FY 2023 FR and CA IPPS Impact File	
"DATA SOURCES FOR THIS FY 2023 RULE IMPACT FILE ARE THE FOLLOWING: MARCH 2022 UPDATE OF FY 2021 MEDPAR, MARCH 2022 UPDATE OF PROVIDER SPECIFIC FILE (PSF), FY2019/FY2020 COST REPORT DATA"	
"DISCLAIMER: The variables in the impact file are based on information at the time of the final rule (or correction notice as applicable) which are used to model payments for the upcoming Fiscal Year (2023) and may not reflect what is used for actual payment (e.g: Wage Index, DSH, IME) for FY 2023. Refer to the quarterly Provider Specific File (PSF) for variables used for actual payment (Note: Since the PSF is updated quarterly there is typically a 3-month lag until the latest information is posted)."	
Provider Number	6 digit Medicare provider number; the first 2 digits are the state code.
Name	"Name of Medicare provider from OSCAR.(""blank"" = unknown)"
Geographic Labor Market Area	The Geographic CBSA location based on OMB's Core Based Statistical Area (CBSA) designations.  The CBSA assignment is based on where the provider is physically located based on SSA state and county code information.  Rural areas are designated by 2-digit SSA state codes.
Pre-Reclass Labor Market Area	Pre-reclassification CBSA
Post-Reclass Labor Market Area	Post-reclassification CBSA for FY 2023
Payment Labor Market Area	Payment CBSA (urban or rural) for purposes of determining capital payments & operating payments (other than wage index)
FIPS County Code	Federal Information Processing Standard (FIPS) county code.  The FIPS system is used to Identify the county in which provider is geographically located and this field be used in conjunction with the MSA/CBSA crosswalk file.
REGION	"1=NEW ENGLAND (CT, ME, MA, NH, RI, VT); 2=MIDDLE ATLANTIC (NJ, NY, PA); 3=EAST NORTH CENTRAL (IL, IN, MI, OH, WI); 4=WEST NORTH CENTRAL (IA, KS, MN, MO, NE, ND, SD); 5=SOUTH ATLANTIC (DE, DC, FL, GA, MD, NC, SC, VA, WV); 6=EAST SOUTH CENTRAL (AL, KY, MS, TN); 7=WEST SOUTH CENTRAL (AR, LA, OK, TX); 8=MOUNTAIN (AZ, CO, ID, MT, NV, NM, UT, WY); 9=PACIFIC (AK, CA, HI, OR, WA); 40=PUERTO RICO (PR)"
URGEO	Urban or Rural designation of the provider’s geographic CBSA
URSPA	Urban or Rural designation of the provider’s payment CBSA
RECLASS	Reclass Status FY 2023:  N -provider did not reclassify; W -provider reclassified for wage index; L provider reclassified under 1886(d)(8)(B) of the SSA; S-provider redesignated as rural under Sec. 401 of BIPA.
Wage Index	"FY 2023 wage index after applying the MGCRB reclassifications, rural floor, imputed floor, adjustments for the Frontier wage index provision, the P.L. 108-173 Sec 505 adjustments, the lowest quartile wage index adjustment and the 5-percent cap, as applicable. The wage index reflects the application of national rural floor budget neutrality required under the Affordable Care Act."
LUGAR	Provider is located in a Lugar County as defined in 1886(d)(8)(B) of the Act
Section 401 hospital	A 'Y' denotes urban providers redesignated as rural under CFR 412.103 (Sec 401 of BIPA).
Section 401 or LUGAR Hospitals with a MGCRB Wage Index Reclass	A 'Y' denotes a hospital that is redesignated as rural under CFR 412.103 (Sec 401 of BIPA) or is located in a Lugar County as defined in 1886(d)(8)(B) of the Act (and did not waive its LUGAR status) AND also is reclassified to another CBSA through the MGCRB.
Section 505 eligible	A 'Y' denotes providers eligible to receive a wage index adjustment under Sec. 505 of P.L. 108-173 for FY 2023
Section 505 adjustment	Wage adjustment for providers who are eligible to receive a wage index adjustment under Sec. 505 of P.L. 108-173 for FY 2023
Cost of Living Adjustment	Cost of Living Adjustment factor based on data from the U.S. Office of Personnel Management for IPPS providers located in Alaska or Hawaii for IPPS operating payments
Resident to Bed Ratio	Resident to Bed Ratio. Used to determine IME factor for operating IPPS payments
RDAY	Resident to Average Daily Census (ADC) ratio. Used to calculate the IME adjustment for Capital IPPS.
BEDS	The number of total beds obtained from cost report data.*
Average Daily Census	Calculated as the ratio of Total Acute Inpatient Days to Total Days in the Cost Reporting Period obtained from cost report data.*
TCHOP	IME adjustment factor for Operating IPPS
TCHCP	IME adjustment factor for Capital IPPS
DSHPCT	Disproportionate Share Hospital Patient Percentage (DPP) as determined from the Medicaid ratio from the March 2022 update of the Provider Specific File (PSF) & the most recent SSI data  
DSHOPP	Estimated FY 2023 Operating Disproportionate Share Hospital (DSH) adjustment. Reflects a 75% reduction to the DSH adjustment required under Section 3333 of the Affordable Care Act
DSHCPP	FY 2023 Capital Disproportionate Share Hospital (DSH) adjustment
DSH_LY	Estimated FY 2022 Operating Disproportionate Share Hospital (DSH) adjustment. Reflects a 75% reduction to the DSH adjustment required under Section 3333 of the Affordable Care Act
UCP_ADJ	"FY 2023 Uncompensated Care Payment Factor is the proportion of the additional payment amount for uncompensated care costs that a DSH hospital will receive under the implementation of Section 3133 of the Affordable Care Act. The Uncompensated Care Payment Factor is the hospital's uncompensated care costs relative to all DSH hospital's uncompensated care costs. DSH hospitals are identified as those hospitals that are projected to receive DSH for FY 2023. Note, these amounts do not reflect any changes that may result from the 15-day period after the publication of the final rule for hospitals to review and submit comments on the accuracy of the list of mergers we identified in the final rule.  "
UCP and IHS/PR Supplemental Payment Per Claim Amount	"For FY 2023, the 3-year claims average based on MedPAR files from FY18, FY19, and FY21.  For FY 2023 and subsequent fiscal years, we are making a supplemental payment for IHS/Tribal and Puerto Rico hospitals. The supplemental per claim amount is included in this variable, therefore for IHS/Tribal and Puerto Rico hospitals this variable includes both the UCP per claim amount and the Supplemental Payment per claim amount. Per Claim Amounts were used in determination of outlier payments and used to estimate if a SCH is paid on a hospital specific rate or federal rate on a per claim basis.  Note, these amounts do not reflect any changes that may result from the 15-day period after the publication of the final rule for hospitals to review and submit comments on the accuracy of the list of mergers we identified in the final rule.  "
UCP_ADJ_LY	FY 2022 Uncompensated Care Payment Factor is the proportion of the additional payment amount for uncompensated care costs that a DSH hospital will receive under the implementation of Section 3133 of the Affordable Care Act. The Uncompensated Care Payment Factor is the hospital's uncompensated care costs relative to all DSH hospital's uncompensated care costs. DSH hospitals are identified as those hospitals that were projected to receive DSH for FY 2022.
UCP Per Claim Amount LY	FY 2022 Uncompensated Care Per Claim Amount based on a hospital's assigned Uncompensated Care Payment amount divided by the 2-year claims average based on MedPAR files from FY18-FY19.   Per Claim Amount is used in determination of outlier payments and used to determine if the SCH is paid on a hospital specific rate or federal rate on a per claim basis.
Operating CCR	Ratio of Medicare operating costs to Medicare covered charges from the March 2022 update of the Provider Specific File (PSF). CCRs do not have the adjustment factor applied.
Capital CCR	Ratio of Medicare capital costs to Medicare covered charges from the March 2022 update of the Provider Specific File (PSF). CCRs do not have the adjustment factor applied.
Provider Type	Type of provider - key:  0=IPPS; 7=Rural Referral Center (RRC); 8=Indian Health Service (IHS); 16=Sole Community Hospital (SCH); 17=SCH/RRC; 21=Essential Access Community Hospital (EACH); 22=EACH/RRC based on the March 2022 update of the PSF.
HSP Rate	Hospital Specific Payment (HSP) Rate updated to FY 2023 for SCH providers.  HSP Rate is based on the March 2022 update of the Provider Specific File (PSF).
BILLS	"Total number of Medicare cases for the provider from the FY 2021 MedPAR, March 2022 update"
CASETA39	Transfer adjusted cases under Grouper V39 and FY 2022 Post-Acute Transfer Policy
CMIV39	Case Mix Index under Grouper V39 (generally applicable for SCH providers paid under their Hospital Specific Payment rate).
TACMIV39	Transfer adjusted Case Mix Index under Grouper V39 and FY 2022 Post-Acute Transfer Policy
IME_CASETA39	Transfer adjusted cases under Grouper V39 for Medicare Advantage cases submitted by teaching hospitals that receive a fee-for-service IME payment. The IME payment associated with these cases are included in the budget neutrality calculations and in payment modelling.
IME_TACMIV39	Transfer adjusted Case Mix under Grouper V39 for Medicare Advantage cases submitted by teaching hospitals that received a fee-for-service IME payment. These CMIs are used to calculate the IME payments for budget neutrality.
CASETA40	Transfer Adjusted Cases under Grouper V40 and FY 2023 Post-Acute Transfer Policy
CMIV40	Case Mix Index under Grouper V40 (generally applicable for SCH providers paid under their Hospital Specific Payment rate).
TACMIV40	Transfer adjusted Case Mix Index under Grouper V40 and FY 2023 Post-Acute Transfer Policy
IME_CASETA40	Transfer adjusted cases under Grouper V40 for Medicare Advantage cases submitted by teaching hospitals that receive a fee-for-service IME payment. The IME payment associated with these cases are included in the budget neutrality calculations and in payment modelling.
IME_TACMIV40	Transfer adjusted Case Mix under Grouper V40 for Medicare Advantage cases submitted by teaching hospitals that received a fee-for-service IME payment. These CMIs are used to calculate the IME payments for budget neutrality.
GAF	Geographic adjustment factor (GAF) for Capital IPPS for FY 2023
Capital Cost of Living Adjustment	"Capital COLA factor for hospitals located in Alaska and Hawaii, which is based on the applicable operating IPPS COLA factor"
OUTFACT_F	Estimated operating outlier payments as a percentage of the provider's Federal operating IPPS payments**
COUTFACT_F	Estimated capital outlier payments as a percentage of the provider's Federal capital IPPS payments**
Medicare Percentage	Medicare days as a percent of total inpatient days (not available for all providers)
Medicaid Percentage	Medicaid days as a percent of total inpatient days (not available for all providers)
Hospitals with 5% or more of cases that reported experiencing homelessness	A 'Y' denotes providers whose claims indicate that at least 5 percent of their IPPS cases involve diagnosis codes describing patients experiencing homelessness.  These cases are based on the reporting of ICD-10-CM diagnosis code Z59.0 (Homelessness).
Proxy Value Based Purchasing Adjustment Factor	Proxy payment adjustment for value based purchasing program (Section 1886(o) of the Act) is the final payment adjustment factor from the prior fiscal year.
Proxy Readmission Adjustment Factor	Proxy payment adjustment for Hospital Readmissions Reduction Program (Section 1886(q) of the Act) is the final payment adjustment factor from the prior fiscal year. Maryland and Puerto Rico hospitals are exempt from the payment adjustment.
Proxy Quality Reduction	"Value of '1' indicates a hospital that was found not to have successfully reported designated quality measures under the Hospital Inpatient Quality Reporting (IQR) Program as shown in the March 2022 update of the Provider Specific File (PSF), and therefore was modeled as receiving a reduction to the percentage increase in the market basket index for FY 2023 under §412.64(d)(2). (Note, this variable will not reflect any subsequent adjustments, if any, to this indicator made in the PSF, and may not reflect the hospital’s final determination under the hospital IQR program.)"
Proxy EHR Reduction	"Value of '1' indicates a hospital that was found not to be a meaningful electronic health record (EHR) user for the applicable EHR reporting period and did not receive an exception as shown in the March 2022 update of the Provider Specific File (PSF), and therefore was modeled as receiving a reduction to the percentage increase in the market basket index for FY 2023 under §§ 412.64(d)(3)-(4). (Note, this variable will not reflect any subsequent adjustments, if any, to this indicator made in the PSF, and may not reflect the hospital’s final determination under the Promoting Interoperability Program.)"
Ownership Control Type	"Type of ownership control from cost report data:  ""G"" = Government; ""P"" = Proprietary; ""V"" = Voluntary; and ""X"" = Unknown."
"*The most recent available cost report data were used (FYs 2019 - 2020). A ""zero"" value may indicate unavailable or incomplete data. "	
"**FY 2023 these factors were calculated using data that included COVID-19 cases and a fixed-loss amount of $41,325."	
	
