This is the home page for the FY 2022 Hospital Inpatient PPS proposed rule. The list below centralizes any IPPS file(s) related to the proposed rule. The list contains the proposed rule (display version or published Federal Register version) and a subsequent published correction notices (if applicable), all tables, additional data and analysis files and the impact file. For files related to the Long-Term Care Hospital PPS, please visit /Medicare/Medicare-Fee-for-Service-Payment/LongTermCareHospitalPPS/index.

FY 2022 IPPS Proposed Rule

CMS-1752-P

Date of Display: April 27, 2021

Title: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Proposed Policy Changes and Fiscal Year 2022 Rates; Quality Reporting and Medicare and Medicaid Promoting Interoperability Programs Requirements for Eligible Hospitals and Critical Access Hospitals

Comment Period:  To be assured consideration, comments must be received no later than 5 p.m. EDT on June 28, 2021.

The FY 2022 IPPS/LTCH PPS final rule will be issued in multiple parts. CMS received over 6,500 public comments on the FY 2022 IPPS/LTCH PPS proposal rule. The public comments on our proposals relating to disproportionate share hospital payments, organ acquisition costs, and the provisions of the Consolidated Appropriations Act, 2021, related to payments to hospitals for direct graduate medical education (GME) and indirect medical education (IME) costs, which were included in the FY 2022 IPPS/LTCH PPS proposed rule, will be addressed in subsequent parts.

Associated Rules - FY 2022 Interim Final Rule with Comment Period

CMS-1762-IFC

Date of Display: April 27, 2021

Title: Medicare Program; Modification of Limitations on Redesignation by the Medicare Geographic Classification Review Board (MGCRB)

Summary: This interim final rule with comment period (IFC) amends our current regulations to allow hospitals with a rural redesignation under the Social Security Act ( the Act) to reclassify through the Medicare Geographic Classification Review Board (MGCRB) using the rural reclassified area as the geographic area in which the hospital is located. These regulatory changes align our policy with the decision in Bates County Memorial Hospital v. Azar, effective with reclassifications beginning with fiscal year (FY) 2023. We would also apply the policy in this IFC when deciding timely appeals before the Administrator of applications for reclassifications beginning with FY 2022 that were denied by the MGCRB due to the current policy, which does not permit hospitals with rural redesignations to use the rural area’s wage data for purposes of reclassifying under the MGCRB.

Comment Period: To be assured consideration, comments must be received no later than 5 p.m. EDT on June 28, 2021.

FY 2022 Proposed Rule Data Files

1. FY 2022 Proposed Rule Impact File (ZIP): This file contains data elements by provider that were used in calculating the proposed FY 2022 rates and impacts.
2. AOR/BOR File (ZIP): This zip file for the FY 2022 proposed rule contains one excel spreadsheet with multiple tabs: one for the After Outliers Removed (AOR) and one for the Before Outliers Removed (BOR). There are also two tabs containing the variable descriptions. The variables in these files are used in the calculations of the relative weights as well as other calculations for the inpatient PPS. All text files in the zip file are for 508 compliance.
3. Case Mix Index File (ZIP): This file contains the non-transfer adjusted case mix index (CMI) based on the MS-DRGs billed on the claim in the year the claim was incurred (that is, during FY 2019, using the V36 Grouper ).
4. FY 2022 Proposed Rule: HCRIS Data File (ZIP): CMS uses hospital cost report data from the Medicare Cost Report, Hospital Form 2552-10, to calculate the Cost-to-Charge Ratios (CCRs) used in the cost based MS-DRG relative weight methodology.  The database for the Medicare cost reports is the Healthcare Cost Report Information System (HCRIS).  The CCRs used in the calculation of the MS DRG relative weights for the FY 2022 IPPS Proposed Rule are derived from the December 31, 2020 quarterly update of the FY 2019 HCRIS.   (HCRIS is updated on a quarterly basis).
5. Cost Center HCRIS Lines Supplemental Data File (ZIP): This supplemental data file shows the cost report lines that are used for the Cost Center CCR calculations, which are part of the MS-DRG Relative Weights calculations.
6. Proposed Standardizing File (ZIP): This file is used to standardize charges for the rate building process.
7. County to CBSA Crosswalk File and Urban CBSAs and Constituent Counties for Acute Care Hospitals File (ZIP): This file contains two tabs: A crosswalk of county codes to CBSAs  and a list of Urban CBSAs and Constituent Counties for Acute Care Hospitals Files.
8. FY 2022 Proposed Rule Wage Index Public Use Files (ZIP): Open Attached Zip file. Attached is a PDF with a description of each zip file. Main zip file contains 5 zip files:
   • FY 2022 Proposed Rule Wage Index PUFs; S3 Part II and Occ Mix Data
   • FY 2022 Proposed Rule Average Hourly Wage by Provider and CBSA Public Use File
   • FY 2022 Proposed Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Occupational Mix Factor by Provider
   • FY 2022 Proposed Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Pre-Reclass Wage Indexes by CBSA
   • FY 2022 Proposed Rule AHW by Provider Area Listing
9. FY 2022 IPPS Proposed Rule: Medicare DSH Supplemental Data File (ZIP): This spreadsheet has 3 tabs (text files for each tab are included for Section 508 compliance):   The first tab is the File Layout for second tab of the spreadsheet. The second tab contains the proposed rule FY 2022 Factor 3 and data used to calculate Factor 3 to implement Section 3133 of the ACA, Improvements to Medicare DSH Payments. The third tab contains a list of hospitals that have undergone a merger where the data of the merging hospitals have been combined to calculate the Factor 3 for the surviving hospital for FY 2022.
10. Lugar Hospitals in Counties that Qualify for an Outmigration Adjustment for FY 2022:
    Note, this file will no longer be posted as all relevant information is available in Table 2.
11. FY 2022 New Technology Thresholds Proposed Rule (ZIP): Contains the proposed cost thresholds by MS-DRG for the cost criteria for new technology add-on payments for applications for FY 2023.
12. FY 2022 Proposed Imputed State Floors (ZIP): Contains proposed imputed floors. See table for complete details.
13. Intermediary Letters (ILs) 73-25 (PDF) and 74-23 (PDF) Historic Documents Cited in the FY 2022 IPPS / LTCH proposed rule: The Intermediary Letters (IL) 73-25 and 74-23 were cited in the 2022 IPPS proposed rule (86 Fed. Reg. 25070 at 25656) and are being posted on this website as CMS historical documents only. The IL 73-25 and IL 74-23 are not to be construed as current Medicare policy.

FY 2022 Proposed Rule Tables

1. Table 1A-1E (ZIP): This excel spreadsheet contains the proposed FY 2022 Operating and Capital National Standardized Amounts.
2. FY 2022 Proposed Rule Tables 2, 3 and 4A and 4B (Wage Index Tables) (ZIP):  Table 2- Proposed Case-Mix Index and Wage Index Table by CMS Certification Number (CCN); Table 3- Proposed Wage Index Table by CBSA; Table 4A - Proposed List of Counties Eligible for the Out-Migration Adjustment under Section 1886(d)(13) of the Act; Table 4B - Proposed Counties Redesignated under Section 1886(d)(8)(B) of the Act (LUGAR COUNTIES)
3. Table 5 (ZIP): Proposed MS-DRGs, Relative Weighting Factors and Geometric and Arithmetic Mean Length of Stay
4. Tables 6A-6J and Tables 6P.1a-6P.3a (ZIP): Table 6A-New Diagnosis Codes; Table 6B-New Procedure Codes; Table 6C-Invalid Diagnosis Codes; Table 6D- Invalid Procedure Codes; Table 6E-Revised Diagnosis Code Titles; Table 6G.1- Proposed Secondary Diagnosis Order Additions to the CC Exclusions List; Table 6G.2- Proposed Principal Diagnosis Order Additions to the CC Exclusions List; Table 6H.1- Proposed Secondary Diagnosis Order Deletions to the CC Exclusions List; Table 6H.2- Proposed Principal Diagnosis Order Deletions to the CC Exclusions List; Table 6I.1- Proposed Additions to the MCC List; Table 6I.2- Proposed Deletions to the MCC List; and Table 6J.1- Proposed Additions to the CC List. Tables 6P.1a-6P.2c (ICD-10-CM and ICD-10-PCS Codes for Proposed MS-DRG Changes): See summary tab in excel spreadsheet called “CMS-1752-P TABLE 6P ICD-10-CM and ICD-10-PCS Codes for MS-DRG Changes.xlsx” for a complete description of all tables. Table 6P.3a (ICD-10-CM Codes for Potential MS-DRG Changes): See summary tab in excel spreadsheet called “CMS-1752-P Table 6P.3a ICD-10-CM Codes for Potential MS-DRG Changes.xlsx” for a complete description of the table.
5. Tables 7A and 7B (ZIP): Tables 7A and 7B contain the number of discharges, and selected percentile lengths of stay for both MS-DRGs, version 38 and MS-DRGs, proposed version 39.
6. Tables 8A, 8B, and 8C (ZIP): Tables 8A and 8B contain the proposed FY 2022 IPPS operating and capital statewide average cost-to-charge-ratios. Table 8C contains the proposed FY 2022 LTCH statewide average cost-to-charge-ratios.
7. Table 16 (ZIP): Proxy Hospital Value-Based Purchasing (VBP) Program Adjustment Factors for FY 2022
8. Table 18 (ZIP): Proposed FY 2022 Medicare DSH Uncompensated Care Payment Factor 3

FY 2022 Proposed Alternatives Considered Files

1. FY 2022 Proposed Rule Alternative Considered Budget Neutrality Factors, Adjustments, Standardized Amounts (ZIP): Contains Operating and Capital National Standardized Amounts as well as other factors, such as budget neutrality factors and the fixed-loss outlier threshold, determined under the FY 2022 proposed rule alternatives considered.
2. FY 2022 Proposed Rule Alternatives Considered Impact File (ZIP) - Updated 05/26/2021: This file contains data elements by provider that were used in developing the rates under the FY 2022 proposed rule alternatives considered.
3. FY 2022 Proposed Rule Alternatives Considered MS-DRG Weights (ZIP): Contains MS-DRG weights determined under the FY 2022 proposed rule alternatives considered.
4. FY 2022 Proposed Rule Alternatives Considered MS-DRG Related Files (ZIP): - Updated 06/03/2021:  Contains multiple zip files including AOR/BOR file, standardization file and CMI file determined under the FY 2022 proposed rule alternatives considered.
5. FY 2022 Proposed Rule Alternatives Considered HCRIS Data File (ZIP): CMS uses hospital cost report data from the Medicare Cost Report, Hospital Form 2552-10, to calculate the Cost-to-Charge Ratios (CCRs) used in the cost based MS-DRG relative weight methodology.  The database for the Medicare cost reports is the Healthcare Cost Report Information System (HCRIS).  The CCRs used in the calculation of the MS‑DRG relative weights under the FY 2022 proposed rule alternatives considered are derived from the December 31, 2020 quarterly update of the FY 2019 cost reports.  (HCRIS is updated on a quarterly basis).
6. FY 2022 Proposed Rule Alternatives Considered Wage Index Files (ZIP): Contains wage indexes calculated using factors (such as the rural floor budget neutrality factor) determined under the FY 2022 proposed rule alternatives considered.
7. FY 2022 Proposed Rule Alternatives Considered CMI and Discharges for RRC Status (ZIP):  Contains the regional median CMI and discharge values used for purposes of determining RRC status determined under the FY 2022 proposed rule alternatives considered.
8. FY 2022 Proposed Rule Alternatives Considered New Technology Thresholds (ZIP): Contains the cost thresholds by MS-DRG using data under the FY 2022 proposed rule alternatives considered for the cost criteria for new technology add-on payments for applications for FY 2023.