FY 2024 IPPS Proposed Rule Home Page

This is the home page for the FY 2024 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 http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/LongTermCareHospitalPPS/index.html.

FY 2024 IPPS Proposed Rule

CMS-1785-P

Date of Display: April 10, 2023

Description: Medicare Program; Proposed Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long‑Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2024 Rates; Quality Programs and Medicare Promoting Interoperability Program Requirements for Eligible Hospitals and Critical Access Hospitals; Rural Emergency Hospital and Physician-Owned Hospital Requirements; and Disclosures of Ownership Comment Solicitation

Comment Period: To be assured consideration, comments must be received no later than 5 p.m. EDT on June 9, 2023.

Proposed Rule Medicare Disproportionate Share Hospital (DSH) Payments: Counting Certain Days Associated with Section 1115 Demonstrations in the Medicaid Fraction

CMS-1788-P

Date of Display: February 24, 2023

Description: This proposed rule would revise our regulations on the counting of days associated with individuals eligible for certain benefits provided by section 1115 demonstrations in the Medicaid fraction of a hospital’s disproportionate patient percentage. The proposed revised regulation would be effective for discharges occurring on or after October 1, 2023.

Comment Period:  To be assured consideration, comments must be received no later than 5 p.m. EDT on May 1, 2023.
 

FY 2024 Proposed Rule Data Files

1. FY 2024 Proposed Rule Impact File: This file contains data elements by provider that were used in calculating the proposed FY 2024 rates and impacts. 
2. AOR/BOR File: This zip file for the FY 2024 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. This file also contains the arithmetic and geometric mean lengths of stay which was previously included in Tables 7A and 7B. 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 2022, using the V39 Grouper).
4. FY 2024 Proposed Rule HCRIS Data File: 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 2024 IPPS Proposed Rule are derived from the December 31, 2022 quarterly update of the FY 2021 HCRIS.  (HCRIS is updated on a quarterly basis).
5. (Note, This file was updated on April 11, 2023) - Cost Center HCRIS Lines Supplemental Data File: 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. In addition, the NPRM FY 2024 normalization factor is included on the second tab.
6. Proposed Standardizing File: 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: This file contains two tabs: A crosswalk of county codes to CBSAs (including the revised CBSA delineations for FY 2024) and a list of Urban CBSAs and Constituent Counties for Acute Care Hospitals Files.
8. FY 2024 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 5 zip files: 
   • FY 2024 Proposed Rule Wage Index PUFs; S3 Part II and Occ Mix Data
   • FY 2024 Proposed Rule Average Hourly Wage by Provider and CBSA Public Use File
   • FY 2024 Proposed Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Occupational Mix Factor by Provider
   • FY 2024 Proposed Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Pre-Reclass Wage Indexes by CBSA
   • FY 2024 Proposed Rule AHW by Provider Area Listing
9. FY 2024 Proposed Rule Imputed Floor Public Use File: Contains multiple tabs demonstrating step by step calculation of the imputed floor. 
10. FY 2024 IPPS Proposed Rule Medicare DSH Supplemental Data File: This spreadsheet has 4 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 FY 2024 proposed rule 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 2024. The fourth tab contains the Medicare DSH estimates to support the calculation of the proposed Factor 1. 
11. FY 2024 New Technology Thresholds Proposed Rule: Contains the proposed cost thresholds by MS-DRG for the cost criteria for new technology add-on payments for applications for FY 2025. 
12. Supplementary Provider-level file with Beneficiary Characteristics: This file is a supplemental file to Table III.  Provider Deciles by Beneficiary Characteristics in the Appendix of the proposed rule and contains the percentage of discharges at each hospital for each of the following characteristics: race/ethnicity, dual eligibility for Medicaid and Medicare, Medicare low income subsidy (LIS) enrollment, a joint indicator for dual or LIS enrollment, presence of an ICD-10-CM Z code indicating a “social determinant of health” (SDOH), presence of a behavioral health diagnosis code, receiving ESRD Medicare coverage, qualifying for Medicare due to disability, living in a rural area, and living in an area with an area deprivation index (ADI) greater than or equal to 85. 
13. Supporting Files for Alternate Analysis with Application of the NonCC Subgroup Criteria: These files in support of the alternate analysis with regard to the application of the NonCC subgroup criteria include an alternate Table 5 – Alternate List of Medicare Severity Diagnosis Related Groups (MS-DRGs), Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay, an alternate Length of Stay (LOS) Statistics file, an alternate Case Mix Index (CMI) file, and an alternate After Outliers Removed and Before Outliers Removed (AOR_BOR) file. Note: See Tables 6P.10a through 6P.10f for the list of MS DRGs and data analyses relating to application of the NonCC subgroup criteria.
14. New Technology Add-On Payment (NTAP) Public Application Summaries: Beginning with FY 2024, applications for new technology add-on payment (NTAP) that are discussed in the IPPS/LTCH PPS proposed rule are posted publicly. To view an application, including additional information regarding applicant assertions and supporting information (with the exception of certain confidential, cost and volume, or copyrighted information), select the application from the list of NTAP Public Application Summaries.

FY 2024 Proposed Rule Tables

1. Table 1A-1E: This excel spreadsheet contains the proposed FY 2024 Operating and Capital National Standardized Amounts.

2. FY 2024 Proposed Rule Tables 2, 3 and 4A and 4B (Wage Index Tables):
   •  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: Proposed MS-DRGs, Relative Weighting Factors and Geometric and Arithmetic Mean Length of Stay

4. Tables 6A-6J.2 and Tables 6P.1a-6P.9a: 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 6H.3 - Principal Diagnosis Codes for Removal from CC Exclusion List – FY 2024; 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.9a (ICD-10-CM and ICD-10-PCS Codes for Proposed MS-DRG and MCE Changes): See summary tab in excel spreadsheet called “CMS-1785-P TABLE 6P ICD-10-CM and ICD-10-PCS Codes for Proposed MS-DRG and MCE Changes.xlsx” for a complete description of all tables. 
5. Tables 6P.10a through 6P.10f include the list of MS DRGs and data analyses relating to application of the NonCC subgroup criteria.
6. Tables 8A, 8B, and 8C: Tables 8A and 8B contain the proposed FY 2024 IPPS operating and capital statewide average cost-to-charge-ratios. Table 8C contains the proposed FY 2024 LTCH statewide average cost-to-charge-ratios.
7. FY 2024 Table 10: Codes Provided by FY 2024 New Technology Add-On Payment Applicants for their Cost Analyses.

8. Table 16A: Proxy Hospital Value-Based Purchasing (VBP) Program Adjustment Factors for FY 2024.
9. Table 18: Proposed FY 2024 Medicare DSH Uncompensated Care Payment Factor 3.