ADDENDUM D.  Proposed CY 2020 GEOGRAPHIC ADJUSTMENT FACTORS (GAFs)*									
"For the purposes of the PFS, GAFs are an analysis tool for comparing approximate aggregate geographic payment adjustment among PFS localities "									
Medicare Administrative Contractor	State	Locality Number	Medicare Locality	2019 GAF*	2020 GAF	"Percent Change 
(2019-2020)"	2021 GAF	"Percent Change
(2019-2021)"	
10112	AL	00	ALABAMA	0.929	0.935	0.7%	0.942	1.4%	
02102	AK	01	ALASKA**	1.294	1.284	-0.8%	1.274	-1.6%	
03102	AZ	00	ARIZONA	0.980	0.972	-0.8%	0.965	-1.5%	
07102	AR	13	ARKANSAS	0.924	0.913	-1.2%	0.901	-2.5%	
01112	CA	54	BAKERSFIELD	1.027	1.028	0.1%	1.029	0.2%	
01112	CA	55	CHICO	1.025	1.021	-0.3%	1.021	-0.3%	
01182	CA	71	EL CENTRO	1.025	1.022	-0.3%	1.022	-0.3%	
01112	CA	56	FRESNO	1.025	1.021	-0.3%	1.021	-0.3%	
01112	CA	57	HANFORD-CORCORAN	1.025	1.021	-0.4%	1.021	-0.4%	
01182	CA	18	LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES CNTY)	1.090	1.086	-0.3%	1.083	-0.6%	
01182	CA	26	LOS ANGELES-LONG BEACH-ANAHEIM (ORANGE CNTY)	1.090	1.092	0.2%	1.094	0.4%	
01112	CA	58	MADERA	1.025	1.021	-0.3%	1.021	-0.3%	
01112	CA	59	MERCED	1.025	1.021	-0.3%	1.021	-0.3%	
01112	CA	60	MODESTO	1.025	1.021	-0.3%	1.021	-0.3%	
01112	CA	51	NAPA	1.119	1.077	-3.8%	1.077	-3.8%	
01112	CA	07	OAKLAND/BERKELEY	1.159	1.134	-2.2%	1.108	-4.4%	
01182	CA	17	OXNARD-THOUSAND OAKS-VENTURA	1.077	1.075	-0.2%	1.072	-0.5%	
01112	CA	61	REDDING	1.025	1.021	-0.3%	1.021	-0.3%	
01112	CA	62	RIVERSIDE-SAN BERNARDINO-ONTARIO	1.033	1.031	-0.2%	1.034	0.1%	
01112	CA	63	SACRAMENTO--ROSEVILLE--ARDEN-ARCADE	1.036	1.030	-0.6%	1.032	-0.4%	
01112	CA	64	SALINAS	1.040	1.048	0.8%	1.055	1.5%	
01182	CA	72	SAN DIEGO-CARLSBAD	1.045	1.052	0.6%	1.060	1.4%	
01112	CA	05	SAN FRANCISCO	1.159	1.177	1.6%	1.195	3.1%	
01112	CA	52	SAN FRANCISCO-OAKLAND-HAYWARD (MARIN CNTY)	1.140	1.106	-3.0%	1.113	-2.4%	
01112	CA	65	SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY)	1.104	1.079	-2.2%	1.094	-0.9%	
01182	CA	73	SAN LUIS OBISPO-PASO ROBLES-ARROYO GRANDE	1.029	1.027	-0.2%	1.029	0.0%	
01112	CA	06	SAN MATEO	1.159	1.182	2.0%	1.205	4.0%	
01112	CA	09	SANTA CLARA	1.175	1.173	-0.1%	1.171	-0.3%	
01112	CA	66	SANTA CRUZ-WATSONVILLE	1.069	1.058	-1.0%	1.067	-0.2%	
01182	CA	74	SANTA MARIA-SANTA BARBARA	1.054	1.052	-0.2%	1.060	0.6%	
01112	CA	67	SANTA ROSA	1.052	1.053	0.1%	1.061	0.9%	
01112	CA	68	STOCKTON-LODI	1.025	1.021	-0.3%	1.021	-0.3%	
01112	CA	53	VALLEJO-FAIRFIELD	1.119	1.077	-3.8%	1.077	-3.8%	
01112	CA	69	VISALIA-PORTERVILLE	1.025	1.021	-0.3%	1.021	-0.3%	
01112	CA	70	YUBA CITY	1.025	1.021	-0.3%	1.021	-0.3%	
01112	CA	75	REST OF CALIFORNIA	1.025	1.021	-0.3%	1.021	-0.3%	
04112	CO	01	COLORADO	1.010	1.010	0.0%	1.010	0.0%	
13102	CT	00	CONNECTICUT	1.072	1.063	-0.8%	1.055	-1.6%	
12202	DC	01	DC + MD/VA SUBURBS	1.126	1.133	0.6%	1.139	1.2%	
12102	DE	01	DELAWARE	1.017	1.013	-0.4%	1.009	-0.8%	
09102	FL	03	FORT LAUDERDALE	1.040	1.034	-0.5%	1.029	-1.0%	
09102	FL	04	MIAMI	1.080	1.076	-0.4%	1.073	-0.7%	
09102	FL	99	REST OF FLORIDA	0.994	0.988	-0.6%	0.982	-1.2%	
10212	GA	01	ATLANTA	1.002	1.000	-0.2%	0.997	-0.5%	
10212	GA	99	REST OF GEORGIA	0.958	0.951	-0.7%	0.944	-1.4%	
01212	HI	01	"HAWAII, GUAM"	1.049	1.048	-0.1%	1.047	-0.2%	
02202	ID	00	IDAHO	0.935	0.922	-1.4%	0.909	-2.8%	
06102	IL	16	CHICAGO	1.059	1.059	0.0%	1.058	-0.1%	
06102	IL	12	EAST ST. LOUIS	1.005	1.000	-0.5%	0.996	-0.9%	
06102	IL	15	SUBURBAN CHICAGO	1.053	1.050	-0.2%	1.048	-0.4%	
06102	IL	99	REST OF ILLINOIS	0.973	0.968	-0.5%	0.964	-0.9%	
08102	IN	00	INDIANA	0.937	0.930	-0.7%	0.922	-1.6%	
05102	IA	00	IOWA	0.934	0.929	-0.5%	0.924	-1.0%	
05202	KS	00	KANSAS	0.944	0.934	-1.0%	0.925	-2.0%	
15102	KY	00	KENTUCKY	0.938	0.934	-0.5%	0.930	-0.9%	
07202	LA	01	NEW ORLEANS	0.996	0.987	-1.0%	0.978	-1.9%	
07202	LA	99	REST OF LOUISIANA	0.958	0.953	-0.5%	0.948	-1.0%	
14112	ME	03	SOUTHERN MAINE	0.989	0.984	-0.5%	0.978	-1.1%	
14112	ME	99	REST OF MAINE	0.951	0.941	-1.0%	0.931	-2.1%	
12302	MD	01	BALTIMORE/SURR. CNTYS	1.067	1.066	-0.1%	1.065	-0.2%	
12302	MD	99	REST OF MARYLAND	1.023	1.026	0.3%	1.029	0.6%	
14212	MA	01	METROPOLITAN BOSTON	1.100	1.100	0.0%	1.100	0.0%	
14212	MA	99	REST OF MASSACHUSETTS	1.043	1.037	-0.6%	1.030	-1.2%	
08202	MI	01	DETROIT	1.025	1.021	-0.4%	1.017	-0.8%	
08202	MI	99	REST OF MICHIGAN	0.964	0.958	-0.7%	0.951	-1.4%	
06202	MN	00	MINNESOTA	0.978	0.976	-0.2%	0.975	-0.3%	
07302	MS	00	MISSISSIPPI	0.915	0.912	-0.3%	0.910	-0.5%	
05302	MO	02	METROPOLITAN KANSAS CITY	0.987	0.976	-1.1%	0.965	-2.2%	
05302	MO	01	METROPOLITAN ST. LOUIS	0.984	0.980	-0.4%	0.977	-0.7%	
05302	MO	99	REST OF MISSOURI	0.938	0.929	-1.0%	0.920	-1.9%	
03202	MT	01	MONTANA***	1.027	1.000	-2.6%	0.973	-5.3%	
05402	NE	00	NEBRASKA	0.930	0.924	-0.7%	0.918	-1.3%	
01312	NV	00	NEVADA***	1.005	1.012	0.7%	1.019	1.4%	
14312	NH	40	NEW HAMPSHIRE	1.022	1.017	-0.5%	1.012	-1.0%	
12402	NJ	01	NORTHERN NJ	1.099	1.102	0.3%	1.104	0.5%	
12402	NJ	99	REST OF NEW JERSEY	1.065	1.069	0.4%	1.072	0.7%	
04212	NM	05	NEW MEXICO	0.975	0.969	-0.6%	0.962	-1.4%	
13202	NY	01	MANHATTAN	1.134	1.144	0.9%	1.155	1.9%	
13202	NY	02	NYC SUBURBS/LONG ISLAND	1.162	1.173	0.9%	1.185	2.0%	
13202	NY	03	POUGHKPSIE/N NYC SUBURBS	1.053	1.068	1.4%	1.082	2.8%	
13292	NY	04	QUEENS	1.164	1.178	1.2%	1.193	2.5%	
13282	NY	99	REST OF NEW YORK	0.960	0.963	0.3%	0.965	0.5%	
11502	NC	00	NORTH CAROLINA	0.956	0.955	-0.1%	0.955	-0.1%	
03302	ND	01	NORTH DAKOTA***	0.980	0.970	-1.0%	0.960	-2.1%	
15202	OH	00	OHIO	0.963	0.962	-0.1%	0.961	-0.2%	
04312	OK	00	OKLAHOMA	0.949	0.937	-1.3%	0.925	-2.5%	
02302	OR	01	PORTLAND	1.020	1.017	-0.3%	1.014	-0.6%	
02302	OR	99	REST OF OREGON	0.976	0.964	-1.2%	0.951	-2.5%	
12502	PA	01	METROPOLITAN PHILADELPHIA	1.061	1.054	-0.6%	1.048	-1.2%	
12502	PA	99	REST OF PENNSYLVANIA	0.973	0.968	-0.5%	0.964	-0.9%	
09202	PR	20	PUERTO RICO	1.003	1.008	0.5%	1.014	1.1%	
14412	RI	01	RHODE ISLAND	1.036	1.036	0.0%	1.037	0.1%	
11202	SC	01	SOUTH CAROLINA	0.941	0.939	-0.2%	0.938	-0.4%	
03402	SD	02	SOUTH DAKOTA***	0.974	0.960	-1.4%	0.946	-2.9%	
10312	TN	35	TENNESSEE	0.935	0.929	-0.7%	0.923	-1.3%	
04412	TX	31	AUSTIN	0.999	1.001	0.2%	1.003	0.4%	
04412	TX	20	BEAUMONT	0.959	0.956	-0.3%	0.953	-0.6%	
04412	TX	09	BRAZORIA	1.002	1.001	-0.1%	1.001	-0.1%	
04412	TX	11	DALLAS	1.002	1.002	0.0%	1.002	0.0%	
04412	TX	28	FORT WORTH	0.986	0.987	0.1%	0.987	0.1%	
04412	TX	15	GALVESTON	1.008	1.005	-0.3%	1.002	-0.6%	
04412	TX	18	HOUSTON	1.013	1.016	0.3%	1.019	0.6%	
04412	TX	99	REST OF TEXAS	0.963	0.964	0.1%	0.964	0.1%	
03502	UT	09	UTAH	0.974	0.961	-1.4%	0.948	-2.7%	
14512	VT	50	VERMONT	0.989	0.980	-0.9%	0.970	-2.0%	
11302	VA	00	VIRGINIA	0.990	0.993	0.3%	0.996	0.6%	
09202	VI	50	VIRGIN ISLANDS	1.003	1.008	0.5%	1.014	1.1%	
02402	WA	02	SEATTLE (KING CNTY)	1.076	1.079	0.3%	1.083	0.6%	
02402	WA	99	REST OF WASHINGTON	1.001	0.995	-0.6%	0.990	-1.1%	
11402	WV	16	WEST VIRGINIA	0.949	0.944	-0.5%	0.940	-0.9%	
06302	WI	00	WISCONSIN	0.953	0.944	-0.9%	0.935	-1.9%	
03602	WY	21	WYOMING***	0.995	0.987	-0.8%	0.978	-1.7%	
"MAC assignments as of May 6, 2019"									
									
GAF equation: (0.50866 * work GPCI) + (0.44839 * PE GPCI) + (0.04295 * MP GPCI).									
									
"* January 1, 2017 through December 31, 2019, 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, 2019, therefore the GAFs for 2020 and 2021 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.									
									
 									
