ADDENDUM D.  Proposed CY 2017 GEOGRAPHIC ADJUSTMENT FACTORS (GAFs)*								
Carrier	Locality Number	Medicare Locality	2016 GAF	2017 GAF	"Percent Change 
(2016 to 2017)"	2018 without 1.0 Work Floor	"Percent Change
(2016-2018 without 1.0 Work Floor)"	
10102	00	ALABAMA	0.932	0.931	-0.1%	0.918	-1.5%	
02102	01	ALASKA**	1.290	1.292	0.2%	1.294	0.3%	
03102	00	ARIZONA	0.995	0.988	-0.7%	0.97	-2.5%	
07102	13	ARKANSAS	0.920	0.923	0.3%	0.91	-1.1%	
01112	54	"BAKERSFIELD, CA"	1.036	1.031	-0.5%	1.026	-1.0%	
01112	55	"CHICO, CA"	1.036	1.031	-0.5%	1.025	-1.1%	
01182	71	"EL CENTRO, CA"	1.036	1.031	-0.5%	1.025	-1.1%	
01112	56	"FRESNO, CA"	1.036	1.031	-0.5%	1.025	-1.1%	
01112	57	"HANFORD-CORCORAN, CA"	1.036	1.031	-0.5%	1.025	-1.1%	
01182	18	"LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES CNTY), CA"	1.092	1.091	-0.1%	1.09	-0.2%	
01182	26	"LOS ANGELES-LONG BEACH-ANAHEIM (ORANGE CNTY), CA"	1.111	1.101	-0.9%	1.09	-1.9%	
01112	58	"MADERA, CA"	1.036	1.031	-0.5%	1.025	-1.1%	
01112	59	"MERCED, CA"	1.036	1.031	-0.5%	1.025	-1.1%	
01112	60	"MODESTO, CA"	1.036	1.031	-0.5%	1.025	-1.1%	
01112	51	"NAPA, CA"	1.137	1.128	-0.8%	1.119	-1.6%	
01182	17	"OXNARD-THOUSAND OAKS-VENTURA, CA"	1.089	1.083	-0.6%	1.077	-1.1%	
01112	61	"REDDING, CA"	1.036	1.031	-0.5%	1.025	-1.1%	
01112	62	"RIVERSIDE-SAN BERNARDINO-ONTARIO, CA"	1.036	1.032	-0.4%	1.03	-0.6%	
01112	63	"SACRAMENTO--ROSEVILLE--ARDEN-ARCADE, CA"	1.036	1.031	-0.5%	1.032	-0.4%	
01112	64	"SALINAS, CA"	1.036	1.033	-0.3%	1.035	-0.1%	
01182	72	"SAN DIEGO-CARLSBAD, CA"	1.036	1.035	-0.1%	1.038	0.2%	
01112	07	"SAN FRANCISCO-OAKLAND-HAYWARD (ALAMEDA/CONTRA COSTA CNTY), CA"	1.124	1.142	1.6%	1.159	3.1%	
01112	52	"SAN FRANCISCO-OAKLAND-HAYWARD (MARIN CNTY), CA"	1.137	1.129	-0.7%	1.133	-0.4%	
01112	05	"SAN FRANCISCO-OAKLAND-HAYWARD (SAN FRANCISCO CNTY), CA"	1.191	1.175	-1.3%	1.159	-2.7%	
01112	06	"SAN FRANCISCO-OAKLAND-HAYWARD (SAN MATEO CNTY), CA"	1.182	1.171	-0.9%	1.159	-1.9%	
01112	65	"SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY), CA"	1.036	1.053	1.6%	1.077	4.0%	
01112	09	"SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY), CA"	1.175	1.175	0.0%	1.175	0.0%	
01182	73	"SAN LUIS OBISPO-PASO ROBLES-ARROYO GRANDE, CA"	1.036	1.031	-0.5%	1.027	-0.9%	
01112	66	"SANTA CRUZ-WATSONVILLE, CA"	1.036	1.042	0.6%	1.054	1.7%	
01182	74	"SANTA MARIA-SANTA BARBARA, CA"	1.036	1.036	0.0%	1.044	0.8%	
01112	67	"SANTA ROSA, CA"	1.036	1.037	0.1%	1.043	0.7%	
01112	68	"STOCKTON-LODI, CA"	1.036	1.031	-0.5%	1.025	-1.1%	
01112	53	"VALLEJO-FAIRFIELD, CA"	1.137	1.128	-0.8%	1.119	-1.6%	
01112	69	"VISALIA-PORTERVILLE, CA"	1.036	1.031	-0.5%	1.025	-1.1%	
01112	70	"YUBA CITY, CA"	1.036	1.031	-0.5%	1.025	-1.1%	
01112	75	REST OF CALIFORNIA	1.036	1.031	-0.5%	1.025	-1.1%	
04112	01	COLORADO	1.009	1.010	0.1%	1.008	-0.1%	
13102	00	CONNECTICUT	1.076	1.075	-0.1%	1.072	-0.4%	
12202	01	DC + MD/VA SUBURBS	1.130	1.128	-0.2%	1.126	-0.4%	
12102	01	DELAWARE	1.024	1.021	-0.3%	1.017	-0.7%	
09102	03	"FORT LAUDERDALE, FL"	1.044	1.042	-0.2%	1.031	-1.2%	
09102	04	"MIAMI, FL"	1.079	1.080	0.1%	1.075	-0.4%	
09102	99	REST OF FLORIDA	0.996	0.995	-0.1%	0.981	-1.5%	
10202	01	"ATLANTA, GA"	1.000	1.001	0.1%	1.001	0.1%	
10202	99	REST OF GEORGIA	0.951	0.954	0.3%	0.948	-0.3%	
01212	01	"HAWAII, GUAM"	1.058	1.054	-0.4%	1.049	-0.9%	
02202	00	IDAHO	0.933	0.934	0.1%	0.916	-1.8%	
06102	16	"CHICAGO, IL"	1.068	1.064	-0.4%	1.059	-0.8%	
06102	12	"EAST ST. LOUIS, IL"	1.008	1.007	-0.1%	0.997	-1.1%	
06102	15	"SUBURBAN CHICAGO, IL"	1.059	1.056	-0.3%	1.053	-0.6%	
06102	99	REST OF ILLINOIS	0.970	0.971	0.1%	0.963	-0.7%	
08102	00	INDIANA	0.948	0.943	-0.5%	0.921	-2.8%	
05102	00	IOWA	0.932	0.933	0.1%	0.918	-1.5%	
05202	00	KANSAS	0.942	0.943	0.1%	0.926	-1.7%	
15102	00	KENTUCKY	0.934	0.936	0.2%	0.925	-1.0%	
07202	01	"NEW ORLEANS, LA"	1.009	1.003	-0.6%	0.99	-1.9%	
07202	99	REST OF LOUISIANA	0.958	0.958	0.0%	0.946	-1.3%	
14112	03	SOUTHERN MAINE	0.988	0.988	0.0%	0.979	-0.9%	
14112	99	REST OF MAINE	0.948	0.949	0.1%	0.936	-1.3%	
12302	01	"BALTIMORE/SURR. CNTYS, MD"	1.063	1.065	0.2%	1.067	0.4%	
12302	99	REST OF MARYLAND	1.023	1.023	0.0%	1.023	0.0%	
14212	01	"METROPOLITAN BOSTON, MA"	1.065	1.082	1.6%	1.1	3.3%	
14212	99	REST OF MASSACHUSETTS	1.022	1.033	1.1%	1.043	2.1%	
08202	01	"DETROIT, MI"	1.011	1.018	0.7%	1.025	1.4%	
08202	99	REST OF MICHIGAN	0.962	0.964	0.2%	0.953	-0.9%	
06202	00	MINNESOTA	0.980	0.979	-0.1%	0.977	-0.3%	
07302	00	MISSISSIPPI	0.922	0.919	-0.3%	0.895	-2.9%	
05302	02	"METROPOLITAN KANSAS CITY, MO"	0.980	0.983	0.3%	0.978	-0.2%	
05302	01	"METROPOLITAN ST. LOUIS, MO"	0.981	0.982	0.1%	0.976	-0.5%	
05302	99	REST OF MISSOURI	0.930	0.934	0.4%	0.918	-1.3%	
03202	01	MONTANA***	1.010	1.018	0.8%	1.009	-0.1%	
05402	00	NEBRASKA	0.931	0.931	0.0%	0.915	-1.7%	
01312	00	NEVADA***	1.025	1.015	-1.0%	1.005	-2.0%	
14312	40	NEW HAMPSHIRE	1.021	1.022	0.1%	1.018	-0.3%	
12402	01	NORTHERN NJ	1.106	1.103	-0.3%	1.099	-0.6%	
12402	99	REST OF NEW JERSEY	1.073	1.069	-0.4%	1.065	-0.7%	
04212	05	NEW MEXICO	0.971	0.973	0.2%	0.966	-0.5%	
13202	01	"MANHATTAN, NY"	1.135	1.134	-0.1%	1.134	-0.1%	
13202	02	"NYC SUBURBS/LONG ISLAND, NY"	1.169	1.166	-0.3%	1.162	-0.6%	
13202	03	"POUGHKPSIE/N NYC SUBURBS, NY"	1.059	1.056	-0.3%	1.053	-0.6%	
13292	04	"QUEENS, NY"	1.166	1.166	0.0%	1.164	-0.2%	
13282	99	REST OF NEW YORK	0.965	0.963	-0.2%	0.954	-1.1%	
11502	00	NORTH CAROLINA	0.959	0.958	-0.1%	0.943	-1.7%	
03302	01	NORTH DAKOTA***	0.981	0.981	0.0%	0.969	-1.2%	
15202	00	OHIO	0.963	0.963	0.0%	0.958	-0.5%	
04312	00	OKLAHOMA	0.936	0.943	0.7%	0.929	-0.7%	
02302	01	"PORTLAND, OR"	1.012	1.016	0.4%	1.02	0.8%	
02302	99	REST OF OREGON	0.973	0.974	0.1%	0.971	-0.2%	
12502	01	"METROPOLITAN PHILADELPHIA, PA"	1.061	1.061	0.0%	1.061	0.0%	
12502	99	REST OF PENNSYLVANIA	0.968	0.970	0.2%	0.968	0.0%	
09202	20	PUERTO RICO	0.837	0.920	9.9%	1.002	19.7%	
14412	01	RHODE ISLAND	1.025	1.031	0.6%	1.036	1.1%	
11202	01	SOUTH CAROLINA	0.948	0.945	-0.3%	0.93	-1.9%	
03402	02	SOUTH DAKOTA***	0.974	0.974	0.0%	0.954	-2.1%	
10302	35	TENNESSEE	0.934	0.935	0.1%	0.923	-1.2%	
04412	31	"AUSTIN, TX"	0.998	0.999	0.1%	0.995	-0.3%	
04412	20	"BEAUMONT, TX"	0.954	0.957	0.3%	0.951	-0.3%	
04412	09	"BRAZORIA, TX"	1.003	1.003	0.0%	1.002	-0.1%	
04412	11	"DALLAS, TX"	1.003	1.003	0.0%	1.002	-0.1%	
04412	28	"FORT WORTH, TX"	0.991	0.989	-0.2%	0.986	-0.5%	
04412	15	"GALVESTON, TX"	1.014	1.011	-0.3%	1.008	-0.6%	
04412	18	"HOUSTON, TX"	1.010	1.012	0.2%	1.013	0.3%	
04412	99	REST OF TEXAS	0.956	0.960	0.4%	0.958	0.2%	
03502	09	UTAH	0.972	0.974	0.2%	0.964	-0.8%	
14512	50	VERMONT	0.988	0.989	0.1%	0.979	-0.9%	
11302	00	VIRGINIA	0.985	0.988	0.3%	0.986	0.1%	
09202	50	VIRGIN ISLANDS	1.002	1.002	0.0%	1.002	0.0%	
02402	02	"SEATTLE (KING CNTY), WA"	1.061	1.069	0.8%	1.076	1.4%	
02402	99	REST OF WASHINGTON	0.984	0.992	0.8%	0.999	1.5%	
11402	16	WEST VIRGINIA	0.939	0.944	0.5%	0.931	-0.9%	
06302	00	WISCONSIN	0.961	0.957	-0.4%	0.944	-1.8%	
03602	21	WYOMING***	1.009	1.002	-0.7%	0.986	-2.3%	
								
GAF equation: (0.50866 * work GPCI) + (0.44839 * PE GPCI) + (0.04295 * MP GPCI).								
								
"* January 1, 2017 through December 31, 2017, GAF reflects a 1.0 Work GPCI floor as required by Section 201 of the MACRA of 2015. "								
"   The 1.0 Work GPCI floor expires on December 31, 2017, therefore the GAFs for 2018 do not reflect a 1.0 floor."								
								
**GAF reflects a 1.5 work GPCI floor in Alaska established by the MIPPA.								
***GAF reflects a 1.0 PE GPCI floor for frontier states established by the Affordable Care Act.								
								
 								
