AOR/BOR File [ZIP, 1MB]
: 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.
Case Mix Index File [ZIP, 44KB]
: 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).
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).
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
FY 2019 IPPS Proposed Rule: Hospital Readmissions Reduction Program Supplemental Data File [ZIP, 5MB]
: 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.
FY 2019 IPPS Proposed Rule: Medicare DSH Supplemental Data File [ZIP, 541KB]
: 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.
Lugar Hospitals in Counties that Qualify for an Outmigration Adjustment for FY 2019 [ZIP, 14KB]
: 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.