Files for FY 2011 Proposed Rule and Supplemental Proposed Rule

Fiscal Year (FY) 2011 hospital inpatient prospective payment systems (IPPS) and long-term care prospective payment system (LTCH PPS) propose rule files (published on May 4, 2010). See below for a list of files from the supplemental proposed rule (published on June 2, 2010).

1. Impact File: This file contains data elements by provider that were used in calculating the Proposed FY 2011 rates and impacts.

2. AOR/BOR File: This zip file contains two excel spreadsheets, one for the Proposed After Outliers Removed (AOR) and one for the Proposed Before Outliers Removed (BOR). There are also two files 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: This file contains FY 2011 proposed hospitals' case mix indexes (CMI) for discharges. A hospital's CMI represents the average diagnosis-related group (DRG) relative weight for that hospital. It is calculated by summing the DRG weights for all Medicare discharges and dividing by the number of discharges.

4. Proposed Standardizing File: This file is used to standardize charges for the rate building process.

5. County to CBSA Crosswalk File: This file lists the CBSA, SSA county code and FIPS county code for all counties. Any changes to the CBSAs through March 2010 have been incorporated. It also contains the old MSA (based on 1990 census data) and old MSA name to which each county was assigned prior to the implementation of CBSAs in FY 2005.

6. Wage Index Public Use Files: Open Attached Zip file. Attached is a PDF with a description of each zip file. Main zip file contains 5 zip files: 1. FY 2011 Proposed Rule Wage Index PUFs; 2. FY 2011 Proposed Rule Average Hourly Wage by Provider and CBSA Public Use File; 3. FY 2011 Proposed Occupational Mix Adjusted and Unadjusted Average Hourly Wages by Provider; 4. FY 2011 Proposed Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Pre-Reclass Wage Indexes by CBSA; 5. FY 2011 Proposed Occupational Mix Factor by Provider PUF.

7. Table 1A-1E: This excel spreadsheet contains the proposed FY 2011 Operating and Capital National and Puerto Rico Specific Standardized Amounts. Additionally, there are two text files corresponding to each tab in the spreadsheet to meet Section 508 compliance.

8. Tables 2, 3A, 3B, 4A, 4B, 4C, 4F, 4J, 9A, 9B, 9C (Wage Index Tables): Proposed FY 2011 Wage Index Tables

9. Proposed Table 5: List of MS-DRGs, Relative Weighting Factors and Geometric and Arithmetic Mean Length of Stay

10. Proposed Tables 6A-6K: Tables 6A -6F: List of new, revised, and deleted ICD-9-CM diagnosis and procedures codes and MS-DRG assignments; Tables 6G contains the Additions to the CC Exclusions List; Table 6H contains the Deletions from the CC Exclusions List. Table 6I contains the complete MCC list; Table 6I.1 contains the additions to the MCC list; Table 6I.2 contains the deletions to the MCC list; Table 6J contains the complete CC list; Table 6J.1 contains the additions to the CC list; Table 6J.2 contains the deletions to the CC list; Table 6K contains the Complete list of CC exclusions for the MS-DRGs; All files are 508 compliant.

11. Proposed Tables 7A and 7B: Tables 7A and 7B contain the number of discharges, and selected percentile lengths of stay for both MS-DRGs, version 27 and MS-DRGs, version 28 as published in the Federal Register. Additionally, there are two text files corresponding to each tab in the spreadsheet to meet Section 508 compliance.

12. Proposed Tables 8A, 8B, and 8c: Tables 8A and 8B contain the proposed FY 2011 IPPS operating and capital statewide average cost-to-charge-ratios as published in the Federal Register. Tables 8C contains the proposed FY 2011 LTCH statewide average cost-to-charge-ratios as published in the Federal Register. Additionally, there are three text files corresponding to each tab in the spreadsheet to meet Section 508 compliance.

13. Proposed Table 10: Table 10 contains the proposed cost thresholds by MS-DRG for the cost criteria for new technology add on payment applications for FY 2012. Additionally, there is a text file corresponding to the table to meet Section 508 compliance

On June 2, 2010, we published a supplemental proposed rule to the FY 2011 hospital IPPS LTCH PPS propose rule (published in the May 4, 2010 Federal Register). The supplemental proposed rule implements certain statutory provisions relating to Medicare payments to hospitals for inpatient services that are contained in the Patient Protection and Affordable Care Act (the Affordable Care Act) as amended by the Health Care and Education Reconciliation Act of 2010 (HCERA) (collectively known as the Affordable Care Act). It also specifies statutorily required changes to the amounts and factors used to determine the rates for Medicare acute care hospital inpatient services for operating costs and capital‑related costs, and for long‑term care hospital costs. Below is a list of files and tables for the supplemental proposed rule. If a file or table is not found in the list below, then the file or table has not changed since the proposed rule published on May 4, 2010 and the file or table can be found in the list above which lists the files and tables from the proposed rule published on May 4, 2010.

14. Supplemental Proposed Impact File: This file contains data elements by provider that were used in calculating the Supplemental Proposed FY 2011 rates and impacts.

15. Supplemental Proposed Table 1A-1E: This excel spreadsheet contains the supplemental proposed FY 2011 Operating and Capital National and Puerto Rico Specific Standardized Amounts. Additionally, there are two text files corresponding to each tab in the spreadsheet to meet Section 508 compliance.

16. Supplemental Proposed Tables 2, 4A, 4B, 4C, 4D-2, 4J, 9A,(Wage Index Tables): Supplemental Proposed FY 2011 Wage Index Tables

17. Supplemental Proposed Table 10: Contains the supplemental proposed cost thresholds by MS-DRG for the cost criteria for new technology add on payment applications for FY 2012. Additionally, there is a text file corresponding to the table to meet Section 508 compliance.

18. Section 1109 Tables (Revised): (On June 4, 2010 we added additional data and information; the list of proposed eligible counties and qualifying hospitals remains the same) Section 1109 of the Health Care and Education Reconciliation Act of 2010, Public L. 111-152 (enacted on March 30, 2010), provides for additional payments for FY 2011 and 2012 for "qualifying hospitals." Section 1109(d) defines a "qualifying hospital" as a "subsection (d) hospital . . . that is located in a county that ranks, based upon its ranking in age, sex and race adjusted spending for benefits under parts A and B. . . per enrollee within the lowest quartile of such counties in the United States." This spreadsheet contains tables related to our proposal of eligible counties and qualifying hospitals.

19. Section 1109 Unadjusted and Adjusted (WBHO) County Spending: Complete list for all Counties of adjusted and unadjusted Medicare Part A and B spending and adjustment factors for Age-Sex-Race (WBHO).