR, a LOMR, other written
comment in response to the request, or preliminary copies of the
revised FIRM panels, FBFM panels, or affected portions of the FIS
report to the community and the requester for review and comment.
14. In Sec. 72.5, paragraphs (a) and (b) are revised to read as
follows:
Sec. 72.5 Exemptions.
(a) Requests for map changes based on mapping or analysis errors or
the effects of natural changes within Special Flood Hazard Areas shall
be exempt from fees.
(b) Requests for LOMAs shall be exempt from fees.
* * * * *
15. Section 72.6 is revised to read as follows:
Sec. 72.6 Unfavorable response.
(a) A request for a CLOMA, CLOMR, or CLOMR-F may be denied or the
determination may contain specific comments, concerns, or conditions
regarding a proposed project or design and its impacts on flood hazards
in a community. A requester is not entitled to any refund of the fees
paid if the determination contains such comments, concerns, or
conditions, or if the request is denied. A requester is not entitled to
any refund of the fees paid if the requester is unable to provide the
appropriate scientific or technical documentation or to obtain required
authorizations, permits, financing, etc., for which the CLOMA, CLOMR,
or CLOMR-F was sought.
(b) A request for a LOMR, LOMR-F, or Physical Map Revision may be
denied or the revisions to the FIRM, FBFM, or both, may not be in the
manner or to the extent desired by the requester. A requester is not
entitled to any refund of the fees paid if the revision request is
denied or if the LOMR, LOMR-F, or Physical Map Revision action does not
revise the map specifically as requested.
16. Section 72.7 is revised to read as follows:
Sec. 72.7 Resubmittals.
(a) Any resubmittal of a CLOMA, CLOMR, CLOMR-F, LOMR, LOMR-F, or
Physical Map Revision request more than 90 days after FEMA notification
that the request has been denied or after the review has been
terminated because insufficient information was provided by the
requester will be treated as an original submission and subject to all
submittal/payment procedures described in Sec. 72.4. The procedure in
Sec. 72.4 also applies to any resubmitted request (regardless of when
it is submitted) if the project on which the request is based has been
altered significantly in design or scope other than as necessary to
respond to comments, concerns, or other findings made by FEMA regarding
the original submission.
(b) When a LOMR, LOMR-F, or Physical Map Revision request is made
following a CLOMR or CLOMR-F issued previously by FEMA, the procedures
in Sec. 72.4 and the appropriate fee, as referenced in Sec. 72.3(c),
apply when the as-built conditions differ from the proposed conditions
on which the issuance of the CLOMR or CLOMR-F was based.
Dated: August 23, 1996.
Richard W. Krimm,
Acting Associate Director, Mitigation Directorate.
[FR Doc. 96-22077 Filed 8-29-96; 8:45 am]
BILLING CODE 6718-04-P
Complete official Federal Register PDF
FR Doc. 96-22010 Airworthiness Directives; Boeing Model 737-300, -400, and -500 Series Airplanes
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Pages 45878-45880]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22010]
-----------------------------------------------------------------------
DEPARTMENT OF TRANSPORTATION
14 CFR Part 39
[Docket No. 95-NM-138-AD; Amendment 39-9728; AD 96-18-04]
RIN 2120-AA64
Airworthiness Directives; Boeing Model 737-300, -400, and -500
Series Airplanes
AGENCY: Federal Aviation Administration, DOT.
ACTION: Final rule.
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SUMMARY: This amendment supersedes two existing airworthiness
directives (AD), applicable to certain Boeing Model 737-300, -400, and
-500 series airplanes, that currently require modification of the
packing and slide containers of the escape slide, and repetitive
inspections of the velcro girt retaining straps of the escape slides at
the forward door. The existing AD's were prompted by reports of slide
girt material interfering with the girt bar stowage brackets during
door opening. This new amendment requires the installation of a new
modification, which constitutes terminating action for the repetitive
inspection requirements. The actions specified by this amendment are
intended to prevent failure or interference of opening of the forward
doors, which could delay or impede the evacuation of passengers during
an emergency.
DATES: Effective October 4, 1996.
The incorporation by reference of certain publications listed in
the regulations is approved by the Director of the Federal Register as
of October 4, 1996.
ADDRESSES: The service information referenced in this AD may be
obtained from Air Cruisers Company, P.O. Box 180, Belmar, New Jersey
07719-0180; and Boeing Commercial Airplane Group, P.O. Box 3707,
Seattle, Washington 98124-2207. This information may be examined at the
Federal Aviation Administration (FAA), Transport Airplane Directorate,
Rules Docket, 1601 Lind Avenue, SW., Renton, Washington; or at the
Office of the Federal Register, 800 North Capitol Street, NW., suite
700, Washington, DC.
FOR FURTHER INFORMATION CONTACT: Roy Boffo, Aerospace Engineer,
Airframe Branch, ANM-120S, FAA, Seattle Aircraft Certification Office,
1601 Lind Avenue, SW., Renton, Washington; telephone (206) 227-2780;
fax (206) 227-1181.
SUPPLEMENTARY INFORMATION: A proposal to amend part 39 of the Federal
Aviation Regulations (14 CFR part 39) by superseding both AD 88-07-07
[amendment 39-5884 (53 FR 9864, March 28, 1988)] and AD 91-24-04
[amendment 39-8090 (56 FR 57588, November 13, 1991)] was published as a
Notice of Proposed Rulemaking (NPRM) in the Federal Register on January
19, 1996 (61 FR 1291). Both of the existing AD's are applicable to
various Boeing Model 737 series airplanes.
The NPRM proposed to continue to require modification of the escape
slide packing and slide containers, which was required previously by AD
88-07-07. The NPRM also proposed to continue to require repetitive
inspections of the velcro girt retaining straps at the forward door of
the escape slides, which was required previously by AD 91-24-04.
Additionally, the NPRM proposed to require modification of the escape
slide girts, which would constitute terminating action for the
repetitive inspection requirements.
Interested persons have been afforded an opportunity to participate
in the making of this amendment. Due consideration has been given to
the comments received.
Support for the Proposal
Two commenters support the proposal.
Request To Allow Removal of Placard
One commenter requests that the proposal be revised to allow
operators to remove the velcro straps attach points and placard on the
slide compartment cover that were installed as part of the modification
required by AD 88-07-07. The commenter adds that some operators have
already removed these items when they installed a modification that was
approved as an alternative method of compliance with the repetitive
inspections required by AD 91-24-04.
The FAA concurs. Once the terminating modification required by
paragraph (c) of this final rule is installed, the velcro straps (and
their attach points) are no longer necessary, and the placard may be
confusing if it remains on the slide compartment. The FAA has revised
paragraph (c) of the final rule to indicate that these items should be
removed.
Request To Continue Approval of Previous Alternative Methods of
Compliance
Several commenters request that the proposal be revised to specify
that alternative methods of compliance (AMOC) approved previously by
the FAA for AD 91-24-04, continue to be considered approved for this
new AD. Specifically, three commenters point out that the FAA had
previously approved, as an AMOC, the accomplishment of the modification
described in Air Cruisers Service Bulletin S.B. 103-25-23 as
terminating action for the repetitive inspections required by AD 91-24-
04. These commenters request that the proposed rule likewise cite this
service bulletin as an alternative terminating action.
The FAA does not concur. The modification described in Air Cruisers
Service Bulletin S.B. 103-25-23 entails adding placards to the escape
slide girt (that depict the proper stowed configuration of the girt)
and removing the velcro straps that were required to be installed by AD
88-07-07. That modification, however, is reliant upon flight attendant
procedures to correctly route the escape slide girt. Several recent
ramp inspections of in-service airplanes have revealed that the girt
material is still being misrouted, even with the placard installed. In
light of this, the FAA has determined that the modification in that Air
Cruisers service bulletin does not fully address the safety concern and
is not as effective as the modification that is required by this new
AD.
The modification specified in this final rule (which is described
in Air Cruisers Service Bulletin S.B. 103-25-19) involves removing the
existing girt; bonding on the girt attachments; installing a detachable
girt; rigging a painter/mooring line; and bonding a placard to the
slide assembly and reidentifying it. This modification will improve the
operation of the escape slide of the forward entry and service doors,
and will eliminate the need to rely on human factors associated with
[[Page 45879]]
ensuring that girt material is stowed properly.
Request To Allow Use of Revised Service Documents
One commenter requests that the proposal be revised to allow
operators to install the terminating modification, proposed in
paragraph (c), in accordance with various revisions of Air Cruisers
Service Bulletin S.B. 103-25-19. The commenter points out that the
service bulletin has been revised several times since the original
version was released in May 1992.
The FAA concurs. The FAA has reviewed and approved all revisions of
Air Cruisers Service Bulletin S.B. 103-25-19 through Revision 7, dated
April 18, 1996. The various revisions are essentially identical, except
for certain minor editorial changes. The FAA has revised paragraph (c)
of the final rule to indicate that accomplishing the modification in
accordance with any of these revisions is acceptable for compliance
with that paragraph.
Conclusion
After careful review of the available data, including the comments
noted above, the FAA has determined that air safety and the public
interest require the adoption of the rule with the changes previously
described. The FAA has determined that these changes will neither
increase the economic burden on any operator nor increase the scope of
the AD.
Cost Impact
There are approximately 1,572 Model 737-300, -400, and -500 series
airplanes, equipped with Air Cruisers forward door escape slide of the
affected design in the worldwide fleet. The FAA estimates that 663
airplanes of U.S. registry will be affected by this proposed AD.
The actions that are currently required by AD 88-07-07 take
approximately 9 work hours per airplane to accomplish, at an average
labor rate of $60 per work hour. Required parts cost approximately $76
per airplane. Based on these figures, the cost impact on U.S. operators
(175 airplanes) of the actions currently required is estimated to be
$107,800, or $616 per airplane.
The actions that are currently required by AD 91-24-04 take
approximately 1 work hour per airplane to accomplish, at an average
labor rate of $60 per work hour. Based on these figures, the cost
impact on U.S. operators (439 airplanes) of the actions currently
required is estimated to be $26,340, or $60 per airplane, per
inspection cycle.
The terminating modification that is required by this new AD will
take approximately 6 work hours per airplane to accomplish, at an
average labor rate of $60 per work hour. Required parts cost
approximately $1,800 per airplane. Based on these figures, the cost
impact on U.S. operators of the new modification requirements of this
AD is estimated to be $1,432,080, or $2,160 per airplane.
The cost impact figures discussed above are based on assumptions
that no operator has yet accomplished any of the requirements of this
AD action, and that no operator would accomplish those actions in the
future if this AD were not adopted.
Regulatory Impact
The regulations adopted herein will not have substantial direct
effects on the States, on the relationship between the national
government and the States, or on the distribution of power and
responsibilities among the various levels of government. Therefore, in
accordance with Executive Order 12612, it is determined that this final
rule does not have sufficient federalism implications to warrant the
preparation of a Federalism Assessment.
For the reasons discussed above, I certify that this action (1) is
not a ``significant regulatory action'' under Executive Order 12866;
(2) is not a ``significant rule'' under DOT Regulatory Policies and
Procedures (44 FR 11034, February 26, 1979); and (3) will not have a
significant economic impact, positive or negative, on a substantial
number of small entities under the criteria of the Regulatory
Flexibility Act. A final evaluation has been prepared for this action
and it is contained in the Rules Docket. A copy of it may be obtained
from the Rules Docket at the location provided under the caption
ADDRESSES.
List of Subjects in 14 CFR Part 39
Air transportation, Aircraft, Aviation safety, Incorporation by
reference, Safety.
Adoption of the Amendment
Accordingly, pursuant to the authority delegated to me by the
Administrator, the Federal Aviation Administration amends part 39 of
the Federal Aviation Regulations (14 CFR part 39) as follows:
PART 39--AIRWORTHINESS DIRECTIVES
1. The authority citation for part 39 continues to read as follows:
Authority: 49 U.S.C. 106(g), 40113, 44701.
Sec. 39.13 [Amended]
2. Section 39.13 is amended by removing amendments 39-5884 (53 FR
9864, March 28, 1988) and 39-8090 (56 FR 57588, November 13, 1991), and
by adding a new airworthiness directive (AD), amendment 39-9728, to
read as follows:
96-18-04 Boeing: Amendment 39-9728. Docket 95-NM-138-AD. Supersedes
AD 88-07-07, amendment 39-5884; and supersedes AD 91-24-04,
amendment 39-8090.
Applicability: Model 737-300, -400, and -500 series airplanes,
line numbers up to and including 2211; equipped with Air Cruisers
forward door escape slides as listed in Air Cruisers Company Service
Bulletin S.B. 103-25-19, Revison 7, dated April 18, 1996;
certificated in any category.
Note 1: This AD applies to each airplane identified in the
preceding applicability provision, regardless of whether it has been
otherwise modified, altered, or repaired in the area subject to the
requirements of this AD. For airplanes that have been modified,
altered, or repaired so that the performance of the requirements of
this AD is affected, the owner/operator must request approval for an
alternative method of compliance in accordance with paragraph (d) of
this AD. The request should include an assessment of the effect of
the modification, alteration, or repair on the unsafe condition
addressed by this AD; and, if the unsafe condition has not been
eliminated, the request should include specific proposed actions to
address it.
Compliance: Required as indicated, unless accomplished
previously.
To prevent failure or interference of opening of the forward
doors, which could delay or impede the evacuation of passengers
during an emergency, accomplish the following:
(a) Within 30 days after December 17, 1991 (the effective date
of 91-24-04, amendment 39-8090), establish operating procedures,
approved by the FAA Principal Maintenance Inspector (PMI), for the
forward doors to include the requirements specified in paragraphs
(a)(1), (a)(2), and (a)(3) of this AD; and thereafter, comply with
those procedures until the modification required by paragraph (c) of
this AD is accomplished. The procedures required by paragraphs
(a)(1) and (a)(2) of this AD must be accomplished by qualified and
trained mechanics. The procedures required by paragraph (a)(3) may
be accomplished by qualified and trained members of the flightcrew
or cabin crew. The training program to implement the procedures
required by this paragraph must be approved by the FAA PMI. Methods
for documentation of compliance with the following procedures must
be approved by the FAA PMI.
(1) Prior to the next flight after December 17, 1991, and
thereafter at intervals not to exceed 200 flight hours, inspect the
condition of the girt retaining straps at the forward doors.
(2) Prior to further flight after December 17, 1991, replace
worn or aged velcro whose grip
[[Page 45880]]
strength will no longer hold the girt retaining straps in position.
(3) Prior to the next flight after December 17, 1991, and
thereafter prior to each flight, inspect the routing of the girt
retaining straps at the forward doors, and reroute straps that are
found not to be routed in accordance with the placarded instructions
installed in accordance with AD 88-07-07, amendment 39-5885, on the
inboard face of the slide compartment.
(b) For Model 737-300 series airplanes: Within 6 months after
May 9, 1988 (the effective date of AD 88-07-07, amendment 39-5885),
modify the escape slide packing and slide containers in accordance
with Boeing Alert Service Bulletin 737-25A1221, dated December 17,
1987, or Revision 1, dated June 2, 1988. This modification must be
accomplished prior to or in conjunction with accomplishment of the
requirements of paragraph (c) of this AD.
(c) Within 36 months after the effective date of this AD, modify
the escape slide girts in accordance with Air Cruisers Company
Service Bulletin S.B. 103-25-19, Revision 7, dated April 18, 1996.
Accomplishment of the modification constitutes terminating action
for the repetitive inspections required by paragraph (a) of this AD.
Once this modification is installed, the placard and velcro straps
(and their attach points) required by the modification specified in
paragraph (b) of this AD may be removed.
Note 2: Accomplishment of this modification prior to the
effective date of this AD in accordance with previous revisions of
Air Cruisers Company Service Bulletin S.B. 103-25-19 is considered
acceptable for compliance with the requirements of this paragraph.
(d) An alternative method of compliance or adjustment of the
compliance time that provides an acceptable level of safety may be
used if approved by the Manager, Seattle Aircraft Certification
Office (ACO), FAA, Transport Airplane Directorate. Operators shall
submit their requests through an appropriate FAA Principal
Maintenance Inspector, who may add comments and then send it to the
Manager, Seattle ACO.
Note 3: Information concerning the existence of approved
alternative methods of compliance with this AD, if any, may be
obtained from the Seattle ACO.
(e) Special flight permits may be issued in accordance with
sections 21.197 and 21.199 of the Federal Aviation Regulations (14
CFR 21.197 and 21.199) to operate the airplane to a location where
the requirements of this AD can be accomplished.
(f) Except as indicated in NOTE 2 of this AD, the terminating
modification shall be done in accordance with Air Cruisers Company
Service Bulletin S.B. 103-25-19, Revision 7, dated April 18, 1996.
This incorporation by reference was approved by the Director of the
Federal Register in accordance with 5 U.S.C. 552(a) and 1 CFR part
51. Copies may be obtained from Air Cruisers Company, P.O. Box 180,
Belmar, New Jersey 07719-0180. Copies may be inspected at the FAA,
Transport Airplane Directorate, 1601 Lind Avenue, SW., Renton,
Washington; or at the Office of the Federal Register, 800 North
Capitol Street, NW., suite 700, Washington, DC.
(g) This amendment becomes effective on Ocotber 4, 1996.
Issued in Renton, Washington, on August 21, 1996.
Darrell M. Pederson,
Acting Manager, Transport Airplane Directorate, Aircraft Certification
Service.
[FR Doc. 96-22010 Filed 8-29-96; 8:45 am]
BILLING CODE 4910-13-U
Complete official Federal Register PDF
FR Doc. 96-22009 Airworthiness Directives; Saab Model SAAB SF340A and SAAB 340B Series Airplanes
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Pages 45880-45883]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22009]
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DEPARTMENT OF TRANSPORTATION
14 CFR Part 39
[Docket No. 95-NM-243-AD; Amendment 39-9727; AD 96-18-03]
RIN 2120-AA64
Airworthiness Directives; Saab Model SAAB SF340A and SAAB 340B
Series Airplanes
AGENCY: Federal Aviation Administration, DOT.
ACTION: Final rule.
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SUMMARY: This amendment adopts a new airworthiness directive (AD),
applicable to certain Saab Model SAAB SF340A and SAAB 340B series
airplanes, that requires installation of an automatic flight idle stop
on the control quadrant in the flight compartment. This amendment is
prompted by several reports of one or both power levers being moved aft
of the flight idle stop on approach. The actions specified by this AD
are intended to prevent such movement of the power lever(s) during
flight, which could result in the loss of power to one or both engines,
as well as severe engine damage.
DATES: Effective October 4, 1996.
The incorporation by reference of certain publications listed in
the regulations is approved by the Director of the Federal Register as
of October 4, 1996.
ADDRESSES: The service information referenced in this AD may be
obtained from SAAB Aircraft AB, SAAB Aircraft Product Support, S-
581.88, Linkoping, Sweden. This information may be examined at the
Federal Aviation Administration (FAA), Transport Airplane Directorate,
Rules Docket, 1601 Lind Avenue, SW., Renton, Washington; or at the
Office of the Federal Register, 800 North Capitol Street, NW., suite
700, Washington, DC.
FOR FURTHER INFORMATION CONTACT: Ruth E. Harder, Aerospace Engineer,
Standardization Branch, ANM-113, FAA, Transport Airplane Directorate,
1601 Lind Avenue, SW., Renton, Washington 98055-4056; telephone (206)
227-1721; fax (206) 227-1149.
SUPPLEMENTARY INFORMATION: A proposal to amend part 39 of the Federal
Aviation Regulations (14 CFR part 39) to include an airworthiness
directive (AD) that is applicable to certain Saab Model SAAB SF340A and
SAAB 340B series airplanes was published in the Federal Register on
March 21, 1996 (61 FR 11591). That action proposed to require
installation of an automatic flight idle stop on the control quadrant
in the flight compartment.
Interested persons have been afforded an opportunity to participate
in the making of this amendment. Due consideration has been given to
the comments received.
Support for the Proposal
One commenter supports the proposal in its entirety.
Request To Extend Compliance Time
Two commenters request that the compliance time for the
installation be extended beyond the proposed 12 months. One commenter
suggests that the compliance time be extended to 18 months so that the
installation may be performed during a regularly scheduled maintenance
interval. This would preclude additional costs incurred from special
scheduling and additional downtime. The other commenter requests that
the compliance time be extended to 20 months because the current number
of available parts and the vendors turnaround time for delivery of
parts will not be able to support the modification of the entire U.S.
fleet of 230 airplanes within 12 months.
The FAA does not concur with the commenters request. In developing
a compliance time for this AD action, the FAA considered not only the
degree of urgency associated with addressing the subject unsafe
condition, but:
1. the recommendations for compliance time specified by the
Luftfartsverket (LFV), which is the airworthiness authority for Sweden,
and by the manufacturer;
2. the availability of required parts; and
3. the practical aspect of installing the required modification
within an interval of time that parallels normal scheduled maintenance
for the majority of affected operators.
Based on information received from the manufacturer relative to
parts availability and vendor turnaround time, the FAA considers that
the 12-month compliance time is adequate if operators make reasonable
efforts to meet this schedule. However, under the provisions of
paragraph (c) of the final rule, the FAA may approve requests for
[[Page 45881]]
adjustments to the compliance time if data are submitted to
substantiate that such an adjustment would provide an acceptable level
of safety.
Request To Reference Latest Revision to Service Information
One commenter requests that the proposal be revised to cite the
latest revisions to the SAAB service bulletins as the appropriate
source of service information.
The FAA concurs with the commenters request. Since issuance of the
notice, SAAB has issued the following revisions to the referenced
service documents:
1. Service Bulletin 340-76-031, Revision 4, dated February 25,
1996.
2. Service Bulletin 340-76-032, Revision 3, dated March 25, 1996.
3. Service Bulletin 340-32-100, Revision 2, dated March 25, 1996.
These revised service bulletins are essentially identical to
previous versions, but contain various minor editorial corrections and
updated cost figures. They do not affect modifications that were
accomplished in accordance with earlier versions of these service
bulletins.
The FAA has revised the final rule to cite the latest versions of
the service bulletins and has added information to specify that
previous accomplishment of the installation in accordance with any
earlier version of the service bulletin is acceptable for compliance
with the applicable parts of the rule.
Request To Allow Continued Flight with Flight Idle Stop Inoperative
One commenter requests that the proposal be revised to provide
relief from the Master Minimum Equipment List (MMEL) provisions to
allow the airplane to continue to be operated if the flight idle (FI)
stop is inoperative. In support of this request, the commenter points
out that the Model SF340 automatic FI stop is unique in that, once the
override mechanism is activated, the system cannot be reset without
maintenance intervention. The commenter requests that the proposed AD
allow affected operators to operate the airplane for at least a single
additional revenue flight to a maintenance base where the FI system can
be reset (or repaired, if necessary). Such relief would preclude what
the commenter considers ``an unreasonable exposure to loss of service''
following such overrides.
The FAA concurs. In the event of a malfunction of the FI stop
system, use of the FI stop override function is available to the flight
crew. However, due to the redundant system design of the FI stop, the
necessity for use of the override is expected to be very rare. In any
case where the automatic system has malfunctioned and/or use of the
override has been necessary, as the commenter correctly notes,
maintenance action is required to return the FI stop system to an
operational condition. If adequate maintenance support is not available
upon landing, the FAA has determined that the airplane may be operated
safely for one revenue flight to a location where appropriate
maintenance can be performed, provided that the FI stop system has been
properly deactivated and placarded for flight crew awareness in
accordance with the provisions of the FAA-approved MMEL. A new
paragraph has been added to the final rule to specify this.
Request To Allow Continued Flight if Anti-Skid System is
Inoperative
This same commenter requests that the proposal be revised to
provide MMEL relief to allow dispatch of an airplane equipped with an
automatic FI stop system when the anti-skid system is inoperative. The
commenter states that, while the quadruple redundancy of the
``release'' signal to the FI stop solenoid will minimize system faults
that cause the solenoid to not release, this redundancy will result in
the inability to defer the anti-skid system.
The FAA does not consider that additional revision of the proposed
rule is necessary. The FI stop system uses wheel-spin-up signals from
the anti-skid system to drive the FI stop to the open position. Other
signals, such as weight-on-wheels signals, are also used to drive the
FI stop to the open position, thus providing a redundant system design
of the FI stop. However, the Abnormal Procedures specified in the FAA-
approved Airplane Flight Manual (AFM) that relate to in-flight failure
of the anti-skid system may include instructions for the flight crew to
activate override of the FI stop upon landing. This use of the FI stop
override then requires maintenance action to reset and, as discussed in
the previous issue, the FAA has determined that a single flight for
return of the aircraft to a location for maintenance will meet
acceptable safety levels. Since the most restrictive requirements take
precedence in the determination of dispatch relief, other equipment,
such as the anti-skid system, may also be required to be repaired to
support the requirements for the FI stop system.
Request To Provide Flight Crew With Indication of Status of FI
System
One commenter supports the intent of the proposal, but requests
that it be revised to include a requirement to provide the flight crew
with adequate indication of the system status and failure annunciation,
as well as a means to verify that the system is operational while in
flight. The commenter considers that a status indicator is required to
inform the flight crew of the mode of the lockout system. As a minimum,
this indicator should inform the crew of two conditions:
1. the system has experienced a failure of some type, and
2. ground idle will not be available when it should be.
This commenter also considers that a means is necessary to allow
the crew to test (fault check) and verify the system status and
operability. Accurate knowledge of the system's status can be critical
to the safety of the operation.
The FAA concurs partially with the commenter's statements about the
need for adequate status indication and crew verification. The
automatic FI stop system has been designed to provide status indication
to the flight crew. The position of the FI stop in either the ``open''
position (no blocking of power levers into beta) or ``closed'' position
is provided by means of indications on the top of the Flight Status
Panel (FSP) as follows:
FI stop (blue): FI stop is open and landing gear is down
and locked. This is the normal indication when the airplane is
electrically powered on the ground. The blue light normally will turn
off when the landing gear is retracted after takeoff, and it does not
illuminate for the duration of the flight. If the landing gear is not
retracted following takeoff, the light will stay on, and the FI stop
will remain open, until all wheels have spun down to less than 9 knots,
which may take up to 90 seconds.
FI stop open (amber): This light indicates an abnormal
situation, showing that the FI stop is open, although landing gear is
not down and locked. The amber light will appear if the FI stop fails
to close after takeoff when the landing gear is retracted, indicating
that there is no protection against movement of the power levers into
beta during flight. This light also will appear if the manual override
knob is pulled, causing the FI stop to open. This status indication is
intended to alert the flight crew when FI stop protection is not
available; therefore, increased crew awareness is necessary to prevent
inadvertent placement of the
[[Page 45882]]
power levers into beta mode during flight.
These status indications do not, however, predict an upcoming
failure of the FI stop to open correctly upon landing. Due to the
redundant system design of the FI stop, and based on the failure
analysis probabilities, malfunction of the FI stop system that would
result in the system remaining closed after touchdown is predicted to
be very infrequent. In the event of a malfunction or if adverse runway
conditions result in the FI stop remaining closed upon touchdown, the
override mechanism is always available to the flight crew. Operators
may refer to SAAB 340 Operations Bulletin No. 52, which describes
procedures to be followed in such an event.
As for the commenter's request for a means to allow the flight crew
to test (fault check) and verify the system status and operability, the
FAA points out that the FI stop lights on the FSP, as described above,
provide an accurate indication of the system operation; in light of
this, the FAA does not consider it necessary to add a flight crew test
in addition to this status information. Additionally, lamp checks may
be performed by the flight crew to ensure that the FI stop indication
lights themselves are operational.
Request To Include Provisions To Minimize Compound System Failures
The same commenter requests that the proposal be revised to include
provisions to minimize or exclude compound systems failures, and to
ensure that the flight crew is able to override the automatic system if
it becomes necessary to do so. If these features are not available, the
commenter requests that the FI stop system be changed to incorporate
them. To support its request, the commenter states that provisions must
be made to eliminate failure modes that would result in certain systems
being simultaneously disabled. The primary concern is the
controllability of the airplane on the ground. Inability to select
ground idle after landing may seriously degrade the airplane's stopping
performance. If a failure that prevents access to ground idle also
disables other ground operation related systems (such as nose wheel
steering), the stopping capability and/or the controllability of the
airplane could be seriously compromised. In order to further improve
the reliability and independence of the FI stop installation, this
commenter urges incorporation of three specific design considerations:
1. the ability to tap the spin-up signal in its rawest usable form,
prior to it being processed by any digital/control component, to avoid
its loss if that component should fail;
2. a redundant, parallel spin-up signal provided in case of a
failure or lack of signal from one sensor;
3. a revision to the system operation that will address the
possibility of reduced wheel spin-up (i.e., hydroplaning).
Related to the possibility of such failures, this commenter also
states that provisions must be made to enable the flight crew to
deliberately and rapidly override the FI stop system. This is necessary
to prevent a system failure from creating a potentially hazardous
situation when the crew is attempting to stop the airplane. The
commenter states that, if power cannot be reduced below flight idle
during the landing roll-out, the stopping capability of the airplane
will be significantly degraded, potentially resulting in a runway
overrun.
The FAA concurs with this commenter's statements, but finds that no
revision to the rule is necessary because the design features suggested
by the commenter already have been incorporated into the FI stop
system. The quadruple redundancy of the ``release'' signal to the FI
stop solenoid has been designed in order to minimize system faults that
would cause the solenoid to not release. If the left or right landing
gear is extended, and if any one of the left or right inboard or
outboard wheel speed signals is greater than 25 knots, or if the left
or right weight-on-wheels signal is true, then the FI stop system is
opened, permitting unrestricted movement of the power levers.
Additionally, in the unlikely event that this combination of data
fails to drive the FI stop to the ``open'' position, a manual override
knob is also available to the flight crew. When this override knob is
pulled, the FI stop will be mechanically forced to the ``open''
position. This combination of the redundant signal inputs and the
override knob was intentionally designed into the FI stop system to
enable selection of beta modes when necessary for slowing action.
Conclusion
After careful review of the available data, including the comments
noted above, the FAA has determined that air safety and the public
interest require the adoption of the rule with the changes previously
described. The FAA has determined that these changes will neither
increase the economic burden on any operator nor increase the scope of
the AD.
Cost Impact
The FAA estimates that 224 airplanes of U.S. registry will be
affected by this proposed AD. Accomplishment of the required
installations will take between 122 and 142 work hours per airplane,
depending upon the configuration of the airplane. The average labor
rate is $60 per work hour. Required parts will cost approximately
$9,300 per airplane. Based on these figures, the cost impact of this AD
on U.S. operators is estimated to be between $3,722,880 and $3,991,680
(or between $16,620 and $17,820 per airplane).
The cost impact figure discussed above is based on assumptions that
no operator has yet accomplished any of the requirements of this AD
action, and that no operator would accomplish those actions in the
future if this AD were not adopted.
Regulatory Impact
The regulations adopted herein will not have substantial direct
effects on the States, on the relationship between the national
government and the States, or on the distribution of power and
responsibilities among the various levels of government. Therefore, in
accordance with Executive Order 12612, it is determined that this final
rule does not have sufficient federalism implications to warrant the
preparation of a Federalism Assessment.
For the reasons discussed above, I certify that this action (1) is
not a ``significant regulatory action'' under Executive Order 12866;
(2) is not a ``significant rule'' under DOT Regulatory Policies and
Procedures (44 FR 11034, February 26, 1979); and (3) will not have a
significant economic impact, positive or negative, on a substantial
number of small entities under the criteria of the Regulatory
Flexibility Act. A final evaluation has been prepared for this action
and it is contained in the Rules Docket. A copy of it may be obtained
from the Rules Docket at the location provided under the caption
ADDRESSES.
List of Subjects in 14 CFR Part 39
Air transportation, Aircraft, Aviation safety, Incorporation by
reference, Safety.
Adoption of the Amendment
Accordingly, pursuant to the authority delegated to me by the
Administrator, the Federal Aviation Administration amends part 39 of
the Federal Aviation Regulations (14 CFR part 39) as follows:
[[Page 45883]]
PART 39--AIRWORTHINESS DIRECTIVES
1. The authority citation for part 39 continues to read as follows:
Authority: 49 U.S.C. 106(g), 40113, 44701.
Sec. 39.13 [Amended]
2. Section 39.13 is amended by adding the following new
airworthiness directive:
96-18-03 Saab Aircraft AB: Amendment 39-9727. Docket 95-NM-243-AD.
Applicability: Model SAAB SF340A series airplanes, serial
numbers -004 through -159 inclusive; and Model SAAB 340B series
airplanes, serial numbers -160 through -379 inclusive; certificated
in any category.
Note 1: This AD applies to each airplane identified in the
preceding applicability provision, regardless of whether it has been
modified, altered, or repaired in the area subject to the
requirements of this AD. For airplanes that have been modified,
altered, or repaired so that the performance of the requirements of
this AD is affected, the owner/operator must request approval for an
alternative method of compliance in accordance with paragraph (c) of
this AD. The request should include an assessment of the effect of
the modification, alteration, or repair on the unsafe condition
addressed by this AD; and, if the unsafe condition has not been
eliminated, the request should include specific proposed actions to
address it.
Compliance: Required as indicated, unless accomplished
previously.
To prevent the movement of both power levers aft of the flight
idle stop during flight, which could result in loss of power to both
engines, as well as severe engine damage, accomplish the following:
(a) Within 12 months after the effective date of this AD,
accomplish the requirements of paragraphs (a)(1), (a)(2), and (a)(3)
of this AD.
Note 2: The actions specified in paragraphs (a)(1) and (a)(2) of
this AD may be accomplished prior to, or in conjunction with, the
accomplishment of the requirement of paragraph (a)(3) of this AD.
(1) Modify the electrical system of the flight idle stop in
accordance with Saab Service Bulletin 340-76-031, Revision 04, dated
February 25, 1996.
Note 3: Accomplishment of this modification prior to the
effective date of this AD in accordance with previous revisions of
Saab Service Bulletin 340-76-031 is considered acceptable for
compliance with this paragraph.
(2) Install a control unit with a wheel spin-up signal in
accordance with Saab Service Bulletin 340-32-100, Revision 02, dated
March 25, 1996.
Note 4: Accomplishment of this installation prior to the
effective date of this AD in accordance with previous revisions of
Saab Service Bulletin 340-32-100 is considered acceptable for
compliance with this paragraph.
(3) Install an automatic flight idle stop on the control
quadrant in the flight compartment in accordance with Saab Service
Bulletin 340-76-032, Revision 03, dated March 25, 1996.
Note 5: Accomplishment of this installation prior to the
effective date of this AD in accordance with previous revisions of
Saab Service Bulletin 340-76-032 is considered acceptable for
compliance with this paragraph.
Note 6: Paragraph 2.A. of the Accomplishment Instructions of
Saab Service Bulletin 340-76-032 specifies procedures for removal of
a mechanical beta stop mechanism from the airplane. Since
installation of a mechanical beta stop mechanism was not previously
required for all airplanes by AD, that mechanism may not have been
installed on certain airplanes affected by this AD. In such cases,
procedures for removal of the mechanical beta stop would not apply.
(b) In cases where the automatic flight idle (FI) stop has
malfunctioned and/or use of the FI stop override has been necessary,
the airplane may be operated for one revenue flight to a location
where required maintenance/repair can be performed, provided that
the FI stop system has been properly deactivated and placarded for
flight crew awareness in accordance with the provisions of the FAA-
approved Master Minimum Equipment List (MMEL).
(c) An alternative method of compliance or adjustment of the
compliance time that provides an acceptable level of safety may be
used if approved by the Manager, Standardization Branch, ANM-113,
FAA, Transport Airplane Directorate. Operators shall submit their
requests through an appropriate FAA Principal Maintenance Inspector,
who may add comments and then send it to the Manager,
Standardization Branch, ANM-113.
Note 7: Information concerning the existence of approved
alternative methods of compliance with this AD, if any, may be
obtained from the Standardization Branch, ANM-113.
(d) Special flight permits may be issued in accordance with
sections 21.197 and 21.199 of the Federal Aviation Regulations (14
CFR 21.197 and 21.199) to operate the airplane to a location where
the requirements of this AD can be accomplished.
(e) The modification and installations shall be done in
accordance with Saab Service Bulletin 340-76-031, Revision 04, dated
February 25, 1996; Saab Service Bulletin 340-32-100, Revision 02,
dated March 25, 1996; and Saab Service Bulletin 340-76-032, Revision
03, dated March 25, 1996. This incorporation by reference was
approved by the Director of the Federal Register in accordance with
5 U.S.C. 552(a) and 1 CFR part 51. Copies may be obtained from SAAB
Aircraft AB, SAAB Aircraft Product Support, S-581.88, Linkoping,
Sweden. Copies may be inspected at the FAA, Transport Airplane
Directorate, 1601 Lind Avenue, SW., Renton, Washington; or at the
Office of the Federal Register, 800 North Capitol Street, NW., suite
700, Washington, DC.
(f) This amendment becomes effective on October 4, 1996.
Issued in Renton, Washington, on August 21, 1996.
Darrell M. Pederson,
Acting Manager, Transport Airplane Directorate, Aircraft Certification
Service.
[FR Doc. 96-22009 Filed 8-29-96; 8:45 am]
BILLING CODE 4910-13-U
Complete official Federal Register PDF
FR Doc. 96-21982 Promulgation of Reid Vapor Pressure Standard; Michigan
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Pages 45893-45898]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-21982]
=======================================================================
-----------------------------------------------------------------------
ENVIRONMENTAL PROTECTION AGENCY
40 CFR Part 52
[MI50-01-7257a; FRL-5542-1]
Promulgation of Reid Vapor Pressure Standard; Michigan
AGENCY: Environmental Protection Agency (EPA).
ACTION: Interim final rule.
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SUMMARY: In this action, the Environmental Protection Agency (EPA)
temporarily is approving a State Implementation Plan (SIP) establishing
a summertime gasoline Reid vapor pressure (RVP) limit of 7.8 pounds per
square inch (psi) for gasoline sold in Wayne, Oakland, Macomb,
Washtenaw, Livingston, St. Clair, and Monroe counties in Michigan
(Detroit-Ann Arbor consolidated metropolitan
[[Page 45894]]
statistical area (CMSA)). The marketing of less volatile gasoline
reduces excessive evaporation of fuel during the summer months.
Evaporated gasoline combines with other pollutants on hot summer days
to form ground-level ozone, commonly referred to as smog. Ozone
pollution is of particular concern because of its harmful effects on
lung tissue and breathing passages.
In a parallel action EPA is proposing to make permanent this
temporary approval of Michigan's SIP revision to establish a RVP limit
of 7.8 psi for gasoline sold in the Detroit-Ann Arbor CMSA. The
proposed SIP revision is published in the proposed rule section of this
Federal Register. The EPA is requesting comments on this rulemaking
action, as well as the proposed rulemaking action. Any public comments
received by EPA will be addressed in the subsequent final rulemaking on
the proposed revision to the Michigan SIP.
An interim final approval action is being taken because EPA finds
good cause under section 553 of the Administrative Procedures Act (APA)
to promulgate this interim rule without prior notice and comment and to
make this action effective July 1, 1996, because of the public health
and timing concerns discussed below.
EFFECTIVE DATE: This interim final rule is effective July 1, 1996
through September 15, 1996.
ADDRESSES: Copies of the documents relevant to this action are
available at the above address for public inspection during normal
business hours.
Comments may be mailed to: Carlton T. Nash, United States
Environmental Protection Agency, Region 5, Air and Radiation Division,
Air Programs Branch (AR-18J), 77 West Jackson Boulevard, Chicago,
Illinois, 60604.
FOR FURTHER INFORMATION CONTACT: Brad J. Beeson at (312) 353-4779.
SUPPLEMENTARY INFORMATION:
I. Background
In April 1995, the Detroit-Ann Arbor CMSA which was nonattainment
for ozone was redesignated to attainment. At the time the area was
redesignated to attainment, EPA approved, as a revision to the Michigan
SIP, a 7.8 psi RVP fuels program as a contingency measure. However,
during the summer of 1995 there were several monitored violations of
the ozone standard in the Detroit area. Therefore, the State is
required to implement an ozone contingency measure.
One of the contingency measures that State has chosen to implement
is a fuels program. The fuels program requires the sale of 7.8 psi
(low-RVP) gasoline during the summer months.
RVP is a measure of a fuel's volatility and thereby affects the
rate at which gasoline evaporates and emits volatile organic compounds
(VOCs). The lower a fuel's RVP, the lower the rate of evaporation of
the fuel. The RVP of gasoline can be lowered by reducing the amount of
its volatile components, such as butane. Lowering RVP in the summer
months can offset the effect of summer temperature upon the evaporation
of gasoline, which in turn lowers emissions of VOCs. Because VOCs are a
component in the formation of ground level ozone on sunny, hot summer
days, reduction of RVP will assist the State of Michigan to reduce
ozone by reducing VOC emissions from vehicles.
The EPA first proposed to regulate gasoline RVP in 1987 (52 FR
31274). The EPA's gasoline RVP proposal resulted in a two-phased final
regulation which was in large part incorporated into the 1990
Amendments to the Clean Air Act (Act) in section 211(h). Phase I of the
regulation took effect in 1990 (54 FR 11868) for the years 1990 and
1991. Phase II of the regulation became effective in 1992 (55 FR
23658). The rule divides the continental United States into two control
regions, Class B and Class C. Generally speaking, the Class B states
are the warmer southern and western states, and Class C states are the
cooler northern states. The Phase II regulation limits the volatility
of gasoline sold during the high ozone season to 9.0 psi for Class C
areas and 7.8 psi for Class B ozone nonattainment areas. Michigan is a
Class C State, and therefore, required under the Federal rule to meet
the 9.0 psi standard.
II. State Submittal
Prior to making its SIP revision submittal, the State has presented
at several public hearings its intention to implement a low-RVP fuels
program. Initially the State presented the State's legislation to
implement a low-RVP gasoline program, House Bill 4898, shortly after
the legislation was passed in the State legislature, in 1993.
Next, as part of the redesignation process for Southeast Michigan,
the State held a public hearing on the redesignation plan, as well as
those measures the State was including in its contingency plan. One of
the contingency measures presented to the public was the low-RVP
gasoline program.
Lastly, the State presented the proposed low-RVP fuels program at a
public hearing as part of the State's contingency measure selection
process. The program presented to the public at these hearings not only
included the State's legislation establishing a 7.8 psi RVP program,
but also the option to market RFG in the area at the discretion of
individual gasoline marketers. Two hearings presenting this proposal
were held in October 1995.
On January 6, 1996, Michigan Governor John Engler sent a letter to
EPA advising EPA the State had selected a low-RVP fuels program as one
of the contingency measures to be implemented in the Detroit area.
Shortly thereafter, on May 16, 1996, the State submitted just the low-
RVP portion of their fuels program to EPA for approval. The SIP
revision submitted by the State was reviewed by EPA to determine
completeness shortly after its submittal, in accordance with the
completeness criteria set out at 40 CFR part 51, Appendix V (1991), as
amended by 57 FR 42216 (August 26, 1991). On May 24, 1996, the State's
SIP submittal was found complete.
III. Analysis of State Submittal
State governments are preempted under section 211(c)(4)(A) of the
Clean Air Act from mandating a gasoline volatility standard not
identical to any Federal standard promulgated under Sec. 211(c)(1) that
is applicable to the same characteristic. However, under 211(c)(4)(C) a
State can require, through a SIP revision, a more stringent RVP
standard for a particular area if the Administrator finds that the more
stringent standard is necessary to achieve the National Ambient Air
Quality Standard for ozone. In addition to demonstrating necessity as
part of the 211(c)(4)(C) waiver process, under section 110 the State
must also submit an adequate description of the low-RVP program and
associated enforcement procedures. If EPA finds that a State has shown
necessity and has provided an adequate description of the program, EPA
may approve the SIP revision requiring the lower State RVP standard for
the selected areas.
A. Demonstration of Necessity
Section 211(c)(4)(C) provides that the Administrator may find that
a State fuel control is necessary if there are no other measures that
would bring about timely attainment or such measures are unreasonable
or impracticable. The necessity showing must demonstrate that the State
is actually in nonattainment or in danger of nonattainment and must
include an evaluation of all available ozone control measures.
Once it was determined that a contingency measure would have to be
implemented, and was necessary
[[Page 45895]]
because of the violation of the ozone air quality standard, the State
organized a workgroup to aid in the selection process. The Contingency
Measure workgroup included participants from industry, state and local
government, environmentalists, and any other interested persons. The
analysis and final recommendations of the workgroup are summarized in a
report.\1\ The workgroup's recommendations were adopted by Michigan's
Governor. The contingency measures selected by the State include a
fuels program that limits RVP to 7.8 psi in the summertime, as well as
expansion of the State's existing Stage I vapor recovery program.
---------------------------------------------------------------------------
\1\ The report is titled ``Evaluation of Air Quality Contingency
Measures for Implementation in Southeast Michigan'' and is included
in the materials submitted by the State for this proposed SIP
revision.
---------------------------------------------------------------------------
As part of the analysis, the workgroup considered several different
emission control technologies including vehicle inspection and
maintenance (basic through enhanced), Stage I vapor recovery, Stage II
vapor recovery, enhanced degreasing controls, oxides of nitrogen
(NOX) controls on stationary sources, and RFG. The reasonableness
and practicality of each of these proposed control measures were
evaluated using a number of factors, including the cost effectiveness
of each measure. After considering and weighting all the factors, the
workgroup selected stricter gasoline RVP control.
Having considered other measures that the State could implement
before a low-RVP program, EPA finds that all other measures the State
could implement are unreasonable or impracticable in this context, or
would be insufficient to bring about timely attainment. The State is
currently expanding its existing Stage I vapor recovery program as part
of its contingency plan. While an I/M program would be a reasonable
control measure, it could not be implemented as quickly as a low-RVP
program and therefore would not reduce emissions in the time-frame
necessary to reduce the likelihood of ozone standard violations and
provide for attainment in as timely a manner as possible. Reformulated
gasoline is not a practicable measure because the Detroit-Ann Arbor
CMSA is designated as an attainment area, and hence is precluded from
opting into the federal RFG program. While there are some additional
reasonable and practicable control measures available, such as more
stringent degreasing rules, Stage II vapor recovery, and NOX
controls on stationary sources, none of these measures considered
individually or collectively would reduce emissions enough to bring
about timely attainment.
Because there are no more reasonable and practicable emission
control programs available in Southeast Michigan that would bring about
timely attainment, EPA finds that a 7.8 psi summertime gasoline RVP
meets the necessity requirement of 211(c)(4)(C) of the Act.
B. Description of Program Including the Enforcement Procedures
Historically, EPA has found that an adequate program description
includes: (1) The counties included in the program, (2) the parties
regulated as part of the program, (3) the general RVP limit, (4) the
control period of the program, and (5) a list of any exceptions to the
general limit for different types of gasoline, such as gasohol and RFG.
An adequate description of the State's enforcement procedures
should include: (1) The recordkeeping requirement for all regulated
parties marketing gasoline, (2) the name of the State agency that will
be enforcing the program, (3) the testing frequency and number of
stations that will be tested, (4) how sampling will be done, (5)
procedures that will be used to determine fuel volatility during
enforcement testing, and (6) the State's authority to levy penalties
and fines for noncompliance with the program.
The Michigan submittal specifies that the gasoline distributed in
Wayne, Oakland, Macomb, Washtenaw, Livingston, St. Clair, and Monroe
counties at the retail level must meet a RVP standard of 7.8 psi or
less per gallon between June 1 and September 15.2 Currently, the
State's rules include a 1.0 psi exemption for ethanol blended fuels. In
addition, the State's rule being developed to include RFG as part of
the program will include a 0.3 psi for RFG. The rule to be submitted
will also exempt gasoline dispensed at marinas, test tracks, and
applications for agricultural purposes from the 7.8 psi limit. Because
the State has satisfied all the program description elements, EPA finds
the State's description of the program is sufficient.
---------------------------------------------------------------------------
\2\ MCLA 290.643 section 3(4), MCLA 290.650d section 10d.
---------------------------------------------------------------------------
To ensure enforcement of the program requirements, all parties
involved with the marketing of gasoline in the area are required to
maintain records for each gasoline shipment.3 The Michigan
Department of Agriculture (MDA) will conduct enforcement of the
program.4 As part of the SIP submittal, the State has committed to
inspect a minimum of 40 percent of the dispensing facilities in the six
county area during the control period. Sampling will be performed in
accordance with the procedures described by EPA in its gasoline
volatility regulations in 40 CFR part 80, Appendix D.5 Gasoline
volatility and ethanol content tests will be performed following
procedures described by EPA in 40 CFR part 80, Appendices E and F,
respectively. Gasoline deemed to be out of compliance will be subject
either to a stop use order or seizure.6 Additionally, MDA has the
authority to levy administrative fines, in addition to applicable civil
and criminal penalties.7 The EPA finds the State's submittal
sufficiently deters non-compliance and ensures effective enforcement of
the program.
---------------------------------------------------------------------------
\3\ MCLA 290.647 section 7(3)-7(4), MCLA 290.649b section 9b(4).
\4\ MCLA 290.641, et seq.
\5\ MCLA 290.647 section 7(4), MCLA 290.643 section 3.
\6\ MCLA 290.643 section 3.
\7\ MCLA 290.647 section 7(5), MCLA 290.613 section 13, MCLA
290.615 section 15.
---------------------------------------------------------------------------
IV. Procedural Requirements
Section 553(b) of the APA provides that the general requirement to
provide for notice and comment in the rulemaking process does not apply
if an agency, for good cause, finds that notice and public procedure
are impracticable, unnecessary or contrary to the public interest.
Additionally, section 553(d) of the APA provides that for good cause an
agency may expedite the effective date of a rule allowing it to take
effect sooner than 30 days from the date of publication. As discussed
below, EPA has concluded that there is good cause to issue this interim
final rule without notice and comment and to make the rule effective
July 1, 1996.
A. Notice and Comment
Section 553(b) of the APA provides that agencies must provide the
public notice and an opportunity to comment on agency rulemaking,
unless one of the specified exceptions applies. Further, section
553(b)(B) of the APA states that notice and comment are not required
``when the agency for good cause finds (and incorporates the finding
and a brief statement of reasons therefor in the rules issued) that
notice and public procedure thereon are impracticable, unnecessary, or
contrary to the public interest.'' Because of unusual circumstances
associated with this rulemaking and for the reasons explained below,
EPA finds good cause to issue this interim final rule without prior
notice and comment.
[[Page 45896]]
1. Time Critical Nature of Action
Ground-level ozone is a threat to public health. Ozone pollution is
of particular concern because of its harmful effects on lung tissue and
breathing passages. To address this threat, EPA places significant
requirements on States to implement programs to control ozone to levels
that protect the public health.
Because of the seriousness of the public health issue, the State of
Michigan wants to implement a program that will provide substantial
emission reduction benefits as soon as this summer. Any program that
could be put in place immediately would help the State avoid violations
of the ozone standard this summer. Conversely, control programs which
take several months to implement would not help protect public health
this summer.
A low-RVP fuels program addresses the need for immediate reductions
because the air quality benefits of a low-RVP program are produced as
soon as the fuel is delivered to retail gasoline stations. Currently,
the State and the regulated industry are prepared to implement a low-
RVP fuels program this summer, beginning July 1, 1996. There are no
other measures the State could implement now to provide the needed
emissions reductions in this time-frame.
Providing notice and comment for this action would run counter to
the public interest because delaying this rulemaking through applying
the normal notice and comment process would mean that the low-RVP
program could not be put into place before the end of this summer.
Without implementing a low-RVP program immediately the State risks
further violations of the ozone standard and an adverse impact on
public health this summer.
2. Prior Extensive Public Process and Public Consensus
Considerable public discussion and comment has already transpired
concerning the State's adoption of a low-RVP fuels program and the
outcome of this process is widespread consensus that a low-RVP fuels
programs in the best approach. In particular, the directly affected
regulated entities have participated extensively in the decision making
process and have notice of the low-RVP fuels program to be implemented
in Southeast Michigan.
Prior to making its submittal, the State discussed its plans to
implement a fuels program beginning in the summer of 1996, featuring
7.8 psi gasoline, with the regulated parties and the general public.
Not only did the State discuss its intentions, it also solicited
comments on the State's plans. Initially, as part of the redesignation
process for Southeast Michigan, the State held a public hearing on the
redesignation plan, as well as those measures the State was including
its contingency plan. One of the contingency measures presented to the
public was a low-RVP fuels program.
Shortly after the State completed its public hearing process on the
redesignation and associated contingency measures, the State submitted
the redesignation request to EPA for approval. In the Federal Register
notice proposing approval of the redesignation, a low-RVP program was
listed as one of the possible contingency measures the State would
implement if necessary. While EPA received a variety of comments on the
proposal, none of the comments concerned the State's choice of low-RVP
as part of the contingency plan, indicating there was no opposition to
the possibility of implementation of this program. The EPA finalized
approval of the Michigan contingency plan including a low-RVP program
as a revision to the Michigan SIP on March 7, 1995.
Because of ozone violations during the summer of 1995 Michigan is
required to select a contingency measure to be implemented from its
contingency plan. To aid in the selection process, the State formed a
workgroup. The Contingency Measure workgroup included participants from
industry, state and local government, environmentalists, and any other
interested persons. The committee eventually narrowed their
recommendation to include a low-RVP fuels program. The Workgroup
recommendation indicates the consensus support for this measure by the
most directly affected and interested parties.
The final step in the contingency measure selection process was to
present the committee's recommendations at a public hearing. Two
hearings were held in October 1995. During the hearings none of the oil
companies objected to the selection of a low-RVP fuels program as a
contingency measure.
During the public participation process, the Detroit media covered
the debate concerning which contingency measure would be selected. A
number of articles and editorials were published in both the Detroit
Free Press and the Detroit News concerning the selection process and
the low-RVP fuels program. On January 6, 1996, Michigan Governor John
Engler sent a letter to EPA identifying a low-RVP fuels program as one
of its contingency measures to be implemented in the Detroit area.
Shortly after the Governor's decision, both the Michigan Department of
Agriculture and the Governor's offices issued press releases concerning
the low-RVP fuels program. Both of these press releases included the
planned start-up date of the program, July 1996. Following these press
releases several more articles on the program were published in the
print media. In addition, the AAA magazine Michigan Living, printed an
article about the low-RVP fuels program including the planned start-up
date of July 1996.
In addition to the general press coverage the program was
receiving, the State held a series of meetings with the oil companies
serving the Detroit area as well as the American Petroleum Institute
(API), an industry association. During these meetings the State,
represented oil companies, and API discussed the details concerning
implementation of a low-RVP fuels program by July 1996.
Providing prior notice and comment is of limited benefit to the
public here because of the extensive public comment process that has
already taken place and the widespread support for the program. This
public process has provided an opportunity for all interested parties
to participate in the decision to implement low-RVP gasoline as a
contingency measure and has generated consensus this is the optimal
approach. In addition, delaying the SIP revision approval to allow for
notice and comment would run counter to the public interest because of
the potential for confusion regarding the applicable requirements. At
this point in time the regulated industry, the general public, and the
State have planned to begin the program on July 1, 1996. Providing
notice and comment would preclude the program from beginning on July 1,
1996, which would likely cause disruption to the regulated industries
and confuse the public.
3. Time Limited Nature of Action
This interim final rule is a temporary SIP revision, which will
expire automatically and be followed by a notice-and-comment rulemaking
to decide whether to make this a permanent SIP revision. The EPA is
requiring that gasoline sold in the Detroit--Ann Arbor ozone
nonattainment area from July 1, 1996 to September 15, 1996, comply with
a 7.8 psi standard. This action does not establish a permanent change
to the
[[Page 45897]]
gasoline RVP requirements in Southeast Michigan.
Prior notice and comment is of limited benefit to the public
because of the limited time period of this action, and the need for
prompt implementation of the program discussed above. In a parallel
action, EPA is proposing to make this temporary RVP limit permanent by
revising Michigan's SIP to establish a RVP limit of 7.8 psi for
gasoline sold in the Detroit--Ann Arbor CMSA. The proposed SIP revision
is published in the proposed rule section of this Federal Register. The
EPA is hereby providing opportunity to comment on this rulemaking
action, as well as on the proposed rulemaking action on the permanent
revision. Any public comments received by EPA will be addressed in the
subsequent final rulemaking on the proposed revision to the Michigan
SIP. Thus, any negative results caused by the lack of notice and
comment would exist only for a short and clearly delineated period.
For all the reasons stated above EPA believes that there is good
cause for issuing this rule without prior notice and comment, as such
prior notice and opportunity to comment under these circumstances is
impracticable, unnecessary, and contrary to the public interest.
B. Effective Period
The APA also provides that a rule may not become effective until 30
days after it is published; this requirement is generally met through
publication in the Federal Register. However, in certain situations the
APA provides that agencies may expedite, or shorten, the time to make
the rule effective. Section 553(d) of the APA provides an exception to
the effective date requirement where an agency finds there is good
cause to expedite the effective date. Because of circumstances specific
to this situation and for the reasons explained below, EPA finds good
cause to make this rule effective as of July 1, 1996.
1. Time Critical Nature of Action
As discussed more fully above, to protect public health during the
upcoming ozone season, the State would need to implement a measure that
would immediately reduce VOC emissions. The low-RVP program proposed by
the State and required here on a temporary basis, would provide such
immediate reductions if EPA's approval is effective by July 1, 1996.
Delaying the effective date until 30 days after publication runs
counter to the public interest because of the need to address the risk
of ozone air pollution occurring this summer. If this rulemaking action
were subject to such a delay, the low-RVP program could not be put into
place before the end of this summer. Without implementing a low-RVP
program immediately the State risks further violations of the ozone
standard and an adverse impact on public health this summer.
2. Prior Public Notice
Delaying the effective date until 30 days after publication is
irrelevant to the lead time needed for compliance because the public
has had substantial public notice of the upcoming low-RVP requirements.
In particular, the directly affected regulated entities and the public
have participated extensively in the decision process to implement this
program starting July 1, 1996, and have notice of that start date.
Hence, delay beyond that date is not necessary for compliance purposes
and will introduce confusion as to when the requirements will apply.
For all the reasons stated above EPA believes that there is good
cause for making this rule effective as of July, 1, 1996, as a later
effective date is impracticable, unnecessary, and contrary to the
public interest.
IV. Action
The EPA is approving a revision to Michigan's SIP to establish a
summertime gasoline RVP limit of 7.8 psi for gasoline sold in Wayne,
Oakland, Macomb, Washtenaw, Livingston, St. Clair, and Monroe counties
and is finding that such a requirement is necessary for the area to
attain the ozone National Ambient Air Quality Standard for ozone, at
least for the period the approval is effective. This approval is
effective from July 1, 1996, to September 15, 1996.
V. Administrative Requirements
A. Applicability to Future SIP Decisions
Nothing in this action should be construed as permitting, allowing
or establishing a precedent for any future request for revision to any
SIP. The EPA shall consider each request for revision to the SIP in
light of specific technical, economic, and environmental factors and in
relation to relevant statutory and regulatory requirements.
B. Executive Order 12866
This action has been classified as a Table 3 action for signature
by the Regional Administrator under the procedures published in the
Federal Register on January 19, 1989 (54 FR 2214-2225), as revised by a
July 10, 1995 memorandum from Mary Nichols, Assistant Administrator for
Air and Radiation. The Office of Management and Budget has exempted
this regulatory action from E.O. 12866 review.
C. Regulatory Flexibility
Under the Regulatory Flexibility Act, 5 U.S.C. 600 et seq., the EPA
must prepare a regulatory flexibility analysis assessing the impact of
any proposed or final rule on small entities (5 U.S.C. 603 and 604).
Alternatively, EPA may certify that the rule will not have a
significant impact on a substantial number of small entities. Small
entities include small businesses, small not-for-profit enterprises,
and government entities with jurisdiction over populations of less than
50,000.
This approval does not create any new requirements. Therefore, I
certify that this action does not have a significant impact on any
small entities affected. Moreover, due to the nature of the Federal-
State relationship under the Act, preparation of the regulatory
flexibility analysis would constitute Federal inquiry into the economic
reasonableness of the State action. The Act forbids EPA to base its
actions concerning SIPs on such grounds. Union Electric Co. v. EPA, 427
U.S. 246, 256-66 (1976).
D. Unfunded Mandates
Under Section 202 of the Unfunded Mandates Reform Act of 1995
(``Unfunded Mandates Act''), signed into law on March 22, 1995, EPA
must prepare a budgetary impact statement to accompany any proposed or
final rule that includes a Federal mandate that may result in estimated
costs to state, local, or tribal governments in the aggregate; or to
the private sector, of $100 million or more. Under Section 205, EPA
must select the most cost-effective and least burdensome alternative
that achieves the objectives of the rule and is consistent with
statutory requirements. Section 203 requires EPA to establish a plan
for informing and advising any small governments that may be
significantly or uniquely impacted by the rule.
This Federal action approves pre-existing requirements under state
or local law, and imposes no new Federal requirements. Accordingly, no
additional costs to state, local, or tribal governments, or the private
sector, result from this action.
E. Petitions for Judicial Review
Under section 307(b)(1) of the Act, petitions for judicial review
of this action must be filed in the United States Court of Appeals for
the appropriate
[[Page 45898]]
circuit by October 29, 1996. Filing a petition for reconsideration by
the Administrator of this final rule does not affect the finality of
this rule for the purposes of judicial review, nor does it extend the
time within which a petition for judicial review may be filed and shall
not postpone the effectiveness of such rule or action. This action may
not be challenged later in proceedings to enforce its requirements (see
section 307(b)(2)).
F. Submission to Congress and the General Accounting Office
Under 5 U.S.C. 808(a)(1)(A) as added by the Small Business
Regulatory Enforcement Fairness Act (SBREFA) EPA submitted a report
containing this rule and other required information to the U.S. Senate,
the U.S. House of Representatives, and the Comptroller General of the
General Accounting Office prior to publication of the rule in the
Federal Register. This rule is not a ``major rule'' as defined by
section 804(2) of the APA as amended. Pursuant to 5 U.S.C. 808(2) as
added by SBREFA, this rule may take effect prior to the date of its
submission to Congress because EPA for good cause has found that
providing for notice and public procedure on this rule is
impracticable, unnecessary, and contrary to the public interest.
List of Subjects in 40 CFR Part 52
Environmental protection, Air pollution control, Hydrocarbons,
Incorporation by reference, Intergovernmental relations, Ozone,
Reporting and recordkeeping requirements.
Dated: June 21, 1996.
David A. Ullrich,
Acting Regional Administrator.
Part 52, chapter I, title 40 of the Code of Federal Regulations is
amended as follows:
PART 52--[AMENDED]
1. The authority citation for part 52 continues to read as follows:
Authority: 42 U.S.C. 7401-7671q.
Subpart X--Michigan
2. Section 52.1170 is amended by adding paragraph (c)(107) to read
as follows:
Sec. 52.1170 Identification of plan.
* * * * *
(c) * * *
(107) On May 16, 1996, the State of Michigan submitted a revision
to the Michigan State Implementation Plan (SIP). This revision is for
the purpose of establishing a gasoline Reid vapor pressure (RVP) limit
of 7.8 pounds per square inch (psi) for gasoline sold in Wayne,
Oakland, Macomb, Washtenaw, Livingston, St. Clair, and Monroe counties
in Michigan. This revision will only be effective from July 1, 1996, to
September 15, 1996.
(i) Incorporation by reference.
(a) House Bill No. 4898; signed and effective November 13, 1993.
(b) Michigan Complied Laws, Motor Fuels Quality Act, Chapter 290,
Sections 642, 643, 645, and 646, 647, and 649 all effective November
13, 1993.
(c) Michigan Complied Laws, Weights and Measures Act of 1964,
Chapter 290, Sections 613, 615; all effective August 28, 1964.
(ii) Additional materials.
(a) Letter from Michigan Governor John Engler to Regional
Administrator Valdas Adamkus, dated January 5, 1996.
(b) Letter from Michigan Director of Environmental Quality Russell
Harding to Regional Administrator Valdas Adamkus, dated May 14, 1996.
(c) State report titled ``Evaluation of Air Quality Contingency
Measures for Implementation in Southeast Michigan,'' submitted to the
EPA on May 14, 1996.
[FR Doc. 96-21982 Filed 8-29-96; 8:45 am]
BILLING CODE 6560-50-P
Complete official Federal Register PDF
FR Doc. 96-21946 Control of Air Pollution From New Motor Vehicles and New Motor Vehicle Engines: Regulations Requiring On-Board Diagnostic (OBD) SystemsAcceptance of Revised California OBD II Requirements
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Pages 45898-45903]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-21946]
-----------------------------------------------------------------------
ENVIRONMENTAL PROTECTION AGENCY
40 CFR Part 86
[AMS-FRL-5602-3]
RIN 2060-AC65
Control of Air Pollution From New Motor Vehicles and New Motor
Vehicle Engines: Regulations Requiring On-Board Diagnostic (OBD)
Systems--Acceptance of Revised California OBD II Requirements
AGENCY: Environmental Protection Agency (EPA).
ACTION: Final Rule.
-----------------------------------------------------------------------
SUMMARY: This final rulemaking revises requirements associated with on-
board diagnostic (OBD) systems. The federal OBD rulemaking, published
February 19, 1993, allowed for compliance with California OBD II
requirements to satisfy federal OBD requirements through the 1998 model
year. The California Air Resources Board has recently revised their OBD
II requirements. This rulemaking promulgates appropriate revisions to
federal OBD regulations such that compliance with the recently revised
OBD II requirements will satisfy federal OBD. This rulemaking does not
require that manufacturers comply with OBD II anti-tampering
provisions. OBD systems in general provide substantial ozone benefits.
EFFECTIVE DATE: This final rule is effective October 29, 1996.
ADDRESSES: Materials relevant to this rulemaking are contained in
Docket No. A-90-35, and are available for public inspection and
photocopying between 8 a.m. and 5:30 p.m. Monday through Friday. The
telephone number is (202) 260-7548 and the facsimile number is (202)
260-4400. A reasonable fee may be charged by EPA for copying docket
material.
FOR FURTHER INFORMATION CONTACT: Todd Sherwood, U.S. Environmental
Protection Agency, 2565 Plymouth Road, Ann Arbor, MI 48105, telephone
(313) 668-4405, or Internet e-mail at
``[email protected].''
SUPPLEMENTARY INFORMATION:
Regulated Entities
Entities potentially regulated by this action are those which
manufacture new motor vehicles and engines. Regulated categories and
entities include:
------------------------------------------------------------------------
Examples of regulated
Category entities
------------------------------------------------------------------------
Industry.................................. New motor vehicle and engine
manufacturers.
------------------------------------------------------------------------
This table is not intended to be exhaustive, but rather provides a
guide for readers regarding entities likely to be regulated by this
action. This table lists the types of entities that EPA is now aware
could potentially be regulated by this action. Other types of entities
not listed in the table could also be regulated. To determine whether
your product is regulated by this action, you should carefully examine
the applicability criteria in Sec. 86.094-17 of title 40 of the Code of
Federal Regulations. If you have questions regarding the applicability
of this action to a particular product, consult the person listed in
the preceding FOR FURTHER INFORMATION CONTACT section.
Electronic Copies of Rulemaking Documents
Electronic copies of the preamble and the regulatory text of this
final rulemaking are available via the Internet on the Office of Mobile
Sources (OMS) Home Page (http://www.epa.gov/OMSWWW/). Users can find
OBD related information and documents through the following path once
they have accessed the OMS Home Page: ``Automobiles,'' ``I/M & OBD,''
``On-Board Diagnostics Files.''
Electronic copies of the preamble and the regulatory text of this
final
[[Page 45899]]
rulemaking are also available on the Office of Air Quality Planning and
Standards (OAQPS) Technology Transfer Network Bulletin Board System
(TTN BBS). Users are able to access and download TTN BBS files on their
first call. After logging onto TTN BBS, to navigate through the BBS to
the files of interest, the user must enter the appropriate command at
each of a series of menus. The steps required to access information on
this rulemaking are listed below. The service is free, except for the
cost of the phone call.
TTN BBS: 919-541-5742 (1,200-14,400 bps, no parity, eight data
bits, one stop bit). Voice help: 919-541-5384 Internet address: TELNET
ttnbbs.rtpnc.epa.gov Off-line: Mondays from 8-12 Noon ET.
1. Technology Transfer Network Top Menu: GATEWAY TO TTN TECHNICAL AREAS
(Bulletin Boards)
2. TTN TECHNICAL INFORMATION AREAS: OMS--Mobile Sources Information
3. OMS BBS === MAIN MENU FILE TRANSFERS: Rulemaking & Reporting
4. RULEMAKING PACKAGES: Inspection & Maintenance
5. Inspection & Maintenance Rulemaking Areas: File Area #2...On-Board
Diagnostics
At this stage, the system will list all available OBD Review files.
To download a file, select a transfer protocol which will match the
terminal software on your computer, then set your own software to
receive the file using that same protocol.
If unfamiliar with handling compressed (i.e., ZIP'd) files, go to
the TTN topmenu, System Utilities (Command: 1) for information and the
necessary program to download in order to unZIP the files of interest
after downloading to your computer. After getting the files you want
onto your computer, you can quit TTN BBS with the oodbye command.
Table of Contents
I. Introduction and Background
II. Requirements of this Final Rulemaking
III. Public Participation
IV. Discussion of Issues
V. Cost Effectiveness
VI. Administrative Requirements
I. Introduction and Background
On February 19, 1993, the EPA promulgated a final rulemaking (58 FR
9468, February 19, 1993) requiring manufacturers of light-duty vehicles
(LDV) and light-duty trucks (LDT) to install on-board emission control
diagnostics (OBD) systems on such vehicles beginning in model year
1994. The regulations promulgated in that final rulemaking require that
manufacturers install OBD systems which monitor emission control
components for any malfunction or deterioration causing exceedances of
certain emission thresholds, and alert the vehicle operator to the need
for repair. That rulemaking also requires that, when a malfunction
occurs, diagnostic information must be stored in the vehicle's computer
to assist the mechanic in diagnosis and repair.
Additionally, that rulemaking makes an allowance for manufacturers
to satisfy the federal OBD requirements through the 1998 model year by
installing systems satisfying the California OBD II requirements
pertaining to those model years. This allowance means that
manufacturers could concentrate on designing one system for OBD
compliance and installing that system nationwide during allowable model
years. As EPA regulations cannot be revised except through EPA
rulemaking, the OBD II requirements allowed under this provision were,
and have continued to be, those existing on the date of publication of
the federal OBD final rulemaking. This means that subsequent changes
made to the OBD II requirements by the California Air Resources Board
(ARB) may be inconsistent and potentially unacceptable for federal OBD
compliance.
On March 23, 1995, EPA published a direct final rule revising
specific federal OBD provisions, including a provision that would allow
manufacturers to comply with federal OBD requirements by optionally
complying with more recent OBD II regulations. EPA believed that the
March 23 direct final rule would not be controversial. In that direct
final rule, EPA stated that, ``If notice is received that any person or
persons wish to submit adverse comments regarding some, but not all of
the actions taken in this rulemaking, then EPA shall withdraw this
final action and publish a proposal only with regard to the actions for
which notice has been received.'' EPA stated that it would make such a
withdrawal if adverse comment was received by April 24, 1995.
EPA received adverse comment from the Motor and Equipment
Manufacturers Association (MEMA). This adverse comment was placed in
the public docket for viewing. The comments submitted by MEMA were
adverse with regard to the revision of 40 CFR 86.094-17(j) that would
allow manufacturers the option of complying with the recently revised
California OBD II requirements (California Air Resources Board Mail-Out
#95-03). (MEMA had initially objected to other specific provisions of
the direct final rule, but MEMA withdrew these objections in a letter
signed May 18, 1995.) Therefore, EPA subsequently removed the provision
of the March 23 direct final rule that pertained to optional compliance
with the revised OBD II requirements of ARB Mail-Out #95-03 (60 FR
37945, July 25, 1995). As a result, the language of the prior final
rule published on February 19, 1993 (58 FR 9468) allowing compliance
with California OBD II requirements was reinstated in Sec. 86.094-
17(j). EPA then reproposed the provision allowing manufacturers to meet
the federal OBD requirements by complying with revised California OBD
II requirements. The proposal did not, however, require that
manufacturers meet the anti-tampering provisions in California's OBD II
regulations. (60 FR 55521, November 1, 1995).
II. Requirements of this Final Rulemaking
This final rulemaking allows manufacturers to comply with federal
OBD requirements by optionally complying with the revised and recently
adopted California OBD II regulations. The allowance for optional
compliance with California OBD II has already been established in the
federal OBD program and was incorporated into the federal OBD final
rulemaking in February 1993. However, since that time, the ARB has made
several revisions to the OBD II regulations.
Because the Agency cannot simply accept the revised OBD II without
undergoing the federal regulatory process, any optional compliance with
California OBD II under the preexisting federal regulations had to be
done according to the OBD II regulations as they existed in February
1993 (ARB Mail Out #92-56, November, 1992). However, the ARB has
determined that several manufacturers would have difficulty complying
with the OBD II regulations as they existed in February 1993. The most
notable requirements that currently pose difficulties are those for
engine misfire detection under all positive torque engine speeds and
conditions and full OBD II implementation on alternative fueled
vehicles. Additionally, most manufacturers have indicated difficulty
meeting other aspects of the OBD II regulations due to, for example,
the complexity of the computer software requirements, and unpredictable
driver actions such as resting a foot on the gas
[[Page 45900]]
pedal while stopped at a traffic light. It is these additional
difficulties that have prompted ARB to provide a ``deficiency''
allowance in their revised OBD II regulations whereby manufacturers can
certify as OBD II compliant despite some reasonably acceptable and
unplanned deficiency in the OBD system.
As a result of the ARB revisions to OBD II, and to remain
consistent with the original intent of providing for optional
compliance with OBD II for federal OBD purposes, and because EPA has
determined that OBD systems complying with the revised OBD II
requirements fully satisfy the intent of the 1990 Clean Air Act
Amendments and federal OBD regulations, this final rulemaking will
provide the same option but will require that manufacturers choosing
this option comply with the more recent OBD II regulations contained in
ARB Mail Out #95-34.
In the proposed rulemaking, EPA proposed allowing manufacturers to
comply with federal OBD requirements by optionally complying with more
recent OBD II regulations, specifically those contained in ARB Mail Out
#95-03, made publicly available January 19, 1995. In this final
rulemaking, the applicable OBD II regulations are contained in Mail Out
#95-34, September 26, 1995. Mail Out #95-34 is identical in content to
Mail Out #95-03, the only differences being slight editorial changes
and reference to an updated version of a Society of Automotive
Engineers (SAE) recommended practice (i.e., SAE J1939) that is not
applicable to light-duty vehicles or light-duty trucks and therefore is
not applicable under the provisions of this final rulemaking.
As a result of this final rule, any federal vehicles complying with
federal OBD by optionally complying with California OBD II are allowed
the same deficiencies as allowed under the OBD II provisions. This is
consistent with revisions deemed necessary by EPA and subsequently made
to federal OBD requirements through a direct final rulemaking published
in March of 1995 (60 FR 15242, March 23, 1995). Note, however, that a
manufacturer requesting certification of a deficient OBD II system must
receive EPA acceptance of any deficiency independently of an acceptance
made by ARB. The Agency will use the same criteria specified by the ARB
in the OBD II regulation, (footnote: Those criteria being the extent to
which the requirements are satisfied overall on the vehicle
applications in question, the extent to which the resultant diagnostic
system design will be more effective than earlier OBD systems, and a
demonstrated good-faith effort to meet the requirements in full by
evaluating and considering the best available monitoring technology)
except that EPA will not provide deficiency allowances for lack of
catalyst monitors or oxygen sensor monitors because the Clean Air Act
specifically requires these monitors no later than the 1996 model year.
The Agency will make every effort to determine the acceptability of OBD
II deficiency requests in concert with ARB staff to avoid the potential
for conflicting determinations. However, the extent to which the
agencies can make concurrent and coordinated findings will rely heavily
on the manufacturer, who will be expected to provide any necessary
information to both agencies in parallel rather than pursuing
deficiency determinations on a separate basis.
III. Public Participation
On November 1, 1995, EPA published a notice of proposed rulemaking
(NPRM) which set forth proposed requirements for complying with federal
OBD regulations by optionally demonstrating compliance with the revised
California OBD II regulations. On December 13, 1995, a public hearing
was held. The period for submission of comments on the NPRM was
scheduled to close on January 16, 1996.
The comments received in response to the NPRM have not been
extensive, and concentrate primarily on the issue of anti-tampering
provisions. More specifically, the comments speak to the
appropriateness of the anti-tampering provisions contained in the
California OBD II regulations but intentionally excluded from any
federal OBD compliance requirements. Comments were also received on the
allowance of optional OBD II compliance for federal OBD purposes
indefinitely, rather than through only the 1998 model year.
Comments were received from original equipment manufacturers,
automotive aftermarket manufacturers and service providers, and one
automotive consultant. The comments along with EPA's analyses and
responses are discussed in the following section. A formal written
``Response to Comments'' document has not been prepared in association
with this rulemaking as all pertinent issues are sufficiently discussed
in this preamble.
IV. Discussion of Issues
A. General Comments on the Proposal
Summary of Proposal: The proposal allowed demonstration of
compliance with revised California OBD II requirements (Mail Out #95-
03) as satisfying federal OBD requirements through the 1998 model year.
Summary of Comments: The American Automobile Manufacturers
Association (AAMA) fully supports the proposed regulatory action,
stating that it will help by limiting the burden on manufacturers
associated with the extremely technologically-challenging development
of enhanced on-board diagnostic systems. The Association of
International Automobile Manufacturers (AIAM) also stated its support,
as did American Suzuki Motor Corporation and Michael Jay Grossman, an
automotive certification consultant. Each of these commenters also
stated that EPA should allow compliance against ARB Mail Out #95-34
rather than Mail Out #95-03, as was proposed.
Analysis of Comments: EPA agrees that Mail Out #95-34 should be
used rather than the proposed Mail Out #95-03. Mail Out #95-34 is
identical in content to Mail Out #95-03, the only differences being
slight editorial changes (the removal of strikeout and underlined text
differentiating old from new text) and reference to an updated version
of a SAE recommended practice (i.e., SAE J1939) that is not applicable
to light-duty vehicles or light-duty trucks and therefore is not
applicable under the provisions of this final rulemaking.
EPA Decision: The final regulatory language will refer to ARB Mail
Out #95-34.
B. California OBD II Anti-Tampering Provisions
Summary of Proposal: The proposal allowed demonstration of
compliance with revised California OBD II requirements (Mail Out #95-
03) as satisfying federal OBD requirements through the 1998 model year,
except that compliance with the tampering protection provisions of the
California OBD II requirements was not required to satisfy federal OBD.
Summary of Comments: Representatives of certain organizations
within the automotive aftermarket made the following comments: (1) EPA
should defer any decision in this proceeding until EPA has rendered a
decision on California's request for a waiver of preemption under
section 209 for its OBD II regulations; (2) EPA's incorporation of
California OBD rules is an unlawful delegation of its powers; (3) EPA
may not certify vehicles containing the anti-tampering devices required
under the California OBD II regulations, because such devices violate
sections 202(m) (4) and (5) and 207 of the Act; (4) the anti-tampering
provisions of the
[[Page 45901]]
California OBD II regulations violate the Semiconductor Chip Protection
Act; (5) the exclusion of the anti-tampering provisions from this
rulemaking is inadequate, because as long as the anti-tampering
regulations are required in California, manufacturers will use such
devices in all their vehicles; (6) the anti-tampering provisions are
unnecessary and eliminate competition in the repair of vehicles; (7)
the anti-tampering provisions of the California OBD II regulations
impose significant economic impact on the automotive aftermarket.
AAMA commented that it believes that both EPA and ARB have the
general legal authority to require anti-tampering measures. Therefore,
AAMA can see no viable cause for not proceeding with the NPRM as
proposed.
Analysis of Comments: (1) Regarding deferment of this rulemaking
until the OBD waiver proceeding is completed, EPA has been processing
the OBD waiver final decision at the same time it has been processing
this final rule. EPA intends to complete the OBD waiver decision either
prior to, at the same time of, or shortly after, the completion of this
rule. However, EPA does not believe that the decisions necessary for
completion of this rulemaking need to be delayed until after the waiver
decision in completed. As discussed below, the issues raised by the
aftermarket in this proceeding and the OBD II waiver proceeding are
more appropriately dealt with in that proceeding, and are not necessary
for completion of this rulemaking. Should the issues raised by the
aftermarket be resolved in favor of the automotive aftermarket, that
resolution will carry over into EPA's broader motor vehicle program,
including the certification of any vehicle that complies with the
requirements promulgated in this rulemaking.
(2) Regarding the contention that EPA has unlawfully delegated its
powers, EPA disagrees with this allegation. As the comments
acknowledge, EPA has gone through a complete notice and comment
rulemaking and found that the regulations that it incorporates today
are consistent with the Act and that it is reasonable and appropriate
for EPA to allow manufacturers to meet EPA's requirements by showing
compliance with California's OBD II regulations, excluding its anti-
tampering provisions. This is not delegation of power, but the
acknowledgment that other entities besides EPA may devise reasonable
methods for meeting particular requirements of the Act. These entities
are not making decisions in place of EPA. EPA's decision to incorporate
OBD II requirements is independent of California's initial decision to
require OBD II in California. Commenters' line of reasoning would seem
to require that EPA purposely ignore any sets of procedures drafted by
another organization, (e.g., a state or a voluntary industry
organization like SAE), no matter how reasonable, simply because EPA
did not think of the procedures first. The restrictions on delegation
of powers in no way require that result.
(3 and 4) The comments allege that California's anti-tampering
provisions violate certain provisions of the Clean Air Act and other
federal law. The comments, however, never explain why such allegations
are relevant to this rulemaking. The regulations EPA promulgates today
explicitly exclude California's anti-tampering provisions from the
federal requirements. EPA is taking no action in this rulemaking that
has any effect on manufacturers legal requirement or ability to
voluntarily equip vehicles with tampering protection measures. To the
extent manufacturers were permitted to do so prior to this rulemaking,
they can do so after the rulemaking. To the extent the Clean Air Act
prevents them from equipping vehicles with tampering protection
measures, nothing in this rulemaking allows manufacturers to circumvent
the Clean Air Act's provisions. The issue of whether the California OBD
II anti-tampering provisions violate the Clean Air Act is simply
irrelevant to this rulemaking, because this rulemaking does not require
manufacturers to meet the anti-tampering provisions. As discussed
above, EPA will be reviewing the comments the aftermarket has provided
on these issues in the California OBD II waiver proceeding. The
comments are relevant in that proceeding, at least to a certain extent,
because in that proceeding, EPA is specifically reviewing the
consistency of California's OBD II provisions, including the anti-
tampering provisions, with section 202(a) of the Act.
(5) Regarding whether exclusion of the anti-tampering provisions is
sufficient for the needs of the commenters, the appropriate issue is
again whether the comments are relevant to this proceeding. The
commenters admit in their comments, as well as in a letter to the
Administrator dated April 30, 1996, that manufacturers will install the
anti-tampering devices on their vehicles, and in fact are currently
doing so, even in the absence of these regulations. Thus, the presence
or absence of these regulations is irrelevant to whether manufacturers
voluntarily equip vehicles with tampering protection measures. As noted
above, EPA will deal with the issues raised by commenters in venues
where such issues are relevant.
(6 and 7) The practicality, cost, and reasonableness of the anti-
tampering provisions are likewise irrelevant to this proceeding because
the anti-tampering provisions are not required by this proceeding.
EPA Decision: The regulatory language need not be changed from that
proposed, with the exception of reference to ARB Mail Out #95-34 rather
than #95-03. Should the anti-tampering provisions of the California OBD
II regulations be deemed unlawful via the waiver process or other
means, they will be removed from the OBD II regulations by the Air
Resources Board and certification approval of vehicles containing anti-
tampering measures consistent with those provisions will cease by both
EPA and ARB.
C. Acceptance of California OBD II Beyond the 1998 Model Year
Summary of Proposal: The proposal allowed demonstration of
compliance with revised California OBD II requirements (Mail Out #95-
03) as satisfying federal OBD requirements through the 1998 model year.
Summary of Comments: Michael Jay Grossman suggested that EPA allow
small volume manufacturers (<10,000 U.S. sales per year) the optional
compliance against the California OBD II regulations beyond the 1998
model year, rather than eliminating this option beginning in the 1999
model year. Mr. Grossman reasons that such an allowance will present no
loss of federal OBD program benefits due to the extremely small number
of small volume manufacturer vehicles in the overall vehicle
population.
Analysis of Comments: Mr. Grossman's suggestion was made by several
commenters during development of the February 1993, federal OBD final
rulemaking, although the comments then were not necessarily limited to
small volume manufacturers. The same arguments against such a policy
apply now as applied then. This alternative was neither proposed by the
Agency, nor is it an attractive alternative from the Agency's
perspective. The federal regulations contain enforcement approaches
consistent with past EPA policies which rely on performance
evaluations, rather than specific design requirements, to encourage
innovative control strategies and improvements in technology. Also,
having effectively two separate regulations mandating the same type of
program is unnecessarily inefficient to enforce.
[[Page 45902]]
Further, the current option for California OBD II demonstration
puts EPA in the position of making mandatory regulatory revisions in
the event ARB revises the OBD II regulations. EPA regulations cannot
incorporate a moving target and, therefore, every regulatory revision
by ARB requires a corresponding revision to federal regulations should
the ARB revision be deemed appropriate for federal purposes. This is
evidenced by the reality of today's rulemaking, which is being done
only because of ARB's recent revisions to OBD II. Upon the effective
date of today's rulemaking, the federally acceptable OBD II
requirements will be those in Mail Out #95-34, and will not be those
contained in any potential future California mail outs pertaining to
OBD II.
Barring passage of the National Low Emission Vehicle regulations
and subsequent agreement among all stakeholders to voluntarily sign
onto its requirements, EPA can see no reason to go forth with this
suggestion. EPA sees merit in undertaking efforts to harmonize federal
OBD requirements with the California OBD II requirements, but will
explore other potential options as opposed to that suggested by Mr.
Grossman.
EPA Decision: EPA will take no action in this final rulemaking to
accommodate this commenter's suggestion. Therefore, no changes to the
proposed regulatory language will be made. As a result, through the
1998 model year, EPA will enforce OBD requirements against either the
California OBD II requirements as they exist in Mail out #95-34 or the
federal OBD requirements, depending on the set of requirements to which
the vehicle has been certified. Beginning with the 1999 model year,
full compliance with the federal OBD requirements will be required for
all vehicles covered by this rulemaking. This will assure designs fully
meeting the goals of the federal OBD program, not only for
preproduction certification but also during in-use operation.
As stated, EPA is exploring options to harmonize federal OBD
requirements with the California OBD II requirements. EPA believes that
effort will result in harmonized OBD system requirements along with
enforcement approaches and regulatory philosophies consistent with each
agency's respective goals. EPA also believes that effort will alleviate
the concerns expressed by Mr. Grossman.
V. Cost Effectiveness
This final rulemaking alters an existing provision by allowing
optional compliance with the most recent ``Revised'' California OBD II
requirements, as opposed to the November 1992, ``Original'' OBD II
requirements, for the purposes of federal OBD compliance. With three
exceptions, the revised OBD II requirements provide regulatory relief
relative to the original OBD II requirements. Those exceptions are: (1)
More stringent catalyst monitoring requirements for 1998 model year low
emission vehicles (LEV), requirements that would not apply to federal
Tier I vehicles; and, (2) more stringent evaporative emission
monitoring requirements for 2000 model year vehicles, requirements that
begin beyond the 1998 model year cutoff of the OBD II compliance
option; and, (3) more stringent anti-tampering provisions, requirements
intentionally excluded from federal OBD compliance demonstration.
Therefore, because this final rulemaking alters an existing provision,
and that alteration provides regulatory relief, there are no additional
costs to original equipment manufacturers associated with this specific
final action.
The automotive aftermarket industry has stated that the provision
of this final rulemaking will result in substantial costs to that
industry. As they argue it, these costs will be incurred because the
anti-tampering measures required under the California OBD II
regulations will present more difficulty for the automotive aftermarket
in carrying out their business of reverse engineering original
equipment manufacturer (OEM) parts and designing replacement or
specialty parts. However, the anti-tampering measures are intentionally
excluded from federal OBD compliance requirements, even when choosing
the optional OBD II compliance demonstration. Therefore, OEMs are, in
effect, voluntarily incorporating anti-tampering measures into their
federal vehicles, and would arguably do so absent the requirement under
the California OBD II regulation. Consequently, EPA cannot understand
how the provisions of this final rulemaking are responsible for any
potential increased costs on the automotive aftermarket, outside those
costs mandated under the Clean Air Act Amendments of 1990 which require
all 1994 and later model year vehicles to incorporate OBD systems into
their designs.
The costs and emission reductions associated with the federal OBD
program were developed for the February 19, 1993, final rulemaking. The
change being made today does not affect the costs and emission
reductions published as part of that rulemaking.
VI. Administrative Requirements
A. Administrative Designation
Under Executive Order 12866 (58 FR 51735, October 4, 1993), the
Agency must determine whether the regulatory action is ``significant''
and therefore subject to OMB review and the requirements of the
Executive Order. The Order defines ``significant regulatory action'' as
one that is likely to result in a rule that may:
(1) Have an annual effect on the economy of $100 million or more or
adversely affect in a material way the economy, a sector of the
economy, productivity, competition, jobs, the environment, public
health or safety, or State, local, or tribal governments or
communities;
(2) Create a serious inconsistency or otherwise interfere with an
action taken or planned by another agency;
(3) Materially alter the budgetary impact of entitlements, grants,
user fees, or loan programs or the rights and obligations of recipients
thereof; or,
(4) Raise novel legal or policy issues arising out of legal
mandates, the President's priorities, or the principles set forth in
the Executive Order.
It has been determined that this rule is not a ``significant
regulatory action'' under the terms of Executive Order 12866 and is
therefore not subject to OMB review.
B. Reporting and Recordkeeping Requirements
This final rulemaking does not change the information collection
requirements submitted to and approved by OMB in association with the
OBD final rulemaking (58 FR 9468, February 19, 1993; and, 59 FR 38372,
July 28, 1994).
C. Impact on Small Entities
EPA has determined that it is not necessary to prepare a regulatory
flexibility analysis in connection with this final rule. This rule will
not have a significant adverse economic impact on a substantial number
of small businesses. This final rulemaking will provide regulatory
relief to both large and small volume automobile manufacturers by
maintaining consistency with California OBD II requirements. It will
not have a substantial impact on such entities. This final rulemaking
will not have a significant impact on businesses that manufacture,
rebuild, distribute, or sell automotive parts, nor those involved in
automotive service and repair, as the revisions affect only
requirements on automobile manufacturers.
[[Page 45903]]
D. Submission to Congress and the General Accounting Office
Under 5 U.S.C. 801(a)(1)(A) as added by the Small Business
Regulatory Enforcement Fairness Act of 1996, EPA submitted a report
containing this rule and other required information to the U.S. Senate,
the U.S. House of Representatives and the Comptroller General of the
General Accounting Office prior to publication of the rule in today's
Federal Register. This rule is not a ``major rule'' as defined by 5
U.S.C. 804(2).
E. Unfunded Mandates Act
Under section 202 of the Unfunded Mandates Reform Act of 1995
(``Unfunded Mandates Act''), signed into law on March 22, 1995, EPA
must prepare a budgetary impact statement to accompany any proposed or
final rule that includes a Federal mandate that may result in estimated
costs to State, local, or tribal governments in the aggregate; or to
the private sector, or $100 million or more. Under section 205, EPA
must select the most cost effective and least burdensome alternative
that achieves the objectives of the rule and is consistent with
statutory requirements. Section 203 requires EPA to establish a plan
for informing and advising any small governments that may be
significantly or uniquely impacted by the rule.
EPA has determined that the final approval action promulgated today
does not include a Federal mandate that may result in estimated costs
of $100 million or more to either State, local, or tribal governments
in the aggregate, or to the private sector.
List of Subjects in 40 CFR Part 86
Environmental protection, Administrative practice and procedure,
Air pollution control, Gasoline, Motor vehicles, Motor vehicle
pollution, Reporting and recordkeeping requirements.
Dated: August 22, 1996.
Carol M. Browner,
Administrator.
For the reasons set out in the preamble, part 86 of title 40 of the
Code of Federal Regulations is amended as follows:
PART 86--CONTROL OF AIR POLLUTION FROM NEW AND IN-USE MOTOR
VEHICLES AND NEW AND IN-USE MOTOR VEHICLE ENGINES: CERTIFICATION
AND TEST PROCEDURES
1. The authority citation for part 86 continues to read as follows:
Authority: 42 U.S.C. 7401 et seq.
Subpart A--[Amended]
2. Section 86.094-17 is amended by revising paragraph (j) to read
as follows:
Sec. 86.094-17 Emission control diagnostic system for 1994 and later
light-duty vehicles and light-duty trucks.
* * * * *
(j) Demonstration of compliance with California OBD II requirements
(Title 13 California Code Sec. 1968.1), as modified pursuant to
California Mail Out #95-34 (September 26, 1995), shall satisfy the
requirements of this section through the 1998 model year except that
compliance with Title 13 California Code Sec. 1968.1(d), pertaining to
tampering protection, is not required to satisfy the requirements of
this section.
* * * * *
[FR Doc. 96-21946 Filed 8-29-96; 8:45 am]
BILLING CODE 6560-50-P
Complete official Federal Register PDF
FR Doc. 96-21289 Safety Standards for Scaffolds Used in the Construction Industry
[Federal Register Volume 61, Number 170 (Friday, August 30, 1996)]
[Rules and Regulations]
[Pages 46026-46131]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-21289]
[[Page 46025]]
_______________________________________________________________________
Part II
Department of Labor
_______________________________________________________________________
Occupational Safety and Health Administration
_______________________________________________________________________
29 CFR Part 1926
Safety Standards for Scaffolds Used in the Construction Industry; Final
Rule
Federal Register / Vol. 61, No. 170 / Friday, August 30, 1996 / Rules
and Regulations
[[Page 46026]]
DEPARTMENT OF LABOR
Occupational Safety and Health Administration
29 CFR Part 1926
[Docket No. S-205]
RIN 1218-AA40
Safety Standards for Scaffolds Used in the Construction Industry
AGENCY: Occupational Safety and Health Administration, U.S. Department
of Labor.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: The Occupational Safety and Health Administration (OSHA)
hereby revises the construction industry safety standards which
regulate the design, construction, and use of scaffolds. The final rule
updates the existing scaffold standards and sets performance-oriented
criteria, where possible, to protect employees from scaffold-related
hazards such as falls, falling objects, structural instability,
electrocution and overloading.
In particular, the final rule has been updated to address types of
scaffolds--such as catenary scaffolds, step and trestle ladder
scaffolds, and multi-level suspended scaffolds--not covered by OSHA's
existing scaffold standards. In addition, the final rule allows
employers greater flexibility in the use of fall protection systems to
protect employees working on scaffolds and extends fall protection to
erectors and dismantlers of scaffolds to the extent feasible. Another
area that the final rule strengthens is training for workers using
scaffolds; the conditions under which such employees must be retrained
are also specified in the final rule. Finally, the language of the rule
has been simplified, duplicative and outdated provisions have been
eliminated, overlapping requirements have been consolidated, and the
performance orientation of the rule has been enhanced to allow
employers as much flexibility in compliance as is consistent with
employee protection.
DATES: Effective dates. This standard will become effective on November
29, 1996, except for Sec. 1926.453(a)(2), which will not become
effective until an Office of Management and Budget (OMB) Control number
is received and displayed for this ``collection of information'' in
accordance with the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et
seq.). OSHA will publish a document in the Federal Register announcing
the effective date of Sec. 1926.453(a)(2).
Incorporation by reference. The incorporations by reference of
certain publications listed in this final rule are approved by the
Director of the Federal Register as of November 29, 1996.
Compliance date: Employers are required to comply with the
provisions of paragraphs (e)(9) and (g)(2) of Sec. 1926.451, which
address safe access and fall protection, respectively, for employees
erecting and dismantling supported scaffolds starting on September 2,
1997.
Comments. Written comments on the paperwork requirements of this
final rule must be submitted on or before October 29, 1996.
ADDRESSES: In compliance with 28 U.S.C. 2112(a), the Agency designates
for receipt of petitions for review of the standard, the Associate
Solicitor for Occupational Safety and Health, Office of the Solicitor,
Room S-4004, U.S. Department of Labor, 200 Constitution Avenue, N.W.,
Washington, D.C. 20210.
Suggestions and information regarding the drafting of non-mandatory
Appendix B, ``Criteria for Determining the Feasibility of Providing
Fall Protection and Safe Access for Workers Erecting or Dismantling
Supported Scaffolds'' should be submitted to the Docket Officer, Docket
S-205, U.S. Department of Labor, Room N-2625, 200 Constitution Avenue,
NW., Washington, D.C. 20210.
FOR FURTHER INFORMATION CONTACT: Ms. Anne C. Cyr, Occupational Safety
and Health Administration, Office of Information and Public Affairs,
Room N-3647, U.S. Department of Labor, 200 Constitution Avenue, N.W.,
Washington, D.C. 20210, Telephone: (202) 219-8148.
SUPPLEMENTARY INFORMATION:
I. Background
Congress amended the Contract Work Hours Standards Act (40 U.S.C.
327 et seq.) in 1969 by adding a new section 107 (40 U.S.C. 333) to
provide employees in the construction industry with a safer work
environment and to reduce the frequency and severity of construction
accidents and injuries. The amendment, commonly known as the
Construction Safety Act (CSA), significantly strengthened employee
protection by authorizing the promulgation of construction safety and
health standards for employees of the building trades and construction
industry working on federal and federally-financed or federally-
assisted construction projects. Accordingly, the Secretary of Labor
issued Safety and Health Regulations for Construction in 29 CFR part
1518 (36 FR 7340, April 17, 1971).
The Occupational Safety and Health Act of 1970 (the OSH Act) (29
U.S.C. 651 et seq.) authorized the Secretary of Labor to adopt
established federal standards issued under other statutes, including
the CSA, as occupational safety and health standards. Accordingly, the
Secretary of Labor adopted the Construction Standards, which had been
issued under the CSA, as OSHA standards (36 FR 10466, May 29, 1971).
The Safety and Health Regulations for Construction were subsequently
redesignated as 29 CFR part 1926 (36 FR 25232, December 30, 1971).
Standards addressing scaffolds, Secs. 1926.451 and 1926.452, were
adopted in subpart L of part 1926 as OSHA standards as part of this
process.
Various amendments were made to subpart L during the first two
years of the OSH Act. The amendments revised scaffold provisions that
addressed planking grades, wood pole scaffold construction, overhead
protection, bracket scaffold loading, and plank spans. Also,
substantive provisions concerning pump jack scaffolds, height of catch
platforms, and guardrails were added (37 FR 25712, December 2, 1972).
Based on concerns regarding the effectiveness of the existing
scaffold standards, OSHA began a complete review of subpart L in 1977.
The Agency consulted the Advisory Committee on Construction Safety and
Health (ACCSH) several times regarding draft revisions to subpart L.
The transcripts of these meetings are part of the public record for
this rulemaking (Ex. 3-4). OSHA addresses specific recommendations from
the ACCSH, as well as those submitted by other rulemaking participants,
in the Summary and Explanation section, below.
On November 25, 1986, OSHA issued a notice of proposed rulemaking
(NPRM) on scaffolds used in construction (51 FR 42680). The proposal
set a period, ending February 23, 1987, during which interested parties
could submit written comments or request a hearing. The Agency twice
granted requests for more time to submit comments and hearing requests.
OSHA first extended the comment and hearing request period to June 1,
1987 (52 FR 5790, February 26, 1987) and then extended that period to
August 14, 1987 (52 FR 20616, June 2, 1987). OSHA received 602 comments
on the proposal, along with several hearing requests.
On January 26, 1988, OSHA announced that it would convene an
informal public hearing on March 22, 1988 to elicit additional
information on
[[Page 46027]]
specific issues related to scaffolds, fall protection and stairways and
ladders (53 FR 2048). The informal public hearing was held on March 22-
23, 1988, with Administrative Law Judge Joel Williams presiding. At the
close of the hearing, Judge Williams set a period, ending May 9, 1988,
for the submission of additional comments and information. OSHA
received 31 submissions, including testimony and documentary evidence,
in response to the hearing notice. On August 11, 1988, Judge Williams
certified the rulemaking record, including the hearing transcript and
all written submissions to the docket, thereby closing the record for
this proceeding.
In 1988, the American National Standards Institute (ANSI), an
organization which sets voluntary consensus standards, approved a
revision of ANSI A10.8-1977, Scaffolding, updating its safety
requirements for the use of scaffolds in construction and demolition
operations. Section 6(b)(8) of the OSH Act requires that when an OSHA
standard differs substantially from an existing national consensus
standard, the Secretary must publish ``a statement of the reasons why
the rule as adopted will better effectuate the purposes of the Act than
the national consensus standard.'' In compliance with that requirement,
OSHA has reviewed the requirements of this final rule with reference to
the corresponding provisions of ANSI A10.8-1988. The Agency discusses
the relationship between the provisions of subpart L and corresponding
provisions of ANSI A10.8-1988 in the Summary and Explanation, below.
On March 29, 1993, OSHA reopened the rulemaking record for subpart
L (58 FR 16509) to obtain additional comments and information regarding
fall protection and safe means of access for employees erecting and
dismantling scaffolds; the use of crossbraces in scaffold systems; and
the use of repair bracket scaffolds. The comment period was scheduled
to end on May 28, 1993. On May 26, 1993, the Agency extended the
comment period (58 FR 30131) to June 29, 1993, in response to a request
for additional time to submit comments. OSHA received 46 comments in
response to the March 29 notice. Those comments are discussed below in
relation to the pertinent provisions of the final rule.
On February 1, 1994, OSHA again reopened the rulemaking record (59
FR 4615) to obtain comments and information regarding scaffold
stairways; repair bracket scaffolds; tank builder scaffolds; a NIOSH
study of workplace fatalities; and scaffold-related material
incorporated from the proposed part 1910, subpart D rulemaking. The
comment period, which ended on March 18, 1994, elicited 46 comments.
Those comments are also discussed below in relation to the pertinent
provisions of the final rule.
A wide range of employers, businesses, labor unions, trade
associations, state governments, and other interested parties
contributed to the development of this record. OSHA appreciates these
efforts to help develop a rulemaking record that provides a sound basis
for the promulgation of revised subpart L.
Based on its review of existing subpart L, OSHA believes that
certain provisions in the existing standards are outdated, redundant,
or ambiguous. In addition, some types of scaffolds used in construction
(e.g., catenary scaffolds) are not clearly addressed by the existing
standards, and some provisions cover only certain types of scaffolds
when they should apply to all. The final rule eliminates those
unnecessary, outdated and redundant provisions (e.g., revised subpart L
states the requirement for guardrails once, rather than 19 separate
times as in the existing standard).
OSHA is coordinating the revision of part 1926, subpart L, with the
ongoing rulemakings initiated to revise the General Industry (part
1910, subpart D) and Shipyard (part 1915, subpart N) scaffold
standards, so that those standards will be consistent, where
appropriate.
II. Hazards Involved
Scaffold-related incidents resulting in injuries and fatalities
continue to occur despite the fact that OSHA has had a scaffold
standard (existing subpart L) in place since 1971 (Exs. 1, 2, 3, 42,
43, 44 and 45). However, the Agency believes that compliance with the
standard being published today will be better than it has been in the
past because this standard has been simplified, brought up to date, and
strengthened to provide additional protection.
Although specific accident ratios cannot be projected for the
estimated 3.6 million construction workers currently covered by subpart
L, the Economic Analysis that accompanies this final rule estimates
that, of the 510,500 injuries and illnesses that occur in the
construction industry annually, 9,750 are related to scaffolds. In
addition, of the estimated 924 occupational fatalities occurring
annually, at least 79 are associated with work on scaffolds.
OSHA prepared the following statistical estimates (based on 4.5
million construction workers then covered by subpart L) to support the
1986 proposal for subpart L, based on a review of accident data
prepared by the Bureau of Labor Statistics (BLS) (Ex. 3-1). The revised
scaffold standards contain a number of provisions designed specifically
to address the findings of this analysis.
a. Seventy-two percent of the workers injured in scaffold accidents
covered by the BLS study attributed the accident either to the planking
or support giving way, or to the employee slipping, or being struck by
a falling object. Plank slippage was the most commonly cited cause.
b. About 70 percent of the workers learned of the safety
requirements for installing work platforms, assembling scaffolds, and
inspecting scaffolds through on-the-job training. Approximately 25
percent had no training in these areas.
c. Only 33 percent of scaffolds were equipped with a guardrail.
The following are recent examples, from the OSHA Integrated
Management Information System (IMIS) data, of the types of accidents
that continue to injure and kill employees working on scaffolds.
In July, 1991, two employees were working on a pump jack
scaffold doing roofing work. The scaffold became overloaded and broke.
The employees fell 12 feet to the ground, resulting in one fatality and
one serious injury.
In August, 1992, two workers were erecting an aluminum
pump jack scaffold. As they were raising the second aluminum pole, the
pole apparently contacted an overhead power line. The pole being raised
was 29 feet 10 inches long and the line was 28 feet 10 inches high. The
line was approximately 11 feet from the house. One employee died and
the other suffered severe burns and was hospitalized. The surviving
employee noted that he thought they had enough room to work around the
power lines, which were not de-energized or shielded.
In July, 1993, a foreman climbed up the frame of a 45 foot
high tubular welded frame scaffold to check on an employee who was
sandblasting inside a stack at a steam plant. The scaffold was not
equipped with guardrails and there was no access ladder. After talking
to the employee, the foreman either fell from the unguarded platform or
fell while climbing down the scaffold end frame, resulting in his
death. There were no witnesses to the fall.
Based on its analysis of the available data and its field
experience in enforcing construction standards, the Agency has
determined that employees using scaffolds are exposed to a
[[Page 46028]]
significant risk of harm. Specifically, scaffold related fatalities
still account for approximately 9% of all fatalities in the
construction workplace. In addition, the above data indicate that the
revised final standard would have prevented many of these accidents
more effectively than compliance with the existing scaffold standards.
Consequently, OSHA finds that the revision of its scaffold standards
for construction is necessary to improve employee protection. OSHA has
determined that, as revised, the standard clearly states employers'
duties and the appropriate compliance measures.
For additional discussion of incidence rates, significance of risk,
and the protectiveness of the final rule, see Section IV, Summary of
the Final Economic Analysis.
III. Summary and Explanation of the Final Rule
The following discussion explains how the final rule corresponds to
or differs from the proposed scaffold standard and the existing
standard, and how the comments and testimony presented on each
provision influenced the drafting of the final rule. Except where
otherwise indicated, proposed provisions which did not elicit comment
have been promulgated as proposed, for reasons stated in the preamble
to the proposed rule which is hereby incorporated by reference (51 FR
42680).
Subpart L--Scaffolds. The title of subpart L of OSHA's Construction
standards has been changed from ``Scaffolding'' to ``Scaffolds'', as
proposed. The word ``scaffold'' is used in the title and throughout the
final rule in lieu of the longer word ``scaffolding.'' This change does
not affect the scope of subpart L. OSHA did not receive any comments
concerning the title of the subpart.
Section 1926.450 Scope, application and definitions applicable to
this subpart. Paragraph (a) of Sec. 1926.450 states the scope and
application of subpart L. The final rule will apply to all scaffolds
used in construction, alteration, repair (including painting and
decorating), and demolition operations covered under 29 CFR part 1926,
except that crane or derrick suspended personnel platforms will
continue to be regulated under Sec. 1926.550(g). Language explicitly
excluding these platforms has been added to the final rule. The
relationship between Sec. 1926.550(g), which covers these platforms,
and subpart L is discussed further in relation to Sec. 1926.451(c)(2)
and NPRM Issue 3, below. In addition, aerial lifts are covered
exclusively in Sec. 1926.453, as noted in paragraph (a) of
Sec. 1926.450. Proposed paragraph (a) covered all scaffolds.
A commenter (Ex. 2-38) recommended that OSHA explicitly exempt
personnel platforms suspended by cranes or derricks from this final
rule. The commenter stated ``[t]his would avoid confusion, both for the
Compliance Officer and the employer.'' As noted above, the Agency
recognizes the need for an exemption and has revised paragraph (a)
accordingly.
Another commenter (Ex. 2-18), representing the elevator industry,
suggested that OSHA revise the scope of proposed subpart L to exclude
``False cars used in elevator construction that are equipped with
independent safeties that operate on the guardrails * * *'' The
commenter supported the suggestion as follows: ``An elevator false car
operates on fixed guiderails * * * equipped with safeties that ride on
the guiderails * * * and are operated automatically by the slackening
of the hoisting rope. Past OSHRC (Occupational Safety and Health Review
Commission) decisions have recognized that a false car is a unique tool
and is not a scaffold.'' The commenter did not cite any specific OSHRC
decisions to support its assertion.
OSHA disagrees with this commenter on this point, because the
findings in two enforcement cases involving the Otis Elevator Company
(12 OSHRC 1470 and 12 OSHRC 1513 (1985)) clearly indicate that the
scaffold standards of subpart L cover false cars. In Otis Elevator
Company, 12 OSHRC 1513 (1985), the final order stated:
The evidence in this case showed that the false cars were used
as elevated working space from which employees installed permanent
elevator rails. The ability to raise and lower the false cars by
means of cables from overhead supports does not remove false cars
from the applicability of the scaffold standard, and a false car is
found to be a scaffold within the meaning of 29 CFR 1926.452(b)(27).
The Agency notes that elevator false cars fit the definition of a
``scaffold'' in final rule Sec. 1926.450(b) in that they are temporary
elevated work platforms used for supporting employees. Accordingly,
there are no apparent grounds for disputing that elevator false cars
are properly regulated under part 1926, subpart L. Therefore, OSHA will
continue to regulate temporary elevated work platforms, such as false
cars and go-devils used in elevator shaft construction, as scaffolds.
The Scaffolding, Shoring and Forming Institute (SSFI) (Ex. 2-367)
recommended that OSHA include ``Window cleaning'' within the scope of
subpart L, because ``[w]indow cleaning is a common activity that, for
the overwhelming majority of instances, uses transportable suspended
scaffolds.'' In addition, the Scaffold Industry Association (SIA) (Ex.
2-368) suggested that OSHA add ``scheduled and unscheduled maintenance
(including but not limited to painting and decorating, tuck pointing,
sand blasting, water proofing and window cleaning)'' to the scope of
subpart L, because maintenance is a type of work ``regularly performed
on scaffolds addressed in this subpart and, therefore, should be
included in the scope.''
Another commenter (Ex. 2-462) stated that expanding the scope of
subpart L to include maintenance would create confusion and ``would
greatly reduce the safety standard already in place for Powered
platforms for exterior building maintenance'' (29 CFR 1910.66).
The Agency is not expanding the scope to include building
maintenance because building maintenance (such as window cleaning) is a
general industry activity, addressed under the appropriate scaffold and
powered platform standards of 29 CFR part 1910.
OSHA received a general comment (Ex. 2-29) which noted that
Sec. 1910.66 addressed powered platforms used for exterior building
maintenance in general industry and urged OSHA to ensure that the
corresponding regulatory language in the construction standard for
scaffolds was consistent. As discussed above, the Agency agrees, and is
coordinating its General Industry, Shipyard and Construction rulemaking
activity so that employers in those industries have consistent
regulation, to the extent that workplace conditions permit.
Paragraph (b) of Sec. 1926.450 lists and defines all major terms
used in subpart L. Proposed terms and definitions which elicited no
comments and which have been promulgated unchanged or with only minor
editorial revisions are not addressed below. Those terms include
``adjustable suspension scaffold'', ``boatswains' chair'', ``body
belt'', ``body harness'', `` brace'', ``cleat'', ``coupler'',
``crawling board'', ``double pole scaffold'', ``exposed power lines'',
``fabricated decking and planking'', ``float (ship) scaffold'', ``form
scaffold'', ``hoist'', ``interior hung scaffold'', ``ladder stand'',
``lean-to scaffold'', ``lower level'', ``mobile scaffold'', ``multi-
level suspension scaffold'', ``multi-point adjustable scaffold'',
``open sides and edges'', ``overhand bricklaying'', ``platform'',
``pole scaffold'', ``pump jack scaffolds'', ``roof bracket scaffold'',
``runner'', ``self-
[[Page 46029]]
contained adjustable scaffold'', ``shore scaffold'', ``single-point
adjustable suspension scaffold'', ``single pole scaffold'', ``step
platform and trestle ladder scaffold'', ``stone setter multi-point
adjustable suspension scaffold'', ``supported scaffold'', ``suspension
scaffold'', ``tube and coupler scaffolds'', ``tubular welded frame
scaffold'', ``two-point suspension scaffold'', ``unstable objects'',
``vertical pickup'', ``walkway'', and ``window jack scaffold''.
As proposed, OSHA is revising its definitions for particular types
of scaffolds by specifying whether a particular type of scaffold is a
``supported'' or a ``suspension scaffold.'' OSHA believes that adding
this information will make it easier for employers to identify the
appropriate general requirements in final rule Sec. 1926.451.
In addition, the Agency has revised subpart L definitions by
deleting language that limits the use of a particular type of scaffold.
Such substantive limitations are more appropriately placed in
regulatory text. Accordingly, for example, OSHA has revised the
definition for ``bricklayers' square scaffolds'' (a scaffold composed
of framed wood squares which support a platform, limited to light and
medium duty) by deleting the words ``limited to light and medium
duty''. Similarly, OSHA has revised the definition for ``coupler'' to
be ``a device for locking together the component tubes of a tube and
coupler scaffold'', deleting language addressing the material used for
the coupler because such requirements are more properly located in
Secs. 1926.451 or 1926.452.
The following discussion covers the terms for which definitions are
being added or revised in this final rule and those proposed terms
which elicited comments.
``Bearer (Putlog).'' This definition is the same as the definition
proposed except that the word ``Putlog,'' an industry-used term, has
been added to the definition. A commenter (Ex. 2-29) suggested putlog
should be included in the proposed definition ``to show a close or
synonymous relationship to the term `bearer' '' and because ``it is a
widely used and understood term.'' The Agency agrees with the commenter
and has revised the proposed definition accordingly.
``Bricklayers' Square Scaffold'' is defined in existing
Sec. 1926.452(b) and the proposed definition is substantively unchanged
in the final rule. The definition deletes the existing Sec. 1926.452(b)
requirements that bricklayers' square scaffolds be constructed of
``wood'' and that the platform capacity be limited to ``light and
medium duty.'' The revised definition recognizes that bricklayers'
square scaffolds can be constructed of materials other than ``wood''
and that their capacity is not limited to ``light and medium duty'' as
long as they can meet the capacity requirements set forth in final rule
Sec. 1926.451(a)(1).
A commenter (Ex. 2-23) suggested that OSHA adopt the ANSI A10.8-
1977 definition for Bricklayers' Square Scaffold which specifies the
use of ``wood'' and the ability to sustain light to medium loads. As
stated above, OSHA believes it would be inappropriate to limit
technological advances that would provide for the use of other
materials with greater capacities. Therefore, the Agency has not made
the suggested revision.
``Carpenters' bracket scaffold.'' This term means a supported
scaffold consisting of a platform supported by brackets attached to
building or structural walls. The final rule is identical to the
proposal. The SIA (Ex. 2-368) suggested that because different trades
(i.e., cement finishers) use this type scaffold, the term be renamed
``bracket scaffold'' exclusively. OSHA recognizes that this type of
scaffold is used by several trade groups. However, OSHA believes that
it is widely recognized in the construction industry that ``carpenters'
bracket scaffolds'' are not used only by carpenters. Therefore, the
Agency is not making the suggested revision.
``Catenary scaffold.'' This type of scaffold is not specifically
addressed in OSHA's existing rule but is covered in final rule
Sec. 1926.452(r). This term refers to a suspension scaffold consisting
of a platform supported by two essentially horizontal and parallel
ropes which are secured to structural members and may be supported by
vertical pickups. The proposed definition has been changed to replace
the language ``fastened to'' with ``supported by'' and a phrase has
been added explaining that horizontal ropes ``may be supported by
vertical pickups.''
One commenter (Ex. 2-23) suggested that OSHA insert the word
``wire'' between the words ``parallel'' and ``rope.''
However, OSHA does not intend to restrict the type of material used
for suspension scaffold rope as long as it is ``capable of supporting
without failure six times the maximum intended load'' as set forth in
final rule Sec. 1926.451(a)(3).
Two commenters (Exs. 2-23 and 2-368) suggested OSHA replace the
words ``fastened to'' with ``supported by'' in this definition. OSHA
agrees that the suggested words more accurately describe the function
of the horizontal ropes with relation to the platform and is revising
the proposed definition accordingly.
In addition, the SIA (Ex. 2-368) suggested that OSHA add the phrase
``and may be supported by vertical pickups''. OSHA agrees with the
commenter. Vertical pick-ups can act as supports for sagging horizontal
ropes. Also, because final rule Sec. 1926.452(r)(1) refers to vertical
pickups, OSHA believes that it is appropriate to include this phrase in
the definitions.
``Chimney hoist.'' This term is being added to recognize a specific
type of multi-point adjustable suspension scaffold used to gain access
to worksites inside chimneys.
``Competent person.'' This term is being added to the final rule as
a matter of convenience for users. The definition is identical to that
found in Sec. 1926.32.
``Continuous run scaffold (run scaffold)'' means a two-point or
multi-point adjustable suspension scaffold constructed using a series
of interconnected braced scaffold members or supporting structures
erected to form a continuous scaffold. This term is being added to
recognize this type of system. The Agency notes that the key element
here is that the scaffold members must be interconnected so that the
erected scaffold acts as a single unit. This would preclude planking
across two independent scaffolds without joining them so the resulting
scaffold acts as one unit. This system allows erecting a lengthy
scaffold without requiring a continuous planked platform, as long as
the smaller platform is properly guarded.
``Deceleration device.'' This term means any mechanism, such as a
rope grab, rip stitch lanyard, specially-woven lanyard, tearing or
deforming lanyard, automatic self-retracting lifelines/lanyard, which
serves to dissipate a substantial amount of energy during a fall
arrest, or otherwise limits the energy imposed on an employee during
fall arrest. The proposed definition, which was effectively identical,
has been editorially revised for the sake of clarity.
Three commenters (Exs. 2-13, 2-368 and 2-516) suggested that rope
grabs and some self-retracting lifelines are not ``deceleration
devices'' but are actually fall arrest devices. OSHA notes, however,
that it is difficult to differentiate clearly between system
components, as suggested, because fall arrest (stopping) and energy
absorption (braking) are closely related. The Agency also observes that
the performance criteria for personal fall arrest equipment address the
entire system, not just ``fall arresters'' or
[[Page 46030]]
``energy absorbers''. Accordingly, OSHA has not made the suggested
change.
``Equivalent.'' This term is used in the final rule to allow
alternative means of complying with the standard. The definition
provides that the employer must be able to demonstrate that the
alternative means of compliance will provide an equal or greater degree
of safety than that attained by using the method or item specified in
the standard. The final definition is identical to the proposed
definition, except that minor editorial changes have been made for the
sake of clarity. The final rule definition is consistent with the
corresponding definitions in Sec. 1910.66 and in part 1926, subparts M
and X.
The SIA (Ex. 2-368) suggested that OSHA not require the employer to
``demonstrate whether or not the scaffold is of `equal or greater
degree of safety' because the employer is too many steps removed from
the manufacturer'' and because requiring the employer to test for
equivalency would create a significant danger that failure would occur.
However, the proposed language reflects the Agency's longstanding
position that employers who choose to deviate from criteria set in OSHA
standards must be able to demonstrate that employee protection has not
been adversely affected. The employer has the flexibility to establish
equivalence by any effective means, including information available
from equipment suppliers and taking into account the specific
circumstances of the work to be done.
``Eye'' or ``eye splice'' means a loop with or without a thimble at
the end of a wire rope. This term is being added to the final rule to
clarify the Agency's intent that this type of connection is an
acceptable way to connect wire ropes without significantly affecting
their strength or capacities. The term is used in final rule
Sec. 1926.451(d) (8) and (9).
``Fabricated frame scaffold'' means a supported or suspended frame
scaffold consisting of platform(s) supported on fabricated end frames
with integral posts, horizontal bearers, and intermediate members. This
is the term for the type of scaffold presently identified as ``tubular
welded frame scaffold.'' OSHA has determined that the current term is
too restrictive because the words ``tubular'' means round and
``welded'' means that metal components are involved. The provisions of
final rule Sec. 1926.452(c), Fabricated frame scaffolds, are not
subject to such limitations. They address fabricated frames and related
scaffold components whether the component parts are square or round, or
made of metal, plastic, wood, or some other material. The final rule
definition is identical to that in the proposed rule.
Two commenters (Exs. 2-13 and 2-320) suggested using the existing
term ``tubular welded frame'' and one commenter (Ex. 2-23) suggested
using the term ``Fabricated tubular frame (Tubular welded frame
scaffold)'' instead of the proposed term. However, as explained above,
OSHA does not intend to restrict this term to ``tubular'' or ``welded''
components.
``Failure.'' This term is used in performance-oriented paragraphs
such as Secs. 1926.451 (a)(1) and (a)(3), which address scaffold
capacity. Because the word might otherwise be interpreted to mean only
breakage or a physical separation of scaffold components, the final
rule definition clearly indicates that load refusal (the point where
the ultimate strength of a component is exceeded) is also considered to
be failure. This is the point where structural members lose their
ability to carry loads although they have not broken or separated. The
term is the same as the term defined in Subpart X of Part 1926, Ladders
and Stairways. The definition for ``failure'' in the final rule is the
same as proposed.
One commenter (Ex. 2-40) suggested that the term ``ultimate
strength'' was not clearly defined. Another commenter (Ex. 2-38)
suggested deleting the last sentence of the proposed definition (Load
refusal is the point where the ultimate strength is exceeded) to avoid
confusion between ``ultimate strength'' and ``overloading without
breaking.'' As OSHA stated above, ``ultimate strength'' may be exceeded
without component parts breaking or separating. Therefore, the Agency
believes the suggested changes are unnecessary.
``Guardrail system.'' This term refers to perimeter protection
composed of vertical barriers which are erected to prevent employees
from falling. The final rule definition is essentially identical to the
proposed definition. This term replaces the definition of ``guardrail''
in the existing rule, which appeared at Sec. 1926.452(b)(10). The old
definition was rail secured to uprights and erected along the exposed
sides and ends of platforms. OSHA believes that this definition did not
adequately reflect the manner in which toprails, midrails and other
intermediate members, and toeboards combine to provide effective fall
protection. The final rule definition of guardrail clearly indicates
that the entire system, including toprail, midrail (or other
intermediate protection), and uprights, is covered when guardrails are
addressed in final rule Sec. 1926.451(e). The definition of guardrail
system used in the proposed rule stated that a guardrail system was ``a
vertical barrier erected to prevent employees from falling from an open
side or edge of a scaffold platform or walkway''. The proposed
definition also distinguished between ``Type I guardrails'', which were
capable of providing fall protection without the use of personal fall
arrest systems, and ``Type II guardrails'', which would need to be
supplemented by personal fall arrest systems (as explained below, OSHA
has not maintained this distinction in the final rule).
The SIA (Ex. 2-368) suggested replacing the word ``prevent'' with
the word ``protect'' in the proposed definition of ``guardrail
system''. According to standard dictionary meanings of both words,
``prevent'' more accurately describes the function of the guardrail
system, which is to keep the employee from going past the perimeter of
the scaffold in the first place. Therefore, the Agency is not making
the suggested change.
Three commenters (Exs. 2-13, 2-53 and 2-370) recommended that OSHA
retain the guardrail rules in the existing scaffold standard and
eliminate the concept of ``Type I'' and ``Type II'' from the proposed
definition of guardrail systems. The commenters suggested that the old
rule's definition of guardrail protection would provide more fall
protection than the definition used in the proposed rule. For reasons
discussed further below, OSHA finds that the final rule's requirements
for guardrail systems, which are essentially identical to those in the
proposed rule, provide more protection than the requirements in the
existing rule. However, OSHA has deleted the discussion of ``Type I''
and ``Type II'' guardrails from the final rule for the sake of clarity
and has added specific criteria for guardrails to final rule
Sec. 1926.451(g).
``Horse scaffold'' means a supported scaffold consisting of a
platform supported by construction horses. Horse scaffolds made of
metal are sometimes known as trestle scaffolds. The proposed definition
was similar except that it did not include the term ``trestle
scaffold.'' The SIA (Ex. 2-368) suggested revising the definition to
specify that horse scaffolds ``may be constructed of wood, metal, or a
combination of both. The metal horses may be referred to as `trestle
horses'.'' Under OSHA's performance-oriented approach to subpart L, an
employer may use any construction materials (e.g., wood or metal) that
enable the scaffold to comply with the capacity requirement set forth
in Sec. 1926.451(a)(1). However,
[[Page 46031]]
the Agency agrees that it would be useful to indicate that some horse
scaffolds constructed of metal are known as trestle scaffolds. OSHA has
revised the definition accordingly.
``Ladder jack scaffold.'' The final rule definition, which is
identical to that in the proposed rule, states that this type of
scaffold is a supported scaffold consisting of a platform supported by
brackets attached to ladders.
A commenter (Ex. 2-23) stated that the capacity of this type of
scaffold should be limited to ``light duty'' and that the words ``light
duty'' should be included in this definition. As discussed above, OSHA
believes it is inappropriate for definitions to include substantive
requirements. In any event, the Agency has determined that a ladder
jack scaffold which complies with the capacity criteria of
Sec. 1926.451(a)(1) and the other pertinent subpart L requirements will
be considered acceptable. Accordingly, OSHA has not made the suggested
change.
``Landing.'' This new term, which has been added to ensure that the
requirements of final rule Sec. 1926.451(e)(4) are clearly understood,
refers to a platform at the end of a flight of stairs.
``Large area scaffold'' means a pole scaffold, tube and coupler
scaffold, systems scaffold, or fabricated frame scaffold erected over
substantially the entire work area, for example; A scaffold erected
over the entire floor area of a room. The Agency has added this term
and definition, along with final rule Sec. 1926.452(d), to provide a
reference point in the standard for this widely used type of scaffold.
``Lifeline'' means a component consisting of a flexible line for
connection to an anchorage at one end to hang vertically (vertical
lifeline) or for connection to anchorages at both ends to stretch
horizontally (horizontal lifeline), and which serves as a means for
connecting other components of a personal fall arrest system to the
anchorage. A vertical lifeline is sometimes known as a dropline. A
horizontal lifeline is sometimes known as a trolley line. This
definition, which was not part of the proposed rule, has been added for
the sake of clarity. The definition in part 1926, subpart M, Fall
Protection, is consistent with the definition in final subpart L. The
proposed terms ``dropline'' and ``trolley line'', along with their
definitions, have been deleted as separate definitions and have been
incorporated into this final rule definition.
One commenter (Ex. 2-57) stated that a ``trolley line'' was a
``horizontal lifeline'' and suggested that OSHA set ``strength
requirements.'' While final rule subpart L does not set numerical load
requirements for ``horizontal lifelines'', criteria for such equipment
are provided in Sec. 1926.502(d), subpart M, as referenced by a note to
final rule Sec. 1926.451(g)(3).
``Masons' adjustable supported scaffold.'' OSHA proposed this term,
which was not defined in existing subpart L, so employers who used
``self-contained adjustable scaffolds'' in masonry operations would
have a clear reference point in revised subpart L. The final rule is
identical to the proposed rule definition.
One commenter (Ex. 2-23) suggested replacing the parenthetical
reference to self contained adjustable scaffolds with the definition
for such scaffolds in ANSI A10.8-1977. However, to limit redundancy and
confusion, OSHA does not believe that this term should be defined by
the format suggested by the commenter.
``Masons' multi-point adjustable suspension scaffold.'' This term
replaces the term ``Masons' adjustable multiple-point suspension
scaffold'' in the existing standard. The term means a two-point or
multi-point adjustable suspension scaffold designed and used for
masonry operations. The final rule definition is the same as that
proposed.
One commenter (Ex. 2-23) suggested OSHA adopt the definition for
this term from ANSI A10.8-1977, which contains the language
``continuous platform.'' However, it is not OSHA's intent to limit this
type of scaffold to a single ``continuous platform.'' All types of
multi-point suspension scaffolds covered by subpart L may consist of
more than one platform. Multi-point scaffolds are not limited by the
number of suspension wires, platforms, or the location of attachment of
the suspension wires to the platform or platforms (Example: A multi-
point scaffold may consist of one platform suspended by four wires or
it may consist of two platforms suspended by four wires). Additionally
the definition suggested by the commenter did not include the words
``masonry operations.'' OSHA is including the words ``masonry
operations'' in this definition so it applies specifically to such
scaffolds used in the masonry trade.
``Maximum intended load'' means the total load of all persons,
equipment, tools, materials, transmitted loads, and other loads
reasonably anticipated to be applied to a scaffold or scaffold
component at any one time. This term replaces the existing terms
``maximum rated load'' and ``workload''. The term addresses the types
of loads which are to be included when determining the maximum load.
OSHA has been concerned that the word ``rated'' in the existing term
``maximum rated load'' does not clearly express how the safety factor
of four (existing rule paragraph 1926.451(a)(7)) or six (existing rule
paragraph 1926.451(a)(2)) is to be incorporated into the determination
of the maximum load. The final rule definition and final rule
Sec. 1926.451(a)(1) clearly indicate that the maximum intended load is
determined without regard to safety factors. Once the maximum intended
load is determined, the employer then applies the pertinent safety
factor to determine the requisite strength for the system in question.
The final rule definition is the same as in the proposed rule
except the word ``employees'' has been replaced with the word
``persons''. The SIA (Ex. 2-368) suggested this change because
``[p]ersons other than employees might be on a scaffold thus
overloading it.'' OSHA agrees that the weight of all ``persons'' needs
to be considered when calculating the maximum intended load.
One commenter (Ex. 2-23) suggested that OSHA add the closely
related term ``scaffold load rating'' which includes definitions for
the words ``heavy-duty loading,'' ``medium-duty loading,'' ``light-duty
loading'' and ``special loading.'' The Agency provides examples of
appropriate measures for ``heavy-duty,'' ``medium-duty'' and ``light-
duty'' scaffold in non-mandatory Appendix A of final rule subpart L.
Accordingly, the Agency believes the appropriate information is
available and no further changes are necessary.
Two comments (Exs. 2-13 and 2-320) suggested replacing the proposed
term and definition of maximum intended load with the term ``Maximum
Rated Load.'' The commenters suggested that the term ``Maximum Rated
Load'' takes into account safety factors established by the designer or
manufacturer.
OSHA agrees that the term ``Maximum Rated Load'' does include
built-in safety factors. As stated above, by not including the words
``safety factor'' in this definition or replacing the proposed term
with ``Maximum Rated Load,'' which implies built-in safety factors,
OSHA clearly indicates that the minimum safety factor of 4:1 as set
forth in final rule Sec. 1926.451(a)(1) applies. The Agency believes it
is appropriate to take into account the ``expected'' burden as well as
the burden a scaffold ``can'' support without failure.
``Needle beam scaffold'' means a suspension scaffold supported by
needle beams. The final rule definition is the same as the proposed
definition. One commenter (Ex. 2-23) suggested
[[Page 46032]]
that OSHA limit the use of this type of scaffold to ``light-duty''.
However, as discussed earlier, the Agency does not intend to limit the
capacity of a scaffold as long as it meets the pertinent requirements
of Sec. 1926.451(a). OSHA has provided examples of measures that would
enable a scaffold to comply with these requirements in non-mandatory
Appendix A.
``Outrigger.'' This term means the structural member of a supported
scaffold used to increase the base width of a scaffold in order to
provide support and stability for the scaffold. The terms, ``outrigger
beam'' and ``outrigger scaffold'' are new definitions provided to
explain the difference between these three similar terms. The final
rule differs from the proposal, which defined outrigger as ``the
structural member of a supported scaffold used to increase the base
width of a scaffold in order to provide greater stability for the
scaffold.'' The wording change was made in response to a comment from
the SIA (Ex. 2-368), suggesting that OSHA replace the word ``greater''
with the words ``support and increased.'' OSHA agrees that the
suggested wording more accurately expresses the Agency's intent.
``Personal fall arrest system.'' This term, which replaces the
proposed term ``body belt/harness system'', refers to a system used to
arrest the fall of an employee from a working level. It consists of an
anchorage, connectors, and a body belt or body harness and may include
a lanyard, deceleration device, lifeline, or suitable combinations of
these. The final rules on fall protection (part 1926, subpart M) and
powered platforms (Sec. 1910.66) also define ``personal fall arrest
system'' in this manner. The final rule definition is essentially the
same as that proposed for ``body belt/harness systems'', and the phrase
``personal fall arrest systems'' appears in the final rule wherever the
phase ``body belt/harness systems'' was used in the proposed rule. A
commenter (Ex. 2-13) suggested that the definition be reworded to
indicate clearly that lifelines and deceleration devices are not always
included as a part of a body belt/harness system. OSHA agrees and has
clarified this point in the revised definition.
OSHA has deleted the proposed term ``platform unit'' and has
incorporated the proposed definition language into final rule
Sec. 1926.451(b)(1)(i), which addresses the construction of scaffold
platforms.
``Power operated hoists.'' This new term refers to hoists which are
powered by other than human energy. The final rule language differs
from the proposed language, which used the term ``mechanically-powered
hoists''. OSHA has revised the terms ``mechanically powered'' and
``manually powered'' hoists to read ``power operated hoists and
manually operated hoists'', because the Agency has determined that the
language should be consistent with ANSI A10.8-1988, paragraph 6.
``Qualified.'' This term is being added to the final rule as a
matter of convenience for users. The definition is identical to that
found in Sec. 1926.32.
``Rated load.'' This new term addresses the maximum load that a
hoist is allowed to lift. The discussion of final rule
Sec. 1926.451(a)(1), below, addresses the use of this term.
``Repair bracket scaffold.'' This new term has been added to
address the type of scaffold addressed by final rule Sec. 1926.452(x).
This term is discussed below in conjunction with the discussion of that
paragraph.
``Scaffold.'' This term refers to a temporary elevated platform
(supported or suspended) and its supporting structure, including points
of anchorage, used for supporting employees or materials or both. The
definition also clearly indicates that crane or derrick suspended
personnel platforms are not scaffolds. The Agency has added the phrase
``including points of anchorage'' to the definition of scaffold in the
final rule to indicate clearly that points of anchorage are considered
to be part of a scaffold.
``Stair tower (Scaffold stairway/tower).'' This new term has been
added to describe the means of access addressed by final rule
Sec. 1926.451(e)(4). This term is addressed in relation to that
provision below.
``Stall load.'' This new term has been added to identify the
maximum load that a hoist can lift without stalling or shutting down.
The use of this term is discussed in relation to final rule
Sec. 1926.451(a)(2), below.
``Stilts'' mean a pair of poles or similar supports with raised
footrests, used to permit walking above the ground or working surface.
This term and definition has been added to recognize this type of
scaffold, which is used by many trades in the construction industry to
allow employees to walk elevated above the ground or working surface.
Final rule paragraph Sec. 1926.452(y) addresses the safe use of this
type of scaffold both as a scaffold itself, and on other types of
scaffolds (large area scaffolds).
``System scaffold'' means a scaffold consisting of posts with fixed
connection points that accept runners, bearers, and diagonals that can
be interconnected at predetermined levels. This new term has been added
to the final rule to recognize the existence and acceptance of this
type of scaffold. The definition is identical to the definition for the
same term found in ANSI A10.8-1988.
``Tank builders' scaffold'' means a supported scaffold consisting
of a platform supported by brackets that are either directly attached
to a cylindrical tank or are attached to devices that are attached to
such a tank. In the February 1, 1994 notice of record reopening (59 FR
4618), OSHA suggested a definition of ``tank builders' scaffold'' for
consideration. That definition was very similar to the final rule
definition except that the reopening notice definition did not
specifically refer to cylindrical tanks and did specify that the
platform was welded to the steel plates of the tank.
The commenters (Exs. 43-19, 43-23, 43-33, 43-34, 43-35, 43-39, 43-
40, 43-42, and 43-43) who responded to the proposed definition for tank
builders' scaffold stated:
A ``tank'' is not necessarily a cylinder. The scaffold is used
on structures that can be cylindrical, rectangular, conical,
spherical, spheroidal, or elliptical. Also, ``tanks'' are
constructed of material other than metal; e.g., fiberglass, wood,
etc. Some tanks have vertical walls that are so thin that a bracket
could not be welded to it; rather, the bracket would have to be
bolted. We would further comment that the bracket is often inserted
into a device which is welded to the steel plate. So we would
suggest not referencing the bracket being attached to the structure,
but rather the bracket being attached to a device that is affixed to
the structure.
In addition, eleven commenters (Exs. 43-19, 43-21, 43-23, 43-27,
43-33, 43-34, 43-35, 43-39, 43-40, 43-42, and 43-43) stated that the
criteria of an April 4, 1975 variance (40 FR 15139), which addressed
tank builder scaffolds, would be adequately addressed by general
provisions of the final rule and the definition of ``tank builders'
scaffold''.
The 1975 variance order stated:
The applicants' business, which is part of the tank building
industry, involves the erection of relatively large steel plate
segments of circumferential rings. Due to the unique nature of the
construction involved, special procedures, including special
scaffolding, have been developed. For example, as opposed to more
conventional scaffolds, tank scaffolds must be highly portable and
have a relatively low density of occupancy by [workers]. These
scaffolds are raised up the shell of the tank as new rings of steel
are added and work is completed at the level below.
Most plate structures are fabricated from standard length plates
* * * each approximately 31.416 feet (9.42 m.) long, [with] brackets
[normally] welded to them while they are on the ground prior to
being
[[Page 46033]]
placed into position on the tank wall. Scaffolding and guardrail
supports are then attached to these brackets. If the applicants were
to comply with [requirements] that [the maximum spacing for supports
be no more than 8 feet (2.4 m.) for guardrails or 10 feet (3.0 m.)
for planking], they assert it would be necessary to lay out each
steel plate into sections with the brackets located approximately
7.854 feet (2.36 m.) apart. Instead, the applicants wish to lay out
the plates into three equal sections with brackets located
approximately 10' 6'' (3.15 m.) apart.
* * * Because the contour of the steel plates of the tank face
is curved and the adjacent edge of the scaffold platform is
straight, there is an open space between them. As a result,
applicants have installed taut wire rope on the scaffold brackets
that extends midway between the innermost edge of the scaffold
platform and the curved plate structure of the tank face to serve as
a safety line in lieu of an inner guardrail assembly.
Since the information submitted to OSHA in relation to the variance
addressed scaffolds used on cylindrical steel tanks, the Agency is
applying the criteria of the variance only to structures that are
approximately cylindrical. The Agency believes that non-cylindrical
structures should be addressed on a case-by-case basis under the
general provisions of the final rule. OSHA notes that 9 of the 11
commenters (Exs. 43-19, 43-23, 43-33, 43-34, 43-35, 43-39, 43-40, 43-
42, and 43-43) mentioned above also stated ``[t]ank builders place the
scaffold inside of a cylinder, traditionally, to erect the tank.''
However, the Agency believes that the requirements of the variance, as
modified in Appendix A of the final rule, can reasonably be applied to
cylindrical tanks that are constructed of materials other than steel.
The final rule definition for ``tank builders' scaffold'' has been
worded accordingly.
OSHA has not promulgated specific requirements for tank builders'
scaffolds in the final rule because the Agency believes that the
requirements for those scaffolds are adequately addressed in the
general provisions of the final rule. The Agency notes that it has
placed several provisions (some of which have been editorially
modified) of the variance in Appendix A for the benefit of employers
who use tank builders' scaffolds, and that the introductory text to the
Appendix clearly indicates that following the Appendix will be
considered to constitute compliance with the requirements of this
standard with regard to scaffolds used in the construction of
cylindrical tanks. However, employers choosing not to follow the
Appendix must still comply with the applicable requirements of
Sec. 1926.451, particularly paragraphs (a) and (f).
``Top plate bracket scaffold.'' This term is being added to the
final rule to recognize a type of scaffold which is similar to
carpenters' bracket scaffolds and form scaffolds. This type of scaffold
consists of a platform supported by brackets that hook over or are
attached to the top plate of a wall. Such scaffolds are used in
residential construction when employees are setting roof trusses.
OSHA has deleted the following terms, which are defined in the old
scaffold standard, from the definition section of the final rule,
because those terms are now defined in other subparts or because the
final rule no longer uses the terms in question: ``heavy duty
scaffold,'' ``light duty scaffold,'' ``medium duty scaffold,''
``midrail,'' ``toeboard,'' and ``working load.'' In addition, the
proposed definitions for ``drop lines'', and ``trolley line'' have been
deleted from this final rule, since they have been incorporated into
the definition of ``lifeline''.
Under Issue L-12 in the preamble of the proposed rule, OSHA
solicited testimony and related information on a suggestion by the
ACCSH (Tr. 206, 6-9-87) that definitions for ``ramp'' and ``runway'' be
added to the standard. The ACCSH indicated that the added definitions
would facilitate clear understanding of the requirements in proposed
Sec. 1926.451(c)(4) (final rule Sec. 1926.451(e)(4)). As noted under
the discussion of the Issue, a member of the ACCSH recommended that the
Agency use the definition of ramp developed by the National Safety
Council.
The one comment (Ex. 2-593) OSHA received addressing the Issue
supported defining the two terms. The commenter did not provide any
suggested wording but indicated that the definitions should be ``clear
and consistent with existing OSHA and ANSI definitions.''
In the final rule, OSHA has replaced the proposed term ``runway''
with the term ``walkway'', to indicate the Agency's regulatory intent
clearly . However, the Agency believes that ``ramp'' is a commonly
understood term and does not require a specific OSHA definition.
Accordingly, OSHA has not added a definition for ``ramp'' to the final
rule.
Paragraph 1926.451(a) Capacity
Final rule paragraph (a) sets the minimum strength criteria for all
scaffold components and connections. The final rule sets scaffold
capacity requirements that are substantively the same as those in
existing subpart L, while eliminating ambiguities and apparent
inconsistencies. The introductory text of the proposed paragraph, which
stated that ``the following requirements applied to all types of
scaffolds except as indicated:'', has been deleted in the final rule
because the Agency has determined that it is too similar to the
introductory text of paragraph (a)(1) and, therefore, is unnecessary.
Paragraph (a)(1) requires that each scaffold and scaffold component
be capable of supporting, without failure, its own weight and at least
4 times the maximum intended load applied or transmitted to it.
Paragraphs (a)(2), (a)(3), (a)(4), (a)(5) and (g) of Sec. 1926.451
provide exceptions to this general rule, and are discussed below. This
provision is based on existing Sec. 1926.451(a)(7), which requires that
scaffolds and scaffold components ``be capable of supporting without
failure at least four times the maximum intended load''.
The final rule clearly provides that the 4 to 1 factor for a
component applies only to the load which is actually applied or
transmitted to that component, and not to the total load placed on the
scaffold. Existing Sec. 1926.451(a)(7), taken literally, could be read
to require that each separate scaffold component be able to support
four times the maximum intended load (MIL) of the entire scaffold. For
example, the existing provision could be interpreted to require that a
crossbrace on a supported scaffold be capable of supporting the same
load as a scaffold leg, that is, be sized to support four times the
entire MIL regardless of where the load is placed on the scaffold and
regardless of the fact that the function of a brace is to prevent sway
and not directly to support the MIL. Such an approach was not OSHA's
intent. The Agency intended that each component be adequate to meet the
4 to 1 factor, but only for the portion of the MIL applied or
transmitted to that component. The MIL for each component depends on
the type and configuration of the scaffold system. Final rule paragraph
(a)(1), which is effectively identical to the corresponding language in
proposed paragraph (a)(1), clearly expresses the Agency's intent. The
proposed provision has been editorially revised and reorganized for the
sake of clarity. In particular, the exceptions to proposed paragraph
(a)(1), which provide different coverage for suspension scaffolds, have
been clearly delineated as separate paragraphs (a)(2) through (a)(6) in
the final rule.
Paragraph (a)(2) of the final rule requires that direct connections
to roofs and floors and counterweights used to balance adjustable
suspension scaffolds be capable of resisting at least 4 times the
tipping moment imposed by the scaffold operating at either the rated
[[Page 46034]]
load of the hoist or at 1.5 (minimum) times the tipping moment imposed
by the scaffold operating at the stall load of the hoist, whichever is
greater. Proposed paragraph (a)(2) simply required that direct
connections to roofs and floors, and counterweights used to support
suspension scaffolds, be capable of providing a resisting moment of at
least four times the tipping moment. The proposed provision was
intended to clarify that the safety factor of four to one also applies
to direct connections to floors and roofs and to counterweight systems.
These areas are as integral to the scaffold system as the scaffold
platform itself. OSHA has revised the proposed provision to account for
the need to base the factor of safety for adjustable suspension
scaffolds on the rated load of the hoist and the stall load of the
hoist.
Several commenters (Exs. 2-8, 2-28, 2-64, 2-367, and 2-516)
indicated that the factors of safety for adjustable suspension
scaffolds should be based on the rated load of the hoist. Four of those
commenters (Exs. 2-28, 2-64, 2-367 and 2-516) and the SIA (Ex. 2-368)
recommended that the stall capacity of the hoist be considered in the
factors of safety.
One of these commenters (Ex. 2-28) stated that many suspended
scaffolds are rigged by inexperienced persons who do not realize that
if the scaffold catches on an obstruction, the maximum lifting power
(stall load) of the hoist can be developed and transmitted to the
counterweights and anchorages. This commenter suggested adding one of
the following requirements to proposed Sec. 1926.451(a)(2) as an
alternative to four times the tipping moment: (1) or 4,000 pounds,
whichever is greater; (2) or 150 % of the maximum pulling power of the
hoist, whichever is greater; or 4 times the rated load of the hoist,
whichever is greater. The SIA (Ex. 2-368) recommended changing the
resisting moment of proposed Sec. 1926.451(a)(2) to ``at least 1.5
times the stall capacity of the hoist or four times the maximum
intended load, whichever is greater.''
Three commenters (Exs. 2-8, 2-28, and 2-516) indicated that
Underwriters Laboratories (U.L.) standard 1323 (Standard for Scaffold
Hoists) limits the maximum output of a scaffold hoist to 3 times the
rated working load of the hoist. One commenter (Ex. 2-64) recommended
that OSHA limit the stall load of a hoist to no more than three times
the rated load of the hoist. Another commenter (Ex. 2-8) stated that if
the safety factor for suspended scaffolds is not based upon the highest
rated working load of any component, normally the hoist, failure can
occur.
Two commenters (Exs. 2-8 and 2-516) presented examples of the
relationship between the stall load of a hoist and the rated load of
the same hoist. One commenter (Ex. 2-8) provided the following example:
A typical hoist with a ``rated working load'' of 1000 lbs. can
exert a pulling force of 3000 lbs. if an obstruction is encountered
such as a window ledge or air conditioner while ascending. If one
designs for a maximum intended load of only 500 lbs. because of a
short light scaffold platform or a work cage and the counterweight
or suspension system is designed for 4:1 MIL then the ultimate load
that the suspension can support is 4 x 500 lbs. MIL or 2000 lbs. A
3000 lb. hoist pull can cause failure or even wire rope failure if 6
x MIL is used. No one intends to stall a hoist on an obstruction
but it does occur. Therefore, a suspended scaffold should be
designed for safety factors based upon MIL or rated working load of
the hoist whichever is greater.
OSHA agrees that the safety factors for the counterweights,
riggings, direct connections to roofs and floors, and suspension ropes
of adjustable suspension scaffolds should be related to the rated load
of the hoist and the stall load of the hoist, and not be based on the
maximum intended load. OSHA agrees with the commenters who stated that
failure can result if the factors of safety are based on the maximum
intended load. Furthermore, the Agency also agrees with the commenters
(Exs. 2-28 and 2-368) who indicated that these factors of safety should
be based on 1.5 times the stall load of the hoist.
The Agency notes that the stall load of a hoist is equal to three
times the rated load of that hoist. When one applies the 4 to 1 safety
factor required (4 x rated load = 4/3 x stall load) the result
would be 1.33 times the stall load. However, while using 1.33 times the
stall load would provide the required safety factor, OSHA is using 1.5
times the stall load based on the above comments. The Agency believes
that such a requirement reduces the possibility of failure due to
improperly installed equipment as well as the dynamic loads that can be
developed when an obstruction is encountered. Accordingly, the Agency
has changed the final rule language so that it requires a factor of
safety of four times the maximum rated load of the hoist or 1.5 times
the stall load of the hoist, whichever is greater.
Paragraph (a)(3) of the final rule provides that ``[e]ach
suspension rope, including its connecting hardware, used on non-
adjustable suspension scaffolds shall be capable of supporting, without
failure, at least 6 times the maximum intended load applied or
transmitted to that rope.'' This is the same requirement as the
proposed rule except that final rule paragraph (a)(3) applies only to
non-adjustable suspension scaffolds, while the requirements for
adjustable suspension scaffolds have been placed in final rule
paragraph (a)(4), below. The proposed rule did not distinguish between
these two types of scaffolds. Proposed paragraph (a)(4)(i) has been
redesignated to Sec. 1926.451(f)(11) of the final rule, to consolidate
all requirements for wire rope used with suspension scaffolds. In
addition, proposed paragraphs (a)(4)(ii) and (iii) have been moved to
non-mandatory Appendix A, so that examples of measures that would
comply with final paragraph (a) are consolidated in one place.
Paragraph (a)(4) of the final rule provides that ``[e]ach
suspension rope, including connecting hardware, used on adjustable
suspension scaffolds shall be capable of supporting, without failure,
at least 6 times the maximum intended load applied or transmitted to
that rope with the scaffold operating at either (a) The rated load of
the hoist, or (b) 2 (minimum) times the stall load of the hoist,
whichever is greater''.
This provision addresses adjustable suspended scaffolds and is
similar to proposed paragraph (a)(3) except that the proposed paragraph
contained the language ``maximum intended load applied or transmitted
to the rope'' instead of ``rated load of the hoist (or at least 2 times
the stall load of the hoist, whichever is greater)''. The proposed rule
was based on existing Sec. 1926.451(a)(19).
Three commenters (Exs. 2-8, 2-64, and 2-516) recommended that OSHA
use ``rated capacity of the hoist'' instead of ``maximum intended
load.'' This recommendation was based on the belief that the safety
factor for adjustable suspended scaffolds should be based on the
highest rated work load of any component, normally the hoist. The
Agency agrees and has modified the proposed rule accordingly. In
addition, the Agency has included language that accounts for the stall
load of the hoist in the factor of safety for the same reasons that
were discussed in regard to final rule Sec. 1926.451(a)(2), except that
the factor to be applied to the stall load has been increased from 1.5
to 2 in order to account for the 6:1 factor of safety applied to
suspension ropes. This factor of safety does not include an added
margin as does the factor of safety in paragraph (a)(2). One commenter
(Ex. 2-516) recommended an 8:1 factor of safety for suspension ropes on
adjustable suspension scaffolds. This recommendation was based on
several factors that can reduce the effective
[[Page 46035]]
strength of a rope: (1) A termination rating of 80% of the wire rope
design strength; (2) time-use of the rope; (3) energy applied to the
system when the overspeed brake is actuated; and (4) failure of the
brake to set or the loss of one end of the platform rigging. The
commenter concluded that these factors can reduce the factor of safety
from 6:1 to 1.15:1, with failure occurring if anything else goes wrong
such as the free end of the platform swinging through its arc.
OSHA notes that this commenter addresses a worst case scenario
which would involve violations of other provisions of the final rule.
The Agency believes that each of the elements of the scenario will be
prevented by compliance with the final rule. For example, final rule
Sec. 1926.451(d)(6) requires winding drum hoists to contain not less
than four wraps of the suspension rope at the lowest point of scaffold
travel, thereby reducing the force applied to the termination at the
winding drum. In addition, final rule Sec. 1926.451(d)(12)(v) prohibits
the use of U-bolt clips at the point of suspension for any scaffold
hoist. Also, final rule Sec. 1926.451(a)(3) requires that suspension
rope connections be considered part of the rope and that they be taken
into account when determining whether a rope is capable of withstanding
without failure at least six times the loads imposed upon it.
Further, final rule Sec. 1926.451(d)(10) requires that a competent
person inspect suspension ropes prior to each workshift or after any
occurrence which could affect a rope's structural integrity. Paragraph
1926.451(d)(10) also requires that defective or damaged ropes be
removed from service. For these reasons, OSHA believes that the final
rule adequately addresses the commenter's concerns.
The third commenter (Ex. 2-29) recommended that OSHA include the
weight of the scaffold and all its components in calculating maximum
intended load. The Agency believes the above described changes made to
proposed paragraph (a) resolve the concerns raised by this comment.
Paragraph (a)(5) of the final rule, which was not part of the
proposed rule, requires that the stall load of any scaffold hoist not
exceed 3 times its rated load. OSHA finds that this requirement is
reasonably necessary to prevent accidental overloading of suspension
scaffold support systems. OSHA notes that U.L. standard 1323 limits the
output force of a scaffold hoist to three times the rated load of the
hoist. As far as OSHA has been able to determine, the other
laboratories which test and list scaffold hoists adhere to the
requirements of U.L. 1323.
A commenter (Ex. 2-64) recommended that OSHA limit the stall load
of scaffold hoists to three times the rated load of the hoist. The
Agency agrees that it is appropriate to add the suggested provision,
for the reasons described above.
Final rule paragraph (a)(6) requires that scaffolds be designed by
a qualified person and constructed and loaded in accordance with that
design. The provision also indicates that non-mandatory Appendix A
provides examples of criteria, including design specifications, that
will enable the employer to comply with paragraph (a) of this section.
Proposed paragraph (a)(1), which focused on supported scaffolds, also
referenced Appendix A for acceptable criteria.
Non-mandatory Appendix A provides examples of design and
construction measures that employers can use to comply with final rule
Sec. 1926.451(a). This Appendix is based on the requirements set by
existing Secs. 1926.451(c)(1)-(4) and by Tables L-3 through L-19. OSHA
has recognized that employers can design and construct scaffolds which
satisfy the performance requirements of the final rule without
following the specifications set by the existing rule, and drafted both
the proposed and final rule Sec. 1926.451(a) accordingly. The Agency
believes that the above-cited specifications could assist an employer
in complying with the capacity requirements of the final rule, so OSHA
has relocated that language to non-mandatory Appendix A.
In Issue 5 of the preamble to the NPRM, OSHA requested comment on
whether or not all scaffold units (such as planks and decks) should
have their capabilities or grades marked on them. Some commenters (Exs.
2-41, 2-46, 2-51, 2-54, 2-73, 2-367, 2-495, 2-512, 2-516, and 2-534)
indicated they favored the requirements for such markings. Two
commenters (Exs. 2-495 and 2-534) stated ``very few people would know
which grade for any species
FR Doc. 96-21289 Safety Standards for Scaffolds Used in the Construction Industry
of wood qualifies that plank as scaffold
grade.'' Those commenters recognized that there was a lack of consensus
concerning the maximum safe loads on certain plank spans, stating that
``[a]t the same time, we believe it may be premature to require that
all planks be so marked since agreement on methodology of determining
load displacement has not been reached by the engineering profession.''
Another commenter (Ex. 2-54) indicated that marks would not wear
off platform units because ``[i]n most instances, planks are placed and
not moved [and are] generally not rubbed against each other
constantly.'' Another commenter (Ex. 2-516) stated ``[i]f it is so worn
that the mark is lost, it probably needs retesting anyway.''
One commenter (Ex. 2-51) stated that while grade marks would wear
off, it seems unlikely ``that every plank on an entire job would
simultaneously suffer such a fate. We believe that invariably, there
would be some plank where grade stamping was legible if grade stamping
ever existed.''
Another commenter (Ex. 2-41) stated ``[k]nowledge of the capacity
of each [piece of] equipment is basic to implementation of this
proposal.''
In addition, the SSFI (Ex. 2-367) pointed out that fabricated plank
stages and platforms are currently marked as to their capacity. They
stated that this ``practice should be continued for fabricated planks,
stages, and platforms, as these are designed for unique applications.''
The commenter also stated ``there is no common practice within the
industry to have solid sawn lumber marked as to their load capacity.''
The SSFI recommended ``that the solid sawn lumber or laminated veneer
be repeatedly and continuously grade[-]stamped along the side edge of
the material at the time the plank is initially purchased.''
Another commenter (Ex. 2-51) stated that ``[s]ince 1980, Timber
Products Inspection has been involved in five cases where plank failure
has resulted in injury and litigation. In all five cases the planks
that failed were purchased as rough Canadian Spruce #1 and better or #2
and better. None of the planks were grade-stamped and one plank was
identified as Lodge pole pine instead of spruce.''
Another commenter (Ex. 2-35) recommended that OSHA adopt the
language of the ANSI A10.8 draft scaffold standard that requires
``solid sawn scaffold plank to bear the grade stamp of a grading agency
approved by the American Lumber Standards Committee.'' The commenter
also stated ``it is essential to assure use of scaffold members of
adequate strength and stiffness.''
In addition, a commenter (Ex. 2-534) stated:
We are strong advocates of requiring that all plank to be used
as scaffold plank be required to be stamped or embossed as
``SCAFFOLD PLANK''. To most people, all planks look alike. Very few
people would know which grade for any species of wood qualifies that
plank as scaffold grade unless the grade stamp is explicit for
flatwise use as ``Scaffold Plank''.
* * * There is everything to gain, and nothing to lose, by
requiring marks that
[[Page 46036]]
communicate to answer the bottom line question, ``Is this plank OK
as a scaffold plank?''
In addressing Issue 5, the ACCSH recommended (Tr. 6/9/87, pp. 64-
65) that all planking and decks, etc., be properly marked as scaffold
materials. The Advisory Committee indicated that a performance
standard, which would allow employers to determine how they wanted to
mark these materials, would be appropriate. Among the options
envisioned by the ACCSH to distinguish the materials intended solely
for scaffold system use were color-coding systems, stamping, and
tagging.
On the other hand, some commenters expressed the view that a
marking requirement would be impractical (Exs. 2-15, 2-20, 2-22, 2-368,
and 2-390). In addition, commenters (Exs. 2-20, 2-53, 2-55, and 2-390)
stated that the requisite costs would be burdensome, and others (Exs.
2-13, 2-15, 2-69, and 2-368) stated that, while manufactured or
fabricated planks or platforms were often or usually marked, carrying
this over to wooden components was inadvisable, citing anticipated
problems with the volume of planks to be marked and the marks wearing
off. Several commenters (Exs. 2-20, 2-55, 2-70, and 2-390) pointed out
the marks would lend a possibly false sense of security or safety, and
some (Exs. 2-20, 2-55, 2-69, and 2-390) added that maintaining the
marks would be neither feasible nor economical. One commenter (Ex. 2-
70) stated ``The user of platform units can calculate the maximum load
that can be placed on a scaffold and it is up to management personnel
to ensure that the scaffolding is not overloaded. I feel that the
marking of platform units does not, in itself, insure a safe
scaffolding.''
After careful evaluation of the above comments, the Agency has
decided not to require marking of platform units. OSHA has determined
that, while markings can increase confidence in and use of appropriate
platform units, they do not add to the inherent safety of the scaffold.
Furthermore, the absence of markings does not establish a lack of
quality.
In addition, materials quality is only one of several factors which
must be considered when erecting a scaffold platform. Other significant
elements include unit size, span, and load applied. A platform unit,
whether wood or metal, solid sawn or prefabricated, which is marked as
appropriate for use as a plank, may be appropriate for use in one set
of conditions but not in another (i.e., longer span or higher load).
Similarly, a platform unit which does not have the quality
characteristics to allow its use in one situation may be acceptable for
use in another (i.e., shorter span or lighter load) whether or not it
is marked. The important consideration in all situations is that the
platform be capable of supporting the load with a design factor of
four.
OSHA believes the grading rules of recognized independent
inspection agencies, such as the American Lumber Standards Committee
(ALSC), provide useful information about wood plank selection and use.
Planks that are marked and used in accordance with pertinent grading
rules of the ALSC or other recognized independent inspection agency
will be deemed to meet the four-to-one requirement. Therefore, given
the extent to which the private sector has voluntarily adopted plank
grading and marking programs, the Agency has concluded that any benefit
resulting from the addition of marking requirements would be minimal.
Wood products such as Canadian spruce, which are alleged to be
unacceptably inferior in some applications, could have standards
developed for their use by a recognized grading agency. OSHA believes
there are combinations of thickness, quality, span, loads, and other
factors that can be established for all species of wood used for
platforms.
Issue 17 of the preamble to the NPRM asked whether the Agency
should specify a minimum slippage capacity of 4,000 pounds and a
minimum breakage capacity of 16,000 pounds for couplers used on tube
and coupler type scaffolds. The SSFI and SIA (Exs. 2-367 and 2-368)
opposed such a requirement, stating that ``the entire scaffold
structure should be required to withstand the specified design loads.''
They also noted that this special component requirement was unlike
other OSHA requirements. The SIA (Ex. 2-368) also stated:
It is redundant and unnecessary to specify a quantitative value
for clamp strength since the required safety factors already in
existence provide the proper strength for the intended load. There
may be cases where the clamps should be of higher value or lower
value, depending on usage. Consequently, requiring a numerical value
may produce the catastrophe which the proposed rule is trying to
avoid in the first place. Existing rules require design by competent
individuals, which provides the proper safeguards against abuse and
eliminates the need for the proposed rule.
Also, a commenter (Ex. 2-15) indicated that a British standard (BS
1129) recognizing 2800 lb. has been in place for 20 years ``with
satisfactory results.'' The commenter stated that most American clamps
are built to BS1129, and went on to indicate that the same 2800 lb.
figure is generally sufficient, except for possible heavy-duty
applications in a specific configuration. The commenter further felt
that specifying a 4,000 lb. minimum slippage capacity would ``outlaw''
many clamps.
One commenter (Ex. 2-22) stated that both slippage and minimum
breakage capacities ``should be equivalent to that required on the
other parts of the scaffold.''
Another commenter (Ex. 2-128) stated ``couplers for tube and clamp
[scaffolds] should be rated by the manufacturer in accordance with a
recognized testing standard [and] certified by an engineer.'' In
addition, a commenter (Ex. 2-13) expounded on the relationship between
the torque applied to tighten a coupler and the slippage capacity, and
noted that proper torque values needed to be determined by tests or
calculations.
The ACCSH (Tr. 6/9/87, pp. 138-147) recommended that OSHA specify
both minimum slippage and breakage capacities and should require
employers to obtain manufacturer's specifications and/or certifications
that a scaffold meets minimum standards. However, the ACCSH did not
endorse the suggested 4000 and 16,000 pound limits and did not propose
any other limits.
After a careful review of the above comments, OSHA has determined
that the capacity provisions set out in final rule Sec. 1926.451(a)
will appropriately address the concerns regarding scaffold strength and
that additional specifications would be redundant.
Issue 21 of the preamble to the NPRM requested public comment on
appropriate field test procedures or certifications for determining the
capacity of scaffolds and scaffold components such as planks and ropes.
As noted above, existing Sec. 1926.451(a)(7) and proposed
Sec. 1926.451(a)(1) require scaffolds to be capable of supporting,
without failure, at least four times the maximum intended load. OSHA
has recognized, however, that field testing of scaffolds and scaffold
components with loads four times greater than the maximum intended load
could cause damage that would render the scaffold and scaffold
components unusable.
One commenter (Ex. 2-54) mentioned reliance on testing laboratories
to ensure that rope and planks meet industry standards. Another
commenter (Ex. 2-64) stated that scaffolds' and support systems' rated
capacities should be marked when manufactured and that any field
testing beyond that set forth in a manufacturer's instructions would be
superfluous and could conflict with those instructions.
[[Page 46037]]
The SSFI (Ex. 2-367) and the SIA (Ex. 2-368) both stated that field
testing of supported scaffolds would permanently damage equipment or
render it useless, and that a visual check of the scaffolding before
use should ensure safety ``as the manufacturer already warrants the
appropriate safety factors.'' The SIA also stated that current testing
methods ``are not suitable for checking the ultimate capacity of
scaffold components.'' The SIA further stated that for metal
components, visual inspection is the only practical method available.
For wooden components, the SIA stated that inherent material variables
make obtaining repeatable results from a suitable bending test
impossible. On the other hand, the SIA recommended that suspension
scaffolds be field tested with the intended load.
Two other commenters (Ex. 2-495 and 2-534) agreed with the SIA that
it is impossible to obtain repeatable results from a bending test.
However, they stated that a minimum threshold design value for flat-
wise bending of planks could be derived from available information for
flat-wise bending for any specie of plank. Those commenters also stated
that field testing would not necessarily permanently damage or render a
plank useless. They stated that strength testing of used planks could
be accomplished by combining visual inspections with deflection testing
using a safe load and deflection testing machines that are currently
available.
One commenter (Ex. 2-516) indicated that a reasonable level of load
testing for scaffold machinery might be found ``somewhere near 1.25
times [the] rated load'' and that ``any field tests should be a ratio
of rated load, not failure load.'' The commenter assumed different
safety factors for moving equipment, suspended scaffold hoists, and
fixed structures. The commenter also questioned whether the safety
factor referred to in Issue 21 was for static, dynamic, or shock loads,
and noted that 4 to 1 is not an engineering safety factor but a gross
factor. In addition, the commenter stated:
Any device or mechanism designed for a structural safety factor
of four-to-one certainly can be tested at some level less than four-
to-one without structural failure. * * * It is difficult to
comprehend the rationale of prohibiting testing of a structure using
1\1/2\ times rated load for fear it will collapse, when the
structure must not collapse at 4 times rated load. There would then
be doubt in my mind as to its ability to meet that 4-to-1 criterion.
Also, the commenter (Ex. 2-516) pointed out that any test of wood
components should consider the effects of aging material, and he listed
a number of variables for which some testing adjustments would be
required. These variables included ``fatigue, finish,'' and ``material
test scales.''
Two commenters (Exs. 2-13 and 2-69) indicated there would be no
need for field testing since scaffolds should be designed for their
intended load with an added safety factor. In particular, one of those
commenters (Ex. 2-13) stated ``[t]here are no appropriate field tests
for such items as planks and ropes. A simple visual inspection is all
that is required by a competent person.''
The ACCSH (Tr. pp. 163-174, 6-9-87) recommended that the
manufacturer's design specifications be recognized as sufficient for
manufactured scaffolds. The ACCSH also recommended that specifications
or testing procedures be specified for job-made scaffolds.
After carefully considering the above comments, OSHA has decided
not to require field testing of scaffolds. Based on the comments
received, the Agency has determined that such testing is not needed and
that, given the inspection and capacity requirements, it would be
difficult or impossible to implement effectively for the range of
materials in question.
Issue 23 of the preamble to the NPRM solicited comments on whether
or not the Agency should revise paragraph 1.(b) of proposed non-
mandatory Appendix A, which provides for selection of wood scaffold
planks according to the grading rules established by a recognized
independent inspection agency. In particular, OSHA asked if the
language should be more specific and, if so, what that language should
be.
Four commenters (Exs. 2-13, 2-22, 2-29, and 2-53) responded that
the proposed Appendix A language was adequate. One commenter (Ex. 2-13)
added ``it should be mandatory that the employer visually check all
scaffold planks before they are used.'' Another commenter (Ex. 2-54)
stated that scaffold planks ``should have identification'' to indicate
that they are scaffold grade.
However, a commenter (Ex. 2-534) noted that ``it may be premature
to require that all planks be so marked since agreement on methodology
of determining load displacement has not been reached by the
engineering profession.''
The SSFI (Ex. 2-367) recommended that scaffold planks be marked,
and noted that the most plank failures are inspection related. The SIA
(Ex. 2-368) recommended that OSHA revise paragraph (b) of proposed
Appendix A to read, in part, as follows:
All solid sawn planking shall be `SCAFFOLD GRADE' plank and
grade stamped as appropriate per the published grading rules of the
recognized independent inspection agency and as approved by the
Board of Review of the American Lumber Standards Committee. The
maximum permissible spans for 2 x 10 inch (nominal 1\1/2\'' x
9\1/4\'' minimum dressed (S4S), 1\5/8\'' x 9\1/2\'' minimum rough
or 2'' x 10'' minimum rough, solid sawn wood planks shall be as
shown in the following table.
Paragraph 1(b) of Appendix A should be expanded and clarified to
eliminate the confusion that exists over the use of nominal
thickness scaffold grade planks on 10 ft. spans for light trades.
This could be achieved by defining a scaffold grade plank in the
manner done in Cal-OSHA standards.
Cal-OSHA Section 1637(e) requires what it calls a ``structural
plank'' for scaffold platforms as follows:
``Except as specified in certain other Orders, all planking
shall be 2-inch (nominal) material selected for scaffold grade plank
as defined in Section 1504 under the heading Lumber--`Structural
Plank'.''
The ACCSH, in its June 9, 1987 (Tr. pp. 175-180), meeting,
recommended that a competent person be responsible for the selection
and use of scaffold materials, where scaffolding materials are not
certified by the manufacturer.
After carefully considering the above comments, OSHA has decided to
modify paragraph 1.(b) of non-mandatory Appendix A to the final rule to
provide for identification of scaffold planks by the grade stamp of the
recognized lumber grading association or independent lumber grading
inspection agency under whose grading rules the planks were selected.
OSHA is also modifying proposed Appendix A to provide that the
association or agency under which the wood is graded should be
certified by the Board of Review, American Lumber Standard Committee as
set forth in the American Softwood Lumber Standard of the U.S.
Department of Commerce. This added language clearly indicates what
constitutes a ``recognized'' inspection agency.
As a separate matter, OSHA is modifying Appendix A to the final
rule to provide that allowable spans of scaffold planks, other than 2 x
10 inch (nominal) or 2 x 9 inch (rough) solid sawn planks which are
addressed in the table in paragraph 1 (b), shall be determined in
accordance with the National Design Specification For Wood Construction
published by the National Forest Products Association or with ANSI
A10.8-1988, paragraph 5. OSHA notes that Appendix A is intended to help
the employer comply with the scaffolding rules. The Agency believes
that the above modifications will facilitate compliance with those
rules.
[[Page 46038]]
Paragraph (a)(6) of the final rule, which was not part of the
proposed rule, requires that scaffolds be designed by a qualified
person and must be constructed and loaded in accordance with that
design. OSHA believes that a ``qualified'' person can design a scaffold
which satisfies the criteria of Sec. 1926.451(a). This provision also
notes that non-mandatory Appendix A contains examples of criteria that
will enable employers to comply with paragraph (a) of this section.
Issue 24 of the preamble of the NPRM noted that existing
Secs. 1926.451(b)(16), (c)(4), (c)(5), (d)(9) and (g)(3) and proposed
Sec. 1926.451(b)(18)(i) and Secs. 1926.452(a)(10), (b)(10), (c)(6) and
(i)(8) require that an engineer design specified scaffold types and/or
components that are not built or loaded in accordance with Tables L-4
through L-13 of existing Sec. 1926.451 or proposed Sec. 1926.451
Appendix A, respectively. OSHA asked for comments regarding the extent
to which the services of an engineer or of a qualified person would be
needed to design scaffolds in accordance with the provisions of
Appendix A or to design scaffolds that, while not in accordance with
Appendix A, would comply with Sec. 1926.451(a).
Two commenters (Exs. 2-69 and 2-437) responded that employers
should be allowed to assess whether individual employees with several
years of hands-on experience are capable of designing and modifying
scaffolds or an engineer's services are required. Also, a commenter
(Ex. 2-22) expressed the view that there was no need for further
licensing and determinations because employers are responsible for
ensuring that scaffolds meet regulations for capacity and that
alterations of scaffold designs are made by qualified individuals. The
AGC commenters (Exs. 2-20, 2-55, and 2-390) stated ``there are many
individuals in the construction industry with many years of experience
who are quite capable of scaffold design and modification. Employers
should be permitted the flexibility to determine if such individuals
are capable or if they should seek the services of an engineer.''
Another commenter (Ex. 2-54) noted that not all engineers are
capable of designing scaffolds and that a good many people who work
with scaffolds do not know all the scaffold limits or strengths. The
commenter acknowledged that complicated scaffold designs require the
skills of an engineer familiar with the equipment available. However,
the commenter added that a competent worker who has followed an
engineer's drawings to erect a scaffold can at times recall and use
that experience in another situation requiring a complicated scaffold
structure.
In addition, a commenter (Ex. 2-21) stated that no additional
specification requiring the use of engineering services was warranted.
The commenter explained that ``[c]onditions on most construction jobs
change daily and can best be handled by qualified foremen or
supervisors on the job.'' Also, a commenter (Ex. 2-31), addressing
pumpjack scaffolds specifically, responded that although he was not an
engineer himself, he knew at least as much as anyone else about
pumpjack scaffolds. He felt that an engineer could be supplanted by
someone with recognized expertise but added that he did not believe a
specific definition of someone qualified to design a scaffold system
could be made.
Both the SSFI (Ex. 2-367) and the SIA (Ex. 2-368) recommended that
a ``qualified person,'' as defined in proposed ANSI A10.8, be allowed
to design those scaffolds that would not require the services of a
registered engineer. They quoted the proposed ANSI definition as
follows:
A term describing one who, by possession of a recognized degree,
certificate, or professional standing, or who by extensive
knowledge, training, and experience, has successfully demonstrated
the ability to solve or resolve problems relating to the subject
matter, the work, or the project.
The suggested definition is identical to the definition of
``qualified'' in Sec. 1926.32(l).
Two Saf-t-Green commenters (Exs. 2-14 and 2-15) stated that people
other than engineers were capable of designing scaffolds. In
particular, one commenter (Ex. 2-15) stated ``There are many good,
practical scaffold designers who are not engineers. They should not be
excluded.''
On the other hand, some responses to Issue 24 stated that the
services of a registered or professional engineer were needed (Exs. 2-
3, 2-9, 2-13, 2-70, 2-128, and 2-516). One such commenter (Ex. 2-13)
stated that he backed using registered professional engineers ``with
the knowledge and training required for [designing] a life support
system'' and queried where ``an equivalent qualified responsible person
could be found?'' One commenter (Ex. 2-70) offered a brief response,
``when in doubt, consult an engineer.'' Another commenter (Ex. 2-516)
responded:
I would rather take my chances with the engineer [-designed
scaffold system]. At least he knows some limits. Any other
definition lets anyone determine by themselves that they are
eminently qualified. All it then takes to be qualified is a big ego,
a little knowledge, and a pile of frame scaffold.
A comment from Aluma-Systems, Incorporated (Ex. 2-128) expressed
the belief that an engineer's services should be required for all but
the simplest of scaffold structures. The commenter indicated that the
Province of Ontario requires that a professional engineer design any
scaffold which exceeds 15 meters in height (approximately 50 feet), any
suspension scaffold where the scaffold consists of more than one
platform, or any suspension scaffold where the weight of the platform
and its components exceed 363 kg.
In addition, two commenters (Exs. 2-12 and 2-53) responded that the
existing regulations were sufficient or adequate. One of the two (Ex.
2-12) stated that there was already sufficient regulation and
questioned whether rules could be made to cover all situations.
In its June 9, 1987, meeting, the ACCSH (Tr. pp. 180-183)
recommended that OSHA authorize a competent person, rather than a
qualified person, to follow Appendix A for scaffold design, but that a
registered professional engineer be required to design scaffolds where
conditions are not covered by Appendix A. The Agency notes that a
competent person, as defined in Sec. 1926.32(f) and in the final rule
for subpart L, is able to detect hazards and has the authority to have
hazards corrected. On the other hand, ``qualified'', as defined in
Sec. 1926.32(m) and in the final rule for subpart L, refers to a person
who has the ability to solve or resolve safety and health problems.
After carefully considering the above comments, OSHA believes that
the proposed rule adequately addressed the conditions under which a
scaffold must be designed by an engineer. Accordingly, the above-listed
proposed requirements (Sec. 1926.451(b)(18)(i) [now final rule
Sec. 1926.451(d)(3)(i)] and Secs. 1926.452(a)(10), (b)(10), (c)(6), and
(i)(8)) have been promulgated in the final rule. As discussed below,
proposed rules Sec. 1926.452(a)(10) and (b)(10) have been revised to
distinguish more clearly between those circumstances where the employer
would need the services of a registered professional engineer and those
situations where the services of a qualified person, who could refer to
non-mandatory Appendix A, would be sufficient.
The Agency believes that there are qualified persons who can
properly design scaffolds without reference to Appendix A. The Agency
also believes that there will be circumstances where the ``qualified
person'' retained to comply with paragraph (a)(6) will need to be a
registered professional engineer.
[[Page 46039]]
Paragraph 1926.451(b) Scaffold Platform Construction
Paragraph 1926.451(b) of this final rule provides criteria for the
construction of scaffolds. Paragraph (b)(1) requires all platforms,
except walkways and those platforms used by employees performing
scaffold erection and dismantling operations, to be fully decked or
planked. In addition, paragraph (b)(1)(i) requires that platform units
be placed so that spaces between units do not exceed 1-inch, except
where employers establish that more space is needed. For example, this
would be necessary to fit around uprights when using side brackets to
extend platform width. Paragraph (b)(1)(ii) provides that, where the
exception created by paragraph (b)(1)(i) applies, employers shall place
platform units as close together as possible, with the space between
the platform and uprights not to exceed 9\1/2\ inches. OSHA set 9\1/2\
inches as the maximum space allowed, because the minimum width for
scaffold units that could be expected to sustain a working load is just
over 9\1/2\ inches. This provision, which is effectively identical to
the provision in the proposed rule, codifies the Agency's longstanding
interpretation of existing Sec. 1926.451(a)(4), which addresses
guardrails on scaffolds, to require that guardrails be erected as close
as possible to the platform planking. Because guardrails normally can
be conveniently attached only at the scaffold uprights, OSHA has
required the platforms to be sized such that there is no gap between
the outermost plank edge and the guardrail. However, most prefabricated
end frames do not have a lateral spacing between uprights which can
accommodate an integral number of commercially-available planks. In
order to comply with the existing rule, some employers have modified
the last plank (notched, slanted, or cut it to size). This can lead to
a significant reduction in plank strength, and possibly cause tipping
of the plank (sideways) if eccentrically loaded. Therefore, to deal
with this problem, proposed and final rule paragraph (b)(1) have
modified the corresponding requirement of the existing standard by
requiring the span between uprights to be planked or decked as fully as
possible, but allowing up to 9\1/2\ inches between the planking or
decking and the guardrail supports. As explained above, 9\1/2\ inches
is the maximum allowable open space.
One commenter (Ex. 2-29) stated that the 1-inch opening allowed by
proposed paragraph (b)(1)(i) would be large enough to ``allow many
tools and small materials to fall through'', and recommended a maximum
space of \1/4\ inch between units. OSHA, however, finds that such a
small maximum space would pose unreasonable compliance burdens, and is
retaining the 1-inch maximum.
The SSFI and the SIA (Exs. 2-367 and 2-368) stated that compliance
with proposed paragraph (b)(1) would be impossible when erecting or
dismantling scaffolds. In particular, the SIA (Ex. 2-368) stated:
For example: On a multi-level supported scaffold where
construction work is to be performed only at the top level, lower
levels would not be planked. Erectors would only use sufficient
planks required to construct the scaffold.
Load requirements limit the number of levels that can be planked
on many installations. The additional cost in labor and material
would be staggering. In addition, the fatigue factor created by
installing full planking from one level to the next would create a
greater hazard to the erectors.
The Agency agrees with the SIA comments and acknowledges that a
requirement to fully plank under these conditions would unreasonably
interfere with the erection and dismantling process. The Agency also
agrees that a requirement to fully plank every intermediate platform
level, where no work other than scaffold erection or dismantling
operations will occur, is overly burdensome. Therefore, OSHA has
revised proposed paragraph (b)(1), which already excepted walkways from
the requirement for full planking or decking, to add an exception to
the final rule to the planking requirements for erection or dismantling
operations. In a situation where no work, other than erecting or
dismantling the scaffold, is being done at intermediate levels, the
final rule requires only that the planking established by the employer
as necessary to provide safe working conditions for employees erecting
or dismantling the scaffold be used. On the other hand, if scaffold
erection or dismantling is being performed from an intermediate level
platform that is being or will be used as a work area, that platform
must be fully planked in accordance with paragraph (b)(1).
Paragraph (b)(2) of the final rule requires that all scaffold
platforms and walkways be at least 18 inches (46 cm) wide, with lesser
widths allowed for ladder jack scaffolds, top plate bracket scaffolds,
pump jack scaffolds, roof bracket scaffolds, and boatswains' chairs,
and for scaffolds in areas shown to be too narrow to accommodate an 18-
inch wide surface. Proposed paragraph (b)(2) also required a minimum
18-inch width, with exceptions for ladder jack scaffolds (12 inches)
and boatswains' chairs (any width). The rationale for setting a 12-inch
minimum width for ladder jack scaffolds, as discussed in the preamble
of the proposal (51 FR 42684-85), was the difficulty of handling one
18-inch wide plank or two 9-inch planks on a ladder, which the Agency
considered more hazardous than working on a 12-inch wide plank. In the
final rule, OSHA has also included pump jack scaffolds in the exception
to paragraph (b)(2) for which a minimum platform width of 12 inches is
permitted, based on a commenter's statement (Ex. 2-31) that OSHA's
performance criteria for pump jack scaffolds enable employees to work
safely on platforms that are 12 inches or 14 inches wide. The commenter
also indicated that requiring pump jack scaffold platforms to be at
least 18 inches, instead of 12 inches, wide would create ``an economic
hardship * * * for this very prevalent size aluminum platform.'' OSHA
agrees that pump jack scaffolds with platforms as narrow as 12 inches
can satisfy the performance criteria of the final rule and has revised
paragraph (b)(2) accordingly.
In addition, the Agency is recognizing top plate bracket scaffolds
and adding them to the list of scaffolds which are permitted to have
platforms not less than 12 inches in width. As discussed above in the
definition section, these are supported scaffolds, similar to
carpenters' bracket scaffolds and form scaffolds, which consist of a
platform supported by brackets that hook over or are attached to the
top plate of a wall. These scaffolds are used in residential
construction for setting trusses, usually for high ceiling situations
(e.g., cathedral ceilings, atria). The Agency has determined that use
of this type of scaffold, even with a 12-inch wide platform, provides
greater protection for employees setting trusses than the use of
ladders, makeshift scaffolds or walking the top plate. OSHA concludes
that it would be less safe to require wider platforms for top plate
scaffolds because setting up this type of scaffold would then require
handling and positioning an 18-inch wide platform or two nine-inch wide
platforms, and handling and positioning larger, heavier brackets, which
is usually done from ladders. OSHA finds that this would be more
hazardous than working on one 12-inch wide platform equipped with fall
protection.
As proposed, OSHA is deleting the requirement that appeared in the
existing scaffold rule at Sec. 1926.451(l)(1), which sets the minimum
dimensions of
[[Page 46040]]
a boatswains' chair at 12 inches by 24 inches, because, with the advent
of slings and molded seats, the Agency believes that setting minimum
dimensions is overly restrictive. This performance-oriented approach is
reflected by the inclusion of language in paragraph (b)(2)(i) which
specifically exempts boatswains' chairs from any width requirements.
The SIA (Ex. 2-368) suggested that platforms as narrow as 12 inches
wide be allowed in areas where entryways are restricted. Another
commenter (Ex. 2-64) suggested that suspension scaffolds designed for
special applications (e.g., to fit through manholes) be permitted to be
as narrow as 12 inches. OSHA realizes that there may be instances where
the nature of the work being performed makes it impossible to make
platforms and walkways at least 18 inches wide. Where the employer can
establish that such a situation exists, the Agency will accept
platforms and walkways that are less than 18 inches wide, provided both
that such platforms and walkways are as wide as is feasible and that
employees are adequately protected from fall hazards by the use of
guardrails and/or personal fall arrest systems, as required by
paragraph (g).
Final rule paragraph (b)(3) (proposed as paragraph (b)(4)) sets the
requirements for the space between the front edge of a platform and the
face of the structure where the scaffold is being used. Paragraph
(b)(3) requires that, except as provided in paragraphs (b)(3)(i) and
(b)(3)(ii), the front edge of all platforms must be no more than 14
inches from the face of the structure, unless the employer implements
guardrail systems or personal fall arrest systems that comply with
paragraph (g) of the final rule to protect employees from falling
between the platform and the structure. Final rule paragraph (b)(3)(i)
requires that the front edges of outrigger scaffolds be no more than
three inches from the face of the structure, as is required by
Sec. 1926.451(g)(4) of OSHA's existing standard. Final rule paragraph
(b)(3)(ii) requires that the front edges of scaffolds used for
plastering and lathing operations be no more than 18 inches from the
face of the structure.
The 18-inch dimension was developed from data collected by Wang
Associates (Ex. 5) which show that a shorter distance between the
scaffold platform and the wall is not feasible for the operators of
plastering and lathing equipment because of interference with the tools
used during such operations. However, these same operations cause the
employee to stand back from the edge and the hazard of falling is
correspondingly reduced. The SIA (Ex. 2-368) supported the 18-inch
provision as being necessary for the types of work covered, while
acknowledging that in some cases 14 inches would be adequate.
Final rule paragraph (b)(3) is effectively identical to proposed
paragraph (b)(4), except that the proposed provision specified ``Type
I'' guardrails instead of requiring compliance with paragraph (g). OSHA
has deleted the designations ``Type I'' and ``Type II'' from the final
rule for subpart L, as discussed above in relation to the definition of
``Guardrail system''.
Existing Sec. 1926.451(a)(4) requires guardrails on all open sides
and ends of a scaffold platform, but does not specify how far away a
scaffold platform may be from a building before the side facing the
building is considered to be an ``open side.'' OSHA's existing scaffold
rule has often been interpreted to mean that no open space is allowed.
However, zero clearance during all phases of construction is not
feasible. The 14-inch limit in proposed paragraph (b)(4) recognized
that during construction the face of the wall being built often moves
out toward the scaffolds. There must be sufficient space at the
beginning of work to allow for the installation of insulation, lathing,
plaster, masonry units, ledges, facings and other architectural or
structural additions. The spacing must be allowed for from the start,
because it is not practical to move large scaffolds away from the wall
as wall construction progresses outward. When the initial set back
distance must be more than 14 inches, the platform can often still be
kept within 14 inches of the building by the use of side brackets or
extensions on supported scaffolds, and by angulated roping, static
lines, or equivalent means on suspension scaffolds.
Two commenters (Exs. 2-41 and 2-465) questioned the use of 14
inches in this provision, suggesting that a maximum of 12 inches be
allowed. While OSHA recognizes that the suggested 12-inch spacing could
be marginally more protective, the Agency also recognizes that, as
discussed above, in many cases an unobstructed working space of at
least 14 inches is necessary. OSHA also notes that ANSI A10.8-1988,
paragraph 4.5.9, allows up to a 16-inch space for supported scaffolds
and a 12-inch space for suspended scaffolds. In support of OSHA's
position, the SIA (Ex. 2-368) endorsed the proposed language as the
proper solution to the problem, while noting that it would prefer 18
inches. The Agency believes that the 14-inch space appropriately
addresses both the safety concerns and the need to allow necessary room
for many of the jobs normally performed from scaffolds.
Final rule paragraph (b)(4) requires each end of a platform unit,
unless cleated or otherwise restrained by hooks or equivalent means, to
extend over the center line of its support at least six inches (15 cm).
This provision is virtually identical to proposed paragraph (b)(5),
which was based on existing Sec. 1926.451(a)(14). The use of cleats,
hooks, and similar securing devices would also be allowed as
alternatives to the six inch extension in the proposed and final rules,
because of their ability to restrain movement of platform units.
OSHA received one comment (Ex. 2-40) on this provision, which
stressed the importance of securing platform units against movement.
Final rule paragraph (b)(5) (proposed paragraph (b)(6)) addresses
the maximum distance platform units may extend over their supports. In
particular, paragraph (b)(5)(i) provides that each end of a platform
unit 10 feet (3 m) or less in length shall not extend over its support
more than 12 inches (30 cm) unless the unit is designed, and installed
so that the cantilevered portion of the unit is able to support
employees or material without tipping or has guardrails which prevent
employee access to the cantilevered end. In addition, paragraph
(b)(5)(ii) provides that each platform unit greater than 10 feet in
length shall not extend over its support more than 18 inches (46 cm),
unless the unit is designed and installed so that the cantilevered
portion of the unit is able to support employees without tipping, or
that the unit has guardrails which block employee access to the
cantilevered end.
OSHA proposed to change the maximum overhang allowed by existing
Sec. 1926.451(a)(14) from 12 inches to 18 inches because many planks in
use are 10 feet long, and are used to span eight foot distances. OSHA
also notes that ANSI A10.8-1988, paragraph 4.17, limits planks from
extending more than 18 inches over their supports, without regard to
the length of the plank.
OSHA's thinking at the time of the proposal was that the existing
requirement was unnecessarily restrictive, and that strict adherence to
the existing maximum overhang limit would require platform units to be
cut if they extended beyond the 12-inch limit.
Although no comments were received on this provision, OSHA has
concluded, upon further consideration of this matter, that the maximum
overhang allowed, unless the above specified
[[Page 46041]]
measures have been taken, should be limited to 12 inches for planks 10
feet or less in length, and 18 inches for planks greater than 10 feet
in length. The Agency concludes that allowing an 18-inch overhang as a
matter of course would be unsafe, because the weight of an employee on
an 18-inch overhang could easily tip a 10-foot plank. However, an 18-
inch overhang on a plank that is longer than 10 feet would be
permissible because the additional weight of the longer platform would
offset the weight of the employee on the overhang. In addition, an
employer who seeks to use platform units that overhang the supports
more than the prescribed distance would be required to satisfy the
performance criteria of paragraph (b)(5) of the final rule.
Under final rule paragraph (b)(6), where platform units are abutted
to create a long platform, each abutted end shall rest on a separate
support surface. Abutted platform units do not rest one on another, but
instead are end-to-end. Consequently, one unit does not support the
other, and proper support can only be provided by separate support
surfaces. This provision is virtually identical to proposed paragraph
(b)(7), except that the final rule has deleted the words ``butt plate
or equivalent means of support'', because those words add nothing to
the requirement for ``separate support.'' This provision is based on
existing Sec. 1926.451(b)(12), which currently applies only to wood
pole scaffolds. OSHA has determined that all scaffolds need proper
platform support and, accordingly, has promulgated this provision.
The Agency has also added a note to this provision stating that
common support members such as ``T'' sections or hook-on platforms
designed to rest on common supports are not prohibited by this
provision. The Agency is doing this to prevent confusion since these
commonly used support members might be considered not to meet the
requirements of this provision.
Final rule paragraph (b)(7) provides that where platforms are
overlapped to create a long platform, the overlap shall occur only over
supports, and shall not be less than 12 inches (30 cm) unless the
platforms are nailed together or otherwise restrained to prevent
movement. This provision is virtually identical to proposed paragraph
(b)(8) which was based on existing Sec. 1926.451(a)(12).
Final rule paragraph (b)(8) requires that at all points of a
scaffold where the platform changes direction, such as turning a
corner, any platform that rests on a bearer at an angle other than a
right angle shall be laid first and platforms which rest at right
angles over the same bearer shall be laid second, on top of the first
platform. This provision is virtually identical to proposed paragraph
(b)(9), which was based on existing Sec. 1926.451(b)(13). While this
provision in OSHA's existing standard addresses only wood pole
scaffolds, OSHA has determined, as with final rule paragraph (b)(6),
that the existing requirement is appropriately applied to the
construction of all scaffold platforms.
Final rule paragraph (b)(9) provides that wood platforms shall not
be covered with opaque finishes, except that platform edges may be
covered or marked for purposes of identification. Platforms may be
coated periodically with wood preservatives, fire-retardant finishes,
and slip-resistant finishes, but the coating may not obscure the top or
bottom wood surfaces. This paragraph is intended to ensure that
structural defects in platforms are not covered from view by the use of
an opaque coating or finish. Hairline cracks can significantly reduce
the strength of a wood member, so early detection of structural defects
is important. Opaque finishes can cover such cracks and make them
difficult to discover. The edges of platform units are excepted from
this rule to allow identification marks, grading marks, or other
similar type of marks to be placed on the unit edges.
This provision is virtually identical to proposed paragraph
(b)(10). The proposal addressed the use of wood preservatives, fire
retardant finishes and slip-resistant finishes in a ``note'', while the
final rule has incorporated the pertinent language directly into the
regulatory text. In short, those finishes may be used as long as they
do not obscure the top or bottom wood surfaces.
Final rule paragraph (b)(10) requires that scaffold components
manufactured by different manufacturers not be intermixed unless the
component parts fit together without force and the resulting scaffold's
structural integrity is maintained by the user. Scaffold components
manufactured by different manufacturers shall not be modified in order
to intermix them unless the resulting scaffold is determined by a
competent person to be structurally sound. OSHA expects that the
competent person who evaluates the scaffold will have the appropriate
knowledge, skill and experience regarding scaffold systems and
components.
This provision is identical to proposed paragraph (b)(11), except
that the proposal did not contain the phrase ``and the resulting
scaffold's structural integrity is maintained by the user''. The SIA
(Ex. 2-368) suggested the added language, citing the ``latest ANSI
A10.8 draft.'' The Agency acknowledges that a scaffold may lack the
requisite structural integrity even though the intermixed components
``fit together without force.'' OSHA agrees that the requirement to
maintain structural integrity should be clearly stated in this
provision and has revised the final rule accordingly.
One commenter (Ex. 2-29) stated ``[m]any, if not all, scaffold
manufacturers void any liability if their scaffold components are
intermixed * * * A standard requirement should not result in a lesser
degree of safety; neither should it encourage an employer to take a
course of action that could increase his liability.'' The SSFI (Ex. 2-
367) stated ``[i]t would be the Institute's recommendation that
scaffold components not be intermixed even though they may re[a]dily
fit together without force. Many times the capacity or bracing
alignment would not be the same as other types of scaffold, thus
creating a hazardous situation.'' OSHA agrees that an unsafe condition
could exist when parts are intermixed, unless adequate precautions are
taken, and believes that paragraph (b)(10), as modified, in conjunction
with Sec. 1926.451(a), provides for adequate precautions to be taken by
the employer to ensure against this eventuality.
Paragraph (b)(11) of the final rule provides that scaffold
components made of dissimilar metals shall not be used together unless
a competent person has determined that galvanic action will not reduce
the strength of any component to a level below that required by
Sec. 1926.451(a). This provision, while effectively identical to
proposed paragraph (b)(12), differs from Secs. 1926.451(c) (1), (2) and
(3) of OSHA's existing rule, which prohibit the use together of any
dissimilar metals on tube and coupler scaffolds. The proposed rule was
intended to extend the prohibition to all scaffolds, because the
problem of dissimilar metals causing galvanic action can occur on any
scaffold, not just tube and coupler scaffolds. However, the proposed
rule was not intended to prohibit all uses of dissimilar metals because
there are many combinations which do not produce significant galvanic
reactions.
One commenter (Ex. 2-41) expressed skepticism as to the ability of
a competent person to discern that galvanic action has not reduced the
strength of any component. However, OSHA finds that any competent
person, as defined by this subpart, would be able to identify the
causes and significance of any deterioration in
[[Page 46042]]
scaffold components. In particular, OSHA expects the competent person,
who is on site and required to inspect the scaffold, to recognize
deterioration due to galvanic reactions, and to take prompt corrective
action.
Paragraph 1926.451(c) Criteria for Supported Scaffolds
Final rule Sec. 1926.451(c) sets criteria for the use of supported
scaffolds. Paragraph (c)(1) of the final rule requires that supported
scaffolds with a height to base width ratio of more than four to one
(including outrigger supports, if used) be restrained from tipping by
guying, tying, bracing, or equivalent means. That provision is based on
existing Sec. 1926.451(e)(1), which covers manually-propelled mobile
scaffolds. Any type of supported scaffold can topple if its center-of-
gravity is too high, and OSHA has therefore expanded the coverage of
this paragraph in the final rule. Final rule paragraph (c)(1)(i)
provides that guys, ties, and braces shall be installed at locations
where horizontal members support both inner and outer legs. In
addition, paragraph (c)(1)(ii) requires, as follows:
(1) Guys, ties, and braces shall be installed according to the
scaffold manufacturer's recommendations or at the closest horizontal
member to the 4:1 height and be repeated vertically at locations of
horizontal members every 20 feet (6.1 m) or less thereafter for
scaffolds 3 feet (0.91 m) wide or less and every 26 feet (7.9 m) or
less thereafter for scaffolds greater than 3 feet (0.91 m) wide;
(2) The top tie, guy or brace of a completed scaffold shall be
placed no further than the 4:1 height from the top; and
(3) Such guys, ties and braces be installed at each end of the
scaffold and at horizontal intervals not to exceed 30 feet (9.1 m)
(measured from one end [not both] towards the other).
This provision of the final rule is essentially the same as
proposed paragraph (b)(13), except that the maximum vertical spacing
has been changed to allow for the scaffolds to be supported at their
strongest points. Proposed paragraphs (b)(13)(i) and (b)(13)(ii), which
specified the horizontal spacing for ties, guys, and braces, were
intended to replace existing Secs. 1926.451 (b)(4), (c)(12), and
(d)(7). These paragraphs of the existing rule required pole scaffolds,
tube and coupler scaffolds, and fabricated frame scaffolds to be tied
and braced at intervals no greater than 26 feet vertically (25 feet for
wood pole scaffolds) and 30 feet horizontally (25 feet for wood pole
scaffolds). These paragraphs have been misinterpreted over the years to
mean that scaffolds less than 26 feet high by 30 feet long (25 by 25
for wood pole scaffolds) do not need guys, ties, or braces. Proposed
paragraph (b)(13)(ii) was intended to replace the 26- and 25-foot
vertical rule and require all scaffolds required by the 4 to 1 rule to
have guys, ties, or braces also to have such connections installed at
each end of the scaffold and at horizontal intervals not to exceed 30
feet (measured from one end only).
The following are examples of how this requirement is to be
applied: (a) If a scaffold is five feet wide, 18 feet high and 50 feet
long, no vertical or horizontal ties and braces are required because
the height is less than four times the width and the four to one rule
does not require connections; (b) if the scaffold is five feet wide, 50
feet high, and 25 feet long, ties and braces are required at least at
the 20- and 40-foot levels at both ends of the scaffold (four ties and
braces in all); (c) if the scaffold is five feet wide, 50 feet tall,
and 70 feet long, ties and braces are required at least at the 20- and
40-foot levels. These would be installed starting from either end, at
least at the zero, 30, 60, and 70-foot horizontal distances (eight ties
and braces in all).
The SSFI (Ex. 2-367) disagreed with the 20-foot limit for bracing
intervals in proposed paragraph (b)(13)(i) and suggested a 20-foot
limit for scaffolds 3 feet wide or less, and a 26 foot limit for
scaffolds more than 3 feet wide. In addition, this commenter suggested
that bracing be at bearing locations or as recommended by the
manufacturer. OSHA agrees with this commenter's suggested bracing
intervals, because the Agency believes that properly erected scaffolds
more than 36 inches wide are more stable than those which are narrower,
and has modified this provision of the final rule accordingly.
The SIA (Ex. 2-368) stated:
We are in agreement with the proposed wording used to define the
location of guys and ties as a function of the scaffold base width
dimension. This proposed wording adequately defines where scaffolds
must be guyed or tied to achieve proper scaffold stability. To
correctly transmit the stabilizing forces through the scaffold,
however, the guys or ties must be placed at locations where
horizontal members support both the inner and outer legs. Guying or
tying a scaffold leg at mid span could buckle the leg and cause an
unexpected scaffold failure. To avoid this danger, it is recommended
that the tie be placed at the closest horizontal member above the
4:1 base to height ratio and repeated vertically at locations of
horizontal members every 20 to 26 feet in height thereafter. The top
tie shall be placed no further than a 4:1 base to height ratio from
the top.
OSHA agrees that guys, ties, and braces should be placed at points
of scaffold structural strength, and has modified this provision of the
final rule accordingly. Furthermore, the Agency agrees with the SIA's
recommendation that the top tie, guy, or brace be placed no more than
the 4:1 height to base ratio from the top of the scaffold, and has
modified the provision accordingly. However, OSHA does not agree with
the SIA suggestion that guys, ties and braces be installed at the
closest horizontal member above the 4 to 1 base to height ratio, and
has revised the language of this provision to reflect the Agency's
finding that these components be installed at the closest horizontal
member to the 4:1 height, whether above or below, to maximize
stability.
In addition, the SIA recommended that OSHA require employers to
consider loads due to wind and weather when guying, tying, or bracing
is installed, whenever scaffolds are partially or fully enclosed. The
Agency notes that these matters are addressed in the general capacity
requirements of final rule Sec. 1926.451(a) and in
Sec. 1926.451(f)(13), which requires that wind screens not be used
unless the scaffold has been secured against the forces imposed.
Another commenter (Ex. 2-38) suggested using the same language as
in existing Sec. 1926.451(e)(1), which requires that the height of a
manually propelled mobile scaffold not exceed four times the minimum
base dimension, ``because it is more understandable.'' Also, a
commenter (Ex. 2-40) stated ``since the standard does not address the
issue of cantilevered work platforms (or their effect on stability),
the allowable height to base width ratio of equal to four or less seems
high.''
Another commenter (Ex. 2-23) recommended a ratio of 3 to 1, but
provided no rationale to support its suggestion. OSHA notes that the
final rule 4:1 ratio is consistent with the requirement in ANSI A10.8-
1988, paragraph 4.31, that free-standing scaffolds with height to base
ratios of more than 4:1 be restrained from tipping by guying or other
means.
Based on these concerns, in the final rule OSHA has added paragraph
(c)(1)(iii), which requires that scaffolds with eccentric loads (such
as cantilevered work platforms) be restrained from tipping through the
use of ties, guys, braces or outriggers.
Final rule paragraph (c)(2) requires that supported scaffold poles,
legs, posts, frames, and uprights bear on base plates and mud sills or
other adequate firm foundation. In particular, final rule paragraph
(c)(2)(i) requires that such footings be level, sound, rigid, and
capable of supporting the scaffold in a
[[Page 46043]]
loaded condition without settling or displacement.
In addition, final rule paragraphs (c)(2) (ii) and (iii) provide
that unstable objects shall neither be used to support scaffolds or
platform units, nor be used as working platforms, respectively. The
reason for these requirements is almost self-explanatory: every
scaffold must stand on a firm footing if it is to withstand the load
that employees, equipment, and materials place on it.
Final rule paragraph (c)(2)(iv) provides that front-end loaders and
similar pieces of equipment shall not be used as scaffold supports
unless they have been specifically designed by the manufacturer for
such use. In addition, final rule paragraph (c)(2)(v) requires that
fork-lifts not be used to support scaffold platforms unless the entire
platform is attached to the fork and the fork-lift is not moved
horizontally while the platform is occupied. Both these requirements
relate to the need for solid support for scaffold platforms and reflect
the fact that front-end loaders, fork-lifts and other such equipment
are not generally designed for this purpose.
Paragraph (c)(2) of the final rule is identical to proposed
paragraph (b)(14), except for two provisions, final rule paragraphs
(c)(2) (iv) and (v), which have been added based on input generated by
responses to Issue 3 of the preamble of the NPRM. Proposed paragraph
(b)(14) consolidated existing requirements that scaffold uprights rest
upon a stable, firm, level footing.
Issue 3 asked if OSHA should prohibit the use of cranes, derricks,
forklifts, front-end loaders, and similar pieces of equipment for the
support of scaffold platforms. In addition, OSHA asked what pieces of
equipment should be prohibited and what other related provisions would
be necessary to ensure employee safety.
Several commenters from the Associated General Contractors of
America (AGC) (Exs. 2-20, 2-55, and 2-390) and the ACCSH (Tr. 6/9/87,
pp. 40-41) noted that OSHA had undertaken rulemaking regarding the use
of cranes and derricks to hoist personnel platforms (NPRM published
February 17, 1984, 49 FR 6280). The AGC commenters stated that the
proposed regulations for crane suspended work platforms already
addressed the concerns raised in Issue 3.
Another commenter (Ex. 2-53) called for the development and
issuance of specific crane suspended platform regulations, and one
respondent (Ex. 2-29) commented that the current regulations on crane
suspended work platforms were acceptable.
On August 2, 1988 (53 FR 29116), OSHA issued a final rule
(Sec. 1926.550(g)) which regulates the use of cranes and derricks to
hoist personnel platforms. Therefore, there is no longer a need for
subpart L to address that subject.
Regarding the use of front-end loaders, one commenter (Ex. 2-33)
responded, in part, that ``front-end loaders should not be used to
hoist worker-loaded scaffold platforms'' and added that the ``[u]se of
forklifts for this purpose should be limited in accordance with * * *
OSHA's General Industry Standards for powered industrial trucks, 29 CFR
1910.178(m)(12).'' The same commenter also stated ``If large platforms
are used in this manner, consideration should be given to requiring
bracing of forks to safeguard against tipping or slipping of the truck
or its forks.''
Another commenter (Ex. 2-70) stated simply ``[w]e do not utilize
forms of equipment to support platforms.'' Two other commenters (Exs.
2-367 and 2-368) stated ``the practice of using cranes, derricks, fork-
lifts, etc., [to support scaffold platforms] is unsafe and should be
prohibited.''
One commenter (Ex. 2-5), a manufacturer of heavy-duty materials-
handling equipment, including forklifts and cranes, stated that ``[f]or
years, we have made the users of our equipment aware that these are
intended solely for the handling of materials and not for personnel.''
The commenter went on to say their company recommends that ``OSHA
develop rules prohibiting the use of forklifts, front-end loaders and
similar pieces of equipment for the support of scaffold platforms,''
and provided the following rationale:
This class of equipment depends on a hydraulic cylinder(s) to
lift and hold the load[-]engaging means. When new, the cylinder has
little leakage past the sealing means, usually packings, but it does
have leakage. After use, the leakage increases. This allows the
load[-]engaging means to 'drift' downward, possibly endangering
personnel on the scaffold platform. Additionally, the load[-
]engaging means of a forklift are usually supported on bearings or
sliding members and chains. With use, wear occurs at these points.
If excellent maintenance is not performed, and worn parts [are not]
promptly replaced, sufficient wear can occur which is not evident
when handling heavy loads, since their gravitational mass overcomes
the friction and keeps the chain tight; however, when supporting a
light load such as a scaffold platform, there is insufficient mass
to overcome the friction with the load [-]engaging means left
suspended when the mechanism is lowered, with a sudden drop of the
load [-] engaging means when dislodged. We have knowledge of this
happening at least two times at Cape Kennedy when a work platform
was raised by a 15,000 pound[-]capacity forklift of our manufacture.
Each time serious injury to the man on the platform occurred.
The ACCSH has recommended (Tr. 6/9/87, pp. 32-48) that OSHA
prohibit the use of front-end loaders and other similar earth-moving
equipment for scaffold support. ACCSH also recommended that OSHA
develop rules allowing the use of forklifts as scaffold platforms only
while the equipment is stationary and while proper fall protection is
provided.
Several commenters (Exs. 2-13, 2-20, 2-22, 2-24, 2-54, 2-55, and 2-
390) favored allowing the use of cranes, derricks, front-end loaders,
and forklifts to support scaffold platforms, in general terms. Three
other commenters (Exs. 2-29, 2-33, and 2-176) favored allowing the use
of forklifts, under specified conditions, to support scaffolds.
Three commenters from the AGC (Exs. 2-20, 2-55, and 2-390) stated
that, in certain instances, where access to a work area was difficult
and the work assignment was of short duration, using scaffold framing
might be more hazardous than using equipment for work platform support.
They added that appropriate personal protective equipment could be used
for employee safety in these situations.
Another commenter (Ex. 2-22) opposed the contemplated prohibition,
stating ``[t]here are a variety of field situations in which the use of
such devices is the only safe way to handle a particular problem. Not
only is there no diminution in the safety level afforded to employees
in such situations, but the level of safety may actually be improved.''
Also, a commenter (Ex. 2-24) termed the ``suggestion that cranes,
forklifts, and other equipment could not be used as platform supports''
as ``totally unrealistic.'' The commenter provided some alternatives
and examples (e.g., long ladders) describing them as involving the use
of generally dangerous equipment. The commenter also noted that when
using this equipment as scaffold support, additional protective
measures would be necessary. These measures would include having the
operator at the controls at all times, having railings on platforms
used above 10 feet in height, and providing safety training.
The Boston Cement Masons and Asphalt Layers Union (BCMALU) (Ex. 2-
54) indicated that the use of this equipment to support scaffold
platforms might be practical in certain circumstances. This commenter
also added that employers ``should note the use of this equipment in
their Daily Report and explain why they used it.''
[[Page 46044]]
A carpentry contractor (Ex. 2-176) said that forklift scaffold(s)
with properly constructed scaffold platforms should be permitted,
provided they are equipped with proper railings, and added that ``[i]f
the workers working from the scaffold do not ride up and down, there is
no danger of their falling off.''
One commenter (Ex. 2-29) stated that ``[f]orklift[-]mounted work
platforms might also be acceptable provided suitable requirements and
restrictions are specified.'' Another commenter (Ex. 2-13), expressing
guarded support of the possible prohibition, stated that since this
``equipment is readily available at job sites * * * [it] will continue
to be used to support workers at elevated working locations.'' The same
commenter further suggested that a minimum requirement for the safe use
of such equipment would be to have a competent engineer responsible for
the design and safe use of the resulting scaffold.
After a careful review of the above comments, OSHA finds there is
insufficient reason to totally ban the use of forklifts, front-end
loaders, and other similar equipment as scaffold supports. OSHA notes
that the commenters are in general agreement that all equipment not
specifically designed to support scaffold platforms must not be used.
Accordingly, the Agency has promulgated new paragraphs (c)(2) (iv) and
(v) in the final rule to provide guidance for the safe use of specific
equipment as scaffold supports. In particular, the added provision
requires that, in the case of fork-lifts, the entire scaffold platform
be secured to the forklift. All supported scaffolds, including those
supported by forklifts, front-end loaders and similar pieces of
equipment, must comply with the applicable requirements of
Sec. 1926.451 for capacity, construction, access, use, and fall
protection.
Paragraph (c)(3) of the final rule requires that supported scaffold
poles, legs, posts, frames, and uprights be plumb and braced to prevent
swaying and displacement. This provision, which is identical to
proposed paragraph (b)(15), consolidates existing Sec. 1926.451
(a)(15), (b)(1), (c)(6) and (e)(8), all of which require that uprights
be secure, plumb, and braced to prevent swaying and displacement of the
scaffold.
Paragraph 1926.451(d) Criteria for Suspension Scaffolds
Final rule paragraph (d) sets criteria for the use of suspension
scaffolds. Paragraph (d)(1) of the final rule requires that all
suspension scaffold support devices, such as outrigger beams, cornice
hooks, parapet clamps, and similar devices, rest on surfaces capable of
supporting at least 4 times the loads imposed on them by the scaffold
operating at the rated load of the hoist (or at least 1.5 times the
loads imposed on them by the scaffold operating at the stall load of
the hoist, whichever is greater).
Proposed paragraph (b)(16) required all suspension scaffold support
devices such as outrigger beams, cornice hooks, parapet clamps, and
similar devices, to rest on surfaces capable of supporting the reaction
forces imposed by the scaffold hoist operating at its maximum rated
load. Both the proposed and final rule are based on existing
Sec. 1926.451(h)(9), which requires that outrigger beams rest on
suitable wood bearing blocks. Final rule paragraph (d)(1) differs from
the proposed provision regarding the way in which the load to be
sustained is expressed. The proposed rule used the term ``maximum rated
load'' instead of the final rule's terms ``rated load of the hoist''
and ``stall load'' of the hoist.
Three commenters (Exs. 2-64, 2-367 and 2-516) recommended a 4 to 1
safety factor based on the rated load of the hoist. Another commenter
(Ex. 2-41) stated that reaction force should include all forces, not
just those from the hoist, and indicated that some safety factor was
needed. The Agency agrees that a clarification is warranted here, and
has modified the final rule to reflect this input. In addition, the
text has been modified to be consistent with final rule Secs. 1926.451
(a)(2) and (a)(4). The Agency concludes that this is necessary in order
to adequately address the issue of the hoist reaching its stall load
when the scaffold strikes an obstruction. OSHA has determined that the
hoist stall capacity needs to be greater than the hoist rated capacity
so that the rigging system will be able to support the loads imposed by
obstructions as well as the load being lifted. This matter is addressed
in greater detail above, in relation to final rule Sec. 1926.451(a)(1).
Final rule paragraphs (d)(2), (d)(3) and (d)(4) set requirements
for outrigger beams used with suspension scaffolds. Paragraph (d)(2) of
the final rule requires that suspension scaffold outrigger beams, when
used, be made of structural metal, or equivalent strength material, and
be restrained to prevent movement. This is identical to proposed
paragraph (b)(17), except as discussed below. The proposal was based on
existing Secs. 1926.451(h)(4) and (k)(8).
The SIA (Ex. 2-368) stated that if the intent of proposed paragraph
(b)(17) was to prohibit the use of wood outrigger beams, the Agency
should simply say so. The proposed language clearly indicated that
outrigger beams must be made of structural metal. However, upon further
consideration of this provision, OSHA believes that other materials
should be allowed if their strength and other pertinent characteristics
are equivalent to those of structural metal. The Agency has therefore
revised the proposed rule accordingly. This revision is in line with
the Agency's policy to permit alternative materials or practices which
provide equivalent protection to employees. Also, OSHA has added the
words ``when used'' to indicate clearly that the provision does not
require outrigger beams to be used but only applies when outrigger
beams are used.
Final rule paragraph (d)(3) sets requirements for the stabilization
of outrigger beams. The introductory language of the paragraph requires
that outrigger beams be secured directly to the supporting surface or
be stabilized using counterweights, except that masons' multi-point
adjustable suspension scaffolds shall not be stabilized by
counterweights. The rule does not allow counterweights for stabilizing
such masons' suspension scaffolds because, with the large loads often
placed on masons' multi-point adjustable suspension scaffolds and the
large counterweights that would be necessary to anchor such systems,
OSHA is concerned that the supporting roof or floor would become
dangerously overloaded.
Final rule paragraph (d)(3) is identical to proposed paragraph
(b)(18), except for a few minor editorial changes as described below.
The final rule clarifies existing Secs. 1926.451 (h)(4) and (j)(5),
which require simply that outriggers be securely fastened or anchored.
Counterweights are not addressed in the existing standard. OSHA has
determined that it is necessary to set criteria for counterweights in
the final rule, however, because counterweights are often the only way
to anchor an outrigger beam without damaging the supporting surface.
Paragraph (d)(3)(i) provides that direct connections shall be
evaluated by a competent person who affirms, based on that evaluation,
that supporting surfaces can support the anticipated loads. In
addition, the paragraph requires masons' multi-point adjustable
suspension scaffold connections to be designed by an engineer
experienced in such scaffold design. OSHA anticipates that compliance
with these provisions will ensure that roof or floor decks are capable
of supporting the loads to be imposed.
[[Page 46045]]
Final rule paragraphs (d)(3)(ii) through (d)(3)(v) require that
counterweights be made of non-flowable material; be specifically
designed for use as scaffold counterweights; be secured to outrigger
beams to prevent accidental displacement; and not be removed from an
outrigger beam until the scaffold is disassembled, respectively. These
requirements are necessary to ensure that counterweights are used only
for their intended purpose and are not displaced or removed
prematurely.
Final rule paragraphs (d)(3)(vi) through (d)(3)(x) set requirements
for securing outrigger beams. In particular, outrigger beams not
stabilized by direct connections to the supporting surface shall be
secured by tiebacks (paragraph (d)(3)(vi)). Tiebacks must be as strong
as the suspension ropes (paragraph (d)(3)(vii)), be secured to a
structurally sound anchorage (paragraph (d)(3)(ix)), and be installed
perpendicular to the structure unless opposing angle tiebacks are
installed (paragraph (d)(3)(x)). In addition, paragraph (d)(3)(viii)
requires that outrigger beams be placed perpendicular to their bearing
support, with the exception described more fully below.
With regard to proposed paragraph (b)(18)(i) (paragraph (d)(3)(i)
in the final rule), a commenter (Ex. 2-40) stated ``we believe that
improper connections are almost always responsible for the failure of
scaffolds. Therefore, criteria for torsion strength evaluation of
bolted
FR Doc. 96-21289 Safety Standards for Scaffolds Used in the Construction Industry
(direct) connections should be included in the standard.'' OSHA
believes that the corresponding requirement in final rule paragraph
(d)(3)(i) for evaluation of direct connections by a competent person
will provide adequate assurance that those connections are designed and
made appropriately, because the competent person must have the ability
to identify any problems with the direct connections and the authority
to have any problems corrected.
Proposed paragraph (b)(18)(ii) (paragraph (d)(3)(ii) in the final
rule) required that counterweights be made of non-flowable solid
material. That, in effect, prohibited the practice of using sandbags or
water-filled buckets as counterweights. The reason for the prohibition
is that counterweights are easily displaced and may leak. Final rule
paragraph (d)(3)(ii) is virtually identical, except that the word
``solid'' has been deleted, because that term is redundant with the
term ``non-flowable'', and a sentence has been added that explicitly
prohibits the use of sand, gravel and other similar material as
counterweights.
A commenter (Ex. 2-41) stated that the proposed paragraph would
cause confusion, inquiring whether, if five 70 pound weights are
considered ``solid,'' 350 one pound weights also would be considered
``solid''? The Agency would consider five 70 pound weights as meeting
this requirement, because objects of this weight would be unwieldy and
less prone to dislocation. However, 350 one pound weights would not
meet this requirement because their light weight would make them more
prone to being dislocated, thus possibly compromising their
effectiveness as a counterweight. OSHA has added the sentence ``Sand,
gravel, and similar materials that can be easily dislocated shall not
be used'' to indicate more clearly what materials are not allowed for
use as counterweights.
Paragraph (d)(3)(iii) of the final rule requires that
counterweights be specifically designed for use as counterweights. This
provision, which was not part of the proposed rule, has been added in
response to input received regarding Issue 26 in the preamble of the
NPRM. That Issue asked if OSHA should require that counterweights be
designed for no other purpose than to counterweight the system, thereby
prohibiting the use of construction materials, such as concrete masonry
units, rolls of felt, etc., as counterweights.
One commenter (Ex. 2-22) opposed requiring that counterweights be
designed for no other purpose than to counterweight the system. This
commenter stated that such a requirement would be unnecessarily costly.
This commenter also stated ``So long as the material used meets the
objective of the safety requirement, there is no need to cause the
expenditure of money on specific materials that do not enhance the
safety of the employee * * *''
Several commenters (Exs. 2-13, 2-29, 2-43, 2-53, 2-54, 2-64, 2-367,
2-368 and 2-465) supported a requirement that counterweights be
specifically designed for no other purpose than to counterweight the
system. These commenters also supported a ban on the use of
construction material as counterweights. The SIA (Ex. 2-368) added that
such a requirement would be practical, feasible, of negligible cost and
would prevent accidents which occur when construction materials used as
counterweights are removed for other purposes.
Another commenter (Ex. 2-13) stated:
Counterweights should be designed for their specific use and
permanently marked with their weight otherwise they are worthless.
Construction material, of any kind, should be banned for use as
counterweights. There is no assurance that proper counterweighting
is being accomplished with construction materials. Also, the
material could be removed for use by others, thus providing an
unstable condition.
Two commenters (Exs. 2-64 and 2-367) stated that there should be a
requirement that counterweights be identified or marked. The SSFI (Ex.
2-367) recommended that ``each counterweight be identified as to its
weight'' and should also ``have the ability to be fastened directly to
the outrigger system.'' Another commenter (Ex. 2-64) wanted
counterweights to be ``clearly marked with their actual weight
(stamped, painted, etc.), so that workers will use the proper amount of
weight.''
In addition, a commenter (Ex. 2-8) stated ``[c]onstruction
materials should not be use[d]. We have seen masons remove block used
as counterweight.''
Also, the ACCSH (Tr. pp. 188-190, 6-9-87) recommended that
counterweights be designed for no other purpose than to counterweight
the system. One member stated ``Certainly OSHA should require
counterweights be designed for no other purpose. It seems to me that
the same day I first read this question I received from OSHA a copy of
`Fatal Facts' that involved this very issue.''
After carefully considering the above comments and the ACCSH
recommendation, OSHA has determined that it is reasonably necessary to
require that counterweights be designed for no other purpose than to
counterweight the system, and to prohibit the use of construction
materials as counterweights. In addition, OSHA has determined that it
is appropriate to require the marking of counterweights with their
weights because that information is needed for the proper design,
selection and installation of counterweights.
Proposed paragraph (b)(18)(iii), which required that counterweights
be connected to outrigger beams by mechanical means, is identical to
final rule paragraph (d)(3)(iv), except that the phrase ``to prevent
accidental displacement'' has been added to the final rule to clarify
the Agency's regulatory intent. The BCMALU (Ex. 2-54) recommended that
the Agency clarify the reason for this provision. The Agency agrees and
has revised the provision accordingly.
Proposed paragraph (b)(18)(iv) required that counterweights not be
removed from a scaffold until the scaffold is disassembled. Final rule
paragraph (d)(3)(v) is identical to the proposed paragraph, except that
the
[[Page 46046]]
final rule specifies that the counterweights may not be removed from
the ``outrigger beam'', rather than from the ``scaffold.'' One
commenter (Ex. 2-41) pointed out that counterweights used with
suspension scaffold outrigger beams are not placed on the scaffold, as
stated in the proposed rule, but are installed on the outrigger beam
above. The Agency agrees, and has revised the provision accordingly.
Proposed paragraph (b)(18)(v) required outrigger beams to be
secured by tiebacks equivalent in strength to the suspension ropes.
This provision was intended to provide a backup system in case the
counterweights became displaced. Although tiebacks alone may not keep a
scaffold from tipping, they will keep the system from falling to the
ground and from causing a progressive failure of nearby scaffolds and
scaffold sections. The intent of the proposed paragraph has been
carried forward in final rule paragraphs (d)(3)(vi) and (vii), which
require the use of tiebacks when direct connections are not used, and
require tieback strength equivalent to that of the suspension ropes,
respectively.
The SSFI and the SIA (Ex. 2-367 and 2-368) noted that outrigger
beams which are bolted to the structure become part of the structure
and do not require tiebacks. The Agency agrees that only
counterweighted outrigger beams need to be secured with tiebacks and
has incorporated appropriate language into paragraphs (d)(3)(vi) and
(d)(3)(vii) accordingly.
In addition, final rule paragraph (d)(3)(viii) requires that
outrigger beams be placed perpendicular to the face of the structure,
except that, where the employer establishes that such placement is
prevented by obstructions, the outrigger shall be placed as near to the
perpendicular as possible and shall be secured using opposing angle
tiebacks. This provision has been added as a partial response to a
commenter (Ex. 2-41) who stated that requiring tiebacks to be installed
parallel to the centerline of the beam, as required by proposed
paragraph (b)(18)(vii), is only safe when the beam is perpendicular to
the edge. OSHA agrees with this comment because a non-perpendicular
beam/tieback arrangement creates a pendulum effect that could endanger
employees. However, the SIA (Ex. 2-368) has pointed out that there may
be circumstances where obstructions prevent the outrigger beam from
being placed perpendicular to the edge. The SSFI and the SIA (Exs. 2-
367 and 2-368) suggested that, in such cases, opposing angle tiebacks
be required. OSHA agrees that opposing angle tiebacks are appropriate
where obstructions prevent perpendicular placement of outriggers, and
has revised the final rule language accordingly.
Proposed paragraphs (b)(18) (vi) and (vii) required that tiebacks
be secured to structurally sound anchorages and that they be parallel
to the outrigger beam. Those provisions correspond to final rule
paragraphs (d)(3) (ix) and (x). OSHA has revised this language, drawing
on examples in the preamble of the NPRM, to provide more specific
direction regarding what constitutes a structurally sound anchorage.
Three AGC commenters (Exs. 2-20, 2-55 and 2-390) stated that the
OSHA interpretation of what is considered an acceptable point of
anchorage (51 FR 42686) was too strict and that the Agency should
permit the use of any available roof structural anchor points since
they are only accommodating a back-up or secondary support system. The
Agency disagrees with this position because the secondary support
system must be capable of providing adequate support in the event of
rigging failure. The revised final rule paragraph specifically
identifies structural members of the building or structure as
appropriate anchor points, and identifies standpipes, vents, other
piping systems, and electrical conduit, as structural elements that do
not provide appropriate anchorages.
Proposed paragraph (b)(18)(vii) required that tiebacks be installed
parallel to the centerline of the beam. The proposed language has been
revised in final rule paragraph (d)(3)(x) to recognize that opposing
angle tiebacks are acceptable alternative means of installation. In
addition, OSHA has replaced the proposed term ``parallel'', with the
term ``perpendicular'' for the sake of clarity.
A commenter (Ex. 2-29) stated ``since tieback anchorages are not
always available exactly where needed, perhaps the wording of these
requirements should be revised to allow tiebacks to be at an angle,
e.g., not to exceed 10 degrees from the centerline of the outrigger * *
*.'' OSHA acknowledges that anchorages are not always conveniently
located and that there may be circumstances where it is necessary to
install the tieback at an angle. However, OSHA believes that when this
is done, it is also necessary to require an opposing angle tieback to
be used so that the pivot radius of the beam is minimized.
Consequently, single tiebacks installed at an angle are not allowed by
the final rule.
Paragraph (d)(4) of the final rule specifies the construction
requirements for outrigger beams used with suspension scaffolds. This
provision requires that suspension scaffold outrigger beams be:
provided with stop bolts or shackles at both ends; securely fastened
together with the flanges turned out when channel iron beams are used
in place of I-beams; installed with all bearing supports perpendicular
to the beam center line; and set and maintained with the web in a
vertical position. In addition, when an outrigger beam is used, the
shackle or clevis with which the suspension rope is attached to the
outrigger beam shall be placed directly over the hoisting machine,
i.e., over the center line of the stirrup. (These requirements are
found in paragraphs (d)(4)(i) through (d)(4)(v).)
These requirements are effectively identical to those in proposed
paragraph (b)(19). The SIA (Ex. 2-368) recommended that OSHA drop the
word ``single'' from proposed paragraph (b)(19)(v) because this
requirement applied to all outrigger beams, not just to ``single
outrigger beams''. The Agency agrees, and has revised this provision of
the final rule accordingly.
Final rule paragraph (d)(5) sets requirements for suspension
scaffold support devices other than outrigger beams. These devices
include cornice hooks, roof irons, parapet clamps, or similar devices.
Under this provision, those devices must be: made of steel, wrought
iron, or materials of equivalent strength; supported by bearing blocks;
secured against movement by tiebacks installed at right angles to the
face of the building or structure unless opposing angle tiebacks are
installed and secured to a structurally sound point of anchorage on the
building or structure (sound points of anchorage include structural
members, but do not include standpipes, vents, other piping systems, or
electrical conduit); and tiebacks shall be equivalent in strength to
the strength of the hoisting rope.
Final rule paragraph (d)(5) is identical to proposed paragraph
(b)(20), except that some minor editorial changes have been made for
the sake of clarity. In particular, OSHA has revised proposed paragraph
(b)(20)(i), which specified ``mild steel, wrought iron, or equivalent
materials,'' by deleting the word ``mild'' and changing ``equivalent
materials'' to ``materials of equivalent strength.'' These revisions
are based, in part, on input from a commenter (Ex. 2-41), who indicated
that the term ``mild steel'' is not defined in readily available
sources. The other change was made to indicate clearly that the
strength of the specified materials was the characteristic by which
`equivalence' would be gauged.
[[Page 46047]]
Proposed paragraph (b)(20)(iii) required the use of tiebacks,
installed at right angles to the face of the structure wherever
possible; secured to a structurally sound portion of the building; and
equivalent in strength to the hoisting rope. As stated in the preamble
to the NPRM (51 FR 42686), vents, standpipes, other piping systems, and
electrical conduits are not acceptable points of anchorage because they
are often made of materials that cannot support the loads that would be
imposed on them if the support device were to fail. OSHA has revised
the proposed provision so that final rule paragraph (d)(5)(iii) allows
opposing angle tiebacks, as well as tiebacks at right angles, and has
incorporated the NPRM preamble list of unacceptable anchorage points to
facilitate compliance. In addition, the Agency has relocated the
requirement for tieback strength equivalent to that of the hoisting
rope to a separate provision (final rule paragraph (d)(5)(iv)).
Two commenters (Exs. 2-64 and 2-368) suggested a requirement that
devices covered by proposed paragraph (b)(20) be marked to indicate
their capacity. OSHA has not done so because the Agency believes that
such markings are not necessary given the capacity requirements set in
final rule Sec. 1926.451(a).
Paragraph (d)(6) of the final rule specifies the minimum length of
suspension rope to be used with different kinds of hoists. In
particular, winding drum hoists are required to have at least four
wraps of suspension rope at the lowest point of scaffold travel. All
other types of hoists are required to have suspension rope long enough
to lower scaffolds to the level below, without having the rope end pass
through the hoist, or to have the rope end configured or provided with
means so that the end does not pass through the hoist.
This provision, which is identical to proposed paragraph (b)(21),
elicited one comment. The BCMALU (Ex. 2-54) recommended that OSHA
require that the rope be long enough to allow the scaffold to be
lowered to the lowest point on the job-site without the rope passing
through the hoist or that the scaffold be initially set up at the
highest point at which it will be used on that job-site. OSHA believes
that the proposed provision adequately addressed the issue of rope run-
through and, accordingly, has not made the suggested revision in the
final rule.
Final rule paragraph (d)(7) states ``The use of repaired wire rope
as suspension rope is prohibited.'' This provision differs from
proposed paragraph (b)(22), which stated ``The repairing of wire
suspension rope is prohibited.'' The proposed requirement was based on
OSHA's view that there is no way to determine the strength capacity of
a repaired wire rope without the danger of over-stressing the repair
and thus rendering the rope unsafe for use on scaffolds. The Agency
recognizes that the proposed rule did not clearly state OSHA's intent.
The act of repairing wire suspension rope is not in itself hazardous.
OSHA is, however, concerned that repaired rope not be used to suspend a
scaffold. Accordingly, OSHA has revised this provision to prohibit the
use of repaired wire rope as suspension rope.
Paragraph (d)(8) of the final rule provides that wire suspension
ropes shall not be joined together except through the use of eye splice
thimbles connected with shackles or coverplates and bolts. This is
virtually identical to proposed paragraph (b)(23). This provision,
which was not in OSHA's existing scaffold standard, reflects OSHA's
determination that the specified measures are the only acceptable ways
to connect wire ropes without significantly affecting rope strength.
The SSFI and the SIA (Exs. 2-367 and 2-368) suggested revision of
the proposed text to read ``wire suspension ropes shall not be joined
together except through the use of eyesplice thimbles connected with
shackles or cover plates and bolts.'' OSHA agrees that the suggested
phrase ``through the use of eye splice thimbles connected'' expresses
the Agency's intent more effectively than the proposed phrase ``by
eyesplicing'' and has revised the language of the final rule
accordingly. The SIA further indicated that this requirement should
apply only to wire suspension ropes used with manual hoists. However,
the Agency concludes that final rule paragraph (d)(8) is applicable to
the joining of all wire suspension rope, not just that which is used
with manual hoists, because compliance with that provision is necessary
to ensure that the wire ropes on all suspended scaffolds are rigged
properly. Therefore, OSHA is not making the suggested change.
Paragraph (d)(9) of the final rule provides that the load end of
wire suspension ropes shall be equipped with proper size thimbles and
secured by eye splicing or equivalent means. This provision is
identical to proposed paragraph (b)(24), which was based on existing
Sec. 1926.451(h)(10) and existing Sec. 1926.451(j)(7).
Final rule paragraph (d)(10) requires that ropes be inspected for
defects by a competent person prior to each workshift and after every
occurrence which could affect a rope's integrity. In addition,
paragraph (d)(10) provides that wire rope shall be replaced if the rope
has any physical damage which impairs its function and strength; any
kinks that might impair the tracking or wrapping of rope around the
drum(s) or sheave(s); six randomly distributed broken wires in one rope
lay or three broken wires in one strand in one rope lay; abrasion,
corrosion, scrubbing, flattening or peening causing loss of more than
one-third of the original diameter of the outside wires; evidence of
any heat damage resulting from a torch or any damage caused by contact
with electrical wires; or evidence that a secondary brake has been
activated during an overspeed condition and engages the suspension rope
(paragraphs (d)(10) (i) through (vi)).
Proposed paragraph (b)(25) provided simply that ``Defective or
damaged ropes shall not be used as suspension ropes or drop lines.''
The proposed language was based on existing Sec. 1926.451(w)(5), which
prohibits damaged ropes from being used on float or ship scaffolds. The
danger of a broken line is a problem not confined to float or ship
scaffolds, so OSHA has extended this provision in the final rule to
cover all suspended scaffolds.
The one comment (Ex. 2-38) on the proposed provision pointed out
that guidelines indicating when rope would be considered to be
defective should be provided. The Agency agrees that employers need to
know what OSHA means by ``defective or damaged rope''. Accordingly,
final rule paragraph (d)(10) incorporates the language of ANSI A10.8-
1988, paragraph 6.7.10, because OSHA finds that those consensus
provisions represent good industry practice.
Paragraph (d)(11) of the final rule requires that swaged
attachments or spliced eyes on wire suspension ropes not be used unless
they are made by the wire rope manufacturer or a qualified person. This
provision is essential to ensure the strength and integrity of such
attachments as eyes and is identical to proposed paragraph (b)(26).
Paragraph (d)(12) of the final rule requires that, when wire rope
clips are used on suspension scaffolds, there shall be a minimum of 3
wire rope clips installed, with the clips a minimum of 6 rope diameters
apart; employers shall follow the manufacturer's recommendations when
installing clips, retightening clips after initial loading, and
inspecting and retightening clips at the start of each workshift; U-
bolt clips (a variety of wire rope clip) shall not be used at the point
of suspension for any
[[Page 46048]]
scaffold hoist; and when U-bolt clips are used, the U-bolt shall be
placed over the dead end of the rope, and the saddle shall be placed
over the live end of the rope.
Proposed paragraph (b)(27) simply stated ``When wire rope clips are
used on suspension scaffolds, they shall be retightened after initial
loading and shall be inspected and retightened periodically
thereafter''. OSHA believed at the time of the proposal that such
performance language conveyed the requirements necessary to ensure that
clips were installed and retightened properly.
Two commenters (Exs. 2-23 and 2-54) recommended that OSHA specify
the minimum number of clips required. In particular, one commenter (Ex.
2-23) recommended a minimum of 3 clips spaced at least 6 rope diameters
apart, with the U-bolt over the dead end of the wire rope. This
commenter added that the clips must not be staggered.
The SIA (Ex. 2-368) recommended that the clips be tightened to the
manufacturer's recommended torque. Another commenter (Ex. 2-64)
suggested that only ``J'' type clamps be used on suspension scaffold
lines and that the clips be inspected and retightened at the start of
each workshift thereafter.
The Agency agrees that more specific requirements are needed so
that employers know how to install and retighten wire rope clips. OSHA
believes that the requirements of ANSI A10.8-1988, paragraph 6.7.11.3,
appropriately address the concerns raised by commenters, and has
incorporated those provisions into paragraph (d)(12) of the final rule.
In addition, the Agency agrees that a minimum of 3 clips spaced at
least 6 rope diameters apart is necessary for safe rigging when wire
rope clips are being used. OSHA notes that several drawings in ANSI
A10.8-1988 which depict the proper rigging of suspension scaffolds show
three wire rope clips on the suspension ropes.
Final rule paragraph (d)(13) requires that suspension scaffold
power-operated hoists and manually operated hoists be of a type tested
and listed by a qualified testing laboratory. This is virtually
identical to proposed paragraph (b)(28), except that OSHA has revised
the proposed terms ``mechanically powered'' and ``manually powered''
hoists to read ``power operated hoists and manually operated hoists''
in the final rule. This revision brings paragraph (d)(13) into line
with the language of ANSI A10.8-1988, paragraph 6. This provision
consolidates existing provisions Secs. 1926.451 (h)(2), (i)(3), (j)(2),
and (k)(1).
Paragraph (d)(14) of the final rule requires that gasoline-powered
equipment and hoists not be used on suspension scaffolds. This
provision is similar to proposed paragraph (b)(29), except that the
final rule now prohibits all gasoline-powered equipment or hoists, not
just gasoline powered hoists.
The proposed provision was based on existing Sec. 1926.451(k)(2)
which allows units to be either electrically or air motor driven. OSHA
has determined that gasoline hoists pose unacceptable fire hazards,
given the confined area of a suspended scaffold and the difficulties
employees would face trying to escape the scaffold if the hoist was
incapacitated and on fire.
The BCMALU (Ex. 2-54) strongly recommended that OSHA prohibit the
use of all gasoline-powered equipment and hoists on suspension
scaffolds because of the high potential for fire. The commenter cited
an example of an accident in which two employees were severely burned
using a gasoline-powered water blaster. The Agency agrees with this
concern and has revised the provision in the final rule accordingly.
Paragraph (d)(15) of the final rule requires that gears and brakes
of power operated hoists used on suspension scaffolds be enclosed. This
is virtually identical to proposed paragraph (b)(30), except a change
in terminology has been made (``mechanically powered'' to ``power
operated''), consistent with the changes made and discussed above under
paragraph (d)(13). The proposed rule was based on existing
Sec. 1926.451(k)(3).
Final rule paragraph (d)(16) provides that, in addition to the
normal operating brake, suspension scaffold power operated hoists and
manually operated hoists shall have a braking device or locking pawl
which engages automatically when a hoist makes either of the following
uncontrolled movements: an instantaneous change in momentum or an
accelerated overspeed. This provision is different from proposed
paragraph (b)(31), which required a brake or pawl to automatically
engage ``when the normal speed of descent of the hoist is exceeded.''
The proposed provision was based on existing Sec. 1926.451(k)(4) but
differed from the existing standard in that it applied to manual as
well as to powered hoists.
One commenter (Ex. 2-8) stated that OSHA should modify the proposed
provision to specifically address an instantaneous change in momentum
and an accelerated overspeed. OSHA agrees that the suggested revision
is appropriate, noting that ANSI A10.8-1988, paragraph 6.3.4.1
addresses both instantaneous stopping type secondary brakes and
deceleration type secondary brakes. The Agency has revised the final
rule's language accordingly.
The SSFI and the SIA (Exs. 2-367 and 2-368) recommended that OSHA
apply this requirement only to powered hoists. OSHA disagrees with
these commenters, noting that, as written, the provision requires a
braking device (for powered hoists) or a locking pawl (for less
sophisticated or manual hoists). The Agency concludes that these
precautions are necessary on all suspension scaffold hoists and,
accordingly, has not made the suggested revision.
Paragraph (d)(17) of the final rule provides that ``Manually
operated hoists shall require a positive crank force to descend.'' This
is the same requirement as proposed paragraph (b)(32), except the term
``manually operated hoists'' replaces the proposed term ``manually-
powered hoists'' for the same reasons as discussed above in relation to
final rule paragraphs (d)(13) and (d)(15).
Issue 27 in the preamble to the NPRM sought comments regarding
proposed Sec. 1926.451 (b)(32) (paragraph (d)(17) of the final rule)
which addresses means of preventing ``free-running'' of hoists during
descent. OSHA's view was that compliance with the proposed paragraph
would preclude this dangerous condition.
One commenter (Ex. 2-31), whose remarks related solely to pumpjack
scaffolds, stated that ``[u]nder ordinary circumstances, free[-]running
does not occur during descent of a pumpjack.''
The ACCSH recommended requiring a positive crank force to lower a
scaffold (Tr. 190-191, 6/9/87). The SSFI (Ex. 2-367) and the SIA (Ex.
2-368) commented that the proposed provision would preclude the use of
a ``boat winch'' type system. The SIA further noted that, to their
knowledge, free-running hoists are ``rare in the marketplace.'' They
added that the requirement was feasible and practical and would involve
negligible additional cost. NIOSH (Ex. 2-40) agreed with the proposed
provision. The BCMALU (Ex. 2-54) stated that although a positive crank
force might be slower than a free-running hoist, it would be safer
which ``is the name of the game, safety.''
One commenter (Ex. 2-29) stated that a positive crank force should
be required for hoists used to lower manually-powered scaffolds.
Another commenter (Ex. 2-53) stated that the proposed requirement is
needed. In addition, a commenter (Ex. 2-64) stated
[[Page 46049]]
that a positive crank force is essential unless the descent speed can
be controlled by some other means.
After carefully considering the above comments and the ACCSH's
recommendation, OSHA has determined that this requirement is necessary
to eliminate the dangerous condition of ``free-running'' hoists during
descent and to ensure employee safety.
Final rule paragraph (d)(18) provides that two-point and multi-
point suspension scaffolds shall be tied or otherwise secured to
prevent them from swaying, as determined necessary based on an
evaluation by a competent person. This paragraph requires, in addition,
that window cleaners' anchors not be used for the purpose of preventing
swaying. This prohibition is based on the fact that window cleaners'
anchors are not designed for the load that could be imposed. This
provision was not part of the proposed rule.
Issue 7 in the preamble of the NPRM asked if the existing
Sec. 1926.451(i)(9) and proposed Sec. 1926.452(p)(5) requirement that
employers secure two-point adjustable suspension scaffolds to prevent
swaying should be extended to cover all suspended scaffolds.
Six commenters (Exs. 2-13, 2-22, and 2-43, 2-471, 2-494, and 2-516)
expressed some measure of support for the idea of extending this
provision to cover all suspended scaffolds.
One commenter (Ex. 2-13) stated as follows:
All exterior scaffolds should be stabilized at each work
location or provide a method of stabilization as described in OSHA
1910.66 [powered platform standard for General Industry] or by
Intermittent Stabilization, as contained in OSHA STD 1-3.3. In
addition, all new buildings over 35 feet in height should be
provided with a permanent engineered methods or means of rigging.
The vast majority of suspended scaffold accidents that do occur
are due to deficient rigging.
A later comment from the same individual (Ex. 2-494) stated
``[w]ith prior planning, there are ways that all scaffolds can be
stabilized * * * Unstabilized scaffolds are a hazard to the occupants,
other workers, and pedestrians below.''
Another commenter (Ex. 2-471) stated as follows:
Any shear wall, with the technology available since November
1982, as described in OSHA Instruction STD 1-3.3, can be made safe
by the installation and the use of Intermittent Stabilization
Building Anchors, to prevent a suspended scaffold from being
displaced by wind forces.
Merely providing perimeter protection and separate safety lines
will not prevent the scaffold and its occupants from being blown
about, being upset, or violently contacting the structure being
serviced, all of which could cause death or injury.
Two commenters (Exs. 2-64 and 2-368) stated that it is neither
possible nor practical to tie in all suspended scaffolds. They stated
that there are many job situations (e.g., sheer or glass walls, or no
wall at all) where stabilization would not work because there are no
points where tie-ins can be made. OSHA acknowledges that there are
circumstances where suspension scaffolds used in construction have no
structure against which to be secured. The present rulemaking takes
into account the likelihood that ``permanent engineered methods'' or
``intermittent stabilization building anchors'' will not be in place
during construction operations. The applicability of Sec. 1910.66 and
OSHA STD. 1-3.3 is limited because they apply to post construction
scaffold activities (such as window washing and light building
maintenance).
The BCMALU (Ex. 2-54) simply expressed support for the existing
requirement that two-point suspension scaffolds be secured to prevent
swaying.
Three commenters from the AGC (Exs. 2-20, 2-55, and 2-390) said
that single-point suspension scaffolds do not have a tendency to sway.
They explained that ``[s]waying generally occurs on two-point
suspensions because of uncoordinated movements by two or three
employees working on the platform as well as the fact that larger
platforms permit movement by employees. This is not the case in single-
point suspensions.''
Another commenter (Ex. 2-29) stated that ``[s]ingle-point
boatswains' platforms should not be included [under this provision] * *
* since this would greatly restrict their use.''
OSHA agrees with the AGC commenters that single-point scaffolds
should not be covered by this provision because, by their nature, they
do not have a tendency to sway. Single-point scaffolds generally
consist of a seat or a small cage which prevents employee movement and
scaffold swaying, and therefore, do not pose the same hazard as multi-
point scaffolds.
One commenter (Ex. 2-41) stated ``based on much research, it is my
opinion that the primary purpose for suspended scaffold restraint on a
platform which has no open sides is to prevent the walking-working
surface from becoming unstable during normal work activities. The
restraint also closes the open side during work activities * * *'' In
addition, the SIA (Ex. 2-368) noted that ``[w]here the work platform is
provided with guardrails on all sides and workers are protected by * *
* safety lines, the protection should be adequate.'' Another commenter
(Ex. 2-516) noted that ``[t]here may be limited situations where
suspended scaffolds for construction cannot be tied into the building
or structure. However, this is not a reason for not having [fall]
protection. Any suspended platform not tied in then definitely needs
guardrails on all four sides.''
In response to Issue 7, the ACCSH recommended (Tr. 79-87, June 9,
1987) that, where determined necessary by a competent person, all
suspended platforms be secured to prevent swaying. The Advisory
Committee indicated that the expertise of the competent person would
enable the employer to determine the situations where it was
appropriate to secure suspended scaffolds against swaying.
After careful consideration of the comments received, OSHA has
decided not to require the use of tie-ins to protect single-point
suspended scaffolds from swaying. As noted above, this type of scaffold
generally consists of a seat or small cage which limits employee
movement and swaying. However, the Agency does agrees with the ACCSH
that the expertise of a competent person will enable the employer to
determine when it is appropriate to secure two-point and multi-point
suspended scaffolds and has worded the final rule accordingly.
In addition, Issue 18 in the preamble of the NPRM asked if there
should be a height limit above which single and two-point adjustable
suspension scaffolds may not be used, and if so, what the height should
be, and why.
Four commenters (Exs. 2-20, 2-55, 2-69, and 2-390) responded by
asking ``what type of equipment could be used above the limit that
would be safe, practical, feasible and economical?'' One commenter (Ex.
2-69) added that the hoist lifting capacity is the only height
limitation for this type of scaffold. Another commenter (Ex. 2-13)
agreed with that point and stated that OSHA should not try to limit the
working height of suspension scaffolds. Two other commenters (Exs. 2-22
and 2-64) simply agreed that there should not be a height limitation.
One of those commenters (Ex. 2-22) added that following ``the safety
standards'' eliminates unsafe conditions.
Some Issue 18 commenters (Exs. 2-41, 2-54, 2-312) felt that the
height of a suspended scaffold was not a problem. One commenter (Ex. 2-
41) stated that a ``height limit in construction should not be a factor
in the safe use of equipment.'' As an example, he observed that
``single-point scaffolds
[[Page 46050]]
have been used in 950 foot elevator shafts for elevator installation *
* *'' The BCMALU (Ex. 2-54) indicated that a greater height would make
workers more aware of hazards and thus more cautious. The commenter
also stated ``[i]t seems most employers and employees are more safety
conscious in high places and careless at 5 to 10 feet from the
ground.'' In addition, he commented that he did not see how OSHA could
restrict use of this equipment because there are situations where these
types of scaffolds are the only equipment that can be used. Also, a
commenter (Ex. 2-312) stated that ``[w]e have outfitted chimney workers
for years so they could work on chimneys that stood 800 to 1000 feet in
height. Never a single accident reported.'' The commenter explained
that descent devices and the chair board systems use ``one friction
principle'' and for these, more rope means more friction with which to
slow descent. In addition, the commenter recommended that subpart L
require that all rope [for these suspended scaffolds] be continuous
length of line, without splices. The commenter further noted that this
requirement would limit the height somewhat.
The SSFI and the SIA (Exs. 2-367 and 2-368) expressed opposition to
a height limitation for suspended scaffolds and recommended that ``the
equipment should be designed by competent persons who will take into
consideration all the hazards involved, thereby providing safe
equipment for the specific job function.'' In addition, the SIA (Ex. 2-
368) stated that suspended scaffolds are practical and feasible at any
height when properly installed and used, and that the height limitation
``would be the ability of the hoist(s) to raise and lower the work
platform.'' Another commenter (Ex. 2-465) stated that this equipment
should be designed by a competent person ``who is thoroughly familiar
with the hazards involved.'' That commenter also stated that suspended
scaffolds are the most feasible and safest methods to use for work on
smoke stacks, towers, and water tanks.
At its meeting of June 9, 1987, the ACCSH responded to Issue 18 by
reiterating the position they previously adopted under Issue 7
regarding two-point suspended scaffolds. (Issue 7 is discussed above in
reference to paragraph (d)(18) of the final rule.) While the ACCSH did
not favor adopting a height limitation for single- and two-point
adjustable suspended scaffolds, they did recommend that these types of
scaffolds be secured to prevent swaying where necessary, as determined
by a competent person (Tr. 6/9/87, pp. 148-150). One ACCSH member
stated ``I would move that if swaying is prohibited, as discussed in
Question Number 7, that no height limit for suspended scaffolds need be
included.''
Based on the input received, OSHA has determined that suspended
scaffolds which comply with the pertinent requirements of subpart L
will be safe regardless of the height at which they are used.
Therefore, the Agency has not added a height limitation to the final
rule.
Final rule paragraph (d)(19) (proposed Sec. 1926.451(b)(3))
requires that single function emergency escape and rescue devices not
be used as working platforms. This paragraph also provides that the
prohibition does not apply to systems which are designed to function
both as working platforms and as emergency systems.
Proposed paragraph (b)(3) simply prohibited the use of emergency
descent devices as working platforms because such devices are not
normally designed for repeated in-place use. However, as stated in the
preamble to the NPRM (51 FR 42685), the proposed provision was not
intended to preclude the use of scaffold systems which have as an
additional feature the capacity to function as an emergency descent
device.
The proposed provision generated a number of comments (Exs. 2-8, 2-
27, 2-29, 2-87 and 2-312) which recommended that OSHA define
``emergency descent device.'' Most of these commenters interpreted the
regulatory language as prohibiting all emergency descent devices from
being used as work platforms despite the clarification provided in the
preamble. Therefore, OSHA has revised the final rule to indicate
clearly that only devices whose sole function is to provide emergency
escape and rescue are not to be used as working platforms.
Paragraph 1926.451(e) Access
Final rule paragraph (e) sets the requirements for safe access to
scaffolds. This paragraph clarifies the requirements of existing
Sec. 1926.451(a)(13), which requires only that ``an access ladder or
equivalent safe access shall be provided.'' The introductory text
states that employers must provide scaffold access which complies with
paragraph (e) for each affected employee. It also specifies that the
access requirements for employees erecting or dismantling supported
scaffolds are prescribed in paragraph (e)(9).
Proposed paragraph (c) began with a note which stated that the
proposed paragraph did not apply to employees erecting or dismantling
scaffolds. In the preamble to the NPRM (51 FR 42687), OSHA stated that
requirements for safe access ``often are not feasible until a scaffold
has been erected and properly braced.'' OSHA relied on the same
rationale for the proposed exemption of erectors and dismantlers from
the fall protection requirements of proposed paragraph (e).
OSHA received no comments on this proposed exemption directly.
However, many of the comments on Issue 8, which requested input
regarding the need to exempt employees erecting and dismantling
scaffolds from the fall protection requirements of proposed paragraph
(e) (promulgated as paragraph (g) of this final rule) stated that
employees erecting and dismantling scaffolds should not be exempted
from protection. In particular, as discussed below in relation to final
rule paragraph (g), commenters stated that it was often feasible to
provide fall protection for employees erecting or dismantling
scaffolds.
Given the evidence that employers can often protect erectors and
dismantlers from fall hazards, OSHA concluded that it was also
appropriate to consider if there are circumstances where safe access
can be provided for those employees. Accordingly, the Agency reopened
the subpart L rulemaking record to solicit input regarding the proposed
exemption (58 FR 16509, March 29, 1993). In particular, OSHA sought
comments about employers' ability to provide safe access for erectors
and dismantlers, the hazards that could be created by efforts to
provide safe access, and the criteria to be satisfied by employers
seeking to qualify for an exception from the proposed requirements for
safe access.
Three commenters (Exs. 34-8, 34-22, and 34-29) supported an access
requirement for scaffold erectors and dismantlers. One commenter (Ex.
34-8) said that its support depended on adding the words ``or
equivalent means'' to such a requirement. OSHA notes that both proposed
Sec. 1926.451(c)(1) and final rule Sec. 1926.451(e) contain the words
``or equivalent means.'' That commenter also stated that in utility
boiler installations ``ladders and/or stairways are incorporated into
scaffolding. Planking and ladders, where feasible, are used to support
erection or dismantling. New access can be provided by cutting out
sections of the boiler wall, but the cost for it in some areas may be
prohibitive.'' The commenter added that safe access can
[[Page 46051]]
be provided on supported scaffolds 100% of the time in non-boiler
installations.
Another commenter (Ex. 34-22) stated that where safe access cannot
be provided, fall protection can be used. In addition, a commenter (Ex.
34-29) responded that safe access is practically always feasible, and
presented ladders, lifts, and crane personnel baskets as examples. OSHA
agrees that safe access can be provided for erectors and dismantlers in
most instances through the use of various types of equipment, including
(but not limited to) ladders, scaffold stairs, manlifts, and fall
protection equipment. However, the Agency notes that the use of a
ladder or fall protection equipment would require a significant degree
of scaffold stability, which may not be present in an incomplete
scaffold. Additionally, the safe use of stair towers, manlifts or crane
personnel platforms is dependent on site conditions and the
availability of the equipment and additionally requires the employer to
comply with the regulations covering that equipment.
Scaffold Consultants (Ex. 34-5) described a hypothetical situation
involving a scaffold 100 feet long by 50 feet high and planked on all
levels. They raised the following points:
1. How many ladders are to be installed? If there is a ladder in
the middle of the scaffold, certainly an erector will not walk 50
feet to a ladder and then back another 50 feet to relocate.
2. Ladders cannot be installed on the interior of the scaffold
because of the continuous, fully planked decking.
3. If more than one ladder is to be installed, then it would of
necessity be on the outside of the scaffold, forcing the erector to
go outside the scaffold on each succeeding level, exposing the
worker to a fall potential. Traditionally, each ladder section is
installed after that level of scaffold has been completed, and the
worker no longer has need to return to a lower level. You cannot
install a ladder section for the next level up until the scaffold
frames, bracing and planking have been erected.
The code already states (1926.451(a)(13)) that an access ladder
or equivalent safe access shall be provided.
OSHA notes that providing safe access for erectors and dismantlers
does not necessarily mean that all levels of a scaffold must be fully
planked. In addition, the Agency cannot specify the number of ladders
or other means of access that must be provided in all cases, because of
the wide range of situations being addressed by this standard.
Regarding access for employees erecting or dismantling suspended
scaffolds, two commenters (Exs. 34-32 and 34-39) stated that access is
not required because suspended scaffolds are usually erected at ground
level and the rigging is performed at the roof level. Another commenter
(Ex. 34-8) stated that OSHA should consider deleting the proposed
exemption as it relates to suspended scaffolds. OSHA agrees that if a
scaffold is erected at ground level and rigging is performed at the
roof level, employees are deemed to have safe access to and from the
scaffold. However, erection and rigging not performed in this manner
require safe access to be provided, in accordance with final rule
paragraph (e).
Five commenters (Exs. 34-31, 34-32, 34-37, 34-39, and 34-43)
opposed, in general, an access requirement for erectors and
dismantlers. One commenter (Ex. 34-43) stated that the means of access
would have to be removed from a scaffold before dismantling can
proceed. In addition, four commenters (Exs. 34-9, 34-10, 34-12, and 34-
17) stated that, while sectional ladders attached at the ends of the
scaffold can be used for access once adequate support is available,
portable ladders on the work platform may create a greater hazard.
Furthermore, three commenters (Exs. 34-32, 34-37, and 34-39) stated
that providing such access is not practicable on supported scaffolds on
the grounds that not all scaffolds require an attached access and when
one is required ``it is installed after the lift is installed,'' and
``it is not available for the erectors.''
In particular, the SIA (Ex. 34-37) stated that supported scaffold
erectors access the scaffold as the erection/dismantling process
progresses in either direction. Although acknowledging that erectors
also access the scaffold from structures or ladders when convenient,
the SIA added that access systems cannot be installed until the
scaffold is structurally sound, which they stated does not occur in
most cases until the scaffold is complete. OSHA finds, however, that
there are many circumstances where outriggers, braces, ties, guys, and
similar equipment can be used as the erection or dismantling processes
proceed in order to secure, stabilize, or reinforce the lower levels of
the scaffold so that safe access can be provided to these completed
levels.
OSHA realizes that there may be instances where safe access cannot
be provided to the actual level where employees are erecting or
dismantling supported scaffolds. However, the Agency has determined
that it is necessary and appropriate to provide these employees with
safe access to and egress from the levels that have been completed.
Another commenter (Ex. 34-11) wrote that most jobs would not meet
the requirements of proposed Sec. 1926.451(c) without an exemption for
erectors and dismantlers. This commenter called for a study to
determine what procedures are needed to provide safe access. OSHA
finds, however, that the rulemaking record provides the necessary
support for promulgation of access requirements for these employees
and, accordingly, has not adopted this commenter's suggestion. OSHA
intends to monitor the effectiveness and compatibility of final rule
paragraphs (e) and (g) carefully for the next several years, to make
sure they are providing the necessary protection for construction
workers. Based on the results of that monitoring, the Agency will
determine if any further action is warranted.
Several commenters responded to OSHA's request for information
about any hazards that would be created through efforts to comply with
proposed paragraph (c). One commenter (Ex. 34-8) stated ``[i]n utility
boiler installations hazards may outweigh benefits. Employees may
attempt to use a ladder that is not properly secured. Would have to
install more access doors and this is not always feasible. In other
applications of supported scaffold problems are not anticipated.''
Four commenters (Exs. 34-9, 34-10, 34-12 and 34-17) stated:
Use of ladders, etc. to provide access to levels that are in the
process of being dismantled would increase the potential to falls.
This is [due] to the fact that the scaffold would no longer be
stable enough to support the access equipment properly. The levels
of scaffold [that] have been completely erected or not yet
dismantled should retain the permanent access equipment intended to
provide access throughout the length of intended service. The risks
involved during the erection and dismantling process can be lessened
by strict adherence to all procedures.
As discussed above, OSHA has determined that safe access can be
provided to levels that have been completely erected or to levels that
remain intact during dismantling operations.
Three commenters (Exs. 34-32, 34-37 and 34-39) stated ``[t]hese
hazards cannot be eliminated during scaffold erection.'' In addition,
two of the commenters (Exs. 34-32 and 34-39) stated ``[t]he erector
travels both horizontally and vertically and may not be in the vicinity
of an access system when descent is necessary. He may not be able to
get safely to the access area if, for instance, planks have been moved.
Most scaffolds are not fully
[[Page 46052]]
planked and planks are moved as erection progresses.''
On the other hand, two commenters (Exs. 34-11 and 34-29) said that
providing safe access for erectors and dismantlers would not create
hazards.
One commenter (Ex. 34-8) stated that employers should have their
scaffolds evaluated by a competent person and that OSHA should consider
erection and dismantling processes and procedures, accident statistics,
and the type of work to be done on the scaffold before determining in a
given situation that safe access is feasible.
Four commenters (Exs. 34-9, 34-10, 34-12 and 34-17) stated
``[c]ertainly the potential for greater risk should be the greater
consideration. The circumstance that bears the most consideration is
`at what point is the scaffold capable of supporting a ladder or other
access device'. At the point that this occurs permanent access ladders
will be able to be attached to provide access.'' Those commenters also
stated that an employer seeking exemption should be able to demonstrate
that compliance with proposed paragraph (c) would create a greater
hazard, be technologically infeasible, or be economically infeasible.
Three commenters (Exs. 34-32, 34-37, and 34-39) stated that
providing a means of access to a scaffold under construction should not
be required because scaffold erectors are trained to safely climb
scaffolds and because worker access to a completed scaffold may be
directly from the structure itself. The commenters further stated this
would make adding an access system expensive and unnecessary. Those
commenters also contended that a requirement to prove infeasibility
would be expensive and time consuming, and is not supported by accident
data.
In response to comments asserting a lack of accident data to
support imposing burdens on employers whose employees erect or
dismantle scaffolds, NIOSH (Ex. 34-40) stated ``[t]he lack of `accident
statistics' to scaffold erectors is likely to be due to insufficient
detail in injury surveillance data, and not necessarily to a lack of
injuries.'' In addition, NIOSH reviewed the accident data (Ex. 21) and
concluded that ``[t]he fatality rate for scaffold erectors during
scaffold erection and dismantling exceeds that for the entire U.S.
construction industry.'' A review of construction accident reports
shows that 10-20% of scaffold deaths and injuries occur during erection
and dismantling; OSHA finds that many of these will be prevented by the
final rule's fall protection requirements for these operations (see the
Benefits Chapter of the Economics Analysis for this rule).
The Agency notes that the Occupational Safety and Health Review
Commission has held (Hoffman Construction Company, 6 OSHRC 1274,
January 4, 1978) that the safe access requirement of the existing
standard (29 CFR 1926.451(a)(13) does not become operative until the
scaffold is completed or use is imminent, and, therefore, does not
apply to scaffold erection and dismantling operations.
OSHA has determined that although scaffold erectors and dismantlers
are exposed to significant access-related hazards, requiring employers
to provide safe access for erectors and dismantlers in all cases would
often create a greater hazard or be infeasible. For example, commenters
have described factors (e.g., instability of scaffold and lack of
adjacent support) which can preclude the provision of safe access. The
Agency agrees that there are some situations where an exemption from
final rule paragraph (e) would be appropriate. However, other
commenters have indicated that employers who carefully evaluate their
scaffold operations can provide safe access or at least minimize
employee exposure to hazards during these operations. Therefore, OSHA
finds that it is appropriate for employers to be able to obtain relief
from the access requirements when such relief has been determined, on a
case by case basis, to be necessary. Accordingly, the Agency has added
final rule paragraph (e)(9), discussed below, which requires (paragraph
(e)(9)(i)) that employers have a competent person assess pertinent
workplace conditions and decide what means of access is appropriate to
use to protect the safety of erectors and dismantlers on any particular
job.
Final rule paragraph (e)(1) provides that access to and between
scaffold platforms more than two feet (0.6 m) above or below the point
of access shall be by portable ladders, hook-on ladders, attachable
ladders, scaffold stairways, stairway-type ladders (such as ladder
stand), ramps, walkways, integral prefabricated scaffold access, or
equivalent means, or by direct access from another scaffold, structure,
personnel hoist, or similar surface. In addition, the final rule
requires that crossbraces not be used as a means of access. This
provision is identical to proposed paragraph (c)(1), except for some
minor changes in terminology made in order to be consistent with
existing industry terms, and the inclusion of scaffold stairways as
another acceptable means of access. The final rule consolidates and
updates existing Sec. 1926.451(e)(5), which requires that ladders or
stairways be provided and used on mobile scaffolds; existing
Sec. 1926.451(q)(3), which requires that connecting runways with
substantial guardrails be used for access to plasterers', decorators',
and large area scaffolds; and existing Sec. 1926.451(y)(9), which
requires that ladders be used for pumpjack scaffold access.
The SSFI and the SIA (Exs. 2-367 and 2-368) recommended the
inclusion of scaffold stair/towers (scaffold stairways) as a recognized
acceptable means of access. The Agency acknowledges that scaffold
stairways are used regularly for scaffold access and agrees that those
stairways should be addressed by subpart L. Accordingly, OSHA has
incorporated regulatory text addressing scaffold stairways into final
rule paragraph (e)(4), discussed below.
Paragraph (e)(2) of the final rule sets requirements for portable,
hook-on and attachable ladders. A note to this paragraph indicates that
additional requirements for the proper construction and use of portable
ladders are contained in subpart X of this part--Stairways and
Ladders--of the construction standards.
In particular, final rule paragraph (e)(2)(i) provides that
portable, hook-on, and attachable ladders shall be positioned so as not
to tip the scaffold.
In addition, final rule paragraphs (e)(2)(ii)-(vi) provide that
hook-on and attachable ladders shall have bottom rungs positioned not
more than 24 inches (61 cm) above the scaffold supporting level; have
rest platforms at 35 foot (10.7 m) maximum vertical intervals on all
supported scaffolds more than 35 feet (10.7 m) high; be specifically
designed for use with the manufactured type of scaffold to be used;
have a minimum rung length of 11-1/2 inches (29 cm); and have uniformly
spaced rungs with a maximum spacing between rungs of 16-3/4 inches,
respectively. Proposed paragraph (c)(2) was effectively identical,
except that the maximum interval between rest platforms has been
increased in the final rule from 20 feet to 35 feet and the maximum
rung spacing has been increased from 12 inches to 16-3/4 inches, as
discussed below.
Issue 28 in the preamble of the NPRM requested public comment on
whether landing platforms should be required at 35-foot maximum
intervals as required by existing Sec. 1926.451(e)(5), or at 20-foot
maximum intervals as required by proposed Sec. 1926.451(c)(2)(iii).
Three commenters (Exs. 2-13, 2-38, and 2-54) responded in support of
the proposed rule's 20-foot maximum. One commenter (Ex. 2-13) favored
the 20-
[[Page 46053]]
foot interval because it would ``allow a person to catch one's
breath.'' He added that he could personally appreciate this requirement
as he has climbed ladders for years. In addition, a commenter (Ex. 2-
38) stated that ``[l]adders should be offset with landings every 20
feet to prevent falling more that 20 feet.'' Another commenter (Ex. 2-
54) responded that the interval in the proposed rule ``would make it so
workers were not always huffing and puffing and place less strain on
ladders and how many workers might be on it at the same time.''
On the other hand, a commenter (Ex. 2-22) responded that the 35-
foot height was ``an acceptable level for the safety of employees and *
* * a practical field requirement.'' Another commenter (Ex. 2-53)
stated ``[l]anding platforms should be required at 35 foot intervals.
No need to change regulations.'' The SSFI and SIA (Exs. 2-367 and 2-
368) stated that the proposed change to the 20-foot height was too
restrictive and unnecessary. In particular, the SIA (Ex. 2-368) stated
that, since most of the scaffolds which require access from the base
have work platforms less than 28 feet from their base, ``the 20 foot
interval requirement would place a rest platform too close to the work
platform and would be unnecess[a]ry.'' This commenter added that there
are no accident statistics to justify changing the height requirement
from 35 ft. to 20 ft.
The ACCSH (Tr. 191-195, 6-9-87) discussed Issue 28 and recommended
that OSHA adopt the proposed 20-foot requirement. One member stated
``[b]ecause employees are often carrying tools or equipment, the 20-
foot requirement is reasonable.'' OSHA proposed to require landing
platforms at 20-foot maximum intervals in an attempt to be consistent
with existing Secs. 1910.27 (d)(1)(ii), (d)(2) and (d)(5) of the
general industry standards.
After a careful review of the evidence in the record as a whole,
OSHA finds that requiring landing platforms at 20- foot intervals is
not supported by evidence that such a change is needed for employee
safety. In addition, evidence was submitted to show that many scaffolds
already have work platforms only a few feet higher than the 20-foot
level and further that establishing a new height, i.e., 20 feet, would
interfere with widely accepted field practice. Accordingly, the final
rule retains the 35-foot maximum intervals for landing platforms,
because it adequately protects the safety of employees who are
accessing scaffolds.
The SSFI (Ex. 2-367) took ``strong objection'' to proposed
paragraph (c)(2)(vi), which required that there be a maximum spacing
between rungs of 12 inches, because portable, hook-on, and attachable
ladders have been produced for many years with uniformly spaced rungs
that do not meet this requirement. The commenter recommended that OSHA
replace this requirement with a requirement that rungs be uniformly
spaced within each section.
The proposed paragraph was based on existing
Sec. 1910.26(a)(1)(iii), which prescribes maximum rung spacing for
portable metal ladders used in general industry. The Agency notes that
prior to the proposal there were no existing OSHA construction
regulations addressing hook-on or attachable ladders, and the proposal
was intended to recognize that these types of ladders are acceptable
means of access.
OSHA agrees with the commenter that the rungs should be uniformly
spaced to prevent misstepping. In addition, OSHA believes that the
16\3/4\ rung spacing allowed on integral prefabricated scaffold access
frames (end frames) (final rule Sec. 1926.451(e)(6)(v)) should be
applied to hook-on and attachable ladders as well, since these ladders
are commonly used with end frames and this will provide uniform rung
spacing for this application. OSHA has revised the language of the
final rule paragraph (c)(2)(vi) accordingly.
Paragraph (e)(3) of the final rule sets requirements for stairway-
type ladders. In particular, paragraphs (e)(3)(i) through (v) require
that stairway-type ladders be positioned so that the bottom step is not
more than 24 inches (61 cm) above the scaffold supporting level; be
provided with rest platforms at 12 foot (3.7 m) maximum vertical
intervals; have a minimum step width of 16 inches (41 cm) (except for
mobile scaffold stairway-type ladders, which are permitted to have a
minimum step width of 11\1/2\ inches); and have slip-resistant treads
on all steps and landings. These provisions are identical to the
corresponding provisions in proposed paragraph (c)(3), except that an
exception has been added in a new final paragraph (e)(3)(iii) to the
minimum rung width in proposed paragraph (c)(3)(iii). This change has
been made to recognize that a minimum step width of 11\1/2\ inches is
acceptable for mobile scaffold stairway-type ladders, as discussed
below.
Proposed paragraph (c)(3)(iii), which was based on
Sec. 1910.29(a)(3)(ii), required a minimum step width of 16 inches. The
SIA (Ex. 2-368) stated that it is necessary to distinguish between
stairway-type ladders and mobile scaffold stairway-type ladders where
the stairway-type ladder is a secondary feature of the platform. The
commenter noted that reduced step width is necessary on this type of
equipment due to space constraints, and pointed out that the reduced
step width is consistent with normal ladder minimum widths. OSHA
agrees, noting that this type of equipment has been demonstrated to be
safe over decades of use, and has revised the final rule accordingly.
Final rule paragraph (e)(3)(iv) requires slip-resistant treads on
all stairs and landings. This rule is based on general industry rule
Sec. 1910.29(a)(3)(iv), which requires the steps to be fabricated from
slip-resistant treads.
Final rule paragraph (e)(4), which has been added based on the
response to the NPRM and the February 1, 1994 notice of reopening (59
FR 4615), sets requirements for scaffold stairway towers used for
access to scaffolds and other elevated work surfaces. OSHA has
determined that compliance with the provisions described below will
enable employees to use scaffold stairways safely.
The SSFI and the SIA (Exs. 2-367 and 2-368) suggested that OSHA
recognize scaffold stairway/towers as acceptable means of access. They
noted that reference to these types of access units had been omitted
from the proposal even though they are in common use and are a safe
method of obtaining access to scaffold units. Both commenters
recommended that OSHA revise the rule to add requirements for inside
and outside handrails; 19-inch minimum length landing platforms; 19-
inch minimum width for stair units; and slip-resistant surfaces for
treads and landings.
In addition, a commenter (Docket S-041, Ex. 3-414) to the Notice of
Proposed Rulemaking for part 1910 subpart D (Walking and Working
Surfaces) stated:
As in the case of guardrails, the stair rails section is based
on the use of this product in permanently installed locations in
buildings or industrial structures. It does not consider stair rails
used in conjunction with scaffold applications.
Scaffold suppliers utilize step units which have been fabricated
specifically to be used as access to scaffold platforms. These step
units are manufactured with hand rails which are sold as a component
of these step units. The OSHA standard should state that these
fabricated step units are acceptable for scaffold access. This will
eliminate the confusion of the compliance officers in attempting to
enforce permanent stair rail standards for scaffold access
components.
On February 1, 1994, OSHA reopened the subpart L rulemaking record
(59 FR 4615) to solicit comments and suggestions regarding the
regulation of scaffold stairways, chimney bracket scaffolds and tank
builders' scaffolds. In
[[Page 46054]]
particular, the Agency requested input on the provisions suggested by
commenters. In addition, although OSHA did not intend subpart X to
apply to stair towers, the Agency was interested in determining if, in
fact, any of the provisions from part 1926, subpart X or from proposed
part 1910, subpart D, would be appropriate requirements for scaffold
stair towers.
The Agency was interested in receiving more input on the need for
specific regulations for scaffold stairways, chimney bracket scaffolds
and tank builders' scaffolds, with special emphasis on fall protection
requirements, including requirements for handrails and guardrail
systems for the unprotected sides and edges of stairway landings. The
provisions of final paragraph (e)(4) are the product of specific
questions raised in the February 1 notice and OSHA's review of the
responses to those questions.
Two commenters (Exs. 43-24 and 43-32) recommended that the Agency
adopt the suggested provisions, although the first of these two
commenters suggested that existing products that do not comply be
accepted. Several other commenters (Exs. 43-6, 43-11, 43-13, 43-14, 43-
22, 43-26, and 43-37) supported the adoption of various modified
versions of the suggested provisions. For example, suggested minimum
heights above the tread nose for handrails (or stairrails) ranged from
27 inches (68.6 cm) to 36 inches (91 cm).
A number of commenters (e.g., Exs. 43-4, 43-6, 43-9, 43-10)
contended that for many years scaffold stairways have been designed and
used in the same manner as they currently are, and have always provided
a safe and effective means of access. These commenters opposed the
promulgation of any provisions that would alter the criteria under
which scaffold stairways are currently designed and used. Most of these
commenters also reported that they know of no accidents that have
occurred due to the use of scaffold stairways.
In addition, many commenters (Exs. 43-13, 43-14, 43-24, 43-26, 43-
37, and 43-44) specifically opposed applying either the requirements of
subpart X or the general industry standards (Sec. 1910.25 and
Sec. 1910.28) to scaffold stairways. These and other commenters
mentioned above indicated that such an application would, in effect,
``outlaw'' scaffold stairways since they cannot meet the requirements
of subpart X due to the fact that scaffold stairways must be designed
and constructed to fit within the confines of 5 foot (4.5 m) by 7 foot
(6.3 m) or 5 foot (4.5 m) by 10 foot (9.1 m) scaffold bays. As a
result, according to these commenters, many employers would simply stop
using most scaffold stairways, and would rely instead on other means of
access that are not as safe as scaffold stairways. However, one
commenter (Ex. 43-8) recommended that scaffold stairways covered by
subpart L be consistent with subpart X and the general industry
standards. Another commenter (Ex. 42-33) supported standardizing the
existing stairway standard's requirements, including hand clearances,
end rail projections, type of surface, and guarding of the open sides
of landings.
Scaffold stairways can provide a safe and effective means of
access, and the Agency has no intention of prohibiting the use of all
existing scaffold stairways. However, the Agency does believe that some
provisions governing the construction and use of scaffold stairways
must be included in final subpart L, and that the provisions should be
as consistent as possible with subpart X and the general industry
standards, in order to ensure the safety of the employees who use
scaffold stairways. Accordingly, OSHA has promulgated the provisions
discussed below.
The introductory language of final rule paragraph (e)(4) requires
that these units be positioned so that the bottom step is not more than
24 inches (61 cm.) above the scaffold supporting level.
Final rule paragraph (e)(4)(i) requires that a stairrail consisting
of a toprail and a midrail be provided on each side of each scaffold
stairway. Furthermore, final paragraph (e)(4)(ii) requires that the
toprail of each stairrail system shall be capable of serving as a
handrail, unless a separate handrail is provided.
Six commenters (Exs. 43-6, 43-11, 43-14, 43-26, 43-37, and 43-44)
indicated that inside and outside handrails should incorporate
midrails. Several commenters (Exs. 43-8, 43-13, 43-14, 43-24, 43-26,
and 43-37) stated that scaffold stairways should incorporate handrails,
stairrails and midrails. One commenter (Ex. 43-45) stated that scaffold
stairways should have stairrail systems with midrails. Another
commenter (Ex. 43-22) stated that inside and outside handrails should
be constructed so that they function as both stairrails and handrails.
OSHA agrees that handrails, stairrails, and midrails are necessary
for adequate employee protection. However, the Agency also believes
that adequate protection can be provided when toprails of stairrail
systems are capable of serving as adequate handrails. Paragraph
(e)(4)(ii) of the final rule recognizes the capability of toprails to
serve as handrails, but also requires that a separate handrail be
provided when toprails are not capable of serving as a handrail.
Final rule paragraph (e)(4)(iii) requires that handrails, and
toprails that serve as handrails, provide a handhold for employees
grasping them to avoid falling. This provision is identical to
Sec. 1926.1052(c)(9), except for the explicit inclusion of toprails.
Monsanto (Ex. 43-45) stated that handrails should have the shape and
dimension necessary to provide a firm handhold, but provided no
specific shapes or dimensions that would meet that suggested
requirement. OSHA agrees that handrails must be shaped and sized in
such a manner that a proper handhold is provided.
Final rule paragraph (e)(4)(iv) requires that stairrail systems and
handrails be surfaced in a manner that prevents injury to employees
from punctures or lacerations, and to prevent snagging of clothing.
This provision is essentially the same as Sec. 1926.1052(c)(8).
Monsanto (Ex. 43-45) suggested that stairrail systems ``be free of
projection and/or puncture/abrasion hazards.'' OSHA agrees that
handrails should not present such hazards, and the final rule's
language reflects this concern.
Final rule paragraph (e)(4)(v) requires that the ends of stairrail
systems and handrails be constructed in a manner that does not
constitute a projection hazard. This provision is essentially identical
to Sec. 1926.1052(c)(10).
Final rule paragraph (e)(4)(vi) requires that scaffold stairway
handrails, and toprails that are used as handrails, have a minimum
clearance of 3 inches (7.6 cm) between the handrail or toprail and
other objects. This provision is essentially the same as
Sec. 1926.1052(c)(11). As mentioned above, one commenter (Ex. 42-33)
stated that hand clearances for scaffold stairways should be the same
as those for stairways covered by subpart X. OSHA agrees with this
commenter and notes that inadequate hand clearances can render
handrails essentially
FR Doc. 96-21289 Safety Standards for Scaffolds Used in the Construction Industry
useless.
Final rule paragraph (e)(4)(vii) requires that stairrails be no
less than 28 inches (71 cm) or more than 37 inches (94 cm) from the
upper surface of the stairrail to the surface of the tread, in line
with the face of the riser at the forward edge of the tread. This
provision differs from the stairrail height requirements of subpart X,
which was never intended to apply to scaffold stairways. Paragraph
(e)(4)(vii) of the final rule is based on the following comments.
One commenter (Ex. 43-11) suggested stairrail height ranging from
27 inches (68.6 cm) to 37 inches (94 cm) vertically
[[Page 46055]]
above the nose of each step. Another commenter (Ex. 43-20) recommended
a range of 22 inches (56 cm) to 41 inches (104 cm). One other commenter
(Ex. 43-45) recommended stairrail systems ``no less than 36 inches (91
cm) high.'' However, several other commenters (Exs. 43-6, 43-13, 43-14,
43-26, and 43-37) recommended that stairrails be no less than 28 inches
(71 cm) and no more than 37 inches (94 cm) above the nose of each step.
OSHA notes that Sec. 1926.1052(c)(3) requires that stairrail
systems installed before March 15, 1991, be no less than 30 inches
(76.2 cm) high, and that those installed after March 15, 1991, be no
less than 36 inches (91.4 cm) high. The Agency recognizes that this
subpart X requirement may not have been appropriate for stairrails on
some scaffold stairtowers, because the construction of stairtowers
differs significantly from that of stairtowers addressed by subpart X.
In particular, stairtowers are fashioned from scaffold components, must
fit within the framing of scaffold units, and rise more steeply than
other stairways. As a practical matter, the steeper the stairway, the
closer the stairrail will be to the stair surface. Therefore, OSHA has
concluded that it is appropriate and adequately protective for
stairtower stairrails to be at least 28 inches, rather than 30 inches,
high. Accordingly, a requirement that employers retrofit scaffold
stairtowers with 30-inch high stairrails, or that employers phase in
30-inch high stairrails at some future time, would be unreasonable.
OSHA believes that existing equipment and designs can comply with the
28-inch height requirement and should continue to be allowed in use. In
addition, OSHA observes that stairtowers with 28-inch high stairrails
are safer than ladders and that requirements to retrofit or redesign
stairtowers could lead cost-averse employers to use ladders instead of
stairtowers.
Final rule paragraph (e)(4)(viii) requires that scaffold stairways
be provided with landing platforms that are at least 18 inches wide and
at least 18 inches (45.7 cm) long at each level. This provision
provides adequate protection for employees without impeding the use of
most scaffold stairways now in use.
Several commenters (Exs. 43-6, 43-13, 43-20, 43-22, 43-24, and 43-
33) who addressed the issue of landing platforms supported requiring
landing platforms at least 19 inches (48.3 cm) wide at every level.
Three other commenters (Exs. 43-14, 43-26, and 43-37) recommended that
landing platforms at least 18 inches (45.7 cm) wide be required at each
level. Four of those commenters (Exs. 43-6, 43-14, 43-26, and 43-37)
also suggested adding to such a provision the alternative of providing
a platform at least 30 inches long (76.2 cm) in the direction of travel
at ``every 14 feet (4.5 m) maximum of stair elevation.'' Those
commenters stated that this would ``allow the continued use of frame
scaffolds spaced 6\1/2\ feet (2.1 m) vertically and system scaffolds
which are based upon 7 foot (2.25 m) maximum vertical bearer spacing.''
In addition, two commenters (Exs. 43-11 and 43-45) recommended a
minimum landing width of 24 inches (61 cm). Another commenter (Ex. 43-
22) recommended that ``landing platforms extend the entire width of the
scaffold instead of only one-half the width as they do now.''
OSHA believes that employee safety mandates that a landing meeting
the requirements and specifications of this provision must be provided
on stairtowers. The Agency also believes that landings must be as wide
as the stairway itself (at least 18 inches (45.8 cm)) in the direction
in which the stairway is measured and at least 18 inches long in the
other direction as well.
Final rule paragraph (e)(4)(ix) requires that each scaffold
stairway be at least 18 inches (45.8 cm) wide between stairrails.
Several commenters (Exs. 43-6, 43-8, 43-11, 43-13, 43-14, 43-20, 43-22,
43-24, 43-26, 43-32, and 43-37) supported a minimum stair width of 19
inches (48.2 cm). However, the record provides no basis for OSHA to
require that stairs be wider than their landings. In addition, 18
inches is the minimum width allowed for normal scaffolds.
Final rule paragraph (e)(4)(x) requires that treads and landings
have slip-resistant surfaces. This provision is consistent with
existing Sec. 1926.1052(a)(7), which requires that slippery conditions
on stairways be eliminated before the stairways are used to reach other
levels.
Several commenters (Exs. 43-6, 43-8, 43-11, 43-13, 43-14, 43-20,
43-22, 43-24, 43-26, 43-32, 43-37, and 43-44) supported a requirement
that treads and landings have slip-resistant surfaces. The Agency
agrees with those commenters, and notes that scaffolds are often used
in conditions that can create slippery surfaces.
Final rule paragraph (e)(4)(xi) requires that scaffold stairways be
installed between 40 degrees and 60 degrees from the horizontal.
Existing Sec. 1926.1052(a)(2) requires that stairs be installed at
between 30 degrees and 50 degrees from horizontal. OSHA believes that a
minimum and a maximum angle must be specified in order to adequately
protect employees from fall hazards. However, the Agency believes that
compliance with existing Sec. 1926.1052(a)(2) will not be feasible for
stairways regulated under subpart L, because scaffold stairways must
fit into the confines of scaffold framing.
Six commenters (Exs. 43-6, 43-13, 43-14, 43-24, 43-37, and 43-44)
opposed the specification of a minimum and a maximum angle from the
horizontal for scaffold stairways. However, five of these commenters
(Exs. 43-6, 43-13, 43-14, 43-37, and 43-44) provided suggested values
in case OSHA should decide to specify a minimum and a maximum angle
anyway. Four (Exs. 43-6, 43-13, 43-14, and 43-37) of those commenters
suggested a minimum angle of 40 degrees and a maximum angle of 55
degrees since the stairs must fit into 7-foot (2.25 m) or 10-foot (3.2
m) bays with landing platforms. The fifth commenter (Ex. 43-44)
recommended angles of 35 degrees and 55 degrees. Three (Exs. 43-6, 43-
14, and 43-37) of those commenters stated that once the angle
approaches 80 degrees, the stairway becomes a ship's ladder. Another
commenter (Ex. 43-11) agreed with that concept but placed the angle at
60 degrees.
One commenter (Ex. 43-11) recommended that the limits be set at 40
degrees and 80 degrees, while another commenter (Ex. 43-22) recommended
a maximum angle of 50 degrees but provided no minimum value. Another
commenter (Ex. 43-32) recommended a minimum angle of 30 degrees and a
maximum angle of 50 degrees in order to make subpart L consistent with
subpart X.
OSHA has determined that scaffold stairways installed in the range
of 40 degrees to 60 degrees from the horizontal will provide safe
employee access and will still be capable of fitting into the confines
of the scaffold frames. Paragraph (e)(4)(xi) of the final rule reflects
this determination.
Final rule paragraph (e)(4)(xii) requires that guardrails meeting
the requirements of 1926.451(g)(4) be provided on the open sides and
ends of each landing.
OSHA asked in the February 1, 1994 reopening notice if guardrails
installed on scaffold stairways should comply with both subpart M (fall
protection) and this subpart L.
One commenter (Ex. 43-8) recommended that such guardrails meet the
requirements of subpart M for the sake of consistency. Another
commenter (Ex. 43-13) suggested that only the
[[Page 46056]]
provisions of subpart L should apply. Two other commenters (Exs. 43-14
and 43-37) opposed any requirement for guardrails on landing platforms,
unless work was to be performed from them, on the grounds that ``(n)o
hazard or accident data supports this requirement.''
OSHA believes that employees on landing platforms must be
adequately protected from fall hazards while on a landing whether they
are working from the landing or not. However, the Agency recognizes
that providing guardrails that meet the requirements of subpart M would
be inappropriate for use on scaffolds and scaffold stair towers because
they are built to other requirements. Instead, OSHA has determined that
scaffold guardrails, as required in subpart L, are appropriate because
employers build scaffold stairways using scaffold components, which are
designed for 36 to 45-inch high guardrails. In addition, the Agency
notes that scaffold stairways have been in use for many years and that
guardrail systems that comply with subpart L have provided adequate
safety for employees using these stairways. Accordingly, final rule
paragraph (a)(4)(xii) requires guardrails between 36 and 45 inches in
height be used on the open sides and ends of each landing.
Final paragraph (e)(4)(xiii) requires riser heights within each
flight of scaffold stairs to be uniform within \1/4\ inch.
Four commenters (Exs. 43-8, 43-32, 43-44, and 43-45) recommended
that OSHA require uniform riser height for all steps within each flight
of stairs. Six commenters (Exs. 43-6, 43-11, 43-13, 43-14, 43-24, and
43-37) responded that a uniform riser height within \1/4\ inch (0.6 cm)
is possible to achieve, except for the first step and the last step
where variations in decking thickness and the use of screw jacks at
ground level make achieving this degree of uniformity difficult. OSHA
believes that a uniform riser height within \1/4\ inch (0.6 cm) for all
steps in each flight of stairs is necessary in order to minimize the
possibility that employees will slip, trip, and fall while they are on
the stairs.
OSHA recognizes that there are situations where the level of the
ground or of the structure to which the stair tower is connected will
cause the spacing of the top or bottom step of the stairway system to
deviate from uniformity with the other steps by more than \1/4\ inch.
The Agency has determined that such deviation will not compromise
employee safety, so long as the stair tower otherwise complies with the
requirements of paragraph (e)(4).
Final paragraph (e)(4)(xiv) requires that tread depth be uniform,
within \1/4\ inch, for each flight of stairs. This provision is
consistent with existing Sec. 1926.1052(a)(3), which requires tread
depth uniformity in other types of stairs used in construction.
Monsanto (Ex. 43-45) supported requirements providing for
uniformity of riser height and tread depth within each flight of
stairs. OSHA believes that tread depth uniformity, within \1/4\ inch,
as required in existing subpart X, is also appropriate for scaffold
stairways. Uniform tread depth reduces the possibility that employees
will slip and fall due to uneven footing.
Final rule paragraph (e)(5) sets requirements for ramps and
walkways used to access scaffolds. Final rule paragraph (e)(5)(i)
provides that ramps and walkways six (6) feet (1.8 m) or more above
lower levels shall be provided with guardrail systems in accordance
with the provisions of part 1926, subpart M--Fall Protection. In
addition, final rule paragraph (e)(5)(ii) provides that ramps and
walkways shall not exceed a slope of one (1) vertical to three (3)
horizontal (20 degrees above the horizontal). Finally, final rule
paragraph (e)(5)(iii) also requires that if the slope of a ramp or
walkway is steeper than one (1) vertical in eight (8) horizontal, the
ramp or walkway must have cleats not more than fourteen (14) inches (35
cm) apart which are securely fastened to the planking to provide secure
footing.
The corresponding proposed paragraph simply required that ramps and
runways be provided with guardrails in accordance with the provisions
of proposed Secs. 1926.501 and 1926.502 (Subpart M). As discussed above
in relation to the final rule term ``ramps'', OSHA has replaced the
term ``runways'' with the term ``walkways'', since the term
``walkway'', unlike the term ``runways'', is defined in this final
rule.
A commenter (Exs. 2-37 and 2-103) stated ``[r]amps and walkways are
used extensively * * * as a means of egress to an elevated surface.
Ramps are also used for material handling equipment. Since no standard
angle of elevation is addressed, an extreme angle of elevation and
slippery surfaces would result in fall-type accidents and muscle
strains.'' The commenter also stated that inadequately guarded walkways
pose fall hazards. The commenter recommended language that would
address the angle of elevation of ramps and would require cleats on
ramps with slopes steeper than one (1) vertical in eight (8) horizontal
to provide a safe foothold.
OSHA recognizes the need to indicate clearly what would be an
appropriate slope for ramps used as access to scaffolds and has
incorporated this language into the final rule as paragraphs
1926.451(e)(5)(ii) and (iii).
The Agency notes that final rule Sec. 1926.451(f)(8) requires that
employees be prohibited from working on scaffolds covered with snow,
ice, or other slippery material except as necessary for removal of such
material. OSHA considers scaffold access ramps and walkways to be part
of the scaffold and will also apply Sec. 1926.451(f)(8) to those ramps
and walkways.
Final rule paragraph (e)(6) sets requirements for integral
prefabricated scaffold access frames. Final rule paragraph (e)(6)(i)
provides that such frames shall be specifically designed and
constructed for use as ladder rungs. Also, final rule paragraph
(e)(6)(ii) requires that the frames have a rung length of at least 8
inches (20 cm). Final rule paragraph (e)(6)(iii) prescribes that rungs
less than 11\1/2\ inches in length shall be used for access only and
not as work platforms unless fall protection, or a positioning device,
is used. In addition, final rule paragraphs (e)(6)(iv) through (vi)
require that integral prefabricated scaffold access frames be uniformly
spaced within each frame section; provided with rest platforms at 35
foot (10.7 m) maximum vertical intervals on all supported scaffolds
more than 35 feet (10.7 m) high; and have a maximum spacing between
rungs of 16\3/4\ inches (43 cm), respectively. In addition, final rule
paragraph (e)(6)(vi) provides that non-uniform rung spacing caused by
joining end frames together is allowed, provided the resulting spacing
does not exceed 16\3/4\ inches (43 cm). These provisions are similar to
those in proposed paragraph (c)(5).
Regarding the proposed introductory text, the SSFI (Ex. 2-367)
recommended using the words ``access frames'' instead of the word
``rung.'' OSHA agrees that the suggested language more clearly states
the Agency's regulatory intent and has revised this paragraph in the
final rule accordingly.
Paragraph (e)(6)(i) of the final rule is identical to proposed
paragraph (c)(5)(i) except that the Agency has editorially revised the
provision to express OSHA's intent more clearly. OSHA recognizes that
the proposed language could have been misinterpreted to require only
that the access frames be designed as scaffold rungs, with no
requirement for them to be constructed in accordance with that design.
OSHA anticipates that these rungs will be designed and constructed
through consultation between the manufacturer and the end
[[Page 46057]]
user in order to satisfy the pertinent requirements of the final rule.
Final rule paragraph (e)(6)(ii) requires a minimum rung length of
eight inches. In addition, final rule paragraph (e)(6)(iii) prohibits
the use of rungs less than 11\1/2\ inches long as work platforms,
unless affected employees are using personal fall arrest systems or
positioning devices that comply with Sec. 1926.502 (paragraphs (d) and
(e), respectively). These two provisions evolved from proposed
(c)(5)(ii), which required a minimum rung length of 11\1/2\ inches (29
cm). Morgen Manufacturing Company (Ex. 2-303) commented that scaffolds
with integral prefabricated scaffold rungs which are only eight inches
long also ``provide safe access [to a work platform] equivalent to that
of a ladder.'' Further, the commenter stated that the 8-inch rungs
``provide surer footing and a better climb than does or can a ladder.''
Another commenter (Ex. 2-23) stated that all ladders should have a
minimum rung length of 12 inches in order to avoid confusion.
To evaluate this point, Issue L-6 of the hearing notice asked if
OSHA should revise proposed Sec. 1926.451(c)(5)(ii) to allow rung
lengths less than 11\1/2\ inches where the rungs were used for access
only. The SIA (Ex. 10; Tr. 3/22/88, p. 159) supported the 11\1/2\-inch
width requirement explaining ``[i]t's our understanding that the 11\1/
2\-inch width was required * * * to allow the workman to stand on a
rung with both feet * * * [A]n 8-inch rung would not be wide enough.''
Similarly, the SSFI (Ex. 5a-19) commented that its members would not
support reducing ``the minimum rung width from 11\1/2\ inches to * * *
eight inches.'' They added that practical usage indicates that 11\1/2\-
inch ladder rungs are appropriate.
Bristol Steel and Iron Works, Inc. (Ex. 13) stated that scaffold
rungs that were less than 11\1/2\ inches long were acceptable ``if they
provide safe access equivalent to that of a ladder.''
Morgen Scaffold's notice of intention to appear at the hearing (Ex.
5a-10), testimony at the hearing (Tr. 20-32, 3-22-88), and post-hearing
comments (Ex. 15), stated that OSHA should either revise the proposed
rule as provided in Issue L-6 or grandfather the existing Morgen
scaffolds to permit continued use of the 8-inch integral rung system.
Morgen contended (Ex. 5a-10, p. 2) that its scaffold tower's
integral rungs provide a safe and stable footing and handhold for
workers using the towers for access to connection points for
installation and removal of bracing and accessories. Morgen's post-
hearing comments (Ex. 15, p. 3) further contended that the Morgen
integral-rung system was safer than those requiring the use of a ladder
and offered the following rationale:
Morgen feels that the tower provides a more secure area from
which to install and remove the bracing and accessories than would a
ladder. When using a ladder with any type of scaffolding, the worker
is generally further from the connection point and must shift his
weight off the ladder to install bracing.
At the hearings, Morgen acknowledged that at no time are workers
able to put both feet on the same eight-inch rung (Tr. 3/22/88, p. 25).
However, Morgen also stated that ``the size of the Morgen tower allows
the worker to hug the tower, which is more secure than merely standing
with both feet on one rung'' (Ex. 15, p. 3). Morgen also asserted that
worker activities, rather than an arbitrary dimension, should be the
main consideration (Ex. 15, p. 7). OSHA believes that the 11\1/2\-inch
dimension is not an ``arbitrary dimension'', because this rung size is
generally recognized as necessary to provide workers with level footing
of sufficient size to enable them to stand on both feet, thus avoiding
the need to balance on one foot.
Morgen recognized (Tr. 28) that it is appropriate for employees to
use personal fall arrest or positioning devices while transporting or
installing scaffold components. Morgen recommends that personal fall
arrest systems be used to protect employees when tower inserts are
being added ``because the worker must keep both hands free to guide the
inserts into position'' (Ex. 15, p. 6). These same systems can be
easily used during other scaffold erection and disassembly procedures.
Morgen also stated (Ex. 15, p. 8) as follows:
Morgen has no objection to the institution of an industry wide
requirement for the use of body belts while installing bracing,
stiff arms, accessories and planking from integral ladder rungs.
Morgen's objection to the language currently proposed is that it
singles out Morgen and implies that the Morgen design is not safe.
Morgen objects to that characterization and feels that its scaffold
is among the safest in the industry. The characteristics which OSHA
wants to address, concerning the safe installation of scaffold
elements while in the air, are not unique to the Morgen scaffold and
do not depend upon a specified rung length.
OSHA agrees that the concerns addressed are not unique to Morgen
scaffolds. However, OSHA disagrees with the position that there is no
practical difference between an eight-inch rung where an employee can
stand only on one foot and must hug the tower to maintain balance and
an 11\1/2\-inch rung where both feet may be placed on a single rung.
OSHA also notes that Sec. 1926.1053(a)(4)(ii) specifies 11\1/2\ inches
as the appropriate minimum rung length on portable ladders.
After a careful evaluation of all the comments received, OSHA has
determined that rungs which are at least 8 inches long but less than
11\1/2\ inches long can be used safely for scaffold access, because
while climbing or descending the employee will normally have only one
foot on a rung at any given time and the 8 inch rungs will accommodate
this. However, employees who are assigned to use such rungs as work
platforms must be provided additional protection by the use of personal
fall arrest systems, or by positioning device systems, which comply
with Sec. 1926.502. This additional safeguard will ensure that
employees required to work from rungs less than 11\1/2\ inches in width
will be adequately protected from falling. This provision of the final
rule has been revised accordingly.
Final rule paragraph (e)(6)(iv) is identical to proposed paragraph
(c)(5)(iii), except that the term ``frame'' has been revised in the
final rule to read ``each frame section,'' so that the provision
clearly addresses situations where end frames are joined together,
producing non-uniform spacing in the area where the frames are joined.
OSHA was concerned that the proposal could have been misinterpreted to
require absolutely uniform spacing for the entire height of the
scaffold. That was not OSHA's intent, as evidenced by proposed
(c)(5)(v) (final rule paragraph (e)(6)(vi)) which prescribed maximum
spacing of rungs, but allowed for non-uniform spacing caused by the
joining of end frames.
Proposed paragraph (c)(5)(iv) differed from final rule paragraph
(e)(6)(v) in that the proposal required rest platforms at 20-foot
intervals instead of 35-foot intervals. This revision is based on the
response to Issue 28, as discussed above in relation to final rule
paragraph (e)(2)(iii).
Proposed paragraph (c)(5)(v) differed from final rule paragraph
(e)(6)(vi) in that the proposal required 16\1/2\-inch instead of 16\3/
4\-inch maximum spacing of rungs. This change reflects input from the
SSFI (Ex. 2-367), which informed OSHA that 16\3/4\ inches is the
current industry guideline for rung spacing. In proposing 16\1/2\
inches OSHA intended to recognize the large number of frames already in
existence without requiring a significant program of frame
modification. Therefore, based on the
[[Page 46058]]
comment indicating that 16\3/4\ inches, not 16\1/2\ inches, is the
prevalent spacing, and because the additional one-fourth-inch spacing
is not believed to be significant, OSHA has modified the final rule to
recognize the 16\3/4\ inch spacing limit.
Final rule paragraph (e)(7) provides that all steps and rungs of
all ladder and stairway type access shall line up vertically with each
other between rest platforms. Proposed paragraph (c)(6) was identical
except that the final rule has added the phrase ``of all ladder and
stairway type access'' so that the final rule more clearly expresses
the Agency's intent.
Final rule paragraph (e)(8) provides that direct access to or from
another surface shall be allowed only when the pertinent surfaces are
not more than 14 inches (36 cm) apart horizontally and not more than 24
inches (61 cm) apart vertically. It is identical to proposed paragraph
(c)(7) except for the addition of the phrase ``to or from another
surface'' and some other minor editorial changes. The 14-inch dimension
was chosen to be consistent with proposed Sec. 1926.451(b)(4)
(promulgated as final rule Sec. 1926.451(b)(3)).
The 24-inch dimension is consistent with final rule paragraphs
(e)(1), (e)(2)(ii) and (e)(3)(i), as discussed above.
Paragraph (e)(9) of the final rule sets access requirements for
employees erecting or dismantling supported scaffolds. The introductory
language of paragraph (e)(9) requires employers to comply with final
paragraphs (e)(9)(i)-(iv) starting on September 2, 1997. OSHA has
delayed implementation of this paragraph (as well as paragraph (g)(2))
so that affected employers have sufficient time to develop and
implement the necessary measures. In addition, the delayed
implementation allows time for OSHA to complete work on non-mandatory
Appendix B, discussed below, which will provide examples of
considerations that employers complying with paragraphs (e)(9) and
(g)(2) would take into account. Paragraph (e)(9)(i) provides that the
means of access for erectors or dismantlers shall be determined by a
competent person, based on specific site conditions and the type of
scaffold being erected. As discussed in relation to the introductory
text of final rule paragraph (e), while the Agency originally proposed
to exempt erectors and dismantlers working on supported scaffolds from
requirements for safe access, careful review of the record has led OSHA
to the conclusion that a competent person is the appropriate individual
to decide what the appropriate means of access for scaffold erectors
and dismantlers is on any particular job, based on specific site
conditions.
As discussed below in relation to final rule Sec. 1926.451(f)(7)
(effectively identical to existing rule Sec. 1926.451(a)(3) and
proposed rule paragraph (d)(7)), employers are required to have the
erection, dismantling or alteration of a scaffold conducted under the
supervision and direction of a competent person who is qualified in the
pertinent subject matter.
OSHA is developing non-mandatory Appendix B, which will be added at
a later date, to provide examples of criteria for the competent person
to consider when evaluating the feasibility and safety of the options
for providing safe access. This final rule reserves Appendix B to
enable OSHA to provide guidance on the feasibility of providing safe
access and fall protection during erection and dismantling. Once that
language has been added, access provided in accordance with non-
mandatory Appendix B will be considered to meet the requirements of
this provision.
Paragraph (e)(9)(ii) of the final rule requires that hook-on or
attachable ladders be installed as soon as practical after the scaffold
erection has progressed to the point permitting their installation and
use. OSHA has included this provision because the rulemaking record
(Exs. 34-9, 34-10, 34-12, and 34-17) indicates that sectional ladders
can be used for access once adequate support is available.
Paragraph (e)(9)(iii) of the final rule recognizes that the end
frames of tubular welded frame scaffolds that meet certain requirements
can be safely used as a means of access for scaffold erectors and
dismantlers. These requirements are based on section 1637(n)(2)(C) of
the California code, as suggested by one of the commenters (Ex. 2-23).
Paragraph (e)(9)(iv) of the final rule provides that crossbracing
is not an acceptable means of access on tubular welded frame scaffolds,
because crossbraces are designed to provide diagonal stability to the
scaffold and are not designed to withstand the forces that could be
applied by employees climbing up and down on them. This provision is
consistent with ANSI A10.8, section 4.18, and with the general
prohibition in final rule paragraph (e)(1), discussed above. This
requirement is being repeated here to ensure that the users are aware
that the prohibition applies to scaffold erectors and dismantlers as
well as to scaffold users. The Agency invites interested parties to
provide OSHA with suggestions and information regarding appropriate
guidance for the competent person.
Paragraph Sec. 1926.451(f) Use
Paragraph (f) of the final rule addresses safe work practices for
the use of scaffolds and the activities which take place on scaffolds.
Paragraph (f)(1) of the final rule provides that scaffolds and
scaffold components shall not be loaded in excess of their maximum
intended loads or rated capacities, whichever is less. This is
identical to proposed paragraph (d)(1), except for the clarifying
phrase ``whichever is less.'' This provision clarifies and consolidates
existing Secs. 1926.451(h)(1), (i)(8), (j)(1), (s)(6), (t)(4), (w)(1),
(x)(3) and (y)(1)(iii). This final rule also complements
Sec. 1926.451(a)(1), which requires that scaffolds be capable of
supporting four times the maximum intended load without failure.
Compliance with this rule ensures that the scaffold's capacity is not
exceeded.
A commenter (Ex. 2-64) suggested deleting the term ``maximum
intended load.'' OSHA has not done so because, as discussed above in
relation to the definition of this term, the Agency believes it is
appropriate to take into account the ``expected'' burden as well as the
burden a scaffold ``can'' support without failure.
Paragraph (f)(2) of the final rule prohibits the use of shore or
lean-to scaffolds. The final rule is identical to proposed paragraph
(d)(2), which was based on existing Sec. 1926.451(a)(20). Such
scaffolds are not properly designed nor properly constructed, and pose
a serious threat to anyone working on them. The two commenters (Exs. 2-
23 and 2-308) who addressed this provision simply agreed with the
continued prohibition of shore and lean-to scaffolds.
Paragraph (f)(3) of the final rule requires that scaffolds and
scaffold components be inspected for visible defects by a competent
person prior to each work shift and after any occurrence which could
affect a scaffold's structural integrity. Final rule paragraph (f)(3)
is identical to proposed paragraph (d)(3), which was based on existing
Secs. 1926.45(i)(7) and (k)(5). Those existing provisions require
inspections of certain types of suspension scaffolds. Given the
importance of detecting defects in scaffolds and scaffold components,
OSHA concludes that all scaffolds need to be inspected at the times
specified in the final rule.
Issue 16 requested comment on the proposed frequency of scaffold
[[Page 46059]]
inspections for visible defects ``prior to each workshift.'' Two
commenters (Exs. 2-13 and 2-69) stated that only certain types of
scaffolds can be fully or partially inspected prior to each workshift.
Those commenters agreed that two-point suspension scaffolds can be
fully inspected, but they indicated that such an inspection could not
be done for ``tubular welded frame scaffold covering a multi-story
building.'' One of them (Ex. 2-13) added that proposed
Sec. 1926.451(d)(3) should specify the types of scaffolds to be
completely inspected prior to each workshift and offered suspension and
small supported scaffolds as examples. The other (Ex. 2-69) stated that
inspecting a multi-story scaffold system could take the majority of the
work shift.
OSHA acknowledges that the amount of time needed to perform visual
inspection may depend on the type and size of the scaffold being
inspected. However, OSHA believes that it is appropriate for the
proposed inspection requirement to cover all types of scaffolds,
because any scaffold (or scaffold component) can have or develop
defects which would pose hazards for employees if allowed to remain in
service without being inspected. In addition, OSHA believes that the
time to conduct a careful inspection for ``visible defects'' will
involve a reasonable amount of time when considered in relation to the
scale of the work in question.
Another commenter (Ex. 2-64) stated that suspended scaffolds (``and
associated equipment'') should be inspected according to the
manufacturer's recommendations. In addition, this commenter provided a
copy of the company's recommended inspection schedule for particular
suspension scaffold components. This commenter also stated that
``improper maintenance was the most frequent cause of product
incidents.''
One commenter (Ex. 2-43) stated that the ``[i]nspection procedures
for swing stages are adequate'' but that ``[w]eekly or monthly
inspections on rolling or stationary scaffolds should be mandated.''
Another commenter (Ex. 2-31) responded that the daily inspections
(prior to each workshift) were ``appropriate for the pumpjack
scaffolding user.''
Eight commenters (Exs. 2-15, 2-22, 2-53, 2-70, 2-367, 2-368, 2-407,
and 2-465) supported specifying scaffold inspection frequency, without
regard to the type or size scaffold inspected. In particular, a
commenter (Ex. 2-22) stated that the inspection frequency should be no
more ``than once per day or after an occurrence.'' Another commenter
(Ex. 2-53) was of the opinion that scaffolds and scaffold components
should be inspected for visible defects prior to each use. The ACCSH
recommended that scaffold inspection should take place prior to use,
and added that a competent person should handle the inspection (Tr.
6/9/87, 136-138).
The SIA (Ex. 2-368) also supported having a competent person
perform the inspection but stated that a full inspection was not
``feasible every time a worker gets on a scaffold.'' The commenter
stated that ``[i]nspection is a critical factor in accident
prevention'' and agreed that the daily inspection, prior to each
workshift, was appropriate. The SIA also discussed specific occurrences
that might alter the condition of a scaffold, explaining that these
``would include unexplained shifting, movement, or malfunction of
equipment where [the] scaffold is a mechanical device.''
In addition, the SSFI (Ex. 2-367) indicated that the recommendation
for daily inspection coincided with the proposed ANSI A10.8
requirements for inspection. They added that a scaffold should be
inspected when it ``has been altered, either by accident or design.''
The BCMALU (Ex. 2-54) supported the inspection of scaffolds and
their components but did not indicate a preferred interval for such
inspections.
After a careful review of these comments, OSHA has determined that
inspections conducted by a competent person before each shift and after
any occurrence that would affect the scaffold's integrity will
adequately protect employees working on scaffolds and ensure that
defects are detected in a timely fashion. Given the variety of
scaffolds and situations that arise regarding their use, the Agency
believes that specifying the inspection frequency would unnecessarily
limit employers' flexibility.
One commenter (Ex. 2-308) stated that all inspection results should
be in writing and be signed by a ``competent person.'' This commenter
pointed out that the duration of a ``workshift'' needed to be defined
if inspection was required before each shift. OSHA believes that such
documentation is unnecessarily burdensome, especially in light of
Sec. 1926.451(f)(4) of this final rule, which requires immediate
repair, replacement, bracing, or removal from service of any scaffold
part that does not meet the strength requirements of Sec. 1926.451 (a)
or (g). In addition, the Agency recognizes that the length of
workshifts varies and has determined that the protection afforded by
this provision is needed whatever the length of the workshift.
Accordingly, OSHA has not added the suggested revisions.
Several commenters (Exs. 2-37, 2-38, and 2-103) stated that there
was a need to define ``competent person.'' OSHA notes that a general
definition of this individual that applies to all construction work
already exists in Sec. 1926.32. Although the definition of competent
person in that section applies to all construction work, OSHA believes
that it is reasonable to repeat this definition of ``competent person''
in the final rule, as a matter of convenience for the user. However,
the Agency notes that the criteria for a ``competent person'' depend on
the situation in which the competent person is working. For example, a
``competent person'' for the purposes of this provision must have had
specific training in and be knowledgeable about the structural
integrity of scaffolds and the degree of maintenance needed to maintain
them. The competent person must also be able to evaluate the effects of
occurrences such as a dropped load, or a truck backing into a support
leg that could damage a scaffold. In addition, the competent person
must be knowledgeable about the requirements of this standard. A
competent person must have training or knowledge in these areas in
order to identify and correct hazards encountered in scaffold work.
Final rule paragraph (f)(4) requires that any part of a scaffold
whose strength has been reduced to less than that required by
Secs. 1926.451(a) shall be immediately repaired or replaced, braced to
meet those provisions, where appropriate, or be removed from service
until repaired. This paragraph applies whenever a scaffold component,
for any reason, lacks the required strength. In particular, under this
provision employers must follow through to address problems identified
pursuant to paragraph (f)(3) of this section. Proposed paragraph (d)(4)
was effectively identical to final rule paragraph (f)(4), except that
the proposal required action only when a competent person determined
that the strength of a part had been compromised, and provided only for
bracing of a part or its removal from service. This provision of the
final rule thus clarifies and consolidates existing Secs. 1926.451
(a)(8) and (o)(6). The proposed paragraph also recognized bracing as an
acceptable means of compliance because OSHA foresaw circumstances where
the removal of a damaged component could be extremely difficult or
hazardous due to its location. However, provision for replacement of a
damaged component was inadvertently left out of the
[[Page 46060]]
proposal. OSHA has included it in the final rule so that the text
clearly expresses the Agency's intent.
Final rule paragraph (f)(5) provides that scaffolds shall not be
moved horizontally while employees are on them, except that mobile
scaffolds may be moved if the provisions of Sec. 1926.452(w) for mobile
scaffolds are followed, and then only if they have been designed by a
registered professional engineer specifically for such movement. Final
rule paragraph (f)(5) is very similar to the proposed paragraph (d)(5)
except that ``laterally'' has been changed to ``horizontally'' for the
sake of clarity. In addition, the proposed exception did not include
scaffolds designed by registered professional engineers specifically
for such movement. The proposed rule was intended to consolidate and
reconcile existing Secs. 1926.451(a)(3) (any scaffold movement must be
conducted under the supervision of a competent person), (e) (6)-(8)
(criteria for moving mobile scaffolds) and (p)(1) (needle beam
scaffolds shall not be moved while in use).
Two commenters (Exs. 2-13 and 2-367) suggested that the Agency
prohibit, in all instances, the moving of mobile scaffolds when
employees are on them, but gave no specific rationale for their
comments. The Agency is not acting on these suggestions because it has
determined that the provisions of final rule paragraph
Sec. 1926.451(f)(7) requiring a competent person to supervise and
direct any movement of a scaffold, and the requirements of
Sec. 1926.452(w), which specifically address the movement of mobile
scaffolds, will provide adequate protection for employees. In addition,
the Agency believes that making employees climb up and down the
scaffold every time it is moved could actually expose them to greater
risk of falling than remaining on a scaffold that is being moved under
the direction of a competent person in accordance with the requirements
of Sec. 1926.452(w).
The SIA (Ex. 2-368) recommended that OSHA add another exception for
some suspension scaffolds which are designed to be moved horizontally
while occupied. The commenter cited as an example scaffolds used for
the construction of bridges and other similar steel structures where it
is impossible to move the scaffold at the ground level. The final rule
allows this type of scaffold to be moved horizontally if the scaffold
has been designed for such movement by a registered professional
engineer.
Paragraph (f)(6) of the final rule addresses the use of scaffolds
near exposed and energized power lines. In particular, this paragraph
requires employers to maintain clearance between power lines and
scaffolds, including any conductive materials on the scaffold. The
minimum clearance for all uninsulated lines and for insulated lines of
more than 300 volts is 10 feet. The minimum clearance for insulated
lines of less than 300 volts is 3 feet. In addition, final rule
paragraph (f)(6)(i) provides that scaffolds and materials may be closer
to power lines than specified above only where necessary to do the
work, and only after the utility company or electrical system operator
has been notified of the need to work closer and the utility company or
electrical system operator has deenergized the lines, relocated the
lines, or installed protective coverings to prevent accidental contact
with the lines.
The final rule provisions in paragraph (f)(6) are very similar to
those in proposed paragraph (d)(6), except that the final rule
addresses materials used on scaffolds; provides an exception for
situations where the employer has contacted the utility company to have
power lines de-energized, relocated or covered to prevent accidental
contact; and sets three feet, rather than two feet, as the minimum
clearance between scaffolds and insulated lines of less than 300 volts.
OSHA has also editorially revised this provision for the sake of
clarity.
The first two changes noted above were made based on input received
in response to Issue L-5 of the hearing notice (53 FR 2051). First, the
ACCSH (Tr. 6/9/87, p. 204) suggested that OSHA revise proposed
Sec. 1926.451(d)(6) to reflect concern that conductive material handled
on a scaffold might contact exposed and energized lines even if the
scaffold itself did not. To this end, the ACCSH recommended that the
introductory language of proposed Sec. 1926.451(d)(6) read as follows:
Scaffolds shall not be erected, used or moved in such a way that
they or any conductive material handled on them can come closer to
exposed and energized power lines than as follows: * * * .
The Edison Electric Institute (EEI) testified (Tr. 190, 3-22-88) in
favor of the suggested language, stating ``[w]e also support your
contention that any conductive extension or persons moving on that
scaffold, the platform, should also comply [with] 10 feet.''
Second, a commenter (Ex. 2-103) suggested that the Agency require
employers to notify the power company when scaffolds are to be erected
near energized power lines and request that the power company de-
energize the line or provide protective covering to prevent accidental
contact.
In Hearing Notice Issue L-5, OSHA indicated its expectation that
adding the suggested language would provide primary employee protection
from electrical shock hazards. The Agency further indicated that
proposed paragraph (d)(6) would apply if the affected employer could
not obtain assurances from the utility company that the lines had been
de-energized or adequately protected from contact.
The SIA testified (Tr. 158, 3-22-88) that the suggested Issue L-5
wording was too vague and recommended that specification-type language,
rather than performance-oriented terminology, ``may be more practical
and enforceable when you are dealing with exposure of this type.'' The
SIA further stated:
We certainly do have the hazard there, particularly in people
erecting the scaffolds and people working on them. There's a great
problem when people go out to erect a scaffold around a building,
there is high voltage wire close by. The question has always been,
well how close can we get to it? Based on California in their table
in some instances they say 6 feet. Some people say that is too close
and I don't know but I think that is really something you need to
address to get input from people who are experts in that area (Tr.
169).
EEI testified (Ex. 11; Tr. 180, 3/22/88) that OSHA should
promulgate the proposed ten-foot minimum clearance between a scaffold
and energized and exposed power lines; that the installation of
protective devices on the power lines be done by ``trained utility line
technicians''; that the ten foot proximity rule should apply to ``any
conductive extension or persons'' on a scaffold (Tr. 190-191); and that
the Hearing Notice Issue L-5 language regarding protective coverings
for energized lines was ``not a safe standard * * *''
In addition, EEI supported requiring employers to notify utilities
before erecting scaffolds in proximity to energized lines, so that the
utilities could determine how to protect scaffold workers. EEI also
stated (Tr. 181):
Any final standard must make it clear that the 10 foot or more
clearances are to be observed unless the line is deenergized or
unless the utility plainly advises the employer that it is safe for
the particular condition involved to erect a scaffold in closer
proximity to the lines than the 10 feet allowed.
It must also be made clear in the final standard that the
utility will have no obligation to be [de]energized or to take steps
to protect lines and that, if the utility deems it appropriate to do
neither, that the 10-foot clearance distance as a minimum * * * must
be observed.
[[Page 46061]]
The EEI described the procedures by which employers contact
utilities when employees need to work in proximity to energized lines,
as follows:
In Wisconsin as part of a one-call system that originated for
digging in the ground to avoid contact with buried facilities. We
have incorporated notification for all electric facilities. So
contractors in Wisconsin who are approaching a job where they detect
the presence of overhead conductors can use the one-call system to
notify the utility of their intent to work. And within 72 hours the
utility comes out and inspects and tells them what they are
proposing is reasonable or not. I am sure there are other states
with similar provisions (Tr. 187).
In response to a question about how work could proceed when a
scaffold must be erected within ten feet of an energized line and the
utility refuses to de-energize the line, EEI testified (Tr. 198) that
the architects and planners for the structure should consider the line
when planning the project. Otherwise, he added, there ``* * * would
have to be a delay until some appropriate protection or alternate feed
for that facility was established.''
Bristol Steel (Exs. 5a-3 and 13) supported focusing attention on
the safeguards necessary to address problems associated with power
lines, stating that the proposed language to require maintaining a safe
distance from power lines or de-energizing the lines to protect
employees from the lines was warranted.
The SSFI (Ex. 5a-19) expressed support for the proposed requirement
that an appropriate distance be maintained between scaffolds and
energized power lines.
The third substantive change made in the final rule to proposed
paragraph (d)(6) was the revision of proposed paragraph (d)(6)(iii) to
increase the minimum clearance between scaffolds and lines to 3 feet
instead of 2 feet. This change was based on the 1990 editions of two
national consensus standards, the National Electrical Safety Code
(NESC) and the National Electrical Code (NEC).
NESC Rule 234C specifies clearances from the nearest conductive
surface to the nearest surface of a building or its projections or its
attachments (scaffolds). The required horizontal clearance to buildings
is intended to provide adequate working space between the conductors or
cables and the building surface to permit workers with small hand tools
to conduct maintenance on a building or other structure. Trained
workers using specialized maintenance tools would also be provided with
adequate clearance.
Specifically, NESC Rule 24C3c(2) states the following:
Service-drop conductors shall not be readily accessible, and
when not in excess of 750 volts, they shall have a clearance of not
less than 3 feet in any direction from windows, doors, porches, fire
escapes, or similar locations.
Section 24C3c(2) was added in the 1984 edition of the NESC to be
consistent with Article 230-24(c) of the NEC. Article 230 of the NEC
covers service conductors.
In the NEC, Article 230-24(c) covers clearances of all overhead
service-drop conductors, and simply refers to Article 230-9,
``Clearances from Building Openings.'' Article 230-9, based on no wind
loading, states the following: ``Service conductors installed as open
conductors or multiconductor cable without an overall outer jacket
shall have a clearance of not less than 3 feet from windows, doors,
porches, fire escapes, or similar locations.''
With no wind loading, the horizontal clearance from the scaffold to
the service conductors must be at least 3 feet. Where wind loading
might cause the conductor to be displaced, the original clearance
distance must be expanded to assure that at least 3 feet of clearance
is maintained between the scaffold and the displaced conductor.
Paragraph (f)(7) of the final rule provides that scaffolds shall
only be erected, moved, dismantled, or altered under the supervision
and direction of a competent person. That paragraph further provides
that the listed activities shall be performed only by experienced and
trained employees selected for such work by the competent person. This
provision is similar to proposed paragraph (d)(7), which was
effectively identical to existing Sec. 1926.451(a)(3).
OSHA received one comment (Ex. 2-23) which recommended the addition
of ``and direction'' between the words ``supervision'' and ``of''
because it would otherwise infer that the supervision need not be at
the scene directing the work. OSHA believes such direct supervision is
necessary, and has revised the final rule to clarify this point. This
commenter also suggested that a qualified person rather than a
competent person be required by this provision. The commenter defined a
qualified person as ``a person designated by the employer who by reason
of experience or instruction is familiar with the operation to be
performed and the hazards involved.'' OSHA acknowledges that the
proposed language does not clearly address the qualifications of a
competent person charged with directing scaffold work. Therefore, the
Agency has revised the language to indicate clearly that the competent
person must be ``qualified'' (as defined in Sec. 1926.32(m)) in the
subject matters for which that person has responsibility.
The Agency has also clarified that the actual work be performed by
experienced and trained employees, selected by the competent person.
This change is based on an ACCSH recommendation (Tr. 88-92, 6-9-87). In
particular, a member of the Advisory Committee stated ``it needs to be
employees that are properly trained and experienced being the only ones
allowed to do this kind of work.'' OSHA agrees with this recommendation
because, unlike other individuals on a finished scaffold, erectors and
disassemblers are exposed to the hazards of working on a partially
completed structure, and a competent person is needed to select the
proper individuals to do this work.
Paragraph (f)(8) of the final rule provides that employees are
prohibited from working on scaffolds covered with snow, ice, or other
slippery material except as necessary for removal of such materials.
This provision is identical to proposed paragraph (d)(8), which was
intended to clarify existing Sec. 1926.451(a)(17). The existing
standard simply required that ``slippery conditions on scaffolds shall
be eliminated as soon as possible after they occur.''
The Agency recognizes that the situation addressed by this
provision differs from situations where workers could be required to
work on scaffolds during storms or high winds, which is addressed by
Sec. 1926.451(f)(12) (discussed below). OSHA notes that snow and ice
removal can be done from ground level on one level built-up scaffolds
(approximately 6 feet) and on suspended scaffolds, since they are
usually accessed at ground level. When dealing with a two or more level
built-up scaffold, removal of slippery material would be conducted
above the 10-foot trigger height requiring normal fall protection
precautions. On the other hand, work on scaffolds during storms or high
winds poses a much greater risk of falling for workers, especially on
tall scaffolds where wind velocity can be much greater than at ground
level. In these situations, materials handling, or even normal
activities such as walking, are adversely affected to the point where
guardrails alone might not be sufficiently protective. Under these
circumstances, the Agency intends the competent person to determine if
the work can be done safely, and the employer to ensure that those
[[Page 46062]]
employees are provided extra protection through the use of personal
fall arrest systems or wind screens. This provision is discussed
further below.
Paragraph (f)(9) of the final rule requires that, where swinging
loads are being hoisted on, to, or near scaffolds such that the loads
could contact the scaffold, tag lines or equivalent measures shall be
utilized to stabilize the loads. This provision is effectively
identical to proposed paragraph (d)(9). The proposed rule was based on
Sec. 1910.28(a)(15), which requires tag lines only when loads are being
hoisted onto the scaffold. The provision covers all hoisting operations
in proximity to scaffolds, because a swinging load can pose a hazard
regardless of its destination. OSHA has made a minor editorial revision
to the proposed rule for the sake of clarity.
Final rule paragraph (f)(10) requires that support ropes used with
adjustable suspension scaffolds have sufficient diameter for
functioning of the brakes and the hoist mechanism. As discussed above
in relation to final rule Sec. 1926.451(a), OSHA has relocated this
provision, which is effectively identical to proposed paragraph
(a)(4)(i), to consolidate the requirements for rope used with
suspension scaffolds.
Paragraph (f)(11) of the final rule requires that suspension ropes
be shielded when a heat-producing process is performed. When acids or
other corrosive substances are used on a scaffold, the ropes shall be
shielded, treated to protect against the corrosive substances, or shall
be of a material which is not adversely affected by the substance being
used. This provision is identical to proposed paragraph (d)(10). The
proposal was essentially the same as existing Sec. 1926.451(a)(18),
which prohibits the use of any heat producing process on scaffolds
supported by fiber or synthetic rope and requires that only treated or
protected fiber or synthetic ropes be used near corrosive substances.
Unlike the existing rule, the revised standard allows the use of heat
producing processes, as long as the ropes are shielded. The provisions
for protection of scaffolds and their components from corrosive
substances and from heat-producing processes are consistent with ANSI
A10.8-1988, Sections 4.27 and 4.28, respectively.
Final rule paragraph (f)(12) prohibits work on or from scaffolds
during storms or high winds unless a competent person has determined
that it is safe for employees to be on the scaffold and these employees
are protected by a personal fall arrest system or wind screens. Wind
screens shall not be used unless the scaffold is secured against the
forces imposed. The proposed rule (paragraph (d)(11)) was based on
general industry regulation Sec. 1910.28(a)(18), which provides that
employees shall not work on scaffolds during storms or high winds.
Proposed paragraph (d)(11) prohibited work on scaffolds during
storms or when wind speeds exceeded 40-mph, unless body belt or harness
systems were used or wind screens were erected. The proposed rule, like
the final rule, provided that wind screens could only be used if the
scaffold was secured against the forces imposed. Issue 6 of the NPRM
requested comments on whether the proposed 40-mph limit was appropriate
and on how to measure the wind speed.
Two commenters (Exs. 2-22 and 2-53) supported the proposed 40-mph
limit. Two other commenters (Exs. 2-13 and 2-41) stated that 25 mph
would be a more appropriate limit. Other commenters (Exs. 2-54 and 2-
64) stated that 40 mph is too high a limit, because of the dangers high
winds present, but did not suggest an alternative limit. Two commenters
(Exs. 2-64 and 2-368) stated that no specific limit should be set
because of the variations in wind speed from ground level to higher
elevations, and from building side to building side. Several commenters
from the AGC (Exs. 2-20, 2-55, 2-70, 2-390, and 2-516) stated that
contractors are presently using ``good judgement'' in determining when
work should cease and that there are no statistics to show otherwise.
The SSFI and the SIA (Exs. 2-367 and 2-368) stated that the most
recent draft language used in the ANSI A10.8 standard should be used.
As adopted, ANSI A10.8-1988, Section 4.22, provides ``[w]orkers shall
not work on scaffolds during storms or high winds.'' In particular, the
SSFI (Ex. 2-367) stated ``[t]here are too many variables for a specific
wind speed to be determined by a governmental agency.'' That commenter
also recommended that OSHA use the term ``high wind'' without
specifying a wind speed, and that the Agency let individual workers
determine if the work should be performed under those conditions. The
SIA (Ex. 2-368) stated ``a set limit of mph can be misleading and
dangerous in that the wind velocity can be 15 mph or lower, yet the
side of the building the men are working on can have gusts in excess of
40 mph. * * * Wind will vary on each side of a building.''
The ACCSH (Tr. 65-79, 6/9/87) recommended that the determination of
wind hazard should be made by a ``competent person.'' OSHA agrees that
designating a competent person to evaluate wind conditions is the
appropriate way to ensure that all the relevant information and the
unique aspects of work locations are considered. OSHA believes this is
a more appropriate way to address the problem than simply specifying a
speed limit without regard to other factors. Accordingly, the Agency
has revised the final rule to reflect the ACCSH suggestion to use a
competent person and the suggestions to use the ANSI language.
Final rule paragraph (f)(13) provides that debris shall not be
allowed to accumulate on platforms, where it could pose a slip, trip,
or fall hazard to employees on or below the platform. This provision is
identical to proposed paragraph (d)(12), which was based on existing
Sec. 1910.28(a)(20). This provision is consistent with ANSI A10.8-1988,
Section 4.24.
Final rule paragraph (f)(14) provides that makeshift devices, such
as but not limited to boxes and barrels, shall not be used on top of
scaffold platforms to increase the working level height of employees.
The Agency has concluded that these makeshift devices will not meet the
pertinent criteria of this final rule, in terms of strength and
stability.
Final rule paragraph (f)(15) prohibits the use of ladders on
scaffolds to increase the employee's working level except when the
employees are on large area scaffolds and the ladder is used in
accordance with the applicable provisions of final rule paragraph
(f)(15)(i)-(iv), discussed below.
The corresponding paragraph in the proposal provided simply that
ladders and makeshift devices not be used to increase scaffold working
heights. This provision was intended to ensure that workers were
provided with a secure work platform, and to eliminate the hazard of
tipping caused by portable ladders exerting a sideways thrust on
scaffold systems. The pertinent provisions are consistent with the
corresponding language in ANSI A10.8-1988, Section 4.29.
NPRM Issue 29 requested public comment on the need for the proposed
prohibition against the use of ladders on scaffolds. Three commenters
(Exs. 2-40, 2-53, and 2-69) favored the use of body/safety belts in
such situations. Of these three, both NIOSH (Ex. 2-40) and another
commenter (Ex. 2-69) noted that there would be no need to prevent the
tipping of a scaffold from sideways thrust exerted by a ladder if the
scaffold were secured laterally. Those commenters added that employees
working above the guardrail system could be guarded from falls by using
a body belt. In addition, NIOSH (Ex. 2-40)
[[Page 46063]]
provided examples, noting that tiebacks, guys, or braces would be used
to secure a scaffold. NIOSH also suggested that OSHA consider requiring
``form scaffolds'' to be near the top of concrete forms. The commenter
indicated that this would ``eliminate the need for workers to be above
the scaffold fall protection system.'' However, NIOSH stated that no
data exist to support this recommendation concerning form scaffolds.
The other commenter (Ex. 2-53) who supported the use of personal fall
arrest systems stated ``safety belts must be used'' when ladders or
other devises are used on top of scaffolds to increase the working
level heights of employees.
One commenter (Ex. 2-15) favored the proposed prohibition of the
use of ladders or makeshift devices to raise the working level of
employees, provided that the prohibition pertains only to scaffolds
subject to tipping that do not completely cover an enclosed area. In
particular, this commenter stated that the proposed prohibition should
not apply to scaffolds built from wall to wall with the entire floor
area covered and with a completely decked top (in effect, a large area
scaffold) from which several trades could use ladders or small
scaffolds to do their work. In addition, two commenters (Exs. 2-1 and
2-54) who addressed proposed paragraph (d)(13), rather than Issue 29,
indicated that ladders can be used on large area scaffolds when
additional precautions are taken.
One commenter (Ex. 2-64) supported applying the proposed
prohibition to suspended scaffolds but did not address other scaffolds.
Another commenter (Ex. 2-13) stated that no ladder or makeshift device
``should be used to increase the height of a scaffold.''
In addition, four commenters (Exs. 2-29, 2-43, 2-367 and 2-368)
explicitly and unconditionally supported the proposed prohibition. Two
commenters (Exs. 2-29 and 2-43) very briefly stated that the use of
ladders and makeshift devices on top of scaffolds to raise working
levels should be prohibited. The SSFI (Ex. 2-367) supported the
proposed prohibition and stated that the use of ladders and makeshift
devices on top of scaffolds makes scaffold systems unstable. The SIA
(Ex. 2-368) supported the proposed prohibition and stated that accident
statistics ``reveal a number of injuries and fatalities due to workers
improvising ladders and makeshift devices to obtain greater working
heights from scaffolds.''
After carefully considering the above comments and the
recommendation from the ACCSH, OSHA has determined that the proposed
prohibition of the use of ladders and makeshift devices on top of
scaffolds is necessary to ensure employee safety. However, the Agency
has also determined that the use of ladders on large area scaffolds is
consistent with efforts to ensure employee safety. As noted above in
the discussion of the definition for ``Large area scaffold'', these
scaffolds cover substantially the entire work area, and are basically
equivalent to working on a floor or large deck of a structure, where
ladders can be used safely. Therefore, the final rule prohibits the use
of makeshift devices on all scaffolds and prohibits the use of ladders
on scaffolds other than large area scaffolds.
Furthermore, the OSHA has determined that the requirements in
proposed Sec. 1926.451(d)(13), which addressed the use of both ladders
and makeshift devices in one provision, should be separated into two
paragraphs so that the final rule clearly expresses the Agency's
regulatory intent. The proposed rule has been revised accordingly.
Final rule paragraph (f)(15)(i) provides that when a ladder is
placed against a structure which is not a part of the scaffold, the
scaffold must be secured against the sideways thrust exerted by the
ladder. This provision was suggested by NIOSH and other commenters on
Issue 29. In addition, paragraphs (f)(15) (ii) through (iv) require
that the platform units be secured to the scaffold to prevent them from
moving; that the ladder legs are all on the same platform unit unless
other means have been provided to stabilize the ladder against platform
unit deflection; and that the ladder legs be secured to prevent them
from slipping and being pushed off the platform unit. These provisions
are based on suggestions made by commenters on Issue 29, as discussed
above.
The Agency believes that compliance with these provisions will
prevent the tipping and instability hazards that led OSHA to propose a
prohibition against the use of ladders on all scaffolds, and has
revised the final rule accordingly.
Final rule paragraph (f)(16) provides that platform units shall not
deflect more than 1/60 of the span when loaded. This provision is
identical to proposed paragraph (d)(14), and is intended to limit the
amount platform units can deflect under load without becoming
overstressed and without their ends being pulled from their supports.
Final rule paragraph (f)(17) requires employers to reduce the
possibility of welding current arcing through suspension wire rope
while employees are performing welding from suspended scaffolds by
insulating the suspended platform and its rigging. OSHA is adding this
new provision to protect employees from the electrocution and platform
collapse hazards posed by arcing welding current. In particular, the
Agency requires that employers rig affected scaffolds with insulated
thimbles (paragraph (f)(17)(i)), insulated wire rope (paragraph
(f)(17)(ii)), and insulated hoist mechanisms (paragraph (f)(17)(iii)).
This paragraph also specifies precautions for grounding the scaffold to
the structure on which welding is being performed (paragraphs (f)(17)
(iv-vi)). These provisions are consistent with ANSI A10.8-1988, Section
6.2.9.
Issue 2 of the NPRM requested comment on the need to regulate
welding equipment used on suspended scaffolds and solicited input
regarding regulatory text then being considered by the ANSI A10.8
Committee. That text, divided into six items, was effectively identical
to the language OSHA has promulgated in paragraph (f)(17).
Four commenters (Exs. 2-20, 2-55, 2-69, and 2-390) stated that this
subject should be covered by the welding standards for construction
(part 1926, subpart J), since the hazards involved in these operations
related directly to welding. The National Constructors Association
(NCA) (Ex. 2-53) went further, saying ``[t]here is no need to regulate
electric welding equipment on scaffolds. NCA member companies do not
have any experience that would indicate additional regulations.''
One respondent (Ex. 2-8) stated that OSHA needed to define the term
``suitable'' as used in describing an insulated thimble (Item (a) of
Issue 2, promulgated as paragraph (f)(17)(i)), because ``[s]omeone
might think that putting electric tape on a metal thimble is
``suitable'' insulation.'' OSHA agrees that the term ``suitable'' could
be interpreted in a way that would result in inadequate insulation and
has adopted regulatory text requiring an ``insulated thimble'' that
provides appropriate protection for the equipment in use.
Another commenter (Ex. 2-13) stated ``[t]he only rule that could
possibly help prevent accidents from welding on suspended scaffolds is
to ground the scaffold. All the scaffold components are conductors and
all could possibly be grounded through the suspension ropes. A
secondary path, of lesser resistance, could possibly help.''
In addition, a commenter (Ex. 2-22) stated that requiring employers
to cover each hoist with protective covers made from insulating
material (Item (c) of Issue 2, promulgated as paragraph (f)(17)(iii))
would have a prohibitive
[[Page 46064]]
cost without having an impact on safety, noting that a ``great number''
of hoists are used on scaffolds. The commenter added that the provision
requiring a grounding conductor to be connected from the unit to the
structure (Item (d) of Issue 2, promulgated as paragraph (f)(17)(iv))
may not be practicable ``because in actual field situations the
machines are constantly and frequently moved.'' In addition, the
commenter stated that the requirement to turn off the welding machine
if the unit grounding lead is disconnected at any time (Item (e) of
Issue 2, promulgated as paragraph (f)(17)(v)) may be impractical,
because ``in actual field situations the machine may be 50 or more feet
from the scaffold.'' Another commenter (Ex. 2-29) suggested that
``[r]equirements should be more performance-oriented to allow
alternative methods to protect the employees working with electric
welding equipment on suspended scaffolds.''
Several commenters (Exs. 2-43, 2-54, 2-64, 2-367, and 2-368)
expressed concern over the hazards of using electric welding equipment
on suspended scaffolds and indicated that they favored promulgation of
the measures raised in Issue 2. One commenter (Ex. 2-64) noted that
OSHA had used the term ``unit'' instead of the terms ``scaffold'' or
``platform'' in Items (d) and (e) of Issue 2 and stated that one of
those other terms should be used instead of ``unit'', for the sake of
clarity. OSHA agrees that the term ``scaffold'' more clearly expresses
the Agency's intent.
In addition, the SSFI (Ex. 2-367) and the SIA (Ex. 2-368) stated
``the specific recommendations developed by OSHA regarding electric
welding equipment are felt to be practical and feasible as several
manufacturers are already using or specifying many of the methods
outlined within the suggested rules.''
Also, on June 9, 1987 (Tr. 26-30), the ACCSH recommended that OSHA
regulate electric welding equipment on suspended scaffolds under
subpart L. In particular, a member of the Advisory Committee stated
``[t]here's a very distinct possibility that you can arc within the
suspended cables, burn the cable and drop the scaffold. That's exactly
why it needs to be addressed.''
Another commenter (Ex. 2-516) expressed concern regarding the
protection provided by insulated thimbles, because ``[a]n insulated
thimble does not prevent the wire rope from hitting the conducting
aluminum skin on the structure and closing the loop. It doesn't stop
the huge current from burning out the power cord and melting the
insulation on the `hot' power leads.'' The commenter also stated that
using more than one ground lead can allow current to ``get loose'',
blowing out adjacent electrical systems and damaging platforms and
their rigging. In particular, the commenter stated ``[p]art of our
problem is that the current from welding machines is high enough to
cause heat damage in metal. The damage manifests itself as melted metal
at the material surface or interface between materials. This damage
seriously reduces strength. Strength is needed to keep the platform
from falling.''
The Agency acknowledges that insulated thimbles, alone, do not
prevent arcing, and that grounding must be undertaken with great care
to minimize stray currents. OSHA has determined that compliance with
the provisions of paragraph (f)(17), taken together, will minimize the
hazards of electric arcing during welding operations on suspended
scaffolds. The Agency has concluded that it is appropriate to address
the hazard of arcing welding current during welding operations on
suspended scaffolds in the final rule for scaffolds, rather than in the
welding standards, because the precautions in question relate to the
scaffold rigging, not to welding procedures, and because placing the
pertinent regulatory text in the rule will facilitate compliance.
Paragraph 1926.451(g) Fall Protection.
Paragraph (g) of the final rule sets fall protection requirements
for employees working on scaffolds, including criteria for guardrail
systems. As discussed above, fall hazards account for a high percentage
of the injuries and fatalities experienced by scaffold workers. OSHA
has determined that compliance with this paragraph will effectively
protect employees from those hazards.
Final rule paragraph (g)(1) sets 10 feet as the threshold height
above which fall protection is required and indicates (paragraphs
(g)(1)(i)--(vii)) what fall protection measures are required for
particular types of scaffolds. In addition, the introductory text
references paragraph (g)(2), which addresses the fall protection
requirements for employees erecting and dismantling supported
scaffolds. Finally, a note has been added at the end of paragraph
(g)(
FR Doc. 96-21289 Safety Standards for Scaffolds Used in the Construction Industry
1), to indicate clearly that the fall protection requirements for
employees installing suspension scaffold support systems on floors,
roofs, and other elevated surfaces are set forth in subpart M (Fall
protection) of the construction standards.
Proposed paragraph (e)(1), dealing with fall protection, was
similar, except that it explicitly excluded erectors and dismantlers
from coverage. As with the proposed access provision (proposed
paragraph (c)), OSHA believed at that time that fall protection
requirements would only be feasible when a scaffold was fully erected
and properly braced. The following paragraphs first discuss the issue
of height requirements for fall protection on scaffolds and then
describe the issues surrounding fall protection for erectors and
dismantlers.
The issue of the appropriate height at which to require fall
protection for employees working on scaffolds is complex, involving
analyses of accident statistics, economic issues, strongly held
opinions, and most importantly, concern for employee protection. OSHA
has been involved with this issue since its inception in 1971, when the
Agency adopted, under Section 6(a) of the Act, a requirement that
scaffolds used in construction require fall protection for employees
working at heights greater than 6 feet. By 1972, however, it had become
apparent that this height requirement was proving onerous and causing
disruption for scaffold users in the construction industry, and the
Agency accordingly revised the height requirement to 10 feet (37 FR
25712, December 2, 1972). This change recognized the fact that the
relevant consensus standard, ANSI A10.8-1969, Section 3.3 had set the
threshold height for scaffold fall protection at 10 feet, and that this
had become the industry standard of practice. OSHA's action also
underscored the need for consistency in height requirements for general
industry and construction unless there are compelling reasons for a
different height requirement (the general industry standard's height
threshold had already been set at 10 feet, in accordance with the ANSI
standard). An example of a situation where a different height
requirement is appropriate is the fall protection height requirement
for scaffolds used in shipyards (29 CFR 1915). This height threshold
differs from that in general industry and construction because shipyard
work is less transient and less dynamic than construction work. For
example, it is not uncommon for a scaffold to be erected in the
shipyard environment and to remain in place for several years as
employees work on various vessels that are brought to the scaffold
``work station'' to be repaired. In addition, shipyard facilities are
completed, finished structures, unlike construction sites, where
activities and crews change daily. Finally, the 5-foot threshold for
fall protection on scaffolds has a long history in this industry: it
has been
[[Page 46065]]
standard industry practice since well before OSHA was established.
The fall protection height requirement in the final rule continues
the height requirement that has been in place in OSHA's construction
standards since 1972; this height threshold is also the current
recommendation of the relevant ANSI standard, A10.8-1988. OSHA's
decision on this issue is based on the Agency's professional judgment
and its experience in enforcing this fall protection requirement in the
existing scaffold standards, a review of the available accident
statistics and studies, and an analysis of the record on this issue.
The following paragraphs discuss this information in greater detail.
First, OSHA has been enforcing this limit for almost a quarter of a
century and has found that employers working in all areas of
construction, from commercial building to the specialty trades,
recognize and comply with this limit. In addition, construction workers
are familiar with and have been trained to use fall protection on
scaffolds at heights of 10 feet and above. Thus, this height
requirement reflects current industry practice and is widely observed
by employers and employees alike.
Second, the accident data on falls among construction workers
suggest that several other areas of construction safety--such as
scaffold stability, protection from electrocution hazards, and
protection from falling objects while working on scaffolds--may have a
greater impact on injuries and fatalities than fall protection height.
An unpublished BLS study, entitled Work Injury Report on Scaffolds,
analyzed work injury reports related to scaffolds submitted from May to
November 1978. The study showed that many causes contribute to
scaffold-related injuries and fatalities (Ex. 3-1). For example, one-
quarter of the accidents related to scaffolds occurred while workers
were ascending or descending a scaffold or stepping onto or off a
scaffold, and 72 percent of these accidents occurred when the planking
or support collapsed or slipped (Ex. 3-1).
A recent OSHA review of the Agency's Integrated Management
Information System (IMIS) records of falls in the construction industry
in the period from April 1984 to June 1994 provided information
regarding 32 fatalities and 60 injuries related to work on scaffolds
that occurred during this interval. Of these, only three fatalities and
six injuries involved heights in the 6 to 10-foot range.
OSHA received many comments on the height threshold for fall
protection for work conducted on scaffolds (Exs. 2-3, 2-9, 2-13, 2-14,
2-15, 2-21, 2-22, 2-29, 2-31, 2-40, 2-41, 2-43, 2-45, 2-54, 2-57, 2-69,
2-70, 2-367, 2-368, 2-407, 2-465, 2-595, 5a-3, 5a-5, 5a-17, and, 5a-
19). These commenters argued either for changing the existing rule's
height threshold or for retaining it. Those in favor of a different
limit argued for fall protection at all heights (Tr. 115-116, 6-8-87,
ACCSH transcript), 4 feet (Exs. 2-14, 2-40, 2-45, 2-54, and 2-465), 5
feet (Ex. 2-29), and 6 feet (Exs. 2-15, 2-57). OSHA's Advisory
Committee for Construction Safety and Health (ACCSH) urged the Agency
to require fall protection on all scaffolds, regardless of elevation
(Tr. 115-116, 6-8-87); however, at least one other rulemaking
participant (Ex. 2-594) argued that such a requirement would be
unrealistic. OSHA solicited other comments and data on this ACCSH
recommendation in Issue L-2 of the hearing notice (53 FR 2050), and
received several comments that such a requirement would not be
appropriate (Exs. 5a-3, 5a-5, 5a-17, 5a-19). This group of commenters
urged OSHA to retain the 10-foot requirement.
Those commenters favoring fall protection heights in the 4- to 6-
foot range gave many reasons for their views. For example, one
commenter (Ex. 2-14) stated that falls from heights of four to five
feet could cause serious injuries ``especially if the fall occurs on a
hard surface with debris scattered about.'' According to the Research &
Trading Corporation (Ex. 2-45):
[f]our feet is consistent with current [general industry]
standards for scaffold guarding [Sec.1910.23(c)]. Four feet
according to the NBS study on nets (NBSIR 85-3271) is the height
beyond which a worker is most likely to hit his head when an
accidental fall occurs, which is to be prevented if possible. Six
feet is useful as a universal compromise for OSHA from its current
slew of height requirements. However, it should be no more than six
(6) feet.
Another commenter (Ex. 2-29) argued for five feet on the grounds
that guarding any height above one section of scaffold, which is about
five feet, would be protective. Both the ANSI Z359 committee and Saf-T-
Green (Exs. 2-57 and 2-15) favored a 6-foot fall protection threshold.
Saf-T-Green reasoned that an even lower limit might be preferable but
acknowledged that there is ``some validity to the claim that one can
jump clear of a small, low rolling tower as it tips if there is no
guardrail. However, if the tower does not tip, a guardrail would
protect against the employee falling over the edge.'' Another commenter
(Ex. 5a-3) argued that consistency with the fall protection
requirements of subpart M (Fall Protection) would suggest that a 6-foot
threshold was appropriate for scaffolds.
Many commenters urged the Agency to retain the 10-foot fall
protection threshold for scaffolds (Exs. 2-3, 2-9, 2-13, 2-21, 2-22, 2-
39, 2-43, 2-69, 2-70, 2-367, 2-368, 2-407, 2-595, 5a-3, 5a-5, 5a-17,
5a-19). According to these commenters, it is important to establish the
height at which fall protection is and is not required (Ex. 2-595) and
the 10-foot threshold has proved both protective and cost-effective.
For example, one commenter (Ex. 2-41) stated:
. . . My investigations led me to believe that work at over ten
foot elevated surfaces was at the very least four times as hazardous
as work at grade, and the injuries were far more serious. I did not
feel that any data I saw warranted a conclusion that the increased
injury was due to anything but [a] higher population working at the
[higher] level.
PPG Industries (Ex. 2-43) commented:
PPG has no problem with the 10 foot height as it stands. The
problem lies in the design of the equipment and the failure of
workers to follow safe practices.
OSHA has carefully analyzed all of the comments and data available
in the record and has determined that it is appropriate to maintain the
10-foot fall protection threshold in the final scaffold standard, as
proposed. This is also the height requirement recommended by the
current national consensus standard, ANSI A10.8-1988. This level
differs from the 6-foot threshold for fall protection set in subpart M
(Fall Protection) for other walking/working surfaces in construction
because scaffolds, unlike these other surfaces, are temporary
structures erected to provide a work platform for employees who are
constructing or demolishing other structures. The same features that
make scaffolds appropriate for short-term use in construction, such as
ease of erection and dismantling also make them less amenable to the
use of fall protection at the time the first level is being erected.
For example, there may be no secure place on the first level for the
installation of guardrails or personal fall arrest systems. Also there
is often no structure adjacent to a scaffold when the first level has
been erected that can be used to anchor a personal fall arrest system,
because the adjacent structure is in the process of being built or
demolished.
This scaffold standard contains many updated and strengthened
requirements for safe erection and maintenance of scaffolds. In
particular, the final rule
[[Page 46066]]
sets clear, performance-oriented requirements for scaffold capacity
(Sec. 1926.451(a)); erection (Secs. 1926.451 (b), (c) and (d)); access
(Sec. 1926.451(e); and use (Sec. 1926.451(f)). The Agency has
determined that compliance with the above-noted requirements will
prevent many of the fall-related injuries and fatalities that would
otherwise result from structural collapse or instability, including
those occurring on scaffolds less than 10 feet in height, because
properly erected scaffolds will not collapse during use.
In addition, OSHA intends to monitor the extent to which compliance
with these revised subpart L requirements for structural integrity
effectively protects employees on scaffolds from fall hazards when they
are working between six and 10 feet above lower levels. At this time,
the data are insufficient to persuade the Agency that the existing 10-
foot threshold needs to be changed. OSHA will carefully review and
examine its enforcement data over the next several years, together with
any investigative reports and other information on incidents that
involve fall hazards. The Agency also intends to work closely with
NIOSH in performing such data collection and analysis. Should it appear
that compliance with this final rule is not providing adequate fall
protection for employees working on scaffolds between six and 10 feet
above lower levels, the Agency will reevaluate the standards and
determine what changes, if any, are warranted.
Paragraphs (g)(1)(i) through (vii) of the final rule specify the
types of fall protection to be used on particular types of scaffolds.
These provisions are essentially the same as the corresponding proposed
provisions, except as discussed below. The proposed and final rule
provisions effectively clarify and consolidate the fall protection
requirements in existing Sec. 1926.451(a)-(y), Sec. 1926.500(c)(2), and
Sec. 1926.1910.29(a)(3)(vii).
Paragraph (g)(1)(i) of the final rule, like proposed paragraph
(e)(1)(i), recognizes that personal fall arrest systems, not
guardrails, are appropriate for use on boatswains' chairs, catenary
scaffolds, float scaffolds, needle beam scaffolds, and ladder jack
scaffolds. This provision consolidates the following paragraphs of the
existing rule Secs. 1926.451(1)(4)--boatswains' chairs; (p)(9)--needle
beam scaffolds; (w)(6)--float scaffolds; and Sec. 1926.752(k)--float
scaffolds for steel erection. This requirement is being applied to
catenary scaffolds and ladder jack scaffolds for the first time.
Paragraph (g)(1)(ii) of the final rule, like proposed paragraph
(e)(1)(ii), requires personal fall arrest systems and guardrail systems
for all single-point adjustable suspension scaffolds (except
boatswains' chairs), and for all two-point adjustable suspension
scaffolds. The requirement to have guardrails and personal fall arrest
systems on two-point scaffolds, which carries forward language in
Sec. 1926.451(i)(8) of the existing rule, is based on the fact that a
guardrail system alone does not provide adequate fall protection when a
suspension rope fails and causes the scaffold to tip or hang from only
one end. Personal fall arrest system protection is also necessary for
single-point systems, because the fall hazard related to suspension
rope failure is as serious as it is with the two-point scaffold.
However, because personal fall arrest systems would be the primary
means of fall protection on single-point and two-point systems, the
provision allows a lower minimum strength guardrail system to be used.
This approach is consistent with that taken in the proposed rule.
Paragraph (g)(1)(iii) of the final rule provides that ``Each
employee on a crawling board (chicken ladder) shall be protected by a
personal fall arrest system, a guardrail system (with minimum 200 pound
toprail capacity), or by a three-fourth inch (1.9 cm) diameter grabline
or equivalent handhold securely fastened beside each crawling board.''
This provision, like proposed paragraph (e)(1)(iii), is essentially the
same as paragraph 1926.451(v)(2) of the existing rule, except that the
existing rule permits grablines (lifelines) or equivalent handholds if
they are securely fastened alongside crawling boards.
Paragraph (g)(1)(iv) of the final rule, like proposed paragraph
(e)(1)(iv), provides that employees on self-contained scaffolds be
protected by both personal fall arrest systems and guardrail systems
when the platform is supported by ropes (as when the scaffold is being
raised or lowered on some systems) and by guardrail systems when the
platform is supported directly by the scaffold frame.
Paragraph (g)(1)(v) of the final rule, similar to proposed
paragraph (e)(1)(v), requires guardrails to be used along scaffold
walkways and to be located within 9\1/2\ inches horizontally of at
least one side of the walkway. OSHA originally proposed that the
walkways be located within 8 inches horizontally of the side of the
walkway. However, for consistency with final rule
Sec. 1926.451(b)(1)(ii), the provision has been revised to allow an
open space of up to 9\1/2\ inches. The provision that guardrails need
only to be provided along one side applies only when the platform is
used solely as a means of access to get from one point on the scaffold
to another. If work activities other than access are performed on or
from the walkway, then the platform is not considered to be a walkway
(see definition of ``walkway''), and other provisions of paragraphs
(g)(1), as appropriate, would apply.
Paragraph (g)(1)(vi) of the final rule provides that fall
protection (i.e., a personal fall arrest system or guardrail) be
provided on all open sides and ends of scaffolds from which employees
are performing overhand bricklaying operations and/or related work,
except those sides and ends next to the wall being laid. This
requirement replaces a note that followed proposed paragraph (e)(1)(v),
which stated that the fall protection requirements for employees
performing overhand bricklaying from supported scaffolds are provided
in Sec. 1926.501, Fall protection (subpart M). OSHA has deleted the
note from the final rule because the Agency has determined that, except
for some system criteria which are referenced from subpart M, it is
appropriate to cover all scaffold fall protection in this final rule
for scaffolds in construction (subpart L).
Paragraph (g)(1)(vi) of the final rule is consistent with
Sec. 1926.501(b)(9), which addresses fall protection for employees
performing overhand bricklaying while on elevated surfaces other than
scaffolds.
Final paragraph (g)(1)(vii) requires that employees on scaffolds
not addressed elsewhere in paragraph (g)(1) be protected either by
guardrails or personal fall arrest systems. This provision is
essentially the same as the fall protection requirement of proposed
paragraph (e)(1), except that the term ``body belt/harness systems or
Type 1 guardrail systems'' has been replaced by ``personal fall arrest
systems or guardrail systems'' for the reasons discussed above.
Paragraph (g)(1) does not apply where there are no ``open sides or
ends'' on the scaffold (see definition in Sec. 1926.451(b)). For the
scaffold to be considered completely enclosed, no perimeter face of the
scaffold may be more than 14 inches from a wall. The requirements for
fall protection will apply at openings such as hoistways, elevator
shafts, stairwells, or similar openings in the scaffold platform, or
openings in the walls of the structure surrounding the platform.
Proposed paragraph (e)(2) stated that each employee on a platform
(except for a self-contained adjustable scaffold or a scaffold type
covered by Sec. 1926.452), less than 45 inches (1.1 m) wide, and 4
[[Page 46067]]
feet (1.2 m) or more above lower levels, shall be protected from
falling to those lower levels by the use of a personal fall arrest
system or guardrail system (with minimum 200 pound toprail capacity).
Proposed paragraph (e)(2) also provided a blanket exemption for
erecting/dismantling activities and referred to the use of a ``Type I
guardrail system.''
This provision, based on existing Sec. 1926.451(a)(4), has been
dropped in the final rule because further analysis of the requirement
showed that there was no real definable target for the requirement and
that 99% of scaffolds would be excluded by the proposed provision.
Paragraph (g)(2) of the final rule addresses fall protection for
employees erecting or dismantling supported scaffolds. Based on the
rulemaking record, developed through NPRM Issue 8 discussed below, OSHA
has determined that it is appropriate to delay the implementation of
paragraph (g)(2) until September 2, 1997. The delay will allow affected
employers sufficient time to implement the appropriate procedures for
addressing the fall protection needs of employees erecting or
dismantling scaffolds. In addition, deferring compliance will allow
time for the Agency to complete non-mandatory Appendix B, which will
provide examples of considerations that a competent person would take
into account when evaluating fall protection options for scaffold
erectors and dismantlers. As discussed above in relation to final rule
paragraph (e)(9), the Agency has also deferred requirements for safe
access for scaffold erectors and dismantlers until September 2, 1997.
Final paragraph (g)(2) requires that employers whose employees
erect or dismantle supported scaffolds after September 2, 1997 ensure
that a competent person determines the feasibility and safety of
providing fall protection for such employees. This paragraph further
requires that affected employers provide fall protection for employees
erecting or dismantling supported scaffolds where the installation and
use of such protection is feasible and does not create a greater
hazard.
NPRM Issue 8 solicited comments concerning the proposed exemption
of employers whose employees perform scaffold erection and dismantling
operations from the fall protection requirements of proposed
Sec. 1926.451(e)(1). The Agency noted that, while supported scaffolds
often do not have a place to which personal fall arrest systems can be
properly attached, suspended scaffolds are often located such that
personal fall arrest systems can be used.
On March 29, 1993, based on the response to Issue 8, OSHA reopened
the public record for proposed subpart L (58 FR 16509) to obtain more
information. The Agency stated that the rulemaking record supported
deleting the proposed exemption of suspended scaffolds and indicated
that a blanket exemption for supported scaffolds might be
inappropriate. In particular, OSHA asked if employers should be
required to provide fall protection for employees erecting or
dismantling supported scaffolds, except where an employer can
demonstrate that providing fall protection was either ``impracticable''
or ``would create a greater hazard.'' The Agency also sought
information about current efforts and the ability to provide fall
protection for employees erecting or dismantling scaffolds. In
addition, OSHA asked if it was appropriate to require fall protection
for those portions of a supported scaffold that have been, or remain,
fully assembled, while exempting those areas where erecting or
dismantling is underway.
The responses to NPRM Issue 8, and the March 29, 1993, reopening of
the record on this Issue fell into two broad groupings. The first group
either supported an across-the-board exemption from fall protection
requirements for all erectors and dismantlers (Exs. 2-3, 2-9, 2-12, and
2-21); or supported an exemption for erectors and dismantlers of
supported scaffolds only (Exs. 2-13, 2-15, 2-30,
2-69, 2-367 and 2-368); or specifically opposed a fall protection
requirement for erectors and dismantlers, even with an exception for
impracticability or greater hazard, favoring instead trained erectors
and dismantlers, a hazard awareness program, controlled access zones,
or a standardized procedure for erecting and dismantling scaffolds
(Exs. 34-5, 34-9, 34-10, 34-12, 34-17, 34-17, 34-20, 34-31, 34-32, 34-
37, and 34-43).
The second group either supported a requirement for fall protection
at all times, including during erecting and dismantling (Exs. 2-22, 2-
43, 2-45, 2-53, 2-497, 34-4, 34-11, and 34-35) or supported a
requirement for fall protection except where the employer demonstrates
that it is infeasible, unsafe, or creates a greater hazard during
erecting and dismantling operations (Exs. 2-29, 2-54, 2-57, 2-70, 34-2,
34-18, 34-19, 34-22, 34-26, 34-29, 34-34, and 34-46). Each of these
arguments is discussed below, along with OSHA's response to the points
raised by the commenters.
Commenters that supported the proposed total exemption of erecting
and dismantling operations from the fall protection requirements argued
(Ex. 2-3) ``[t]his is a situation where someone must be exposed in
order to do the job * * *''; or felt that fall protection would be
detrimental to employee safety (Exs. 2-12 and 2-21). OSHA disagrees
with these commenters and notes that the record describes many
situations where it is feasible to provide fall protection for erectors
and dismantlers.
Commenters that supported a fall protection requirement for
erectors and dismantlers of suspended scaffolds, but not supported
scaffolds (Exs. 2-13,
2-15, 2-30, 2-69, 2-367, and 2-368) argued that it is feasible and
practical to require such protection for suspended scaffolds, but not
for supported scaffolds, due to the lack of an appropriate tie-off
area, and the possibility of drop lines becoming entangled during
climbing and moving procedures which could pull the erector off the
supported scaffold. The Agency agrees with these commenters that it is
virtually always feasible to provide fall protection for workers
erecting or dismantling suspended scaffolds because structures that are
capable of supporting a suspended scaffold are also capable of
providing a safe anchor point for personal fall protection equipment.
On the other hand, OSHA finds that the record does not support an
across-the-board exception from the requirements for fall protection
for erectors and dismantlers of supported scaffolds.
Another group of commenters opposed a fall protection requirement
but emphasized the importance of training in maintaining safety during
erecting and dismantling operations. For example, some commenters (Exs.
34-9, 34-10, 34-12, and 34-17) recommended the following:
1. A formal hazard awareness program shall be implemented.
2. Enforce ``controlled access zones'' allowing only those
people trained in the erection and dismantling of scaffolds to be
present.
3. Develop and strictly enforce standard procedures for the
erection and dismantling of scaffolding. These procedures may
include but not be limited to the following:
a. Fully planking each level before moving on to the next
highest level.
b. Fully securing each level with the proper guardrails prior to
moving to the next higher level.
c. Providing proper access to all completed levels.
d. Develop methods for placing components on upper levels
without placing unnecessary risks on employees.
e. Only those employees actually involved in the erection or
dismantling shall be allowed on the scaffolding.
[[Page 46068]]
The Agency recognizes the importance of training and hazard
awareness programs to employee safety, but finds that these precautions
alone are not adequately protective because site conditions change and
mistakes are made. The Agency finds that providing appropriate fall
protection, whenever it is feasible or will not create a greater
hazard, is the best way to ensure that erectors and dismantlers are
appropriately protected from fall hazards.
The second group consisted of commenters that supported fall
protection for erectors and dismantlers under some (Exs. 2-29, 2-54, 2-
57, 2-70, 34-2, 34-19, 34-22, 34-26, 34-29, and 34-46) or all
conditions (Exs. 2-22, 2-43, 2-45, 2-53, and 2-497). For example, some
commenters argued that if a fall hazard exists, lifelines or some other
fall arresting system should be in place. R&TC (Ex. 2-45) stated:
The use of lightweight outrigger scaffold sections with guard
rails, which can be pushed up the vertical scaffold poles prior to
the new upper level height exposure during erection, seems to be
promising as a fall protection means * * * Furthermore, many
structures can provide overhead anchorage points for workers during
scaffold erection and dismantling without such special scaffold
platforms. For these situations, regular lifelines can easily be
used for vertical and horizontal movement.
R&TC later added (Ex. 2-497) ``[w]hen an overhead anchorage is
available, a bucket truck, manlift or other elevating platform can be
used to install lifelines without a fall hazard.''
Commenters to the Reopening Notice (Exs. 34-4, 34-11, 34-18, and
34-35) also supported a fall protection requirement for erectors and
dismantlers.
Some, such as Dynamic Scientific Controls (DSC) (Ex. 34-18)
provided input on ways to provide fall protection for erectors and
dismantlers. In particular, DSC provided a video showing a scaffold
being erected by an employee who uses a retractable lanyard attached to
the scaffold for fall protection. DSC stated that this method has been
improved by crossbracing the first frame, tying-in to the structure,
using the pulley bracket more often for attaching lifelines in order to
reduce the lifeline angle to less than 45 degrees, and pinning legs
before attaching the lifeline to a higher level. DSC added that using
horizontal lifelines within each frame and extending the length of the
scaffold can provide protection to workers as well. This commenter
noted, however, that any fall arrest system attached to a scaffold
should be an engineered system modelled for that type of scaffold, or
should be designed by a skilled professional engineer.
In addition, the United Brotherhood of Carpenters and Joiners (Ex.
34-11) stated that the ability to provide fall protection can be
greatly increased through modified erection, engineered attachment
points designed into structures, additional scaffold bracing, guying,
and outrigging.
Finally, DBI/SALA (Ex. 34-4) offered the following choices for fall
protection: ``(1) Provide for or suggest a means for a feasible anchor;
(2) If the current state of the art doesn't allow scaffolds to be used
as anchors, maybe a redesign incorporating outriggers or whatever is
required is appropriate.''
The Agency agrees that, if fall protection can be provided, it is
the employer's responsibility to take the actions necessary to protect
employees. However, OSHA has determined, based on the information in
the record, that in some situations, it is not possible to provide fall
protection for erectors and dismantlers of supported scaffolds.
Two commenters, Dynamic Scientific Controls (DSC) (Ex. 34-18) and
the State of Hawaii (Ex. 34-34) commented that the employer should be
required to show that fall protection is infeasible or creates a
greater hazard for the scaffold erector in order to avoid providing
fall protection. Another commenter (Ex.
2-54) added that employers ``should note in their Daily reports why
they can't take [the] necessary precaution[s].''
OSHA agrees that employers must have valid reasons for not
providing fall protection to scaffold erectors and dismantlers, but
does not agree that the employer must put these reasons in writing.
Compliance officers can substantiate employer claims of infeasibility
or greater hazard through on-site observations and discussion with the
competent person and other workers.
Many commenters (Exs. 2-29, 2-54, 2-57, 2-70, 34-2, 34-19, 34-22,
34-26, 34-29, and 34-46) supported a fall protection requirement for
scaffold erectors and dismantlers, if feasible, or unless it would
create a greater hazard. These commenters also provided insight into
the potential problems of providing fall protection for erectors and
dismantlers, and into the factors that must be considered when
determining if fall protection is feasible in a particular situation or
if the use of fall protection would create a greater hazard.
For example, the ANSI Z359 Committee (Ex. 2-57) stated:
It is recognized that fall protection may, in general, be
difficult or impractical to provide in erection and dismantling of
supported scaffolds. This may be due to absence of suitable
anchorages whether independent or integral to the scaffold. However,
there are notable exceptions when independent overhead anchorages
exist which may be used for vertical or horizontal lifelines.
Further, some supported scaffolds can be rigged to provide integral
fall protection without undue encumbrance of the work. There is
concern that granting a broad exemption from fall protection
requirements for supported scaffold erection/dismantling would
reduce the protection even where it is today feasible. Such
exemptions could also discourage future development of fall
protection means to address this subject.
Miller & Long (Ex. 2-70) commented ``If there is an area where
employees can tie off they should do so.''
The Boeing Company (Ex. 34-19) stated that fall protection for
erectors and dismantlers could be provided through the use of boom
supported elevated work platforms, scissors lifts, forklift platforms,
temporary guardrails, fall arrest/restraint systems or other scaffolds.
The Scaffold Training Institute (STI) (Ex. 34-20) indicated that
100% fall protection for erectors is not achievable from a practical
standpoint due to a lack of suitable anchorages. The Institute also
stated that lifelines would become entangled in pipes, lines, platforms
tubes, braces or other obstructions. STI was particularly concerned
that snagged lifelines would restrict the motion of employees and could
lead to falls for erectors whose work requires that they have freedom
of motion in order to carry and to maneuver into place large, bulky
components. The commenter added that the use of lanyards and lifelines
can lead to increased fall hazards, and that a pendulum effect is
created if an erector falls while attached to a lifeline that is
anchored several feet away.
Duke Power (Ex. 34-29) stated ``[f]all protection harnesses tend to
snag on things, butt straps hinder climbing . . . Fall protection also
slows people down.''
SINCO (Ex. 34-22) stated that the effect on the mobility of
employees varies with conditions and the type of fall protection
equipment used, but stated that the effect can be limited by proper
pre-planning and project management. In addition, both SINCO and
Professor Ralph E. Bennett of Purdue University (Ex. 34-26) suggested
that the scaffold must be properly tied or braced, with all components
pinned together, and, that intermediate plank levels be provided to
limit fall height during erection of the uppermost levels.
In addition, SINCO recommended that OSHA require affected employers
to satisfy the following criteria for exemption:
[[Page 46069]]
A qualified person has determined that fall protection
creates a greater hazard than falling freely to the ground or the
closest possible level;
Tests prove that a scaffold or structure would definitely
fail if used as an anchorage;
There are no other means of fall protection available;
Employees have been trained in the recognition and
avoidance of hazards by use of the employer's prescribed methods of
erection; and
Compliance with the requirement for fall protection is
likely to result in a more serious injury compared to the possibility
of a life saved . . .''
SINCO observed that a greater hazard may exist if a falling person
could pull a scaffold over. However, the commenter added that this
hazard would involve more danger to employees on the ground than to
employees on the scaffold. They contended that other employees on the
scaffold may provide ``counter-balance'' that would prevent the
scaffold from overturning. In addition, SINCO stated that this hazard
can be prevented by reinforcing the scaffold's base through the use of
outriggers, counterweights, or tie-downs. The commenter added that this
hazard can be greatly reduced by requiring erectors to remain inside
the frames to decrease any eccentric loading and through the use of
shock absorbers.
Dow Chemical Co. (Ex. 34-46) commented that since each worksite is
unique, fall hazards must be addressed through preplanning of the work
with the aim of eliminating fall hazards and preventing falls. However,
the commenter added, where fall hazards cannot be eliminated, a fall
protection system should be used if it ``provides a more appropriately
safe solution''. Dow also stated that a lanyard long enough to allow
mobility can create tripping hazards and the potential for one worker
to ``pull another worker from their task.'' The commenter added that
``people on-site must have the latitude to address [these hazards].''
OSHA notes that the Agency's own compliance experience concerning
the potential problems of providing 100% fall protection for erectors
and dismantlers is consistent with the positions put forth by the
commenters. OSHA has determined that it would be useful to provide
examples of the factors to be considered by a competent person when
deciding what fall protection is appropriate for employees erecting or
dismantling supported scaffolds. Accordingly, the Agency has reserved
non-mandatory Appendix B, and will be developing informational text
that can be added to subpart L at a later date to serve as a guide to
assist employers in evaluating their worksite conditions.
Several commenters (Exs. 34-8, 34-9, 34-10, 34-12, 34-17, 34-22,
and 34-26) addressing the topic of fall protection for erectors and
dismantlers took no position as to an exception for these workers.
However, they indicated that fully planking sections could reduce
exposure to fall hazards. One of these commenters (Ex. 34-8) stated
that, although full planking and stairway-type ladders would reduce
exposure, their use is not always practical. In addition, four of these
commenters (Exs. 34-9, 34-10, 34-12, and 34-17) stated that ladders
attached at the end of the scaffold would be better because stairway-
type ladders greatly reduce employee movement along the length of the
scaffold.
Four other commenters (Exs. 34-32, 34-35, 34-37, and 34-39)
indicated that such practices would be either infeasible or would
create other hazards. The SIA and SSFI (Exs. 34-37 and 34-32) added
that planking every level would overload tall scaffolds and that
stairways are not needed because erectors do not continually climb up
and down. The SIA also said that fully planking every level would
require that all equipment be hoisted outside the scaffold, creating
additional hazards. Another commenter (Ex. 34-46) stated that a
requirement for fully planking sections ``would unnecessarily restrict
local decisions for safety.''
The Agency has determined that, due to the large variety of
supported scaffolds and an infinite number of unique site conditions
that could affect the feasibility or safety of providing fall
protection, neither a blanket exception nor a requirement for 100% fall
protection is appropriate for erectors and dismantlers. OSHA agrees
with commenters (Exs. 34-8, 34-22, 34-36, and 34-46) that the people on
site (competent person) must have the flexibility to address fall
hazards for erectors and dismantlers on a site-specific basis.
Therefore, OSHA finds that the determination of what fall protection is
feasible and can be used safely at a given worksite should be made by a
competent person at the worksite. The competent person will need to
have the ability and knowledge to decide whether fall protection can be
provided for erectors and dismantlers under the specific site
conditions, and, if so, what measures are appropriate.
Therefore, the Agency has revised the final rule to reflect this
finding, while deferring compliance for one year to allow time for
employers to develop and implement the appropriate procedures. In
addition, as noted above, the Agency will be adding non-mandatory
Appendix B at a later date, to provide examples of situations where it
is feasible to provide fall protection during the erection and
dismantling of supported scaffolds and the criteria the competent
person would consider when deciding the appropriateness of fall
protection during erection and dismantling. Interested parties are
invited to provide OSHA with suggestions and information regarding the
appropriate guidance for the competent person.
Paragraph (g)(3) of the final rule provides that personal fall
arrest systems must comply with the pertinent provisions of
Sec. 1926.502(d) and, in addition, must be attached by lanyard to a
vertical lifeline, horizontal lifeline, or scaffold structural member.
However, when overhead obstructions such as overhead protection or
additional platform levels are part of a single-point or two-point
adjustable suspension scaffold, then vertical lifelines must not be
used, because, in the event of a scaffold collapse, the overhead
components would injure an employee who was tied off to a vertical
lifeline. This provision is essentially the same as proposed paragraph
(e)(3), except that the terms ``dropline'' and ``trolley line'' have
been replaced by the terms ``vertical lifeline'' and ``horizontal
lifeline'' to be consistent with the terms used in subpart M of this
part--Fall Protection.
Paragraph (g)(3)(i) of the final rule requires that vertical
lifelines, when used, be fastened to a fixed safe point of anchorage,
be independent of the scaffold, and be protected from sharp edges and
abrasion. Based on concern that inadequate anchor points may be used,
this paragraph also incorporates the language of the note to proposed
Sec. 1926.451(e)(3), which stated that safe points of anchorage include
structural members of buildings, but do not include standpipes, vents,
other piping systems, electrical conduit, outrigger beams, or
counterweights. This is the same requirement as was proposed in
paragraph (e)(3)(i) of the NPRM and is consistent with the
corresponding language in Sec. 1926.451(i)(8) of the existing rule.
Paragraph (g)(3)(ii) of the final rule states that horizontal
lifelines, when used, shall be secured to two or more structural
members of the scaffold, and shall not be attached only to the
suspension ropes. This is the same requirement as was proposed in
paragraph (e)(3)(ii). It is designed to provide protection to the
employee in the event of a suspension line failure.
[[Page 46070]]
Paragraph (g)(3)(iii) of the final rule provides that, when
lanyards are connected to horizontal lifelines or structural members on
a single-point or two-point adjustable suspension scaffold, the
scaffold must be equipped with additional independent support lines and
automatic locking devices capable of stopping the fall of the scaffold
in the event one or more of the suspension ropes fail. The independent
support lines must be equal in number and strength to the suspension
ropes. This is the same requirement as proposed paragraph (e)(3)(iii).
OSHA believes that in the event of a suspension rope failure, the
additional support lines will keep the scaffold from falling.
Paragraph (g)(3)(iv) of the final rule provides that vertical
lifelines, independent support lines, and suspension ropes must not be
attached to each other, or be attached to or use the same point of
anchorage, or be attached to the same point on the scaffold or body
belt/harness system. This is essentially the same provision as proposed
paragraph (e)(3)(iv), except that the requirements in the final rule
also prohibit the attachment of lines and ropes ``to the same point on
the scaffold or personal fall arrest system.'' This language reflects
the incorporation of the note that accompanied proposed paragraph
(e)(3) into paragraph (g)(3)(i) of the final rule, as discussed above.
Issue 19 in the preamble to the proposed rule noted that some
single-point adjustable suspension scaffolds which are currently in use
have two separate lines (one serves as an independent support line)
attached to two separate anchor points; however, both lines are
connected to a single point on the body support system. A failure of
this single body support mechanism, or body support system, could
result in an uncontrolled fall for the employee. OSHA sought comments
on the question of whether the final rule should permit the use of such
a system. The Agency also asked what criteria would need to be set to
ensure that a single mechanism or body support system prevented
failures. In addition, OSHA inquired about industry experience with
this type of system.
Several commenters (Exs. 2-29, 2-312, 2-367, and 2-368) and the
ACCSH (Tr. 6/9/89, pp. 150-151) were in agreement that OSHA should not
permit the use of systems of the type described in Issue 19. One
commenter (Ex. 2-29) stated simply that ``the standard should not allow
single-point suspension scaffolds with two separate support lines to be
connected to a single point on the body support system.''
The SSFI (Ex. 2-367) recommended ``that OSHA not permit the use of
a lifeline and support line being tied to a single mechanism or body
support system. It is our opinion that the lifeline should be an
independent anchorage with independent support.'' Also, the SIA (Ex. 2-
368) stated:
We are opposed to the use of systems in which the lifeline and
support line connect to a single mechanism or body support system.
The primary suspension line and an independent fall arrest system
should each be anchored to separate body support devices, so that in
the event one line fails, the other will provide protection. The
cost would be equal to the cost of the original suspension, but
could be negligible in many instances.
After a careful review of the comments, OSHA has determined that
the purpose of having separate lines would be defeated if lines were
attached to a single point at either end and that point of attachment
failed, and the final rule (paragraph (g)(3)(iv)) reflects this
determination.
Final rule paragraph (g)(4) sets criteria for guardrail systems
used to provide fall protection for employees working on scaffolds.
These provisions are consistent with the corresponding language of
recently revised subpart M of this part, Fall protection, except as
necessary to address the particular circumstances of construction work
performed from scaffolds.
Paragraph (g)(4)(i) of the final rule provides that guardrail
systems be installed along all open sides and ends of platforms. This
requirement is effectively the same as proposed paragraph (e)(4)(i) and
existing Sec. 1926.451(a)(4). OSHA has added language which clarifies
when guardrails would need to be in place. In the case of suspended
scaffolds, guardrails must be installed before any employee is allowed
on a hoisted scaffold. In the case of supported scaffolds, installation
must occur before employees are permitted to work from the scaffold.
When an employee is on a supported scaffold during the scaffold
erection process, fall protection is covered by final rule paragraph
(g)(2). This clarification is based on language in the State of
California Code, Title 8, paragraph 1637(i)(6) which was submitted to
the docket by the California Department of Industrial Relations (Ex. 2-
23).
Paragraph (g)(4)(ii) of the final rule provides that the top edge
height of toprails or equivalent members on supported scaffolds
manufactured or placed into service after January 1, 2000 must be
between 38 inches (0.97 m) and 45 inches (1.2 m) above the platform
surface. Furthermore, the top edge height of guardrails on supported
scaffolds manufactured and placed into service before January 1, 2000
and on all suspended scaffolds where both a guardrail and a personal
fall arrest system are required must be between 36 inches (0.9 m) and
45 inches (1.2 m). The final rule also provides that toprail height may
exceed 45 inches if the other criteria of paragraph (g)(4) have been
satisfied.
In the proposal, paragraph (e)(4)(ii) proposed a toprail height
between 38 and 45 inches above the platform surface when the guardrail
is the sole means of providing fall protection, and a toprail height
between 36 and 45 inches when the guardrail is used in conjunction with
a personal fall arrest system. The proposed minimum 36-inch toprail
height reflected OSHA's belief that the minimum height requirement for
a guardrail used with personal fall arrest systems should be less than
that for a guardrail on which employees rely for fall protection.
As discussed in the proposed rule (51 FR 42690), the 38-inch lower
limit on guardrail height was proposed in lieu of the 39-inch lower
limit on guardrail height allowed by subpart M (Fall protection) to
allow for guardrail height differentials caused by scaffold platform
unit arrangements. In particular, a frame constructed to hold a toprail
42 inches above a flush-mounted prefabricated deck would be only 40
inches above a scaffold platform made with two-inch solid sawn planks.
If the scaffold planks are overlapped to form a long platform, the
guardrail height would drop to 38 inches.
In addition, the Agency has determined that employers should have
the flexibility, when conditions warrant, to use toprails with heights
higher than 45 inches, so long as the other protective criteria of
paragraph (g)(4) are satisfied. The language of the proposed rule has
been revised to reflect this flexibility. The language of paragraph
(g)(4)(ii) of the final rule is consistent with the corresponding
language in Sec. 1926.502(b)(1), Fall protection (subpart M).
Issue 12 of the preamble to the proposed rule sought comments on
whether OSHA should adopt the language in the 1977 edition of ANSI
A10.8-1977, paragraph 3.3, which sets 36 inches above the work platform
as the minimum guardrail height and on the effectiveness, feasibility
and cost savings of requiring guardrails to be at least 36 inches high.
Issue 12 noted that existing Sec. 1926.451(a)(5), which requires that
guardrails be ``approximately'' 42 inches high, has been interpreted
over
[[Page 46071]]
the years by OSHA to allow a range of 36 inches to 45 inches above the
work platform. These interpretations, dating from 1979, are based on
OSHA Program Directive #200-67 (Revision 1), issued on October 24,
1978, and later renumbered as OSHA Instruction CPL 2.11A. OSHA notes
that the 1988 edition of the pertinent ANSI standard, A10.8-1988,
paragraph 4.5.1, accepts toprails that are installed between 36 and 45
inches above lower levels.
OSHA received many comments on the issue of guardrail heights (Exs.
2-9, 2-12, 2-13, 2-20, 2-21, 2-29, 2-41, 2-50, 2-53, 2-54, 2-55, 2-64,
2-69, 2-367, 2-368, 2-390, 2-476, and Tr. 6/9/87, pp 116-121). The
comments received ranged from those stating that 36 inches was too low
for the bottom of the range, that 36 inches was appropriate, that 45
inches was too high for the top of the allowable range of guardrail
heights, and that no change should be made to the range allowed by
existing OSHA interpretations (i.e., that allowable heights be between
36 and 45 inches above the work platform). The arguments presented by
the commenters are summarized below, along with OSHA's response to
these comments and the Agency's reasoning in reaching a final
determination on the matter.
Several commenters (Exs. 2-9, 2-20, 2-21, 2-50, 2-53, 2-55, 2-64,
2-69, 2-367, 2-368, 2-390, and 2-476) argued for retention of 36 inches
as the minimum guardrail height. The reasons given by these commenters
were that ``no accident statistics justify changing the current range
existing in OSHA standards'' (Ex. 2-368), that 36 inches is adequate or
reasonable (Exs. 2-21, 2-53 and 2-69), that the height is practical,
feasible, and would not incur unmeasurable costs (Ex. 2-64), and that
36 inches is current industry practice (Exs. 2-367 and 2-476). Typical
of these comments was the comment of the SIA (Ex. 2-368):
Guardrails on scaffolds are designed as a perimeter warning for
workers confined to small working areas. Workers do not attain body
motion speeds and momentum that require the drastic changes
proposed.
Doctoral papers and NBS studies used as a basis for the
proposals do not deal with the ``real'' world. Dummies propelled
against a guardrail do not represent a true comparison of a human
being with sense and reflex ability.
Guardrails for scaffolds, whether they be horizontal systems or
crossbrace systems have historically been considered a perimeter
indication. Work is performed in localized areas where movement is
generally restricted from section to section. Workmen are not
subjected to the hazard of ``momentum'' created by body movement
over longer distances as in the case in peripheral railings or
balconies and other crowded or congested areas where body weight and
force may be accelerated * * *
It is apparent that guardrails of most manufacturers will fall
within the proposed 38-inches to 45-inches range. However, there are
many in the stream of commerce, and widely used throughout industry,
which will not. As an example, the GKN Kwikform scaffold system
utilizes a post with guardrail attachment points every 37\1/2\''.
This distance is based on the European standard spacing of one meter
[approximately 39 inches]. There is no justification for outlawing
the equipment which has been used safely for decades. It is more
practical to retain the 36-inches to 45-inches range permitted in
the various industry and ANSI standards.
The SSFI (Ex. 2-367) agreed with the SIA, stating as follows:
The majority of scaffold guardrail posts, manufactured in this
country since 1950, has been designed and manufactured to ANSI A10.8
Standard of 36'' to 42'' guardrail heights. The elimination of the
lower 36-inch limit would result in the requirement to scrap all
these posts and remanufacture new posts.
The cost to replace guardrail units would be very expensive to
the user. In 1983, we estimated that there were at least one million
guardrail units being used. Retrofit changes at that time were
estimated at $4 per unit or a total of $4,000,000. Replacement costs
at $10 per unit would equal $10 million.
In response to this group of commenters, OSHA notes that the
absence of accident statistics substantiating the need for higher
guardrails reflects on the general inadequacy of occupational injury
and illness recording and reporting systems but may well have little or
nothing to do with guardrail heights and their relationship with fall
hazards. It is OSHA's experience that few accident reports contain the
detail that would be necessary to differentiate between the relative
protectiveness of guardrail heights of 36 as opposed to 38 or 39
inches. In addition, although guardrails do function as perimeter
indicators, they also provide fall protection, and it is this aspect of
scaffold guardrails that is of concern in final rule paragraph
(g)(4)(ii). Further, although ``[d]ummies propelled against a
guardrail'' (Ex. 2-368) cannot precisely mimic the responses and
movement of real workers in the actual work environment, the
experiments dismissed by the SIA provide valuable information that
cannot be disregarded by OSHA or other safety professionals.
OSHA recognizes the merit of the SIA and SSFI arguments about
industry's use of scaffold components (e.g., posts) suitable for 36-
inch guardrails (Exs. 2-367 and 2-368), although the Agency also notes
that the $4 to $10 per scaffold unit cost for retrofit or replacement,
respectively, would not be prohibitive even for the smallest scaffold-
using business. Nevertheless, to respond to these concerns, the final
rule grandfathers those guardrails manufactured to meet the 36-inch
minimum height allowed by OSHA for many years and still accepted by
ANSI A10.8-1988. The Agency concludes that allowing the continued use
of these guardrails until they are replaced will eliminate any
potentially adverse impact of the final rule's determination as regards
minimum guardrail heights.
Many commenters (Exs. 2-12, 2-13, 2-29, 2-41, 2-54, 2-407, and Tr.
6/9/87, pp 116-121) share OSHA's concern, as stated in the preamble,
that a minimum guardrail height of 36 inches is insufficiently
protective. For example, one commenter (Ex. 2-407) stated:
[T]he guardrail height requirement should be set from 38-inches
to 45-inches with a midrail. Our experienced opinion has taught us
that 36-inches would be very unsafe. Especially for taller
person[s]. * * * As the industry has been set at 42'' for so many
years we feel that the 38'' to 45'' all inclusive would be
satisfactory to cover the 42'' which so many people would now have,
thus creating no additional expense.
Two other commenters (Exs. 2-29 and 2-41) also expressed concerns
about the adequacy of 36 inch high guardrails for tall employees, as
did Lawrence Stafford, a member of both the ANSI A10.8 Committee and
the SIA, who commented (Ex. 2-13)
I and many other members of S.I.A. do not consider 36-inches as
safe for all scaffold uses. Due to the narrow width of the platforms
on suspended scaffolds, the outboard sides should be protected by a
42-inch high guardrail.
Arguing in the same vein, a representative of OSHA's Advisory
Committee on Construction Safety and Health (June 9, 1987 meeting)
stated: ``I think, if anything, people are getting bigger, not smaller.
To leave something down at 36 inches only increases the hazard to the
fellow working on a suspended scaffold where he needs a much as he can
get * * *'' Another representative said that a 36-inch high guardrail
``strikes you in the wrong place * * * He goes over the rail or he
backs up to it while he's doing some work, it hits him at the wrong
point and he's gone.'' (Tr. 6/9/87, pp. 116-121).
Based on a review of the comments submitted on this issue, the
Agency's experience in enforcing this requirement over the years, and
OSHA's professional judgment, the final rule allows employers to
position scaffold guardrails in the range of 38 to 45-inches on
supported scaffolds, as proposed. This range is also consistent
[[Page 46072]]
with the guardrail criteria set in the revised standard (subpart M) for
Fall protection. However, OSHA recognizes that plank overlap is a
legitimate reason to accept a somewhat lower guardrail height on some
scaffolds. Thus, although the record indicates that most scaffolds on
the market fall within the 38- to 45-inch range (Ex. 2-368), some
scaffolds have been manufactured to meet the 36-inch lower guardrail
height limit accepted by ANSI. To allow the manufacturers of these
scaffolds the necessary time to redesign their systems, the Agency is
grandfathering 36-inch guardrail heights on all scaffolds manufactured
and installed before January 1, 2000. These scaffolds may continue to
be used throughout their normal service life, as long as they continue
to meet the other requirements of subpart L.
Final rule paragraph (g)(4)(iii), which is effectively identical to
proposed paragraph (e)(4)(iii), states that, when midrails, screens,
mesh, intermediate vertical members (such as balusters), solid panels,
or equivalent structural members are used, they are to be installed
between the top edge of the guardrail system and the scaffold platform.
This is essentially the same requirement as existing
Sec. 1926.451(a)(5), except that the existing language mentioned only
midrails and provided for the use of midrails ``when required.'' In the
final rule OSHA has revised the existing language to reflect the
variety of options available and to express the Agency's intent
clearly.
Final rule paragraphs (g)(4)(iv) through (vi) (proposed as
paragraphs (e)(4)(iv)-(vi)) specify the criteria necessary to ensure
that the midrails, screens, mesh, and baluster type protection required
by paragraph (g)(4)(iii) will be properly placed and effective.
Paragraph (g)(4)(iv) requires that midrails, when used, be installed at
a height midway between the top edge of the guardrail system and the
platform surface. Paragraph (g)(4)(v) requires that screens and mesh,
when used, extend from the top edge of the guardrail system to the
scaffold platform, and along the entire opening between the supports.
Paragraph (g)(4)(vi) requires that intermediate vertical members (such
as balusters or additional rails), when used, be not more than 19
inches (48 cm) apart.
The SSFI and SIA (Exs. 2-367 and 2-368) recommended the addition of
the word ``approximately'' to the midrail height required in paragraph
(iv). These commenters argued that, without the flexibility provided by
this word, the provision was unnecessarily restrictive and did not
properly address varying platform heights (such as where adjoining
platforms overlap) or the height variations allowed for toprails. OSHA
agrees that it is appropriate to allow for such variation, and the
final provision reflects this suggestion.
Paragraph (g)(4)(vii) of the final rule provides that toprails or
equivalent members be capable of withstanding, without failure, a force
applied in any downward or horizontal direction at any point along
their top edge of at least 100 pounds (445 n) for guardrail systems
installed on single-point adjustable suspension scaffolds and on two-
point adjustable suspension scaffolds, and at least 200 pounds (890 n)
for guardrail systems installed on all other scaffolds.
The strength criteria for guardrail systems on single-point
adjustable and two-point adjustable suspension scaffolds differ from
the criteria set for guardrails used on other types of scaffolds
because of the functions guardrails serve on these types of suspension
scaffolds. Fall protection on these suspension scaffolds is provided by
a combination of personal fall arrest systems (PFAS) and guardrails,
rather than by either guardrails or PFAS alone. Guardrails on single-
point adjustable and two-point adjustable suspension scaffolds
delineate the scaffold edge, restrain movement, provide handholds, and
prevent misstepping. A guardrail system can serve these functions
without having the strength that would be needed if the guardrails were
the primary means of providing fall protection. Therefore, OSHA has set
the minimum capacity for guardrail systems used on single-point and
two-point scaffolds at 100 pounds rather than at 200 pounds.
This is the same substantive requirement as was proposed in
paragraph (e)(4)(vii); however, the language has been modified as
discussed above to replace the proposed terms ``Type I'' and ``Type
II'' guardrails with the pertinent performance criteria. One commenter
(Ex. 2-44) recommended that the force requirements be changed to 100
pounds for Type I toprails and 80 pounds for Type II toprails. OSHA has
maintained the proposed strength requirements, i.e., 100 pounds, for
all toprails because the Agency believes that they are necessary to
prevent employees from breaking through toprails if they fall against
them.
Final rule paragraph (g)(4)(viii) provides that when the loads
specified in paragraph (g)(4)(vii) are applied in a downward direction,
the top edge may not drop below the height above the platform surface
prescribed in paragraph (g)(4)(ii). Proposed paragraph (e)(4)(viii) was
identical to the corresponding requirement in the final rule except
that the proposal limited deflection to 38 inches on supported
scaffolds (Type I guardrails) and 36 inches on suspended scaffolds
(Type II guardrails). The parallel final rule provision does not
contain the proposed guardrail designations, for the reasons discussed
above, and the provision also reflects minor editorial changes.
Paragraph (g)(4)(ix) of the final rule states that midrails,
screens, mesh, intermediate vertical members, solid panels, and
equivalent structural members must be capable of withstanding, without
failure, a force applied in any downward or horizontal direction at any
point along the midrail or other member of at least 75 pounds (333 n)
for guardrail systems with a minimum 100 pound toprail capacity, and at
least 150 pounds (666 n) for guardrail systems with a minimum 200 pound
toprail capacity. Except for the changes in guardrail system
terminology discussed above, this provision is the same as proposed
paragraph (e)(4)(ix).
The 150 pound force requirement is not specified in the existing
standard. However, the existing requirements (e.g.,
Sec. 1926.451(b)(15) et al.) require midrails to be made of 1 x 6-inch
lumber (or other material providing equivalent protection). The
existing standard also requires midrails to be not more than 8 feet
long (Sec. 1926.451(a)(5)), and to be made of a minimum 1,500 fiber
stress construction grade lumber (see Sec. 1926.451(a)(9)). On the
average, such wooden midrails can support loads up to approximately 160
pounds before breaking. Therefore, OSHA is replacing the specific
reference to 1 x 6-inch lumber with the performance criterion of 150
pounds force. Similarly, OSHA has adopted a performance criterion of 50
pounds for toeboards in final rule paragraph Sec. 1926.451(f)(3).
The only commenter (Ex. 2-44) on this issue recommended that the
proposed force requirements be changed to 75 pounds for Type I and 40
pounds for Type II midrails. OSHA has not made this change because the
Agency believes that the final rule's strength requirements for
midrails are necessary to prevent employees from breaking through
midrails or other intermediate members of the guardrail system. In
addition, OSHA has not maintained the distinction between Type I and
Type II midrails made in the proposal.
Final rule paragraph (g)(4)(x) (proposed paragraph (e)(4)(x))
provides that a separate guardrail section is not required on the ends
of suspension scaffolds when the scaffold's support system (stirrup) or
hoist prevents
[[Page 46073]]
passage of employees. One commenter (Ex. 2-8) suggested that OSHA
specify a maximum space of 10 inches between the hoist or stirrup and
the side guardrail or structure. Another commenter (Ex. 2-28) suggested
that the language of this paragraph be changed from ``does not allow
passage'' to ``does not allow normal passage without climbing over the
stirrup.'' OSHA has not made the suggested changes because this
requirement is clear as written.
Paragraph (g)(4)(xi) (proposed paragraph (e)(4)(xi)) of the final
rule requires that guardrail systems be so surfaced as to prevent
injury to an employee from punctures or lacerations, and to prevent the
snagging of clothing. This provision is consistent with
Sec. 1926.502(b)(6), which sets criteria for guardrails used in
construction, other than on scaffolds.
The language of the final rule is effectively identical to that in
the proposed rule, except that the proposed rule contained the words
``which could cause an employee to fall.'' OSHA used those words to
explain that one reason that guardrail systems should have smooth
surfaces is to prevent snagging of clothing. OSHA did not intend by
this language to limit protection to those situations where snagging
would actually result in a fall. OSHA realizes that other hazards, such
as exposure to falling objects, could arise if an employee's clothing
snagged on a guardrail surface. In the final rule, OSHA has revised the
proposed language accordingly.
The SSFI and SIA (Exs. 2-367 and 2-368) objected to the inclusion
of this provision in the final rule. Both commenters stated that the
provision would be ``impractical in the construction industry because
of the different types of equipment used,'' and would be
``unquestionably over-restrictive for the construction industry.'' The
SIA (Ex. 2-368) added ``As worded, even the standard guardrail posts
could be considered hazardous.'' OSHA believes that this existing
requirement is still needed and is promulgating the proposed provision
as editorially revised. The Agency does not intend this provision to be
interpreted to mean that guardrail system components have sanded or
finished surfaces. Instead, OSHA intends that such surfaces be free of
breaks and jagged edges that could cause cuts or lacerations, or snag
employee's clothes.
Paragraph (g)(4)(xii) of the final rule, which is effectively
identical to proposed paragraph (e)(4)(xii), requires that toprails and
midrails not be so long as to constitute a hazard. This is identical to
the corresponding provision in subpart M, (Fall protection)
Sec. 1926.502(b)(7), and is intended to protect employees from
projection hazards.
Paragraph (g)(4)(xiii) of the final rule, which is identical to
proposed paragraph (e)(4)(xiii), prohibits the use of steel banding and
plastic banding as toprails or midrails. Although such banding can
often withstand a 200 pound load, it can tear easily if twisted. In
addition, such banding often has sharp edges which can cut a hand if
seized. This is identical to the corresponding provision in subpart M
(Fall protection), Sec. 1926.502(b)(8).
Paragraph (g)(4)(xiv) of the final rule requires that guardrail
systems using manila, plastic or synthetic rope as rails be inspected
by a competent person as frequently as necessary to ensure that the
guardrails comply with the performance criteria in final rule
Sec. 1926.451(g). This provision has been added based on the response
to Hearing Notice Issue L-10.
Issue L-10 sought testimony and related information on an ACCSH
recommendation (Tr. 212-214, 6/9/87) that the Agency bar the use of
manila rope and plastic rope as toprails and midrails of guardrail
systems used on scaffolds. This recommendation reflected ACCSH's
concern that manila rope and plastic rope can lose strength quickly
when exposed to water and sun.
The SIA (Exs. 5a-16 and 10, Tr. 3/22/99, pp. 160-161) disagreed
with this view on the grounds that it should not be necessary to
restrict the type of material that can be used because other provisions
of the standard spell out system strength requirements for guardrails.
Another commenter (Exs. 5a-3 and 13) agreed, noting that, particularly
for short-term use, ``a rope is handy, adequate, and perfectly safe.''
This commenter stated that these ropes ``should not be barred from use
on scaffolds providing they are capable of supporting a 100-pound load
(Type II) or a 200-pound load (Type I) applied in any direction without
excessive deflection.''
Zurn Industries (Ex. 2-81) commented that ``plastic rope'' should
be defined, but did not provide such a definition. Zurn also stated
``[t]here are synthetic ropes made of plastic materials that do not sag
or lose strength when exposed to water or sun.'' This commenter also
suggested applying performance language to all materials used for
guardrails since future technology might provide more advanced types of
plastic rope.
After carefully considering the above comments and testimony, OSHA
believes that it is not necessary to prohibit the use of manila,
plastic or synthetic rope as guardrails on scaffolds. The Agency
realizes that these types of ropes can deteriorate over time from
environmental exposure. However, the Agency also realizes that such
ropes can have a useful lifespan before significant deterioration
occurs. Consequently, OSHA is promulgating final rule
Sec. 1926.451(g)(4)(xiv), which allows the use of plastic, manila or
synthetic rope only on condition that such ropes be inspected as often
as necessary to ensure their integrity. This provision is consistent
with the approach taken in Sec. 1926.502(b)(16), which sets generic
performance criteria for guardrails used in construction.
Paragraph (g)(4)(xv) of the final rule permits the use of
crossbracing in lieu of either a midrail or a toprail when certain
criteria are met. This provision is based on responses to NPRM Issue 13
and the March 29, 1993, reopening of the record. In particular,
crossbracing would be accepted in lieu of a toprail when the crossing
point is between 38 and 48 inches above the work surface. Also,
crossbracing would be accepted in lieu of a midrail when the crossing
point is between 20 and 30 inches above the work surface. In addition,
the end points of each upright must be no more than 48 inches apart,
which will reduce the slope of the crossbracing and result in a surface
that is similar to that of a standard guardrail.
The Agency received over 30 comments in response to Issue 13 and
the March, 1993 reopening of the record on the issue of the use of
crossbracing in lieu of guardrails (Exs. 2-13, 2-14, 2-20, 2-22, 2-26,
2-29, 2-30, 2-37, 2-43, 2-54, 2-55, 2-128, 2-330, 2-367, 2-368, 2-390,
2-476, 34-1, 34-9, 34-10, 34-11, 34-12, 34-15, 34-17, 34-19, 34-22, 34-
29, 34-32, 34-34, 34-35, 34-37, 34-39, 34-43, 34-46, and Tr. 6/9/87,
pp. 121-126). These comments are discussed below,
Issue 13 of the NPRM sought comments concerning whether OSHA should
accept crossbracing on intermediate levels of supported scaffolds as an
alternative to the existing and proposed rules requiring guardrail
systems on such levels. The Issue raised the question of whether
crossbraces are as effective as guardrail-type systems in preventing
falls, and asked for comments on two sets of provisions that had been
developed by the SIA and other interested industry groups.
Issue 13 presented the first three alternatives as a group
(hereafter Items 1(a)-(c)). Item 1(a) would have allowed crossbracing
in lieu of a midrail if the crossing point was at or between 20 and
[[Page 46074]]
32 inches above the work surface. Item 1(b) provided that crossbracing
would be allowed in lieu of both midrail and toprail if the crossing
point was at or between 30 and 48 inches above the work surface and the
end points of the uprights were 54 inches, or less, apart. Item 1(c)
would have prohibited the use of crossbracing in lieu of a toprail or
midrail on the top level of a scaffold (Issue 13 repeated this
suggested provision as Item 2(c)).
Issue 13 also presented a second set of alternatives for
crossbracing (hereafter Items 2(a)-(d)). Item 2(a) provided that
crossbracing would be allowed in lieu of a toprail if the crossing
point was at or between 39 and 49 inches above the work surface and the
endpoints of the uprights were 54 inches, or less, apart. Item 2(b)
provided that crossbracing would be allowed in lieu of a midrail if the
crossing point was at or between 20 inches and 30 inches above the
working surface. Item 2(d) would prohibit the use of crossbracing in
lieu of both the toprail and midrail on the same scaffold level at the
same time.
Commenters to Issue 13 were split into two groups: those supporting
(Exs. 2-14, 2-20, 2-22, 2-26, 2-30, 2-53, 2-55, 2-367, 2-368, 2-390,
and 2-476) and those rejecting (Exs. 2-13, 2-29, 2-37, 2-43, 2-54, 2-
128, and ACCSH) the use of crossbracing in lieu of guardrails.
The ACCSH (Tr. 6/9/87, pp. 121-129) and six commenters (Exs. 2-13,
2-29, 2-37, 2-43, 2-54 and 2-128) opposed OSHA recognizing crossbracing
a
FR Doc. 96-21289 Safety Standards for Scaffolds Used in the Construction Industry
s a substitute for a standard guardrail. One commenter (Ex.2-13 )
stated ``that there is no substitute for the protection afforded by a
constant-height guardrail''. The same commenter added that ``there is
no industry standard to allow a substitution in that the OSHA standards
have required guardrail systems since 1971''.
On the other hand, those commenters favoring crossbracing argued
that crossbracing should be allowed in lieu of the entire guardrail
system (Exs. 2-14, 2-20, 2-26, 2-30, 2-55, 2-367, 2-368, 2-390, and 2-
476), or that crossbracing should be permitted on intermediate levels
(Ex. 2-53), or that it should be permitted as a midrail only if the
midpoint of the ``X'' was 20 to 32 inches from the platform (Ex. 2-22).
Specifically, commenters in the group favoring crossbracing argued
that requiring guardrails in all situations could result in structural
instability (Ex. 2-14), was impractical, increased the likelihood of
accidents, could cause problems when attempting to attach guardrails to
the scaffold frame, and might raise issues of economic feasibility (Ex.
2-368). Some of these commenters also argued that available statistics
did not support retention of the existing rule's prohibition against
the use of crossbracing in lieu of guardrails (Exs. 2-20, 2-55, 2-367,
2-368, and 2-390).
For example, one commenter (Ex. 2-14) stated:
If cross braces and guardrail cannot be placed on the same
studs, and only toprails and midrails are used to connect a run of
scaffold frames other than the top run, a very hazardous structural
situation is created. This is due to the lack of triangulation which
crossbraces provide.
The SIA (Ex. 2-368) argued that:
Each time workers completed one level they would have to remove
the guardrail posts and rails, install frames and cross braces,
plank the next level, install guardrail posts and rails and repeat
the procedure at each level.
The increased work would create a greater possibility of
accident than that which it proposes to prevent.
The SIA also commented, argued that:
It is impractical and economically unfeasible to require
manufacturers to call in all their scaffolds for refurbishing. There
is no way the owners of scaffolds would comply nor any way the
manufacturer could force them to do so. The result would be a far
greater hazard due to alteration of the scaffold frames by persons
not qualified to perform the delicate welding required on steel
scaffold. It is further impossible when you consider the fact that
there are hundreds of thousands of separate owners of scaffold
frames manufactured by numerous manufacturers, many of which are no
longer in business.
The AGC (Exs. 2-20, 2-55, and 2-390) stated that crossbracing can
be used as an effective guardrail, because ``studies do not reflect
actual field conditions and accident statistics do not reflect the need
for the existing standard.'' OSHA notes, however, that inadequate
accident statistics and that lack of detailed annotation about the
details of accidents that are reported should not be taken as evidence
that no relationship exists.
Based on its review of the above-discussed comments, OSHA decided
that more information was needed in order to determine if the Agency
should allow the use of crossbracing in lieu of guardrail top rails or
midrails. Accordingly, on March 29, 1993, OSHA reopened the public
record on subpart L (58 FR 16509) for additional input. In particular,
the Agency requested comments regarding the extent to which
supplemental rail systems could be used with crossbraces to meet the
guardrail requirements of subpart L.
The commenters to the Reopening of the record either agreed with or
opposed the use of crossbracing in lieu of a guardrail in about the
same proportions as the earlier commenters. Their comments, which are
closely related to those addressed by the earlier commenters on this
issue, are only briefly summarized below:
--Those opposed to the use of crossbracing (Exs. 34-1, 34-11, 34-19,
34-22, 34-29, 34-34, and 34-35) argued that crossbraces would not
provide protection equivalent to that provided by standard guardrails,
because crossbracing lacks the uniform height and consistent spacing
between toprails and midrails that are found in guardrail systems and
are necessary for adequate protection (Ex. 34-11); because there are
variations in attachment heights, distances between crossmembers, and
the strength of the attachment points where crossbracing is used (Ex.
34-34); and because the use of crossbraces may promote shortcuts in
scaffold erection since employers might fail to measure the points of
the crossbracing or to add toeboards (Ex. 34-19). In addition, one
commenter stated that crossbraces should be supplemented by midrails
and toprails because employees may fall through the triangular void on
either side of the intersection of the braces, and added that
crossbraces may give a false sense of security (Ex. 34-35), and another
(Ex. 34-22) stated that commercial scaffolds are all capable of being
fitted with conventional guardrails, and that crossbraces can, at best,
only be used to replace either the toprail or midrail, not both.
--Those supporting the use of crossbracing in lieu of guardrails
(midrail or toprail) urged OSHA to adopt certain height requirements
for the crossing points of the crossbracing. For example, five
commenters (Exs. 34-9, 34-10, 34-12, 34-17, 34-37) stated that
crossbracing could be substituted for a midrail as the crossing point
of the brace is between 20 and 31 inches above the work surface, while
others argued that crossbracing could be used in lieu of a toprail or
midrail if the crossing point fell in the range of 30 to 48 inches
above the working surface. Another group of participants (Exs. 34-9,
34-10, 34-12, and 34-17) were of the opinion that crossbracing
substituting for a midrail should have a crossing point in the 20- to
30-inch range. A large number of commenters (Exs. 34-9, 34-10, 34- 12,
34-17, 34-32, 34-37, and 34-39) stated that end points of the
crossbraces must be no more than 54 inches apart.
[[Page 46075]]
Another group of commenters (Exs. 34-5, 34-9, 34-10, 34-12, 34-17,
34-22, and 34-29) provided information on supplemental rail systems,
such as those produced by Waco, Safway or Nail. These commenters stated
that such systems are feasible and would provide protection equivalent
to guardrails that comply with proposed subpart L in certain
situations.
Donald Nail (Ex. 34-15) commented as follows:
* * * I have devised a way to enhance scaffold safety. The
safety rail which I invented can be conveniently attached to
scaffold crossbraces, thus eliminating the excuses of those
employers and employees who simply do not want to put them up.
This invention is not currently on the market due to resistance
from the scaffold and construction industries. If OSHA regulations
were changed to require a guardrail with scaffolding, employer
compliance would follow without undue economic hardship. The average
cost would be about $5 (plus the rail) per frame as opposed to
current systems averaging $30.
The basic concept for my automatic guard rail is that you cannot
erect a welded-frame scaffold without crossbraces. The automatic
guardrail would be permanently attached to the crossbraces with a
slide ring on each end of the rail . . . The guard rail will fold up
with the crossbraces when they are taken down for shipping or
storage. The crossbraces are easier and quicker to install with the
guard rail attached than without, not to mention safer. If the guard
rail is permanently attached to the crossbraces the workmen will
have installed the guard rails automatically, thereby helping to
reduce numerous fatalities and thousands of scaffold injuries each
year.
However, commenters opposed to the use of supplemental rail systems
(Exs. 34-32, 34-37, and 34-39) argued that the Safway panel can only be
installed on walk-through frames that have attachment members on both
sides. They added that these systems were designed to be used in cases
where crossbracing is not required in every bay.
SIA (Ex. 34-37) commented that the Waco system has not been
accepted by industry because: (a) It can only be used on a specific
type scaffold frame; (b) It increases the number of pieces three-fold
because it also requires two additional rails; (c) It significantly
increases the dead load on the scaffold; (d) It has not proved to be
economically feasible. The commenter added that Patent Scaffolding Co.
has had a similar device consisting of four pieces for 10 years, but
that it has not been widely used for the same reasons.
In addition, the SIA contended that the Nails Safety Rails system
is not feasible because:
(a) It is a proprietary system which cannot be used universally.
(b) It cannot be used with angle braces which account for 60% of
most inventory.
(c) When attached to the crossbrace it becomes permanent (since
it is riveted on) and therefore, by its very nature must be used
(with the crossbrace) where it would not be required--thus adding
considerable more dead load to the scaffold.
(d) It requires another inventory item not usually included in
stock.
(e) It requires extra attachments to the scaffold frame.
(f) It creates costly maintenance problems when plaster and
cement hinder sliding the rail.
(g) It is not cost effective.
The Agency finds that the supplemental railings discussed above can
be used as guardrails in some situations. However, these supplemental
systems are not compatible with all scaffolds, and will thus not
address the guardrail vs. crossbracing issue. In addition, based on the
determination, discussed above, that crossbracing can be used safely in
lieu of either a midrail or a toprail, but not both, the Agency finds
no reason to mandate the use of these supplemental railings. Employers
may still use these railing in situations where they are appropriate to
protect employees working on scaffolds from fall hazards.
After carefully reviewing the extensive record on this issue, the
Agency has determined that it is appropriate to allow crossbracing in
lieu of a midrail or a toprail (but not both). The crossing point
heights and crossbrace endpoint distance spelled out in the final rule
are based on a combination of those raised in Issue 13 of the NPRM and
those specified in the California code and reflect OSHA's evaluation of
the record as a whole.
OSHA disagrees that crossbracing can be used in lieu of both the
midrail and the toprail of a standard guardrail system. The principal
reasons for this determination are that the voids on each side of the
intersection of the crossbraces present a serious fall hazard to
employees working on scaffolds, and that the uneven height and spacing
of crossbraces also contribute to the fall hazard. For example, if OSHA
permitted crossbracing in lieu of both a toprail and a midrail, the
voids below the crossing point of the crossbrace could be as high as 48
inches. This would be inconsistent with good safety practice and with
subpart M of this part (Fall protection), which requires that openings
in walls or other vertical surfaces not exceed 30 inches in height
unless a guardrail is installed. In addition, Review Commission
decisions (see, for example, 10 OSHRC 1937 and 7 OSHRC 1951) have
consistently upheld OSHA's position that crossbracing is not equivalent
to a guardrail in the degree of protection provided. Support for the
position taken in the final rule also comes from California, where the
State Code initially allowed the use of crossbracing in lieu of a
guardrail system but was changed in 1976 to limit the use of
crossbracing as only a midrail or a toprail, but not both. A review of
California's experience shows that permitting the use of crossbracing
in lieu of either a midrail or a toprail has not compromised employee
safety. Washington State and Arizona both allow such use of
crossbracing; OSHA notes that these three states together account for
well over 10 percent of all U.S. construction work. In addition,
specifics of the California code agree with those in the final rule.
For example, California accepts crossbracing as a toprail if the
intersection of the ``X'' occurs at 45 inches (+/-3 inches). Issue 13
suggested a range of 39 to 49 inches for the height of the crossing
point, and the final rule accepts a range of 38 to 48 inches to reflect
the lower limit of guardrail height permitted by this final subpart L,
and the upper limit permitted by the California code.
In addition, the final rule specifies that the end points of each
upright be no more than 48 inches apart, not 54 inches as suggested by
many commenters and raised in NPRM Issue 13. This spacing (48 inches)
is consistent with the California code and will reduce the slope of the
crossbracing and result in a flatter surface that is more consistent
with that of a standard guardrail, and will provide equivalent
protection.
The Agency has concluded that crossbracing where the crossing point
is between 20 and 30 inches can serve safely as a midrail since the use
of a standard top rail will provide the uniform height that the Agency
has determined is necessary, while the use of a toe board will limit
the size of any openings (voids) on either side of the crossing point.
Similarly, OSHA believes that where the crossing point occurs in
the 38- to 48-inch range the crossbracing must be supplemented by a
midrail. Otherwise, an opening as high as 48 inches could occur,
allowing an employee to fall. These conditions would also occur if
crossbracing were permitted to be used in lieu of a complete standard
guardrail. Accordingly, the final rule contains provisions allowing use
of crossbraces as a substitute for either the midrail or toprail, but
not both, providing that the crossing point and end point distances
specified in the final rule are observed.
[[Page 46076]]
Paragraph 1926.451(h). Falling object protection.
This paragraph addresses the protection of employees from scaffold-
related falling object hazards. Paragraph (h)(1) of the final rule
provides that employees working on scaffolds wear hardhats and be
protected from falling hand tools, debris, and other small objects
through the installation of toeboards, screens, or guardrail systems or
through the erection of debris nets, catch platforms, or canopy
structures that deflect falling objects. In addition, when the falling
objects to which employees on scaffolds may be exposed are too large,
heavy or massive to be contained or deflected by any of the above-
listed measures, the employer must protect affected employees by
placing any such potential falling objects away from the edge of a
surface from which they might fall and must secure those materials as
necessary to prevent their falling.
This provision is similar to proposed paragraph (f)(1), which was
based on existing Secs. 1926.451(a)(16) and (h)(13). OSHA has added the
phrase ``hand tools, debris, and other small'' to describe the type and
size of objects that OSHA expects would be handled by toeboards,
screens, guardrails, canopies, debris nets and catch platforms. In
addition, the Agency has added language which requires that employers
place materials away from an edge over which they might fall and secure
those objects as necessary to prevent their falling, if those materials
are so large, heavy or massive that the above-listed measures would not
contain or deflect them. The changes that have been made to this
requirement since the proposal are based on comments received from the
SSFI and the SIA (Exs. 2-367 and 2-368) indicating that ``compressors,
marble, pipe, large bolts, etc. could be potentially falling objects''
and that it is unreasonable to require guarding against such large
objects.
OSHA agrees that the protective measures required by the proposed
paragraph would not be adequate to withstand large objects. For
example, a slab of marble facing would smash through screens or
guardrails if it had not been properly stored and retained. In fact, an
object of this mass would probably crash through a debris net or even a
catch platform or protective canopy. As provided by the final rule, the
appropriate way to protect affected employees from such large items is
to locate those items away from the edge and to secure them to keep
them from falling.
Because objects falling from scaffolds may injure employees working
below, final rule paragraph (h)(2) requires employers to protect
affected employees from that hazard and sets forth several alternative
means by which employers can provide the required protection. The
provisions of proposed paragraph (f)(2) were identical, except that
debris nets and catch platforms have been added to the final rule,
because, based on review of the rulemaking record, OSHA considers such
measures to be acceptable alternatives.
Paragraph (h)(2)(i) provides for the use of barricades on lower
levels to exclude employees from areas where falling objects might
land. Compliance with this new provision will enable employers to
eliminate employee exposure to the hazard.
Under paragraph (h)(2)(ii), employers would be required to provide
toeboards along the edge of platforms more than ten feet above lower
levels for a distance sufficient to protect workers below, except that
on float (ship) scaffolds, an edging of \3/4\ inch x 1\1/2\ inch
wood, or a material with equivalent strength, may be used in lieu of a
toeboard. This provision differs from existing Sec. 1926.451(a)(4),
which requires toeboards to be erected along the entire length of all
open sides and ends of all scaffolds more than 10 feet high. The final
rule, like proposed paragraph (f)(2)(ii), requires toeboards only where
needed to protect employees below from falling object hazards.
For example, on a long scaffold where employees are working on the
ground near one end of the scaffold, compliance with this provision
would require the scaffold to have a toeboard at the end over the
employees below, but not at the other end. This would be the case
regardless of the height of the scaffold work platform. This change
recognizes that toeboards and equivalent members are for the protection
of employees below. Accordingly, if no employees are exposed, no
protective measures are necessary.
Paragraph (h)(2)(iii) of the final rule provides, as an
alternative, for erection of paneling or screening in cases where tools
or other materials are piled to a height higher than the top edge of a
toeboard. The panel or screen must extend from the toeboard (or
platform) to the top of the guardrail and be erected for a distance
sufficient to protect employees below. In addition, the panel or screen
would need to be capable of withstanding, without failure, a force of
at least 150 pounds, applied in any downward or outward direction at
any point along the screen (to comply with paragraph (g)(4)(ix)). This
provision is effectively identical to proposed paragraph (f)(2)(iii).
The proposed rule referenced the proposed Sec. 1926.502 criteria for
screens, while the final rule directly incorporates the applicable
strength requirement from Sec. 1926.502(b)(5), Fall protection (subpart
M). OSHA believes that this revision will facilitate compliance by
eliminating the need for employers to look up a cross reference.
Paragraph (h)(2)(iv) of the final rule allows employers to protect
employees from falling objects through the installation of a guardrail
system which complies with Sec. 1926.451(g)(4) and which has openings
small enough to reject passage of potential falling objects. This
provision is identical to proposed paragraph (f)(2)(iv).
Paragraph (h)(2)(v) of the final rule provides that employers can
protect employees working below scaffolds from falling objects through
the installation of debris nets, catch platforms, or canopies that have
sufficient strength to withstand the impact forces of potential falling
objects.
In contrast to final rule paragraph (h)(2)(v), proposed paragraph
(f)(2)(v) provided only for the use of a canopy structure. OSHA has
added debris nets and catch platforms to this provision in response to
the statement by Bristol Steel (Ex. 5a-3) that debris nets or catch
platforms immediately below a scaffold could be more protective than a
canopy many feet below. The Agency agrees that properly installed
debris nets and catch platforms in place immediately below a scaffold
will stop objects from falling closer to the source, and will lessen
the possibility that these falling objects will pick up momentum and
bounce off the canopy, injuring workers some distance from the area
below the scaffold.
Hearing Notice Issue L-13 sought testimony and comments on a
suggestion by the ACCSH (Tr. 6/9/87, 214-15) that proposed
Sec. 1926.451(f)(2)(v) specify nine feet as the proper height for the
placement of a canopy. The ACCSH noted that the proposed requirement
did not specify a height for canopy placement. According to the ACCSH,
a canopy set at 15 or 20 feet would not protect employees below.
However, the Advisory Committee did not provide a supporting rationale
for its position.
Both the SIA (Exs. 10 and 5a-16, and Tr. 3/22/88, pp. 162-163) and
SSFI (Ex. 5a-19) supported the placement of the canopy at a height of
10 feet. The SIA pointed out that standard scaffold frames are six-feet
high and adding a three-foot frame would raise the canopy top,
including the plank, to a height of
[[Page 46077]]
almost 10 feet. The SIA suggested that OSHA specify a ``maximum''
distance of 10 feet, noting that the proposed standard would not have
allowed for any variation to accommodate these standard frames. The
SSFI's comment stated that canopies ``should be erected no greater than
10 feet above the work surface'' and that because the intent of this
requirement was to provide employee protection from small falling
objects and/or light debris, ``the term `reasonable' should be included
within the definition.'' In addition, the SSFI asked what anticipated
impact forces such canopies would be required to withstand.
The National Chimney & Cooling Tower Association (Ex. 2-593)
indicated that no height restriction was appropriate for canopies. The
commenter stated that restricting the height would severely hamper
equipment access. Bristol Steel (Ex. 5a-3) supported allowing maximum
flexibility for designing various types of falling object protection
for varying situations. This commenter stated that there should be no
limitation on canopy height as long as the canopy functions as
intended.
After carefully considering the comments and testimony received in
response to this issue, OSHA believes that specifying a maximum height
for canopy placement could unnecessarily restrict the use of equipment.
In addition, the Agency believes that the use of performance-oriented
language, requiring that canopies be strong enough to withstand the
impact forces of potential falling objects, will ensure employee safety
and at the same time provide the flexibility necessary to respond
adequately to advances in technology as well as unusual or changing
work-site conditions. The employer is responsible for determining the
maximum size of potential falling objects and providing the appropriate
protection.
Final rule paragraph (h)(3) sets criteria for the use of canopies.
Paragraph (h)(3)(i) of the final rule, which is identical to proposed
paragraph (f)(1)(i), requires that canopies be installed between the
falling object hazard and the employees. Paragraph (h)(3)(ii) of the
final rule, which is identical to proposed paragraph (f)(1)(ii),
requires the use of additional independent support lines to support the
scaffold in the event of suspension support rope failure, in cases
where canopies are used for falling object protection on suspended
scaffolds. The reason for this requirement, as stated in the discussion
of final rule paragraph (g)(3), is that in the event of a suspension
rope failure, the additional lines would keep the scaffold from
falling.
Paragraph (h)(3)(iii) of the final rule, which is identical to
proposed paragraph (f)(1)(iii), requires that independent support lines
and suspension ropes not be attached to the same point of anchorage.
This new provision will prevent the loss of the backup safety systems
in the event of suspension rope anchorage failure.
Final rule paragraph (h)(4) sets strength criteria for toeboards.
Paragraph (h)(4)(i), which is a new requirement, requires that
toeboards be capable of withstanding, without failure, a force of at
least 50 pounds applied in any downward or horizontal direction at any
point along the toeboard. This provision contains a note which
indicates that toeboards built in accordance with Appendix A of subpart
L will be deemed to comply with the standard. This provision, which is
consistent with the corresponding requirement in OSHA's Fall Protection
standard, Sec. 1926.502(j)(2) (subpart M), is identical to proposed
paragraph (f)(3)(i).
Final rule paragraph (h)(4)(ii) sets forth the construction
requirements for toeboards. This provision requires that toeboards be
at least three and one-half inches high, fastened securely in place,
and have not more than \1/4\-inch clearance above the walking/working
surface. In addition, toeboards must be solid or have openings no
greater than one inch in the greatest dimension. This provision, which
is consistent with the corresponding requirement of the Fall Protection
standard, Sec. 1926.502(j)(3) (subpart M), is identical to proposed
paragraph (f)(3)(ii), except as discussed below.
OSHA received one comment on proposed paragraph (f)(3)(ii). That
commenter (Ex. 2-29) recommended a maximum space of \1/4\-inch between
the lower edge of the toeboard and the platform instead of the proposed
\1/2\-inch on the grounds that ``many small tools and fastener
materials can pass through a \1/2\-inch opening.'' OSHA agrees that
reducing this opening will enhance employee protection and has changed
the language of the final rule accordingly.
Other Issues Related to Sec. 1926.451
Issue L-7 of the hearing notice solicited testimony and related
information on the extent to which proposed Sec. 1926.451 (``General
requirements'') adequately covers smokestack hoist scaffolds. The
Agency also requested testimony and information on stack hoist hazards
not addressed by the general requirements, and explained that the issue
was being raised in light of ongoing efforts to update ANSI standard
A10.22, Safety Requirements for Rope Guided and Non-Guided Workmen's
Hoists. OSHA noted that the final rule might need to include provisions
to address the hazards unique to stack hoist scaffolds. However,
because stack hoist scaffolds are included in the definitions of
``scaffold'' and ``suspension scaffold'' used in the scaffold rules,
OSHA concludes that the final rule does not need to include specific
coverage for stack hoist scaffolds. OSHA notes that, since the
proposal, the ANSI A10.22-1977 standard for stack hoist scaffolds has
been rescinded and has not been replaced.
Sec. 1926.452 Additional Requirements Applicable to Specific Types of
Scaffolds
Section 1926.452 of the final rule contains requirements that
supplement the requirements of Sec. 1926.451 with regard to particular
types of scaffolds. The identified scaffolds have unique features which
require specific attention. This approach is consistent with that taken
in existing Secs. 1926.451 (b) through (y), which set out additional
provisions for specific types of scaffolds.
OSHA received comments (Exs. 2-13 and 2-23) which suggested that
specific scaffold design criteria and fall protection requirements be
added to proposed Sec. 1926.452 (particularly to proposed paragraphs
(i), (l), (m), (q), (r), (s), (t), (u) and (v)). OSHA has determined
that compliance with the performance-oriented provisions of final rule
Secs. 1926.451 and 1926.452, taken together, will provide adequate
protection for employees working on scaffolds. Further, the Agency
believes that the specification language suggested by the commenters
would limit innovation and impose unreasonable burdens on employers.
As discussed in the preamble to the proposed rule (51 FR 42691-6),
many existing Sec. 1926.451 requirements are not being carried forward
in final rule Sec. 1925.452 because the topics they address (capacity,
construction, access, fall protection and falling object protection)
are covered by provisions in final rule Sec. 1926.451. The provisions
being reordered are presented in Table 1, which shows the requirement
in OSHA's existing rule and the corresponding provision in the final
rule being published today.
[[Page 46078]]
Table 1.--Provisions Being Reordered in the Final Rule
----------------------------------------------------------------------------------------------------------------
Existing paragraph Final rule paragraph
----------------------------------------------------------------------------------------------------------------
Sec. 1926.451(b)(1)..................... Sec. 1926.451(c)(3), (d)(1)
Sec. 1926.451(b)(3)..................... Sec. 1926.451(b)(3)
Sec. 1926.451(b)(4)..................... Sec. 1926.451(c)(2)
Sec. 1926.451(b)(6)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(b)(8)..................... Sec. 1926.451(d)(1)
Sec. 1926.451(b)(11).................... Sec. 1926.451(b)(1)
Sec. 1926.451(b)(12).................... Sec. 1926.451(b)(4), (6) and Sec. 1926.451(a)(1)
Sec. 1926.451(b)(13).................... Sec. 1926.451(b)(7)
Sec. 1926.451(b)(15).................... Sec. 1926.451(g)
Tables L-4 through L-9................... Sec. 1926.451(a)(1) and (g)
Sec. 1926.451(c)(1)..................... Sec. 1926.451(a)(1) and (c)(1)
Sec. 1926.451(c)(2)..................... Sec. 1926.451(a)(1) and (c)(1)
Sec. 1926.451(c)(3)..................... Sec. 1926.451(a)(1) and (c)(1)
Sec. 1926.451(c)(5)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(c)(6)..................... Sec. 1926.451(d)(1)
Sec. 1926.451(c)(7) [last sentence]..... Sec. 1926.451(a)(1)
Sec. 1926.451(c)(12).................... Sec. 1926.451(c)(2)
Sec. 1926.451(c)(13).................... Sec. 1926.451(g)
Tables L-10 through L-12................. Sec. 1926.451(a)(1)
Sec. 1926.451(d)(1)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(d)(4)..................... Sec. 1926.451(b)(15)
Sec. 1926.451(d)(7)..................... Sec. 1926.451(b)(14)
Sec. 1926.451(d)(8)..................... Sec. 1926.451(a)(1) and Appendix A
Sec. 1926.451(d)(10).................... Sec. 1926.451(g)
Sec. 1926.451(q)(2)..................... Sec. 1926.451(b)(1)
Sec. 1926.451(q)(3)..................... Sec. 1926.451(e)
Sec. 1926.451(q)(4)..................... Sec. 1926.451(g)
Sec. 1926.451(n)(1)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(n)(2)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(n)(5)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(n)(7)..................... Sec. 1926.451(c)(3)
Table 15................................. Sec. 1926.451(a)(1)
Sec. 1926.451(o)(2)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(o)(3)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(o)(6)..................... Sec. 1926.451(f)(5)
Sec. 1926.451(o)(7)..................... Sec. 1926.451(g)
Table 16................................. Sec. 1926.451(a)(1)
Sec. 1926.451(m)(1)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(m)(3)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(m)(4)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(m)(5)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(b)(4)
Sec. 1926.451(b)(5)
Sec. 1926.451(m)(6)..................... Sec. 1926.451(g)
Sec. 1926.451(x)(1)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(x)(2)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(b)(4)
Sec. 1926.451(b)(5)
Sec. 1926.451(x)(3)..................... Sec. 1926.451(f)(2)
Sec. 1926.451(x)(4)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(b)(1)
Sec. 1926.451(b)(4)
Sec. 1926.451(b)(5)
Sec. 1926.451(x)(5)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(b)(4)
Sec. 1926.451(b)(5)
Sec. 1926.451(g)
Sec. 1926.451(x)(6)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(b)(4)
Sec. 1926.451(b)(5)
Sec. 1926.451(g)
Tables L-17, 18 and 19................... Sec. 1926.451(a)(1)
Sec. 1926.451(g)
Sec. 1926.451(g)(1) (in part)........... Sec. 1926.451(a)(1)
Sec. 1926.451(g)(4)..................... Sec. 1926.451(b)(3)
Sec. 1926.452(i)(8)
Sec. 1926.451(g)(5)..................... Sec. 1926.451(g)
Table L-13............................... Sec. 1926.451(a)(1)
Sec. 1926.451(y)(1)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(f)(2)
Sec. 1926.451(y)(3)..................... Sec. 1926.451(b)(1)
Sec. 1926.451(y)(4) (i) and (ii) (also Sec. 1926.451(a)(1)
(iii) in part).
[[Page 46079]]
Sec. 1926.451(y)(5) (also (y)(6) and Sec. 1926.451(c)(3)
(y)(7) in part).
Sec. 1926.451(y)(9)..................... Sec. 1926.451(e)
Sec. 1926.451(y)(10).................... Sec. 1926.451(a)
Sec. 1926.451(y)(11).................... Sec. 1926.451(g)
Sec. 1926.451(s)(5)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(b)(5)
Sec. 1926.451(s)(6)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(f)(2)
Sec. 1926.451(t)(3)..................... Sec. 1926.451(g)
Sec. 1926.451(t)(4)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(f)(2)
Sec. 1926.451(k)(1)..................... Sec. 1926.451(d)(13)
Sec. 1926.451(k)(2)..................... Sec. 1926.451(d)(14)
Sec. 1926.451(k)(3)..................... Sec. 1926.451(d)(15)
Sec. 1926.451(k)(4)..................... Sec. 1926.451(d)(16)
Sec. 1926.451(k)(5)..................... Sec. 1926.451(f)(3)
Sec. 1926.451(k)(8)..................... Sec. 1926.451(d)(2) through (d)(16)
Sec. 1926.451(k)(9)..................... Sec. 1926.451(g)
Sec. 1926.451(k)(10).................... Sec. 1926.451
Sec. 1926.451(l)(4)..................... Sec. 1926.451(g)
Sec. 1926.451(l)(6)..................... Sec. 1926.451(d)(5)
Sec. 1926.451(h)(1)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(f)(2)
Sec. 1926.451(h)(2)..................... Sec. 1926.451(d)(13)
Sec. 1926.451(h)(3)..................... Sec. 1926.451(a)(2)
Sec. 1926.451(h)(4)..................... Sec. 1926.451(d)(4)
Sec. 1926.451(h)(5)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(h)(6)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(d)(3)(i)
Sec. 1926.451(h)(7)..................... Sec. 1926.451(d)(4)(iii)
Sec. 1926.451(h)(8)..................... Sec. 1926.451(d)(4)(i)
Sec. 1926.451(h)(9)..................... Sec. 1926.451(d)(2)
Sec. 1926.451(h)(10).................... Sec. 1926.451(d)(9)
Sec. 1926.451(d)(7)
Sec. 1926.451(h)(11).................... Sec. 1926.451(d)(4)(iv)
Sec. 1926.451(h)(12).................... Sec. 1926.451(a)(1)
Sec. 1926.451(i)(2)..................... Sec. 1926.451(g)
Sec. 1926.451(i)(9)..................... Sec. 1926.451(d)(18)
Sec. 1926.451(j)(1)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(f)(2)
Sec. 1926.451(j)(2)..................... Sec. 1926.451(d)(13)
Sec. 1926.451(j)(3)..................... Sec. 1926.451(b)(4)
Sec. 1926.451(b)(5)
Sec. 1926.451(j)(4)..................... Sec. 1926.451(d)(4)
Sec. 1926.451(d)(5)
Sec. 1926.451(j)(5)..................... Sec. 1926.451(d)(4)(iii)
Sec. 1926.451(d)(3)
Sec. 1926.451(d)(4)(i)
Sec. 1926.451(j)(6)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(a)(2)
Sec. 1926.451(j)(7)..................... Sec. 1926.451(d)(9)
Sec. 1926.451(d)(7)
Sec. 1926.451(j)(8)..................... Sec. 1926.452(q)(1)
Sec. 1926.452(q)(2)
Sec. 1926.451(j)(9)..................... Sec. 1926.451(g)
Sec. 1926.451(w)(1)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(f)(2)
Sec. 1926.451(w)(2)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(w)(4)..................... Sec. 1926.451(g)
Sec. 1926.451(w)(5)..................... Sec. 1926.451(a)(2)
Sec. 1926.451(f)(4)
Sec. 1926.451(w)(6)..................... Sec. 1926.451(g)
Sec. 1926.451(r)(2)..................... Sec. 1926.451(a)(2)
Sec. 1926.452(t)(3)
Sec. 1926.451(r)(3)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(r)(4)..................... Sec. 1926.451(a)(1)
Sec. 1926.451(r)(5)..................... Sec. 1926.451(g)
Sec. 1926.451(e)(1)..................... Sec. 1926.451(c)(2)
Sec. 1926.451(e)(2)..................... Sec. 1926.451(a)(1)
Sec. 1926.452(w)(2)
Sec. 1926.451(e)(4)..................... Sec. 1926.451(b)(1)
[[Page 46080]]
Sec. 1926.451(e)(5)..................... Sec. 1926.451(e)(1)
Sec. 1926.451(e)(2)
Sec. 1926.451(e)(3)
Sec. 1926.451(e)(8)..................... Sec. 1926.451(c)(3)
Sec. 1926.451(d)(1)
Sec. 1926.452(w)(2)
Sec. 1926.451(e)(10).................... Sec. 1926.451(g)
----------------------------------------------------------------------------------------------------------------
Paragraph (a) Pole Scaffolds
Final rule paragraph (a) sets requirements for the proper use of
bearers, braces and runners on pole scaffolds. The corresponding
provision in existing Sec. 1926.451(b) is titled ``Wood pole
scaffolds.'' The final rule has deleted the word ``wood'' from the
title of the paragraph, since pole scaffolds can be constructed of
other materials. In addition, the final rule provides that pole
scaffolds over 60 feet in height be designed by a registered
professional engineer, and must be constructed and loaded in accordance
with that design. The provision also notes that non-mandatory Appendix
A contains examples of criteria that will enable an employer to comply
with design and loading requirements for pole scaffolds under 60 feet
in height. These provisions are virtually identical to those in the
proposal, except for minor editorial revisions for the sake of clarity,
as discussed below. In addition, as illustrated by Table 2, many
existing Sec. 1926.451(b) requirements are being carried forward in
paragraph (a) of Sec. 1926.452 of the final rule.
Table 2.--Provisions Being Renumbered in the Final Rule
------------------------------------------------------------------------
Existing paragraph Final rule paragraph
------------------------------------------------------------------------
Sec. 1926.451(b)(14)................. Sec. 1926.452(a)(1)
Sec. 1926.451(b)(9).................. Sec. 1926.452(a)(2)
Sec. 1926.451(b)(10)................. Sec. 1926.452(a)(3)
Sec. 1926.451(b)(10)................. Sec. 1926.452(a)(4)
Sec. 1926.451(b)(5).................. Sec. 1926.452(a)(5)
Sec. 1926.451(b)(5).................. Sec. 1926.452(a)(6)
Sec. 1926.451(b)(6).................. Sec. 1926.451(a)
Sec. 1926.451(b)(7).................. Sec. 1926.452(a)(7)
Sec. 1926.451(b)(7), (10)............ Sec. 1926.452(a)(8)
Sec. 1926.451(b)(2).................. Sec. 1926.452(a)(9)
Sec. 1926.451(b)(16)................. Sec. 1926.452(a)(10)
------------------------------------------------------------------------
OSHA received three comments (Exs. 2-13, 2-367 and 2-368) on
proposed Sec. 1926.452(a). The SSFI (Ex. 2-367) recommended that OSHA
change the term ``Ledger'' to ``Runners'' because ``Runners'' is the
correct terminology. OSHA agrees and has incorporated that change into
paragraph (a) of the final rule.
The other commenters (Exs. 2-13 and 2-368) objected to the proposed
deletion of the word ``wood'' from the title of this paragraph, stating
that this section refers only to wood pole scaffolds. OSHA believes
that all pole scaffolds, whatever their composition, need to be covered
by the criteria of proposed paragraph (a) and, accordingly, has not
made the suggested change.
Finally, the Agency has editorially revised the text of final rule
Sec. 1296.452(a)(10) to clarify that non-mandatory Appendix A contains
examples of criteria that will enable an employer to comply with design
and loading requirements for pole scaffolds under 60 feet in height,
and that pole scaffolds over 60 feet in height must be designed by a
registered professional engineer. This revision highlights the fact
that the proposed criteria and now the final rule criteria in non-
mandatory Appendix A are limited to heights of less than 60 feet.
Paragraph (b) Tube and Coupler Scaffolds
Paragraph (b) sets requirements for the use of bearers, bracing,
runners and couplers on tube and coupler scaffolds. In addition, the
final rule provides that tube and coupler scaffolds over 125 feet in
height be designed by a registered professional engineer, and be
constructed and loaded in accordance with such design. The provision
also notes that non-mandatory Appendix A contains examples of criteria
that will enable an employer to comply with design and loading
requirements for tube and coupler scaffolds under 125 feet in height.
These provisions are virtually identical to the proposed provisions,
except as discussed below.
Final rule paragraph (b)(1), which is identical to the
corresponding provision of the proposed rule, is a new requirement for
tube and coupler scaffolds. This provision requires that platforms not
be moved until the next location has been properly prepared to support
the platform being moved. This is the same requirement as existing
Sec. 1926.451(b)(14) (final rule Sec. 1926.452(a)(1)) for wood pole
(pole) scaffolds. This rule was added to this section because it
addressed the problem of platform stability during construction, a
problem which exists for tube and coupler scaffolds as well as pole
scaffolds.
Paragraph (b)(2) of the final rule requires the installation of
transverse bracing at the scaffold ends and, at least, at every third
set of posts horizontally and every fourth post vertically. This
paragraph provides for diagonal bracing from the outer or inner posts
or runners upward to the next outer or inner posts or runners. In
addition, building ties must be installed at the bearer levels between
the diagonal braces in conformance with Sec. 1926.451(c)(1). This
provision is consistent with existing Sec. 1926.451(c)(10).
This requirement differs from the proposed paragraph (b)(2), which
required transverse bracing to be installed for each section of six
levels between the fourth and sixth level.
The SSFI and the SIA (Exs. 2-367 and 2-368) recommended that
transverse bracing be installed at the base and be repeated every third
and fourth level vertically, and that building ties be installed ``at
bearer levels adjacent to the bracing'' (Ex. 2-367), or at ``the bearer
levels between the diagonal brace[s]'' (Ex. 2-368). In support of the
suggested change, the SIA (Ex. 2-368) stated ``[t]his revision would
correct the inaccuracy which has existed for years in the current
standard and will conform to proper engineering criteria.'' Another
commenter (Ex. 2-15) pointed out that the proposal did not require
transverse bracing at the base of the scaffold. In addition, a
commenter (Ex. 2-42) recommended that transverse bracing be installed
at the scaffold ends and at least at every third set of posts, that
such bracing be installed on every level and that it extend diagonally
from the inner or outer posts or runners.
OSHA has determined that the proposed bracing specifications would
not provide adequate structural stability for tube and coupler
scaffolds. In
[[Page 46081]]
particular, OSHA has concluded that bracing at the third and fourth
levels, as suggested by the SSFI and the SIA and as provided in ANSI
A10.8-1988, paragraph 8.11, will provide appropriate stability. On the
other hand, the Agency believes that bracing at every level would be
unnecessarily burdensome, perhaps even affecting the capacity of the
scaffold. Therefore, OSHA is returning to the approach taken by
existing Sec. 1926.451(c)(10). The Agency has concluded that compliance
with the suggested provisions will increase scaffold stability
appropriately and has revised the final rule to reflect this finding.
In addition, OSHA has drafted the final provision to indicate clearly
that the placement of building ties must comply with final rule
Sec. 1926.451(c)(1) (proposed as Sec. 1926.451(b)(13)).
Paragraph (b)(3) of the final rule, which is basically the same as
the proposed paragraph, is based on existing Sec. 1926.451(c)(11). This
provision sets requirements for the installation of longitudinal
bracing across the inner and outer rows of posts for straight run
scaffolds. In particular, such bracing must be installed diagonally in
both directions and shall extend from the base of the end posts upward
to the top of the scaffold at a 45 degree angle. Where scaffold length
is greater than height, bracing shall be repeated at least at every
fifth post. Where scaffold length is less than height, such bracing
shall be installed from the base of the end posts upward to the
opposite end posts and then in alternating directions until reaching
the top of the scaffold. In addition, bracing shall be installed as
close as possible to the intersection of the bearer and post or of the
runner and post. The proposed provision was identical, except that it
did not specify that only straight run scaffolds were covered or that
the bracing had to be installed as close as possible to a post's
intersection with bearers or runners.
The SSFI and the SIA (Exs. 2-367 and 2-368) suggested that OSHA
limit application of the proposed provision to straight run scaffolds
and that the Agency specify the proximity of bracing to the
intersection of posts with bearers or runners. The Agency believes that
limiting the provision to straight run scaffolds is appropriate, since
when a tube and coupler scaffold is installed around circular
structures or at corners, the inside leg is braced in the direction
perpendicular to the walkway (platform) because the runners come in at
less than 180 degrees. In addition, OSHA agrees that it is appropriate
to include requirements regarding where to position bracing, and the
final provision has been written accordingly. (Bracing requirements for
those tube and coupler scaffolds that are not straight run scaffolds
are found in final rule Sec. 1926.451(c).)
Paragraph (b)(4) of the final rule requires that bracing be
attached to the runners as close to the post as possible, where
conditions preclude attachment of bracing to posts. This provision is
basically the same as the proposed provision, which was based on
existing Sec. 1926.451(c)(11). OSHA has modified this provision based
on comments from the SSFI and the SIA (Exs. 2-367 and 2-368) which
suggested that ``as close to the post as possible'' be added to the end
of this paragraph. The Agency recognizes that attachment to the post,
while the most desirable option, is not always possible. In
circumstances where such attachment is not possible, OSHA has
determined that attachment to the runner, as close as possible to the
post, will still maximize directional stability and provide the
strength necessary to properly brace the scaffold.
Paragraphs (b)(5) through (b)(10) of the final rule are identical
to corresponding provisions of the proposed rule, except for some minor
editorial revision to paragraph (b)(10). As explained in the preamble
to the proposed rule (51 FR 42691), these provisions are based on
existing Secs. 1926.451 (b) and (c).
Paragraph (c) Fabricated Frame Scaffolds
Paragraph (c) of the final rule provides additional requirements
for fabricated frame scaffolds (tubular welded frame scaffolds). Two
commenters (Exs. 2-13 and 2-320) recommended that OSHA retain the
title, ``Tubular Welded Frame Scaffolds'' used in the existing rule. As
discussed above in reference to the definitions in Sec. 1926.450(b),
however, OSHA has not followed this suggestion but has retained the
existing title in parentheses after the new title. Paragraph (c) of the
final rule is virtually identical to the corresponding provision in the
proposal except as discussed below.
Paragraph (c)(1) of the final rule is a new requirement for
fabricated frame scaffolds. It requires that platforms not be moved
until the next location is properly prepared and ready to support the
platform being moved. This provision is necessary to ensure that the
scaffold is positioned on a level and stable surface, as discussed for
final rule Sec. 1926.451(b)(1), above.
Final rule paragraphs (c)(2), (c)(3) and (c)(6), which are
identical to the corresponding proposed paragraphs, are effectively
identical to existing Sec. 1926.451(d) (3), (5) and (9), respectively.
Final rule paragraph (c)(4), which is identical to the parallel
provision of the proposed rule, requires the locking together of end
frames, and is essentially the same as existing Sec. 1926.451(d)(6).
This requirement only applies where uplift forces are strong enough to
displace the end frames or panels, such as when a hoist is being used
that could snag the scaffold during a hoist operation.
Final rule paragraph (c)(5) specifies the proper placement of
platform support brackets. Improper placement of such cantilever
supports can significantly reduce their support capacity and thus
endanger employees working on top of the platform. Proposed paragraph
(c)(5) set seating requirements for brackets and required that brackets
not be bent or twisted from those positions. This provision of the
final rule is identical except that it also allows the use of bracket
systems to support loads other than employees only where the system has
been designed and built to withstand the tipping forces imposed by
those other loads.
OSHA received comments from the SSFI and the SIA (Exs. 2-367 and 2-
368) suggesting that such brackets be allowed for the support of
personnel but not for the storage or support of materials. Based on
those comments, Issue L-8 of the hearing notice solicited testimony and
supporting information regarding the revision of proposed
Sec. 1926.452(c)(5) to require that side brackets on fabricated frame
scaffolds ``* * * be used to support personnel only and shall not be
used for storage or support of materials.'' OSHA also indicated that,
in the Agency's opinion, this area would be adequately covered by
proposed Sec. 1926.451(a)(1), which sets capacity requirements, and
proposed Sec. 1926.451(d)(1), which prohibits overloading.
The SIA (Exs. 5a-16 and 10) stated that, since users may not know
the load capacities of their side brackets without consulting a loading
table, they may unintentionally overload the units. The SIA explained
that ``employees tend not to respect the dangers involved'' with side
bracket loads, which ``induce an eccentric load and overturning
propensity on the scaffold system.'' They further noted that the
``aisle'' provided by a series of side brackets is typically 20 inches
wide, which provides insufficient room for employees to step around
stored material. The SIA testimony (Tr. 3/22/88, p. 160) repeated these
concerns but added that bracket systems properly
[[Page 46082]]
designed to take loads other than workers should not be prohibited by
the final rule.
Bristol Steel (Exs. 5a-3 and 13) stated that proposed
Sec. 1926.451(a)(1) and (d)(1) would adequately address the SIA and
SSFI concerns, and therefore did not support the suggested additional
language.
After carefully considering the above-described comments, OSHA has
determined that fabricated frame scaffolds which utilize bracket
systems must be used only to support personnel, unless the scaffold has
been designed for other loads by a qualified engineer and been built to
withstand the tipping forces caused by the loads being placed on the
bracket supported section of the scaffold. The final rule reflects this
determination (paragraph (c)(5)(iii)). OSHA believes that compliance
with this requirement will provide employees working on fabricated
frame scaffolds with the protection they need while working on this
type of scaffold.
Paragraph (d) Plasterers', Decorators' and Large Area Scaffolds
(d) of the final rule requires that plasterers', decorators' and
large area scaffolds be constructed in accordance with
Sec. 1926.452(a), (b), or (c) of this section. This requirement is
identical to that in the proposed rule. Paragraph (d) references the
provisions of paragraphs (a), (b), and (c) because plasters',
decorators' and large area scaffolds are almost always constructed
using pole scaffolds, tube and coupler scaffolds, or fabricated frame
scaffolds. The existing rule, Sec. 1926.451(q)(1), required that the
scaffolds in question be built only according to the existing rules for
pole scaffolds. OSHA believes that compliance with the provisions of
Secs. 1926.452(a), (b) or (c) will provide appropriate protection for
employees covered by paragraph (d).
Paragraph (e) Bricklayers' Square Scaffolds (Squares)
Paragraph (e) provides additional requirements for bricklayers'
square scaffolds (squares). This paragraph requires that scaffolds made
of wood be reinforced with gussets on both sides of each corner
(paragraph (e)(1)); that diagonal braces be installed on all sides of
each square (paragraph (e)(2)); that diagonal braces be installed
between squares on the rear and front sides of the scaffold, and extend
from the bottom of each square to the top of the next square (paragraph
(e)(3)); and that scaffolds of this type not exceed three tiers in
height, that they be constructed and arranged so that one square rests
directly above the other, and that the upper tiers stand on a
continuous row of planks laid across the next lower tier and be nailed
down or otherwise secured to prevent displacement (paragraph (e)(4)).
These requirements are identical to those in the proposed rule.
Final rule paragraphs (e)(1), (2), and (3) contain essentially the
same requirements as existing Secs. 1926.451(n)(3) and (4), except that
the specific requirements for the size of the member are being replaced
by the capacity requirements of Sec. 1926.451(a)(1). OSHA notes that
non-mandatory Appendix A of this final rule provides examples of
component dimensions for bricklayers' square scaffolds that would be
deemed to comply with Sec. 1926.451(a)(1). Final rule paragraph (e)(4)
contains the same requirement as existing Sec. 1926.451(n)(6).
Paragraph (f) Horse Scaffolds
Paragraph (f) provides additional requirements for horse scaffolds.
This paragraph requires that horse scaffolds not be constructed or
arranged more than two tiers or 10 feet (3.0 m) in height, whichever is
less (paragraph (f)(1)); when arranged in tiers, that each horse be
placed directly over the horse in the tier below (paragraph (f)(2));
when arranged in tiers, the legs of each horse shall be nailed down or
otherwise secured to prevent displacement (paragraph (f)(3)); and that,
when arranged in tiers, each tier shall be crossbraced (paragraph
(f)(4)). These requirements, which are identical to the parallel
provisions of the proposed rule, correspond to existing
Sec. 1926.451(o)(1), (o)(4) and (o)(5), respectively.
Paragraph (g) Form Scaffolds and Carpenters' Bracket Scaffolds
Paragraph (g) of the final rule, which is effectively unchanged
since the proposal, provides additional rules for form scaffolds and
carpenters' bracket scaffolds. Under the existing standard, carpenters'
bracket scaffolds and form scaffolds are addressed separately (existing
Secs. 1926.451(m) and (x), respectively). However, OSHA has determined
that the two types are so similar that it is appropriate to address
them in a single paragraph.
Final rule paragraph (g)(1) carries forward the requirements for
attachment of a scaffold to a supporting framework or structure set by
existing Sec. 1926.451(m)(2), (x)(4)(ii), and (x)(5).
Paragraph (g)(2), in turn, maintains the existing
Sec. 1926.451(x)(6)(i) requirement that wooden bracket form scaffolds
be an integral part of the form panel. Paragraph (g)(3), like existing
Sec. 1926.451(x)(5)(i), requires that folding type metal brackets, when
extended for use, shall be either bolted or secured with a locking-type
pin.
Paragraph (h) Roof Bracket Scaffolds
Paragraph (h) of the final rule provides additional requirements
for roof bracket scaffolds. This paragraph requires that scaffold
brackets be constructed to fit the pitch of the roof and provide a
level support for the platform (paragraph (h)(1)); and that brackets be
anchored in place by nails unless it is impractical to use nails
(paragraph (h)(2)). Paragraph (h)(2) further provides that brackets
shall be held in place with first-grade manila rope of at least three-
fourth inch diameter, or a rope with equivalent strength, when nails
are not used. These provisions are essentially identical to the
corresponding proposed provisions and to existing Secs. 1926.451(u)(1)
and (u)(2), respectively.
Existing Sec. 1926.451(u)(3) requires the installation of catch
platforms below the working area of roofs more than 16 feet from the
ground and having a slope greater than 4 inches in 12 inches without a
parapet. This provision also requires that the platform extend at least
2 feet from the eaves and that employees be protected from falls by a
guardrail system unless employees are using personal fall arrest
systems. The existing provision is being replaced by the general fall
protection requirements of Sec. 1926.451(g). The final rule, like the
proposal, allows guardrails on roof bracket scaffolds to be mounted on
a catch platform or be attached to the eaves. Therefore, the Agency has
concluded that there is no need to mention catch platforms in this
provision. OSHA has determined that it is appropriate to allow
employers flexibility in choosing where to attach guardrails. The
Agency notes that a catch platform is an elevated work platform that
meets the definition of a scaffold and therefore must comply with the
pertinent provisions of this final rule.
Paragraph (i) Outrigger Scaffolds
Paragraph Sec. 1926.452(i) of the final rule provides additional
requirements for outrigger scaffolds. Except for editorial changes, as
noted below, the requirements of the final rule are identical to those
of the proposed rule. Paragraphs (i)(1) through (i)(4), which set
requirements for the proper positioning and securing of outrigger
beams, are consistent with existing Sec. 1926.451(g)(1). Some editorial
changes have been made to proposed paragraph (i)(2), as suggested by a
commenter (Ex. 2-64), in order to clarify OSHA's
[[Page 46083]]
regulatory intent that the supporting beam be used in its strongest
orientation. Paragraphs (i)(5) and (i)(6), which require that the
inboard ends of outrigger beams be securely anchored and that the
entire supporting structure be securely braced, respectively, are
effectively identical to existing Sec. 1926.451(g)(2). Proposed
paragraph (i)(5) has undergone minor editorial changes since the
proposal: the existing provisions have been broken down into their
component parts to facilitate compliance.
Final rule paragraph (i)(7), which is identical to the
corresponding requirement in the proposed rule, requires that platform
units be nailed, bolted or otherwise secured to outriggers, to prevent
displacement. The corresponding language in existing
Sec. 1926.451(g)(4) required simply that planking be secured to the
beams. OSHA believes that the revised language better expresses the
Agency's intention that employers use effective means when securing
platform units to outrigger beams.
Paragraph (i)(8) requires that scaffolds and scaffold components be
designed by a registered professional engineer and constructed and
loaded in accordance with such design. This provision has been revised
to reflect OSHA's determination that the design of this type of
scaffold involves calculations that required the skills of a registered
professional engineer, and that the criteria in the proposed rule had
such limited applicability as to be of virtually no help to employers
in almost all situations. The proposed rule was based on existing
Sec. 1926.451(g)(3).
Paragraph (j) Pump Jack Scaffolds
Paragraph 1926.452(j) of the final rule provides additional rules
for pump jack scaffolds. Paragraph (j)(1) requires that pump jack
brackets, braces, and accessories be fabricated from metal plates and
angles. In addition, each pump jack bracket shall have two positive
gripping mechanisms to prevent any failure or slippage. This provision
is identical to the proposed paragraph and to existing
Sec. 1926.451(y)(2).
Paragraph (j)(2) requires that poles be secured to the structure by
rigid triangular bracing or equivalent, at the bottom, top, and other
points as necessary. In addition, that provision further requires that
when the pump jack has to pass bracing that is already installed, an
additional brace must be installed approximately four feet (1.2 m)
above the brace to be passed. That additional brace must be left in
place until the pump jack has been moved and the original brace
reinstalled. These requirements, which are identical to the proposed
paragraph except for an editorial revision, are essentially the same as
existing Secs. 1926.451(y)(4) (iii) and (iv).
NPRM Issues 9 and 22 asked for comments about whether OSHA should
remove the requirement for bottom braces on pump jack scaffolds. One
commenter (Ex. 2-13) stated that from his experience, * * * ``no one
uses any but the top pole brace.'' Another commenter (Ex. 2-31) agreed
with this assessment, saying, in part, ``[i]n terms of common practice,
the bottom brace is virtually nonexistent. In terms of practicality,
homeowners do not permit holes made in their foundation.'' This same
commenter continued that ``[i]n terms of functions, the bottom brace
does not relieve the pole from breaking,'' and added as follows:
There exists the misconception that a pumpjack pole will shoot
out when a load is applied to it. Fact is, the greater the load, the
greater the anchorage. Our in plant testing is done with no brace
securement. This, along with my 10 years plus of field inspections,
substantiates the unreality of a bottom brace. More accidents would
be experienced from tripping over bottom braces; and eye accidents
from securement to concrete. Overwhelmingly, the bottom brace simply
does not belong. When a wooden pumpjack pole is used,
Sec. 1926.451(a)(1) can better be achieved with mid-bracing. The
location of a pumpjack on a pole is not a true fulcrum point. That
is an erroneous assumption that precedes the pole pulling away from
the wall at the bottom assumption.
NIOSH recommended (Ex. 2-40) bracing or securing the bottom of pump
scaffold columns ``in some manner at all times.'' NIOSH stated that if
``the employer chooses to brace in a different manner than suggested by
the [existing] regulations, then the method used must be shown to be
equivalent to that required by the regulations.''
Another commenter (Ex. 2-54) stated the ``bottom brace should
remain for poles, [because that part of the scaffold] is the one part
that is easiest to hit and move.'' The commenter added that the
``bottom brace seems like the one that is needed the most * * *'' After
reviewing this issue, the ACCSH also recommended that the requirement
for a bottom brace be retained (Tr. 6/9/87, pp. 95-96).
Based on its review of the comments, OSHA has determined that
employers do need to brace the bottom of the support pole to keep it in
place, but that it is not necessary to specify the use of a rigid
triangular bottom brace. Other methods, such as anchoring the pole to
the ground, would provide equivalent support. Therefore, the final rule
requires, as did the proposal, that pumpjack poles be braced at the
bottom by triangular bracing or equivalent means.
A commenter (Ex. 2-52) stated that ``[a] requirement for braces
every ten vertical feet has been eliminated. Insofar as the same
applies to wooden poles, we believe this requirement should be
maintained in the Regulations.'' OSHA is aware that existing
Sec. 1926.451(y)(4)(i) provides for 10 foot spacing of poles (
FR Doc. 96-21289 Safety Standards for Scaffolds Used in the Construction Industry
center to
center) when wood scaffold planks are used as platforms for pump jack
scaffolds. That paragraph further provides that pole spacing may exceed
10 feet center to center when fabricated platforms are used that fully
comply with all other provisions of existing paragraph (y). The Agency
proposed to delete existing paragraph (y)(4)(i) because OSHA believed
that compliance with the capacity requirements of proposed
Sec. 1926.451 (a)(1) would provide adequate assurance that a pump jack
scaffold was structurally sound and able to hold the anticipated loads.
As indicated above, the Agency believes that it is appropriate to focus
on the capacity of the scaffold, not on the exact spacing of the
braces, when evaluating the adequacy of a particular pump jack
scaffold. Accordingly, OSHA has not made the suggested change.
That commenter also stated ``The explanation for additional bracing
is confusing. We believe the phrase `on the side opposite the brace
from the pump jack' should read: `above the brace to be passed'.'' OSHA
agrees that the suggested language, which appears in existing
Sec. 1926.451(y)(4)(iv), more clearly expresses the Agency's intent,
and this is reflected in the final rule at paragraph (j)(2).
Paragraph (j)(3) provides, when guardrails are used for fall
protection, that a workbench may be used as the toprail only if the
workbench complies with the requirements of Secs. 1926.451(g)(4) (ii),
(vii), (viii) and (xiii). This provision is effectively identical both
to the proposed provision and to existing Sec. 1926.451(y)(12).
Paragraph (j)(4) provides that work benches shall not be used as
scaffold platforms. This provision, which is identical to the
corresponding provision of the proposed rule, is effectively identical
to existing Sec. 1926.451(y)(13).
Paragraph (j)(5) provides, when poles are made of wood, that the
pole lumber shall be straight-grained, free of shakes, large loose or
dead knots, and other defects which might impair strength. This
provision, which is unchanged from that in the proposed rule, is based
on existing Sec. 1926.451(y)(6). OSHA has deleted existing
specification language
[[Page 46084]]
which addressed the dimensions and type of wood to be used, because
OSHA believes that wood poles which comply with the performance
requirements of final rule Sec. 1926.451(a)(1) will provide adequate
protection for affected employees.
Paragraph (j)(6) provides, when wood poles are constructed of two
continuous lengths, that the lengths shall be joined together with the
seam parallel to the bracket. This provision, which is unchanged from
the corresponding provision of the proposed rule, is based on existing
Sec. 1926.451(y)(7). The Agency has deleted the existing specification
language, which addressed the dimensions of the wood to be used and the
means of joining, because OSHA believes, again, that compliance with
Sec. 1926.451(a)(1) will provide adequate protection for affected
employees. The Agency notes that the language in question has been
included in non-mandatory Appendix A to provide an example of how an
employer could comply with Sec. 1926.451(a).
Final rule paragraph (j)(7) requires, when two by fours are spliced
to make a pole, that mending plates be installed at all splices to
develop the full strength of the member. This provision differs from
the proposed requirement because it requires mending plates at splices.
Proposed paragraph (j)(7) required that splices be constructed to
develop the full strength of the member, but did not require mending
plates.
NPRM Issue 9 asked whether proposed paragraph (j)(7) should require
mending plates on all spliced wooden poles. One commenter (Ex. 2-13)
wanted the Agency to prohibit the splicing of wood poles used for pump
jack scaffolds. His explanation was that:
[t]here is no splice that can equal the strength of the total
pole cross section. Wood pole lengths should be limited to
commercially available lengths.
From my experience, at work sites across this nation, no one
uses any but the top pole brace. All the more reason to eliminate
splicing to gain added pole lengths.
The same commenter added ``[t]he vast majority of the accidents
involving pump jack scaffolds are caused by pole failure at a splice''.
Another commenter (Ex. 2-31) said that a mending plate addresses
the typical way a wooden pole breaks, i.e., laterally. He added that
in-house tests conducted by his firm showed that poles with the plates
are three times stronger than those without them, and went on to say
that the cost factor for plate use is negligible. The ACCSH also
recommended that mending plates be used on all splices (Tr. 6/9/87, pp.
95-96).
Based on its review of the comments and its knowledge of pumpjack
scaffolds, OSHA has determined that mending plates provide an
appropriate increase in the strength of spliced poles, and final rule
paragraph (j)(7) reflects this determination. OSHA also believes that
requiring wood poles to be made entirely of one piece of wood (i.e., no
splices) would not be realistic because many contractors use this type
of scaffold and splices with mending plates are at least as strong as
unspliced wood. Although OSHA is aware that splices are potential weak
points in a pole, the Agency finds that mending plates provide
assurance that the spliced pole has adequate strength.
Several commenters (Exs. 2-23, 2-31 and 2-52) suggested that the
final rule include the general requirements applicable to pump jack
scaffolds found in this section of OSHA's existing scaffold standard.
However, the final rule sets out general requirements for all
scaffolds, including pump jack scaffolds, in Sec. 1926.451, and OSHA
has therefore not made the suggested change.
Paragraph (k) Ladder Jack Scaffolds
Paragraph 1926.452(k) of the final rule provides additional
requirements for ladder jack scaffolds. Paragraph (k)(1) provides that
platforms shall not exceed a height of 20 feet (6.1 m). This provision,
which is identical to that in the proposed rule, is based on existing
Sec. 1926.451(s)(1) and current safe industry practice.
Paragraph (k)(2) requires that all ladders used to support ladder
jack scaffolds meet the requirements of subpart X of 29 CFR part 1926--
Stairways and Ladders, except that job-made ladders, which are
permitted by subpart X, are not permitted to be used to support ladder
jack scaffolds. This provision, which is identical to the parallel
requirement in the proposed rule, is consistent with existing
Sec. 1926.451(s)(2). The existing standard referenced two national
consensus standards which, as subsequently updated, have been
incorporated into the pertinent provisions of subpart X. In particular,
existing Sec. 1926.451(s)(2) implicitly prohibited the use of job-built
ladders.
Two commenters (Exs. 2-20 and 2-55) opposed the proposed
prohibition on the use of job-made ladders as ladder jack scaffold
support, and stated that job-made ladders constructed according to
proposed Sec. 1926.1053 (subpart X) could serve as adequate supports
for ladder jack scaffolds. However, OSHA concludes, based on the record
and the Agency's experience in the construction industry, that job-made
ladders that comply with the requirements of Sec. 1926.1053 may not be
able to support the heavy point loading imposed by ladder jack scaffold
brackets. OSHA has therefore determined that the use of a job-made
ladder to support a ladder jack scaffold could lead to scaffold
collapse, and the final rule reflects this finding. OSHA's final rule
is thus consistent on this point with the position taken by the
corresponding ANSI standard, A10.8-1988, paragraph 17.2.2, which
provides that only manufactured ladders may be used to support ladder-
type scaffolds or platforms.
Paragraph (k)(3) provides that the ladder jack be so designed and
constructed that it will bear either on the side rails and ladder rungs
or on the ladder rungs alone. This paragraph further requires that the
bearing area for a ladder jack that bears only on the rungs shall be at
least 10 inches (25.4 cm) on each rung to ensure adequate support. This
provision, which is identical to that in the proposed rule, is
effectively identical to existing Sec. 1926.451(s)(3).
Paragraph (k)(4) requires that ladders used to support ladder jacks
be placed, fastened, or equipped with devices to prevent slipping. This
provision, which is identical to that in the proposed rule, is
effectively identical to existing Sec. 1926.451(s)(4) and is intended
to prevent employee falls caused by displacement of the ladder.
Paragraph (k)(5) provides that scaffold platforms shall not be
bridged one to another. This paragraph, which is identical to the
proposed requirement, is a new requirement that is intended to ensure
the stability of the system and to prevent accidental overloading. The
provision would prohibit situations where, for example, four ladders
are used to support three platforms. OSHA is prohibiting bridging
because this practice often leads to overloading of the two ladders in
the middle. This provision does not prohibit passage from one scaffold
to another if the scaffolds are close enough for employees to walk (but
not to jump or swing) from one scaffold to the other.
Three commenters [Exs. 2-23, 2-367, and 2-368] urged OSHA to
include specific language in the final rule addressing acceptable
dimensions and loading of ladder jack scaffolds. OSHA has not made the
suggested revisions because the Agency believes that the capacity
requirements found in final rule Sec. 1926.451(a) adequately address
these matters.
Another commenter (Ex. 2-308) recommended that ladder jack
scaffolds be prohibited because they ``cannot be
[[Page 46085]]
secured at the top,'' safe access is not possible, and an anchorage for
attaching a lifeline or lanyard is not available. Although the Agency
agrees that the conditions described by this commenter may occur in
some construction situations, they are not characteristic of ladder
jack scaffolds per se. Employers using ladder jack scaffolds must still
comply with the applicable general requirements of Sec. 1926.451, such
as those addressing capacity, access and fall protection, i.e., the
three situations mentioned by the commenter. In particular, employees
working on ladder jack scaffolds must be protected from fall hazards by
personal fall arrest systems which comply with the criteria set in
subpart M, Sec. 1926.502(d) (Fall protection) (final rule
Sec. 1926.451(g)(1)(ii)). Ladder jack scaffolds which do not comply
with those requirements must not be used.
Based on the rulemaking record and the Agency's own experience,
OSHA has determined that ladder jack scaffolds used in compliance with
the requirements of the final rule provide acceptable and safe working
surfaces for employees. Accordingly, the final rule does not prohibit
the use of ladder jack scaffolds.
Paragraph (l) Window Jack Scaffolds
Paragraph (l) of the final rule provides additional requirements
for window jack scaffolds. This paragraph provides that window jack
scaffolds shall be securely attached to the window opening (paragraph
(l)(1)), shall be used only for the purpose of working at the window
opening through which the jack is placed (paragraph (l)(2)) and shall
not be used to support planks placed between one window jack and
another, or to support other elements of scaffolding. These
requirements are necessary to ensure the safety of employees working
from these platforms.
These provisions of the final rule are identical to the
corresponding proposed provisions. Paragraph (l)(1) is a new
requirement, and is intended to ensure that the scaffold is not
accidentally displaced. Final rule paragraphs (l)(2) and (l)(3) are
identical to existing Secs. 1926.451(t)(1) and (t)(2), respectively.
Paragraph (m) Crawling Boards
Paragraph (m) of the final rule provides additional requirements
for crawling boards (chicken ladders). The final rule requires that
crawling boards extend from the roof peak to the eaves when used in
connection with roof construction, repair, or maintenance (paragraph
(m)(1)), and that crawling boards be secured to the roof by ridge hooks
or by means which satisfy equivalent criteria (e.g., strength and
durability) (paragraph (m)(2)). These requirements are designed to
ensure that crawling boards used by employees performing roof work are
as secure as possible.
The provisions of the final rule, which are effectively identical
to those of the proposed paragraph, are based on requirements in
existing Secs. 1926.451(v) (1) and (3), respectively. The other
provisions of existing Sec. 1926.451(v)(1) are being relocated to non-
mandatory Appendix A since they have been replaced by the capacity
requirements of revised Sec. 1926.451(a)(1). The existing rule's
requirement to clinch nails has been deleted because the
inaccessibility of many nail points makes clinching impossible.
Existing Sec. 1926.451(v)(2) is being replaced by the fall protection
requirements of revised Sec. 1926.451(e)(1).
Paragraph (n) Step, Platform, and Trestle Ladder Scaffolds
Paragraph (n) of the final rule provides additional requirements
for step, platform, and trestle ladder scaffolds. The provisions of
final rule paragraph (n) are virtually identical to the provisions of
the proposed paragraph.
Paragraph (n)(1) provides that scaffold platforms not be placed any
higher than the second highest rung or step of the ladder supporting
the platform. This provision is consistent with paragraphs 17.4 and
17.5 of ANSI A10.8-1988, and is intended to ensure the stability of
this type of scaffold.
Paragraph (n)(2) requires that all ladders used in conjunction with
step, platform and trestle ladder scaffolds meet the requirements of
subpart X of 29 CFR part 1926--Stairways and Ladders, except that job-
made ladders must not be used to support such scaffolds. A commenter
(Ex. 2-23) suggested that ladders used in conjunction with step,
platform and trestle ladder scaffolds be required to comply with
subpart X or with the pertinent ANSI standards. The commenter also
suggested that OSHA prohibit the use of job-made ladders to support
such scaffolds. Final rule paragraph (n)(2), which is identical to the
proposed paragraph, addresses both of these concerns.
Paragraph (n)(3) provides that ladders used to support step,
platform, and trestle ladder scaffolds shall be placed, fastened, or
equipped with devices to prevent slipping. Paragraph (n)(4) requires
that scaffolds not be bridged one to another. Bridging, as discussed
above under paragraph (k)(5), occurs when four ladders are used to
support three platforms. OSHA is prohibiting bridging because this
practice often leads to overloading of the two ladders in the middle.
Although step, platform and trestle ladder scaffolds were not
specifically addressed in OSHA's existing scaffold rule, they are
covered by the general requirements in existing rule Sec. 1926.451(a).
Final rule paragraphs (n) (2), (3), and (4) correspond to the
ladder jack scaffold provisions in final rule Sec. 1926.451(k) (2), (4)
and (5), respectively. The ``ladder-type'' scaffolds covered by
paragraph (n) differ from ladder jack scaffolds in that the platform
rests directly on the ladder step or rung, whereas ladder jack scaffold
platforms rest on brackets.
Paragraph (o) Single-point Adjustable Scaffolds
Paragraph (o) provides additional requirements for single-point
adjustable scaffolds. This paragraph combines existing
Sec. 1926.451(k), single-point adjustable suspension scaffolds, and
Sec. 1926.451(l), boatswains' chairs, because boatswains' chairs are a
form of single-point adjustable suspension scaffold. One commenter (Ex.
2-23) opposed the combining of these paragraphs from the existing rule
because they [boatswains' chairs and other single-point adjustable
scaffolds] ``have different requirements because of the different
positions in which the rider rides.'' OSHA has determined, however,
that the characteristics of single-point adjustable suspension
scaffolds and boatswains' chairs are sufficiently similar so that the
requirements of final rule paragraph (o), along with the general
requirements in Sec. 1926.451, appropriately address both types of
scaffolds.
Paragraph (o)(1) provides, when two single-point adjustable
suspension scaffolds are combined to form a two-point adjustable
suspension scaffold, that the resulting scaffold meet the requirements
for two-point adjustable suspension scaffolds in final rule paragraph
(p). This provision, which is identical to the proposed paragraph, is
based on existing Sec. 1926.451(k)(6).
Paragraph (o)(2) addresses the circumstances under which the
supporting rope between a scaffold and a suspension device is permitted
to deviate from a vertical position (i.e., at a 90 degree angle from
level grade). This paragraph requires that the supporting rope between
the scaffold and the suspension device be kept vertical unless the
following four conditions are met: the rigging must have been designed
by a qualified person; the scaffold must be accessible to rescuers;
[[Page 46086]]
the supporting rope must be protected to ensure that it will not chafe
at any point where a change in direction occurs; and the scaffold must
not be able to sway into another surface. Whenever swaying of the
scaffold could bring the scaffold into contact with another surface,
the supporting rope must be vertical, with no exceptions.
Proposed paragraph 1926.452(o)(2) required that supporting ropes be
vertical and be kept from swaying, except where the scaffold is on the
outside of a dome-like or slanted structure and the appropriate
supports have been designed and installed. NPRM Issue 10 noted that
existing Sec. 1926.451(k)(7) requires the support rope for single-point
adjustable suspension scaffolds to be vertical. OSHA asked if the
exception provided by proposed paragraph (o)(2) was appropriate. The
Agency further requested suggestions regarding a maximum permissible
angle and any other conditions that needed to be specified.
The AGC (Exs. 2-20, 2-55, and 2-390) stated that ``[a]ngles that
are too severe would impair work operation and thus preclude the use of
suspensions.'' Another commenter (Ex. 2-69) echoed that view, and added
that ``[f]lexibility is needed for certain operations when using
suspended scaffolds.'' A manufacturer (Ex. 2-43) mentioned skylight and
barrel-vault work as examples of situations which preclude the use of
vertical lines. The commenter also stated ``* * * when suspended, the
worker must be accessible to rescuers. One can envision a worker
dangling in space below a dome with no way to get to him.''
Another commenter (Ex. 2-64) stated ``[t]he supporting rope for
single-point adjustable suspension scaffolds should be allowed to
deviate from vertical without defining any maximum limits. Each
situation under these conditions is a special case and has its own
limiting circumstances. It would not be feasible to establish standard
limits for all possible special situations.'' (emphasis in original)
Another commenter (Ex. 2-22) stated that deviation from vertical
should be permitted. The commenter further stated ``[t]he same
practical field problems arise in the case of a curved surface of any
type as does in the case of the dome-type or slanted structure. There
is no safety difference in the three special situations and they
require an exception because of their unique character.''
One commenter (Ex. 2-13) stated as follows:
There never was a reason for the suspension rope for a single
point suspension scaffold to be vertical. In fact, most are used
with the rope other than vertical. The same applies for two point
suspension scaffolds. There is no maximum or minimum angle of
deviation from the vertical. The load reaction to the rope does not
change; but the rope(s) must be protected from sharp edges at the
change in direction.
In addition, the SSFI and the SIA (Exs. 2-367 and 2-368) addressed
this issue in their comments on proposed 1926.452(o)(2). They
recommended that, when a scaffold is on the outside of a dome-type,
slanted or set-in structure, the use of intermediate supports to change
the direction of the rope from the vertical be allowed provided that
such supports have been designed by a competent person and have been
installed in a manner that prevents chafing of the rope.
The SIA (Ex. 2-368) commented that ``[m]any work operations require
non-vertical lines due to set-backs, curved surfaces, areas under
soffits, following a bowser line, spherical water tanks, etc.'' In
addition, the SSFI responded to Issue 10 as follows ``[t]he SSFI agrees
that some deviation from vertical support should be allowed. Cases in
which this would occur are special in nature and should only be allowed
when designed by a competent person.''
The ACCSH (Tr. 96-97, 6-9-87) recommended that deviation from
vertical should be allowed only under the supervision of a ``qualified
person.'' A member of the ACCSH stated that the qualified person would
be ``a competent design engineer that has experience in this
discipline.''
OSHA agrees that there are circumstances where the support lines of
single-point adjustable suspension scaffolds need to deviate from
vertical, and that under controlled circumstances, the swaying of
support lines should be allowed. The Agency concludes that the
requirements for design by a qualified person, accessibility to
rescuers, protection of supporting rope from chafing, and prohibition
of swaying where the scaffold could contact another surface are
appropriate measures, and final rule paragraph (o)(2) reflects this
determination.
Paragraph (o)(3) requires that the tackle used with boatswains'
chairs be ball bearing or bushed blocks containing safety hooks and
properly ``eye'' spliced minimum five-eight (\5/8\) inch (1.6 cm)
diameter first grade manila rope, or other rope that meets the
performance criteria of the above-specified manila rope. The proposed
provision, based on existing Sec. 1926.451(l)(5), was effectively
identical, except that it did not specifically address the hook used to
suspend the boatswains' chair. OSHA recognizes that the use of an open
hook could allow a chair to be dislodged if the rigging hung up on an
obstruction. The corresponding ANSI standard, A10.8-1988, paragraph
6.14.5, provides for the use of a hook with a safety latch over the
opening (safety hook) to prevent dislodging of the chair. The Agency
agrees that it is appropriate to explicitly require that employers who
have their employees use boatswains' chair rig their scaffolds with
safety hooks and has revised the proposed rule accordingly. In
addition, OSHA believes that locking safety hooks, such as are required
for use with crane and derrick suspended personnel platforms
(Sec. 1926.550(g)(4)(iv)(B)), would provide the most effective
protection for affected employees. A minor editorial revision to the
proposed paragraph replaces the phrase ``or equivalent'' with language
which states clearly that any rope used in lieu of \5/8\ inch diameter
first grade manila rope must, at least, satisfy the final rule's
criteria (e.g., strength and durability) for manila rope.
Paragraph (o)(4) provides that boatswains' chair seat slings be
reeved through four corner holes in the seat; shall cross each other on
the underside of the seat; and shall be rigged so as to prevent
slippage which could cause an out-of-level condition. This paragraph,
which is identical to the proposed provision and is based on existing
Sec. 1926.451(l)(2), is intended to prevent tipping of the chair.
Paragraph (o)(5) requires, except as provided in paragraph (o)(6),
that boatswains' chair seat slings be a minimum of five-eight (\5/8\)
inch (1.6 cm) diameter fiber or synthetic rope or other rope which
satisfies equivalent performance criteria. This provision, which is
substantively identical to the proposed provision, is based on existing
Sec. 1926.451(l)(2). A minor editorial revision to the proposed
paragraph replaces the phrase ``or equivalent'' with language which
states clearly that any rope used in lieu of \5/8\ inch diameter fiber
or synthetic rope must, at least, satisfy the final rule's criteria
(e.g., strength, slip resistance, and durability) for fiber or
synthetic rope. In addition, the final rule has deleted the proposed
language ``when employees are not using a heat-producing process such
as gas or arc welding'' as being unnecessary since final rule paragraph
(o)(6) specifically addresses the issue of rope use when heat producing
processes are in operation.
Paragraph (o)(6) requires that boatswains' chair seat slings be a
[[Page 46087]]
minimum of three-eight (\3/8\) inch (1.0 cm) wire rope, when a heat-
producing process such as gas or arc welding is being conducted. This
provision, which is substantively identical to the proposed provision
and is based on existing Sec. 1926.451(l)(3), is necessary to ensure
that the chair's sling is made of fire-resistant materials.
Paragraph (o)(7) requires that non-cross-laminated wood
boatswains's chairs be reinforced on their underside by cleats securely
fastened to prevent the board from splitting. This provision is
identical to the proposed provision. Existing Sec. 1926.451(l)(1)
requires all boatswains' chairs to be cleated. As noted in the preamble
to the proposed rule (51 FR 42694), this paragraph recognizes that
plywood-type wood seats which comply with Sec. 1926.451(a)(1) are
strong enough to use as boatswains' chairs without being reinforced
with cleats.
Paragraph (p) Two-point Adjustable Suspension Scaffolds (Swing Stages)
Paragraph (p) provides additional requirements for two-point
adjustable suspension scaffolds (swing stages). The introduction to
this paragraph states that paragraph (q) addresses stonesetters' multi-
point adjustable suspension scaffolds, masons' multi-point adjustable
suspension scaffolds or other multi-point suspension scaffolds.
Paragraph (p)(1) provides that platforms not be more than 36 inches
(0.9 m) wide unless designed by a qualified person to prevent unstable
conditions. This provision, which is identical to proposed paragraph
(p)(1), is essentially the same as existing Sec. 1926.451(i)(1), which
limits platform width to 36 inches.
A commenter (Ex. 2-23) recommended that such platforms ``* * * not
be less than 20 inches nor more than 36 (0.9 m) inches wide unless
designed by a registered civil or mechanical engineer to prevent
unstable conditions.'' OSHA has not adopted the commenter's
recommendation for a 20-inch minimum width, because the Agency
considers the 18-inch minimum platform width set in final rule
Sec. 1926.451(b)(2) to be adequate. In addition, OSHA has not adopted a
requirement for a platform wider than 36 inches to be designed by a
registered engineer, because the Agency believes that a person who is
``qualified'' as defined in both Sec. 1926.450(b) and Sec. 1926.32(m)
will have the skills and expertise needed to design such a platform.
Paragraph (p)(2) requires that the platform be securely fastened to
hangers (stirrups) by U-bolts or other means which satisfy
Sec. 1926.451(a). This provision is based on existing
Sec. 1926.451(i)(1). Proposed paragraph (p)(2) has been editorially
revised to replace the term ``equivalent means'' with language which
indicates clearly that ``other'' means of fastening the platform to
hangers must satisfy the criteria of Sec. 1926.451(a).
Paragraph (p)(3) provides that the blocks for fiber or synthetic
ropes consist of at least one double and one single block, and that the
sheaves of all blocks fit the size of the rope used. This provision,
which is identical to the proposed provision and is based on existing
Sec. 1926.451(i)(6), is intended to ensure that these types of rope are
maintained under proper tension and do not slip out of their sheaves.
Paragraph (p)(4) requires that platforms be of the ladder-type,
plank-type, beam-type, or light-metal type. Light metal-type platforms
having a rated capacity of 750 pounds or less and platforms 40 feet
(12.2 m) or less in length shall be tested and listed by a nationally-
recognized testing laboratory. This provision is based on existing
Sec. 1926.451(i)(10). Proposed paragraph (p)(4) was similar to this
provision of the final rule, except that the final rule excludes
platforms rated over 750 pounds or platforms longer than 40 feet. This
revision has been made based on a comment (Ex. 2-539) which stated:
Underwriters' Laboratories has issued a standard for safety
called UL 1322 covering fabricated scaffold stages. This standard
covers stage platforms with loads up to 750 pounds and lengths up to
40 feet. They do not have standards covering heavier loads or longer
lengths. It is not practical to have a requirement for UL testing
and approval on products that UL arbitrarily refuses to test or
approve.
The Agency notes that the 1994 edition of UL 1322 has the same limits
cited by the commenter, and agrees with the commenter that it is not
realistic to require testing and approval of a product that nationally-
recognized testing laboratories do not test or approve.
Proposed paragraph (p)(5) provided that two-point suspension
scaffolds be securely lashed to the building or structure to prevent
them from swaying. The paragraph further required that window cleaners'
anchors not be used for this purpose. The requirement now appears in
final rule Sec. 1926.451(d)(18) and is applicable to all multi-point
suspended scaffolds. The provision is based on existing
Sec. 1926.451(i)(9).
Final paragraph (p)(5), proposed as paragraph (p)(6), requires that
two-point scaffolds not be bridged or otherwise connected one to
another during raising and lowering operations unless the bridge
connections are articulated and the hoists properly sized. This
paragraph is similar to the proposed paragraph, except for editorial
revisions made for clarity. No comments were received on this
provision.
OSHA notes that paragraph (p)(5) is not intended to prohibit
passage from one scaffold to another, but to prevent significant
overloading of the hoist nearest the bridging device during operation
of the hoist, or displacement of the bridge if the hoist is used to
raise or lower one of the scaffolds. Many hoists are only sized to
support one end of a two-point system. If one of two bridged scaffolds
were to be raised by a hoist, a bridge laid between the scaffolds could
be displaced unless the bridge is articulated (connected). This could
also significantly increase the load on the hoist if it is not properly
sized. The final rule addresses these two hazards by requiring bridge
connections to be articulated and requiring that hoists be properly
sized. These requirements thus allow for properly engineered solutions.
Final rule paragraph (p)(6), identical to proposed paragraph
(p)(7), is a new requirement. It allows passage from one platform to
another only when the platforms are at the same height, when the
platforms abut each other, and when walk-through stirrups specifically
designed for this purpose are used.
Paragraph (q) Multi-point Suspension Scaffolds, Stonesetters' Multi-
point Adjustable Suspension Scaffolds, and Masons' Multi-point
Adjustable Suspension Scaffolds
Paragraph 1926.452(q) of the final rule provides additional
requirements for multi-point suspension scaffolds, stonesetters' multi-
point adjustable suspension scaffolds, and masons' multi-point
adjustable suspension scaffolds. This paragraph combines and clarifies
the provisions of existing Sec. 1926.451(h), stonesetters' adjustable
multi-point suspension scaffolds, and existing Sec. 1926.451(j),
masons' adjustable multi-point suspension scaffolds, and indicates
clearly that paragraph (q) applies to other multi-point adjustable
suspension scaffolds as well.
Paragraph (q)(1) provides that, when two or more scaffolds are
used, they shall not be bridged one to another unless they are designed
to be bridged, the bridge connections are articulated (connected), and
the hoists are properly sized. This paragraph of the final rule, which
is identical to proposed paragraph (q)(1), is based on the same
concerns about displacement of the
[[Page 46088]]
bridge and hoist overloading that resulted in final rule
Sec. 1926.452(p)(5).
Paragraph (q)(2) provides that, if bridges are not used, passage
may be made from one platform to another only when the platforms are at
the same height and are abutting. This provision, which is essentially
identical to that in the proposed rule, is based on the same concerns
that resulted in final rule Sec. 1926.452(p)(6). OSHA has editorially
revised proposed paragraph (q)(2) to delete the word ``closely''
because that word is redundant with the word ``abutting.''
Paragraph (q)(3) requires that scaffolds be suspended from metal
outriggers, brackets, wire rope slings, hooks, or equivalent means.
This provision, which is essentially identical to the corresponding
requirement in the proposed rule, is virtually the same as existing
Sec. 1926.451(j)(4), which addresses stonesetters' adjustable multi-
point suspension scaffolds. OSHA has deleted the word ``iron'' from the
proposed language, based on comments from the SSFI and the SIA (Exs. 2-
367 and 2-368) stating that it is appropriate to have brackets or hooks
fabricated from material other than iron. OSHA agrees with this point
and concludes that employees on these scaffolds will be adequately
protected by brackets or hooks made of other materials, as long as
those components satisfy the strength criteria set in final rule
Sec. 1926.451(a)(1). The final rule reflects this conclusion.
Paragraph (r) Catenary Scaffolds
Paragraph 1926.452(r) of the final rule provides additional
requirements for catenary scaffolds. In OSHA's existing scaffold
standard, catenary scaffolds were addressed only by the general
provisions applicable to all scaffolds. The new provisions in paragraph
(r) thus address specific concerns not directly addressed by the
existing standard. These provisions are identical to proposed
Sec. 1926.452(r).
Paragraph (r)(1) allows no more than one platform to be placed
between consecutive vertical pickups, and no more than two platforms to
be used on a catenary scaffold. These requirements are intended to
prevent overloading of this type of scaffold. This paragraph is
consistent with the corresponding provision of ANSI A10.8-1988,
paragraph 20.4.
Paragraph (r)(2) requires that platforms supported by wire ropes
have hook-shaped stops on each end of the platforms to prevent the
platforms from slipping off the wire ropes. These hooks shall be so
placed that they will prevent the platforms from falling if one of the
horizontal wire ropes breaks. This language is consistent with the
corresponding provision of ANSI A10.8-1988, paragraph 20.1.
Paragraph (r)(3) of the final rule provides that wire ropes shall
not be tightened to the extent that the application of a scaffold load
will overstress them. This provision is consistent with the
corresponding language of ANSI A10.8-1988, paragraph 20.2.
Paragraph (r)(4) requires that wire ropes be continuous and without
splices between anchors. This language is consistent with the
corresponding language in ANSI A10.8-1988, paragraph 20.2, and is
necessary to ensure that the rope has sufficient integrity to handle
the load.
Paragraph (s) Float (Ship) Scaffolds
Paragraph (s) provides additional requirements for float (ship)
scaffolds. These provisions are identical to those in proposed
Sec. 1926.452(s), which were based on existing Sec. 1926.451(w) (3) and
(5).
Paragraph (s)(1) requires that the platform be supported by a
minimum of two bearers, each of which shall project a minimum of six
inches (15.2 cm) beyond the platform on both sides. This will ensure
that the platform will be fully supported. In addition, each bearer
shall be securely fastened to the platform to prevent slippage.
Paragraph (s)(2) provides that rope connections shall be such that
the platform cannot shift or slip. Platform slippage is a significant
factor in scaffold accidents.
Paragraph (s)(3) provides that, when only two ropes are used with
each float, those ropes shall be arranged so as to provide four ends
which are securely fastened to overhead supports, and each supporting
rope shall be hitched around one end of the bearer and pass under the
platform to the other end of the bearer where it is hitched again,
leaving sufficient rope at each end for the supporting ties. This
requirement is necessary to ensure that the supporting ropes are
properly attached to both the platform and to the overhead support to
prevent the scaffold from falling. These requirements are designed to
ensure safe use of these commonly used job-built scaffolds.
Paragraph (t) Interior Hung Scaffolds
Paragraph (t) provides additional requirements for interior hung
scaffolds. These provisions are identical to those of the proposed
paragraph. Paragraph (t)(1) requires that scaffolds be suspended only
from the roof structure or other structural members such as ceiling
beams. This requirement is necessary to ensure that these suspended
scaffolds are supported by structural members with adequate capacity
for safe use. This is the same requirement as existing
Sec. 1926.451(r)(1).
Paragraph (t)(2), which is a new provision, requires that the
supporting members be inspected and checked for strength before the
scaffold is erected. This requirement is necessary because such points
of support cannot be assumed to be strong enough to support a scaffold
since they may already be loaded to their capacity or they may have
deteriorated over time. This provision is consistent with ANSI A10.8-
1988, paragraph 16.7.
Paragraph (t)(3) provides that suspension ropes and cables be
connected to the overhead supporting members by shackles, clips,
thimbles, or by other means which provide equivalent strength, security
and durability. This paragraph of the final rule (identical to the
proposed paragraph) deletes the specific connection requirements of
existing Sec. 1926.451(r)(2), which OSHA determined were obsolete, and
specifies criteria that OSHA has found to be current safe practice. The
strength requirement of existing Sec. 1926.451(r)(2) is now covered by
final rule paragraph Sec. 1926.451(a)(3), which specifies strength
criteria for suspension ropes on all types of scaffolds.
Paragraph (u) Needle Beam Scaffolds
Paragraph (u) of the final rule provides additional requirements
for needle beam scaffolds. These provisions are identical to proposed
paragraph 1926.452(u) except for minor editorial revisions. Paragraph
(u)(1) requires that scaffold support beams be installed on edge. This
provision is based on existing Sec. 1926.451(p)(1), and is necessary to
ensure that support beams are installed in a way that maximizes their
strength.
Paragraph (u)(2) provides that ropes or hangers be used for
supports, except that one end of a needle beam scaffold may be
supported by a permanent structural member. This provision is based on
existing Secs. 1926.451(p)(2) and (8), and is necessary to ensure that
these scaffolds are properly supported by rope or hangers that meet the
strength criteria of Sec. 1926.451(a).
Paragraph (u)(3) requires that the ropes be securely attached to
the needle beams. This is a change from existing Sec. 1926.451(p)(3),
which specified that all rope attachments must be either a scaffold
hitch or properly made eye splices. OSHA determined that the existing
rule is too restrictive, because other knots and means of attachment,
such as wire rope clips, can adequately
[[Page 46089]]
support the scaffold without decreasing employee safety.
Paragraph (u)(4) provides that the support connection be arranged
so as to prevent the needle beam from rolling or becoming displaced,
which could result in tipping of the platform. This provision is based
on existing Sec. 1926.451(p)(4).
Paragraph (u)(5) provides that platform units shall be securely
attached to the needle beams by bolts or equivalent means. In addition,
cleats and overhang are not considered to be adequate means of
attachment. Final rule paragraph (u)(5) clarifies the requirements of
existing Sec. 1926.451(p)(6), which only required that planks be
secured against slipping. Also, under the existing rule, cleats and
overhang could be used to secure the units. As stated in the preamble
to the NPRM (51 FR 42695), OSHA has concluded that cleats or overhang
do not adequately secure platform units to needle beam scaffolds,
because needle beam scaffolds have a tendency to twist, and cleats and
overhangs used to secure platforms will not provide sufficient means of
holding the platforms. This could result in platforms coming loose and
falling.
Paragraph (v) Multi-level Suspended Scaffolds
Paragraph 1926.452(v) of the final rule provides additional
requirements for multi-level suspended scaffolds. These scaffolds are
suspended scaffolds with more than one working level. The provisions of
paragraph (v) are identical to those in the proposed paragraph, except
for minor editorial changes. Although these types of scaffolds are not
specifically addressed in the existing standard, they are covered by
the general requirements in existing Sec. 1926.451. The new provisions
address concerns not covered by the existing standard or by final rule
Sec. 1926.451.
Paragraph (v)(1) requires that multi-level suspended platform
scaffolds be equipped with additional independent support lines, equal
in number to the number of points supported and of equivalent strength
to the suspension ropes, and be rigged to support the scaffold in the
event the suspension rope(s) fail. These additional lines would support
the scaffold, and prevent collapse in the event of primary support line
failure.
Paragraph (v)(2) provides that the independent support lines and
suspension ropes shall not be attached to the same points of anchorage.
This provision reflects OSHA concern that the independent support lines
would not protect workers from scaffold collapse if the independent
lines and the suspension ropes were attached to the same anchorage
point when the anchorage failed.
Paragraph (v)(3) requires that supports for platforms be attached
directly to the support stirrup and not to any other platform. This
provision is intended to protect against platform overloading.
Paragraph (w) Mobile Scaffolds
Paragraph (w) provides additional rules for mobile scaffolds. This
paragraph consolidates and clarifies the provisions of existing
Sec. 1926.451(e) and existing Sec. 1926.453. This paragraph applies to
all mobile scaffolds, not just to those which are manually propelled.
This paragraph of the final rule is effectively identical to that in
the proposed rule, except as discussed below.
Paragraph (w)(1) provides that scaffolds shall be braced by cross,
horizontal, or diagonal braces, or combination thereof, to prevent
racking or collapse of the scaffold and to secure vertical members
together laterally so as to automatically square and align the vertical
members. In addition, scaffolds shall be plumb, level, and squared. All
brace connections shall be secured. This paragraph also provides that
scaffolds constructed of tube and coupler components shall conform to
the requirements of Sec. 1926.452(b) (paragraph (w)(1)(i)), and that
scaffolds constructed of fabricated frame components shall conform to
the requirements of Sec. 1926.452(c) (paragraph (w)(1)(ii)). The
provisions of paragraph (w)(1) are substantively identical to the
corresponding provisions in existing Secs. 1926.451(e)(3) and (e)(9).
Paragraph (w)(2) requires that scaffold casters and wheels be
locked with positive wheel and/or wheel and swivel locks, or equivalent
means, to prevent movement of the scaffold while the scaffold is used
in a stationary manner. This provision is effectively identical to
existing Sec. 1926.451(e)(8).
Paragraph (w)(3) provides that manual force used to move the
scaffold shall be applied as close to the base as practicable, but not
more than five feet (1.5 m) above the supporting surface. This
paragraph is essentially the same as existing Sec. 1926.451(e)(6),
which required that propelling forces be applied as close to the base
as possible. However, the final rule limits the height at which the
force can be applied to 5 feet above the supporting surface, to
minimize overturning forces. One commenter (Ex. 2-23) recommended that
scaffolds not be moved manually unless the propelling force is applied
to the wheels only. Although such a requirement may be appropriate for
powered scaffolds, the Agency sees no rationale for applying this
provision to scaffolds being moved manually. OSHA has not adopted the
suggested change because compliance would be unwieldy and would expose
employees to hazards from the rolling wheels.
The proposed language has been modified in the final rule to
indicate clearly that final paragraph (w)(3) applies only when mobile
scaffolds are being moved manually. This provision is consistent with
ANSI A10.8-1988, paragraph 11.3.1.
Paragraph (w)(4), which is a new provision, requires that power
systems used to propel mobile scaffolds be designed for such use. In
addition, forklifts, trucks, similar motor vehicles, or add-on motors
shall not be used to propel scaffolds unless the scaffold is designed
for such propulsion systems.
Paragraph (w)(5) requires that scaffolds be stabilized to prevent
tipping during movement. This provision is effectively identical to the
corresponding provision in existing Sec. 1926.451(e)(6).
Paragraph (w)(6) provides that employees shall not be allowed to
ride on scaffolds unless the following conditions exist:
1. The surface on which the scaffold is being moved shall be
within three degrees of level, and free of pits, holes, and
obstructions (paragraph (w)(6)(i));
2. The height-to-base width ratio of the scaffold during
movement shall be two to one or less, unless the scaffold is
designed and constructed to meet or exceed nationally-recognized
stability test requirements (paragraph (w)(6)(ii));
3. Outrigger frames, when used, shall be installed on both sides
of the scaffold (paragraph (w)(6)(iii));
4. When power systems are used, the propelling force shall be
applied directly to the wheels, and shall not produce a speed in
excess of one foot per second (0.3 mps) (paragraph (w)(6)(iv)); and
5. No employee is on any part of the scaffold which extends
outward beyond the wheels, casters, or other supports (paragraph
(w)(6)(v)).
These provisions are based in part on the provisions of existing
Sec. 1926.451(e)(7).
Proposed paragraph (w)(6)(ii) set the maximum height-to-base width
ratio at two to one or less. OSHA has revised the proposed provision to
allow a higher ratio when the scaffold is designed and constructed in
accordance with nationally-recognized stability test requirements. This
change is discussed in relation to Issue 4, below.
Proposed paragraph (x)(6)(iv) required that the propelling force be
applied
[[Page 46090]]
directly to the wheels (not to the frame) when power systems are used
to propel scaffolds, and limited the speed of the scaffold to 2 feet
per second. The proposed provision was intended to protect against a
scaffold toppling over should it strike an object.
One commenter (Ex. 2-423) stated as follows:
In our initial testing we tested several speeds including 2'/Sec
and found these to be far too fast for an operator to drive through
narrow areas and through debris that would be encountered on a
construction site. With all the units sold by our company, I have
never had anyone say the Motorized Scaffold (r) was too slow. I
cannot speak for other means of propelling scaffold but we would not
allow our Motorized Scaffold (r) to drive faster than one foot per
second.
OSHA agrees that allowing motor-propelled scaffolds to drive faster
than one foot per second could create problems for operators and has
revised the rule accordingly.
Issue 4 raised a question regarding existing
Sec. 1926.451(e)(7)(ii), which required manually propelled mobile
scaffolds to be not more than twice as high as they are wide when
employees ride on them. The proposed rule, Sec. 1926.452(w), extended
this requirement to cover both manually propelled and motor-propelled
mobile scaffolds. OSHA asked whether the final rule should raise the
current ratio, 2:1, to 3:1 or higher on those systems which are built
with a lower center of gravity, and, if so, what would be appropriate
limitations.
The ACCSH discussed Issue 4 at length (Tr. 48-61, June 9, 1987).
Several members expressed concern about employees riding mobile
scaffolds while the scaffolds were being moved, regardless of the
height-to-base ratio mandated. As OSHA explained to the Committee,
scaffold equipment manufacturers had informed the Agency that a motor
propelled mobile scaffold which exceeded the existing and proposed 2:1
ratio would be safe for use because the attachment of motor units would
lower the center of gravity, thereby increasing the scaffold's
stability (Tr. 52-53). Members of the Advisory Committee questioned the
extent to which the weight of the motor unit would provide sufficient
stability, citing concerns about the manner in which employers would
calculate the height-to-base ratio using the weight of the motor unit
and the extent to which wind or overhead power lines would pose
hazards. Ultimately, the ACCSH voted to recommend simply that OSHA
prohibit riding on mobile scaffolds (Tr. 61).
One commenter (Ex. 2-53) stated that the ``existing rule on
manually propelled mobile scaffolds'' should not be extended to motor-
propelled mobile scaffolds but did not explain why. The AGC commented
(Exs. 2-20, 2-55, and 2-390) that ``[i]n maintaining a performance-
oriented standard, OSHA should provide for manufacturer's
recommendations when movement of a rolling scaffold is required.''
These three comments further stated that OSHA should allow the use of
those mobile scaffolds that have a lower center of gravity and thus
have the capability ``of being moved at a higher ratio.'' Another
participant (Ex. 2-69) commented that ``[W]hen movement of a rolling
scaffold is required, OSHA should provide for use of manufacturers'
recommendations in keeping with a performance-oriented approach.''
One commenter (Ex. 2-70) stated that 3:1 ratio would be acceptable
if the scaffold had a low center of gravity. Another commenter (Ex. 2-
516) added a number of details and factors involved in calculating or
arriving at a safe ``gross ratio'' for mobile scaffolds, and indicated
that ``higher ratios may be permitted in specific instances when
operated under constant and continuous supervision, and when designed
by qualified engineers.'' In particular, the commenter explained that
the 2:1 ratio ``is a minimum standard, established for uniformity,
simplicity, and safety. Higher ratios can easily be achieved in given
instances, but allowing those ratios to be in general use is unwise''
(emphasis in the original). To illustrate the rationale behind this
assertion, the commenter stated, in part, that:
There is a moment in each vertical rolling scaffold leg due to
caster offset. This moment is increased when the wheel is stopped by
a stone or curb, because the tower inertia then acts on the caster
support as a force acting from the center of gravity of the tower,
to the wheel.
The force from the `pushing' and the inertia change depends on
the weight of the scaffold, its velocity, how fast it stops, and how
hard it is being pushed or driven. The moment felt at the scaffold
leg depends on the force, the height of the center of gravity, the
flatness of the rolling surface, whether only one wheel carries the
load, and where on the scaffold it is being pushed.
The height of the center of gravity depends on how much load is
put on top of the scaffold, and the height of the scaffold.
[emphasis in original]
Another commenter (Ex. 2-50) stated that an extension of the ratio
for some scaffolds should not be limited to 3:1. As an example, the
commenter explained that ``some motorized scaffolding, and batteries,
hydraulics, and motors mounted low on the frame are capable of reaching
20-30 feet high with their bases only 6 feet wide.'' The commenter, a
representative from a building contractor's association, added that
``the manufacturers test the machines extensively for upset.''
One commenter (Ex. 2-15) stated ``[e]ven the 2:1 is too permissive
for small, light towers which are usually the most top[-]heavy,
especially with a man on top. This provision is not enforceable. [It
would be] better to forbid riding at all.'' Another commenter (Ex. 2-
29) commented that ``[i]ncreasing the height-to-base ratio of mobile
scaffolds ridden by employees would expose employees to an unacceptable
fall hazard.'' In addition, a commenter (Ex. 2-54) stated that ``2 to 1
is a good ratio, as there is less chance of tipping over and a better
chance for worker[s] to jump off [the] scaffold, and not get hurt, if
[the] scaffold began to tip.'' The SSFI (Ex. 2-367) recommended that
``under no circumstances should the 2:1 height-to-width ratio be raised
to 3:1 for systems built with a `lower center of gravity.' Tipping of
rolling towers is one of the primary causes of accidents and no changes
should be made.''
The SSFI further stated that they have ``always and will continue
to recommend prohibiting riding rolling scaffolds.'' The commenter
noted that ``riding of motor[-]propelled scaffolds is especially
hazardous as the scaffold is normally not designed for such loads.
Motors should not be added to scaffold towers unless the towers are
specially designed to accommodate those forces.'' Another commenter
(Ex. 2-476), also holding the view that riding rolling scaffolds should
not be allowed, recommended that:
Motorized means should not be attached to frame scaffold towers
to promote riding. The 2 to 1 base-to-height ratio, which allows
riding, is not being used by workers riding rolling towers, and
workers are riding rolling towers with any base-to-height ratio. The
scaffold frame rolling towers were not designed to be ridden, and
were not designed for special add-on motors for propulsion.
Another commenter (Ex. 2-13) stated ``[m]obile scaffolds should
never be moved when occupied. The only time they are involved in
accidents is when they are moved while occupied. To allow any but
specifically designed scaffolds to be moved while occupied is totally
unacceptable.''
The SIA (Ex. 2-368) indicated that:
[M]any of our members advocate prohibiting riding of mobile
scaffolds at any time. Others oppose such drastic action, since this
would place undue hardship on those trades which perform a high
percentage of their work on mobile scaffolds. The
[[Page 46091]]
alternative is to develop provisions for their safe use* * * Motors
should not be added to scaffold towers unless the towers are
specifically designed to accommodate the increased forces exerted on
the legs of the scaffold frames.
The SIA (Ex. 2-368) also stated that statistics they had developed over
the past 10 years ``indicate a high incidence of accidents on rolling
scaffolds,'' and that ``[i]t is our position that any raising of the
2:1 ratio would result in increased accidents.''
A commenter (Ex. 2-476) stated that scaffold frames are not
designed for the forces imposed on them by motors that are added on for
propulsion. OSHA agrees with the commenters who raised concerns about
the ability of scaffold frames to accommodate motors and has modified
proposed Sec. 1926.452(x)(6) accordingly.
OSHA agrees with the commenters who indicated that the riding of
some mobile scaffolds can be hazardous. However, OSHA believes that the
rulemaking record supports modification of the current regulations to
allow greater use of mobile scaffolds for this purpose, provided
additional appropriate precautions are taken.
The key concern in specifying the existing 2:1 ratio is stability
of the scaffold. OSHA believes, based on the evidence submitted, that
the existing 2:1 ratio is still the appropriate limit for all manually-
propelled mobile scaffolds and has promulgated final rule paragraph
(w)(6)(ii) accordingly.
OSHA also believes that, given appropriate engineering design,
there are higher ratios which can be used safely on some power-
propelled mobile scaffolds. As recommended by one commenter (Ex. 2-
423), such designs must be proven to be safe, however, by subjecting
the scaffold to stability tests such as the nationally recognized ANSI
A92 tests used by the manufacturers of elevating and rotating work
platforms. Where such tests have not been made, employees are not
allowed to ride the scaffold. This, OSHA notes, does not preclude
manufacturers or others from conducting or establishing such tests to
demonstrate that a product meets appropriate stability criteria. The
Agency believes that equipment meeting such tests and criteria should
be permissible and has promulgated final rule paragraph (w)(6)(iii)
accordingly.
OSHA also believes that compliance with the requirements of
Sec. 1926.451 and final rule paragraph (w)(6)(iv) (that the power be
applied directly to the wheels and that the speed be limited to no more
than 1 foot per second, as recommended by a commenter (Ex. 2-423))
adequately addresses cases where a mobile scaffold is equipped with a
motor.
Paragraph (w)(7), which is identical to the proposed paragraph,
requires that platforms not extend outward beyond the base supports of
the scaffold unless outrigger frames or equivalent devices are used to
ensure stability. Compliance with this provision will prevent eccentric
loading of the scaffold frame that could cause the scaffold to tip
over.
Paragraph (w)(8) provides that, where leveling of the scaffold is
necessary, screw jacks or equivalent means be used. This is a specific
way of complying with Sec. 1926.451(c)(2) of the final rule, which
requires firm, level foundations. This provision is consistent with the
corresponding provision in ANSI A10.8-1988, paragraph 11.1.4.
Paragraph (w)(9) requires that caster stems and wheel stems be
pinned or otherwise secured to scaffold legs or adjustment screws.
Proposed paragraph (w)(9) was identical, except that it did not
specifically provide for the securing of stems to adjustment screws.
This revision is based on input received on this provision from the
SSFI and SIA (Exs. 2-367 and 2-368). OSHA agrees that adjustment screws
provide appropriate attachment points for caster stems and wheel stems,
so that specifically mentioning them in the final rule will clearly
express the Agency's intent and facilitate compliance.
Paragraph (w)(10) provides that, before a scaffold is moved,
employees on the scaffold shall be made aware of the move. This
requirement, which was not part of the proposal, is based on input
received from a commenter (Ex. 2-23) on this section. OSHA agrees with
this input, and has revised the proposed paragraph accordingly. In
addition, OSHA notes that this requirement is consistent with ANSI
A10.8-1988, paragraph 11.2.3.5.
Issue 14 asked whether OSHA should allow mobile scaffolds to move
only along their longitudinal axes while employees are riding on them.
OSHA noted that compliance with this provision, which was suggested by
ACCSH (Ex. 4), would maximize scaffold stability during movement,
because tipping is more likely to occur when a scaffold is moved along
its transverse axis.
Two commenters (Exs. 2-50 and 2-368) stated that such a provision
would be difficult to enforce. Three commenters (Exs. 2-22, 2-53, and
2-368) also stated that this provision would be impractical. The SIA
(Ex. 2-368) went on to explain that:
[S]uch a provision would make it difficult for workers to
perform their duties without violating standards. Sometimes it is
necessary to make even slight adjusting movement of the scaffold in
order to reach the area of work. If workers were prohibited from
moving the scaffold even the slightest amount along the narrow axis,
they would tend to extend their reach over the side of the scaffold,
thus creating an even greater hazard.
Some mobile scaffolds are almost square, which would require a
tape measure to determine when there would be a violation. The
fatigue created by the worker climbing up and down each time he
wished to move the scaffold would tend to increase the likelihood of
an accident.
Another commenter (Ex. 2-50) reasoned that it had never had a
scaffold accident under the existing standards, so it expected that the
proposed requirement would be unreasonably restrictive and difficult to
monitor. Another commenter (Ex. 2-22) foresaw no increase in employee
safety to balance against possible problems encountered by those
required to implement the provisions.
On the other hand, one commenter (Ex. 2-29) simply favored adopting
the suggested provision. Another commenter (Ex. 2-43) agreed that
``rolling scaffolds should be moved in a safe manner'' but added that
``[e]nforcing this requirement will continue to provide special
challenges.''
Five commenters (Exs. 2-13, 2-15, 2-37, 2-54, and 2-367) found the
provision unacceptable, because they felt employees should not be
permitted to ride mobile scaffolds at all. Another commenter (Ex. 2-
308), responding to proposed 1926.452(w), also said that employees
should never be allowed to ride scaffolds. One other commenter (Ex. 2-
13) agreed but added an exception for scaffolds ``that have been
specifically designed for such movement.''
OSHA agrees with the SIA (Ex. 2-368), which indicated that such a
requirement would make it difficult for workers to perform their duties
without violating the standard because it would sometimes be necessary
to make slight adjustments of a scaffold to safely reach the work area.
OSHA is concerned that if workers were prohibited from moving the
scaffold along its transverse axis, even slightly, they would find
themselves in circumstances where they would extend their bodies over
the side of the scaffold to reach a place where they need to perform
work, instead of climbing down the scaffold to reposition it. This
would create a greater hazard because the employee would be at risk of
falling or of tipping the scaffold.
Accordingly, the Agency has not adopted the suggested language in
the
[[Page 46092]]
final rule. OSHA believes the proposed provisions set forth in
Sec. 1926.452(w), Mobile Scaffolds, appropriately address the concerns
of employees riding scaffolds.
(x) Repair Bracket Scaffolds
The March 29, 1993, Federal Register notice reopening the
rulemaking record (58 FR 16509) sought information regarding ``chimney
bracket scaffolds.'' The Agency described such scaffolds as consisting
of platforms supported by brackets which are secured in place by one or
more wire ropes placed in an approximately horizontal plane around the
circumference of the structure and tensioned by a turnbuckle. The
Agency noted that it had recently received information (Exs. 31 and 32)
which suggested that proposed Sec. 1926.451 might not adequately
protect employees on these scaffolds from falls and other hazards.
OSHA noted that it was considering whether specific fall protection
requirements were needed in subpart L for protection of employees on
chimney bracket scaffolds. The Agency also noted that it was
considering the appropriateness of promulgating technical requirements
for chimney bracket scaffolds that are more detailed than those
proposed for scaffolds in general. Accordingly, the March 29, 1993,
Federal Register notice presented a series of questions aimed at
developing criteria for safe use of chimney bracket scaffolds. One
commenter (Ex. 34-35) stated ``[u]nless it can be determined by a
competent person beforehand that the chimney can support a bracket and
an independent safety line and fall protection is used, other means
such as balling, explosives or remote crane suspended hydraulic
attachments should be used.'' OSHA also received substantive input on
chimney bracket scaffolds [repair bracket scaffolds] from one
commenter, the National Advisory Committee for Health & Safety in the
Chimney, Stack, Silo and Natural Draft Cooling Tower Industry (NACHS)
(Ex. 34-33). Those comments are discussed below in relation to the
pertinent provisions of the final rule. The NACHS, a trade association
presenting the experience and views of companies which use the
scaffolds in question, referred to these scaffolds as ``repair bracket
work platforms'' in its comment. Based on that input, the Agency has
determined that the term ``repair bracket scaffold'' should be used in
place of the term ``chimney bracket scaffold.''
The NACHS (Ex. 34-33) indicated that a ``repair bracket scaffold''
is a type of supported scaffold that has been used safely for over 80
years for tuckpointing on brick chimneys; crack repairs; the
installation of bands on brick or concrete chimneys; painting; access
to caps, hoods, and lightning protection systems; installation of
permanent platforms; piece-meal demolition of brick, concrete, and
steel chimneys; waterproofing brick and concrete chimneys; 360 degree
access at any given elevation for any activity; and steeple access.
According to the commenter, these scaffolds are installed by encircling
a structure with a minimum one-half-inch diameter wire, tensioned by a
minimum one-inch turnbuckle. Brackets are then placed over the wire
rope, and scaffold planking (12-inch minimum width), guardrail posts
and handrails are installed on the brackets.
Based on the information received, OSHA again reopened the
rulemaking record (59 FR 4615, February 1, 1994) to solicit comment on
draft regulatory text that the Agency was considering for inclusion in
the final rule. In addition, the Agency noted that it was considering
whether employees working on chimney bracket scaffolds needed to be
protected from fall hazards by both a ``Type I'' guardrail, as would
have been required by proposed Sec. 1926.451(e)(4), and a personal fall
arrest system. Also, OSHA noted that it was considering what provisions
must be made for rescue of employees from chimney bracket scaffolds in
the event of scaffold collapse or a medical emergency. The Agency
indicated that it was developing criteria for employers who would need
to comply with these provisions. As is discussed below in relation to
the provisions of final rule paragraph (x), the Agency also raised
Items (a) through (l) for consideration as prospective provisions of
the final rule. (All references to Items and Issues in this paragraph
of the preamble relate to the February 1, 1994 reopening notice.) The
one commenter, Monsanto, (Ex. 43-45) who responded to those Items
stated that they should be adopted in the final rule.
Based on the rulemaking record, OSHA has determined that it is
appropriate to add a new paragraph (x) to Sec. 1926.452 to address the
use of `repair bracket scaffolds'. In addition, a definition of that
term, based on the NACHS comment, is being added to Sec. 1926.450(b),
Definitions.
Paragraph (x)(1) requires employers to secure brackets in place
with \1/2\ inch diameter wire rope that extends around the
circumference of the chimney. This provision, which incorporates the
language from Items (a) and (b) of the February 1, 1994 notice (59 FR
4617), codifies established good industry practice as described by the
NACHS (Ex. 34-33).
Final rule paragraph (x)(2) requires that each bracket be attached
to the securing wire rope (or ropes) by a positive locking device
capable of preventing the unintentional detachment of the bracket from
the rope, or by some other means which prevents unintentional
detachment. The NACHS (Ex. 34-33) indicated that brackets are
positioned on the cable in the course of erecting the scaffold. Issue 6
asked if OSHA should require a positive locking device on the bracket
hook that is placed over the wire rope to prevent unintentional
separation of the bracket from the wire rope. Continental Chimney Inc.
(CCI) and NACHS (Exs. 43-1 and 43-21) supported such a requirement.
Final rule paragraph (x)(3) requires that each bracket, at the
contact point between the supporting structure and the bottom of the
bracket, be provided with a ``shoe'' (heel block or foot) capable of
preventing the lateral movement of the bracket. Issue 7 asked if OSHA
should incorporate such a requirement in the final rule. CCI and NACHS
(Exs. 43-1 and 43-21) commented that a ``shoe'' was needed to prevent
lateral movement. In addition, CCI stated ``The bottom of our [bracket]
feet have an angle cut into them to prevent them from getting caught up
on obstructions on the chimney and becoming disconnected if the
scaffold system should slip.''
Final rule paragraph (x)(4) requires that platform units be secured
to brackets in a manner that prevents the separation of platform units
from brackets and prevents movement of platform units or brackets on a
completed scaffold. This provision is based on Item (e), which provided
that platform units shall be secured to the brackets. Issue 4 asked how
employers should fasten platform units to brackets so that they do not
inadvertently detach. CCI (Ex. 43-1) stated ``We have used \1/8\''
cable with \1/4\'' rope. \1/4\'' rope is enough most of the time. The
\1/8\'' cable provides added security and can be secured adequately be
tying it in right along side the \1/4\'' rope. Using clamps here would
never work.'' The NACHS (Ex. 43-21) responded that employers should
secure platform units to brackets ``[b]y any positive system available,
i.e., wire, rope, etc.'' OSHA has determined that it is appropriate to
allow employers flexibility in choosing the means of securing platform
units and has added final rule paragraph (x)(4) accordingly.
Final rule paragraph (x)(5) provides that, when a wire rope is
placed around
[[Page 46093]]
a structure to provide safe anchorage for personal fall arrest systems
that are used by employees erecting or dismantling repair bracket
scaffolds, the wire rope shall be at least \5/16\ inches in diameter
and shall, in all other respects, satisfy the requirements of subpart
M, OSHA's Fall Protection Standard. This paragraph, which is
effectively identical to Item (l) of the February Notice, codifies
established good practices as described by the NACHS (Ex. 34-33).
Final rule paragraph (x)(6) requires that each wire rope used for
securing brackets in place or as an anchorage for personal fall arrest
systems be protected from damage due to contact with edges, corners,
protrusions, or other discontinuities of the supporting structure or
scaffold components. Issue 10 of the Reopening Notice asked how
employers protected wire ropes from abrasion. CCI (Ex. 43-1) stated
``Our brackets hold the cable 3'' below our decking.'' The NACHS (Ex.
43-21) responded ``[t]he bracket scaffold support cable is static, and
abrasion experienced from * * * installation does not affect its
integrity. The hardwood cable block spacers (@ [+ or -] 36'' centers)
minimize and often prevent the cable from making contact with the
structure's surface.'' OSHA has determined, based on the comments, that
adequate means of protecting wire rope from abrasion are readily
available to affected employers.
Final rule paragraph (x)(7) provides that tensioning of each wire
rope used for securing brackets in place or as an anchorage for
personal fall arrest systems shall be by means of a turnbuckle at least
1 inch in diameter, or by some other equivalent means. This paragraph,
which is very similar to Item (b) of the Reopening Notice, codifies
established good practice as described by the NACHS (Ex. 34-33). OSHA
has allowed employers the flexibility to use means other than a single
turnbuckle for tensioning wire ropes, where the alternative means
provide equivalent tension, because the Agency wants to encourage
innovation and provide flexibility. In addition, OSHA anticipates,
based on information from NACHS (Ex. 34-33), that there may be
circumstances where more than one turnbuckle will be needed to tension
the wire rope, depending on the diameter of the chimney.
Final rule paragraph (x)(8) requires that each turnbuckle be
connected to the other end of its rope by use of a proper-size
eyesplice thimble. Issue 8 of the February Notice asked if OSHA should
add such a requirement to the final rule. CCI (Ex. 43-1) stated
``Thimbles are very helpful in keeping the cable in good condition.
These can be fit over the turn buckle eye and then closed back up.''
Also, the NACHS (Ex. 43-21) commented that OSHA should add a
requirement for the use of a proper size thimble.
Final rule paragraph (x)(9) provides that U-bolt wire rope clips
shall not be used on any wire rope used to secure brackets or to serve
as an anchor for personal fall arrest systems. OSHA expressed concern
in the February 1, 1994 reopening notice that the use of U-bolt wire
rope clips as wire rope fasteners on the horizontal support ropes could
result in damage to the dead end of the rope. Further, if a segment of
damaged dead end later were to become part of the live end due to an
increase in the circumference of the structure, the Agency was
concerned that the wire rope would be unable to support the loads
imposed on it.
CCI responded (Ex. 43-1) ``The use of U wire rope clips does not
damage the wire rope significantly when they a
FR Doc. 96-21289 Safety Standards for Scaffolds Used in the Construction Industry
re not over-tightened.
Double-saddle clips are not as strong as U wire rope clips and are
difficult to put on the cable.'' Also, Charles Greene (Ex. 43-47), a
safety consultant, stated he ``[w]ould recommend that fist or saddle
clips be used to fasten the horizontal support ropes that support the
bracket scaffolds.''
OSHA disagrees with CCI regarding the safety of using U-bolt wire
rope clips, based on the Agency's review of Rosnagles Handbook of
Rigging and the Wire Rope User's Handbook. The information in those
publications clearly indicates that the use of U-bolt wire rope clips
could significantly damage wire ropes. Where wire rope is used to
secure brackets, U-bolt clips shall not be used because a segment of
damaged dead end could later become part of the live end due to an
increase in the circumference of the structure. By contrast, the
standard allows U-bolts in other applications, such as where the U-bolt
is used at the end (dead end) of the wire rope and that part of the
wire rope is never moved into the live section. Accordingly, because of
the risk of damaging the wire rope, OSHA is prohibiting the use of U-
bolt wire rope clips on repair bracket scaffold support cables.
Final rule paragraph (x)(10) requires employers to ensure that
materials are not dropped to the outside of the supporting structure.
This paragraph is based on Item (j) of the February Notice. In
addition, Issue 2 of the Reopening Notice asked if requirements other
than those in proposed Sec. 1926.451(f) (Sec. 1926.451(h) of the final
rule) were needed to address the hazards of materials falling to the
outside of the structure. The NACHS (Ex. 34-33) indicated that chunks
of material generated during demolition operations are ``dropped
piecemeal down the inside of the chimney and kept off the scaffold.''
There was no response to Issue 2. OSHA believes that this requirement
simply codifies existing good industry practice and provides an
appropriate supplement to the provisions of final rule
Sec. 1926.451(h).
Final rule paragraph (x)(11) requires that erection of a repair
bracket scaffold be performed in only one direction around the
structure. This provision is based on item (k); as with the other
``items'' from the February 1, 1994 notice, the Agency believes that
this paragraph simply codifies established good industry practice.
In addition, the February 1, 1994 reopening notice raised several
Issues and Items which did not result in the addition of requirements
to the final rule. For example, Reopening Issue 1 asked how employers
would provide a safe anchorage point for personal fall arrest systems
and whether compliance with the General Industry standard for powered
platforms, Sec. 1910.66, Appendix C would be appropriate. The NACHS
(Ex. 43-21) stated that a wire rope anchorage point could be attached
to a structure ``by means of tensioning devices i.e., turnbuckles and
hardwood cable spacer (stand off) blocks.'' The commenter also stated
that conformance with Sec. 1910.66, Appendix C, should not be required
``because the chimney bracket scaffold erector is secured to an
independent anchor (ladder) during the installation process.'' Based on
this information, OSHA has not added the cross-reference to the General
Industry standard to the final rule.
In addition, Item (i) provided for a competent person to inspect
the supporting structure before scaffold erection begins, and Issue 3
asked what criteria a competent person should apply when inspecting the
supporting structure. The NACHS (Ex. 43-21) stated that the criteria
should be determined by the ``competent person'' (as defined in
existing Sec. 1926.32(f)) and ``should be the responsibility of each
contractor on a project by project basis.'' Charles Greene (Ex. 43-47)
stated that OSHA should require inspection of wire rope before each
use. The Agency believes that compliance with the general requirements
in final rule Sec. 1926.451(f)(3), which provides that a competent
person shall inspect scaffolds (including supporting structures and
anchorage points) for visible defects prior to each work shift and
after any occurrence that could affect the
[[Page 46094]]
scaffolds' structural integrity, will provide adequate assurance that
unsafe scaffolds are not used. Accordingly, the Agency has not added
additional specific criteria for inspection of repair bracket scaffolds
to the final rule.
Reopening Issue 3 sought comment on the use of a wire rope placed
at the platform level in lieu of an inner guardrail system on tank
builders' scaffolds. The Steel Tank Institute (STI) (Ex. 43-5) stated:
One STI member uses a fabricated hook with an eyelet for
attaching a safety lanyard and harness. The hook is hooked over the
top plate of steel on the tank being erected. This system allows a
high degree of mobility for workers since the hook can slide
horizontally along the steel plate, and results in 100% fall
protection. If such a system is used, the space between the scaffold
planks and the tank shell should not be an issue.
OSHA believes that, in general, the use of guardrail systems or
personal fall arrest systems would provide more effective protection
than the system described by the STI. The Agency also believes,
however, that the method described by this commenter to use personal
fall arrest systems could be used in many cases to provide protection
equivalent to the wire rope guardrail described in Issue 3.
Reopening Issue 5 asked what criteria, if any, should be set for
brackets used with repair bracket scaffolds. CCI (Ex. 43-1) stated that
there was ``no need'' to set such criteria. In addition, the NACHS (Ex.
43-21) responded ``[n]o criteria should be set by OSHA that may
restrict material and system improvements that are in constant change
due to modern technology.'' The Agency agrees that it is important to
encourage development of improved systems and materials. Furthermore,
OSHA believes that compliance with the requirements in final rule
Secs. 1926.451 (a), (b) and (c), will ensure that brackets used on
repair bracket scaffolds provide adequate protection for employees.
Accordingly, the Agency has not added specific criteria for brackets to
the final rule.
Reopening Issue 9 asked whether the safety factor for wire rope
used with repair bracket scaffolds should be 4:1, as recommended by the
NACHS (Ex. 34-33), or 6:1, as provided in proposed Sec. 1926.451(a) and
in Item (d). OSHA noted that a 4:1 safety factor might be inadequate
because the use of wire rope clips reduces the strength of the rope.
The NACHS (Ex. 43-21) stated ``[t]he Committee unanimously recommends a
safety factor of 4:1 be satisfied.'' OSHA believes that the strength of
wire ropes used with repair bracket scaffolds is just as important as
the strength of ropes used with other scaffolds. Therefore, the Agency
has determined that the 6:1 safety factor which OSHA has set as a
general requirement for wire ropes (final rule Sec. 1926.451(a)) is
also appropriate for wire ropes used with repair brackets.
Reopening Issue 11 asked if OSHA should specify that each platform
unit on a chimney bracket scaffold shall extend at least 12 inches over
its supports, as recommended by NACHS (Ex. 34-33) and provided by Item
(f), or extend at least 6 inches (unless cleated or otherwise
restrained) as provided by proposed Sec. 1926.451(b). CCI (Ex. 43-1)
stated that platform units should extend out at least 12 inches. The
NACHS (Ex. 43-21) stated that OSHA should require minimum extension of
6 inches unless cleated or otherwise restrained as provided by proposed
Sec. 1926.451(b), but did not explain why it had changed its position.
OSHA believes that compliance with the 6-inch requirement as set forth
in final rule Sec. 1926.451(b)(4) will adequately protect employees
working on repair bracket scaffolds.
Items (c) and (h) would have incorporated strength and guardrail
requirements into paragraph (x). These provisions are not needed
because the general requirements in final rule Sec. 1926.451 (a) and
(g) adequately address scaffold capacity and fall protection.
Item (g) provided that the span of platform units from bracket to
bracket shall not exceed 5 feet on the outside of the brackets. As
noted above, Monsanto (Ex. 43-45) supported the inclusion of this
provision in the final rule. The Agency notes that while span is a
factor, the issue is already addressed by the general requirements for
minimum and maximum overhang (final rule Sec. 1926.451(b)(4) and (5)),
and the capacity requirements of Sec. 1926.451(a). There is thus no
need to add this requirement to the final rule.
Paragraph (y) Stilts
Final rule paragraph (y) provides requirements for the use of
stilts. Neither OSHA's existing scaffold standard (subpart L) nor the
proposed rule directly addressed the use of stilts. NPRM Issue 20 asked
if OSHA should prohibit or regulate the use of stilts. In particular,
the Agency requested suggestions as to the appropriate construction and
use of stilts, fall protection for employees wearing stilts, floor
conditions in areas where stilts are being used, and other necessary
considerations.
The SSFI (Ex. 2-367) stated that they ``would support OSHA's
prohibition on using stilts while undertaking work on scaffolds'' as
this ``would be considered unsafe.'' Another commenter (Ex. 2-29)
stated, ``stilts are not recommended for construction conditions.
Unlevel working surfaces, debris, etc. are particular problems when
using stilts.''
On the other hand, a commenter (Ex. 2-13) stated, ``OSHA should not
prohibit the use of stilts. They have been used safely for many years.
They should never be used near any unprotected opening.'' The SIA (Exs.
2-368, 5a-16) agreed that the Agency should promulgate a rule
permitting the use of stilts but should spell out ``some safety rules,
particularly when their use places the worker at heights above the
standard guardrail protection.'' Many commenters on Issue 20 used a
specific height (length) of no more than 40 inches as a cut off point
above which they considered the use of stilts to be unsafe (Exs. 2-47,
2-61, 2-63, 2-67, 2-78, 2-156, and 2-304).
Over 460 other commenters expressed the view that Issue 20 was the
first step towards a prohibition on the use of stilts. Those comments
stated that prohibiting the use of stilts would cause employees to
sustain injuries from over-reaching and falling from ladders, stools,
platforms, homemade benches, boards, inverted buckets and other devices
they would otherwise use to elevate themselves when doing painting,
finishing or ceiling work. In particular, one commenter (Ex. 2-99)
stated
Based on our experiences over these many years, we have found
stilts to be a very safe and effective means to perform work in a
timely and efficient and safe manner. Whenever stilts are used on a
project, we have found that general housekeeping improves. There is
much less debris found even on a short term basis than there would
be with conventional scaffolding. We are able to use stilts to reach
areas where conventional scaffolding and even ladders would be
unsafe due to jobsite conditions. We do not let just any employee
work on stilts. Our safety record attests to that. During the twenty
(20) years we have used stilts, we have only had two (2) accidents
involving the stilts--and both of these accidents were by the same
employee.
Most of the commenters stressed the need for proper training for
employees who use stilts (Exs. 2-6, 2-301, 2-379, and 2-406B). Most of
the comments also indicated that some safety provisions, such as debris
control, are needed if stilts are to be used.
Based on the concerns expressed by commenters, Issue L-4 of the
hearing notice (53 FR 2048, January 26, 1988) set out four provisions
that OSHA was considering for inclusion in the final rule for subpart L
and solicited public input. Final rule Secs. 1926.452(y)(1) and (2)
address the use of stilts on large area
[[Page 46095]]
scaffolds, and Secs. 1926.452 (y)(3) and (4) provide criteria for the
use of stilts in general. These are based on the first through fourth
provisions, respectively, raised in Hearing Notice Issue L-4.
The Association of the Wall and Ceiling Industries International
testified (Tr. 3/22/88, p. 86, Ex. 5a-14) in favor of the proposed
provisions. The SIA testified that stilt use was widespread and that
stilts were considered a useful tool by the ceiling and wall industries
(Tr. 3/22/88, pp. 157-158). The SIA testimony supported three
provisions that OSHA is adopting, but did not express an opinion on the
fourth provision (final paragraph (y)(2)).
Paragraph (y)(1) requires that employees not wear stilts on
scaffolds except when the employees are on large area scaffolds. This
paragraph is effectively identical to the language in the first
provision raised for consideration in Issue L-4.
Paragraph (y)(2) provides, when employees wearing stilts are on
large area scaffolds where guardrail systems are being used, that the
dimensions of the guardrail system shall be increased to offset the
height of the stilts. This paragraph corresponds to the language in the
second provision raised for consideration in Issue L-4.
The SIA (Ex. 2-368) commented that a standard providing for the use
of stilts on scaffolds should address guardrail height on scaffolds
where stilts are being used.
Paragraph (y)(3) of the final rule provides that all surfaces on
which stilts are used shall be flat and free of pits, holes and
obstructions, such as debris, as well as all other tripping and falling
hazards. This paragraph is identical to the language in the third
provision raised for consideration in Issue L-4.
Many commenters noted the importance of removing potential tripping
hazards where stilts are used (Exs. 2-54, 2-71, 2-99, 2-149, 2-166, 2-
205, 2-219, 2-256, 2-272, 2-283, 2-295, 2-307, and 2-324). For example,
a commenter (Ex. 2-54) stated:
It would seem those that would have the opportunity to use
stilts the most would be stepping into a lot of loose debris that
has fallen and quite vulnerable to injury from slipping and falling.
Paragraph (y)(4) of the final rule provides that stilts shall be
properly maintained and that any alterations of the original equipment
must be approved by the manufacturer. This paragraph is identical to
the language in the fourth provision raised for consideration in Issue
L-4.
Several commenters who responded to Issue 20 addressed the
condition of stilts. Those commenters (Exs. 2-59, 2-62, 2-71, 2-72, 2-
108, 2-211, 2-219, 2-237, 2-243, 2-301, 2-304, 2-304, 2-313, 2-324, 2-
379, 2-406B, and 2-409), generally, indicated that requirements for
proper maintenance and inspection of stilt equipment, including straps
and fittings, were needed. A number of manufacturers, contractors, and
workers who use stilts also expressed strong approval for the use of
manufactured stilts (as opposed to the use of job-made stilts) (Exs. 2-
47, 2-127, 2-154, 2-257, 2-304-25, and 2-411A). The Agency has no
information which indicates that job-made stilts pose a greater hazard
than manufactured stilts, and therefore is not covering them
differently under this paragraph. OSHA will monitor work experience
under this provision to determine if it is appropriate to treat
manufactured and job-built stilts differently.
Section 1926.453 Aerial Lifts
OSHA proposed to delete existing Sec. 1926.451(f), Elevating and
rotating work platforms, because the Agency believed that the existing
provision was redundant with existing Sec. 1926.556, Aerial lifts,
which is in subpart N, Cranes, Derricks, Hoists, Elevators and
Conveyors, of the Construction Standards. Existing Sec. 1926.451(f)
provides only that employers comply with ANSI A92.2-1969, Vehicle
Mounted Elevating and Rotating Work Platforms. This requirement is also
found in Sec. 1926.556. Section 1926.556, in turn, sets some specific
requirements for specified lift operations, but primarily references
ANSI A92.2-1969.
The SIA (Ex. 2-368) objected to the proposed deletion, stating that
equipment which falls under the definition of ``scaffold'' should be
addressed by subpart L. ANSI A92.2-1969 classifies elevating and
rotating work platforms as ``scaffolds.''
Based on consideration of the comment, OSHA believes that the
retention of existing Sec. 1926.451(f) would not be appropriate.
However, the Agency agrees with the commenter that this type of
equipment is a scaffold and that it should be addressed by subpart L.
In order to facilitate the efforts of construction employers to
safeguard employees who use elevating and rotating work platforms, the
Agency has decided to move the requirements of Sec. 1926.556 to a new
Sec. 1926.453, Aerial lifts, in subpart L. The introductory text to
this section indicates that Sec. 1926.453 applies only to ANSI A92.2
type equipment (vehicle mounted elevating and rotating work platforms),
and further notes that the requirements of Sec. 1926.451 and
Sec. 1926.452 do not apply to this type of equipment.
In addition, OSHA recognizes that the A92 Committee has updated
A92.2-1969 and has adopted other A92 standards which address
technological advances and evolving safe industry practices regarding
elevating and rotating work platforms. The Agency has determined that
compliance with the pertinent A92 standards adopted by ANSI since 1969
will provide employee safety at least equivalent to that attained
through compliance with ANSI A92.2-1969. Accordingly, OSHA is providing
a list of post-1969 ANSI A92 standards which are presently available,
and is placing this list in a new non-mandatory Appendix C to this
standard (subpart L). This non-mandatory appendix can be updated as
necessary to include future revisions of the A92 standards or other
relevant information.
Paragraph (a) addresses general requirements for aerial lifts,
while paragraph (b) contains specific requirements for this equipment.
Paragraph (b)(1) through (b)(5) specify requirements for ladder trucks
and tower trucks, extensible and articulating boom platforms,
electrical tests, bursting safety factors, and welding standards for
aerial lifts, respectively
Section 1926.454 Training Requirements
Section 1926.454 addresses training for employees working with
scaffolds. The introductory text indicates clearly that this section
both supplements and clarifies the training provisions in existing
Sec. 1926.21(b)(2). That standard, which applies to all construction
work, requires employers to ``instruct each employee in the recognition
and avoidance of unsafe conditions and the regulations applicable to
his work environment to control or eliminate any hazards or other
exposure to illness or injury.'' While that language clearly
articulates the employer's general duty to provide training, OSHA
believes it is appropriate to provide more specific direction regarding
the training necessary for employees who work on scaffolds.
Accordingly, Sec. 1926.454 sets certain criteria allowing employers to
tailor training to fit their workplace circumstances.
The introductory text of proposed Sec. 1926.460 indicated that OSHA
would cite employers for violations of the added training requirements
in this section only when a citation was issued concurrently under the
provisions of proposed Secs. 1926.450, 1926.451 or 1926.452. However,
it is clear to OSHA that this approach is not appropriate and does not
provide adequate
[[Page 46096]]
employee protection, because the training of an employee does not
necessarily ensure that an employee will follow the substantive safety
provisions of the standard in every case.
OSHA's enforcement of the standard's training requirement does not
depend on the extent to which an employer is fulfilling other
compliance obligations under subpart L. In this regard, the scaffold
standard is like any other OSHA standard that provides for both hazard
prevention and employee training. The employer has separate duties to
provide protection and to train employees, and may be cited for
violating either or both types of requirements.
Paragraph (a) of the final rule sets training requirements for
employers who have employees working on scaffolds. The introductory
text requires employers to ensure that each employee whose employment
involves being on a scaffold is trained to recognize the hazards
associated with the type of scaffold being used and to understand the
procedures which must be followed to control or minimize those hazards.
Proposed paragraph (a) required that all employees using scaffolds
to perform a job task be instructed in the proper construction, use,
placement and care of the scaffolds they are using, and in the
applicable provisions of this subpart. OSHA has determined that the
proposed provision should be revised to provide more specific direction
regarding how employees working on scaffolds are to be trained. In
addition, the Agency recognizes that it is appropriate to distinguish
between the training needed by employees erecting and dismantling
scaffolds and the training needed by employees who are on scaffolds in
the course of their work. Accordingly, final rule paragraph (a)
addresses employees who are working on scaffolds and final rule
paragraph (b) addresses employees who are erecting and dismantling
scaffolds. OSHA anticipates that some employees, such as those who use
adjustable suspension scaffolds, will need training that complies with
both paragraph (a) and paragraph (b).
The SIA and the Duke Power Company (Exs. 2-368 and 2-465) commented
that employees who use scaffolds do not need to know how to construct,
place, and care for these scaffolds. The SIA (Ex. 2-368) stated ``Does
every single worker on the job need to know how the scaffold is
constructed, or how it was placed, or how it is to be cared for? This
should be the responsibility of some ``competent'' person, but not
everyone on the scaffold.'' In addition, Duke Power (Ex. 2-465) noted
``the majority of scaffolds used are not constructed by the employees
using them.'' As noted above, OSHA agrees with these concerns and final
rule Sec. 1926.454 reflects this thinking.
The introductory language of final rule paragraph (a) also requires
employers to ensure that each affected employee has been trained by a
person who is qualified in the pertinent subject matters. The
requirement for training by a qualified person has been added to the
final rule to ensure that the training is adequate. The ACCSH (Tr. 6/9/
87, p. 266) recommended that OSHA require the involvement of a
competent person in the program to provide appropriate assurance that
employees will be adequately trained. However, the Agency has decided
that a qualified person would be more appropriate because it is the
knowledge, skill or experience of the trainer, not the trainers
authority, which determines the adequacy of the training provided.
Limiting the delivery of the required training only to a competant
person would prevent employers from taking advantage of outside sources
of training, such as scaffold manufacturers and suppliers, that
regularly provide these types of services to clients.
Paragraphs (a)(1) through (a)(5) address five areas in which
training must be provided, as applicable. Final rule paragraph (a)(1)
requires that affected employees be trained in the nature of any
electrical hazards, fall hazards and falling object hazards in the work
area. Many employees have been killed or seriously injured because they
were unaware of workplace hazards or did not understand the
consequences of exposure to those hazards. This provision clearly
indicates the hazards (i.e., electrocution, falls and falling objects)
regarding which training must be provided. This paragraph elaborates on
the requirements of existing Sec. 1926.21(b)(2), which addresses
training in the general recognition and avoidance of hazards.
Final rule paragraph (a)(2) requires that affected employees be
trained in the correct procedures for protection from electrical
hazards and for erecting, maintaining, and disassembling the required
fall protection systems and falling object protection systems.
Employees who are on scaffolds while working need to know how
protective systems function, so that they know how to install, maintain
or remove these systems, as necessary. For example, where a scaffold
has been erected without the protective measures necessary for work to
be performed on or from the scaffold, the employees subsequently coming
onto the scaffold would need to install them. Even where the scaffold
erectors have installed the required protection for affected employees,
the employees working on the scaffold need to know when and how to
maintain that protection, so that a hazardous situation does not
develop during scaffold use. Proposed paragraph (a) addressed this
subject only in general terms.
The ANSI Z359 Committee stated (Ex. 2-57)
``[P]ersons who work on scaffolds should be required to undergo
fall protection training. This is not specified in sufficient detail
in 1926.460. The content, specificity and training environment for a
fall protection training program should perhaps be considered as the
subject of a national standard.'' OSHA agrees with this comment and
has revised the proposed training provision accordingly.
Paragraph (a)(3) requires that employees be trained in the proper
use of the scaffold and in the proper handling of materials on the
scaffold. This paragraph is effectively identical to the corresponding
provision of proposed paragraph (a). The language regarding the proper
handling of materials has been added to facilitate compliance with the
requirements for falling object protection.
Paragraph (a)(4) requires that employees be trained in the maximum
intended load and the load-carrying capacities of the scaffolds used.
This language is effectively identical with the corresponding language
of proposed paragraph (a).
Paragraph (a)(5) requires that employees be trained in the
pertinent requirements of subpart L. This provision is effectively
identical to the corresponding language in proposed paragraph (a).
Paragraph (b) of the final rule addresses training for employees
assembling, maintaining or dismantling scaffolds. The introductory
language of paragraph (b) requires that the employer have each employee
who erects, disassembles, moves, operates, repairs, maintains, or
inspects a scaffold trained by a competent person so that the employee
can recognize any hazards related to such work duties. This provision
is effectively identical to the language in proposed paragraph (a). As
noted above, final rule paragraph (b) is designed to differentiate
clearly between the training needed by employees erecting and
dismantling scaffolds and the training needed by employees who are on
scaffolds in the course of their work. In addition, this provision
corresponds, in part, to the language in proposed paragraph (b), which
required that employees repairing scaffolds be
[[Page 46097]]
competent individuals ``trained and familiar with the design criteria,
intended use, and the proper procedures for repairing the defective
component(s).''
The introductory language of final paragraph (b) requires the
employer to ensure that each affected employee has been trained by a
competent person in four areas, as applicable. As discussed above in
relation to final rule Sec. 1926.454(a), OSHA has added this
requirement in response to a recommendation from the ACCSH (Tr. 266, 2/
9/87).
Paragraph (b)(1) requires that affected employees be trained in the
nature of scaffold hazards. This provision effectively restates the
existing Sec. 1926.21(b)(2) requirement that employees be instructed in
the recognition and avoidance of unsafe conditions.
Paragraph (b)(2) requires that affected employees be trained in the
correct procedures for erecting, disassembling, moving, operating,
repairing, inspecting, and maintaining the type of scaffold in
question. This language, which is consistent with the corresponding
language in proposed paragraphs (a) and (b), indicates clearly that
training must address the particular type(s) of scaffold with which
each affected employee will be working. Training provided to an
employee to construct, repair or dismantle one type of scaffold will
not necessarily enable that employee to repair another type.
Paragraph (b)(3) requires that affected employees be trained in the
design criteria, maximum load-carrying capacity, and intended use of
the scaffold. This provision is consistent with the corresponding
language in final rule paragraph (a)(4).
Final rule paragraph (b)(4) requires that affected employees be
trained in the pertinent requirements of subpart L. This provision,
like final rule paragraph (a)(5), is effectively identical to the
corresponding language in proposed paragraph (a).
Non-mandatory Appendix D lists various training topics that may be
important for the employers and employees erecting or dismantling
scaffolds. The list is not all-inclusive, and OSHA is providing it
solely as informational guidance. The employer may need to address
topics or situations not mentioned in the Appendix which are specific
to the employer's particular circumstances.
Proposed paragraph (c), which addressed training specifically for
employees who operate suspended scaffolds, has been deleted from the
final rule, because the Agency has determined that training for these
employees is adequately covered by the requirements in paragraphs (a),
(b) and (c) of the final rule.
Final paragraph (c) requires the employer to retrain any employee
when the employer has reason to believe that the employee does not have
the understanding and skill required by paragraph (a) or (b) of this
section. Employees must be retrained, as necessary, to restore the
requisite scaffold-related proficiency. Circumstances where the
provision requires retraining include, but are not limited to, the
following situations: first, whenever there is a change at the worksite
that presents a hazard about which the employee has not been trained
(paragraph (c)(1)(i)); second, where changes in the types of scaffolds,
fall protection, falling object protection, or other equipment present
a hazard about which the employee has not been trained (paragraph
(c)(1)(ii)); and, third, where inadequacies in an affected employee's
work practices involving scaffolds indicate that the employee has not
retained the requisite proficiency (paragraph (c)(1)(iii)). This
provision simply clarifies the language of proposed Sec. 1926.460(d),
which stated that employees would receive training and retraining as
necessary. OSHA notes that this provision is essentially identical to
the corresponding retraining requirements in the Construction Industry
fall protection standard (Sec. 1926.503(d)) and the General Industry
standards for permit-required confined spaces (Sec. 1910.146(g)(2)) and
personal protective equipment (Sec. 1910.132(f)(3)).
NPRM Issue 15 solicited comments regarding employee training and
retraining on scaffold use. In particular, OSHA asked for data on the
costs and effectiveness of training requirements in reducing the risk
of injuries or fatalities, and whether more or less specific
requirements were appropriate. Commenters were also asked to provide
the Agency with information about currently available safety programs
and their adequacy; the safety records of employees who have been
trained; the scope and necessary elements of training programs; the
relationship of the additional specific provisions in proposed
Sec. 1926.460 to the more general Sec. 1926.21 requirements; the costs
and benefits of these provisions; and possible recordkeeping burdens
these provisions might involve.
The SIA (Ex. 2-368) stated: ``[T]he SIA devotes a considerable
portion of its budget to promotion of safety and training through
audio-visual programs and training courses for the safe use of
scaffolds. We believe that training will reduce accidents and would
like to see some additional requirements in the scaffold standards.''
However, the SIA expressed concern that employers would have to
``establish and maintain extensive records on each employee'' because
the rule would expose them to ``increased liability from an insurance
standpoint'' and to OSHA citations. The SIA also indicated that
training would not be able to cover all foreseeable equipment use, and
that an employer who assumed that training was all-encompassing would
be compromising the safety of its employees. Furthermore, the SIA
stated that the proposed training requirements would pose practical
problems for employers because of employee mobility and related
staffing concerns.
Based on the above-discussed concerns, the SIA made the following
recommendations regarding `additional' training requirements:
As a minimum, employers should be required to furnish to
employees working on scaffolds printed safety rules (Codes of Safe
Practice) for the particular type scaffold they are using. The
employee should be required to read the rules in the presence of the
employer or his agent (a competent person) and be questioned as to
whether the employee understands the rules.
Due to the extreme hazard associated with the use of suspended
scaffolds, a written training program should be required. The
program should include formal certification by the employer upon
completion of the program by the employee. Persons without such
training should not be allowed to work on suspended scaffolds.
OSHA notes that the training requirements in both the final rule
and the proposed rule have been framed in performance-oriented
language. This approach allows employers the flexibility to establish
programs which reconcile the need for training with the circumstances
at particular workplaces.
The AGC (Exs. 2-20, 2-55, and 2-390) contended that any additional
training requirements would be redundant and economically infeasible,
given the construction industry's high employee turnover. The GLFEA and
ABC (Exs. 2-22 and 2-69) commented that training requirements would
``impose practical problems'' due to workforce mobility. In addition,
the GLFEA, ABC and the Builders' Association of Missouri (Ex. 2-50)
stated that the requirements of Sec. 1926.21 already adequately address
training. The GLFEA added that ``other constraints * * * such as
insurance costs and workers compensation rates, impose a requirement on
* * * employers to train their employees and * * * follow safety
requirements.''
[[Page 46098]]
OSHA recognizes that employee turnover can increase an employer's
training responsibilities. The Agency notes, however, that the existing
standard already requires construction employers to provide training
for their employees, notwithstanding employee turnover or other day-to-
day changes in the employer's workforce. Furthermore, the Agency
believes that Sec. 1926.454, insofar as it elaborates on the training
requirements of existing Sec. 1926.21(b)(2), simply codifies good
industry practice and provides useful direction for how training
programs can ``do it right.'' Accordingly, OSHA has determined, based
on the rulemaking record, that any additional responsibilities imposed
by final rule Sec. 1926.454 are reasonable and necessary to protect
employees from serious hazards.
Furthermore, employers need not retrain employees who are trained
by a previous employer or were trained prior to the effective date of
the standard, as long as the employee demonstrates the proficiency
required by the pertinent provisions of this section. This approach is
consistent with that taken in part 1910, subpart I (Personal protective
equipment) and part 1926, subpart M (Fall protection).
A manufacturer of suspended scaffolds, Sky Climber, recommended
(Ex. 2-64) requiring that all riggers and operators of suspension
scaffold equipment be formally trained and certified and carry a
certificate or license to evidence their completion of training. That
commenter provided the following to explain their position:
Improper rigging and operator error were the second and third
major cause and cost of our product incidents. We believe that
training of operators and riggers will substantially reduce the
frequency and cost of incidents. In fact, of the over 1500 persons
who complete our Training Program in operation, maintenance and
rigging since 1980, to our knowledge, not one has been involved in a
suspension scaffold incident.
Sky Climber added that this training should be mandatory, and since
``[t]he primary responsibility for training rests with the employer * *
* he or some other qualified party should provide the required
training.''
Seedorff Masonry Inc.(Ex. 2-407) commented
We have always used our foreman as the instructor and this has
worked out very well. We can agree that there could be an additional
rule on this point, however additional paperwork would not be
feasible. We could find our superintendents only doing paperwork
without enough time to oversee job sites and develop good safety on
the job sites.
The SSFI (Ex. 2-367) commented in favor of proposed Sec. 1926.460,
stating as follows:
Members of the SSFI are in full support of the training
requirements for the contractor provided within the OSHA revision.
If followed, the training requirements would reduce the number of
accidents on construction projects. There currently exist many
Institute Safety Rules and Recommendations as well as many
recommendations developed by the manufacturers of the equipment. As
a minimum, those requirements can be used and, if followed, should
dramatically reduce the accidents of construction employees. These
construction employees should be trained by the contractor at the
construction site prior to their actual start of work, and should
not be trained on-the-job as they are working.
Alum-A-Pole Corporation, a manufacturer of pumpjack scaffolds,
stated (Ex. 2-31) ``[o]n-the-job training is the mode in which pumpjack
users gain proficiency in proper installation. On that basis,
sequential pictorial instructions with minimal verbiage * * * if
adhered to, would virtually eliminate accidents.''
Two commenters (Exs. 2-2 and 2-13) expressed the view that cost
should not be an issue in matters of safety. In addition, one of these
commenters (Ex. 2-13) found from his own experience that both employers
and employees should be trained and retrained.
Another commenter (Ex. 2-54) supported training and retraining and
provided details of the commenter's training program. The comment
touched on the value of discussions, involving both workers and
apprentices, regarding the proper way to use equipment. In particular,
the commenter indicated that employees are more productive when they
are confident that they have the right equipment and know how to use
it.
In addition, discussion by the ACCSH on Issue 15 noted that
training is cost-effective and beneficial for both employees and
employers (Tr. 6/9/87, pp. 130-136). One member stated: ``I've heard
several employers state that these training programs save 4 to 5
percent of the gross cost of the project, which oftentimes is more than
double the amount that they got the bid by in the first place.
They might have gotten the bid by less than 2 percent, but they
save 5 percent with the proper training program.''
Issue L-1 of the hearing notice (53 FR 2049) requested testimony
and related information on any current training programs which issue
certificates or licenses to indicate that employees have been
adequately trained to erect, use or dismantle specific types of
scaffolds. The Agency indicated that it was considering adding a
requirement for verification of compliance through a written
certification. In particular, OSHA sought comment on the following
language:
Sec. 1926.461 Certification. (a) The employer shall certify that
all employees who are erecting, maintaining and dismantling
scaffolds, have been adequately trained in the appropriate
precautions and safe practices before they are allowed to perform
any such scaffold work.
(b) The employer shall certify that the employee has been
trained by preparing a certification record which includes the
identity of the person trained, the signature of the employer or the
person who conducted the training, and the date the training or
retraining was completed. The certification record shall be prepared
at the completion of training and shall be maintained on file for
the duration of the employee's employment. The certification record
shall be made available upon request to the Assistant Secretary for
Occupational Safety and Health or designee.
Issue L-1 stated that the above language would not require the
``collection of information,'' and would not, therefore, impose a
paperwork burden on the employer under the terms of the Paperwork
Reduction Act (44 U.S.C. Chapter 35) and the implementing regulations
(5 CFR 1320.7(j)).
The Association of Wall and Ceiling Industries (AWCI) (Ex. 9; Tr.
3/22/88, p. 83-84) testified that certifying somebody as adequately
trained ``opens up a potential of increased liability so what I'm
asking OSHA to do for us is to provide some definition of `adequately
trained.' Whether this is a model training program or perhaps a listing
of the subjects to be covered under this adequacy of training and also
some indication of who's going to do the training.'' AWCI also asked
whether any employee who works on a scaffold must be trained in its
proper construction, placement, and care.
The AWCI (Ex. 9; Tr. 3/22/88, p. 84-85) also noted that, given the
constant exchange of employees in the construction industry,
``portability'' of training was a point of concern. They questioned,
for example, whether a contractor who has trained employees on a
project and rehires them a month and half later would have to retrain
them. Similarly, in response to a question regarding the type of
training scaffold erectors typically receive, AWCI stated that:
* * * most of it is on-the-job training that's handed down to
new employees as they come aboard the company or is brought by the
employees from the previous
[[Page 46099]]
company. The training programs could have been derived from the
manufacturer of the scaffolding equipment, could be derived from the
in-house training program that the contractor has and some of these
contractors have extensive programs in place on-site. It could also
be derived from the scaffold industry association * * * programs
that they have in place * * * '' (Ex. 9; Tr. 3/22/88, pp. 91-92.)
The AWCI further testified (Ex. 9; Tr. 3/22/88, p. 90) that EPA's
asbestos abatement certification program provided ``[t]he ground floor
of employee protection.'' They pointed out that the program requires 3
days of classroom training, including some ``hands-on,'' and includes a
listing of all points the program is to cover. In addition, the AWCI
testified that ``[the program] gives employees an added margin of
safety by making them aware of the hostile environment they're going to
be in, and added that a foreman, contractor, or supervisor must go for
an additional day of training and that they receive instruction
regarding insurance programs and legal ramifications.'' When asked to
comment on EPA's certification program versus that which might be
required for scaffold erection, the AWCI replied (Tr. 3/22/88, p. 91)
that OSHA should specify the points ``to be covered in the training
program and the credentials of the trainer'' if OSHA is going to
require a certification program.
In addition, Bristol Steel (Ex. 13; Tr. 3/23/88, pp. 2-147 and 2-
148) stated that certification is a weighty responsibility with
significant legal implications. Bristol Steel also contended that any
legal liability arising from a certification program should be the
burden of a trade organization (Tr. 3/23/88, pp. 2-181-182).
Bristol Steel also stated (Ex. 13) that the proposed certification
requirement would add a paperwork burden to employers. The commenter
added that before requiring certification, OSHA should show that such a
requirement could be ``implemented and universally enforced and will
cause a material reduction in scaffold accidents.''
The SIA testified (Ex. 10; Tr. 3/22/88 p. 151) that a certification
requirement would expose employers to ``tremendous liability to civil
and even criminal negligence suits in addition to those penalties
prescribed under OSHA.'' The SIA added that they ``worked closely with
Cal-OSHA in developing a certification program in 1981, which had to be
abandoned because the SIA and its members could not assume the
liability created by Cal-OSHA's insistence that we `certify the
competency of the worker'.''
The Montague-Betts Company, Inc. and SEAVAC testified that training
and certification of workers using scaffolds were appropriate and
useful, but that ``a lot of definition of scope and what certification
consists of is necessary before * * * people can take a final position
as to the complete merits and workings of such a proposal'' (Tr. 3/23/
88, pp. 2-198). Montague-Betts (Ex. 5a-5) stated that certification of
employees using scaffolds is appropriate. On the other hand, SEAVAC
(Ex. 5a-17) stated that certification is appropriate for employees who
erect or dismantle scaffolds but not for other employees.
The SSFI (Ex. 5a-19) stated that training for individuals who use
and erect scaffolds had been a subject of great debate within the
institute and stated that their members were ``very supportive of a
[s]tandard that would require training for the use, erection, and
dismantling of scaffolds.'' They recommended the following elements for
training:
--Two categories of training: one for scaffold users and one for
scaffold erectors and dismantlers;
--Issuing employee ``qualification cards'' that could be presented to
employers, and which would certify completion of a sanctioned training
program;
--Nationally uniform training programs;
--A national program requiring certification to balance economic
consideration among contractors;
--A gradual transition for the implementation of such a training
program;
--Permitting vocational trades, technical, or other qualified teaching
organizations or contractors to provide this type of training service;
--Not allowing training and certification to be substituted for
existing safety requirements, such as those provided by the equipment
manufacturer.
Some commenters opposed the certification language in Issue L-1.
One (Ex. 2-593) indicated that the training requirements in
Sec. 1926.21 and proposed Sec. 1926.460 were sufficient. Another (Ex.
2-594) called the section regarding certification ``too restrictive.''
Monsanto (Ex. 2-595) disagreed with certification of training and
retention of the certification in a file. Monsanto indicated that it
had not had problems with scaffold erection, maintenance, and
dismantling that would warrant certification of training. They added
that the proposed retention requirement for certification information
documents would ``present an unwarranted paperwork burden on the
employer.''
The Edison Electric Institute (Ex. 5a-6) responded that a written
certification was unnecessary and would add a significant paperwork
burden for employers. EEI added that regular training would assure that
employees know how to safely ``handle scaffolds.'' EEI also stated that
the work involved in these operations is not so sophisticated that
routine training should be considered inadequate.
OSHA has determined, based on its review of the record, that a
written certification would impose an additional burden on employers
without a demonstrable increase in worker safety. OSHA can determine if
workers have been adequately trained by talking with the employees and
observing their work habits. In addition, the Paperwork Reduction Act,
as recently revised, classifies certification as a type of information
burden for which OSHA must present a justification. Given the Agency's
conclusion that the necessary information can be obtained without
referring to documents, such a burden would not be justified.
Therefore, the final rule will not contain a requirement for training
certification.
Non-Mandatory Appendix A to Subpart L--Scaffold Specifications
This appendix is provided as a guide to assist employers in
complying with the requirements of Sec. 1926.451. This appendix is non-
mandatory. As stated above in the discussion of paragraph 1926.451(a),
scaffolds built in accordance with this Appendix A will be considered
to meet the intent of this revised subpart L. A full discussion of the
contents of this Appendix A, and any comments on the proposed Appendix
A, is found above, in the discussion of Sec. 1926.451(a).
Non-Mandatory Appendix B to Subpart L--Criteria for Determining the
Feasibility and Safety of Providing Safe Access and Fall Protection for
Scaffold Erectors and Dismantlers
This space is being reserved for publication of informational
guidance at a later date.
Non-Mandatory Appendix C to Subpart L--List of National Consensus
Standards
This Appendix is provided to serve as a guide to employers required
to provide appropriate employee protection under Sec. 1926.453, Aerial
Lifts. This Appendix reflects the proliferation of equipment-specific
ANSI A92 standards since the adoption of ANSI A92.2-1969.
[[Page 46100]]
Non-Mandatory Appendix D to Subpart L--List of Training Topics for
Scaffold Erectors and Dismantlers
OSHA has developed this Appendix to assist employers in identifying
appropriate topics for training scaffold erectors and dismantlers.
Non-Mandatory Appendix E to Subpart L--Drawings and Illustrations
This Appendix provides drawings of particular types of scaffolds
and scaffold components, and graphic illustrations of bracing patterns
and tie spacing patterns. It is intended to provide visual guidance to
assist the user in complying with the requirements of this standard.
IV. Economic Assessment and Regulatory Flexibility Analysis
Introduction
Executive Order (EO) 12866 requires regulatory agencies to conduct
an economic analysis for rules that meet certain criteria. The most
frequently used criterion under EO 12866 is that the rule will impose
annual costs on the economy of $100 million or more. OSHA's final
standard for scaffolds in construction does not meet this criterion, or
any of the other criteria specified by EO 12866, and therefore does not
require an economic analysis. Nevertheless, OSHA has decided to conduct
such an analysis to provide the regulated community with as much
information about the rule as possible. The Regulatory Flexibility Act
of 1980, as amended in 1996, requires OSHA to determine whether the
Agency's regulatory actions will have a significant impact on a
substantial number of small entities. Making this determination
requires OSHA to perform a screening analysis to identify any such
impacts. Consistent with these requirements, OSHA has prepared this
economic analysis and regulatory flexibility screening analysis of the
final rule for scaffolds in construction. The final rule being
published today will replace the outdated consensus standard addressing
scaffolds in construction that was adopted by OSHA in 1971 and has
remained largely unchanged since then.
This analysis includes a description of the industries affected by
the regulation, an evaluation of the risks addressed, an assessment of
the benefits attributable to the final standard, a determination of the
technological feasibility of the new requirements, an estimate of the
costs of compliance with the standard, a determination of the economic
feasibility of compliance with the standard, and an analysis of the
economic and other impacts associated with this rulemaking, including
those on small businesses. The following is a summary of this analysis,
which is available from OSHA's docket office.
The Final Standard for Scaffolds in Construction
This final standard for scaffolds in the construction industry
makes many changes to the consensus standard adopted by OSHA in 1971
and codified at 29 CFR 1926.450 to 1926.453 (Subpart L of OSHA's
construction industry standards). Appendix A of the Final Economic
Analysis compares, on a provision-by-provision basis, the final
standard with the standard that has been on the books since 1971. In
this economic analysis, the standard being published today is referred
to as the final standard, while the standard it replaces is termed the
``existing'' standard.
One of the important distinctions between the two standards is the
clarity and simplicity of the final standard, which is written in
language that people in the construction industry use to describe
scaffolds and their components. Technical terms required to convey
information accurately and unambiguously are defined clearly in
paragraph (b) of final rule Sec. 1926.450. The final rule also updates
the regulatory text to reflect changes in technology that have occurred
in the quarter century since the existing standard was written. These
changes will permit scaffold manufacturers and users to benefit from
technological change and give them additional flexibility in using up-
to-date equipment. The final standard also clarifies and resolves
issues of terminology or areas of confusion that have been identified
by scaffold users over the years. In the past, OSHA has addressed
implementation problems of this sort in letters of interpretation or
compliance memoranda or directives; the final standard corrects and
revises the provisions that gave rise to these interpretations.
Finally, the final standard adds protection for employees using
scaffolds. The principal areas in the new standard that have been
strengthened are employee training, protection from electrical hazards,
and procedures for employees engaged in the erection and dismantling of
scaffolds. These requirements reflect OSHA's long experience in
accident investigation in the construction industry, as well as an
extensive analysis of the leading causes of scaffold-related fatalities
and injuries.
Affected Industries
The requirements of the final standard apply to all establishments
in the construction industry. As classified by the 1987 Standard
Industrial Classification (SIC) manual, the industry can be divided
into three broad types of activities: building construction general
contractors (SIC 15), heavy construction general and special trade
contractors (SIC 16), and construction by other special trade
contractors (SIC 17).
There are 572,850 establishments in the construction sector
employing approximately 4.7 million employees. Small establishments
with one to nine employees, which represent 82 percent (or 469,349) of
establishments, collectively employ only 1.4 million employees (30
percent). The number of construction workers is estimated to be
approximately 3.6 million. OSHA estimates that there are approximately
2.34 million construction workers (65 percent of all construction
workers) who frequently work on scaffolds and who would be affected by
the final standard for scaffolds.
Evaluation of Risk and Potential Benefits
Of the 510,500 injuries and illnesses reportedly occurring in the
construction industry annually, an estimated 9,750 are related to
scaffolds. Similarly, of the estimated 924 occupational fatalities
occurring annually among construction employees, at least 79 fatalities
are associated with work on scaffolds. OSHA estimates that the new
requirements in the final rule will prevent 47 of these fatalities and
4,455 of these injuries annually; these numbers are above and beyond
the fatalities and injuries that would be prevented if construction
employers complied with OSHA's existing scaffold standard. OSHA
estimates that the total value of the cost savings associated with this
revised standard is $90 million per year. This estimate of cost savings
considers only those scaffold related injuries that involve lost
workdays.
Costs and Technological Feasibility
The total estimated costs associated with the final standard amount
to about $12.62 million annually. The largest single cost ($5.85
million) is associated with inspections of non-suspended scaffolds
before use. The remaining costs are attributable to requirements for
additional training for employees exposed to potential hazards
involving work on scaffolds ($5.30 million) and for fall protection for
employees erecting and dismantling scaffolds\1\ ($1.47 million). Table
ES-1 shows the annual costs of compliance associated with the final
rule.
[[Page 46101]]
Table ES-1.--Annual Costs of Compliance With the Final Rule for
Scaffolds in Construction
------------------------------------------------------------------------
Provision Annual cost
------------------------------------------------------------------------
Training: $5,298,708
Training for Workers Who Use Scaffolds.................. 3,014,949
Training for Scaffold Erectors, Dismantlers, Inspectors
and Repairers.......................................... 2,283,759
Fall Protection for Erectors and Dismantlers of
Scaffolds\1\............................................. 1,466,431
Scaffold Inspection....................................... 5,851,823
-------------
Total............................................... 12,616,962
------------------------------------------------------------------------
Source: US Department of Labor, OSHA, Office of Regulatory Analysis,
1996.
(1) This requirement has a one year delayed implementation date.
Because the requirements of the final standard can be met with
existing equipment and methods, the standard is technologically
feasible.
Economic Impacts
Compliance with the requirements of the final standard has been
determined to be economically feasible and is not expected to produce
significant adverse economic impacts on firms in the construction
industry. The estimated compliance costs represent less than 0.002
percent of construction revenues. Given the minimal price increase
necessary to cover the costs of the final standard, employers should be
able to pass these compliance costs on their customers. However, even
if all costs were absorbed by the affected firms (a highly unlikely
scenario), the average reduction in profits would be only 0.04 percent.
Regulatory Flexibility Screening Analysis
Pursuant to the Regulatory Flexibility Act of 1980 as amended (5
U.S.C. 601 et seq.), OSHA has assessed the small-business impact of the
final standard for scaffolds used in construction, and has certified
based on that assessment and the underlying data, that the standard
will not have a significant impact on a substantial number of small
entities. The controlling consideration for a regulatory flexibility
analysis is whether the standard would impose significant economic
impacts on a substantial number of small entities. The significance of
any economic impact is measured by the effect on profits, market share,
and an entity's financial viability.
The small establishment size standards established by the U.S.
Small Business Administration (SBA) for the construction industry,
which are based on establishment receipts, are $17 million for
establishments in SICs 15 and 16, and $7 million for establishments in
SIC 17. Of the 572,850 establishments affected by the revised standard,
493,637 1 establishments, or about 86 percent of all construction
establishments, are considered small establishments as defined by the
SBA.
---------------------------------------------------------------------------
\1\ 144,671 establishments in SIC 15, 28,206 establishments in
SIC 16 and 320,637 establishments in SIC 17.
---------------------------------------------------------------------------
OSHA assessed the potential economic impacts of the rule on all
affected establishments and has concluded that the rule is economically
feasible and will not impose a substantial burden on construction
employers. As indicated above, firms would only have to increase the
price charged for their services by, at most, 0.002 percent of the
value of their sales in order to recover the money they expended on
compliance. In the unlikely event that firms could not pass any of
these costs to their customers and had to absorb all of the costs
themselves (a highly unlikely scenario), the average reduction in
profits caused by these costs would be only 0.04 percent. On average,
the value of receipts for establishments in the construction industry
is estimated to be $1.12 million. Firms with sales in this range
clearly fall within the SBA size standard.
To ensure that even the smallest firms in this industry would not
be significantly impacted by the costs of compliance associated with
the final standard, OSHA also examined the financial profile for small
construction establishments with 9 or fewer employees at the four-digit
SIC code level, which constitutes the overwhelming majority of firms in
this industry. To examine the impact of the standard on the smallest
and potentially most affected firms, OSHA made a series of extreme-case
assumptions: that all employees in these establishments use scaffolds
in the course of their work and that these establishments have not
implemented any of the new work practices or procedures required by the
final rule. In addition, OSHA assumed that two employees at each firm
would require fall protection systems and training in the erection and
dismantling of supported-scaffolds. Assuming a baseline turnover rate
of 15 percent, and using the formulas presented in Chapter V of the
Economic Analysis, such a small establishment, which represents an
extreme-case impact situation, would incur compliance costs of $603
2 annually.
---------------------------------------------------------------------------
\2\ Annual 15 minute-training for workers who use scaffolds =
$11, annual training cost for erectors and dismantlers = $130,
annual cost of fall protection = $106, and annual scaffold
inspection cost = $356.
---------------------------------------------------------------------------
Table ES-2 presents the results of this extreme-case analysis. It
shows estimated compliance costs and economic impacts relative to
revenues and pre-tax income for small businesses by four-digit SIC code
level. OSHA compared the baseline financial data for these firms with
OSHA's estimate of the standard's annual compliance cost by computing
compliance costs as a percentage of revenue. This approach (Table ES-2)
reflects extreme case impacts because it assumes that employers have to
recover the costs of achieving compliance by increasing their prices.
Under this full cost pass-through scenario, the maximum average
expected price increase required to recover the full costs of
compliance with this standard would be extremely small, approximately
0.1 percent. The four-digit industry estimated to experience the
highest potential price increase would be Painting and Paper Hanging
(SIC 1721), where firms could have to increase prices by 0.18 percent.
Again, since these impacts are based on extreme-case costs, they are
likely to be overestimating.
Under the second scenario used to test the impacts of actions on
markets--the no cost pass-through scenario--firms are assumed not to be
able to pass any of their costs through to their customers in the form
of price increases. If no costs can be passed on, firms would have to
absorb these costs entirely from their profits (a highly unlikely
scenario). Using this assumption, the average expected decline in
profits for these very small firms would be only 1.44 percent. The
largest potential impact of the standard would be anticipated in the
Plastering, Drywall and Acoustical industry (SIC 1742), where firms
could experience a decline in profits of 2.71 percent. Such impacts are
not large enough to be significant because they mean, for example, that
the profit rate for such a company would decline only from 5.0 percent
to 4.9 3 percent. As noted, these figures are based on highly
conservative assumptions and are therefore likely to overestimate
standard's impact.
---------------------------------------------------------------------------
\3\ $22,265/$445,303 = 5.0%, $22,265 x (100 - 2.71%) /$445,303
= 4.9%.
---------------------------------------------------------------------------
Because fixed costs, such as those for preparing training
materials, are larger as a percentage of revenues the smaller the firm,
the smallest firms will experience the greatest economic
[[Page 46102]]
impacts. If the smallest firms, with extreme-case costs, will
experience no significant impact, it is reasonable to conclude that
larger firms will not experience significant economic impacts. Thus,
because this standard will not have a significant impact either on the
smallest establishments (those with 9 or fewer employees) or on the
typical establishment in this industry, OSHA certifies that this final
standard will not have a significant economic impact on a substantial
number of small entities, as defined by the SBA.
Table ES-2.--Economic Impacts of the Final Scaffold Standard on Construction Businesses With 5 Employees. By 4-
Digit SIC, Using Worst-Case Compliance Assumptions
----------------------------------------------------------------------------------------------------------------
Value of Compliance
industry Pre-tax Compliance costs as a
SIC industry receipts per income per costs as a percent of
establishment establishment percent of pre-tax
[a] [b] revenues income
----------------------------------------------------------------------------------------------------------------
15 Building Construction-General Contractors......... $1,039,353 $56,692 0.06 1.06
1521 General Contractors-Single-Family Houses.......... 824,664 61,225 .07 0.98
1522 General Contractors-Residential Buildings......... 989,058 73,430 .06 0.82
1531 Operative Builders................................ 2,459,972 81,999 .02 0.73
1541 General Contractors-Industrial Buildings &
Warehouses............................................. 1,159,689 52,713 .05 1.14
1542 General Contractors-Non-residential Buildings..... 1,278,174 61,972 .05 0.97
16 Heavy Construction Other than Building
Construction........................................... 934,365 59,460 .06 1.01
1622 Bridge, Tunnel and Elevated Highway Construction.. 1,312,204 47,717 .05 1.26
1623 Water, Sewer, Pipeline and Communications......... 832,093 50,430 .07 1.19
1629 Heavy Construction, nec........................... 717,664 50,019 .08 1.20
17 Special Trade Contractors......................... 471,876 32,888 .13 1.83
1711 Plumbing, Heating & Air Conditioning.............. 520,496 31,545 .12 1.91
1721 Painting and Paper Hanging........................ 331,775 30,664 .18 1.96
1731 Electrical Work................................... 463,498 34,411 .13 1.75
1741 Masonry, Stone Setting............................ 357,551 25,462 .17 2.37
1742 Plastering, Drywall, Acoustical................... 445,303 22,265 .14 2.71
1743 Terrazzo, Tile, Marble and Mosaic Work............ 404,702 28,820 .15 2.09
1751 Carpentry Work.................................... 414,681 32,672 .15 1.84
1752 Floor Laying and Other Floor Work, nec............ 573,175 39,949 .11 1.51
1761 Roofing, Siding and Sheet Metal Work.............. 470,902 30,680 .13 1.96
1771 Concrete Work..................................... 510,955 36,386 .12 1.66
1791 Structural Steel Erection......................... 541,947 36,130 .11 1.67
1793 Glass and Glazing Work............................ 555,960 32,852 .11 1.83
1796 Installation or Erection of Building Equipment,
nec.................................................... 581,564 30,841 .10 1.95
1799 Special Trade Contractors, nec.................... 504,453 40,509 .12 1.49
-------------------------------------------------------
Average............................................. ............. ............. .10 1.44
----------------------------------------------------------------------------------------------------------------
Source: U.S. Department of Labor, OSHA, Office of Regulatory Analysis, 1996.
[a] Based on Small Business Administration, Office of Advocacy, Table 3: The Number of Firms, Establishments,
Employment, Annual Payroll, and Estimated Receipts by Industry and Firm Size, 1993.
[b] Average revenue per establishment x mean profit rate for SIC (derived from Dun and Bradstreet Information
Services, Industry Norms and Key Business Ratios 1994-95) x conversion formula based on the federal corporate
tax schedule.
[c] Annual cost of compliance of 603 per establishment assumes that all workers (5) would require training in
the initial year and that all new workers in subsequent years would require training. Two workers will be
trained in dismantling and erecting procedures. Estimates also assume that fall protection will be required
for erectors and dismantlers and that inspections of non-suspended scaffolds will be required.
nec=Not elsewhere classified.
In addition, OSHA has drafted the final standard for scaffolds in
the construction industry to achieve adequate protection for affected
employees while imposing minimal impacts on small employers. For
example, the final rule maintains the performance-oriented approach of
the proposed standard, allowing employers the flexibility to take
workplace conditions into account when framing their compliance
strategies. In addition, OSHA considered and adopted several
alternatives designed to minimize small business impacts. For example,
revisions reflected in the final standard's requirements for fall
protection (grandfathering existing guardrail systems and allowing some
use of crossbracing in lieu of guardrails) will enable small entities
to minimize their compliance burdens. Accordingly, OSHA has determined
that the final rule effectively addresses small employer concerns.
V. Environmental Assessment
Finding of No Significant Impact
This final rule and its major alternatives have been reviewed in
accordance with the requirements of the National Environmental Policy
Act (NEPA) of 1969 (42 U.S.C. 4321 et seq.), the Guidelines of the
Council on Environmental Quality (CEQ) (40 CFR part 1500), and OSHA's
DOL NEPA Procedures (29 CFR part 11). As a result of this review, the
Assistant Secretary for OSHA has determined that the final rule will
have no significant environmental impact.
The revisions to Subpart L--Scaffolds focus on the reduction of
accidents or injuries by means of work practices and procedures, proper
use and handling of equipment, and training, as well as on changes in
language, definition, and format of the standard. These revisions do
not impact on air, water, or soil quality, plant or animal life, the
use of land, or other aspect of the environment. As such, these
revisions are, therefore, categorized as excluded actions according to
subpart B, Sec. 11.10, of the DOL NEPA regulation.
VI. Pertinent Legal Authority
The purpose of the Occupational Safety and Health Act, 29 U.S.C.
Secs. 651
[[Page 46103]]
et seq. (``the Act''), is ``to assure so far as possible every working
man and woman in the Nation safe and healthful working conditions and
to preserve our human resources.'' 29 U.S.C. Sec. 651(b). To achieve
this goal, Congress authorized the Secretary of Labor to promulgate and
enforce occupational safety and health standards. 29 U.S.C.
Secs. 655(a) (authorizing summary adoption of existing consensus and
fe
FR Doc. 96-21289 Safety Standards for Scaffolds Used in the Construction Industry
deral standards within two years of Act's enactment), 655(b)
(authorizing promulgation of standards pursuant to notice and comment),
654(b) (requiring employers to comply with OSHA standards).
A safety or health standard is a standard ``which requires
conditions, or the adoption or use of one or more practices, means,
methods, operations, or processes, reasonably necessary or appropriate
to provide safe or healthful employment.'' 29 U.S.C. Sec. 652(8).
A standard is reasonably necessary or appropriate within the
meaning of Section 652(8) if it substantially reduces or eliminates
significant risk, and is economically feasible, technologically
feasible, cost effective, consistent with prior Agency action or a
justified departure, supported by substantial evidence, and is better
able to effectuate the Act's purposes than any national consensus
standard it supersedes. See 58 Fed. Reg. 16612-16616 (March 30, 1993).
OSHA has generally considered, at minimum, a fatality risk of 1/
1000 over a 45-year working lifetime to be a significant health risk.
See the Benzene standard, Industrial Union Dep't v. American Petroleum
Institute, 448 U.S. 607, 646 (1980); the Asbestos standard, Building
and Constr. Trades Dep't, AFL-CIO v. Brock, 838 F.2d 1258, 1265 (D.C.
Cir 1988); the Formaldehyde standard, International Union, UAW v.
Pendergrass, 878 F.2d 389, 392 (D.C. Cir 1989).
A standard is technologically feasible if the protective measures
it requires already exist, can be brought into existence with available
technology, or can be created with technology that can reasonably be
expected to be developed. American Textile Mfrs. Institute v. OSHA, 452
U.S. 490, 513 (1981) (``ATMI''); AISI v. OSHA, 939 F.2d 975, 980 (D.C.
Cir. 1991).
A standard is economically feasible if industry can absorb or pass
on the costs of compliance without threatening its long term
profitability or competitive structure. See ATMI, 452 U.S. at 530 n.
55; AISI, 939 F.2d at 980.
A standard is cost effective if the protective measures it requires
are the least costly of the available alternatives that achieve the
same level of protection. ATMI, 453 U.S. at 514 n. 32; International
Union, UAW v. OSHA, 37 F.3d 665, 668 (D.C. Cir. 1994) (``LOTO III'').
Section 6(b)(7) authorizes OSHA to include among a standard's
requirements labeling, monitoring, medical testing and other
information gathering and transmittal provisions. 29 U.S.C.
Sec. 655(b)(7).
All standards must be highly protective. See 58 Fed. Reg. at 16614-
16615; LOTO III, 37 F.3d at 669. Finally, whenever practical, standards
shall ``be expressed in terms of objective criteria and of the
performance desired.'' Id.
VII. Recordkeeping
The Agency has estimated the paperwork burden of the final rule
entitled ``Scaffolds Used in the Construction Industry'' under the
guidelines of the Paperwork Reduction Act of 1995. Under that Act,
burden is defined as the total time, effort, or financial resources
expended by persons to generate, maintain, retain, or disclose or
provide information to or for a Federal Agency. The Agency has
concluded that there is only one collection of information in the final
rule on ``Scaffolds Used in the Construction Industry'' that
potentially could create a burden [as defined above] for the
construction industry. The collection of information in located in
Sec. 1926.453(a)(2). This provision requires the employer to obtain a
written certification from the manufacture of aerial lifts under
certain specified conditions. In particular, the requirement reads as
follows:
Aerial lifts may be ``field modified'' for uses other than those
intended by the manufacturer provided the modification has been
certified in writing by the manufacturer or by any other equivalent
entity, such as a nationally recognized testing laboratory, to be in
conformity with all the applicable provisions of the ANSI A92.2-1969
and this section and to be at least as safe as the equipment was
before modification.
This provision was adopted by OSHA in May 1971 as an established
Federal standard which had been promulgated by the Bureau of Labor
Standards for the Construction Industry in April 1971. OSHA failed to
identify this provision as subject to the Paperwork Reduction Act of
1995 (PRA-95) and did not obtain approval from OMB for this collection
as required by PRA-95. This error was discovered in the course of
preparing the final rule for Scaffolds Used in the Construction
Industry. This provision, currently located in Sec. 1926.556(a)(2) is
redesignated as Sec. 1926.453(a)(2) and removed unchanged from its
present location in Subpart N to Subpart L (Scaffolds Used in the
Construction Industry). Through this final rule, OSHA is soliciting
comments on the burden associated with the collection. It is OSHA
intent to review and analyze all comments received on the collection of
information and then to seek proper approvals from OMB under PRA-95.
Once approval is received, OSHA will publish a notice in the Federal
Register to indicate the OMB Approval Number and the effective date of
the provision.
Collections of Information: Request for Comments
The Department of Labor, as part of its continuing effort to reduce
paperwork and respondent burden, conducts a preclearance consultation
program to provide the general public and Federal agencies with an
opportunity to comment on proposed and/or continuing collections of
information in accordance with the Paperwork Reduction Act of 1995
(PRA95) (44 U.S.C. 3506(c)(2)(A)). This program helps to ensure that
requested data can be provided in the desired format, reporting burden
(time and financial resources) is minimized, collection instruments are
clearly understood, and the impact of collection requirements on the
respondents can be properly assessed. Currently, OSHA is soliciting
comments concerning the proposed approval for the paperwork
requirements of 29 CFR part 1926, subpart L, Scaffolds used in the
Construction Industry. Written comments should:
Evaluate whether the proposed collection of information is
necessary for the proper performance of the function of the agency,
including whether the information will have a practical utility;
Evaluate the accuracy of the Agency's estimate of the
burden of the proposed collection of information, including the
validity of the methodology and assumptions used;
Enhance the quality, utility, and clarity of the
information to be collected; and
Minimize the burden of the collection of information on
those who are to respond, including through the use of appropriate
automated, electronic, mechanical, or other technological collection
techniques or other forms of information technology, e.g., permitting
electronic submissions of responses.
Background
OSHA in its final rule for Scaffolds Used in the Construction
Industry is
[[Page 46104]]
redesignating existing Sec. 1926.556 (subpart N), Aerial Lifts to
Sec. 1926.453 (subpart L), Aerial Lifts because these type of equipment
are, in fact, scaffolds. The existing regulation, Sec. 1926.556(a)(2),
contained a requirement for manufacturer certification of ``field
modified'' aerial lifts. This provision, along with the rest of
Sec. 1296.556, is being redesignated Sec. 1926.453(a)(2) in this final
rule.
OSHA believes that manufacturer certification of ``field modified''
aerial lifts is necessary to ensure that modifications to these types
of scaffolds will not adversely affect the strength, stability, or
other characteristics necessary for their safe use.
Current Actions
This notice requests OMB approval of the paperwork requirements in
Scaffolds Used in the Construction Industry (29 CFR 1926, subpart L).
Type of Review: New.
Agency: Occupational Safety and Health Administration, U.S.
Department of Labor.
Title: Scaffolds Used in the Construction Industry (29 CFR 1926,
subpart L).
OMB Number: 1218-AA40.
Agency Docket No.: S-205.
Frequency: On occasion.
Affected Public: Business or other for-profit, Federal government,
State and local governments.
Number of respondents: 10,000.
Estimated Time per Respondent: 2 hours.
Total Estimated Cost: $513,200.
Total Burden Hours: 20,000.
Comments submitted in response to this notice will be summarized
and/or included in the request for Office of Management and Budget
approval of the information collection request. They will also become a
matter of public record.
VIII. State Plan Standards
The 25 states and territories with their own OSHA-approved
occupational safety and health plans must adopt a comparable standard
within 6 months of the publication date of the final rule. These states
and territories are: Alaska, Arizona, California, Connecticut (for
State and local government employees only), Hawaii, Indiana, Iowa,
Kentucky, Maryland, Michigan, Minnesota, New York (for State and local
government employees only), Nevada, New Mexico, North Carolina, Oregon,
Puerto Rico, South Carolina, Tennessee, Utah, Vermont, Virginia, Virgin
Islands, Washington, and Wyoming. Until such time as a comparable
standard is promulgated, Federal OSHA will provide interim enforcement
assistance, as appropriate, in these states and territories.
IX. Federalism
The final rule has been reviewed in accordance with Executive Order
12612 (52 FR 41685, October 30, 1987) regarding Federalism. The Order
requires that agencies, to the extent possible, refrain from limiting
State policy options, consult with states prior to taking any actions
that would restrict State policy options, and take such actions only
when there is clear constitutional authority and the presence of a
problem of national scope. The Order provides for preemption of State
law only if there is a clear Congressional intent for the agency to do
so. Any such preemption is to be limited to the extent possible.
Section 18 of the Occupational Safety and Health Act (OSH Act),
expresses Congress' clear intent to preempt State laws relating to
issues with respect to which Federal OSHA has promulgated occupational
safety and health standards. Under the OSH Act, a State can avoid
preemption only if it submits, and obtains Federal approval of a plan
for the development of such standards and their enforcement.
Occupational safety and health standards developed by such Plan States
must, among other things, be at least as effective in providing safe
and healthful employment and places of employment as the Federal
standards. Where such standards are applicable to products distributed
or used in interstate commerce, they may not unduly burden commerce and
must be justified by compelling local conditions, see section 18(c)(2).
The Federal standard on construction operations involving scaffolds
addresses hazards that are not unique to any one state or region of the
country. Nonetheless, States with occupational safety and health plans
approved under section 18 of the OSH Act will be able to develop their
own State standards to deal with any special problems which might be
encountered in a particular State. Moreover, because this standard is
written in general, performance-oriented terms, there is considerable
flexibility to State plans to require, and for affected employers to
use, methods of compliance which are appropriate to the working
conditions covered by the standard.
In brief, this final rule addresses a clear national problem
related to occupational safety and health in the construction industry.
Those states which have elected to participate under section 18 of the
OSH Act are not preempted by this standard, and will be able to address
any special conditions within the framework of the Federal Act while
ensuring that the state standards are at least as effective as that
standard.
List of Subjects in 29 CFR Part 1926
Construction industry, Construction safety, Occupational safety and
health, Protective equipment, Safety, Scaffolds.
Authority
This document was prepared under the direction of Joseph A. Dear,
Assistant Secretary of Labor for Occupational Safety and Health, U.S.
Department of Labor, 200 Constitution Avenue, N.W., Washington, D.C.
20210.
Accordingly, pursuant to sections 4, 6, and 8 of the Occupational
Safety and Health Act of 1970 (29 U.S.C. 653, 655, 657), section 107 of
the Contract Work Hours and Safety Standards Act (40 U.S.C. 333),
Secretary of Labor's Order No. 1-90 (55 FR 9033), and 29 CFR part 1911,
29 CFR part 1926 is amended as set forth below.
Signed at Washington, D.C., this 16th day of August 1996.
Joseph A. Dear,
Assistant Secretary of Labor.
PART 1926--[AMENDED]
1. Subpart L of Part 1926 is revised to read as follows:
Subpart L--Scaffolds
Sec.
1926.450 Scope, application and definitions applicable to this
subpart.
1926.451 General requirements.
1926.452 Additional requirements applicable to specific types of
scaffolds.
1926.453 Aerial lifts.
1926.454 Training.
Appendix A to Subpart L--Scaffolds
Appendix B to Subpart L--Scaffolds
Appendix C to Subpart L--Scaffolds
Appendix D to Subpart L--Scaffolds
Appendix E to Subpart L--Scaffolds
Authority: Section 107, Contract Work Hours and Safety Standards
Act (Construction Safety Act) (40 U.S.C. 333); Secs. 4, 6, 8,
Occupational Safety and Health Act of 1970 (29 U.S.C. 653, 655,
657); Secretary of Labor's Order No. 1-90 (55 FR 9033); and 29 CFR
Part 1911.
Subpart L--Scaffolds
Sec. 1926.450 Scope, application and definitions applicable to this
subpart.
(a) Scope and application. This subpart applies to all scaffolds
used in workplaces covered by this part. It does not apply to crane or
derrick suspended personnel platforms, which are covered by
Sec. 1926.550(g). The criteria for aerial lifts are set out exclusively
in Sec. 1926.453.
[[Page 46105]]
(b) Definitions. Adjustable suspension scaffold means a suspension
scaffold equipped with a hoist(s) that can be operated by an
employee(s) on the scaffold.
Bearer (putlog) means a horizontal transverse scaffold member
(which may be supported by ledgers or runners) upon which the scaffold
platform rests and which joins scaffold uprights, posts, poles, and
similar members.
Boatswains' chair means a single-point adjustable suspension
scaffold consisting of a seat or sling designed to support one employee
in a sitting position.
Body belt (safety belt) means a strap with means both for securing
it about the waist and for attaching it to a lanyard, lifeline, or
deceleration device.
Body harness means a design of straps which may be secured about
the employee in a manner to distribute the fall arrest forces over at
least the thighs, pelvis, waist, chest and shoulders, with means for
attaching it to other components of a personal fall arrest system.
Brace means a rigid connection that holds one scaffold member in a
fixed position with respect to another member, or to a building or
structure.
Bricklayers' square scaffold means a supported scaffold composed of
framed squares which support a platform.
Carpenters' bracket scaffold means a supported scaffold consisting
of a platform supported by brackets attached to building or structural
walls.
Catenary scaffold means a suspension scaffold consisting of a
platform supported by two essentially horizontal and parallel ropes
attached to structural members of a building or other structure.
Additional support may be provided by vertical pickups.
Chimney hoist means a multi-point adjustable suspension scaffold
used to provide access to work inside chimneys. (See ``Multi-point
adjustable suspension scaffold''.)
Cleat means a structural block used at the end of a platform to
prevent the platform from slipping off its supports. Cleats are also
used to provide footing on sloped surfaces such as crawling boards.
Competent person means one who is capable of identifying existing
and predictable hazards in the surroundings or working conditions which
are unsanitary, hazardous, or dangerous to employees, and who has
authorization to take prompt corrective measures to eliminate them.
Continuous run scaffold (Run scaffold) means a two- point or multi-
point adjustable suspension scaffold constructed using a series of
interconnected braced scaffold members or supporting structures erected
to form a continuous scaffold.
Coupler means a device for locking together the tubes of a tube and
coupler scaffold.
Crawling board (chicken ladder) means a supported scaffold
consisting of a plank with cleats spaced and secured to provide
footing, for use on sloped surfaces such as roofs.
Deceleration device means any mechanism, such as a rope grab, rip-
stitch lanyard, specially-woven lanyard, tearing or deforming lanyard,
or automatic self-retracting lifeline lanyard, which dissipates a
substantial amount of energy during a fall arrest or limits the energy
imposed on an employee during fall arrest.
Double pole (independent pole) scaffold means a supported scaffold
consisting of a platform(s) resting on cross beams (bearers) supported
by ledgers and a double row of uprights independent of support (except
ties, guys, braces) from any structure.
Equivalent means alternative designs, materials or methods to
protect against a hazard which the employer can demonstrate will
provide an equal or greater degree of safety for employees than the
methods, materials or designs specified in the standard.
Exposed power lines means electrical power lines which are
accessible to employees and which are not shielded from contact. Such
lines do not include extension cords or power tool cords.
Eye or Eye splice means a loop with or without a thimble at the end
of a wire rope.
Fabricated decking and planking means manufactured platforms made
of wood (including laminated wood, and solid sawn wood planks), metal
or other materials.
Fabricated frame scaffold (tubular welded frame scaffold) means a
scaffold consisting of a platform(s) supported on fabricated end frames
with integral posts, horizontal bearers, and intermediate members.
Failure means load refusal, breakage, or separation of component
parts. Load refusal is the point where the ultimate strength is
exceeded.
Float (ship) scaffold means a suspension scaffold consisting of a
braced platform resting on two parallel bearers and hung from overhead
supports by ropes of fixed length.
Form scaffold means a supported scaffold consisting of a platform
supported by brackets attached to formwork.
Guardrail system means a vertical barrier, consisting of, but not
limited to, toprails, midrails, and posts, erected to prevent employees
from falling off a scaffold platform or walkway to lower levels.
Hoist means a manual or power-operated mechanical device to raise
or lower a suspended scaffold.
Horse scaffold means a supported scaffold consisting of a platform
supported by construction horses (saw horses). Horse scaffolds
constructed of metal are sometimes known as trestle scaffolds.
Independent pole scaffold (see ``Double pole scaffold'').
Interior hung scaffold means a suspension scaffold consisting of a
platform suspended from the ceiling or roof structure by fixed length
supports.
Ladder jack scaffold means a supported scaffold consisting of a
platform resting on brackets attached to ladders.
Ladder stand means a mobile, fixed-size, self-supporting ladder
consisting of a wide flat tread ladder in the form of stairs.
Landing means a platform at the end of a flight of stairs.
Large area scaffold means a pole scaffold, tube and coupler
scaffold, systems scaffold, or fabricated frame scaffold erected over
substantially the entire work area. For example: a scaffold erected
over the entire floor area of a room.
Lean-to scaffold means a supported scaffold which is kept erect by
tilting it toward and resting it against a building or structure.
Lifeline means a component consisting of a flexible line that
connects to an anchorage at one end to hang vertically (vertical
lifeline), or that connects to anchorages at both ends to stretch
horizontally (horizontal lifeline), and which serves as a means for
connecting other components of a personal fall arrest system to the
anchorage.
Lower levels means areas below the level where the employee is
located and to which an employee can fall. Such areas include, but are
not limited to, ground levels, floors, roofs, ramps, runways,
excavations, pits, tanks, materials, water, and equipment.
Masons' adjustable supported scaffold (see ``Self-contained
adjustable scaffold'').
Masons' multi-point adjustable suspension scaffold means a
continuous run suspension scaffold designed and used for masonry
operations.
Maximum intended load means the total load of all persons,
equipment, tools, materials, transmitted loads, and other loads
reasonably anticipated to be applied to a scaffold or scaffold
component at any one time.
[[Page 46106]]
Mobile scaffold means a powered or unpowered, portable, caster or
wheel-mounted supported scaffold.
Multi-level suspended scaffold means a two-point or multi-point
adjustable suspension scaffold with a series of platforms at various
levels resting on common stirrups.
Multi-point adjustable suspension scaffold means a suspension
scaffold consisting of a platform(s) which is suspended by more than
two ropes from overhead supports and equipped with means to raise and
lower the platform to desired work levels. Such scaffolds include
chimney hoists.
Needle beam scaffold means a platform suspended from needle beams.
Open sides and ends means the edges of a platform that are more
than 14 inches (36 cm) away horizontally from a sturdy, continuous,
vertical surface (such as a building wall) or a sturdy, continuous
horizontal surface (such as a floor), or a point of access. Exception:
For plastering and lathing operations the horizontal threshold distance
is 18 inches (46 cm).
Outrigger means the structural member of a supported scaffold used
to increase the base width of a scaffold in order to provide support
for and increased stability of the scaffold.
Outrigger beam (Thrustout) means the structural member of a
suspension scaffold or outrigger scaffold which provides support for
the scaffold by extending the scaffold point of attachment to a point
out and away from the structure or building.
Outrigger scaffold means a supported scaffold consisting of a
platform resting on outrigger beams (thrustouts) projecting beyond the
wall or face of the building or structure, the inboard ends of which
are secured inside the building or structure.
Overhand bricklaying means the process of laying bricks and masonry
units such that the surface of the wall to be jointed is on the
opposite side of the wall from the mason, requiring the mason to lean
over the wall to complete the work. It includes mason tending and
electrical installation incorporated into the brick wall during the
overhand bricklaying process.
Personal fall arrest system means a system used to arrest an
employee's fall. It consists of an anchorage, connectors, a body belt
or body harness and may include a lanyard, deceleration device,
lifeline, or combinations of these.
Platform means a work surface elevated above lower levels.
Platforms can be constructed using individual wood planks, fabricated
planks, fabricated decks, and fabricated platforms.
Pole scaffold (see definitions for ``Single-pole scaffold'' and
``Double (independent) pole scaffold'').
Power operated hoist means a hoist which is powered by other than
human energy.
Pump jack scaffold means a supported scaffold consisting of a
platform supported by vertical poles and movable support brackets.
Qualified means one who, by possession of a recognized degree,
certificate, or professional standing, or who by extensive knowledge,
training, and experience, has successfully demonstrated his/her ability
to solve or resolve problems related to the subject matter, the work,
or the project.
Rated load means the manufacturer's specified maximum load to be
lifted by a hoist or to be applied to a scaffold or scaffold component.
Repair bracket scaffold means a supported scaffold consisting of a
platform supported by brackets which are secured in place around the
circumference or perimeter of a chimney, stack, tank or other
supporting structure by one or more wire ropes placed around the
supporting structure.
Roof bracket scaffold means a rooftop supported scaffold consisting
of a platform resting on angular-shaped supports.
Runner (ledger or ribbon) means the lengthwise horizontal spacing
or bracing member which may support the bearers.
Scaffold means any temporary elevated platform (supported or
suspended) and its supporting structure (including points of
anchorage), used for supporting employees or materials or both.
Self-contained adjustable scaffold means a combination supported
and suspension scaffold consisting of an adjustable platform(s) mounted
on an independent supporting frame(s) not a part of the object being
worked on, and which is equipped with a means to permit the raising and
lowering of the platform(s). Such systems include rolling roof rigs,
rolling outrigger systems, and some masons' adjustable supported
scaffolds.
Shore scaffold means a supported scaffold which is placed against a
building or structure and held in place with props.
Single-point adjustable suspension scaffold means a suspension
scaffold consisting of a platform suspended by one rope from an
overhead support and equipped with means to permit the movement of the
platform to desired work levels.
Single-pole scaffold means a supported scaffold consisting of a
platform(s) resting on bearers, the outside ends of which are supported
on runners secured to a single row of posts or uprights, and the inner
ends of which are supported on or in a structure or building wall.
Stair tower (Scaffold stairway/tower) means a tower comprised of
scaffold components and which contains internal stairway units and rest
platforms. These towers are used to provide access to scaffold
platforms and other elevated points such as floors and roofs.
Stall load means the load at which the prime-mover of a power-
operated hoist stalls or the power to the prime-mover is automatically
disconnected.
Step, platform, and trestle ladder scaffold means a platform
resting directly on the rungs of step ladders or trestle ladders.
Stilts means a pair of poles or similar supports with raised
footrests, used to permit walking above the ground or working surface.
Stonesetters' multi-point adjustable suspension scaffold means a
continuous run suspension scaffold designed and used for stonesetters'
operations.
Supported scaffold means one or more platforms supported by
outrigger beams, brackets, poles, legs, uprights, posts, frames, or
similar rigid support.
Suspension scaffold means one or more platforms suspended by ropes
or other non-rigid means from an overhead structure(s).
System scaffold means a scaffold consisting of posts with fixed
connection points that accept runners, bearers, and diagonals that can
be interconnected at predetermined levels.
Tank builders' scaffold means a supported scaffold consisting of a
platform resting on brackets that are either directly attached to a
cylindrical tank or attached to devices that are attached to such a
tank.
Top plate bracket scaffold means a scaffold supported by brackets
that hook over or are attached to the top of a wall. This type of
scaffold is similar to carpenters' bracket scaffolds and form scaffolds
and is used in residential construction for setting trusses.
Tube and coupler scaffold means a supported or suspended scaffold
consisting of a platform(s) supported by tubing, erected with coupling
devices connecting uprights, braces, bearers, and runners.
Tubular welded frame scaffold (see ``Fabricated frame scaffold'').
Two-point suspension scaffold (swing stage) means a suspension
scaffold consisting of a platform supported by hangers (stirrups)
suspended by two ropes from overhead supports and equipped with means
to permit the
[[Page 46107]]
raising and lowering of the platform to desired work levels.
Unstable objects means items whose strength, configuration, or lack
of stability may allow them to become dislocated and shift and
therefore may not properly support the loads imposed on them. Unstable
objects do not constitute a safe base support for scaffolds, platforms,
or employees. Examples include, but are not limited to, barrels, boxes,
loose brick, and concrete blocks.
Vertical pickup means a rope used to support the horizontal rope in
catenary scaffolds.
Walkway means a portion of a scaffold platform used only for access
and not as a work level.
Window jack scaffold means a platform resting on a bracket or jack
which projects through a window opening.
Sec. 1926.451 General requirements.
This section does not apply to aerial lifts, the criteria for which
are set out exclusively in Sec. 1926.453.
(a) Capacity (1) Except as provided in paragraphs (a)(2), (a)(3),
(a)(4), (a)(5) and (g) of this section, each scaffold and scaffold
component shall be capable of supporting, without failure, its own
weight and at least 4 times the maximum intended load applied or
transmitted to it.
(2) Direct connections to roofs and floors, and counterweights used
to balance adjustable suspension scaffolds, shall be capable of
resisting at least 4 times the tipping moment imposed by the scaffold
operating at either the rated load of the hoist, or 1.5 (minimum) times
the tipping moment imposed by the scaffold operating at the stall load
of the hoist, whichever is greater.
(3) Each suspension rope, including connecting hardware, used on
non-adjustable suspension scaffolds shall be capable of supporting,
without failure, at least 6 times the maximum intended load applied or
transmitted to that rope.
(4) Each suspension rope, including connecting hardware, used on
adjustable suspension scaffolds shall be capable of supporting, without
failure, at least 6 times the maximum intended load applied or
transmitted to that rope with the scaffold operating at either the
rated load of the hoist, or 2 (minimum) times the stall load of the
hoist, whichever is greater.
(5) The stall load of any scaffold hoist shall not exceed 3 times
its rated load.
(6) Scaffolds shall be designed by a qualified person and shall be
constructed and loaded in accordance with that design. Non-mandatory
Appendix A to this subpart contains examples of criteria that will
enable an employer to comply with paragraph (a) of this section.
(b) Scaffold platform construction. (1) Each platform on all
working levels of scaffolds shall be fully planked or decked between
the front uprights and the guardrail supports as follows:
(i) Each platform unit (e.g., scaffold plank, fabricated plank,
fabricated deck, or fabricated platform) shall be installed so that the
space between adjacent units and the space between the platform and the
uprights is no more than 1 inch (2.5 cm) wide, except where the
employer can demonstrate that a wider space is necessary (for example,
to fit around uprights when side brackets are used to extend the width
of the platform).
(ii) Where the employer makes the demonstration provided for in
paragraph (b)(1)(i) of this section, the platform shall be planked or
decked as fully as possible and the remaining open space between the
platform and the uprights shall not exceed 9\1/2\ inches (24.1 cm).
Exception to paragraph (b)(1): The requirement in paragraph (b)(1)
to provide full planking or decking does not apply to platforms used
solely as walkways or solely by employees performing scaffold erection
or dismantling. In these situations, only the planking that the
employer establishes is necessary to provide safe working conditions is
required.
(2) Except as provided in paragraphs (b)(2)(i) and (b)(2)(ii) of
this section, each scaffold platform and walkway shall be at least 18
inches (46 cm) wide.
(i) Each ladder jack scaffold, top plate bracket scaffold, roof
bracket scaffold, and pump jack scaffold shall be at least 12 inches
(30 cm) wide. There is no minimum width requirement for boatswains'
chairs.
(ii) Where scaffolds must be used in areas that the employer can
demonstrate are so narrow that platforms and walkways cannot be at
least 18 inches (46 cm) wide, such platforms and walkways shall be as
wide as feasible, and employees on those platforms and walkways shall
be protected from fall hazards by the use of guardrails and/or personal
fall arrest systems.
(3) Except as provided in paragraphs (b)(3) (i) and (ii) of this
section, the front edge of all platforms shall not be more than 14
inches (36 cm) from the face of the work, unless guardrail systems are
erected along the front edge and/or personal fall arrest systems are
used in accordance with paragraph (g) of this section to protect
employees from falling.
(i) The maximum distance from the face for outrigger scaffolds
shall be 3 inches (8 cm);
(ii) The maximum distance from the face for plastering and lathing
operations shall be 18 inches (46 cm).
(4) Each end of a platform, unless cleated or otherwise restrained
by hooks or equivalent means, shall extend over the centerline of its
support at least 6 inches (15 cm).
(5)(i) Each end of a platform 10 feet or less in length shall not
extend over its support more than 12 inches (30 cm) unless the platform
is designed and installed so that the cantilevered portion of the
platform is able to support employees and/or materials without tipping,
or has guardrails which block employee access to the cantilevered end.
(ii) Each platform greater than 10 feet in length shall not extend
over its support more than 18 inches (46 cm), unless it is designed and
installed so that the cantilevered portion of the platform is able to
support employees without tipping, or has guardrails which block
employee access to the cantilevered end.
(6) On scaffolds where scaffold planks are abutted to create a long
platform, each abutted end shall rest on a separate support surface.
This provision does not preclude the use of common support members,
such as ``T'' sections, to support abutting planks, or hook on
platforms designed to rest on common supports.
(7) On scaffolds where platforms are overlapped to create a long
platform, the overlap shall occur only over supports, and shall not be
less than 12 inches (30 cm) unless the platforms are nailed together or
otherwise restrained to prevent movement.
(8) At all points of a scaffold where the platform changes
direction, such as turning a corner, any platform that rests on a
bearer at an angle other than a right angle shall be laid first, and
platforms which rest at right angles over the same bearer shall be laid
second, on top of the first platform.
(9) Wood platforms shall not be covered with opaque finishes,
except that platform edges may be covered or marked for identification.
Platforms may be coated periodically with wood preservatives, fire-
retardant finishes, and slip-resistant finishes; however, the coating
may not obscure the top or bottom wood surfaces.
(10) Scaffold components manufactured by different manufacturers
shall not be intermixed unless the components fit together without
force and the scaffold's structural integrity is maintained by the
[[Page 46108]]
user. Scaffold components manufactured by different manufacturers shall
not be modified in order to intermix them unless a competent person
determines the resulting scaffold is structurally sound.
(11) Scaffold components made of dissimilar metals shall not be
used together unless a competent person has determined that galvanic
action will not reduce the strength of any component to a level below
that required by paragraph (a)(1) of this section.
(c) Criteria for supported scaffolds. (1) Supported scaffolds with
a height to base width (including outrigger supports, if used) ratio of
more than four to one (4:1) shall be restrained from tipping by guying,
tying, bracing, or equivalent means, as follows:
(i) Guys, ties, and braces shall be installed at locations where
horizontal members support both inner and outer legs.
(ii) Guys, ties, and braces shall be installed according to the
scaffold manufacturer's recommendations or at the closest horizontal
member to the 4:1 height and be repeated vertically at locations of
horizontal members every 20 feet (6.1 m) or less thereafter for
scaffolds 3 feet (0.91 m) wide or less, and every 26 feet (7.9 m) or
less thereafter for scaffolds greater than 3 feet (0.91 m) wide. The
top guy, tie or brace of completed scaffolds shall be placed no further
than the 4:1 height from the top. Such guys, ties and braces shall be
installed at each end of the scaffold and at horizontal intervals not
to exceed 30 feet (9.1 m) (measured from one end [not both] towards the
other).
(iii) Ties, guys, braces, or outriggers shall be used to prevent
the tipping of supported scaffolds in all circumstances where an
eccentric load, such as a cantilevered work platform, is applied or is
transmitted to the scaffold.
(2) Supported scaffold poles, legs, posts, frames, and uprights
shall bear on base plates, mud sills or other adequate firm foundation.
(i) Footings shall be level, sound, rigid, and capable of
supporting the loaded scaffold without settling or displacement.
(ii) Unstable objects shall not be used to support scaffolds or
platform units.
(iii) Unstable objects shall not be used as working platforms.
(iv) Front-end loaders and similar pieces of equipment shall not be
used to support scaffold platforms unless they have been specifically
designed by the manufacturer for such use.
(v) Fork-lifts shall not be used to support scaffold platforms
unless the entire platform is attached to the fork and the fork-lift is
not moved horizontally while the platform is occupied.
(3) Supported scaffold poles, legs, posts, frames, and uprights
shall be plumb and braced to prevent swaying and displacement.
(d) Criteria for suspension scaffolds. (1) All suspension scaffold
support devices, such as outrigger beams, cornice hooks, parapet
clamps, and similar devices, shall rest on surfaces capable of
supporting at least 4 times the load imposed on them by the scaffold
operating at the rated load of the hoist (or at least 1.5 times the
load imposed on them by the scaffold at the stall capacity of the
hoist, whichever is greater).
(2) Suspension scaffold outrigger beams, when used, shall be made
of structural metal or equivalent strength material, and shall be
restrained to prevent movement.
(3) The inboard ends of suspension scaffold outrigger beams shall
be stabilized by bolts or other direct connections to the floor or roof
deck, or they shall have their inboard ends stabilized by
counterweights, except masons' multi-point adjustable suspension
scaffold outrigger beams shall not be stabilized by counterweights.
(i) Before the scaffold is used, direct connections shall be
evaluated by a competent person who shall confirm, based on the
evaluation, that the supporting surfaces are capable of supporting the
loads to be imposed. In addition, masons' multi-point adjustable
suspension scaffold connections shall be designed by an engineer
experienced in such scaffold design.
(ii) Counterweights shall be made of non-flowable material. Sand,
gravel and similar materials that can be easily dislocated shall not be
used as counterweights.
(iii) Only those items specifically designed as counterweights
shall be used to counterweight scaffold systems. Construction materials
such as, but not limited to, masonry units and rolls of roofing felt,
shall not be used as counterweights.
(iv) Counterweights shall be secured by mechanical means to the
outrigger beams to prevent accidental displacement.
(v) Counterweights shall not be removed from an outrigger beam
until the scaffold is disassembled.
(vi) Outrigger beams which are not stabilized by bolts or other
direct connections to the floor or roof deck shall be secured by
tiebacks.
(vii) Tiebacks shall be equivalent in strength to the suspension
ropes.
(viii) Outrigger beams shall be placed perpendicular to its bearing
support (usually the face of the building or structure). However, where
the employer can demonstrate that it is not possible to place an
outrigger beam perpendicular to the face of the building or structure
because of obstructions that cannot be moved, the outrigger beam may be
placed at some other angle, provided opposing angle tiebacks are used.
(ix) Tiebacks shall be secured to a structurally sound anchorage on
the building or structure. Sound anchorages include structural members,
but do not include standpipes, vents, other piping systems, or
electrical conduit.
(x) Tiebacks shall be installed perpendicular to the face of the
building or structure, or opposing angle tiebacks shall be installed.
Single tiebacks installed at an angle are prohibited.
(4) Suspension scaffold outrigger beams shall be:
(i) Provided with stop bolts or shackles at both ends;
(ii) Securely fastened together with the flanges turned out when
channel iron beams are used in place of I-beams;
(iii) Installed with all bearing supports perpendicular to the beam
center line;
(iv) Set and maintained with the web in a vertical position; and
(v) When an outrigger beam is used, the shackle or clevis with
which the rope is attached to the outrigger beam shall be placed
directly over the center line of the stirrup.
(5) Suspension scaffold support devices such as cornice hooks, roof
hooks, roof irons, parapet clamps, or similar devices shall be:
(i) Made of steel, wrought iron, or materials of equivalent
strength;
(ii) Supported by bearing blocks; and
(iii) Secured against movement by tiebacks installed at right
angles to the face of the building or structure, or opposing angle
tiebacks shall be installed and secured to a structurally sound point
of anchorage on the building or structure. Sound points of anchorage
include structural members, but do not include standpipes, vents, other
piping systems, or electrical conduit.
(iv) Tiebacks shall be equivalent in strength to the hoisting rope.
(6) When winding drum hoists are used on a suspension scaffold,
they shall contain not less than four wraps of the suspension rope at
the lowest point of scaffold travel. When other types of hoists are
used, the suspension ropes shall be long enough to allow the scaffold
to be lowered to the level below without the rope end passing through
[[Page 46109]]
the hoist, or the rope end shall be configured or provided with means
to prevent the end from passing through the hoist.
(7) The use of repaired wire rope as suspension rope is prohibited.
(8) Wire suspension ropes shall not be joined together except
through the use of eye splice thimbles connected with shackles or
coverplates and bolts.
(9) The load end of wire suspension ropes shall be equipped with
proper size thimbles and secured by eyesplicing or equivalent means.
(10) Ropes shall be inspected for defects by a competent person
prior to each workshift and after every occurrence which could affect a
rope's integrity. Ropes shall be replaced if any of the following
conditions exist:
(i) Any physical damage which impairs the function and strength of
the rope.
(ii) Kinks that might impair the tracking or wrapping of rope
around the drum(s) or sheave(s).
(iii) Six randomly distributed broken wires in one rope lay or
three broken wires in one strand in one rope lay.
(iv) Abrasion, corrosion, scrubbing, flattening or peening causing
loss of more than one-third of the original diameter of the outside
wires.
(v) Heat damage caused by a torch or any damage caused by contact
with electrical wires.
(vi) Evidence that the secondary brake has been activated during an
overspeed condition and has engaged the suspension rope.
(11) Swaged attachments or spliced eyes on wire suspension ropes
shall not be used unless they are made by the wire rope manufacturer or
a qualified person.
(12) When wire rope clips are used on suspension scaffolds:
(i) There shall be a minimum of 3 wire rope clips installed, with
the clips a minimum of 6 rope diameters apart;
(ii) Clips shall be installed according to the manufacturer's
recommendations;
(iii) Clips shall be retightened to the manufacturer's
recommendations after the initial loading;
(iv) Clips shall be inspected and retightened to the manufacturer's
recommendations at the start of each workshift thereafter;
(v) U-bolt clips shall not be used at the point of suspension for
any scaffold hoist;
(vi) When U-bolt clips are used, the U-bolt shall be placed over
the dead end of the rope, and the saddle shall be placed over the live
end of the rope.
(13) Suspension scaffold power-operated hoists and manual hoists
shall be tested and listed by a qualified testing laboratory.
(14) Gasoline-powered equipment and hoists shall not be used on
suspension scaffolds.
(15) Gears and brakes of power-operated hoists used on suspension
scaffolds shall be enclosed.
(16) In addition to the normal operating brake, suspension scaffold
power-operated hoists and manually operated hoists shall have a braking
device or locking pawl which engages automatically when a hoist makes
either of the following uncontrolled movements: an instantaneous change
in momentum or an accelerated overspeed.
(17) Manually operated hoists shall require a positive crank force
to descend.
(18) Two-point and multi-point suspension scaffolds shall be tied
or otherwise secured to prevent them from swaying, as determined to be
necessary based on an evaluation by a competent person. Window
cleaners' anchors shall not be used for this purpose.
(19) Devices whose sole function is to provide emergency escape and
rescue shall not be used as working platforms. This provision does not
preclude the use of systems which are designed to function both as
suspension scaffolds and emergency systems.
(e) Access. This paragraph applies to scaffold access for all
employees. Access requirements for employees erecting or dismantling
supported scaffolds are specifically addressed in paragraph (e)(9) of
this section.
(1) When scaffold platforms are more than 2 feet (0.6 m) above or
below a point of access, portable ladders, hook-on ladders, attachable
ladders, stair towers (scaffold stairways/towers), stairway-type
ladders (such as ladder stands), ramps, walkways, integral
prefabricated scaffold access, or direct access from another scaffold,
structure, personnel hoist, or similar surface shall be used.
Crossbraces shall not be used as a means of access.
(2) Portable, hook-on, and attachable ladders (Additional
requirements for the proper construction and use of portable ladders
are contained in subpart X of this part--Stairways and Ladders):
(i) Portable, hook-on, and attachable ladders shall be positioned
so as not to tip the scaffold;
(ii) Hook-on and attachable ladders shall be positioned so that
their bottom rung is not more than 24 inches (61 cm) above the scaffold
supporting level;
(iii) When hook-on and attachable ladders are used on a supported
scaffold more than 35 feet (10.7 m) high, they shall have rest
platforms at 35-foot (10.7 m) maximum vertical intervals.
(iv) Hook-on and attachable ladders shall be specifically designed
for use with the type of scaffold used;
(v) Hook-on and attachable ladders shall have a minimum rung length
of 11\1/2\ inches (29 cm); and
(vi) Hook-on and attachable ladders shall have uniformly spaced
rungs with a maximum spacing between rungs of 16\3/4\ inches.
(3) Stairway-type ladders shall:
(i) Be positioned such that their bottom step is not more than 24
inches (61 cm) above the scaffold supporting level;
(ii) Be provided with rest platforms at 12 foot (3.7 m) maximum
vertical intervals;
(iii) Have a minimum step width of 16 inches (41 cm), except that
mobile scaffold stairway-type ladders shall have a minimum step width
of 11\1/2\ inches (30 cm); and
(iv) Have slip-resistant treads on all steps and landings.
(4) Stairtowers (scaffold stairway/towers) shall be positioned such
that their bottom step is not more than 24 inches (61 cm.) above the
scaffold supporting level.
(i) A stairrail consisting of a toprail and a midrail shall be
provided on each side of each scaffold stairway.
(ii) The toprail of each stairrail system shall also be capable of
serving as a handrail, unless a separate handrail is provided.
(iii) Handrails, and toprails that serve as handrails, shall
provide an adequate handhold for employees grasping them to avoid
falling.
(iv) Stairrail systems and handrails shall be surfaced to prevent
injury to employees from punctures or lacerations, and to prevent
snagging of clothing.
(v) The ends of stairrail systems and handrails shall be
constructed so that they do not constitute a projection hazard.
(vi) Handrails, and toprails that are used as handrails, shall be
at least 3 inches (7.6 cm) from other objects.
(vii) Stairrails shall be not less than 28 inches (71 cm) nor more
than 37 inches (94 cm) from the upper surface of the stairrail to the
surface of the tread, in line with the face of the riser at the forward
edge of the tread.
(viii) A landing platform at least 18 inches (45.7 cm) wide by at
least 18 inches (45.7 cm) long shall be provided at each level.
(ix) Each scaffold stairway shall be at least 18 inches (45.7 cm)
wide between stairrails.
(x) Treads and landings shall have slip-resistant surfaces.
[[Page 46110]]
(xi) Stairways shall be installed between 40 degrees and 60 degrees
from the horizontal.
(xii) Guardrails meeting the requirements of paragraph (g)(4) of
this section shall be provided on the open sides and ends of each
landing.
(xiii) Riser height shall be uniform, within \1/4\ inch, (0.6 cm)
for each flight of stairs. Greater variations in riser height are
allowed for the top and bottom steps of the entire system, not for each
flight of stairs.
(xiv) Tread depth shall be uniform, within \1/4\ inch, for each
flight of stairs.
(5) Ramps and walkways. (i) Ramps and walkways 6 feet (1.8 m) or
more above lower levels shall have guardrail systems which comply with
subpart M of this part--Fall Protection;
(ii) No ramp or walkway shall be inclined more than a slope of one
(1) vertical to three (3) horizontal (20 degrees above the horizontal).
(iii) If the slope of a ramp or a walkway is steeper than one (1)
vertical in eight (8) horizontal, the ramp or walkway shall have cleats
not more than fourteen (14) inches (35 cm) apart which are securely
fastened to the planks to provide footing.
(6) Integral prefabricated scaffold access frames shall:
(i) Be specifically designed and constructed for use as ladder
rungs;
(ii) Have a rung length of at least 8 inches (20 cm);
(iii) Not be used as work platforms when rungs are less than 11\1/
2\ inches in length, unless each affected employee uses fall
protection, or a positioning device, which complies with Sec. 1926.502;
(iv) Be uniformly spaced within each frame section;
(v) Be provided with rest platforms at 35-foot (10.7 m) maximum
vertical intervals on all supported scaffolds more than 35 feet (10.7
m) high; and
(vi) Have a maximum spacing between rungs of 16\3/4\ inches (43
cm). Non-uniform rung spacing caused by joining end frames together is
allowed, provided the resulting spacing does not exceed 16\3/4\ inches
(43 cm).
(7) Steps and rungs of ladder and stairway type access shall line
up vertically with each other between rest platforms.
(8) Direct access to or from another surface shall be used only
when the scaffold is not more than 14 inches (36 cm) horizontally and
not more than 24 inches (61 cm) vertically from the other surface.
(9) Effective September 2, 1997, access for employees erecting or
dismantling supported scaffolds shall be in accordance with the
following:
(i) The employer shall provide safe means of access for each
employee erecting or dismantling a scaffold where the provision of safe
access is feasible and does not create a greater hazard. The employer
shall have a competent person determine whether it is feasible or would
pose a greater hazard to provide, and have employees use a safe means
of access. This determination shall be based on site conditions and the
type of scaffold being erected or dismantled.
(ii) Hook-on or attachable ladders shall be installed as soon as
scaffold erection has progressed to a point that permits safe
installation and use.
(iii) When erecting or dismantling tubular welded frame scaffolds,
(end) frames, with horizontal members that are parallel, level and are
not more than 22 inches apart vertically may be used as climbing
devices for access, provided they are erected in a manner that creates
a usable ladder and provides good hand hold and foot space.
(iv) Cross braces on tubular welded frame scaffolds shall not be
used as a means of access or egress.
(f) Use. (1) Scaffolds and scaffold components shall not be loaded
in excess of their maximum intended loads or rated capacities,
whichever is less.
(2) The use of shore or lean-to scaffolds is prohibited.
(3) Scaffolds and scaffold components shall be inspected for
visible defects by a competent person before each work shift, and after
any occurrence which could affect a scaffold's structural integrity.
(4) Any part of a scaffold damaged or weakened such that its
strength is less than that required by paragraph (a) of this section
shall be immediately repaired or replaced, braced to meet those
provisions, or removed from service until repaired.
(5) Scaffolds shall not be moved horizontally while employees are
on them, unless they have been designed by a registered professional
engineer specifically for such movement or, for mobile scaffolds, where
the provisions of Sec. 1926.452(w) are followed.
(6) The clearance between scaffolds and power lines shall be as
follows: Scaffolds shall not be erected, used, dismantled, altered, or
moved such that they or any conductive material handled on them might
come closer to exposed and energized power lines than as follows:
----------------------------------------------------------------------------------------------------------------
Insulated lines voltage Minimum distance Alternatives
----------------------------------------------------------------------------------------------------------------
Less than 300 volts................ 3 feet (0.9 M).......................
More than 50 kv.................... 10 feet (3.1 M) plus 4.0 inches (10 2 times the length of the line
cm) for each 1 kv over 50 kv. insulator, but never less than 10
feet (3.1 m).
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
Uninsulated lines voltage Minimum distance Alternatives
----------------------------------------------------------------------------------------------------------------
Less than 50 kv.................... 10 feet (3.1 M)......................
More than 50 kv.................... 10 feet (3.1 M) plus 4.0 inches (10 2 times the length of the line
cm) for each 1 kv over 50 kv. insulator, but never less than 10
feet (3.1 m).
----------------------------------------------------------------------------------------------------------------
Exception to paragraph (b)(6): Scaffolds and materials may be
closer to power lines than specified above where such clearance is
necessary for performance of work, and only after the utility company,
or electrical system operator, has been notified of the need to work
closer and the utility company, or electrical system operator, has
deenergized the lines, relocated the lines, or installed protective
coverings to prevent accidental contact with the lines.
(7) Scaffolds shall be erected, moved, dismantled, or altered only
under the supervision and direction of a competent person qualified in
scaffold erection, moving, dismantling or alteration. Such activities
shall be performed only by experienced and trained employees selected
for such work by the competent person.
(8) Employees shall be prohibited from working on scaffolds covered
with snow, ice, or other slippery material except as necessary for
removal of such materials.
[[Page 46111]]
(9) Where swinging loads are being hoisted onto or near scaffolds
such that the loads might contact the scaffold, tag lines or equivalent
measures to control the loads shall be used.
(10) Suspension ropes supporting adjustable suspension scaffolds
shall be of a diameter large enough to provide sufficient surface area
for the functioning of brake and hoist mechanisms.
(11) Suspension ropes shall be shielded from heat-producing
processes. When acids or other corrosive substances are used on a
scaffold, the ropes shall be shielded, treated to protect against the
corrosive substances, or shall be of a material that will not be
damaged by the substance being used.
(12) Work on or from scaffolds is prohibited during storms or high
winds unless a competent person has determined that it is safe for
employees to be on the scaffold and those employees are protected by a
personal fall arrest system or wind screens. Wind screens shall not be
used unless the scaffold is secured against the anticipated wind forces
imposed.
(13) Debris shall not be allowed to accumulate on platforms.
(14) Makeshift devices, such as but not limited to boxes and
barrels, shall not be used on top of scaffold platforms to increase the
working level height of employees.
(15) Ladders shall not be used on scaffolds to increase the working
level height of employees, except on large area scaffolds where
employers have satisfied the following criteria:
(i) When the ladder is placed against a structure which is not a
part of the scaffold, the scaffold shall be secured against the
sideways thrust exerted by the ladder;
(ii) The platform units shall be secured to the scaffold to prevent
their movement;
(iii) The ladder legs shall be on the same platform or other means
shall be provided to stabilize the ladder against unequal platform
deflection, and
(iv) The ladder legs shall be secured to prevent them from slipping
or being pushed off the platform.
(16) Platforms shall not deflect more than \1/60\ of the span when
loaded.
(17) To reduce the possibility of welding current arcing through
the suspension wire rope when performing welding from suspended
scaffolds, the following precautions shall be taken, as applicable:
(i) An insulated thimble shall be used to attach each suspension
wire rope to its hanging support (such as cornice hook or outrigger).
Excess suspension wire rope and any additional independent lines from
grounding shall be insulated;
(ii) The suspension wire rope shall be covered with insulating
material extending at least 4 feet (1.2 m) above the hoist. If there is
a tail line below the hoist, it shall be insulated to prevent contact
with the platform. The portion of the tail line that hangs free below
the scaffold shall be guided or retained, or both, so that it does not
become grounded;
(iii) Each hoist shall be covered with insulated protective covers;
(iv) In addition to a work lead attachment required by the welding
process, a grounding conductor shall be connected from the scaffold to
the structure. The size of this conductor shall be at least the size of
the welding process work lead, and this conductor shall not be in
series with the welding process or the work piece;
(v) If the scaffold grounding lead is disconnected at any time, the
welding machine shall be shut off; and
(vi) An active welding rod or uninsulated welding lead shall not be
allowed to contact the scaffold or its suspension system.
(g) Fall protection. (1) Each employee on a scaffold more than 10
feet (3.1 m) above a lower level shall be protected from falling to
that lower level. Paragraphs (g)(1) (i) through (vii) of this section
establish the types of fall protection to be provided to the employees
on each type of scaffold. Paragraph (g)(2) of this section addresses
fall protection for scaffold erectors and dismantlers.
Note to paragraph (g)(1): The fall protection requirements for
employees installing suspension scaffold support systems on floors,
roofs, and other elevated surfaces are set forth in subpart M of
this part.
(i) Each employee on a boatswains' chair, catenary scaffold, float
scaffold, needle beam scaffold, or ladder jack scaffold shall be
protected by a personal fall arrest system;
(ii) Each employee on a single-point or two-point adjustable
suspension scaffold shall be protected by both a personal fall arrest
system and guardrail system;
(iii) Each employee on a crawling board (chicken ladder) shall be
protected by a personal fall arrest system, a guardrail system (with
minimum 200 pound toprail capacity), or by a three-fourth inch (1.9 cm)
diameter grabline or equivalent handhold securely fastened beside each
crawling board;
(iv) Each employee on a self-contained adjustable scaffold shall be
protected by a guardrail system (with minimum 200 pound toprail
capacity) when the platform is supported by the frame structure, and by
both a personal fall arrest system and a guardrail system (with minimum
200 pound toprail capacity) when the platform is supported by ropes;
(v) Each employee on a walkway located within a scaffold shall be
protected by a guardrail system (with minimum 200 pound toprail
capacity) installed within 9\1/2\ inches (24.1 cm) of and along at
least one side of the walkway.
(vi) Each employee performing overhand bricklaying operations from
a supported scaffold shall be protected from falling from all open
sides and ends of the scaffold (except at the side next to the wall
being laid) by the use of a personal fall arrest system or guardrail
system (with minimum 200 pound toprail capacity).
(vii) For all scaffolds not otherwise specified in paragraphs
(g)(1)(i) through (g)(1)(vi) of this section, each employee shall be
protected by the use of personal fall arrest systems or guardrail
systems meeting the requirements of paragraph (g)(4) of this section.
(2) Effective September 2, 1997, the employer shall have a
competent person determine the feasibility and safety of providing fall
protection for employees erecting or dismantling supported scaffolds.
Employers are required to provide fall protection for employees
erecting or dismantling supported scaffolds where the installation and
use of such protection is feasible and does not create a greater
hazard.
(3) In addition to meeting the requirements of Sec. 1926.502(d),
personal fall arrest systems used on scaffolds shall be attached by
lanyard to a vertical lifeline, horizontal lifeline, or scaffold
structural member. Vertical lifelines shall not be used when overhead
components, such as overhead protection or additional platform levels,
are part of a single-point or two-point adjustable suspension scaffold.
(i) When vertical lifelines are used, they shall be fastened to a
fixed safe point of anchorage, shall be independent of the scaffold,
and shall be protected from sharp edges and abrasion. Safe points of
anchorage include structural members of buildings, but do not include
standpipes, vents, other piping systems, electrical conduit, outrigger
beams, or counterweights.
(ii) When horizontal lifelines are used, they shall be secured to
two or more structural members of the scaffold, or they may be looped
around both suspension and independent
[[Page 46112]]
suspension lines (on scaffolds so equipped) above the hoist and brake
attached to the end of the scaffold. Horizontal lifelines shall not be
attached only to the suspension ropes.
(iii) When lanyards are connected to horizontal lifelines or
structural members on a single-point or two-point adjustable suspension
scaffold, the scaffold shall be equipped with additional independent
support lines and automatic locking devices capable of stopping the
fall of the scaffold in the event one or both of the suspension ropes
fail. The independent support lines shall be equal in number and
strength to the suspension ropes.
(iv) Vertical lifelines, independent support lines, and suspension
ropes shall not be attached to each other, nor shall they be attached
to or use the same point of anchorage, nor shall they be attached to
the same point on the scaffold or personal fall arrest system.
(4) Guardrail systems installed to meet the requirements of this
section shall comply with the following provisions (guardrail systems
built in accordance with Appendix A to this subpart will be deemed to
meet the requirements of paragraphs (g)(4) (vii), (viii), and (ix) of
this section):
(i) Guardrail systems shall be installed along all open sides and
ends of platforms. Guardrail systems shall be installed before the
scaffold is released for use by employees other than erection/
dismantling crews.
(ii) The top edge height of toprails or equivalent member on
supported scaffolds manufactured or placed in service after January 1,
2000 shall be installed between 38 inches (0.97 m) and 45 inches (1.2
m) above the platform surface. The top edge height on supported
scaffolds manufactured and placed in service before January 1, 2000,
and on all suspended scaffolds where both a guardrail and a personal
fall arrest system are required shall be between 36 inches (0.9 m) and
45 inches (1.2 m). When conditions warrant, the height of the top edge
may exceed the 45-inch height, provided the guardrail system meets all
other criteria of paragraph (g)(4).
(iii) When midrails, screens, mesh, intermediate vertical members,
solid panels, or equivalent structural members are used, they shall be
installed between the top edge of the guardrail system and the scaffold
platform.
(iv) When midrails are used, they shall be installed at a height
approximately midway between the top edge of the guardrail system and
the platform surface.
(v) When screens and mesh are used, they shall extend from the top
edge of the guardrail system to the scaffold platform, and along the
entire opening between the supports.
(vi) When intermediate members (such as balusters or additional
rails) are used, they shall not be more than 19 inches (48 cm) apart.
(vii) Each toprail or equivalent member of a guardrail system shall
be capable of withstanding, without failure, a force applied in any
downward or horizontal direction at any point along its top edge of at
least 100 pounds (445 n) for guardrail systems installed on single-
point adjustable suspension scaffolds or two-point adjustable
suspension scaffolds, and at least 200 pounds (890 n) for guardrail
systems installed on all other scaffolds.
(viii) When the loads specified in paragraph (g)(4)(vii) of this
section are applied in a downward direction, the top edge shall not
drop below the height above the platform surface that is prescribed in
paragraph (g)(4)(ii) of this section.
(ix) Midrails, screens, mesh, intermediate vertical members, solid
panels, and equivalent structural members of a guardrail system shall
be capable of withstanding, without failure, a force applied in any
downward or horizontal direction at any point along the midrail or
other member of at least 75 pounds (333 n) for guardrail systems with a
minimum 100 pound toprail capacity, and at least 150 pounds (666 n) for
guardrail systems with a minimum 200 pound toprail capacity.
(x) Suspension scaffold hoists and non-walk-through stirrups may be
used as end guardrails, if the space between the hoist or stirrup and
the side guardrail or structure does not allow passage of an employee
to the end of the scaffold.
(xi) Guardrails shall be surfaced to prevent injury to an employee
from punctures or lacerations, and to prevent snagging of clothing.
(xii) The ends of all rails shall not overhang the terminal posts
except when such overhang does not constitute a projection hazard to
employees.
(xiii) Steel or plastic banding shall not be used as a toprail or
midrail.
(xiv) Manila or plastic (or other synthetic) rope being used for
toprails or midrails shall be inspected by a competent person as
frequently as necessary to ensure that it continues to meet the
strength requirements of paragraph (g) of this section.
(xv) Crossbracing is acceptable in place of a midrail when the
crossing point of two braces is between 20 inches (0.5 m) and 30 inches
(0.8 m) above the work platform or as a toprail when the crossing point
of two braces is between 38 inches (0.97 m) and 48 inches (1.3 m) above
the work platform. The end points at each upright shall be no more than
48 inches (1.3 m) apart.
(h) Falling object protection. (1) In addition to wearing hardhats
each employee on a scaffold shall be provided with additional
protection from falling hand tools, debris, and other small objects
through the installation of toeboards, screens, or guardrail systems,
or through the erection of debris nets, catch platforms, or canopy
structures that contain or deflect the falling objects. When the
falling objects are too large, heavy or massive to be contained or
deflected by any of the above-listed measures, the employer shall place
such potential falling objects away from the edge of the surface from
which they could fall and shall secure those materials as necessary to
prevent their falling.
(2) Where there is a danger of tools, materials, or equipment
falling from a scaffold and striking employees below, the following
provisions apply:
(i) The area below the scaffold to which objects can fall shall be
barricaded, and employees shall not be permitted to enter the hazard
area; or
(ii) A toeboard shall be erected along the edge of platforms more
than 10 feet (3.1 m) above lower levels for a distance sufficient to
protect employees below, except on float (ship) scaffolds where an
edging of \3/4\ x 1\1/2\ inch (2 x 4 cm) wood or equivalent may be
used in lieu of toeboards;
(iii) Where tools, materials, or equipment are piled to a height
higher than the top edge of the toeboard, paneling or screening
extending from the toeboard or platform to the top of the guardrail
shall be erected for a distance sufficient to protect employees below;
or
(iv) A guardrail system shall be installed with openings small
enough to prevent passage of potential falling objects; or
(v) A canopy structure, debris net, or catch platform strong enough
to withstand the impact forces of the potential falling objects shall
be erected over the employees below.
(3) Canopies, when used for falling object protection, shall comply
with the following criteria:
(i) Canopies shall be installed between the falling object hazard
and the employees.
(ii) When canopies are used on suspension scaffolds for falling
object protection, the scaffold shall be equipped with additional
independent
[[Page 46113]]
support lines equal in number to the number of points supported, and
equivalent in strength to the strength of the suspension ropes.
(iii) Independent support lines and suspension ropes shall not be
attached to the same points of anchorage.
(4) Where used, toeboards shall be:
(i) Capable of withstanding, without failure, a force of at least
50 pounds (222 n) applied in any downward or horizontal direction at
any point along the toeboard (toeboards built in accordance with
Appendix A to this subpart will be deemed to meet this requirement);
and
(ii) At least three and one-half inches (9 cm) high from the top
edge of the toeboard to the level of the walking/working surface.
Toeboards shall be securely fastened in place at the outermost edge of
the platform and have not more than \1/4\ inch (0.7 cm) clearance above
the walking/working surface. Toeboards shall be solid or with openings
not over one inch (2.5 cm) in the greatest dimension.
Sec. 1926.452 Additional requirements applicable to specific types of
scaffolds.
In addition to the applicable requirements of Sec. 1926.451, the
following requirements apply to the specific types of scaffolds
indicated. Scaffolds not specifically addressed by Sec. 1926.452, such
as but not limited to systems scaffolds, must meet the requirements of
Sec. 1926.451.
(a) Pole scaffolds. (1) When platforms are being moved to the next
level, the existing platform shall be left undisturbed until the new
bearers have been set in place and braced, prior to receiving the new
platforms.
(2) Crossbracing shall be installed between the inner and outer
sets of poles on double pole scaffolds.
FR Doc. 96-21289 Safety Standards for Scaffolds Used in the Construction Industry
(3) Diagonal bracing in both directions shall be installed across
the entire inside face of double-pole scaffolds used to support loads
equivalent to a uniformly distributed load of 50 pounds (222 kg) or
more per square foot (929 square cm).
(4) Diagonal bracing in both directions shall be installed across
the entire outside face of all double- and single-pole scaffolds.
(5) Runners and bearers shall be installed on edge.
(6) Bearers shall extend a minimum of 3 inches (7.6 cm) over the
outside edges of runners.
(7) Runners shall extend over a minimum of two poles, and shall be
supported by bearing blocks securely attached to the poles.
(8) Braces, bearers, and runners shall not be spliced between
poles.
(9) Where wooden poles are spliced, the ends shall be squared and
the upper section shall rest squarely on the lower section. Wood splice
plates shall be provided on at least two adjacent sides, and shall
extend at least 2 feet (0.6 m) on either side of the splice, overlap
the abutted ends equally, and have at least the same cross-sectional
areas as the pole. Splice plates of other materials of equivalent
strength may be used.
(10) Pole scaffolds over 60 feet in height shall be designed by a
registered professional engineer, and shall be constructed and loaded
in accordance with that design. Non-mandatory Appendix A to this
subpart contains examples of criteria that will enable an employer to
comply with design and loading requirements for pole scaffolds under 60
feet in height.
(b) Tube and coupler scaffolds. (1) When platforms are being moved
to the next level, the existing platform shall be left undisturbed
until the new bearers have been set in place and braced prior to
receiving the new platforms.
(2) Transverse bracing forming an ``X'' across the width of the
scaffold shall be installed at the scaffold ends and at least at every
third set of posts horizontally (measured from only one end) and every
fourth runner vertically. Bracing shall extend diagonally from the
inner or outer posts or runners upward to the next outer or inner posts
or runners. Building ties shall be installed at the bearer levels
between the transverse bracing and shall conform to the requirements of
Sec. 1926.451(c)(1).
(3) On straight run scaffolds, longitudinal bracing across the
inner and outer rows of posts shall be installed diagonally in both
directions, and shall extend from the base of the end posts upward to
the top of the scaffold at approximately a 45 degree angle. On
scaffolds whose length is greater than their height, such bracing shall
be repeated beginning at least at every fifth post. On scaffolds whose
length is less than their height, such bracing shall be installed from
the base of the end posts upward to the opposite end posts, and then in
alternating directions until reaching the top of the scaffold. Bracing
shall be installed as close as possible to the intersection of the
bearer and post or runner and post.
(4) Where conditions preclude the attachment of bracing to posts,
bracing shall be attached to the runners as close to the post as
possible.
(5) Bearers shall be installed transversely between posts, and when
coupled to the posts, shall have the inboard coupler bear directly on
the runner coupler. When the bearers are coupled to the runners, the
couplers shall be as close to the posts as possible.
(6) Bearers shall extend beyond the posts and runners, and shall
provide full contact with the coupler.
(7) Runners shall be installed along the length of the scaffold,
located on both the inside and outside posts at level heights (when
tube and coupler guardrails and midrails are used on outside posts,
they may be used in lieu of outside runners).
(8) Runners shall be interlocked on straight runs to form
continuous lengths, and shall be coupled to each post. The bottom
runners and bearers shall be located as close to the base as possible.
(9) Couplers shall be of a structural metal, such as drop-forged
steel, malleable iron, or structural grade aluminum. The use of gray
cast iron is prohibited.
(10) Tube and coupler scaffolds over 125 feet in height shall be
designed by a registered professional engineer, and shall be
constructed and loaded in accordance with such design. Non-mandatory
Appendix A to this subpart contains examples of criteria that will
enable an employer to comply with design and loading requirements for
tube and coupler scaffolds under 125 feet in height.
(c) Fabricated frame scaffolds (tubular welded frame scaffolds).
(1) When moving platforms to the next level, the existing platform
shall be left undisturbed until the new end frames have been set in
place and braced prior to receiving the new platforms.
(2) Frames and panels shall be braced by cross, horizontal, or
diagonal braces, or combination thereof, which secure vertical members
together laterally. The cross braces shall be of such length as will
automatically square and align vertical members so that the erected
scaffold is always plumb, level, and square. All brace connections
shall be secured.
(3) Frames and panels shall be joined together vertically by
coupling or stacking pins or equivalent means.
(4) Where uplift can occur which would displace scaffold end frames
or panels, the frames or panels shall be locked together vertically by
pins or equivalent means.
(5) Brackets used to support cantilevered loads shall:
(i) Be seated with side-brackets parallel to the frames and end-
brackets at 90 degrees to the frames;
(ii) Not be bent or twisted from these positions; and
(iii) Be used only to support personnel, unless the scaffold has
been designed for other loads by a qualified
[[Page 46114]]
engineer and built to withstand the tipping forces caused by those
other loads being placed on the bracket-supported section of the
scaffold.
(6) Scaffolds over 125 feet (38.0 m) in height above their base
plates shall be designed by a registered professional engineer, and
shall be constructed and loaded in accordance with such design.
(d) Plasterers', decorators', and large area scaffolds. Scaffolds
shall be constructed in accordance with paragraphs (a), (b), or (c) of
this section, as appropriate.
(e) Bricklayers' square scaffolds (squares). (1) Scaffolds made of
wood shall be reinforced with gussets on both sides of each corner.
(2) Diagonal braces shall be installed on all sides of each square.
(3) Diagonal braces shall be installed between squares on the rear
and front sides of the scaffold, and shall extend from the bottom of
each square to the top of the next square.
(4) Scaffolds shall not exceed three tiers in height, and shall be
so constructed and arranged that one square rests directly above the
other. The upper tiers shall stand on a continuous row of planks laid
across the next lower tier, and shall be nailed down or otherwise
secured to prevent displacement.
(f) Horse scaffolds. (1) Scaffolds shall not be constructed or
arranged more than two tiers or 10 feet (3.0 m) in height, whichever is
less.
(2) When horses are arranged in tiers, each horse shall be placed
directly over the horse in the tier below.
(3) When horses are arranged in tiers, the legs of each horse shall
be nailed down or otherwise secured to prevent displacement.
(4) When horses are arranged in tiers, each tier shall be
crossbraced.
(g) Form scaffolds and carpenters' bracket scaffolds. (1) Each
bracket, except those for wooden bracket-form scaffolds, shall be
attached to the supporting formwork or structure by means of one or
more of the following: nails; a metal stud attachment device; welding;
hooking over a secured structural supporting member, with the form
wales either bolted to the form or secured by snap ties or tie bolts
extending through the form and securely anchored; or, for carpenters'
bracket scaffolds only, by a bolt extending through to the opposite
side of the structure's wall.
(2) Wooden bracket-form scaffolds shall be an integral part of the
form panel.
(3) Folding type metal brackets, when extended for use, shall be
either bolted or secured with a locking-type pin.
(h) Roof bracket scaffolds. (1) Scaffold brackets shall be
constructed to fit the pitch of the roof and shall provide a level
support for the platform.
(2) Brackets (including those provided with pointed metal
projections) shall be anchored in place by nails unless it is
impractical to use nails. When nails are not used, brackets shall be
secured in place with first-grade manila rope of at least three-fourth
inch (1.9 cm) diameter, or equivalent.
(i) Outrigger scaffolds. (1) The inboard end of outrigger beams,
measured from the fulcrum point to the extreme point of anchorage,
shall be not less than one and one-half times the outboard end in
length.
(2) Outrigger beams fabricated in the shape of an I-beam or channel
shall be placed so that the web section is vertical.
(3) The fulcrum point of outrigger beams shall rest on secure
bearings at least 6 inches (15.2 cm) in each horizontal dimension.
(4) Outrigger beams shall be secured in place against movement, and
shall be securely braced at the fulcrum point against tipping.
(5) The inboard ends of outrigger beams shall be securely anchored
either by means of braced struts bearing against sills in contact with
the overhead beams or ceiling, or by means of tension members secured
to the floor joists underfoot, or by both.
(6) The entire supporting structure shall be securely braced to
prevent any horizontal movement.
(7) To prevent their displacement, platform units shall be nailed,
bolted, or otherwise secured to outriggers.
(8) Scaffolds and scaffold components shall be designed by a
registered professional engineer and shall be constructed and loaded in
accordance with such design.
(j) Pump jack scaffolds. (1) Pump jack brackets, braces, and
accessories shall be fabricated from metal plates and angles. Each pump
jack bracket shall have two positive gripping mechanisms to prevent any
failure or slippage.
(2) Poles shall be secured to the structure by rigid triangular
bracing or equivalent at the bottom, top, and other points as
necessary. When the pump jack has to pass bracing already installed, an
additional brace shall be installed approximately 4 feet (1.2 m) above
the brace to be passed, and shall be left in place until the pump jack
has been moved and the original brace reinstalled.
(3) When guardrails are used for fall protection, a workbench may
be used as the toprail only if it meets all the requirements in
paragraphs (g)(4) (ii), (vii), (viii), and (xiii) of Sec. 1926.451.
(4) Work benches shall not be used as scaffold platforms.
(5) When poles are made of wood, the pole lumber shall be straight-
grained, free of shakes, large loose or dead knots, and other defects
which might impair strength.
(6) When wood poles are constructed of two continuous lengths, they
shall be joined together with the seam parallel to the bracket.
(7) When two by fours are spliced to make a pole, mending plates
shall be installed at all splices to develop the full strength of the
member.
(k) Ladder jack scaffolds. (1) Platforms shall not exceed a height
of 20 feet (6.1 m).
(2) All ladders used to support ladder jack scaffolds shall meet
the requirements of subpart X of this part--Stairways and Ladders,
except that job-made ladders shall not be used to support ladder jack
scaffolds.
(3) The ladder jack shall be so designed and constructed that it
will bear on the side rails and ladder rungs or on the ladder rungs
alone. If bearing on rungs only, the bearing area shall include a
length of at least 10 inches (25.4 cm) on each rung.
(4) Ladders used to support ladder jacks shall be placed, fastened,
or equipped with devices to prevent slipping.
(5) Scaffold platforms shall not be bridged one to another.
(l) Window jack scaffolds. (1) Scaffolds shall be securely attached
to the window opening.
(2) Scaffolds shall be used only for the purpose of working at the
window opening through which the jack is placed.
(3) Window jacks shall not be used to support planks placed between
one window jack and another, or for other elements of scaffolding.
(m) Crawling boards (chicken ladders). (1) Crawling boards shall
extend from the roof peak to the eaves when used in connection with
roof construction, repair, or maintenance.
(2) Crawling boards shall be secured to the roof by ridge hooks or
by means that meet equivalent criteria (e.g., strength and durability).
(n) Step, platform, and trestle ladder scaffolds. (1) Scaffold
platforms shall not be placed any higher than the second highest rung
or step of the ladder supporting the platform.
(2) All ladders used in conjunction with step, platform and trestle
ladder scaffolds shall meet the pertinent requirements of subpart X of
this part--Stairways and Ladders, except that job-
[[Page 46115]]
made ladders shall not be used to support such scaffolds.
(3) Ladders used to support step, platform, and trestle ladder
scaffolds shall be placed, fastened, or equipped with devices to
prevent slipping.
(4) Scaffolds shall not be bridged one to another.
(o) Single-point adjustable suspension scaffolds. (1) When two
single-point adjustable suspension scaffolds are combined to form a
two-point adjustable suspension scaffold, the resulting two-point
scaffold shall comply with the requirements for two-point adjustable
suspension scaffolds in paragraph (p) of this section.
(2) The supporting rope between the scaffold and the suspension
device shall be kept vertical unless all of the following conditions
are met:
(i) The rigging has been designed by a qualified person, and
(ii) The scaffold is accessible to rescuers, and
(iii) The supporting rope is protected to ensure that it will not
chafe at any point where a change in direction occurs, and
(iv) The scaffold is positioned so that swinging cannot bring the
scaffold into contact with another surface.
(3) Boatswains' chair tackle shall consist of correct size ball
bearings or bushed blocks containing safety hooks and properly ``eye-
spliced'' minimum five-eighth (\5/8\) inch (1.6 cm) diameter first-
grade manila rope, or other rope which will satisfy the criteria (e.g.,
strength and durability) of manila rope.
(4) Boatswains' chair seat slings shall be reeved through four
corner holes in the seat; shall cross each other on the underside of
the seat; and shall be rigged so as to prevent slippage which could
cause an out-of-level condition.
(5) Boatswains' chair seat slings shall be a minimum of five-eight
(\5/8\) inch (1.6 cm) diameter fiber, synthetic, or other rope which
will satisfy the criteria (e.g., strength, slip resistance, durability,
etc.) of first grade manila rope.
(6) When a heat-producing process such as gas or arc welding is
being conducted, boatswains' chair seat slings shall be a minimum of
three-eight (\3/8\) inch (1.0 cm) wire rope.
(7) Non-cross-laminated wood boatswains' chairs shall be reinforced
on their underside by cleats securely fastened to prevent the board
from splitting.
(p) Two-point adjustable suspension scaffolds (swing stages). The
following requirements do not apply to two-point adjustable suspension
scaffolds used as masons' or stonesetters' scaffolds. Such scaffolds
are covered by paragraph (q) of this section.
(1) Platforms shall not be more than 36 inches (0.9 m) wide unless
designed by a qualified person to prevent unstable conditions.
(2) The platform shall be securely fastened to hangers (stirrups)
by U-bolts or by other means which satisfy the requirements of
Sec. 1926.451(a).
(3) The blocks for fiber or synthetic ropes shall consist of at
least one double and one single block. The sheaves of all blocks shall
fit the size of the rope used.
(4) Platforms shall be of the ladder-type, plank-type, beam-type,
or light-metal type. Light metal-type platforms having a rated capacity
of 750 pounds or less and platforms 40 feet (12.2 m) or less in length
shall be tested and listed by a nationally recognized testing
laboratory.
(5) Two-point scaffolds shall not be bridged or otherwise connected
one to another during raising and lowering operations unless the bridge
connections are articulated (attached), and the hoists properly sized.
(6) Passage may be made from one platform to another only when the
platforms are at the same height, are abutting, and walk-through
stirrups specifically designed for this purpose are used.
(q) Multi-point adjustable suspension scaffolds, stonesetters'
multi-point adjustable suspension scaffolds, and masons' multi-point
adjustable suspension scaffolds. (1) When two or more scaffolds are
used they shall not be bridged one to another unless they are designed
to be bridged, the bridge connections are articulated, and the hoists
are properly sized.
(2) If bridges are not used, passage may be made from one platform
to another only when the platforms are at the same height and are
abutting.
(3) Scaffolds shall be suspended from metal outriggers, brackets,
wire rope slings, hooks, or means that meet equivalent criteria (e.g.,
strength, durability).
(r) Catenary scaffolds. (1) No more than one platform shall be
placed between consecutive vertical pickups, and no more than two
platforms shall be used on a catenary scaffold.
(2) Platforms supported by wire ropes shall have hook-shaped stops
on each end of the platforms to prevent them from slipping off the wire
ropes. These hooks shall be so placed that they will prevent the
platform from falling if one of the horizontal wire ropes breaks.
(3) Wire ropes shall not be tightened to the extent that the
application of a scaffold load will overstress them.
(4) Wire ropes shall be continuous and without splices between
anchors.
(s) Float (ship) scaffolds. (1) The platform shall be supported by
a minimum of two bearers, each of which shall project a minimum of 6
inches (15.2 cm) beyond the platform on both sides. Each bearer shall
be securely fastened to the platform.
(2) Rope connections shall be such that the platform cannot shift
or slip.
(3) When only two ropes are used with each float:
(i) They shall be arranged so as to provide four ends which are
securely fastened to overhead supports.
(ii) Each supporting rope shall be hitched around one end of the
bearer and pass under the platform to the other end of the bearer where
it is hitched again, leaving sufficient rope at each end for the
supporting ties.
(t) Interior hung scaffolds. (1) Scaffolds shall be suspended only
from the roof structure or other structural member such as ceiling
beams.
(2) Overhead supporting members (roof structure, ceiling beams, or
other structural members) shall be inspected and checked for strength
before the scaffold is erected.
(3) Suspension ropes and cables shall be connected to the overhead
supporting members by shackles, clips, thimbles, or other means that
meet equivalent criteria (e.g., strength, durability).
(u) Needle beam scaffolds. (1) Scaffold support beams shall be
installed on edge.
(2) Ropes or hangers shall be used for supports, except that one
end of a needle beam scaffold may be supported by a permanent
structural member.
(3) The ropes shall be securely attached to the needle beams.
(4) The support connection shall be arranged so as to prevent the
needle beam from rolling or becoming displaced.
(5) Platform units shall be securely attached to the needle beams
by bolts or equivalent means. Cleats and overhang are not considered to
be adequate means of attachment.
(v) Multi-level suspended scaffolds. (1) Scaffolds shall be
equipped with additional independent support lines, equal in number to
the number of points supported, and of equivalent strength to the
suspension ropes, and rigged to support the scaffold in the event the
suspension rope(s) fail.
(2) Independent support lines and suspension ropes shall not be
attached to the same points of anchorage.
(3) Supports for platforms shall be attached directly to the
support stirrup and not to any other platform.
(w) Mobile scaffolds. (1) Scaffolds shall be braced by cross,
horizontal, or
[[Page 46116]]
diagonal braces, or combination thereof, to prevent racking or collapse
of the scaffold and to secure vertical members together laterally so as
to automatically square and align the vertical members. Scaffolds shall
be plumb, level, and squared. All brace connections shall be secured.
(i) Scaffolds constructed of tube and coupler components shall also
comply with the requirements of paragraph (b) of this section;
(ii) Scaffolds constructed of fabricated frame components shall
also comply with the requirements of paragraph (c) of this section.
(2) Scaffold casters and wheels shall be locked with positive wheel
and/or wheel and swivel locks, or equivalent means, to prevent movement
of the scaffold while the scaffold is used in a stationary manner.
(3) Manual force used to move the scaffold shall be applied as
close to the base as practicable, but not more than 5 feet (1.5 m)
above the supporting surface.
(4) Power systems used to propel mobile scaffolds shall be designed
for such use. Forklifts, trucks, similar motor vehicles or add-on
motors shall not be used to propel scaffolds unless the scaffold is
designed for such propulsion systems.
(5) Scaffolds shall be stabilized to prevent tipping during
movement.
(6) Employees shall not be allowed to ride on scaffolds unless the
following conditions exist:
(i) The surface on which the scaffold is being moved is within 3
degrees of level, and free of pits, holes, and obstructions;
(ii) The height to base width ratio of the scaffold during movement
is two to one or less, unless the scaffold is designed and constructed
to meet or exceed nationally recognized stability test requirements
such as those listed in paragraph (x) of Appendix A to this subpart
(ANSI/SIA A92.5 and A92.6);
(iii) Outrigger frames, when used, are installed on both sides of
the scaffold;
(iv) When power systems are used, the propelling force is applied
directly to the wheels, and does not produce a speed in excess of 1
foot per second (.3 mps); and
(v) No employee is on any part of the scaffold which extends
outward beyond the wheels, casters, or other supports.
(7) Platforms shall not extend outward beyond the base supports of
the scaffold unless outrigger frames or equivalent devices are used to
ensure stability.
(8) Where leveling of the scaffold is necessary, screw jacks or
equivalent means shall be used.
(9) Caster stems and wheel stems shall be pinned or otherwise
secured in scaffold legs or adjustment screws.
(10) Before a scaffold is moved, each employee on the scaffold
shall be made aware of the move.
(x) Repair bracket scaffolds. (1) Brackets shall be secured in
place by at least one wire rope at least \1/2\ inch (1.27 cm) in
diameter.
(2) Each bracket shall be attached to the securing wire rope (or
ropes) by a positive locking device capable of preventing the
unintentional detachment of the bracket from the rope, or by equivalent
means.
(3) Each bracket, at the contact point between the supporting
structure and the bottom of the bracket, shall be provided with a shoe
(heel block or foot) capable of preventing the lateral movement of the
bracket.
(4) Platforms shall be secured to the brackets in a manner that
will prevent the separation of the platforms from the brackets and the
movement of the platforms or the brackets on a completed scaffold.
(5) When a wire rope is placed around the structure in order to
provide a safe anchorage for personal fall arrest systems used by
employees erecting or dismantling scaffolds, the wire rope shall meet
the requirements of subpart M of this part, but shall be at least \5/
16\ inch (0.8 cm) in diameter.
(6) Each wire rope used for securing brackets in place or as an
anchorage for personal fall arrest systems shall be protected from
damage due to contact with edges, corners, protrusions, or other
discontinuities of the supporting structure or scaffold components.
(7) Tensioning of each wire rope used for securing brackets in
place or as an anchorage for personal fall arrest systems shall be by
means of a turnbuckle at least 1 inch (2.54 cm) in diameter, or by
equivalent means.
(8) Each turnbuckle shall be connected to the other end of its rope
by use of an eyesplice thimble of a size appropriate to the turnbuckle
to which it is attached.
(9) U-bolt wire rope clips shall not be used on any wire rope used
to secure brackets or to serve as an anchor for personal fall arrest
systems.
(10) The employer shall ensure that materials shall not be dropped
to the outside of the supporting structure.
(11) Scaffold erection shall progress in only one direction around
any structure.
(y) Stilts. Stilts, when used, shall be used in accordance with the
following requirements:
(1) An employee may wear stilts on a scaffold only if it is a large
area scaffold.
(2) When an employee is using stilts on a large area scaffold where
a guardrail system is used to provide fall protection, the guardrail
system shall be increased in height by an amount equal to the height of
the stilts being used by the employee.
(3) Surfaces on which stilts are used shall be flat and free of
pits, holes and obstructions, such as debris, as well as other tripping
and falling hazards.
(4) Stilts shall be properly maintained. Any alteration of the
original equipment shall be approved by the manufacturer.
Sec. 1926.453 Aerial lifts.
(a) General requirements. (1) Unless otherwise provided in this
section, aerial lifts acquired for use on or after January 22, 1973
shall be designed and constructed in conformance with the applicable
requirements of the American National Standards for ``Vehicle Mounted
Elevating and Rotating Work Platforms,'' ANSI A92.2-1969, including
appendix. Aerial lifts acquired before January 22, 1973 which do not
meet the requirements of ANSI A92.2-1969, may not be used after January
1, 1976, unless they shall have been modified so as to conform with the
applicable design and construction requirements of ANSI A92.2-1969.
Aerial lifts include the following types of vehicle-mounted aerial
devices used to elevate personnel to job-sites above ground:
(i) Extensible boom platforms;
(ii) Aerial ladders;
(iii) Articulating boom platforms;
(iv) Vertical towers; and
(v) A combination of any such devices. Aerial equipment may be made
of metal, wood, fiberglass reinforced plastic (FRP), or other material;
may be powered or manually operated; and are deemed to be aerial lifts
whether or not they are capable of rotating about a substantially
vertical axis.
(2) Aerial lifts may be ``field modified'' for uses other than
those intended by the manufacturer provided the modification has been
certified in writing by the manufacturer or by any other equivalent
entity, such as a nationally recognized testing laboratory, to be in
conformity with all applicable provisions of ANSI A92.2-1969 and this
section and to be at least as safe as the equipment was before
modification.
(b) Specific requirements. (1) Ladder trucks and tower trucks.
Aerial ladders shall be secured in the lower traveling position by the
locking device on top of the truck cab, and the manually operated
device at the base of the ladder before the truck is moved for highway
travel.
[[Page 46117]]
(2) Extensible and articulating boom platforms. (i) Lift controls
shall be tested each day prior to use to determine that such controls
are in safe working condition.
(ii) Only authorized persons shall operate an aerial lift.
(iii) Belting off to an adjacent pole, structure, or equipment
while working from an aerial lift shall not be permitted.
(iv) Employees shall always stand firmly on the floor of the
basket, and shall not sit or climb on the edge of the basket or use
planks, ladders, or other devices for a work position.
(v) A body belt shall be worn and a lanyard attached to the boom or
basket when working from an aerial lift.
(vi) Boom and basket load limits specified by the manufacturer
shall not be exceeded.
(vii) The brakes shall be set and when outriggers are used, they
shall be positioned on pads or a solid surface. Wheel chocks shall be
installed before using an aerial lift on an incline, provided they can
be safely installed.
(viii) An aerial lift truck shall not be moved when the boom is
elevated in a working position with men in the basket, except for
equipment which is specifically designed for this type of operation in
accordance with the provisions of paragraphs (a) (1) and (2) of this
section.
(ix) Articulating boom and extensible boom platforms, primarily
designed as personnel carriers, shall have both platform (upper) and
lower controls. Upper controls shall be in or beside the platform
within easy reach of the operator. Lower controls shall provide for
overriding the upper controls. Controls shall be plainly marked as to
their function. Lower level controls shall not be operated unless
permission has been obtained from the employee in the lift, except in
case of emergency.
(x) Climbers shall not be worn while performing work from an aerial
lift.
(xi) The insulated portion of an aerial lift shall not be altered
in any manner that might reduce its insulating value.
(xii) Before moving an aerial lift for travel, the boom(s) shall be
inspected to see that it is properly cradled and outriggers are in
stowed position except as provided in paragraph (b)(2)(viii) of this
section.
(3) Electrical tests. All electrical tests shall conform to the
requirements of ANSI A92.2-1969 section 5. However equivalent d.c.;
voltage tests may be used in lieu of the a.c. voltage specified in
A92.2-1969; d.c. voltage tests which are approved by the equipment
manufacturer or equivalent entity shall be considered an equivalent
test for the purpose of this paragraph (b)(3).
(4) Bursting safety factor. The provisions of the American National
Standards Institute standard ANSI A92.2-1969, section 4.9 Bursting
Safety Factor shall apply to all critical hydraulic and pneumatic
components. Critical components are those in which a failure would
result in a free fall or free rotation of the boom. All noncritical
components shall have a bursting safety factor of at least 2 to 1.
(5) Welding standards. All welding shall conform to the following
standards as applicable:
(i) Standard Qualification Procedure, AWS B3.0-41.
(ii) Recommended Practices for Automotive Welding Design, AWS D8.4-
61.
(iii) Standard Qualification of Welding Procedures and Welders for
Piping and Tubing, AWS D10.9-69.
(iv) Specifications for Welding Highway and Railway Bridges, AWS
D2.0-69.
Note to Sec. 1926.453: Non-mandatory Appendix C to this subpart
lists examples of national consensus standards that are considered
to provide employee protection equivalent to that provided through
the application of ANSI A92.2-1969, where appropriate. This
incorporation by reference was approved by the Director of the
Federal Register in accordance with 5 U.S.C. 552(a) and 1 CFR part
51. Copies may be obtained from the American National Standards
Institute. Copies may be inspected at the Docket Office,
Occupational Safety and Health Administration, U.S. Department of
Labor, 200 Constitution Avenue, NW., room N2634, Washington, DC or
at the Office of the Federal Register, 800 North Capitol Street,
NW., suite 700, Washington, DC.
Sec. 1926.454 Training requirements.
This section supplements and clarifies the requirements of
Sec. 1926.21(b)(2) as these relate to the hazards of work on scaffolds.
(a) The employer shall have each employee who performs work while
on a scaffold trained by a person qualified in the subject matter to
recognize the hazards associated with the type of scaffold being used
and to understand the procedures to control or minimize those hazards.
The training shall include the following areas, as applicable:
(1) The nature of any electrical hazards, fall hazards and falling
object hazards in the work area;
(2) The correct procedures for dealing with electrical hazards and
for erecting, maintaining, and disassembling the fall protection
systems and falling object protection systems being used;
(3) The proper use of the scaffold, and the proper handling of
materials on the scaffold;
(4) The maximum intended load and the load-carrying capacities of
the scaffolds used; and
(5) Any other pertinent requirements of this subpart.
(b) The employer shall have each employee who is involved in
erecting, disassembling, moving, operating, repairing, maintaining, or
inspecting a scaffold trained by a competent person to recognize any
hazards associated with the work in question. The training shall
include the following topics, as applicable:
(1) The nature of scaffold hazards;
(2) The correct procedures for erecting, disassembling, moving,
operating, repairing, inspecting, and maintaining the type of scaffold
in question;
(3) The design criteria, maximum intended load-carrying capacity
and intended use of the scaffold;
(4) Any other pertinent requirements of this subpart.
(c) When the employer has reason to believe that an employee lacks
the skill or understanding needed for safe work involving the erection,
use or dismantling of scaffolds, the employer shall retrain each such
employee so that the requisite proficiency is regained. Retraining is
required in at least the following situations:
(1) Where changes at the worksite present a hazard about which an
employee has not been previously trained; or
(2) Where changes in the types of scaffolds, fall protection,
falling object protection, or other equipment present a hazard about
which an employee has not been previously trained; or
(3) Where inadequacies in an affected employee's work involving
scaffolds indicate that the employee has not retained the requisite
proficiency.
Non-Mandatory Appendices
(Non-mandatory) Appendix A to Subpart L--Scaffold Specifications
This Appendix provides non-mandatory guidelines to assist
employers in complying with the requirements of subpart L of this
part. An employer may use these guidelines and tables as a starting
point for designing scaffold systems. However, the guidelines do not
provide all the information necessary to build a complete system,
and the employer is still responsible for designing and assembling
these components in such a way that the completed system will meet
the requirements of Sec. 1926.451(a). Scaffold components which are
not selected and loaded in accordance with this Appendix, and
components for which no specific guidelines or tables are given in
this Appendix (e.g., joints, ties, components for wood pole
scaffolds more than 60 feet in height, components for heavy-duty
horse
[[Page 46118]]
scaffolds, components made with other materials, and components with
other dimensions, etc.) must be designed and constructed in
accordance with the capacity requirements of Sec. 1926.451(a), and
loaded in accordance with Sec. 1926.451(d)(1).
Index to Appendix A for Subpart L
1. General guidelines and tables.
2. Specific guidelines and tables.
(a) Pole scaffolds:
Single-pole wood pole scaffolds.
Independent wood pole scaffolds.
(b) Tube and coupler scaffolds.
(c) Fabricated frame scaffolds.
(d) Plasterers', decorators' and large area scaffolds.
(e) Bricklayers' square scaffolds.
(f) Horse scaffolds.
(g) Form scaffolds and carpenters' bracket scaffolds.
(h) Roof bracket scaffolds.
(i) Outrigger scaffolds (one level).
(j) Pump jack scaffolds.
(k) Ladder jack scaffolds.
(l) Window jack scaffolds.
(m) Crawling boards (chicken ladders).
(n) Step, platform and trestle ladder scaffolds.
(o) Single-point adjustable suspension scaffolds.
(p) Two-point adjustable suspension scaffolds.
(q)(1) Stonesetters' multi-point adjustable suspension
scaffolds.
(q)(2) Masons' multi-point adjustable suspension scaffolds.
(r) Catenary scaffolds.
(s) Float (ship) scaffolds.
(t) Interior hung scaffolds.
(u) Needle beam scaffolds.
(v) Multi-level suspension scaffolds.
(w) Mobile scaffolds.
(x) Repair bracket scaffolds.
(y) Stilts.
(z) Tank builders' scaffolds.
1. General Guidelines and Tables
(a) The following tables, and the tables in Part 2--Specific
guidelines and tables, assume that all load-carrying timber members
(except planks) of the scaffold are a minimum of 1,500 lb-f/in\2\
(stress grade) construction grade lumber. All dimensions are nominal
sizes as provided in the American Softwood Lumber Standards, dated
January 1970, except that, where rough sizes are noted, only rough
or undressed lumber of the size specified will satisfy minimum
requirements.
(b) Solid sawn wood used as scaffold planks shall be selected
for such use following the grading rules established by a recognized
lumber grading association or by an independent lumber grading
inspection agency. Such planks shall be identified by the grade
stamp of such association or agency. The association or agency and
the grading rules under which the wood is graded shall be certified
by the Board of Review, American Lumber Standard Committee, as set
forth in the American Softwood Lumber Standard of the U.S.
Department of Commerce.
(i) Allowable spans shall be determined in compliance with the
National Design Specification for Wood Construction published by the
National Forest Products Association; paragraph 5 of ANSI A10.8-1988
Scaffolding-Safety Requirements published by the American National
Standards Institute; or for 2 x 10 inch (nominal) or 2 x 9 inch
(rough) solid sawn wood planks, as shown in the following table:
------------------------------------------------------------------------
Maximum Maximum
permissible permissible
Maximum intended nominal load (lb/ span using span using
ft\2\) full thickness nominal
undressed thickness
lumber (ft) lumber (ft)
------------------------------------------------------------------------
25...................................... 10 8
50...................................... 8 6
75...................................... 6
------------------------------------------------------------------------
(ii) The maximum permissible span for 1\1/4\ x 9-inch or wider
wood plank of full thickness with a maximum intended load of 50 lb/
ft.\2\ shall be 4 feet.
(c) Fabricated planks and platforms may be used in lieu of solid
sawn wood planks. Maximum spans for such units shall be as
recommended by the manufacturer based on the maximum intended load
being calculated as follows:
------------------------------------------------------------------------
Rated load capacity Intended load
------------------------------------------------------------------------
Light-duty............... 25 pounds per square foot applied
uniformly over the entire span area.
Medium-duty.............. 50 pounds per square foot applied
uniformly over the entire span area.
Heavy-duty............... 75 pounds per square foot applied
uniformly over the entire span area.
One-person............... 250 pounds placed at the center of
the span (total 250 pounds).
Two-person............... 250 pounds placed 18 inches to the
left and right of the center of the span
(total 500 pounds).
Three-person............. 250 pounds placed at the center of
the span and 250 pounds placed 18 inches to
the left and right of the center of the span
(total 750 pounds).
------------------------------------------------------------------------
Note: Platform units used to make scaffold platforms intended
for light-duty use shall be capable of supporting at least 25 pounds
per square foot applied uniformly over the entire unit-span area, or
a 250-pound point load placed on the unit at the center of the span,
whichever load produces the greater shear force.
(d) Guardrails shall be as follows:
(i) Toprails shall be equivalent in strength to 2 inch by 4 inch
lumber; or
1\1/4\ inch x \1/8\ inch structural angle iron; or
1 inch x .070 inch wall steel tubing; or 1.990 inch x .058
inch wall aluminum tubing.
(ii) Midrails shall be equivalent in strength to 1 inch by 6
inch lumber; or
1\1/4\ inch x 1\1/4\ inch x \1/8\ inch structural angle
iron; or
1 inch x .070 inch wall steel tubing; or
1.990 inch x .058 inch wall aluminum tubing.
(iii) Toeboards shall be equivalent in strength to 1 inch by 4
inch lumber; or
1\1/4\ inch x 1\1/4\ inch structural angle iron; or
1 inch x .070 inch wall steel tubing; or
1.990 inch x .058 inch wall aluminum tubing.
(iv) Posts shall be equivalent in strength to 2 inch by 4 inch
lumber; or
1\1/4\ inch x 1\1/4\ inch x \1/8\ structural angle iron; or
1 inch x .070 inch wall steel tubing; or
1.990 inch x .058 inch wall aluminum tubing.
(v) Distance between posts shall not exceed 8 feet.
(e) Overhead protection shall consist of 2 inch nominal planking
laid tight, or \3/4\-inch plywood.
(f) Screen installed between toeboards and midrails or toprails
shall consist of No. 18 gauge U.S. Standard wire one inch mesh.
2. Specific guidelines and tables.
(a) Pole Scaffolds.
Single Pole Wood Pole Scaffolds
--------------------------------------------------------------------------------------------------------------------------------------------------------
Light duty up to 60 feet Medium duty up to 60 feet Heavy duty up to 60 feet
Light duty up to 20 feet high high high high
--------------------------------------------------------------------------------------------------------------------------------------------------------
Maximum intended load (lbs/ft 25........................... 25.......................... 50.......................... 75
\2\).
Poles or uprights.............. 2 x 4 in..................... 4 x 4 in.................... 4 x 4 in.................... 4 x 6 in.
Maximum pole spacing 6 feet....................... 10 feet..................... 8 feet...................... 6 feet
(longitudinal).
Maximum pole spacing 5 feet....................... 5 feet...................... 5 feet...................... 5 feet
(transverse).
[[Page 46119]]
Runners........................ 1 x 4 in..................... 1\1/4\ x 9 in............... 2 x 10 in................... 2 x 10 in.
Bearers and maximum spacing of
bearers:
3 feet..................... 2 x 4 in..................... 2 x 4 in.................... 2 x 10 in. or 3 x 4 in...... 2 x 10 in. or 3 x 5 in.
5 feet..................... 2 x 6 in. or 3 x 4 in........ 2 x 6 in. or 3 x 4 in. 2 x 10 in. or 3 x 4 in...... 2 x 10 in. or 3 x 5 in.
(rough).
6 feet..................... ............................. ............................ 2 x 10 in. or 3 x 4 in...... 2 x 10 in. or 3 x 5 in.
8 feet..................... ............................. ............................ 2 x 10 in. or 3 x 4 in...... ............................
Planking....................... 1\1/4\ x 9 in................ 2 x 10 in................... 2 x 10 in................... 2 x 10 in.
Maximum vertical spacing of 7 feet....................... 9 feet...................... 7 feet...................... 6 ft. 6 in.
horizontal members.
Bracing horizontal............. 1 x 4 in..................... 1 x 4 in.................... 1 x 6 in. or 1\1/4\ x 4 in.. 2 x 4 in.
Bracing diagonal............... 1 x 4 in..................... 1 x 4 in.................... 1 x 4 in.................... 2 x 4 in.
Tie-ins........................ 1 x 4 in..................... 1 x 4 in.................... 1 x 4 in.................... 1 x 4 in.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Note: All members except planking are used on edge. All wood
bearers shall be reinforced with \3/16\ x 2 inch steel strip, or the
equivalent, secured to the lower edges for the entire length of the
bearer.
Independent Wood Pole Scaffolds
--------------------------------------------------------------------------------------------------------------------------------------------------------
Light duty up to 60 feet Medium duty up to 60 feet Heavy duty up to 60 feet
Light duty up to 20 feet high high high high
--------------------------------------------------------------------------------------------------------------------------------------------------------
Maximum intended load.......... 25 lbs/ft\2\................. 25 lbs/ft\2\................ 50 lbs/ft\2\................ 75 lbs/ft\2\.
Poles or uprights.............. 2 x 4 in..................... 4 x 4 in.................... 4 x 4 in.................... 4 x 4 in.
Maximum pole spacing 6 feet....................... 10 feet..................... 8 feet...................... 6 feet.
(longitudinal).
Maximum (transverse)........... 6 feet....................... 10 feet..................... 8 feet...................... 8 feet.
Runners........................ 1\1/4\ x 4 in................ 1\1/4\ x 9 in............... 2 x 10 in................... 2 x 10 in.
Bearers and maximum spacing of
bearers:
3 feet..................... 2 x 4 in..................... 2 x 4 in.................... 2 x 10 in................... 2 x 10 in. (rough).
6 feet..................... 2 x 6 in. or 3 x 4 in........ 2 x 10 in. (rough) or 3 x 8 2 x 10 in................... 2 x 10 in. (rough).
in.
8 feet..................... 2 x 6 in. or 3 x 4 in........ 2 x 10 in. (rough) or 3 x 8 2 x 10 in................... ............................
in.
10 feet.................... 2 x 6 in. or 3 x 4 in........ 2 x 10 in.-- (rough) or 3 x ............................ ............................
3 in.
Planking....................... 1\1/4\ x 9 in................ 2 x 10 in................... 2 x 10 in................... 2 x 10 in.
Maximum vertical spacing of 7 feet....................... 7 feet...................... 6 feet...................... 6 feet.
horizontal members.
Bracing horizontal............. 1 x 4 in..................... 1 x 4 in.................... 1 x 6 in. or 1\1/4\ x 4 in.. 2 x 4 in.
Bracing diagonal............... 1 x 4 in..................... 1 x 4 in.................... 1 x 4 in.................... 2 x 4 in.
Tie-ins........................ 1 x 4 in..................... 1 x 4 in.................... 1 x 4 in.................... 1 x 4 in.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Note: All members except planking are used on edge. All wood
bearers shall be reinforced with \3/16\ x 2 inch steel strip, or the
equivalent, secured to the lower edges for the entire length of the
bearer.
(b) Tube and coupler scaffolds.
Minimum Size of Members
----------------------------------------------------------------------------------------------------------------
Light duty Medium duty Heavy duty
----------------------------------------------------------------------------------------------------------------
Maximum intended load................ 25 lbs/ft\2\........... 50 lbs/ft\2\........... 75 lbs/ft\2\.
Posts, runners and braces............ Nominal 2 in. (1.90 Nominal 2 in. (1.90 Nominal 2 in. (1.90
inches) OD steel tube inches) OD steel tube inches) OD steel tube
or pipe. or pipe. or pipe.
Bearers.............................. Nominal 2 in. (1.90 Nominal 2 in. (1.90 Nominal 2\1/2\ in.
inches). inches). (2.375 in.).
OD steel tube or pipe OD steel tube or pipe OD steel tube or pipe
and a maximum post and a maximum post and a maximum post
spacing of 4 ft. x 10 spacing of 4 ft. x 7 spacing of 6 ft. x 6
ft.. ft. or. ft.
Nominal 2\1/2\ in.
(2.375 in.).
OD steel tube or pipe
and a maximum post
spacing of 6 ft. x 8
ft.*.
Maximum runner spacing vertically.... 6 ft. 6 in............. 6 ft. 6 in............. 6 ft. 6 in.
----------------------------------------------------------------------------------------------------------------
* Bearers shall be installed in the direction of the shorter dimension.
Note: Longitudinal diagonal bracing shall be installed at an
angle of 45 deg. (5 deg.).
[[Page 46120]]
Maximum Number of Planked Levels
------------------------------------------------------------------------
Maximum number of
additional planked levels Maximum
--------------------------- height of
Light Medium Heavy scaffold
duty duty duty (in feet)
------------------------------------------------------------------------
Number of Working Levels:
1........................... 16 11 6 125
2........................... 11 1 0 125
3........................... 6 0 0 125
4........................... 1 0 0 125
------------------------------------------------------------------------
(c) Fabricated frame scaffolds. Because of their prefabricated
nature, no additional guidelines or tables for these scaffolds are
being adopted in this Appendix.
(d) Plasterers', decorators', and large area scaffolds. The
guidelines for pole scaffolds or tube and coupler scaffolds
(Appendix A (a) and (b)) may be applied.
(e) Bricklayers' square scaffolds.
Maximum intended load: 50 lb/ft.\2\*
---------------------------------------------------------------------------
* The squares shall be set not more than 8 feet apart for light
duty scaffolds and not more than 5 feet apart for medium duty
scaffolds.
---------------------------------------------------------------------------
Maximum width: 5 ft.
Maximum height: 5 ft.
Gussets: 1 x 6 in.
Braces: 1 x 8 in.
Legs: 2 x 6 in.
Bearers (horizontal members): 2 x 6 in.
(f) Horse scaffolds.
Maximum intended load (light duty): 25 lb/ft.\2\ **
---------------------------------------------------------------------------
** Horses shall be spaced not more than 8 feet apart for light
duty loads, and not more than 5 feet apart for medium duty loads.
---------------------------------------------------------------------------
Maximum intended load (medium duty): 50 lb/ft.\2\ **
Horizontal members or bearers:
Light duty: 2 x 4 in.
Medium duty: 3 x 4 in.
Legs: 2 x 4 in.
Longitudinal brace between legs: 1 x 6 in.
Gusset brace at top of legs: 1 x 8 in.
Half diagonal braces: 2 x 4 in.
(g) Form scaffolds and carpenters' bracket scaffolds.
(1) Brackets shall consist of a triangular-shaped frame made of
wood with a cross-section not less than 2 inches by 3 inches, or of
1\1/4\ inch x 1\1/4\ inch x \1/8\ inch structural angle iron.
(2) Bolts used to attach brackets to structures shall not be
less than \5/8\ inches in diameter.
(3) Maximum bracket spacing shall be 8 feet on centers.
(4) No more than two employees shall occupy any given 8 feet of
a bracket or form scaffold at any one time. Tools and materials
shall not exceed 75 pounds in addition to the occupancy.
(5) Wooden figure-four scaffolds:
Maximum intended load: 25 lb/ft.\2\
Uprights: 2 x 4 in. or 2 x 6 in.
Bearers (two): 1 x 6 in.
Braces: 1 x 6 in.
Maximum length of bearers (unsupported): 3 ft. 6 in.
(i) Outrigger bearers shall consist of two pieces of 1 x 6
inch lumber nailed on opposite sides of the vertical support.
(ii) Bearers for wood figure-four brackets shall project not
more than 3 feet 6 inches from the outside of the form support, and
shall be braced and secured to prevent tipping or turning. The knee
or angle brace shall intersect the bearer at least 3 feet from the
form at an angle of approximately 45 degrees, and the lower end
shall be nailed to a vertical support.
(6) Metal bracket scaffolds:
Maximum intended load: 25 lb/ft.\2\
Uprights: 2 x 4 inch
Bearers: As designed.
Braces: As designed.
(7) Wood bracket scaffolds:
Maximum intended load: 25 lb/ft.\2\
Uprights: 2 x 4 in or 2 x 6 in
Bearers: 2 x 6 in
Maximum scaffold width: 3 ft 6 in
Braces: 1 x 6 in
(h) Roof bracket scaffolds. No specific guidelines or tables are
given.
(i) Outrigger scaffolds (single level). No specific guidelines
or tables are given.
(j) Pump jack scaffolds. Wood poles shall not exceed 30 feet in
height. Maximum intended load--500 lbs between poles; applied at the
center of the span. Not more than two employees shall be on a pump
jack scaffold at one time between any two supports. When 2 x 4's
are spliced together to make a 4 x 4 inch wood pole, they shall be
spliced with ``10 penny'' common nails no more than 12 inches center
to center, staggered uniformly from the opposite outside edges.
(k) Ladder jack scaffolds. Maximum intended load--25 lb/ft\2\.
However, not more than two employees shall occupy any platform at
any one time. Maximum span between supports shall be 8 feet.
(l) Window jack scaffolds. Not more than one employee shall
occupy a window jack scaffold at any one time.
(m) Crawling boards (chicken ladders). Crawling boards shall be
not less than 10 inches wide and 1 inch thick, with cleats having a
minimum 1 x 1\1/2\ inch cross-sectional area. The cleats shall be
equal in length to the width of the board and spaced at equal
intervals not to exceed 24 inches.
(n) Step, platform, and trestle ladder scaffolds. No additional
guidelines or tables are given.
(o) Single-point adjustable suspension scaffolds. Maximum
intended load--250 lbs. Wood seats for boatswains' chairs shall be
not less than 1 inch thick if made of non-laminated wood, or \5/8\
inches thick if made of marine quality plywood.
(p) Two-point adjustable suspension scaffolds. (1) In addition
to direct connections to buildings (except window cleaners' anchors)
acceptable ways to prevent scaffold sway include angulated roping
and static lines. Angulated roping is a system of platform
suspension in which the upper wire rope sheaves or suspension points
are closer to the plane of the building face than the corresponding
attachment points on the platform, thus causing the platform to
press against the face of the building. Static lines are separate
ropes secured at their top and bottom ends closer to the plane of
the building face than the outermost edge of the platform. By
drawing the static line taut, the platform is drawn against the face
of the building.
(2) On suspension scaffolds designed for a working load of 500
pounds, no more than two employees shall be permitted on the
scaffold at one time. On suspension scaffolds with a working load of
750 pounds, no more than three employees shall be permitted on the
scaffold at one time.
(3) Ladder-type platforms. The side stringer shall be of clear
straight-grained spruce. The rungs shall be of straight-grained oak,
ash, or hickory, at least 1\1/8\ inches in diameter, with \7/8\ inch
tenons mortised into the side stringers at least \7/8\ inch. The
stringers shall be tied together with tie rods not less than \1/4\
inch in diameter, passing through the stringers and riveted up tight
against washers on both ends. The flooring strips shall be spaced
not more than \5/8\ inch apart, except at the side rails where the
space may be 1 inch. Ladder-type platforms shall be constructed in
accordance with the following table:
[[Page 46121]]
Schedule for Ladder-Type Platforms
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
Length of Platform............... 12 feet.................. 14 & 16 feet............ 18 & 20 feet.
Side stringers, minimum cross
section (finished sizes):
At ends...................... 1\3/4\ x 2\3/4\ in..... 1\3/4\ x 2\3/4\ in.... 1\3/4\ x 3 in.
At middle.................... 1\3/4\ x 3\3/4\ in..... 1\3/4\ x 3\3/4\ in.... 1\3/4\ x 4 in.
Reinforcing strip (minimum)......
(2)A \1/8\ x \7/8\ inch steel
reinforcing strip shall be
attached to the side or
underside, full length.
Rungs............................
(2)Rungs shall be 1\1/8\ inch
minimum diameter with at least
\7/8\ inch in diameter tenons,
and the maximum spacing shall be
12 inches to center.
Tie rods:
Number (minimum)............. 3........................ 4....................... 4
Diameter (minimum)........... \1/4\ inch............... \1/4\ inch.............. \1/4\ inch
Flooring, minimum finished size.. \1/2\ x 2\3/4\ in...... \1/2\ x 2\3/4\ in..... \1/2\ x 2\3/4\ in.
----------------------------------------------------------------------------------------------------------------
Schedule for Ladder-Type Platforms
------------------------------------------------------------------------
------------------------------------------------------------------------
Length of Platform.......... 22 & 24 ft.......... 28 & 30 ft.
Side stringers, minimum
cross section (finished
sizes):
At ends................. 1\3/4\ x 3 in....... 1\3/4\ x 3\1/2\
in.
At middle............... 1\3/4\ x 4\1/4\ in 1\3/4\ x 5 in.
Reinforcing strip (minimum).
(1)A \1/8\ x \7/8\-inch
steel reinforcing strip
shall be attached to the
side or underside, full
length.
Rungs.......................
(1)Rungs shall be 1\1/8\
inch minimum diameter with
at least \7/8\ inch in
diameter tenons, and the
maximum spacing shall be 12
inches to center. Tie rods.
Number (minimum)........ 5................... 6.
Diameter (minimum)...... \1/4\ in............ \1/4\ in.
Flooring, minimum finished \1/2\ x 2\3/4\ in. \1/2\ x 2\3/4\ in.
size.
------------------------------------------------------------------------
(4) Plank-Type Platforms. Plank-type platforms shall be composed
of not less than nominal 2 x 8 inch unspliced planks, connected
together on the underside with cleats at intervals not exceeding 4
feet, starting 6 inches from each end. A bar or other effective
means shall be securely fastened to the platform at each end to
prevent the platform from slipping off the hanger. The span between
hangers for plank-type platforms shall not exceed 10 feet.
(5) Beam-Type Platforms. Beam platforms shall have side
stringers of lumber not less than 2 x 6 inches set on edge. The
span between hangers shall not exceed 12 feet when beam platforms
are used. The flooring shall be supported on 2 x 6 inch cross
beams, laid flat and set into the upper edge of the stringers with a
snug fit, at intervals of not more than 4 feet, securely nailed to
the cross beams. Floor-boards shall not be spaced more than \1/2\
inch apart.
(q)(1) Multi-point adjustable suspension scaffolds and
stonesetters' multi-point adjustable suspension scaffolds. No
specific guidelines or tables are given for these scaffolds.
(q)(2) Masons' multi-point adjustable suspension scaffolds.
Maximum intended load--50 lb/ft2. Each outrigger beam shall be
at least a standard 7 inch, 15.3 pound steel I-beam, at least 15
feet long. Such beams shall not project more than 6 feet 6 inches
beyond the bearing point. Where the overhang exceeds 6 feet 6
inches, outrigger beams shall be composed of stronger beams or
multiple beams.
(r) Catenary scaffolds. (1) Maximum intended load--500 lbs.
(2) Not more than two employees shall be permitted on the
scaffold at one time.
(3) Maximum capacity of come-along shall be 2,000 lbs.
(4) Vertical pickups shall be spaced not more than 50 feet
apart.
(5) Ropes shall be equivalent in strength to at least \1/2\ inch
(1.3 cm) diameter improved plow steel wire rope.
(s) Float (ship) scaffolds. (1) Maximum intended load--750 lbs.
(2) Platforms shall be made of \3/4\ inch plywood, equivalent in
rating to American Plywood Association Grade B-B, Group I, Exterior.
(3) Bearers shall be made from 2 x 4 inch, or 1 x 10 inch rough
lumber. They shall be free of knots and other flaws.
(4) Ropes shall be equivalent in strength to at least 1 inch
(2.5 cm) diameter first grade manila rope.
(t) Interior hung scaffolds.
Bearers (use on edge): 2 x 10 in.
Maximum intended load: Maximum span
25 lb/ft.\2\: 10 ft.
50 lb/ft.\2\: 10 ft.
75 lb/ft.\2\: 7 ft.
(u) Needle beam scaffolds.
Maximum intended load: 25 lb/ft.\2\
Beams: 4 x 6 in.
Maximum platform span: 8 ft.
Maximum beam span: 10 ft.
(1) Ropes shall be attached to the needle beams by a scaffold
hitch or an eye splice. The loose end of the rope shall be tied by a
bowline knot or by a round turn and a half hitch.
(2) Ropes shall be equivalent in strength to at least 1 inch
(2.5 cm) diameter first grade manila rope.
(v) Multi-level suspension scaffolds. No additional guidelines
or tables are being given for these scaffolds.
(w) Mobile Scaffolds. Stability test as described in the ANSI
A92 series documents, as appropriate for the type of scaffold, can
be used to establish stability for the purpose of
Sec. 1926.452(w)(6).
(x) Repair bracket scaffolds. No additional guidelines or tables
are being given for these scaffolds.
(y) Stilts. No specific guidelines or tables are given.
(z) Tank builder's scaffold.
(1) The maximum distance between brackets to which scaffolding
and guardrail supports are attached shall be no more than 10 feet 6
inches.
(2) Not more than three employees shall occupy a 10 feet 6 inch
span of scaffold planking at any time.
(3) A taut wire or synthetic rope supported on the scaffold
brackets shall be installed at the scaffold plank level between the
innermost edge of the scaffold platform and the curved plate
structure of the tank shell to serve as a safety line in lieu of an
inner guardrail assembly where the space between the scaffold
platform and the tank exceeds 12 inches (30.48 cm). In the event the
open space on either side of the rope exceeds 12 inches (30.48 cm),
a second wire or synthetic rope appropriately placed, or guardrails
in accordance with Sec. 1926.451(e)(4), shall be installed in order
to reduce that open space to less than 12 inches (30.48 cm).
[[Page 46122]]
(4) Scaffold planks of rough full-dimensioned 2-inch (5.1
cm) x 12-inch (30.5 cm) Douglas Fir or Southern Yellow Pine of
Select Structural Grade shall be used. Douglas Fir planks shall have
a fiber stress of at least 1900 lb/in\2\ (130,929 n/cm\2\) and a
modulus of elasticity of at least 1,900,000 lb/in\2\ (130,929,000 n/
cm\2\), while Yellow Pine planks shall have a fiber stress of at
least 2500 lb/in\2\ (172,275 n/cm\2\) and a modulus of elasticity of
at least 2,000,000 lb/in\2\ (137,820,000 n/cm\2\).
(5) Guardrails shall be constructed of a taut wire or synthetic
rope, and shall be supported by angle irons attached to brackets
welded to the steel plates. These guardrails shall comply with
Sec. 1926.451(e)(4). Guardrail supports shall be located at no
greater than 10 feet 6 inch intervals.
Non-Mandatory Appendix B to Subpart L--Criteria for Determining the
Feasibility of Providing Safe Access and Fall Protection for Scaffold
Erectors and Dismantlers
[Reserved]
Non-Mandatory Appendix C to Subpart L--List of National Consensus
Standards
ANSI/SIA A92.2-1990 Vehicle-Mounted Elevating and Rotating Aerial
Devices
ANSI/SIA A92.3-1990 Manually Propelled Elevating Aerial Platforms
ANSI/SIA A92.5-1990 Boom Supported Elevating Work Platforms
ANSI/SIA A92.6-1990 Self-Propelled Elevating Work Platforms
ANSI/SIA A92.7-1990 Airline Ground Support Vehicle-Mounted Vertical
Lift Devices
ANSI/SIA A92.8-1993 Vehicle-Mounted Bridge Inspection and
Maintenance Devices
ANSI/SIA A92.9-1993 Mast-Climbing Work Platforms
Non-Mandatory Appendix D to Subpart L--List of Training Topics for
Scaffold Erectors and Dismantlers
This Appendix D is provided to serve as a guide to assist
employers when evaluating the training needs of employees erecting
or dismantling supported scaffolds.
The Agency believes that employees erecting or dismantling
scaffolds should be trained in the following topics:
General Overview of Scaffolding
regulations and standards
erection/dismantling planning
PPE and proper procedures
fall protection
materials handling
access
working platforms
foundations
guys, ties and braces
Tubular Welded Frame Scaffolds
specific regulations and standards
components
parts inspection
erection/dismantling planning
guys, ties and braces
fall protection
general safety
access and platforms
erection/dismantling procedures
rolling scaffold assembly
putlogs
Tube and Clamp Scaffolds
specific regulations and standards
components
parts inspection
erection/dismantling planning
guys, ties and braces
fall protection
general safety
access and platforms
erection/dismantling procedures
buttresses, cantilevers, & bridges
System Scaffolds
specific regulations and standards
components
parts inspection
erection/dismantling planning
guys, ties and braces
fall protection
general safety
access and platforms
erection/dismantling procedures
buttresses, cantilevers, & bridges
Scaffold erectors and dismantlers should all receive the general
overview, and, in addition, specific training for the type of
supported scaffold being erected or dismantled.
(Non-mandatory) Appendix E to Subpart L--Drawings and Illustrations
This Appendix provides drawings of particular types of scaffolds
and scaffold components, and graphic illustrations of bracing
patterns and tie spacing patterns.
This Appendix is intended to provide visual guidance to assist
the user in complying with the requirements of subpart L, part 1926.
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Sec. 1926.556 [Removed]
2. Section 1926.556 is removed.
[FR Doc. 96-21289 Filed 8-29-96; 8:45 am]
BILLING CODE 4510-26-P
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