Decisions Made

• Additive rather than multiplicative

  • Multiplicative allows any one extremely high or extremely low value to dominate the index. Because the actual impact of indirect measures is unknown, additive allows the impact to be more easily controlled

• 50% direct, 50% indirect

  • No evidence that one is more important than the other

• Indirect measure developed based on weights, with 50% to the death rate and 25% to poverty and prevalence

  • Death is the ultimate failure of access to care, therefore its weight is double the weight of the other measures

• Index applied to Part A Supplemental funding only

  • Implementation will be incremental, starting with Part A Supplemental since SON has been part of it since 1996