This is the home page for the FY 2023 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 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/LongTermCareHospitalPPS.

FY 2023 IPPS Proposed Rule

CMS-1771-P

Date of Display: April 18, 2022

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 2023 Rates; Quality Programs and Medicare Promoting Interoperability Program Requirements for Eligible Hospitals and Critical Access Hospitals; Costs Incurred for Qualified and Non-qualified Deferred Compensation Plans; and Changes to Hospital and Critical Access Hospital Conditions of Participation

Comment Period: To be assured consideration, comments must be received no later than 5 p.m. EDT on June 17, 2022.

FY 2023 Proposed Rule Data Files

1. FY 2023 Proposed Rule Impact File (ZIP): This file contains data elements by provider that were used in calculating the proposed FY 2023 rates and impacts.
2. AOR/BOR File (ZIP): Since we are proposing to calculate the relative weights for FY 2023 by calculating two sets of weights (and then averaging the two sets of relative weights), one including and one excluding COVID-19 claims, we are providing an AOR/BOR file for each calculation. The excel spreadsheet in each zip file contains multiple tabs: Tabs for the After Outliers Removed (AOR) and tabs 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. This file also contains the arithmetic and geometric mean lengths of stay which was previously included in Tables 7A and 7B.
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 2021, using the V38 Grouper).
4. FY 2023 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 2023 IPPS Proposed Rule are derived from the December 31, 2021 quarterly update of the FY 2020 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. 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 (including the revised CBSA delineations for FY 2023) and a list of Urban CBSAs and Constituent Counties for Acute Care Hospitals Files.
8. FY 2023 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 2023 Proposed Rule Wage Index PUFs; S3 Part II and Occ Mix Data
   • FY 2023 Proposed Rule Average Hourly Wage by Provider and CBSA Public Use File
   • FY 2023 Proposed Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Occupational Mix Factor by Provider
   • FY 2023 Proposed Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Pre-Reclass Wage Indexes by CBSA
   • FY 2023 Proposed Rule AHW by Provider Area Listing
9. Proposed List of Hospitals whose FY 2022 Wage Index in Table 2 for FY 2023 is Different than what was Listed in FY 2022 Final Rule. See indicator in Table 2.
10. FY 2023 Proposed Imputed State Floors (ZIP): Contains multiple tabs demonstrating step by step calculation of the imputed floor.
11. FY 2023 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 2023 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 2023. 
12. 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 2024.

FY 2023 Proposed Rule Tables

1. Table 1A-1E (ZIP): This excel spreadsheet contains the proposed FY 2023 Operating and Capital National Standardized Amounts.
2. FY 2023 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.6c (ZIP): Table 6A-New Diagnosis Codes; Table 6B-New Procedure Codes; Table 6C-Invalid Diagnosis 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; Table 6J.1- Proposed Additions to the CC List; and Table 6J.2 – Proposed Deletions to the CC List. Tables 6P.1a-6P.6c (ICD-10-CM and ICD-10-PCS Codes for Proposed MS-DRG and MCE Changes): See summary tab in excel spreadsheet called “CMS-1771-P TABLE 6P ICD-10-CM and ICD-10-PCS Codes for MS-DRG and MCE Changes.xlsx” for a complete description of all tables.
5. Tables 7A and 7B: As proposed, information usually found in Tables 7A and 7B (the number of discharges, and selected percentile lengths of stay for both MS-DRGs, version 39 and MS-DRGs, proposed version 40) has been moved to the AOR/BOR file (see above Proposed Rule Data Files).
6. Tables 8A, 8B, and 8C (ZIP): Tables 8A and 8B contain the proposed FY 2023 IPPS operating and capital statewide average cost-to-charge-ratios. Table 8C contains the proposed FY 2023 LTCH statewide average cost-to-charge-ratios.
7. Table 15: As was the case for the FY 2022 IPPS/ LTCH PPS proposed and final rules, we are no longer including Table 15, which had typically included the fiscal year readmissions payment adjustment factors. This is because hospitals have not yet had the opportunity to review and correct the data before the data are made public under our policy regarding the reporting of hospital[1]specific data.  After hospitals have been given an opportunity to review and correct their calculations for FY 2023, we will post Table 15 (which will be available via the internet on the CMS website) to display the final FY 2023 readmissions payment adjustment factors, which will be applicable to discharges occurring on or after October 1, 2022. We expect Table 15 will be posted on the CMS website in the fall of 2022.
8. Table 16 (ZIP): Proxy Hospital Value-Based Purchasing (VBP) Program Adjustment Factors That Would Apply for FY 2023 If Our Proposals to Revise the Scoring and Payment Methodology for That Program Year Are Not Finalized
9. Table 18 (ZIP): Proposed FY 2023 Medicare DSH Uncompensated Care Payment Factor 3

FY 2023 Proposed Alternatives Considered Files

1. FY 2023 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 2023 proposed rule alternatives considered.
2. FY 2023 Proposed Rule Alternatives Considered Impact File (ZIP): This file contains data elements by provider that were used in developing the rates under the FY 2023 proposed rule alternatives considered. This file contains only the variables where one or more values differ from those in the FY 2023 Proposed Rule IPPS Impact File.
3. FY 2023 Proposed Rule Alternatives Considered MS-DRG Weights (ZIP): Contains MS-DRG weights determined under the FY 2023 proposed rule alternatives considered. Note: Since we are proposing to calculate the relative weights for FY 2023 by calculating two sets of weights (and then averaging the two sets of relative weights), one including and one excluding COVID-19 claims, we have provided the AOR/BOR file with all cases in the Data Files above. In addition, the standardizing file for the alternatives considered is the same in the Data Files above.
4. FY 2023 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 2023 proposed rule alternatives considered.
5. FY 2023 Proposed Rule Alternatives Considered New Technology Thresholds (ZIP): Contains the cost thresholds by MS-DRG using data under the FY 2023 proposed rule alternatives considered for the cost criteria for new technology add-on payments for applications for FY 2024.