Files for FY 2015 Proposed Rule and Correction Notice

Title
Files for FY 2015 Proposed Rule and Correction Notice
Fiscal Year
2015
Type of File
Tables and Data Files
Description
See Below
    1.  FY 15 NPRM Impact File: This file contains data elements by provider that were used in calculating the proposed FY 2015 rates and impacts. Updated May 20, 2014 to include PTYPE for FY 2014.
    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. Revised Post-Acute Care Transfer Adjusted Cases and Associated MS-DRG Relative Weights File: The number of post-acute care transfer adjusted cases for certain MS-DRGs included in the FY 2015 proposed rule AOR/BOR file was inadvertently miscalculated. Specifically, the variable caseadj in the tabs AOR_v31 and AOR_v32 in the file BOR_AOR_v31_v32.xlsx was miscalculated for certain MS-DRGs. This zip file contains what the number of post-acute care transfer adjusted cases in the tabs AOR_v31 and AOR_v32 would have been in the absence of the miscalculation. It also contains what the MS-DRG v32 weights would have been in the absence of the miscalculation. All text files in the zip file are for 508 compliance.
    4. Case Mix Index File: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 2013, using the V30 Grouper).
    5. Proposed Standardizing File: This file is used to standardize charges for the rate building process.
    6. County to CBSA Crosswalk File: This file contains two tabs, one for the “Old CBSAs” and one for the proposed “New CBSAs”. Each tab lists the CBSA, SSA county code and FIPS county code for all counties.
    7. Proposed FY 2015 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:
      • FY 2015 Proposed Rule Wage Index PUFs; S3 Part II and Occ Mix Data
      • FY 2015 Proposed Rule Average Hourly Wage by Provider and CBSA Public Use File
      • FY 2015 Proposed Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Occupational Mix Factor by Provider
      • FY 2015 Proposed Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Pre-Reclass Wage Indexes by CBSA
      • FY 2015 Proposed Rule AHW by Provider Area Listing
    8. FY 2015 IPPS Proposed Rule: Hospital Readmissions Reduction Program Supplemental Data File: This file contains the proposed FY 2015 proxy payment adjustment factors under the Hospital Readmissions Reduction Program and the number of cases and excess readmissions ratios for the five conditions (heart failure, pneumonia and acute myocardial infarction, chronic obstructive pulmonary disease and total hip/total knee arthroplasty) used to calculate the proxy payment adjustment factors. In addition, it contains information on the number of cases for each of the applicable conditions excluded in the calculation of the readmission payment adjustment factors, and it contains DRG relative weight information to estimate the proxy payment adjustment factors.
    9. FY 2015 IPPS Proposed Rule: Medicare DSH Supplemental Data File: This file contains the proposed FY 2015 Factor 3 and data used to calculate Factor 3 to implement Section 3133 of the ACA, Improvements to Medicare DSH Payments. In addition, the file contains the data used for Medicare DSH estimates to support of the calculation of Factor 1. Lastly, the file contains a proposed list of hospitals that have underwent a merger so the data of the merging hospitals has been combined to calculate the Factor 3 for the surviving hospital, as proposed in the FY 2015 IPPS Proposed Rule. The proposed Factor 3 is the proposed proportion of the uncompensated care amount that a DSH hospital will receive under the proposed implementation of Section 3133 of the Affordable Care Act. The proposed Factor 3 is the hospital's proposed Medicaid days and Medicare SSI days relative to all DSH hospitals proposed Medicaid days and Medicare SSI days. DSH hospitals are identified as those hospitals that are projected to receive DSH for FY 2015. We note that the proposed FY 2015 uncompensated care payment amount was calculated based on CBO insurance estimates published in February 2014, available at the time of the preparation of the proposed rule, and the CBO has since released updated insurance estimates. For the FY 2015 IPPS Final Rule, we intend to use the most recent CBO insurance estimates available during the preparation of the final rule to calculate the FY 2015 uncompensated care payment amount.
    10. Working Paper No. OR-32: This paper entitled, “A Methodology for Determination of Reasonable FTE Compensation for Hospital-Based Physicians” outlines the methodology for establishing the initial reasonable compensation equivalence (RCE) limits.
    11. Lugar Hospitals in Counties that Qualify for an Outmigration Adjustment: Beginning with FY 2010, lists each Lugar hospital (deemed urban under section 1886(d)(8)(B) of the Act) that is located in a county that qualifies for an outmigration adjustment (Table 4J); the 3-year period for which the hospital is eligible for the outmigration adjustment; and whether or not the hospital accepted the outmigration adjustment in lieu of its urban status for each year of its 3-year eligibility. Please note that in the FY 2012 IPPS final rule, CMS finalized a policy that allows a Lugar hospital that is eligible for and accepts the outmigration adjustment to automatically waive its urban status for the 3-year period for which the outmigration adjustment is effective. Updated May 29, 2014 to correct the Lugar CBSA for several providers.
    12. Table 1A-1E: This excel spreadsheet contains the proposed FY 2015 Operating and Capital National and Puerto Rico Specific Standardized Amounts.
    13. Proposed FY 2015 Wage Index Tables: Contains two zip files. One zip file with proposed wage index tables using FY 2014 CBSA Delineations (Contains Tables 2-1, 3A-1, 3B-1, 4A-1, 4B-1, 4C-1, 4D-1, 4E-1, 4F-1, 9A-1, 9C-1). Second zip file containing proposed wage index tables using proposed FY 2015 CBSA Delineations (Contains Tables 2-2, 3A-2, 3B-2, 4A-2, 4B-2, 4C-2, 4D-2, 4E-2, 4F-2, 4J, 9A-2, 9C-2)
    14. Table 5: List of proposed MS-DRGs, Relative Weighting Factors and Geometric and Arithmetic Mean Length of Stay
    15. Tables 6I-6K: Table 6I Complete MCC list; Table 6J Complete CC list; Table 6K Complete list of CC exclusions for the MS-DRGs
    16. Tables 7A and 7B: Tables 7A and 7B contain the number of discharges, and selected percentile lengths of stay for both MS-DRGs, version 31 and MS-DRGs, version 32
    17. Tables 8A, 8B, and 8C: Tables 8A and 8B contain the proposed FY 2015 IPPS operating and capital statewide average cost-to-charge-ratios as published in the Federal Register. Tables 8C contains the proposed FY 2015 LTCH statewide average cost-to-charge-ratios as published in the Federal Register.
    18. Table 10: Contains the proposed cost thresholds by MS-DRG for the cost criteria for new technology add on payment applications for applications for FY 2016.
    19. Table 14: List of Hospitals with Fewer than 1,600 Medicare Discharges Based on the December 2013 update of the FY 2013 MedPAR file and Potentially Eligible Hospitals’ FY 2015 Low-Volume Payment Adjustment for Discharges Occurring Before April 1, 2015 (Eligibility for the low-volume payment adjustment is also dependent upon meeting the mileage criteria specified at § 412.101(b)(2)(ii) of the regulations.)
    20. Table 15: Proposed FY 2015 Readmissions Adjustment Factors
    21. Table 16: Proposed Updated Proxy Hospital Inpatient Value-Based Purchasing (VBP) Program Adjustment Factors for FY 2015
    22. Table 17: FY 2015 Preliminary Analysis of the Hospital Acquired Conditions Reduction Program
    23. Table 18: Proposed FY 2015 Medicare DSH Uncompensated Care Payment Factor 3

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