1
 The FY 2013 Home Health Agency Prospective Payment pricing
 subroutines (HHA CICS PRICER 2013.0) are furnished by the Centers
 for Medica re & Medicaid Services (CMS). The responsibility for
 installing, modifying, testing and verifying the accuracy of
 this routine is tha t of the user.

 Please report any problems or direct any questions you may have
  to Sarah Shirey of the Division of Institution Claims (410)
  786-0187.  You can also receive clarification of technical
  matters if needed. IN ORDER TO ASSURE THAT THE PROBLEMS YOU MAY
  EXPERIENCE ARE NOT A RESULT OF YOUR INTERFACE PROGRAM(S), TEST
  PRICER USING THE CMS SUPPLIED
 TEST PROGRAM HHMGR130).

 This subroutine has been tested by CMS.

 *-----*-----*-----*-----*-----*-----*-----*-----*-----*-----*-----*
 NOTE! NOTE! NOTE!

 FOR CY 2010 THE HHA PRICER HAS HAD THE RECORD LAYOUT FOR THE BILLING
 RECORD INCREASED FROM 450 BYTES TO 500 BYTES !!!

 *-----*-----*-----*-----*-----*-----*-----*-----*-----*-----*-----*


1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

 TABLE OF CONTENTS

 VOLUME I

 Section  . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page

 I. Introduction

 I-1. General    . . . . . . . . . . . . . . . . . . . . . . . .  I-1

 I-2. Summary of PRICER 2013.0 changes . . . . . . . . . . . . . . I-3

 II. Installing the FY 2013.0 Prospective Payment HHA CICS PRICER

 II-1. General . . . . . . . . . . . . . . . . . . . . . . . . .  II-1

 II-2. Copying the HHCAL Files to Disk . . . . . . . . . . . . .  II-1

 II-3. Compiling and Linkage of HHMGR130, HHOPN130, HHDRV130 and the yearly
 HH Calculation modules  . .  . . . . . . . . . . . . . . . . . .  II-1

 II-4. HHA CICS PRICER Assurance Testing  . . . . . . . . . . . .  II-1

 II-5. HHA CICS PRICER Installation Requirements  . . . . . . . .  II-2

 III.Using the FY 2013.0 Prospective Payment HHA CICS PRICER Module (HHCAL063)

 III-1. General  . . . . . . . . . . . . . . . . . . . . . . . .  III-1

 III-2. Using HHCAL130 . . . . . . . . . . . . . . . . . . . . .  III-1

 IV. Using the FY 2013 Prospective Payment HHA CICS PRICER Subroutine (HHDRV130)

 IV-1. General   . . . . . . . . . . . . . . . . . . . . . . . .  IV-1

 IV-2. Using HHDRV130  . . . . . . . . . . . . . . . . . . . . .  IV-1

 V. Using the FY 2013 Prospective Payment HHA CICS PRICER Subroutine (HHOPN130)

 V-1. General   . . . . . . . . . . . . . . . . . . . . . . . .  IV-1

 V-2. Using HHOPN130  . . . . . . . . . . . . . . . . . . . . .  IV-1


 VI. HHA CICS PRICER Assurance Testing Using HHMGR130

 VI-1. General  . . . . . . . . . . . . . . . . . . . . . . . . .  V-6

 VI-2. Using HHMGR130 . . . . . . . . . . . . . . . . . . . . . . V-6

 VI-3. Testing User Supplied Data Using HHMGR130 . . . . . . . .   V-6



1  FILE # 14 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT
 =========================================================================
    VOLUME II
     FILES
 =========================================================================
MU00.@BFN2699.HHNDM130
MU00.@BFN2699.HHNDM130.LOAD
=============================================================
 NAME      VERSION        DESCRIPTION
CBSA130     2013.0 HHA CORE BASED STATISTICAL AREA FILE CY 2013
                       ADDED   12/01/2013 EFFECTIVE DATES
HHA130   R* 2013.0 HHA TEST BILLING FILE  RECORD LENGTH STILL 500
                       (WITH NEW & OLD TEST CLAIMS AND SUPPLY ADD ON)
HHA130OT R* 2013.0 HHA TEST BILLING OUTPUT RECORD LENGTH STILL 500
                       (WITH NEW & OLD TEST CLAIMS)
HHCAL015 R* 2001.5 HHA CALC PROGRAM CY2001
HHCAL022 R* 2002.2 HHA CALC PROGRAM CY2002
HHCAL032 R* 2003.2 HHA CALC PROGRAM CY2003
HHCAL043 R* 2004.3 HHA CALC PROGRAM CY2004
HHCAL052 R* 2005.2 HHA CALC PROGRAM CY2005
HHCAL065 R* 2006.5 HHA CALC PROGRAM CY2006
HHCAL073 R* 2007.3 HHA CALC PROGRAM CY2007
HHCAL087 R* 2008.7 HHA CALC PROGRAM CY2008
HHCAL094 R* 2009.4 HHA CALC PROGRAM CY2009
HHCAL10C R* 2010.C HHA CALC PROGRAM CY2010.C 1/1/2010 TO 3/31/2010
HHCAL109 R* 2010.9 HHA CALC PROGRAM CY2010.9 4/1/2010 TO 12/31/2011
HHCAL111 R* 2011.1 HHA CALC PROGRAM CY2011.1 1/1/2011 TO 12/31/2011
HHCAL120 R* 2012.0 HHA CALC PROGRAM CY2012.0 1/1/2012 TO 12/31/2012
HHCAL130 R* 2013.0 HHA CALC PROGRAM CY2013.0 1/1/2013 TO 12/31/2013
HHDRV130 R* 2013.0 HHA DRIVER PROGRAM 05  M-REV-DATA        OCCURS 108
HHMGR130 R* 2013.0 HHA CMS TESTING MANAGER MODULE VERSION UPDATE ONLY
HHOPN130 R* 2013.0 HHA OPEN PROGRAM   05  M-REV-DATA        OCCURS 108
HRG120      2013   HHA RESOURCE GROUP FILE NEW CY2013 CODES
MANU130  R* 2013.0 HHA INSTALLATION MANUAL CY2013.0 (CY2013)
MSA050      2005   HHA METROPOLITAN STATISTICAL AREA
PROV050     2006   HHA TEST HHA PROVIDERS
PRT130   R* 2013.0 HHA TEST RESULTS PRINT (WITH NEW & OLD TEST CLAIMS)
REV130      2013.0 HHA REVENUE CODE FILE NEW REV CODES EFFECTIVE 1/1/12

R* = REVISED WITH THIS RELEASE.
R  = REVISED FOR VERSION UPDATE ONLY

            2013.0 HHA REVISIONS ARE TO INCREASE NUMBER OF DECIMALS IN
                       WORK FIELDS FOR MORE ACCURACY IN CALCULATIONS
                       AND INCREASE THE FIELD LENGTH FOR FIELD
                       HHA-PROV-PAYMET-TOTAL TO 9.2


 =========================================================================

     ii



1  FILE # 2 HHA CICS PRICER INSTALATION GUIDE DOCUMENT


 LIST OF ILLUSTRATIONS

 Figure  . . . . . . . . . . . . . . . . . . . . . . . . .    Page

 1.1 Flowchart of HHA CICS PRICER system  . . . . . . . . . . . . .   I-3

 1.2 Sysour counts from HHMGR . . . . . . . . . . . . . . . . . . .  I-4

 2.1 Layout of PRICER INSTALLATION TAPE/CARTRIDGE or NETWORK DATA
   MOVER (NDM) FILE . . . . . . . . . . . . . . . . . . . . . . . . II-2

 2.2. Sample JCL - Tape To Disk Load of PRICER Installation
   Tape/Cartridge . . . . . . . . . . . . . . . . . . . . . . . . . II-3

 2.3. Sample JCL - Creates load modules for HHDRV'S & HHCAL'S
   Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . .  II-4

 3.1 Sample JCL - Download of the (NDM) File PRICER Installation
   file . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . III-1

 3.2 VS/COBOL FOR Z/OS JCL - Compile HHCALs,  HHOPN130, and HHDRV130 . III-2

 3.3 VS/COBOL FOR Z/OS JCL - Linkedit HHMGR130 . . . . . . . . . .   III-3

 4.1 Layout - Argument 1: HHA-INPUT-DATA Sent to HHCAL  . . . . . .  IV-2

 4.2 Layout - Argument 2: HOLD-VARIABLES Sent to HHCAL  . . . . . .  IV-4

 4.3 Layout - Argument 3: HHA WAGE INDEX Sent to HHCAL  . . . . . .  IV-5

 5.1 Layout - REVENUE FILE RECORD . . . . . . . . . . . . . . . . .  V-1

 5.2 Layout - MSA FILE RECORD . . . . . . . . . . . . . . . . . . .  V-1

 5.3 Layout - CBSA FILE RECORD  . . . . . . . . . . . . . . . . . .  V-2

 5.4 Layout - HRG FILE RECORD . . . . . . . . . . . . . . . . . . .  V-2

 5.5 Layout - Provider Specific File  . . . . . . . . . . . . . . .  V-3

 5.6 EXPECTED TEST RESULTS  . . . . . . . . . . . . . . . . . . . .  V-7

 5.7 VS/COBOL II -- SAMPLE JCL TO EXECUTE HHMGR130 . . . . . . . .   V-8

 5.8 TEST HHA DATA RECORD FORMAT  . . . . . . . . . . . . . . . . .  V-9

 5.9 PAYMENT CENSUS DIVISION COMPOSITION  . . . . . . . . . . . . .  V-12




     iii



1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

 I. INTRODUCTION
 I-1. GENERAL
 HHA CICS PRICER refers to a group of programs which will calculate
 the payment Amount for a Home Health services based on the data
 elements passed to it. It will return the payment amount and other
 data used in pricing or error indications if pricing could not be
 properly executed. HHA CICS PRICER will price starting Oct 1, 2000.
 Every fiscal year, a new module will be added as each year's HHCALC
 module is developed. All of each fiscal years HHCALC's will be sent.
 There are three levels of processing within PRICER, Flowchart Figure
 1.1.

 1. HHMGR130 -This is a test driver module and it should be used for
 the installation and testing phases of the CICS PRICER. It calls the
 Open program to accommodate the CICS version of the HH PPS System

 2. HHOPN130 -This open program does all the open and load functions,
 such as loading the Home Health Regional Group (HRG) File, the
 revenue (REV) File, the Metropolitan Statistical Wage Index (MSA)
 File, and the Core Based Statistical Area Wage Index File (CBSA).
 Then it calls the driver (HHDRV130)

 3. HHDRV130 - This program selects the HRG record, the REV record,
 and the MSA or CBSA wage-index record for each claim being processed,
 assembles the necessary pricing variables, and screens the claim
 service from date calling the appropriate HHCAL Module for each
 claim.

  4. HHCAL013, HHCAL020, HHCAL030, HHCAL041, HHCAL050, and HHCAL063 --
 In these modules is where all of the edits and calculations are
 performed. A new fiscal year module will be added each year.

  5. The Provider Regional files --- only for VA, HMO, and FEHB's.
 Intermediaries do not need these files. The VA, HMO, and FEHB's must
 add the necessary JCL to unload and --- use only the Regional file
 that pertains to them, unload shown in FIGURE 2.2.
      *
  The purpose of this manual is to provide Intermediary technical
 staff with the information necessary to understand, install, test,
 debug, support and, if necessary, modify the Fiscal Year (FY) 2013.0
 HHA CICS PRICER driver routine (HHDRV130).

  The Intermediary is required to use the Calculation Modules
 (HHCAL013, HHCAL020, HHCAL030, HHCAL041, HHCAL050, and HHCAL063) for
 pricing Home Health Agency (HHA) Perspective Payment System claims.
 The design of the CALC Modules allows the Intermediary flexibility in
 the man er in which it may be installed. The CALC Modules are
 intended to execute as a subroutine (Called) of the PRICER Driver
 Program (HHD V100) or of an Intermediary written inter-face program.
 The CALC modules can execute as stand-alone routines, if they are
 passed the necessary data.

      I-1

1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT


  Included with this documentation is a PRICER INSTALLATION TAPE or
 NDM FILE. With the 10 regions Provider Specific File (which must be
 created by the Intermediary), the TAPE/CARTRIDGE or NDM file contains
 all files that should be needed to execute PRICER. A test driver
 (HHMGR130) program, a test HHA claim file and a test results file are
 also included on the TAPE/CARTRIDGE or NDM file. These can be useful
 to assure that the PRICER is executing properly.

  In preparing this manual, the following assumptions were made:

  1. The reader is familiar with IBM 370 Principals of Operation as
  well as VS/COBOL II, and OS JCL.

  2. The datasets required by PRICER will be copied to disk and
  catalogued according to your data center conventions.

  3. The volume serial numbers on the sample JCL will be replaced with
 the volume serial number of the transfer TAPE/CARTRIDGE received by
 your installation. This number will be indicated on the outside of
 the TAPE/CARTRIDGE you receive.

  4. HHOPN130 will be installed in the Intermediary system at a point
 where it receives fully edited data. This opens and loads the HRG
 records, the revenue records, and the MSA and CBSA wage index records
 for given claims.

  5. HHDRV130 will be installed in the Intermediary system at a point
 where it receives fully edited data. This selects the HRG-record, the
 revenue record, and the MSA or CBSA wage index record for a given
 claim.





















     I-2


1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

  I-2. SUMMARY OF CHANGES FOR PRICER 2008 for services on or after October 1, 20

   A) Claim services after September 30, 2000 FY2008 ** Use Pricer
   2013.0

   1. Changes made for FY 2013.0 effective Jan. 1, 2013 as follows:
 a) Update outlier threshold amount.
 b) Update Federal Rates.
 c) Update wage index.
 d) Update MSA.
 e) Update rev table.
 f) Add CBSA file to use in pricing calculation
 g) Rural diferential pricing calculation

  *** NOTE ***
   2. NEW VERSION FOR FY 2001 (HHCAL013)
   Identified were payment anomalies in the calculations for claims
 involving partial episode payments (PEPs) and significant change on
 condition (SCIC) adjustments. These are both cases where our payment
 is prorated on a basis of a number of days of service provide
  at a particular payment level.

  ==========================================================================
         -----        --------           --------
        ! HHA ! ---->! HHMGR  ! ------ >! HHAOUT !
         -----        --------           --------
                         !                      ------
                         !               +<--- !  REV ! CY2013 CODES
                         !               !      ------
                         !               !      ------
                         !               +<--- !  HRG ! CY2012 CODES
                         !    -------    !      ------
                         +-> ! HHOPN ! <-+
                              -------    !      ------
                                 !       +<--- ! MSAX !
                                 !       !      ------
                                 !       !      ------
                                 !       +<--- ! CBASX ! CY2013
                                 !              ------
                              -------
                             ! HHDRV !
                              -------
                                 !
        +-------+----+--------+--+---+------+-----+------++----+
        !       !    !        !      !      !     !      !!    !
    ----+-----  !  --+------  !  ----+----  !  ---+----- !! ---+-----
   ! HHCAL015 ! ! ! HHCAL032 !! ! HHCAL043! ! ! HHCAL052!!!! HHCAL073!
    ----------  !  ---------  !  ---------  !  --------- !! ---------
                !             !             !            !+-+
       ---------+    ---------+    ---------+  ----------+  +---------
      ! HHCAL022 !  ! HHCAL094 !  ! HHCAL087 !! HHCAL065 ! ! HHCAL10C !
       ----------    ----------    ----------  ----------   ----------
                                                         !
                                +------------+-----------+--+
                      ----------+  ----------+ ----------+  +---------
                     ! HHCAL130 ! ! HHCAL120 !! HHCAL111 ! ! HHCAL109 !
                      ----------   ----------  ----------   ----------


           Figure 1.1: Flowchart of Pricer System.

  ==========================================================================


    I-3

1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

  -- PROGRAM HHMGR130  VERSION  ===> M2013.0
  -- PROGRAM HHOPN130  VERSION  ===> O2013.0
  -- PROGRAM HHDRV130  VERSION  ===> D2013.0

  -- PROGRAM HHMGR130  VERSION  ===> M2013.0
  -- PROGRAM HHOPN130  VERSION  ===> O2013.0
  -- PROGRAM HHDRV130  VERSION  ===> D2013.0

  -- PROGRAM HHCAL015  VERSION  ===> P2001.5
  -- PROGRAM HHCAL022  VERSION  ===> P2002.2
  -- PROGRAM HHCAL032  VERSION  ===> P2003.2
  -- PROGRAM HHCAL043  VERSION  ===> P2004.3
  -- PROGRAM HHCAL052  VERSION  ===> P2005.2
  -- PROGRAM HHCAL065  VERSION  ===> P2006.5
  -- PROGRAM HHCAL073  VERSION  ===> P2007.3
  -- PROGRAM HHCAL087  VERSION  ===> P2008.7
  -- PROGRAM HHCAL094  VERSION  ===> P2009.4
  -- PROGRAM HHCAL10C  VERSION  ===> P2010.C
  -- PROGRAM HHCAL109  VERSION  ===> P2010.9
  -- PROGRAM HHCAL111  VERSION  ===> P2011.1
  -- PROGRAM HHCAL120  VERSION  ===> P2012.0
  -- PROGRAM HHCAL130  VERSION  ===> P2013.0

  -- FY2001 RECORD COUNT  ===> 000000152
  -- FY2002 RECORD COUNT  ===> 000000074
  -- FY2003 RECORD COUNT  ===> 000000080
  -- FY2004 RECORD COUNT  ===> 000000052
  -- FY2005 RECORD COUNT  ===> 000000036
  -- CY2006 RECORD COUNT  ===> 000000035
  -- CY2007 RECORD COUNT  ===> 000000033
  -- CY2008 RECORD COUNT  ===> 000000033
  -- CY2009 RECORD COUNT  ===> 000000020
  -- CY2010C RECORD COUNT ===> 000000021
  -- CY20109 RECORD COUNT ===> 000000021
  -- CY2011  RECORD COUNT ===> 000000013
  -- CY2012  RECORD COUNT ===> 000000010
  -- CY2013  RECORD COUNT ===> 000000010

  -- INPUT  COUNTS FOR HHAFILE  ===> 000000589
  -- OUTPUT COUNTS FOR OUTFILE  ===> 000000589
  -- OUTPUT COUNTS FOR PRTFILE  ===> 000000589

   Figure 1.2: SYSOUR COUNTS FROM HHMGR PROGRAM.

     I-4

1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

  II. INSTALLING THE FY 2013.0 PROSPECTIVE PAYMENT SUBROUTINES (PRICER)
   II-1. GENERAL
  A. Installing the PRICER Version 2013.0 consists of the following
  steps:

 1. All Intermediaries -- copy only files 1 through 16 to disk.

 2. All HMO's, VA and FEHB's -- Copy all files to disk.

 3. Compile and link HHMGR130 (optional) , HHOPN130, HHDRV130, and the
 yearly calculation modules HHCAL013, HHCAL020, HHCAL030, HHCAL041,
 HHCAL050, and HHCAL063.

 4. Perform assurance testing. HHMGR130 may be used to test the PRICER
 (see Section V).

 5. Install PRICER 2013.0 in production. ** NOTE: HHMGR, HHOPN, HHDRV,
 and all HHCAL modules are written in VS/COBOL Z/OS and were developed
 and tested on an IBM 3090. Insta ling this software on equipment that
 is not IBM compatible will require program modifications.

   II-2. COPYING THE PRICER FILES TO DISK

  A. Pricer installation tape/cartridge process.

 1. The files contained on the PRICER Installation Tape/Cartridge were
 created with the IBM IEBGENER utility. The files may be copied to
 disk using any utility capable of copying a fixed length record data
 set.

 2. The PRICER Installation Tape/Cartridge contains the installation
 manual, the program source code and data files necessary to inst ll
 PRICER. The tape/Cartridge is IBM Standard Label, 1600 BPI and
 contains twenty-seven files. The files and their respective location,
 block size, logical record length and description are shown in Figure
 2.1. Figure 2.2 shows sample JCL for loading the files to d sk.

  B. Pricer installation NDM file process.

 1. The files contained on the PRICER Installation NDM file were
 created with the IBM IEBGENER utility. The files may be copied to
 disk using any utility capable of copying a fixed length record data
 set.

 2. The PRICER NDM file contains the installation manual, the program
 source code and data files necessary to install PRICER. The NDM file
 is a disk file transmitted via the NDM system containing twenty-five
 files. The files and their block size, logical record length and
 description are shown in Figure 2.1. Figure 3.1 shows sample JCL for
 downloading the NDM files to disk files for processing.

 ** NOTE: (FIGURE 3.1 MUST BE RUN IN ORDER TO USE THESE FILES!!!)

             II-1



1 FILE # 13 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

   II-3. COMPILING AND LINKAGE OF HHMGR130, HHOPN130, HHDRV130 and
   HHCALs

 A. All programs were developed to use VS/COBOL Z/OS.

 B. The HHCALculation Modules are intended to be CALLed by a user
 written interface program or to be CALLed by HHDRV130. They may be
 dynamically loaded or the user may INCLUDE the HHCAL culations when
 linking to the user interface module.

 C. HHMGR Calls the latest HHOPN, which in turn calls the latest
 HHDRV version, which in turn calls the appropriate HHCALculation
 module.  When linking HHMGR, the user should include HHOPN, HHDRV,
 and the appropriate year HHCAL module.

 D. Sample JCL for compiling and linking HHMGR, HHOPN, HHDRV, and
 HHCAL Modules is shown in Figures 2.2 and 2.3 for VS/COBOL Z/OS.



  II-4. PRICER ASSURANCE TESTING

 A. It is the users responsibility to assure that the PRICER is
 executing properly at the user site. The quickest way to test HHDRV
 nd HHCAL is to execute HHMGR, and HHOPN using the Test Claims (see
 Sect. IV).































             II-1A


1 FILE # 13 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT


   ** NOTE: IBM Standard Label: 1600 BPI

   II-5.  PRICER INSTALLATION REQUIREMENTS

   PRICER 2013.0 must be installed prior to paying PPS (HHA) Claims with a
   service date of October 1, 2000 or after.
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !                                   !
  ! FILE # ! FILE NAME!  LRECL ! BLKSIZE!  DESCRIPTION                      !
  +========+==========+========+========+===================================+
  !        !          !        !        !  PROSPECTIVE PAYMENT SYSTEM       !
  !        !          !        !        !      FROM CMS FOR FY 2013.0       !
  !        !          !        !        !                                   !
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !      (PRODUCTION FILE)            !
  !   1    ! CBSA110  !  80    !  800   ! Urban/Rural Wage Index File       !
  !        !          !        !        ! Core Based Statistical Aread      !
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !                                   !
  !   2    ! HHA110IN !  500   ! 5000   !  HHA TEST FILE - INPUT            !
  !        !          !        !        !                                   !
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !                                   !
  !   3    ! HHA110OT !  500   ! 5000   !  HHA TEST FILE - OUTPUT Results   !
  !        !          !        !        !                                   !
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !                                   !
  !   4    ! HHCAL015 !   80   !   800  !  CALCulation program source       !
  !        !          !        !        !  code for FY 2001                 !
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !                                   !
  !   5    ! HHCAL022 !   80   !   800  !  CALCulation program source       !
  !        !          !        !        !  code for FY 2002                 !
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !                                   !
  !   6    ! HHCAL032 !   80   !   800  !  CALCulation program source       !
  !        !          !        !        !  code for FY 2003                 !
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !                                   !
  !   7    ! HHCAL043 !   80   !   800  !  CALCulation program source       !
  !        !          !        !        !  code for FY 2004                 !
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !                                   !
  !   8    ! HHCAL052 !   80   !   800  !  CALCulation program source       !
  !        !          !        !        !  code for FY 2005                 !
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !                                   !
  !   9    ! HHCAL065 !   80   !   800  !  CALCulation program source       !
  !        !          !        !        !  code for FY 2006                 !
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !                                   !
  !  10    ! HHCAL073 !   80   !   800  !  CALCulation program source       !
  !        !          !        !        !  code for FY 2007.1               !
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !                                   !
  !  11    ! HHCAL087 !   80   !   800  !  CALCulation program source       !
  !        !          !        !        !  code for FY 2008.4               !
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !  code (VS/COBOL II) for FY 2005   !
  !  12    ! HHCAL094 !   80   !   800  !  CALCulation program source       !
  !        !          !        !        !  code for FY 2013.0               !
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !  code (VS/COBOL II) for FY 2005   !
  !  13    ! HHCAL10C !   80   !   800  !  CALCulation program source       !
  !        !          !        !        !  code for FY 2013.0               !
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !  code (VS/COBOL II) for FY 2005   !
  !  14    ! HHCAL109 !   80   !   800  !  CALCulation program source       !
  !        !          !        !        !  code for FY 2013.0               !
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !                                   !
  !  15    ! HHDRV130 !   80   !   800  !  PPS Driver program source        !
  !        !          !        !        !  code (VS/COBOL II) for FY 2005   !
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !                                   !
  !  16    ! HHMGR130 !   80   !   800  !  Test Manager program source      !
  !        !          !        !        !  code (VS/COBOL II)               !
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !                                   !
  !  17    ! HHOPN130 !   80   !   800  !  Test Open    program source      !
  !        !          !        !        !  code (VS/COBOL II)               !
  +--------+----------+--------+--------+-----------------------------------+


 CONTINUED NEXT PAGE
    II-2

1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

  CONITNUED FROM PREVIOUS PAGE

  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !                                   !
  ! FILE # ! FILE NAME!  LRECL ! BLKSIZE!  DESCRIPTION                      !
  +========+==========+========+========+===================================+
  !        !          !        !        !                                   !
  !  18    ! HRG080   !  80    !  800   !  HRG FILE                         !
  !        !          !        !        !                                   !
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !                                   !
  !  19    ! MANU110  !   80   !  9040  !  PPS PRICER MANUAL FOR FY 2005.0  !
  !        !          !        !        !                                   !
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !      (PRODUCTION FILE)            !
  !  20    ! MSA050   !  80    !  800   ! Urban/Rural Wage Index File       !
  !        !          !        !        ! Metropolitan Statistical Area     !
  +--------+----------+--------+--------+-----------------------------------+
  +-------THESE FILES ARE ONLY FOR VA HMO AND FEHB-- WHEN AVAILABLE ------  !
  !  21    ! PROVR01  !        !        !                                   !
  !  Thru  !   Thru   !   240  !  2400  !  Provider Regions 1 thru 10       !
  !  29    ! PROVR10  !        !        !  (NEW FORMAT)                     !
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !                                   !
  !  30    ! PROV050  !   240  !  2400  !  Provider TEST FILE               !
  !        !          !        !        !                                   !
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !                                   !
  !  30    ! PRT103   !  133   !   1330 !  Expectied Test Results           !
  !        !          !        !        !                                   !
  +--------+----------+--------+--------+-----------------------------------+
  !        !          !        !        !                                   !
  !  31    ! REV110   !  80    !  800   !  REVENUE FILE                     !
  !        !          !        !        !                                   !
  +--------+----------+--------+--------+-----------------------------------+
   ** NOTE: IBM Standard Label: 1600 BPI

   ------------------------------------------------------------------
   Figure 2.1: Layout of PRICER INSTALLATION TAPE/CARTRIDGE and
     NETWORK DATA MOVER (NDM) FILE
   ------------------------------------------------------------------





     II-3



1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

  //LOAD PROC DSN=,FILE=,FB=FB,LRECL=80,BLK=800,PREF=,MEDIA=,
  // DATE=
  //COPY EXEC PGM=IEBGENER
  //SYSPRINT DD SYSOUT=A
  //SYSIN DD DUMMY,DCB=BLKSIZE=80
  //SYSUT1 DD DISP=OLD,DSN=&DSN,
  // LABEL=(&FILE,SL),
  // UNIT=TAPE,VOL=(,RETAIN,SER=XXXXXX),
  // DCB=(RECFM=&FB,LRECL=&LRECL,BLKSIZE=&BLK,DEN=3)
  //SYSUT2 DD DSN=&PREF..HHATEST.&DSN,
  // DISP=(NEW,CATLG,DELETE),UNIT=SYSDA,
  // SPACE=(&BLK,(1000),RLSE),
  // DCB=(RECFM=&FB,LRECL=&LRECL,BLKSIZE=&BLK)
  //PEND
  //PPS EXEC LOAD,PREF='XX.XXXX',FILE=1,
  //  DSN=FOREIGN.&MEDIA.PSF&DATE..HHA110
  //MANUAL EXEC LOAD,PREF='XX.XXXX',FILE=2,DSN=MANU103,
  //  LRECL=80,BLK=9040,FB=FBA
  //MGR EXEC LOAD,PREF='XX.XXXX',FILE=3,DSN=HHMGR130
  //COPY.SYSUT2 DD DSN=&PREF..HHATEST.&DSN..COBOL
  //OPN EXEC LOAD,PREF='XX.XXXX',FILE=4,DSN=HHOPN130
  //COPY.SYSUT2 DD DSN=&PREF..HHATEST.&DSN..COBOL
  //DRV EXEC LOAD,PREF='XX.XXXX',FILE=4,DSN=HHDRV130
  //COPY.SYSUT2 DD DSN=&PREF..HHATEST.&DSN..COBOL
  //CALYR1 EXEC LOAD,PREF='XX.XXXX',FILE=5,DSN=HHCAL015
  //COPY.SYSUT2 DD DSN=&PREF..HHATEST.&DSN..COBOL
  //CALYR2 EXEC LOAD,PREF='XX.XXXX',FILE=5,DSN=HHCAL022
  //COPY.SYSUT2 DD DSN=&PREF..HHATEST.&DSN..COBOL
  //CALYR3 EXEC LOAD,PREF='XX.XXXX',FILE=6,DSN=HHCAL032
  //COPY.SYSUT2 DD DSN=&PREF..HHATEST.&DSN..COBOL
  //CALYR4 EXEC LOAD,PREF='XX.XXXX',FILE=7,DSN=HHCAL043
  //COPY.SYSUT2 DD DSN=&PREF..HHATEST.&DSN..COBOL
  //CALYR5 EXEC LOAD,PREF='XX.XXXX',FILE=8,DSN=HHCAL052
  //COPY.SYSUT2 DD DSN=&PREF..HHATEST.&DSN..COBOL
  //CALYR6 EXEC LOAD,PREF='XX.XXXX',FILE=9,DSN=HHCAL065
  //COPY.SYSUT2 DD DSN=&PREF..HHATEST.&DSN..COBOL
  //CALYR7 EXEC LOAD,PREF='XX.XXXX',FILE=9,DSN=HHCAL073
  //COPY.SYSUT2 DD DSN=&PREF..HHATEST.&DSN..COBOL
  //CALYR8 EXEC LOAD,PREF='XX.XXXX',FILE=9,DSN=HHCAL089
  //COPY.SYSUT2 DD DSN=&PREF..HHATEST.&DSN..COBOL
  //CALYR8 EXEC LOAD,PREF='XX.XXXX',FILE=9,DSN=HHCAL094
  //COPY.SYSUT2 DD DSN=&PREF..HHATEST.&DSN..COBOL
  //CALYR9 EXEC LOAD,PREF='XX.XXXX',FILE=9,DSN=HHCAL10C
  //COPY.SYSUT2 DD DSN=&PREF..HHATEST.&DSN..COBOL
  //CALYR10 EXEC LOAD,PREF='XX.XXXX',FILE=9,DSN=HHCAL109
  //COPY.SYSUT2 DD DSN=&PREF..HHATEST.&DSN..COBOL
  //CALYR11 EXEC LOAD,PREF='XX.XXXX',FILE=9,DSN=HHCAL110
  //COPY.SYSUT2 DD DSN=&PREF..HHATEST.&DSN..COBOL
  //CALYR11 EXEC LOAD,PREF='XX.XXXX',FILE=9,DSN=HHCAL120
  //COPY.SYSUT2 DD DSN=&PREF..HHATEST.&DSN..COBOL
  //CALYR11 EXEC LOAD,PREF='XX.XXXX',FILE=9,DSN=HHCAL130
  //COPY.SYSUT2 DD DSN=&PREF..HHATEST.&DSN..COBOL
  //HHATEST EXEC LOAD,PREF='XX.XXXX',FILE=10,DSN=HHA110,LRECL=500,
  // BLK=5000
  //MSA  EXEC LOAD,PREF='XX.XXXX',FILE=11,DSN=MSA050
  //CBSA EXEC LOAD,PREF='XX.XXXX',FILE=12,DSN=CBSA110
  //REV  EXEC LOAD,PREF='XX.XXXX',FILE=13,DSN=REV110
  //HRG  EXEC LOAD,PREF='XX.XXXX',FILE=14,DSN=HRG080
  //PRTTEST EXEC LOAD,PREF='XX.XXXX',FILE=15,DSN=PRT103,LRECL=133,
  // BLK=1330,FB=FBA

  ****** NOTE ADDED JCL FOR HMO, VA AND FEHB WHEN AVAILABLE ******
  //REG1
   THRU EXEC LOAD,PREF='XX.XXXX',FILE=16,DSN=PROVR01,LRECL=240,BLK=2400
  //REG0    (THRU 25, (THRU PROVR10)
   **NOTE: Supply your own JOB card and apply your data center's
   standards.

  ------------------------------------------------------------------------------
  Figure 2.2: Sample JCL - Tape to Disk load of the PRICER Installation Tape
  ------------------------------------------------------------------------------


     II-4

1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

  //ALOC  EXEC PGM=IEFBR14
  //SYSPRINT DD SYSOUT=A
  //DD1 DD DSN=XX.XXXX.HHATEST.LOAD.XXXXXXXX,
  // DISP=(NEW,CATLG,DELETE),UNIT=SYSDA,
  // SPACE=(TRK,(15,3,3)),
  // DCB=(RECFM=U,BLKSIZE=3120,DSORG=PO)
  //*
  //COMPLOAD EXEC COBCCL,
  // CAPEX='MLIST,MDMAP,XCOUNT,NOSOU,NOTRU,CSXREF',
  // SYSIN='XX.XXXX.HHATEST.XXXXXXXX.COBOL',
  // COPYLIB='SYS1.COBLIB',
  // SUBPGMS='SYS1.COBLIB',
  // SYSLMOD='XX.XXXX.HHATEST.LOAD.XXXXXXXX',
  // SYSOUT='A'
  //STEP01.CAICSL DD DSN=&CSL1,UNIT=SYSDA,
  // SPACE=(CYL,(1,1,1)),DISP=(NEW,PASS)
  //STEP02.SYSLIN DD
  // DD *
  NAME XXXXXXXX(R)

   **NOTE: Supply your own JOB card and apply your data center's
   standards. Run once for each COBOL Program.

   -----------------------------------------------------------------------
    Figure 2.3: Sample JCL - Creates load modules for HHDRV's and HHCAL's.
   -----------------------------------------------------------------------



















     II-5



1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

  III. USING THE FY 2013.0 PROSPECTIVE PAYMENT PRICER SUBROUTINE (HHCAL)

   III-1. GENERAL

   The purpose of the PPS PRICER subroutine (HHCAL) is to provide the
   user with the proper payment amount for HHA Claims. Each HHCAL
   processes one Fiscal Years bills. PRICER will be processing the
   latest 2 year period.

   The Open program (HHOPN) calls the driver program (HHDRV) which
   calls the HHCAL and passes the necessary data or a user written
   interface program calls HHCAL supplying it with the necessary data.
   HHCAL will calculate the payment amount for Home Health services
   based on the data elements passed to it. It will return the payment
   amount & other data used in pricing or error codes if pricing could
   not be properly executed. Since HHCAL expects fully edited and
   audited data, it performs only rudimentary data edits. It is the
   responsibility of the Intermediary to assure the accuracy of the
   data that is submitted to the HHCAL subroutine.

   III-2. USING HHCAL
   Using HHCAL for batch requires:

  1. Installing PRICER as specified in Section II.

  2. Execute HHOPN and HHDRV or a user written interface program that
   passes the proper data.

 HHCALculation modules can execute independently if a user written
 interface  program supplies the necessary data i.e., HRG, REVENUE,
 MSA, and CBSA WAGE INDEX files.
  ------------------------------------------------------------------------------
  //LOAD PROC FB=FB,PREF='XX.XXXX',DSN=DATA103
  //COPY EXEC PGM=IEBGENER
  //SYSPRINT DD SYSOUT=A
  //SYSIN DD DUMMY,DCB=BLKSIZE=80
  //** SYSUT1 => WILL BE THE NDM FILE FROM CMS ***
  //SYSUT1 DD DISP=OLD,DSN=&PREF..PRICER.&DSN(&MEMBER),
  // DCB=(RECFM=FB,LRECL=&LRECL,BLKSIZE=&BLK)
  //SYSUT2 DD DSN=&PREF..PRICER.&MEMBER,
  // DISP=(NEW,CATLG,DELETE),UNIT=SYSDA,
  // SPACE=(&BLK,(2500),RLSE),
  // DCB=(RECFM=&FB,LRECL=&LRECL,BLKSIZE=&BLK)
  //PEND
  //MANUAL EXEC LOAD,LRECL=80,BLK=9040,MEMBER=MANU103,FB=FBA
  //MGR EXEC LOAD,LRECL=80,BLK=800,MEMBER=HHMGR130
  //COPY.SYSUT2 DD DSN=&PREF..PRICER.&MEMBER..COBOL
  //OPN EXEC LOAD,LRECL=80,BLK=800,MEMBER=HHOPN130
  //COPY.SYSUT2 DD DSN=&PREF..PRICER.&MEMBER..COBOL
  //DRV EXEC LOAD,LRECL=80,BLK=800,MEMBER=HHDRV130
  //COPY.SYSUT2 DD DSN=&PREF..PRICER.&MEMBER..COBOL
  //CALYR1 EXEC LOAD,LRECL=80,BLK=800,MEMBER=HHCAL015
  //COPY.SYSUT2 DD DSN=&PREF..PRICER.&MEMBER..COBOL
  //CALYR2 EXEC LOAD,LRECL=80,BLK=800,MEMBER=HHCAL022
  //COPY.SYSUT2 DD DSN=&PREF..PRICER.&MEMBER..COBOL
  //CALYR3 EXEC LOAD,LRECL=80,BLK=800,MEMBER=HHCAL032
  //COPY.SYSUT2 DD DSN=&PREF..PRICER.&MEMBER..COBOL

     III-1
1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

  //CALYR4 EXEC LOAD,LRECL=80,BLK=800,MEMBER=HHCAL043
  //COPY.SYSUT2 DD DSN=&PREF..PRICER.&MEMBER..COBOL
  //CALYR5  EXEC LOAD,LRECL=80,BLK=800,MEMBER=HHCAL052
  //COPY.SYSUT2 DD DSN=&PREF..PRICER.&MEMBER..COBOL
  //CALYR6  EXEC LOAD,LRECL=80,BLK=800,MEMBER=HHCAL065
  //COPY.SYSUT2 DD DSN=&PREF..PRICER.&MEMBER..COBOL
  //CALYR7  EXEC LOAD,LRECL=80,BLK=800,MEMBER=HHCAL073
  //COPY.SYSUT2 DD DSN=&PREF..PRICER.&MEMBER..COBOL
  //HHAFILE EXEC LOAD,LRECL=500,BLK=5000,MEMBER=HHA110
  //MSA     EXEC LOAD,LRECL=80,BLK=800,MEMBER=MSA050
  //CBSA    EXEC LOAD,LRECL=80,BLK=800,MEMBER=CBSA110
  //REV     EXEC LOAD,LRECL=80,BLK=800,MEMBER=REV110
  //HRG     EXEC LOAD,LRECL=80,BLK=800,MEMBER=HRG080
  //PRTFILE EXEC LOAD,LRECL=133,BLK=1330,MEMBER=PRT103,FB=FBA

  ****** NOTE ADDED JCL FOR HMO, VA AND FEHB WHEN AVAILABLE *****
  //REG1
   THRU EXEC LOAD,LRECL=240,BLK=2400,MEMBER=PROVR01
  //REG0    (THRU PROVR10)
   **NOTE: Supply your own JOB card and apply your data center's
  standards.  Figure 3.1: Sample JCL - NDM FILE disk download of the
  PRICER Installation NDM FILE




















     III-2



1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

  //ALOC  EXEC PGM=IEFBR14
  //SYSPRINT DD SYSOUT=A
  //DD1 DD DSN=XX.XXXX.HHATEST.LOAD.XXXXXXXX,
  // DISP=(NEW,CATLG,DELETE),UNIT=SYSDA,
  // SPACE=(TRK,(15,3,3)),
  // DCB=(RECFM=U,BLKSIZE=3120,DSORG=PO)
  //*
  //COMPLOAD EXEC COB2UCL,
  // PARM.COB2=(APOST,NODYNAM,LIB,RES,NONAME,AWO,OFF,TERM,
  //  X,'TRUNC(BIN)',NOADV,NOOPT,DUMP,OBJ,'DATA(24)')
  // PARM.LKED=(LIST,NOADV,NOOPT,XREF,LET,MAP,'AMODE(24)')
  //COB2.SYSIN DD DSN=XX.XXXX.HHATEST.XXXXXXXX.COBOL,DISP=SHR
  //COB2.SYSTERM DD SYSOUT=A
  //LKED.SYSLMOD DD XX.XXXX.HHATEST.LOAD.XXXXXXXX,DISP=SHR
  //LKED.SYSUT1 DD UNIT=SYSDA
  /*

   **NOTE: Supply your own JOB card and apply your data center's
   standards. Run once for each COBOL II Program.

   **NOTE: Parm card information may vary based on your data center.

  Figure 3.2: Sample JCL - Creates load modules for HHDRVs VS/COBOL
    Z/OS and HHCALs.
  ------------------------------------------------------------------------------

  //ALOC EXEC PGM=IEFBR14
  //SYSPRINT DD SYSOUT=A
  //DD1 DD DSN=XX.XXXX.HHATEST.LOAD.HHMGR130,DISP=(,CATLG,DELETE),
  // UNIT=SYSDA,SPACE=(TRK,(15,3,3)),
  // DCB=(RECFM=U,BLKSIZE=13030,DSORG=PO)
  //*
  //PPMGR EXEC COB2UCL,
  // PARM.COB2=(APOST,NODYNAM,LIB,RES,NONAME,AWO,OFF,TERM,
  // X,'TRUNC(BIN)',NOADV,NOOPT,DUMP,OBJ,'DATA(24)')
  // PARM.LKED=(LIST,NOADV,NOOPT,XREF,LET,MAP,'AMODE(24)')
  //COB2.SYSIN DD DSN=XX.XXXX.HHATEST.HHMGR130.COBOL,DISP=SHR
  //COB2.SYSTERM DD SYSOUT=A
  //LKED.SYSLMOD DD XX.XXXX.HHATEST.LOAD.HHMGR130,DISP=SHR
  //LKED.SYSIN DD *
  NAME HHATEST2(R)

   **NOTE: Supply your own JOB card and apply your data center's
   standards.
   **NOTE: Parm card information may vary based on your data center.

  Figure 3.3: Sample JCL - Linkedit HHMGR.




     III-3


1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT


  IV. Using the FY 2013.0 Prospective Payment Subroutine (HHDRV130)

   IV-1.  GENERAL

   HHDRV is a batch driver program that performs the following:

   1. Loads the HRG, REVENUE Files

   2. Loads the Wage Index File - for the latest ONE Year period.

   3. Selects the HRG and revenue-record, the wage-index for the
  appropriate claim, and passes to HHCAL.

   4. Calls the appropriate yearly HHCALculation Module.

   5. Passes the necessary data to price the claim.

   6. Passes the necessary data back to HHMGR130 to print the results.


   IV-2.  USING HHDRV
   Using HHDRV for batch requires:

  1. Installing PRICER as specified in Section II.

  2. Execute HHDRV or a user written interface program that passes the
   proper data.

   HHCALculation modules can execute independently if a user written
   interface program supplies the necessary data i.e., HRG, REVENUE
   AND wage index files.

 V. Using the FY 2013.0 Prospective Payment Subroutine (HHOPN130)

   V-1.  GENERAL

   HHOPN is a batch program that performs the following:

   1. Opens and loads the HRG, REVENUE Files

   2. Opens and loads the MSA and CBSA Wage Index Files - for the
      latest ONE Year period.

   3. Calls the HHDRV Module.

   5. Passes the necessary data to price the claim.

   6. Passes the necessary data back to HHMGR130 to print the results.


   IV-2.  USING HHOPN
   Using HHDRV for batch requires:

  1. Installing PRICER as specified in Section II.

  2. Execute HHOPN or a user written interface program that passes the
   proper data.



     IV-1



1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

  +------------------------------+---------+------+------------------------+
  !                              !         !      !         COBOL          !
  !          FIELD               !   LOC   ! SIZE +------------+-----------+
  !                              !         !      !   PICTURE  !   USAGE   !
  +==============================+=========+======+============+===========+
  !                              !         !      !            !           !
  ! National Provider Identifier !  1- 10  !  10  ! X(10)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !                              !         !      !            !           !
  ! Provider Hic                 !  11-22  !  12  ! X(12)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !                              !         !      !            !           !
  ! Provider Number              !  23-28  !  6   ! X(06)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !                              !         !      !            !           !
  ! Type Of Bill                 !  29-31  !  3   ! X(03)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !                              !         !      !            !           !
  ! PEP INDICATOR                !  32     !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !                              !         !      !            !           !
  ! PEP  NO OF DAYS              !  33-35  !  3   ! 9(03)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !                              !         !      !            !           !
  ! INITIAL PAYMENT INDICATOR    !  36     !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !                              !         !      !            !           !
  ! FILLER                       !  37-43  !  7   ! X(07)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !                              !         !      !            !           !
  ! MSA CODE FIELD               !  44-52  !  9   ! 9(07)V9)02 ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !                              !         !      !            !           !
  !         FILLER (BLANK)       !  44-46  !  3   ! X(03)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !                              !         !      !            !           !
  !         MSA CODE             !  47-50  !  4   ! X(04)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !                              !         !      !            !           !
  !         FILLER (BLANK)       !  51-52  !  2   ! X(02)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! CBSA-DATA REDEFINES MSA Code !  44-52  !  9   ! 9(07)V9)02 ! DISPLAY   !
  !             Field            !         !      !            !           !
  +------------------------------+---------+------+------------+-----------+
  !         FILLER (BLANK)       !  44-45  !  2   ! X(02)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !         CBSA CODE            !  46-50  !  5   ! X(05)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !         FILLER (BLANK)       !  51-52  !  2   ! X(02)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! SERVICE FROM DATE            !  53-60  !      !            !           !
  !      Discharge Century       !         !  2   ! 9(02)      ! DISPLAY   !
  !      Discharge Year          !         !  2   ! 9(02)      ! DISPLAY   !
  !      Discharge Month         !         !  2   ! 9(02)      ! DISPLAY   !
  !      Discharge Day           !         !  2   ! 9(02)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! SERVICE THRU DATE            !  61-68  !      !            !           !
  !      Discharge Century       !         !  2   ! 9(02)      ! DISPLAY   !
  !      Discharge Year          !         !  2   ! 9(02)      ! DISPLAY   !
  !      Discharge Month         !         !  2   ! 9(02)      ! DISPLAY   !
  !      Discharge Day           !         !  2   ! 9(02)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! SERVICE ADMIT DATE           !  69-76  !      !            !           !
  !      Discharge Century       !         !  2   ! 9(02)      ! DISPLAY   !
  !      Discharge Year          !         !  2   ! 9(02)      ! DISPLAY   !
  !      Discharge Month         !         !  2   ! 9(02)      ! DISPLAY   !
  !      Discharge Day           !         !  2   ! 9(02)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+

 CONTINUED NEXT PAGE
    IV-2

1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

  CONITNUED FROM PREVIOUS PAGE

  +------------------------------+---------+------+-------------------------
  !                              !         !      !         COBOL          !
  !          FIELD               !   LOC   ! SIZE +------------+-----------+
  !                              !         !      !   PICTURE  !   USAGE   !
  +==============================+=========+======+============+===========+
  !                              !         !      !            !           !
  ! HRG DATA  OCCURS 6 TIMES     !  77-250 !  174 !            !           !
  +------------------------------+---------+------+------------+-----------+
  !     HRG MEDICAL REVIEW IND   !  77     !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     HRG INPUT CODE           !  78-82  !  5   ! X(05)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     HRG OUTPUT CODE          !  83-87  !  5   ! X(05)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     HRG NO OF DAYS           !  88-90  !  3   ! 9(03)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     HRG WEIGHT               !  91-96  !  6   ! 9(02)V9)04)! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     HRG PAYMENT              !  97-105 !  9   ! 9(07)V9)02)! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! REVENUE DATA  OCCURS 6 TIMES ! 251-400 !  150 !            !           !
  +------------------------------+---------+------+------------+-----------+
  !     REVENUE CODE             ! 251-254 !  4   ! X(04)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     REVENUE COVERED VISITS   ! 255-257 !  3   ! 9(03)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     REVENUE DOLLAR RATE      ! 258-266 !  9   ! 9(07)V9(02)! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     REVENUE COST             ! 267-275 !  9   ! 9(07)V9)02)! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! RETURN CODE                  ! 401-402 !  2   ! 9(02)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! REVENUE SUM COVERED VISITS   ! 403-407 !  5   ! 9(05)      ! DISPLAY   !
  !     OCCURANCES 1 THRU 3      !         !      !            !           !
  +------------------------------+---------+------+------------+-----------+
  ! REVENUE SUM COVERED VISITS   ! 408-412 !  5   ! 9(05)      ! DISPLAY   !
  !     OCCURANCES 1 THRU 6      !         !      !            !           !
  +------------------------------+---------+------+------------+-----------+
  ! OUTLIER PAYMENT              ! 413-421 !  9   ! 9(07)V9(02)! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! TOTAL PAYMENT                ! 422-430 !  9   ! 9(07)V9(02)! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-CASE-MIX-DATA            ! 431-446 ! 16   ! GROUP      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-LUPA-ADD-ON-PAYMENT      ! 431-435 !  5   ! 999V99     ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-LUPA-SRC-ADM             ! 436-436 !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-RECODE-IND               ! 437-437 !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-EPISODE-TIMING           ! 438-438 !  1   ! 9          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+

 CONTINUED NEXT PAGE
    IV-3

1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

  CONITNUED FROM PREVIOUS PAGE

  +------------------------------+---------+------+-------------------------
  !                              !         !      !         COBOL          !
  !          FIELD               !   LOC   ! SIZE +------------+-----------+
  !                              !         !      !   PICTURE  !   USAGE   !
  +==============================+=========+======+============+===========+
  ! HHA-SEVERITY-POINTS          ! 439-446 !  8   ! GROUP      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-CLINICAL-SEV-EQ1         ! 439-439 !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-FUNCTION-SEV-EQ1         ! 440-440 !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-CLINICAL-SEV-EQ2         ! 441-441 !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-FUNCTION-SEV-EQ2         ! 442-442 !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-CLINICAL-SEV-EQ3         ! 443-443 !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  + HHA-FUNCTION-SEV-EQ3         + 444-444 +  1   + X          + DISPLAY  -+
  +------------------------------+---------+------+------------+-----------+
  ! HHA-CLINICAL-SEV-EQ4         ! 445-445 !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-FUNCTION-SEV-EQ4         ! 446-446 !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-PROV-TOTAL-DATA          ! 447-446 ! 20   ! GROUP      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-PROV-OUTLIER-PAY-TOTAL   ! 447-456 ! 10   ! 9(8)V99    ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-PROV-PAYMET-TOTAL        ! 457-466 ! 10   ! 9(8)V99    ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! FILLER                       ! 467-500 ! 34   ! X(34)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+

   ------------------------------------------------------------------------
   FIGURE 4.1: HHCAL Call List Argument # 1 (HOLD-INPUT-DATA)
   HHA INPUT Data Sent to HHCAL
   ------------------------------------------------------------------------

    IV-4


1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT


  +------------------------------+----------+-----+----------------------+
  !                              !          !     !       COBOL          !
  !            FIELD             !   LOC    !SIZE +------------+---------+
  !                              !          !     !  PICTURE   !  USAGE  !
  +==============================+==========+=====+============+=========+
  !                              !          !     !            !         !
  ! OPTION SWITCH   'A'          !   1      !  1  ! X(01)      ! DISPLAY !
  +------------------------------+----------+-----+------------+---------+
  !                              !          !     !            !         !
  ! HHDRV VERSION                !   2-8    !  7  ! X(07)      ! DISPLAY !
  +------------------------------+----------+-----+------------+---------+
  !                              !          !     !            !         !
  ! HHCAL VERSION                !   9-15   !  7  ! X(07)      ! DISPLAY !
  +------------------------------+----------+-----+------------+---------+
  !                              !          !     !            !         !
  ! FILLER                       !   16-35  ! 20  ! X(20)      ! DISPLAY !
  +------------------------------+----------+-----+------------+---------+

  FIGURE 4.2: HHCAL Call List Argument #  2 (HOLD-VARIABLES-DATA)
    Data Returned by HHCAL


  +------------------------------+---------+------+-------------------------+
  !                              !         !      !        COBOL            !
  !            FIELD             !   LOC   ! SIZE +------------+------------+
  !                              !         !      !  PICTURE   !  USAGE     !
  +==============================+=========+======+============+============+
  ! MSA or Rural Area Code       !  1-4    !   4  ! X(04)      ! DISPLAY    !
  +------------------------------+---------+------+------------+------------+
  ! Effective Date               !  5-12   !   8  ! X(08)      ! DISPLAY    !
  !     (CCYYMMDD) format)       !         !      !            !            !
  +------------------------------+---------+------+------------+------------+
  ! Wage Index                   !  13-18  !   6  ! 9(02)V9999 ! DISPLAY    !
  +------------------------------+---------+------+------------+------------+

    -------------------------------------------------------------------------
    FIGURE 4.3: HHCAL Call List Argument # 3 (WAGE-INDEX-DATA)
    -------------------------------------------------------------------------






     IV-5



1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

  +------------------------------+---------+------+------------------------+
  !                              !         !      !        COBOL           !
  !            FIELD             !   LOC   ! SIZE +------------+-----------+
  !                              !         !      !  PICTURE   !  USAGE    !
  +==============================+=========+======+============+===========+
  !     REVENUE CODE             !  1-4    !  4   ! X(04)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     FILLER                   !  5      !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     EFFECTIVE DATE CCYYMMDD  !  6-13   !  8   ! X(08)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     FILLER                   !  14     !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     DOLLAR RATE (NON-RURAL)  !  15-23  !  9   ! 9(07)V9(02)! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     FILLER                   !  24     !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     DOLLAR RATE  (RURAL)     !  25-33  !  9   ! 9(07)V9(02)! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     FILLER                   !  34     !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     DOLLAR RATE (NON-RURAL)  !  35-43  !  9   ! 9(07)V9(02)! DISPLAY   !
  +     non reprting             +         +      +            +           +
  +------------------------------+---------+------+------------+-----------+
  !     FILLER                   !  44     !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     DOLLAR RATE  (RURAL)     !  45-53  !  9   ! 9(07)V9(02)! DISPLAY   !
  +     non reprting             +         +      +            +           +
  +------------------------------+---------+------+------------+-----------+
  !     FILLER                   !  54-80  !  1   ! X(27)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+

   ------------------------------------------------------------------------
    FIGURE 5.1: REVENUE FILE RECORD LAYOUT
   ------------------------------------------------------------------------+

  +------------------------------+---------+------+------------------------+
  !                              !         !      !        COBOL           !
  !            FIELD             !   LOC   ! SIZE +------------+-----------+
  !                              !         !      !  PICTURE   !  USAGE    !
  +==============================+=========+======+============+===========+
  !     MSA CODE                 !  1-4    !  4   ! X(04)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     FILLER                   !   5     !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     EFFECTIVE DATE CCYYMMDD  !   6-13  !  8   ! X(08)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     FILLER                   !   14    !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     WAGE INDEX               !  15-20  !  6   ! 9(02)V9(04)! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     FILLER                   !  21-28  !  8   ! X(08)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     MSA NAME                 !  29-80  !  52  ! X(52)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+

  -------------------------------------------------------------------------
   FIGURE 5.2: MSA FILE RECORD LAYOUT
  -------------------------------------------------------------------------








     V-1

1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

  +------------------------------+---------+------+------------------------+
  !                              !         !      !        COBOL           !
  !            FIELD             !   LOC   ! SIZE +------------+-----------+
  !                              !         !      !  PICTURE   !  USAGE    !
  +==============================+=========+======+============+===========!
  !     CBSA CODE                !  1-5    !  5   ! X(05)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     FILLER                   !   6     !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     EFFECTIVE DATE CCYYMMDD  !   7-14  !  8   ! X(08)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     FILLER                   !   15    !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     WAGE INDEX               !  16-21  !  6   ! 9(02)V9(04)! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     FILLER                   !  21-21  !  1   ! X(01)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     STATE COUNTY CODE        !  13-28  !  6   ! X(06)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     FILLER                   !  29-29  !  1   ! X(01)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     CBSA NAME                !  30-68  !  39  ! X(39)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     FILLER                   !  69-80  !  12  ! X(12)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+

    -----------------------------------------------------------------------
    FIGURE 5.3: CBSA FILE RECORD LAYOUT
    -----------------------------------------------------------------------

  +------------------------------+---------+------+------------------------+
  !                              !         !      !        COBOL           !
  !            FIELD             !   LOC   ! SIZE +------------+-----------+
  !                              !         !      !  PICTURE   !  USAGE    !
  +==============================+=========+======+============+===========!
  !     HRG CODE                 !  1-5    !  5   ! X(05)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     FILLER                   !   6     !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     EFFECTIVE DATE CCYYMMDD  !   7-14  !  8   ! X(08)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     FILLER                   !   15    !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     HRG CODE WEIGHT          !  16-20  !  6   ! 9(02)V9(04)! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     FILLER                   !    21   !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     HRG code 2               !  22-26  !  5   ! X(05)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     FILLER                   !    27   !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     HRG CODE2 WEIGHT         !  28-33  !  6   ! 9(02)V9(04)! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     FILLER                   !  34-80  !  46  ! X(46)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
    -----------------------------------------------------------------------
    FIGURE 5.4: HRG FILE RECORD LAYOUT
    -----------------------------------------------------------------------

     V-2

1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

  +------------------------------+----------+-----------------------------+
  !                              !          !     !      COBOL            !
  !            FIELD             !   LOC    !SIZE +-------------+---------+
  !                              !          !     !  PICTURE    ! USAGE   !
  +==============================+==========+=====+=============+=========+
  ! National Provider Identifier !  1-10    !  10 ! X(10)       !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Provider Number              !  11-16   !     !             !         !
  !   Provider State Code        !          !  2  ! 9(02)       !DISPLAY  !
  !   Provider Number            !          !  4  ! X(04)       !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Provider Effective Date      !  17-24   !     !             !         !
  !   Effective Century          !          !  2  ! 9(02)       !DISPLAY  !
  !   Effective Year             !          !  2  ! 9(02)       !DISPLAY  !
  !   Effective Month            !          !  2  ! 9(02)       !DISPLAY  !
  !   Effective Day              !          !  2  ! 9(02)       !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Fiscal Year Begin Date       !  25-32   !     !             !         !
  !   Effective Century          !          !  2  ! 9(02)       !DISPLAY  !
  !   Effective Year             !          !  2  ! 9(02)       !DISPLAY  !
  !   Effective Month            !          !  2  ! 9(02)       !DISPLAY  !
  !   Effective Day              !          !  2  ! 9(02)       !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Report Date                  !  33-40   !     !             !         !
  !   Effective Century          !          !  2  ! 9(02)       !DISPLAY  !
  !   Effective Year             !          !  2  ! 9(02)       !DISPLAY  !
  !   Effective Month            !          !  2  ! 9(02)       !DISPLAY  !
  !   Effective Day              !          !  2  ! 9(02)       !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Termination Date             !  41-48   !     !             !         !
  !   Effective Century          !          !  2  ! 9(02)       !DISPLAY  !
  !   Effective Year             !          !  2  ! 9(02)       !DISPLAY  !
  !   Effective Month            !          !  2  ! 9(02)       !DISPLAY  !
  !   Effective Day              !          !  2  ! 9(02)       !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! PPS Waiver Code              !  49      !  1  ! X(01)       !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Intermediary Number          !  50-54   !  5  ! 9(05)       !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Provider Type                !  55-56   !  2  ! X(02)       !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Current Census Division      !  57      !  1  ! 9(01)       !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Chg Code for Wage-index      !          !     !             !         !
  ! Reclassification             !  58      !  1  ! X(01)       !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Metropolitan Statistical     !  59-62   !  4  ! X(04)       !DISPLAY  !
  !   Area (MSA) Actual Geo Loc  !          !     !             !         !
  +------------------------------+----------+-----+-------------+---------+

  (continues on next page)
     V-3

1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

  (continued from previous page)

  +------------------------------+----------+-----+-----------------------+
  !                              !          !     !         COBOL         !
  !           FIELD              !   LOC    !SIZE +-------------+---------+
  !                              !          !     !   PICTURE   ! USAGE   !
  +------------------------------+----------+-----+-------------+---------+
  ! Metropolitan Statistical     !  63-66   !  4  ! X(04)       !DISPLAY  !
  !   Area (MSA) Wage-index Loc  !          !     !             !         !
  ! (chg code for WI reclass = y)!          !     !             !         !
  +------------------------------+----------+-----+-------------+---------+
  ! Metropolitan Statistical     !  63-66   !  4  ! X(04)       !DISPLAY  !
  !   Area (MSA) Wage-index Loc  !          !     !             !         !
  ! (chg code for WI reclass = y)!          !     !             !         !
  +------------------------------+----------+-----+-------------+---------+
  ! Metropolitan Statistical     !  67-70   !  4  ! X(04)       !DISPLAY  !
  !   Area (MSA) Standardized Loc!          !     !             !         !
  +------------------------------+----------+-----+-------------+---------+
  ! Sole Community Hospital rate !  71-72   !  2  ! X(2)        !DISPLAY  !
  +------------------------------+--------  !-----+-------------+---------+
  ! Change Code for Lugar Reclass!  73      !  1  ! X           !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Temporary Relief Indicator   !  74      !  1  ! X           !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Federal PPS Blend Indicator  !  75      !  1  ! X(01)       !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Filler                       !  76-80   !  5  ! X(05)       !         !
  +------------------------------+----------+-----+-------------+---------+
  ! Facility Specific Rate       !  81-87   !  7  ! 9(05)V99    !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Cost of Living Adjustment    !  88-91   !  4  ! 9(01)V999   !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Intern-to-Bed Ratio          !  92-96   !  5  ! 9(01)V9999  !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Number of Beds (Bed Size)    !  97-101  !  5  ! 9(05)       !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Cost to charge ratio (CCR)   !  102-105 !  4  ! 9(01)V9(03) !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Case Mix Index               !  106-110 !  5  ! 9(01)V9999  !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Supplemental Security Income !  111-114 !  4  ! V9(04)      !DISPLAY  !
  ! Ratio (used to derive DSH %) !          !     !             !         !
  +------------------------------+----------+-----+-------------+---------+
  ! Medicaid Ratio               !  115-118 !  4  ! V9(04)      !DISPLAY  !
  !  (used to derive DSH %)      !          !     !             !         !
  +------------------------------+----------+-----+-------------+---------+
  ! PPS Blend Year Indicator     !  119     !  1  ! X(01)       !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! PRUP Update Factor           !  130-125 !  6  ! 9(01)V9(05) !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+

  (continues on next page)
    V-4

1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

  (continued from previous page)

  +------------------------------+----------+-----+-----------------------+
  !                              !          !     !         COBOL         !
  !           FIELD              !   LOC    !SIZE +-------------+--------=+
  !                              !          !     !   PICTURE   ! USAGE   !
  +------------------------------+----------+-----+-------------+---------+
  ! Dsh Percent                  !  126-129 !  4  ! V9(04)      !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! FYE DATE   CCYYMMDD          !  130-137 !  8  ! 9(08)       !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! FILLER                       !  138-160 !  23 ! X(23)       !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Capital Pass Thru Amount     !  161-166 !  6  ! 9(04)V9(2)  !DISPLAY  !
  !   Per Diem from Cost Report  !          !     !             !         !
  +------------------------------+----------+-----+-------------+---------+
  ! Direct Medical Ed. Pass thru !  167-172 !  6  ! 9(04)V9(02) !DISPLAY  !
  ! Amount Per Diem/Cost Report  !          !     !             !         !
  +------------------------------+----------+-----+-------------+---------+
  ! Organ Acquisition  Pass Thru !  173-178 !  6  ! 9(04)V9(02) !DISPLAY  !
  ! Amount Per Diem/Cost Report  !          !     !             !         !
  +------------------------------+----------+-----+-------------+---------+
  ! Total Pass Thru Amount,      !  179-184 !  6  ! 9(04)V9(02) !DISPLAY  !
  !   Including Miscellaneous    !          !     !             !         !
  !   Per Diem from Cost Report  !          !     !             !         !
  +------------------------------+----------+-----+-------------+---------+
  ! Capital PPS Payment Code     !  185     !  1  !  X(01)      !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Capital Hosp. Specific Rate  !  186-191 !  6  ! 9(4)V99     !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Old Capital Harmless Rate    ! 192-197  !  6  ! 9(4)V99     !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! New Capital Harmless Ratio   ! 198-202  !  5  ! 9(1)V9999   !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Capital Cost to Charge Ratio ! 203-206  !  4  ! 9V999       !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! New Hospital                 ! 207      !  1  ! X           !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Capital IME                  ! 208-212  !  5  ! 9V9999      !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Capital Exceptions           ! 231-218  !  6  ! 9(4)V99     !DISPLAY  !
  +------------------------------+----------+-----+-------------+---------+
  ! Filler                       ! 219-240  ! 22  ! X(22)       !DISPLAY  !
  +-----------------------------------------------------------------------+
   -----------------------------------------------------------------------
   FIGURE 5.5: PROVIDER SPECIFIC RECORD LAYOUT
   -----------------------------------------------------------------------


     V-5



1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

 VI. PRICER ASSURANCE TESTING USING HHMGR130

   VI-1. GENERAL

   It is the responsibility of the user to assure that PRICER is
   executing properly at the user's site. HHMGR130 is provided by CMS
   in order to facilitate that testing.

   Instructions for installing HHMGR130 and loading the Test Bill and
   Provider Files can be found in Section I.

   HHMGR130 is a batch driver program that performs the following:

   1. Reads the Test Claim File.

   2. The HRG is in the test Claim.

   3. Calls "HHOPN130".

   4. Prints the results.

   Your test results can be compared to the Expected Test Results
   report located in file 10. You can also build your own test data
   and submit it to HHMGR130.

   VI-2. USING HHMGR130

  A. VS/COBOL Z/OS

   Using HHMGR130 for batch PRICER testing requires three steps:

   1. Install PRICER as specified in Section II

   2. VS/COBOL FOR Z/OS -- Execute HHMGR130 using the test files (see
   Figure 5.2 of sample JCL).

   3. Compare the printed results to the Expected Test Results
   (FILE #11)

  If any discrepancies occur, check to assure that the installation
  and testing instructions were carefully followed. If so, contact CMS
  as soon as possible.

   VI-3. TESTING USER SUPPLIED DATA USING HHMGR130

  The Test Claim File may not contain all probable billing situations
  that an Intermediary may encounter. It is a sound practice for the
  user to build their own test data for inclusion in the HHMGR130
  test.

  The user will be required to have test files:

   1. The Test Bill File (see Figure 5.3)

     V-6

1  FILE # 2 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

   2. The Test files File (Figures 4.1, 4.5, 4.6, 4.7
   is the best source for this data)

  +-----------------------------------------------------------------------+
  !                   PRINT IMAGE RESULTS FOR OPERATING                   !
  +------------------------------+---------+------+-----------------------+
  !                              !         !      !         COBOL         !
  !               FIELD          !   LOC   ! SIZE +-----------+-----------+
  !                              !         !      !  PICTURE  !   USAGE   !
  +==============================+=========+======+===========+===========+
  !  PRINT IMAGE FORMAT          !  1-133  !      !  DISPLAY  !           !
  +------------------------------+---------+------+-----------+-----------+

   ------------------------------------------------------------------------
      FIGURE 5.6: Expected Test Results Format
   ------------------------------------------------------------------------

































     V-7



1  FILE # 02 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

  //HHATEST PROC LIB=SYS1.COB2LIB,PREF=
  //COBOL2 EXEC PGM=HHATEST
  //STEPLIB DD DSN=&PREF..HHATEST.LOAD.HHMGR130,DISP=SHR
  // DD DSN=&PREF..HHATEST.LOAD.HHOPN130,DISP=SHR
  // DD DSN=&PREF..HHATEST.LOAD.HHDRV130,DISP=SHR
  // DD DSN=&PREF..HHATEST.LOAD.HHCAL130,DISP=SHR
  // DD DSN=&PREF..HHATEST.LOAD.HHCAL130,DISP=SHR
  // DD DSN=&PREF..HHATEST.LOAD.HHCAL120,DISP=SHR
  // DD DSN=&PREF..HHATEST.LOAD.HHCAL10C,DISP=SHR
  // DD DSN=&PREF..HHATEST.LOAD.HHCAL094,DISP=SHR
  // DD DSN=&PREF..HHATEST.LOAD.HHCAL087,DISP=SHR
  // DD DSN=&PREF..HHATEST.LOAD.HHCAL073,DISP=SHR
  // DD DSN=&PREF..HHATEST.LOAD.HHCAL065,DISP=SHR
  // DD DSN=&PREF..HHATEST.LOAD.HHCAL052,DISP=SHR
  // DD DSN=&PREF..HHATEST.LOAD.HHCAL043,DISP=SHR
  // DD DSN=&PREF..HHATEST.LOAD.HHCAL032,DISP=SHR
  // DD DSN=&PREF..HHATEST.LOAD.HHCAL022,DISP=SHR
  // DD DSN=&PREF..HHATEST.LOAD.HHCAL015,DISP=SHR
  //SYSPRINT DD SYSOUT=A
  //SYSOUR DD SYSOUT=A
  //SYSOUT DD SYSOUT=A
  //SYSUDUMP DD SYSOUT=A
  //PRTFILE DD SYSOUT=A
  //HRG DD DISP=SHR,DSN=&PREF..HHATEST.HRG080
  //MSA DD DISP=SHR,DSN=&PREF..HHATEST.MSA050
  //cbs DD DISP=SHR,DSN=&PREF..HHATEST.CBSA110
  //REV DD DISP=SHR,DSN=&PREF..HHATEST.REV110
  //HHAFILE DD DISP=OLD,DSN=&PREF..HHATEST.HHA110
  //OUTFILE DD DSN=&PREF..HHATEST.OUT,
  // DISP=(,CATLG,DELETE),UNIT=SYSDA,
  // SPACE=(TRK,(50,5),RLSE),
  // DCB=(RECFM=FB,LRECL=500,BLKSIZE=5000)
  // PEND
  //T1  EXEC HHATEST,PREF='XX.XXXX'

   ** Note: Supply your own job card and apply your data center's standards.

   --------------------------------------------------------------------------
     FIGURE 5.7 - Sample JCL to Execute HHMGR120 VS/COBOL II
   --------------------------------------------------------------------------

     V-8



1  FILE # 02 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

  +------------------------------+---------+------+------------------------+
  !                              !         !      !         COBOL          !
  !          FIELD               !   LOC   ! SIZE +------------+-----------+
  !                              !         !      !   PICTURE  !   USAGE   !
  +==============================+=========+======+============+===========+
  ! National Provider Identifier !  1- 10  !  10  ! X(10)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! Provider Hic                 !  11-22  !  12  ! X(12)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! Provider Number              !  23-28  !  6   ! X(06)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! Type Of Bill                 !  29-31  !  3   ! X(03)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! PEP INDICATOR                !  32     !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! PEP  NO OF DAYS              !  33-35  !  3   ! 9(03)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! INITIAL PAYMENT INDICATOR    !  36     !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! FILLER                       !  37-43  !  7   ! X(07)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! MSA CODE FIELD               !  44-52  !  9   ! 9(07)V9)02 ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !         FILLER (BLANK)       !  44-46  !  3   ! X(03)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !         MSA CODE             !  47-50  !  4   ! X(04)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !         FILLER (BLANK)       !  51-52  !  2   ! X(02)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! CBSA-DATA REDEFINES MSA Code !  44-52  !  9   ! 9(07)V9)02 ! DISPLAY   !
  !             Field            !         !      !            !           !
  +------------------------------+---------+------+------------+-----------+
  !         FILLER (BLANK)       !  44-45  !  2   ! X(02)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !         CBSA CODE            !  46-50  !  5   ! X(05)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !         FILLER (BLANK)       !  51-52  !  2   ! X(02)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! SERVICE FROM DATE            !  53-60  !      !            !           !
  !      Discharge Century       !         !  2   ! 9(02)      ! DISPLAY   !
  !      Discharge Year          !         !  2   ! 9(02)      ! DISPLAY   !
  !      Discharge Month         !         !  2   ! 9(02)      ! DISPLAY   !
  !      Discharge Day           !         !  2   ! 9(02)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+


  CONTINUES NEXT PAGE

     V-9



1  FILE # 02 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

  CONTINUED FROM PREVIOUS PAGE

  +------------------------------+---------+------+------------------------+
  !                              !         !      !         COBOL          !
  !          FIELD               !   LOC   ! SIZE +------------+-----------+
  !                              !         !      !   PICTURE  !   USAGE   !
  +==============================+=========+======+============+===========+
  ! SERVICE THRU DATE            !  61-68  !      !            !           !
  !      Discharge Century       !         !  2   ! 9(02)      ! DISPLAY   !
  !      Discharge Year          !         !  2   ! 9(02)      ! DISPLAY   !
  !      Discharge Month         !         !  2   ! 9(02)      ! DISPLAY   !
  !      Discharge Day           !         !  2   ! 9(02)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! SERVICE ADMIT DATE           !  69-76  !      !            !           !
  !      Discharge Century       !         !  2   ! 9(02)      ! DISPLAY   !
  !      Discharge Year          !         !  2   ! 9(02)      ! DISPLAY   !
  !      Discharge Month         !         !  2   ! 9(02)      ! DISPLAY   !
  !      Discharge Day           !         !  2   ! 9(02)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HRG DATA OCCURS 6 TIMES      !  77-250 !  174 !            !           !
  +------------------------------+---------+------+------------+-----------+
  !     HRG MEDICAL REVIEW IND   !  77     !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     HRG INPUT CODE           !  78-82  !  5   ! X(05)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     HRG OUTPUT CODE          !  83-87  !  5   ! X(05)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     HRG NO OF DAYS           !  88-90  !  3   ! 9(03)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     HRG WEIGHT               !  91-96  !  6   ! 9(02)V9)04)! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     HRG PAYMENT              !  97-105 !  9   ! 9(07)V9)02)! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! REVENUE DATA OCCURS 6 TIMES  ! 251-400 !  150 !            !           !
  +------------------------------+---------+------+------------+-----------+
  !     REVENUE CODE             ! 251-254 !  4   ! X(04)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     REVENUE COVERED VISITS   ! 255-257 !  3   ! 9(03)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     REVENUE DOLLAR RATE      ! 258-266 !  9   ! 9(07)V9(02)! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  !     REVENUE COST             ! 267-275 !  9   ! 9(07)V9)02)! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! RETURN CODE                  ! 401-402 !  2   ! 9(02)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! REVENUE SUM COVERED VISITS   ! 403-407 !  5   ! 9(05)      ! DISPLAY   !
  !     OCCURANCES 1 THRU 3      !         !      !            !           !
  +------------------------------+---------+------+------------+-----------+
  ! REVENUE SUM COVERED VISITS   ! 408-412 !  5   ! 9(05)      ! DISPLAY   !
  !     OCCURANCES 1 THRU 6      !         !      !            !           !
  +------------------------------+---------+------+------------+-----------+
  ! OUTLIER PAYMENT              ! 413-421 !  9   ! 9(07)V9(02)! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! TOTAL PAYMENT                ! 422-430 !  9   ! 9(07)V9(02)! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-CASE-MIX-DATA            ! 431-446 ! 16   ! GROUP      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-LUPA-ADD-ON-PAYMENT      ! 431-435 !  5   ! 999V99     ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-LUPA-SRC-ADM             ! 436-436 !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-RECODE-IND               ! 437-437 !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-EPISODE-TIMING           ! 438-438 !  1   ! 9          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-SEVERITY-POINTS          ! 439-446 !  8   ! GROUP      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-CLINICAL-SEV-EQ1         ! 439-439 !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-FUNCTION-SEV-EQ1         ! 440-440 !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-CLINICAL-SEV-EQ2         ! 441-441 !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-FUNCTION-SEV-EQ2         ! 442-442 !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-CLINICAL-SEV-EQ3         ! 443-443 !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  + HHA-FUNCTION-SEV-EQ3         + 444-444 +  1   + X          + DISPLAY  -+
  +------------------------------+---------+------+------------+-----------+
  ! HHA-CLINICAL-SEV-EQ4         ! 445-445 !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-FUNCTION-SEV-EQ4         ! 446-446 !  1   ! X          ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-PROV-TOTAL-DATA          ! 447-446 ! 20   ! GROUP      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-PROV-OUTLIER-PAY-TOTAL   ! 447-456 ! 10   ! 9(8)V99    ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! HHA-PROV-PAYMET-TOTAL        ! 457-466 ! 11   ! 9(9)V99    ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+
  ! FILLER                       ! 467-500 ! 33   ! X(33)      ! DISPLAY   !
  +------------------------------+---------+------+------------+-----------+

   ------------------------------------------------------------------------
   FIGURE 5.8: Test Claim Data Record Format
   ------------------------------------------------------------------------




     V-10


1  FILE # 02 HHA CICS PRICER INSTALLATION GUIDE DOCUMENT

   -----------------------------------------------------------------------------
     5.9 Payment Census Division Composition:
   -----------------------------------------------------------------------------

                            6. West North Central
  1. New England
                              16,76 Iowa
   07 Connecticut             17,70 Kansas
   20 Maine                   24,77  Minnesota
   22 Massachusetts           26 Missouri
   30 New Hampshire           28 Nebraska
   41 Rhode Island            35 North Dakota
   47 Vermont                 43 South Dakota


  2. Middle Atlantic        7. West South Central

   39,43 Pennsylvania         04 Arkansas
   31 New Jersey              19,71 Louisiana
   33 New York                37 Oklahoma
   40 Puerto Rico             45,67,74 Texas
   41 Virgin Islands


  3. South Atlantic         8. Mountain

   08 Delaware                03 Arizona
   09 District of Columbia    06 Colorado
   10,68,69 Florida           13 Idaho
   11 Georgia                 27 Montana
   21,80 Maryland             29 Nevada
   34 North Carolina          32 New Mexico
   42 South Carolina          46 Utah
   49 Virginia                53 Wyoming
   51 West Virginia


  4. East North Central     9. Pacific

   14,78 Illinois             02 Alaska
   15 Indiana                 05,55,75 California
   23 Michigan                12 Hawaii
   36,72 Ohio                 38 Oregon
   52 Wisconsin               50 Washington
                              65 Guam
                              66 Northern Marianas Islands

  5. East South Central

   01 Alabama
   18 Kentucky
   25 Mississippi
   44 Tennessee


     V-12

