Files for FY 2019 Proposed Rule and Correction Notice

Title
Files for FY 2019 Proposed Rule and Correction Notice
Fiscal Year
2019
Type of File
Tables and Data Files
Description
See below
  1. FY 19 NPRM Impact File : This file contains data elements by provider that were used in calculating the proposed FY 2019 rates and impacts. 
  2. AOR/BOR File : This zip file for the FY 2019 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 : 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 2017, using the V34Grouper).
  4. FY 2019 Proposed Rule: HCRIS Data File - Opens in a new window : 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 2019 IPPS Proposed Rule are derived from the December 31, 2017 quarterly update of the FY 2016 HCRIS. (HCRIS is updated on a quarterly basis).
  5. Proposed Standardizing File : This file is used to standardize charges for the rate building process.
  6. County to CBSA Crosswalk File and Urban CBSAs and Constituent Counties for Acute Care Hospitals File : 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 (formerly Table 4E).
  7. FY 2019 Proposed Rule Wage Index Public Use Files : Open Attached Zip file. Attached is a PDF with a description of each zip file. Main zip file contains 6 zip files:
    • FY 2019 Proposed Rule Wage Index PUFs; S3 Part II and Occ Mix Data
    • FY 2019 Proposed Rule Average Hourly Wage by Provider and CBSA Public Use File
    • FY 2019 Proposed Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Occupational Mix Factor by Provider
    • FY 2019 Proposed Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Pre-Reclass Wage Indexes by CBSA
    • FY 2019 Proposed Rule AHW by Provider Area Listing
  8.   FY 2019 IPPS Proposed Rule: Hospital Readmissions Reduction Program Supplemental Data File : This file contains the proposed FY 2019 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, acute myocardial infarction, chronic obstructive pulmonary disease, total hip/total knee arthroplasty, and coronary artery bypass grafting) used to calculate the proposed 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 proposed proxy readmission payment adjustment factors, and it contains MS‑DRG case-mix information to estimate the proposed proxy payment adjustment factors.
  9. FY 2019 IPPS Proposed Rule: Medicare DSH Supplemental Data File : This spreadsheet has 4 tabs. The first tab is the File Layout for the spreadsheet. The second tab contains the proposed rule FY 2019 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 so that the data of the merging hospitals have been combined to calculate the Factor 3 for the surviving hospital for FY 2019. The fourth tab contains the data used for Medicare DSH estimates to support the calculation of the proposed Factor 1. The Factor 3 in the second tab is the amount available for uncompensated care payments that a DSH hospital will receive under the implementation of Section 3133 of the Affordable Care Act. DSH hospitals are identified as those hospitals that are projected to receive DSH payments for FY 2019. Text files for each tab are included for Section 508 compliance.
  10. Monthly Summary of Charges for Charge Inflation Factor : Excel spreadsheet contains two tabs. One has monthly charges by provider from January 2016 through December 2016. One has monthly charges by provider from January 2017 through December 2017.
  11. Lugar Hospitals in Counties that Qualify for an Outmigration Adjustment for FY 2019 : Beginning with FY 2010, this table 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; 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.
  12. FY 2020 Proposed New Technology Thresholds : (Formerly 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 2020.
  13. Table 1A-1E (ZIP) : This excel spreadsheet contains the Final Rule and Correction Notice FY 2020 Operating and Capital National Standardized Amounts.
  14. FY 2019 Proposed Rule Tables 2, 3 and 4 (Wage Index Tables) (ZIP) : Contains five tabs, three for the final rule and two for the correction notice. (It has been brought to our attention that there may be an error with some of the CBSA Three Year Average Hourly Wages in table 3 of the final rule. For MGCRB reclassifications, per the MGCRB rules, hospitals are to use the Three Year MGCRB Reclassification Data File on the CMS website.)
    • Table 2- Case-Mix Index and Wage Index Table by CMS Certification Number (CCN);
    • Table 3- Wage Index Table by CBSA;　
    • Table 4 - List of Counties Eligible for the Out-Migration Adjustment under Section 1886(d)(13) of the Act.
  15. Table 5 (ZIP) : Contains two tabs, one for the final rule and one for the correction notice, which contains the following: List of MS-DRGs, Relative Weighting Factors and Geometric and Arithmetic Mean Length of Stay
  16. Tables 6A-6J.2 and Tables 6P.1-6P.1k (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 6F-Revised Procedure 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; Table 6J.1- Proposed Additions to the CC List; Table 6J.2- Proposed Deletions to the CC List; Tables 6P.1-6P.1k (ICD-10-CM and ICD-10-PCS Codes for Proposed MS-DRG Changes): See summary tab in excel spreadsheet called “CMS-1694-P TABLE 6P ICD-10-CM and ICD-10-PCS Codes for Proposed MS-DRG Changes.xlsx” for complete description of all tables.
  17. 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 36 and MS-DRGs, version 37. This file contains 3 tabs: Table 7A (final rule) Table 7B (final rule), and Table 7B correction notice).
  18. Tables 8A, 8B, and 8C (ZIP) : Tables 8A and 8B contain the proposed FY 2019 IPPS operating and capital statewide average cost-to-charge-ratios. Table 8C contains the proposed FY 2019 LTCH statewide average cost-to-charge-ratios.
  19. Table 10: No longer a Table; see #12.
  20. Table 15 (ZIP) :  Proposed Proxy FY 2019 Readmissions Adjustment Factors
  21. Table 16 (ZIP) : Proposed Proxy Hospital Value-Based Purchasing (VBP) Program Adjustment Factors for FY 2019
  22. Table 18 (ZIP) : FY 2020 Medicare DSH Uncompensated Care Payment Factor 3.

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