Files for FY 2016 Proposed Rule and Correction Notice

Below are the data files and impact file for the FY 2016 Proposed Rule. The tables for the FY 2016 proposed rule are located on a separate list.

1. FY 16 NPRM Impact File: This file contains data elements by provider that were used in calculating the proposed FY 2016 rates and impacts. 
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. 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 2014, using the V31 Grouper).
4. FY 2016 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 2016 IPPS Proposed Rule are derived from the December 31, 2014 quarterly update of the FY 2013 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 2016 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 2016 Proposed Rule Wage Index PUFs; S3 Part II and Occ Mix Data
   • FY 2016 Proposed Rule Average Hourly Wage by Provider and CBSA Public Use File
   • FY 2016 Proposed Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Occupational Mix Factor by Provider
   • FY 2016 Proposed Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Pre-Reclass Wage Indexes by CBSA
   • FY 2016 Proposed Rule AHW by Provider Area Listing
   • FY 2016 Proposed Rule Puerto Rico Specific Occupational Mix Adjusted and Unadjusted AHWs by Provider PUF
8. FY 2016 IPPS Proposed Rule: Hospital Readmissions Reduction Program Supplemental Data File:  This file contains the proposed FY 2016 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 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 readmission payment adjustment factors, and it contains DRG relative weight information to estimate the proposed proxy payment adjustment factors.
9. FY 2016 IPPS Proposed Rule: Medicare DSH Supplemental Data File: This file contains the proposed FY 2016 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 list of hospitals that have undergone a merger so that the data of the merging hospitals has been combined to calculate the Factor 3 for the surviving hospital for FY 2016. The Factor 3 is the proportion of the uncompensated care amount that a DSH hospital will receive under the implementation of Section 3133 of the Affordable Care Act. For FY 2016, the Factor 3 is the hospital's Medicaid days and Medicare SSI days relative to all DSH hospitals Medicaid days and Medicare SSI days. DSH hospitals are identified as those hospitals that are projected to receive DSH for FY 2016. Updated May 1, 2015 to correct the 3-year average claim count and per claim uncompensated care amounts in this supplemental file.
10. Supplemental New Technology Thresholds for Applications for 2016: Contains a supplemental table with New Technology Add-On Payment thresholds for FY 2016. Note: See discussion in the FY 2016 IPPS/LTCH Proposed Rule (80 FR 24460).
11. Lugar Hospitals in Counties that Qualify for an Outmigration Adjustment  for FY 2016: 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. Table 1A-1E: This excel spreadsheet contains the proposed FY 2016 Operating and Capital National and Puerto Rico Specific Standardized Amounts.
13. FY 2016 Proposed Rule Tables 2 and 3 (Wage Index Tables): Table 2- Proposed Case-Mix Index and Wage Index Table by CCN; Table 3- Proposed Wage Index Table by CBSA. Note: Table 2 contains information by CCN and information from the following tables that have been provided in previous fiscal years:  Tables 2, 4J, 9A, and 9C. Table 3 contains information by CBSA and information from the following tables that have been provided in previous fiscal years: Tables 3A, 3B, 4A, 4B, 4C, 4D, and 4F. See the data files page for the Constituent Counties for Acute Care Hospitals File (formerly table 4E).
14. Table 5: List of proposed MS-DRGs, Relative Weighting Factors and Geometric and Arithmetic Mean Length of Stay.
15. Tables 6B-6M and Tables 6P.1a-6P.2a: Table 6B-New Procedure Codes; Table 6I-Proposed Complete Major CC List; Table 6J-Proposed Complete CC List; Table 6K-Proposed Complete List of CC Exclusions; Table 6L-Proposed Principal Diagnosis Is Its Own MCC List; Table 6M-Proposed Principal Diagnosis Is Its Own CC List; Table 6M.1-Proposed Additions to the Principal Diagnosis Is Its Own CC List;
16. Tables 6P.1a-6P.2a (ICD-10-PCS Code Translations for Proposed MS-DRG Changes): See summary tab in excel spreadsheet and/or summary file file in zip file called “CMS-1632-P TABLE 6P.1a-6P.2a.zip” for complete description of all tables
17. Tables 7A and 7B: Tables 7A and 7B contain the number of discharges, and selected percentile lengths of stay for both MS-DRGs, version 32 and MS-DRGs, version 33
18. Tables 8A, 8B, and 8C: Tables 8A and 8B contain the proposed FY 2016 IPPS operating and capital statewide average cost-to-charge-ratios as published in the Federal Register. Table 8C contains the proposed FY 2016 LTCH statewide average cost-to-charge-ratios as published in the Federal Register.
19. 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 2017.
20. Table 15:  Proposed FY 2016 Proxy Readmissions Adjustment Factors
21. Table 16: Proposed Proxy Hospital Inpatient Value-Based Purchasing (VBP) Program Adjustment Factors for FY 2016
22. Table 18: Proposed FY 2016 Medicare DSH Uncompensated Care Payment Factor 3