| U.S. DEPARTMENT OF LABOR | |
| OFFICE OF WORKERS' COMPENSATION PROGRAMS | |
| COST TO CHARGE RATIO HIGH VALUES FOR FY 2012 | |
| FOR CALCULATING MAXIMUM ALLOWABLES FOR NON-PPS HOSPITAL SERVICES | |
| (These are usually services provided by non-PPS covered hospitals: psychiatric, | |
| long-term care, and rehabilitation hospitals, and skilled nursing facilities (SNF).) | |
| OWCP FORMULA FOR NON-PPS HOSPITAL SERVICES: | |
| Where: | |
| BA = Billed Amount | |
| CCR = State Cost to Charge Ratio | |
| 1.26 = DOL OWCP Adjustment Factor | |
| MA = Maximum Allowable | |
| Formula: MA = BA x CCR x 1.26 | |
| Payment Rule: Pay lesser of BA or MA | |
| Total | |
| CCR | |
| STATE | Factor |
| Alabama | 0.341 |
| Alaska | 0.722 |
| Arizona | 0.352 |
| Arkansas | 0.361 |
| California | 0.288 |
| Colorado | 0.430 |
| Connecticut | 0.562 |
| Delaware | 0.519 |
| District of Columbia | 0.345 |
| Florida | 0.262 |
| Georgia | 0.391 |
| Hawaii | 0.504 |
| Idaho | 0.549 |
| Illinois | 0.377 |
| Indiana | 0.461 |
| Iowa | 0.441 |
| Kansas | 0.434 |
| Kentucky | 0.379 |
| Louisiana | 0.354 |
| Maine | 0.491 |
| Maryland | 0.817 |
| Massachusetts | 0.493 |
| Michigan | 0.460 |
| Minnesota | 0.533 |
| Mississippi | 0.346 |
| Missouri | 0.362 |
| Montana | 0.490 |
| Nebraska | 0.477 |
| Nevada | 0.443 |
| New Hampshire | 0.449 |
| New Jersey | 0.184 |
| New Mexico | 0.386 |
| New York | 0.546 |
| North Carolina | 0.389 |
| North Dakota | 0.442 |
| Ohio | 0.506 |
| Oklahoma | 0.392 |
| Oregon | 0.454 |
| Pennsylvania | 0.431 |
| Puerto Rico | 0.520 |
| Rhode Island | 0.388 |
| South Carolina | 0.320 |
| South Dakota | 0.428 |
| Tennessee | 0.360 |
| Texas | 0.345 |
| Utah | 0.582 |
| Vermont | 0.642 |
| Virgin Islands ** | 0.780 |
| Virginia | 0.368 |
| Washington | 0.483 |
| West Virginia | 0.470 |
| Wisconsin | 0.500 |
| Wyoming | 0.529 |
** Note: No figures were published for Virgin Islands for 2012. OWCP will continue to use 2008 figures for V.I. hospitals (if any).