Annual Direct GME Update Factors

ACTUAL UPDATE FACTORS*

Updating to the Midpoint And Ending From the Using of Cost Reporting Period Midpoint of Update Beginning Cost Factor of Reporting Period Beginning January 1, 2005 December 31, 2005 January 1, 2004 1.0285 February 1, 2005 January 31, 2006 February 1, 2004 1.0340 March 1, 2005 February 28, 2006 March 1, 2004 1.0416 April 1, 2005 March 31, 2006 April 1, 2004 1.0452 May 1, 2005 April 30, 2006 May 1, 2004 1.0390 June 1, 2005 May 31, 2006 June 1, 2004 1.0344 July 1, 2005 June 30, 2006 July 1, 2004 1.0370 August 1, 2005 July 31, 2006 August 1, 2004 1.0379 September 1, 2005 August 31, 2006 September 1, 2004 1.0348 October 1, 2005 September 30, 2006 October 1, 2004 1.0345 November 1, 2005 October 31, 2006 November 1, 2004 1.0386 December 1, 2005 November 30, 2006 December 1, 2004 1.0424 January 1, 2006 December 31, 2006 January 1, 2005 1.0423 February 1, 2006 January 31, 2007 February 1, 2005 1.0398 March 1, 2006 February 28, 2007 March 1, 2005 1.0294 April 1, 2006 March 31, 2007 April 1, 2005 1.0168 May 1, 2006 April 30, 2007 May 1, 2005 1.0164 June 1, 2006 May 31, 2007 June 1, 2005 1.0226 July 1, 2006 June 30, 2007 July 1, 2005 1.0231 August 1, 2006 July 31, 2007 August 1, 2005 1.0225 September 1, 2006 August 31, 2007 September 1, 2005 1.0260 October 1, 2006 September 30, 2007 October 1, 2005 1.0268 November, 1, 2006 October 31, 2007 November 1, 2005 1.0263 December 1, 2006 November 30, 2007 December 1, 2005 1.0269 January 1, 2007 December 31, 2007 January 1, 2006 1.0252 February 1, 2007 January 31, 2008 February 1, 2006 1.0216 Last Update: September 1, 2021 Updating to the Midpoint And Ending From the Using of Cost Reporting Period Midpoint of Update Beginning Cost Factor of Reporting Period Beginning March 1, 2007 February 29, 2008 March 1, 2006 1.0236 April 1, 2007 March 31, 2008 April 1, 2006 1.0314 May 1, 2007 April 30, 2008 May 1, 2006 1.0392 June 1, 2007 May 31, 2008 June 1, 2006 1.0419 July 1, 2007 June 30, 2008 July 1, 2006 1.0418 August 1, 2007 July 31, 2008 August 1, 2006 1.0415 September 1, 2007 August 31, 2008 September 1, 2006 1.0400 October 1, 2007 September 30, 2008 October 1, 2006 1.0396 November 1, 2007 October 31, 2008 November 1, 2006 1.0406 December 1, 2007 November 30, 2008 December 1, 2006 1.0460 January 1, 2008 December 31, 2008 January 1, 2007 1.0531 February 1, 2008 January 31, 2009 February 1, 2007 1.0549 March 1, 2008 February 28, 2009 March 1, 2007 1.0515 April 1, 2008 March 31, 2009 April 1, 2007 1.0430 May 1, 2008 April 30, 2009 May 1, 2007 1.0236 June 1, 2008 May 31, 2009 June 1, 2007 1.0058 July 1, 2008 June 30, 2009 July 1, 2007 1.0006 August 1, 2008 July 31, 2009 August 1, 2007 1.0013 September 1, 2008 August 31, 2009 September 1, 2007 0.9992 October 1, 2008 September 30, 2009 October 1, 2007 0.9944 November 1, 2008 October 31, 2009 November 1, 2007 0.9899 December 1, 2008 November 30, 2009 December 1, 2007 0.9865 January 1, 2009 December 31, 2009 January 1, 2008 0.9824 February 1, 2009 January 31, 2010 February 1, 2008 0.9821 March 1, 2009 February 28, 2010 March 1, 2008 0.9861 April 1, 2009 March 31, 2010 April 1, 2008 0.9926 May 1, 2009 April 30, 2010 May 1, 2008 1.0082 June 1, 2009 May 31, 2010 June 1, 2008 1.0228 July 1, 2009 June 30, 2010 July 1, 2008 1.0267 August 1, 2009 July 31, 2010 August 1, 2008 1.0238 September 1, 2009 August 31, 2010 September 1, 2008 1.0223 October 1, 2009 September 30, 2010 October 1, 2008 1.0228 Last Update: September 1, 2021

Updating to the Midpoint And Ending From the Using of Cost Reporting Period Midpoint of Update Beginning Cost Factor of Reporting Period Beginning November 1, 2009 October 31, 2010 November 1, 2008 1.0213 December 1, 2009 November 30, 2010 December 1, 2008 1.0154 January 1, 2010 December 31, 2010 January 1, 2009 1.0114 February 1, 2010 January 31, 2011 February 1, 2009 1.0119 March 1, 2010 February 28, 2011 March 1, 2009 1.0115 April 1, 2010 March 31, 2011 April 1, 2009 1.0116 May 1, 2010 April 30, 2011 May 1, 2009 1.0116 June 1, 2010 May 31, 2011 June 1, 2009 1.0132 July 1, 2010 June 30, 2011 July 1, 2009 1.0156 August 1, 2010 July 31, 2011 August 1, 2009 1.0187 September 1, 2010 August 31, 2011 September 1, 2009 1.0240 October 1, 2010 September 30, 2011 October 1, 2009 1.0292 November 1, 2010 October 31, 2011 November 1, 2009 1.0337 December 1, 2010 November 30, 2011 December 1, 2009 1.0356 January 1, 2011 December 31, 2011 January 1, 2010 1.0359 February 1, 2011 January 31, 2012 February 1, 2010 1.0370 March 1, 2011 February 29, 2012 March 1, 2010 1.0382 April 1, 2011 March 31, 2012 April 1, 2010 1.0370 May 1, 2011 April 30, 2012 May 1, 2010 1.0346 June 1, 2011 May 31, 2012 June 1, 2010 1.0318 July 1, 2011 June 30, 2012 July 1, 2010 1.0294 August 1, 2011 July 31, 2012 August 1, 2010 1.0290 September 1, 2011 August 31, 2012 September 1, 2010 1.0276 October 1, 2011 September 30, 2012 October 1, 2010 1.0248 November 1, 2011 October 31, 2012 November 1, 2010 1.0200 December 1, 2011 November 30, 2012 December 1, 2010 1.0168 January 1, 2012 December 31, 2012 January 1, 2011 1.0154 February 1, 2012 January 31, 2013 February 1, 2011 1.0155 March 1, 2012 February 28, 2013 March 1, 2011 1.0184 April 1, 2012 March 31, 2013 April 1, 2011 1.0208 May 1, 2012 April 30, 2013 May 1, 2011 1.0196 June 1, 2012 May 31, 2013 June 1, 2011 1.0175 Last Update: September 1, 2021

Updating to the Midpoint And Ending From the Using of Cost Reporting Period Midpoint of Update Beginning Cost Factor of Reporting Period Beginning July 1, 2012 June 30, 2013 July 1, 2011 1.0167 August 1, 2012 July 31, 2013 August 1, 2011 1.0179 September 1, 2012 August 31, 2013 September 1, 2011 1.0172 October 1, 2012 September 30, 2013 October 1, 2011 1.0127 November 1, 2012 October 31, 2013 November 1, 2011 1.0121 December 1, 2012 November 30, 2013 December 1, 2011 1.0156 January 1, 2013 December 31, 2013 January 1, 2012 1.0186 February 1, 2013 January 31, 2014 February 1, 2012 1.0174 March 1, 2013 February 28, 2014 March 1, 2012 1.0135 April 1, 2013 March 31, 2014 April 1, 2012 1.0107 May 1, 2013 April 30, 2014 May 1, 2012 1.0110 June 1, 2013 May 31, 2014 June 1, 2012 1.0137 July 1, 2013 June 30, 2014 July 1, 2012 1.0154 August 1, 2013 July 31, 2014 August 1, 2012 1.0135 September 1, 2013 August 31, 2014 September 1, 2012 1.0132 October 1, 2013 September 30, 2014 October 1, 2012 1.0173 November 1, 2013 October 31, 2014 November 1, 2012 1.0204 December 1, 2013 November 30, 2014 December 1, 2012 1.0210 January 1, 2014 December 31, 2014 January 1, 2013 1.0203 February 1, 2014 January 31, 2015 February 1, 2013 1.0185 March 1, 2014 February 28, 2015 March 1, 2013 1.0168 April 1, 2014 March 31, 2015 April 1, 2013 1.0166 May 1, 2014 April 30, 2015 May 1, 2013 1.0149 June 1, 2014 May 31, 2015 June 1, 2013 1.0104 July 1, 2014 June 30, 2015 July 1, 2013 1.0033 August 1, 2014 July 31, 2015 August 1, 2013 0.9994 September 1, 2014 August 31, 2015 September 1, 2013 0.9995 October 1, 2014 September 30, 2015 October 1, 2013 0.9986 November 1, 2014 October 31, 2015 November 1, 2013 0.9988 December 1, 2014 November 30, 2015 December 1, 2013 1.0004 January 1, 2015 December 31. 2015 January 1, 2014 1.0015 February 1, 2015 January 31, 2016 February 1, 2014 1.0018 Last Update: September 1, 2021

Updating to the Midpoint And Ending From the Using of Cost Reporting Period Midpoint of Update Beginning Cost Factor of Reporting Period Beginning March 1, 2015 February 29, 2016 March 1, 2014 1.0008 April 1, 2015 March 31, 2016 April 1, 2014 1.0007 May 1, 2015 April 30, 2016 May 1, 2014 1.0034 June 1, 2015 May 31, 2016 June 1, 2014 1.0062 July 1, 2015 June 30, 2016 July 1, 2014 1.0105 August 1, 2015 July 31, 2016 August 1, 2014 1.0120 September 1, 2015 August 31, 2016 September 1, 2014 1.0093 October 1, 2015 September 30, 2016 October 1, 2014 1.0099 November 1, 2015 October 31, 2016 November 1, 2014 1.0107 December 1, 2015 November 30, 2016 December 1, 2014 1.0101 January 1, 2016 December 31, 2016 January 1, 2015 1.0091 February 1, 2016 January 31, 2017 February 1, 2015 1.0094 March 1, 2016 February 28, 2017 March 1, 2015 1.0126 April 1, 2016 March 31, 2017 April 1, 2015 1.0155 May 1, 2016 April 30, 2017 May 1, 2015 1.0166 June 1, 2016 May 31, 2017 June 1, 2015 1.0188 July 1, 2016 June 30, 2017 July 1, 2015 1.0229 August 1, 2016 July 31, 2017 August 1, 2015 1.0262 September 1, 2016 August 31, 2017 September 1, 2015 1.0256 October 1, 2016 September 30, 2017 October 1, 2015 1.0229 November 1, 2016 October 31, 2017 November 1, 2015 1.0204 December 1, 2016 November 30, 2017 December 1, 2015 1.0175 January 1, 2017 December 31, 2017 January 1, 2016 1.0168 February 1, 2017 January 31, 2018 February 1, 2016 1.0183 March 1, 2017 February 28, 2018 March 1, 2016 1.0209 April 1, 2017 March 31, 2018 April 1, 2016 1.0214 May 1, 2017 April 30, 2018 May 1, 2016 1.0212 June 1, 2017 May 31, 2018 June 1, 2016 1.0216 July 1, 2017 June 30, 2018 July 1, 2016 1.0209 August 1, 2017 July 31, 2018 August 1, 2016 1.0214 September 1, 2017 August 31, 2018 September 1, 2016 1.0229 October 1, 2017 September 30, 2018 October 1, 2016 1.0241 Last Update: September 1, 2021

Updating to the Midpoint And Ending From the Using of Cost Reporting Period Midpoint of Update Beginning Cost Factor of Reporting Period Beginning November 1, 2017 October 31, 2018 November 1, 2016 1.0263 December 1, 2017 November 30, 2018 December 1, 2016 1.0284 January 1, 2018 December 31, 2018 January 1, 2017 1.0291 February 1, 2018 January 31, 2019 February 1, 2017 1.0282 March 1, 2018 February 28, 2019 March 1, 2017 1.0249 April 1, 2018 March 31, 2019 April 1, 2017 1.0240 May 1, 2018 April 30, 2019 May 1, 2017 1.0235 June 1, 2018 May 31, 2019 June 1, 2017 1.0204 July 1, 2018 June 30, 2019 July 1, 2017 1.0173 August 1, 2018 July 31, 2019 August 1, 2017 1.0154 September 1, 2018 August 31, 2019 September 1, 2017 1.0169 October 1, 2018 September 30, 2019 October 1, 2017 1.0193 November 1, 2018 October 31, 2019 November 1, 2017 1.0189 December 1, 2018 November 30, 2019 December 1, 2017 1.0172 January 1, 2019 December 31, 2019 January 1, 2018 1.0173 February 1, 2019 January 31, 2020 February 1, 2018 1.0178 March 1, 2019 February 29, 2020 March 1, 2018 1.0173 April 1, 2019 March 31, 2020 April 1, 2018 1.0174 May 1, 2019 April 30, 2020 May 1, 2018 1.0191 June 1, 2019 May 31, 2020 June 1, 2018 1.0217 July 1, 2019 June 30, 2020 July 1, 2018 1.0239 August 1, 2019 July 31, 2020 August 1, 2018 1.0241 September 1, 2019 August 31, 2020 September 1, 2018 1.0194 October 1, 2019 September 30, 2020 October 1, 2018 1.0093 November 1, 2019 October 31, 2020 November 1, 2018 1.0022 December 1, 2019 November 30, 2020 December 1, 2018 1.0038 January 1, 2020 December 31, 2020 January 1, 2019 1.0082 February 1, 2020 January 31, 2021 February 1, 2019 1.0115 March 1, 2020 February 28, 2021 March 1, 2019 1.0134 April 1, 2020 March 31, 2021 April 1, 2019 1.0128 May 1, 2020 April 30, 2021 May 1, 2019 1.0118 June 1, 2020 May 31, 2021 June 1, 2019 1.0127 Last Update: September 1, 2021

Updating to the Midpoint And Ending From the Using of Cost Reporting Period Midpoint of Update Beginning Cost Factor of Reporting Period Beginning July 1, 2020 June 30, 2021 July 1, 2019 1.0138 August 1, 2020 July 31, 2021 August 1, 2019 1.0154 September 1, 2020 August 31, 2021 September 1, 2019 1.0215 October 1, 2020 September 30, 2021 October 1, 2019 1.0339 November 1, 2020 October 31, 2021 November 1, 2019 1.0458 December 1, 2020 November 30, 2021 December 1, 2019 1.0519 January 1, 2021 December 31, 2021 January 1, 2020 1.0538

PROJECTED UPDATE FACTORS**

Updating to the Midpoint And Ending From the Using of Cost Reporting Period Midpoint of Cost Update Beginning Reporting Factor of Period Beginning February 1, 2021 January 31, 2022 February 1, 2020 1.0556 March 1, 2021 February 28, 2022 March 1, 2020 1.0598 April 1, 2021 March 31, 2022 April 1, 2020 1.0602 May 1, 2021 April 30, 2022 May 1, 2020 1.0568 June 1, 2021 May 31, 2022 June 1, 2020 1.0531 July 1, 2021 June 30, 2022 July 1, 2020 1.0505 August 1, 2021 July 31, 2022 August 1, 2020 1.0491 September 1, 2021 August 31, 2022 September 1, 2020 1.0463 October 1, 2021 September 30, 2022 October 1, 2020 1.0421 November 1, 2021 October 31, 2022 November 1, 2020 1.0373 December 1, 2021 November 30, 2022 December 1, 2020 1.0321 January 1, 2022 December 31, 2022 January 1, 2021 1.0264 February 1, 2022 January 31, 2023 February 1, 2021 1.0199 March 1, 2022 February 28, 2023 March 1, 2021 1.0130 April 1, 2022 March 31, 2023 April 1, 2021 1.0110 Last Update: September 1, 2021

Updating to the Midpoint And Ending From the Using of Cost Reporting Period Midpoint of Cost Update Beginning Reporting Factor of Period Beginning May 1, 2022 April 30, 2023 May 1, 2021 1.0134 June 1, 2022 May 31, 2023 June 1, 2021 1.0159 July 1, 2022 June 30, 2023 July 1, 2021 1.0166 August 1, 2022 July 31, 2023 August 1, 2021 1.0157 September 1, 2022 August 31, 2023 September 1, 2021 1.0147 October 1, 2022 September 30, 2023 October 1, 2021 1.0143 November 1, 2022 October 31, 2023 November 1, 2021 1.0145 December 1, 2022 November 30, 2023 December 1, 2021 1.0147 * The actual update factor revises the earlier projected factor for the specified cost reporting period. It is applied to the prior period's per resident amount and used in determining the current period's final settlement. For cost reporting periods beginning on or after July 1, 1987, the actual update factor accounts for the 12-month percentage change in the Consumer Price Index for All Urban Consumers (CPI-U) ending at the midpoint of the specified cost reporting period.

** The projected update factor for a specified cost reporting period is applied to the prior period's per resident amount and used only for interim payment purposes. Projected update factors are based on forecasts of the CPI-U All Items that are provided to CMS by IHS Global Insight, Inc. on a quarterly basis.

Last Update: September 1, 2021