000100 IDENTIFICATION DIVISION.                                         00010001
000200 PROGRAM-ID. ESCAL130.                                            00020001
000300*AUTHOR.     CMS                                                  00030001
000400*       EFFECTIVE JANUARY 1, 2013                                 00040001
000500******************************************************************00050001
000600* 4/06/05 - ALLOW PROVIDER TYPE '05' FOR PEDIATRIC HOSP          *00060001
000700*         - TO BE EFFECTIVE WITH THE NEXT RELEASE                *00070001
000800*         - CHANGED IN 0100-INITIAL-ROUTINE WITH PROVIDER        *00080001
000900*           TYPE '40'                                            *00090001
001000* 1/01/06 - NEW CBSA TABLE FOR CY2006                            *00100001
001100*         - UPDATE 2005 MSA COMPOSITE RATES WITH 1.6% INCREASE   *00110001
001200* 1/18/07 - THE MSA-WAGE-FACTOR-2007 WAS NOT IMPLEMENTED DURING  *00120001
001300*           THE FIRST THREE MONTHS OF 2007                       *00130001
001400*         - MSA-CBSA BLEND PERCENT NOW SET AT 50% MSA 50% CBSA   *00140001
001500*         - ADDITIONAL VARIABLES WERE CREATED IN ORDER TO MAKE   *00150001
001600*           CHANGING VALUES EASIER (IN WORKING STORAGE RATHER    *00160001
001700*           THAN IN THE PROCEDURE DIVISION)                      *00170001
001800*         - THIS PROGRAM NOW REFLECTS ENHANCEMENTS MADE SO THAT  *00180001
001900*           TESTING OF THE CODE DOES NOT REQUIRE COMMENTING      *00190001
002000*           IN/OUT LINES OF CODE.  IN ADDITION CALCULATED        *00200001
002100*           VARIABLES ARE NOW PASSED BACK WHEN TEST CASES ARE    *00210001
002200*           ENCOUNTERED IN ORDER FOR THE MASTER DRIVER TO PRINT  *00220001
002300*           MORE INFORMATION ABOUT WHAT WENT ON IN THIS PROGRAM  *00230001
002400* 1/19/07 - INDEPENDENT ESRD FACILITY WAGE NOW    $132.49        *00240001
002500*           HOSPITAL BASED ESRD FACILTIY WAGE NOW $136.68        *00250001
002600*           DRUG ADD-ON ADJUSTMENT AFTER 4/1/07   1.1490         *00260001
002700* 1/26/07 - MSA COMPOSITE PAYMENT RATES INCREASED 1.6% ABOVE THE *00270001
002800*           2006 RATES.  THIS MEANS THAT THE RATES PASSED FROM   *00280001
002900*           THE DRIVER, WHICH ARE 2005 RATES, NEED TO BE         *00290001
003000*           MULTIPLIED BY 1.016 AND THEN ROUNDED TO GET THE 2006 *00300001
003100*           RATE AND THEN THAT RESULT MULTIPLIED BY ANOTHER 1.016*00310001
003200*           AND ROUNDED AGAIN TO GET THE 4/1/2007 RATE.  THIS    *00320001
003300*           NECESSARY ROUNDING MAKES THE RESULTS AGREE WITH THOSE*00330001
003400*           PUBLISHED IN THE FEDERAL REGISTER.  THIS METHOD WAS  *00340001
003500*           VERIFIED VIA TEDIOUS EXCEL SPREADSHEET CALCULATIONS  *00350001
003600* 10/30/07- MSA COMPOSITE PAYMENT RATES DID NOT INCREASE FROM THE*00360001
003700*           2007/04/01 RATES.  THE COMPOSITE BASE RATES DID NOT  *00370001
003800*           CHANGE FROM THE 07/04/01 FACILITY RATES.             *00380001
003900*           THE BLEND OF MSA TO CBSA WAS CHANGED TO 25% MSA AND  *00390001
004000*           75% CBSA.                                            *00400001
004100*           THE DRUG ADDON FACTOR WAS INCREASED TO 1.1550        *00410001
004200*           ALL OTHER FIGURES REMAINED THE SAME.                 *00420001
004300* 11/21/07- CHANGES WERE MADE TO ALL THE CALCULATION SUBROUTINES *00430001
004400*           BEGINNING IN 2005 IN ORDER TO ENSURE THAT THE        *00440001
004500*           PC-PRICER CAN USE THE **EXACT** SAME CODE THAT EXISTS*00450001
004600*           ON THE MAINFRAME.  IN ORDER TO ENSURE THAT THE       *00460001
004700*           LINKAGE SECTION REMAINS THE SAME, THE FILLER AREAS   *00470001
004800*           LOCATED AT THE END OF EACH '05' LEVEL HAVE BEEN      *00480001
004900*           MODIFIED TO INCLUDE VARIABLES NEEDED FOR PROOFING OF *00490001
005000*           THE MAINFRAME CODE AS WELL AS DISPLAYING ON THE PC-  *00500001
005100*           PRICER.                                              *00510001
005200*         -      THE VARIABLE LABELED 'P-ESRD-RATE' IS NEVER     *00520001
005300*           USED IN CALCUALTIONS SINCE THE DRIVER IS THE ONLY ONE*00530001
005400*           THAT USES IT IN SPECIAL CIRCUMSTANCES AT THE FISCAL  *00540001
005500*           INTERMEDIARIES.  THEREFORE A DUAL USE WAS MADE OF IT *00550001
005600*           SO THAT THE PC-PRICER CAN MAKE USE OF THE VERY       *00560001
005700*           LIMITED SPACE LEFT.  THE VARIABLE NAME WAS REDEFINED *00570001
005800*           TO 'CASE-MIX-FCTR-ADJ-RATE' TO REFLECT IT'S USAGE ON *00580001
005900*           THE PC-PRICER.                                       *00590001
006000*         -        USAGE OF THE THESE FILLER AREAS AND THE       *00600001
006100*           'CASE-MIX-FCTR-ADJ-RATE' VARIABLE WILL ONLY OCCUR    *00610001
006200*           WHEN A 'T' (FOR TESTING) IS IN THE LAST COLUMN OF THE*00620001
006300*           INPUT RECORD.  OTHERWISE THESE VARIABLES WILL CONTAIN*00630001
006400*           SPACES WHEN NOT IN TEST MODE.  MOST OF THE MOVES TO  *00640001
006500*           THESE VARIABLES OCCURS IN THE 9000-MOVE-RESULTS PARA-*00650001
006600*           GRAPH.  A FEW MOVES MUST OCCUR IN OTHER AREAS OF THE *00660001
006700*           PROGRAM.                                             *00670001
006800* 11/07/08- ALL CODE FOR 2006-2008 WAGE ADJUSTED PAYMENTS WERE   *00680001
006900*           REMOVED BECAUSE THERE IS NO LONGER A BLEND BETWEEN   *00690001
007000*           MSA AND CBSA STARTING 1/1/2009.                      *00700001
007100*           THE DRUG ADDON FACTOR WAS CHANGED TO 1.1520          *00710001
007200*           THE HOSPITAL AND INDEPENDENT ESRD FACILITY PAYMENT   *00720001
007300*           RATES ARE NOW THE SAME.  THE TWO VARIABLES WERE LEFT *00730001
007400*           IN THE PROGRAM IN CASE THEY DECIDE TO MAKE THEM      *00740001
007500*           DIFFERENT IN THE FUTURE.                             *00750001
007600* 12/03/08- RENAMED THIS SUBROUTINE ESCAL091 AND CHANGED THE     *00760001
007700*           APPROPRIATE VERSION INFORMATION.  THE 9.0 VERSION OF *00770001
007800*           THE PRICER WAS SENT OUT IN NOVEMBER.  AFTERWARDS THE *00780001
007900*           POLICY PEOPLE WHO SET THE WAGE INDEXES, CHANGED THEIR*00790001
008000*           MINDS ABOUT CBSA 16700 AND RESCINDED THE WAGE INDEX. *00800001
008100*           THIS NECESSITATED A RE-RELEASE OF THE ESRD PRICER IN *00810001
008200*           ORDER TO MAKE SURE THAT THE FI'S ARE USING THE LATEST*00820001
008300*           VERSION AT THE START OF CY2009.                      *00830001
008400* 11/02/09- Renamed this subroutine ESCAL100 and changed the     *00840001
008500*           appropriate version information.  Changed the        *00850001
008600*           composite rate (Hosp-Based-Pmt-Rate and Indp-ESRD-Fac*00860001
008700*           -Pmt-Rate) to 135.15.  Also changed the Drug-Addon to*00870001
008800*           1.1500.                                              *00880001
008900*         - Began reorganization of program so that it can be    *00890001
009000*           used with the Bundled rate payment system as well as *00900001
009100*           the Composite rate payment system.  In that light,   *00910001
009200*           changed WAGE-NEW-CBSA-RECORD to COM-CBSA-WAGE-RECORD *00920001
009300*           and added BUN-CBSA-WAGE-RECORD which is not used in  *00930001
009400*           this version of the program.  Changed corresponding  *00940001
009500*           variable names to agree with the new name.           *00950001
009600* 10/29/10- Renamed this subroutine ESCAL110.  This pricer       *00960001
009700*           changed from being only a Composite Rate pricer to   *00970001
009800*           processing line-items using both the Composite Rate  *00980001
009900*           methodology AND a Bundled (now called PPS) Rate      *00990001
010000*           methodology during a blend period that lasts from    *01000001
010100*           2011 to 2013.  The original composite rate code has  *01010001
010200*           been completely rewritten to conform to the new      *01020001
010300*           manner of pricing as well as being more efficient.   *01030001
010400*           There are too many changes to list from the bundled  *01040001
010500*           methodology to put here.                             *01050001
010600*           On the composite-rate side of the program, the drug  *01060001
010700*           add-on has been changed to 14.7 percent and the      *01070001
010800*           the composite rate changed to $138.53.               *01080001
010900*           Also added new variable A-49-CENT-PART-D-DRUG-ADJ    *01090001
011000*           to the composite-rate side of the calculation which  *01100001
011100*           is an adjustment for ESRD drugs and biologicals      *01110001
011200*           currently paid under Part-D.                         *01120001
011300* 03/07/11- Renamed this subroutine ESCAL116.  This was due to   *01130001
011400*           problems found in the initial version which was re-  *01140001
011500*           leased to FISS for their initial work in bringing up *01150001
011600*           the new pricer.  Future revisions may be needed.     *01160001
011700* 10/28/11- Renamed this subroutine ESCAL120.  Four changes are: *01170001
011800*           (1) fixed the onstart calculation to count from day  *01180001
011900*           one and therefore use 120 days vs the 121 days prior *01190001
012000*           calculation (which counted from the second day).     *01200001
012100*           (2) added an output variable which is the amount of  *01210001
012200*           the low volume that is added to a line-item payment  *01220001
012300*           when the provider is a low-volume provider.  This is *01230001
012400*           for recovery purposes.                               *01240001
012500*           (3) added an input variable for the Quality Incentive*01250001
012600*           Program (QIP).  The specific number in this field    *01260001
012700*           comes from FISS which maintaines the Provider        *01270001
012800*           Specific File and the number ultimately is provided  *01280001
012900*           by the Quality people at CMS.                        *01290001
013000*           (4) made necessary changes for CY 2012.  A noteworthy*01300001
013100*           change is how blended payments are calculated.  In   *01310001
013200*           2011 there was a 49 cent Part D drug adjustment.  In *01320001
013300*           2012 this 49 cent is added to the Base-Payment-Rate  *01330001
013400*           and then the 2.1 % productivity is applied.  This    *01340001
013500*           means that the base rate starts at $139.02 and after *01350001
013600*           the 2.1% increase the base rate is $141.94.          *01360001
013700*           Another change is in calculating the BSA.  The super-*01370001
013800*           script is now the same in the Composite Rate portion *01380001
013900*           of the code as it is in the PPS portion of the code. *01390001
014000* FUTURE    This program is intended to be used in a running TEN *01400001
014100*           year (current year and nine prior years) mode.       *01410001
014200*           As of 10/10, there are no plans on which variables to*01420001
014300*           remove since plans may change yet again.             *01430001
014400* ESCAL121  ESCAL120...Note that there is NO ESCAL120 calculating 01440001
014500*           subroutine due to a reversing of CBSA 41980 composite 01450001
014600*           & PPS WAGE INDEX which was sent out with the ESDRV120 01460001
014700*           subroutine prior to the start of the calendar year.   01470001
014800*           There is NO difference between the original ESCAL120  01480001
014900*           and ESCAL121 except the notational difference in the  01490001
015000*           version number.                                       01500001
015100* 11/14/12- ESCAL130 - Made annual updates for CY 2013 to match   01510007
015200*           specifications from the Chronic Care Policy Group.    01520001
015300*           In addition, code was added to implement the          01530001
015400*           assignment of the pediatric hemodialysis rate to      01540008
015500*           revenue code 0881 (ultrafiltration) when reported     01550001
015600*           on a pediatric claim (CR 7064 - Requirement #11).     01560001
015700*           List of changes for CY 2013 -->                       01570004
015800*           - Composite payment rate for blended payments:        01580003
015900*              changed BASE-PAYMENT-RATE to 145.20.               01590003
016000*           - Drug add-on to the composite payment system for     01600003
016100*             blended payments:                                   01610003
016200*              changed DRUG-ADDON to 1.1400.                      01620003
016300*           - ESRD PPS base rate:                                 01630003
016400*              changed BUNDLED-BASE-PMT-RATE to 240.36            01640003
016500*              (after taking into account both -->                01650003
016600*                    - the market basket update, and              01660003
016700*                    - the wage index budget neutrality adjustment01670003
016800*                      factor).                                   01680003
016900*           - ESRD PPS outlier per treatment MAP amount for       01690003
017000*             adult patients:                                     01700003
017100*              changed ADJ-AVG-MAP-AMT-GT-17 to 59.42.            01710003
017200*           - ESRD PPS outlier per treatment MAP amount for       01720003
017300*             pediatric patients:                                 01730004
017400*              changed ADJ-AVG-MAP-AMT-LT-18 to 41.39.            01740003
017500*           - ESRD PPS outlier threshold fixed dollar loss amount 01750003
017600*             for adult patients:                                 01760004
017700*              changed FIX-DOLLAR-LOSS-GT-17 to 110.22.           01770003
017800*           - ESRD PPS outlier threshold fixed dollar loss amount 01780003
017900*             for pediatric patients:                             01790003
018000*              changed FIX-DOLLAR-LOSS-LT-18 to 47.32.            01800003
018100*           - 25 percent of the basic case-mix adjusted composite 01810003
018200*             payment amount:                                     01820004
018300*              changed COM-CBSA-BLEND-PCT to 0.25.                01830003
018400*           - 75 percent of the ESRD PPS payment amount:          01840003
018500*              changed BUN-CBSA-BLEND-PCT to 0.75.                01850003
018600*                                                                 01860001
018700******************************************************************01870001
018800 DATE-COMPILED.                                                   01880001
018900 ENVIRONMENT DIVISION.                                            01890001
019000 CONFIGURATION SECTION.                                           01900001
019100 SOURCE-COMPUTER.            IBM-Z990.                            01910001
019200 OBJECT-COMPUTER.            ITTY-BITTY-MACHINE-CORPORATION.      01920001
019300 INPUT-OUTPUT  SECTION.                                           01930001
019400 FILE-CONTROL.                                                    01940001
019500                                                                  01950001
019600 DATA DIVISION.                                                   01960001
019700 FILE SECTION.                                                    01970001
019800/                                                                 01980001
019900 WORKING-STORAGE SECTION.                                         01990001
020000 01  W-STORAGE-REF                  PIC X(46) VALUE               02000001
020100     'ESCAL130      - W O R K I N G   S T O R A G E'.             02010006
020200 01  CAL-VERSION                    PIC X(05) VALUE 'C13.0'.      02020006
020300                                                                  02030001
020400 01  DISPLAY-LINE-MEASUREMENT.                                    02040001
020500     05  FILLER                     PIC X(50) VALUE               02050001
020600         '....:...10....:...20....:...30....:...40....:...50'.    02060001
020700     05  FILLER                     PIC X(50) VALUE               02070001
020800         '....:...60....:...70....:...80....:...90....:..100'.    02080001
020900     05  FILLER                     PIC X(20) VALUE               02090001
021000         '....:..110....:..120'.                                  02100001
021100                                                                  02110001
021200 01  PRINT-LINE-MEASUREMENT.                                      02120001
021300     05  FILLER                     PIC X(51) VALUE               02130001
021400         'X....:...10....:...20....:...30....:...40....:...50'.   02140001
021500     05  FILLER                     PIC X(50) VALUE               02150001
021600         '....:...60....:...70....:...80....:...90....:..100'.    02160001
021700     05  FILLER                     PIC X(32) VALUE               02170001
021800         '....:..110....:..120....:..130..'.                      02180001
021900/                                                                 02190001
022000******************************************************************02200001
022100*  This area contains all of the old Composite Rate variables.   *02210001
022200* They will be eliminated when the transition period ends - 2014 *02220001
022300******************************************************************02230001
022400 01  HOLD-COMP-RATE-PPS-COMPONENTS.                               02240001
022500     05  H-PAYMENT-RATE             PIC 9(04)V9(02).              02250001
022600     05  H-PYMT-AMT                 PIC 9(04)V9(02).              02260001
022700     05  H-WAGE-ADJ-PYMT-AMT        PIC 9(04)V9(02).              02270001
022800     05  H-PATIENT-AGE              PIC 9(03).                    02280001
022900     05  H-AGE-FACTOR               PIC 9(01)V9(03).              02290001
023000     05  H-BSA-FACTOR               PIC 9(01)V9(04).              02300001
023100     05  H-BMI-FACTOR               PIC 9(01)V9(04).              02310001
023200     05  H-BSA                      PIC 9(03)V9(04).              02320001
023300     05  H-BMI                      PIC 9(03)V9(04).              02330001
023400     05  HGT-PART                   PIC 9(04)V9(08).              02340001
023500     05  WGT-PART                   PIC 9(04)V9(08).              02350001
023600     05  COMBINED-PART              PIC 9(04)V9(08).              02360001
023700     05  CALC-BSA                   PIC 9(04)V9(08).              02370001
023800                                                                  02380001
023900                                                                  02390001
024000* The following two variables will change from year to year       02400001
024100* and are used for the COMPOSITE part of the Bundled Pricer.      02410001
024200 01  DRUG-ADDON                     PIC 9(01)V9(04) VALUE 1.1400. 02420004
024300 01  BASE-PAYMENT-RATE              PIC 9(04)V9(02) VALUE 145.20. 02430004
024400                                                                  02440001
024500* The next two percentages MUST add up to 1 (i.e. 100%)           02450001
024600* They will continue to change until CY2009 when CBSA will be 1.0002460001
024700 01  MSA-BLEND-PCT                  PIC 9(01)V9(02) VALUE 0.00.   02470001
024800 01  CBSA-BLEND-PCT                 PIC 9(01)V9(02) VALUE 1.00.   02480001
024900                                                                  02490001
025000* CONSTANTS AREA                                                  02500001
025100* The next two percentages MUST add up TO 1 (i.e. 100%)           02510001
025200 01  NAT-LABOR-PCT                  PIC 9(01)V9(05) VALUE 0.53711.02520001
025300 01  NAT-NONLABOR-PCT               PIC 9(01)V9(05) VALUE 0.46289.02530001
025400                                                                  02540001
025500* The next variable is only applicapable for the 2011 Pricer.     02550001
025600 01  A-49-CENT-PART-D-DRUG-ADJ      PIC 9(01)V9(02) VALUE 0.49.   02560001
025700                                                                  02570001
025800 01  HEMO-PERI-CCPD-AMT             PIC 9(02)       VALUE 20.     02580001
025900 01  CAPD-AMT                       PIC 9(02)       VALUE 12.     02590001
026000 01  CAPD-OR-CCPD-FACTOR            PIC 9(01)V9(06) VALUE         02600001
026100                                                         0.428571.02610001
026200* The above number technically represents the fractional          02620001
026300* number 3/7 which is three days per week that a person can       02630001
026400* receive dialysis.  It will remain this value ONLY for the       02640001
026500* COMPOSITe side of the Bundled Pricer.  The Bundled portion will 02650001
026600* use the calculation method which is more understandable and     02660001
026700* follows the method used by the Policy folks.                    02670001
026800                                                                  02680001
026900*  The following number that is loaded into the payment equation  02690001
027000*  is meant to BUDGET NEUTRALIZE changes in THE CASE MIX INDEX    02700001
027100*  and   --DOES NOT CHANGE--                                      02710001
027200                                                                  02720001
027300 01  CASE-MIX-BDGT-NEUT-FACTOR      PIC 9(01)V9(04) VALUE 0.9116. 02730001
027400                                                                  02740001
027500 01  COMPOSITE-RATE-MULTIPLIERS.                                  02750001
027600*Composite rate payment multiplier (used for blended providers)   02760001
027700     05  CR-AGE-LT-18           PIC 9(01)V9(03) VALUE 1.620.      02770001
027800     05  CR-AGE-18-44           PIC 9(01)V9(03) VALUE 1.223.      02780001
027900     05  CR-AGE-45-59           PIC 9(01)V9(03) VALUE 1.055.      02790001
028000     05  CR-AGE-60-69           PIC 9(01)V9(03) VALUE 1.000.      02800001
028100     05  CR-AGE-70-79           PIC 9(01)V9(03) VALUE 1.094.      02810001
028200     05  CR-AGE-80-PLUS         PIC 9(01)V9(03) VALUE 1.174.      02820001
028300                                                                  02830001
028400     05  CR-BSA                 PIC 9(01)V9(03) VALUE 1.037.      02840001
028500     05  CR-BMI-LT-18-5         PIC 9(01)V9(03) VALUE 1.112.      02850001
028600/                                                                 02860001
028700******************************************************************02870001
028800*    This area contains all of the NEW Bundled Rate variables.   *02880001
028900******************************************************************02890001
029000 01  HOLD-BUNDLED-PPS-COMPONENTS.                                 02900001
029100     05  H-BUN-NAT-LABOR-AMT        PIC 9(04)V9(02).              02910001
029200     05  H-BUN-NAT-NONLABOR-AMT     PIC 9(04)V9(02).              02920001
029300     05  H-BUN-BASE-WAGE-AMT        PIC 9(04)V9(04).              02930001
029400     05  H-BUN-AGE-FACTOR           PIC 9(01)V9(03).              02940001
029500     05  H-BUN-BSA                  PIC 9(03)V9(04).              02950001
029600     05  H-BUN-BSA-FACTOR           PIC 9(01)V9(04).              02960001
029700     05  H-BUN-BMI                  PIC 9(03)V9(04).              02970001
029800     05  H-BUN-BMI-FACTOR           PIC 9(01)V9(04).              02980001
029900     05  H-BUN-ONSET-FACTOR         PIC 9(01)V9(04).              02990001
030000     05  H-BUN-COMORBID-MULTIPLIER  PIC 9(01)V9(03).              03000001
030100     05  H-BUN-ADJUSTED-BASE-WAGE-AMT                             03010001
030200                                    PIC 9(07)V9(04).              03020001
030300     05  H-BUN-WAGE-ADJ-TRAINING-AMT                              03030001
030400                                    PIC 9(07)V9(04).              03040001
030500     05  H-CC-74-PER-DIEM-AMT       PIC 9(07)V9(04).              03050001
030600     05  H-HEMO-EQUIV-DIAL-SESSIONS PIC 9(07)V9(04).              03060001
030700     05  H-PPS-FINAL-PAY-AMT        PIC 9(07)V9(02).              03070001
030800     05  H-FULL-CLAIM-AMT           PIC 9(07)V9(02).              03080001
030900     05  H-LV-BUN-ADJUST-BASE-WAGE-AMT                            03090001
031000                                    PIC 9(07)V9(04).              03100001
031100     05  H-LV-PPS-FINAL-PAY-AMT     PIC 9(07)V9(04).              03110001
031200     05  H-LV-OUT-PREDICT-SERVICES-MAP                            03120001
031300                                    PIC 9(07)V9(04).              03130001
031400     05  H-LV-OUT-CM-ADJ-PREDICT-M-TRT                            03140001
031500                                    PIC 9(07)V9(04).              03150001
031600     05  H-LV-OUT-PREDICTED-MAP                                   03160001
031700                                    PIC 9(07)V9(04).              03170001
031800     05  H-LV-OUT-PAYMENT           PIC 9(07)V9(04).              03180001
031900                                                                  03190001
032000     05  H-COMORBID-MULTIPLIER      PIC 9(01)V9(03).              03200001
032100     05  IS-HIGH-COMORBID-FOUND     PIC X(01).                    03210001
032200         88  HIGH-COMORBID-FOUND               VALUE 'Y'.         03220001
032300                                                                  03230001
032400     05  H-COMORBID-DATA  OCCURS 6 TIMES                          03240001
032500            INDEXED BY H-COMORBID-INDEX                           03250001
032600                                    PIC X(02).                    03260001
032700     05  H-COMORBID-CWF-CODE        PIC X(02).                    03270001
032800                                                                  03280001
032900     05  H-BUN-LOW-VOL-MULTIPLIER   PIC 9(01)V9(03).              03290001
033000                                                                  03300001
033100     05  QIP-REDUCTION              PIC 9(01)V9(03).              03310001
033200     05  SUB                        PIC 9(04).                    03320001
033300                                                                  03330001
033400     05  THE-DATE                   PIC 9(08).                    03340001
033500     05  INTEGER-LINE-ITEM-DATE     PIC S9(09).                   03350001
033600     05  INTEGER-DIALYSIS-DATE      PIC S9(09).                   03360001
033700     05  ONSET-DATE                 PIC 9(08).                    03370001
033800     05  MOVED-CORMORBIDS           PIC X(01).                    03380001
033900                                                                  03390001
034000 01  HOLD-OUTLIER-PPS-COMPONENTS.                                 03400001
034100     05  H-OUT-AGE-FACTOR           PIC 9(01)V9(03).              03410001
034200     05  H-OUT-BSA                  PIC 9(03)V9(04).              03420001
034300     05  H-OUT-BSA-FACTOR           PIC 9(01)V9(04).              03430001
034400     05  H-OUT-BMI                  PIC 9(03)V9(04).              03440001
034500     05  H-OUT-BMI-FACTOR           PIC 9(01)V9(04).              03450001
034600     05  H-OUT-ONSET-FACTOR         PIC 9(01)V9(04).              03460001
034700     05  H-OUT-COMORBID-MULTIPLIER  PIC 9(01)V9(03).              03470001
034800     05  H-OUT-LOW-VOL-MULTIPLIER   PIC 9(01)V9(03).              03480001
034900     05  H-OUT-ADJ-AVG-MAP-AMT      PIC 9(03)V9(02).              03490001
035000     05  H-OUT-FIX-DOLLAR-LOSS      PIC 9(04)V9(02).              03500001
035100     05  H-OUT-LOSS-SHARING-PCT     PIC 9(01)V9(02).              03510001
035200     05  H-OUT-PREDICTED-SERVICES-MAP                             03520001
035300                                    PIC 9(07)V9(04).              03530001
035400     05  H-OUT-IMPUTED-MAP          PIC 9(07)V9(04).              03540001
035500     05  H-OUT-CM-ADJ-PREDICT-MAP-TRT                             03550001
035600                                    PIC 9(07)V9(04).              03560001
035700     05  H-OUT-PREDICTED-MAP        PIC 9(07)V9(04).              03570001
035800     05  H-OUT-PAYMENT              PIC 9(07)V9(04).              03580001
035900     05  H-OUT-HEMO-EQUIV-PAYMENT   PIC 9(07)V9(04).              03590001
036000                                                                  03600001
036100                                                                  03610001
036200* The following variable will change from year to year and is     03620001
036300* used for the BUNDLED part of the Bundled Pricer.                03630001
036400 01  BUNDLED-BASE-PMT-RATE          PIC 9(04)V9(02) VALUE 240.36. 03640004
036500                                                                  03650001
036600* The next two percentages MUST add up to 1 (i.e. 100%)           03660001
036700* They start in 2011 and will continue to change until CY2014 when03670001
036800* BUN-CBSA-BLEND-PCT will be 1.00                                 03680001
036900* The third blend percent is for those providers that waived the  03690001
037000* blended percent and went to full PPS.  This variable will be    03700001
037100* eliminated in 2014 when it is no longer needed.                 03710001
037200 01  COM-CBSA-BLEND-PCT             PIC 9(01)V9(02) VALUE 0.25.   03720004
037300 01  BUN-CBSA-BLEND-PCT             PIC 9(01)V9(02) VALUE 0.75.   03730004
037400 01  WAIVE-CBSA-BLEND-PCT           PIC 9(01)V9(02) VALUE 1.00.   03740001
037500                                                                  03750001
037600* CONSTANTS AREA                                                  03760001
037700* The next two percentages MUST add up TO 1 (i.e. 100%)           03770001
037800 01  BUN-NAT-LABOR-PCT              PIC 9(01)V9(05) VALUE 0.41737.03780001
037900 01  BUN-NAT-NONLABOR-PCT           PIC 9(01)V9(05) VALUE 0.58263.03790001
038000 01  TRAINING-ADD-ON-PMT-AMT        PIC 9(02)V9(02) VALUE 33.44.  03800001
038100                                                                  03810001
038200*  The following number that is loaded into the payment equation  03820001
038300*  is meant to BUDGET NEUTRALIZE changes in the bundled case-mix  03830001
038400*  and   --DOES NOT CHANGE--                                      03840001
038500                                                                  03850001
038600 01  TRANSITION-BDGT-NEUT-FACTOR    PIC 9(01)V9(04) VALUE 0.9690. 03860001
038700                                                                  03870001
038800 01  PEDIATRIC-MULTIPLIERS.                                       03880001
038900*Separately billable payment multiplier (used for outliers)       03890001
039000     05  PED-SEP-BILL-PAY-MULTI.                                  03900001
039100         10  SB-AGE-LT-13-PD-MODE   PIC 9(01)V9(03) VALUE 0.319.  03910001
039200         10  SB-AGE-LT-13-HEMO-MODE PIC 9(01)V9(03) VALUE 1.185.  03920001
039300         10  SB-AGE-13-17-PD-MODE   PIC 9(01)V9(03) VALUE 0.476.  03930001
039400         10  SB-AGE-13-17-HEMO-MODE PIC 9(01)V9(03) VALUE 1.459.  03940001
039500     05  PED-EXPAND-BUNDLE-PAY-MULTI.                             03950001
039600*Expanded bundle payment multiplier (used for normal billing)     03960001
039700         10  EB-AGE-LT-13-PD-MODE   PIC 9(01)V9(03) VALUE 1.033.  03970001
039800         10  EB-AGE-LT-13-HEMO-MODE PIC 9(01)V9(03) VALUE 1.219.  03980001
039900         10  EB-AGE-13-17-PD-MODE   PIC 9(01)V9(03) VALUE 1.067.  03990001
040000         10  EB-AGE-13-17-HEMO-MODE PIC 9(01)V9(03) VALUE 1.277.  04000001
040100                                                                  04010001
040200 01  ADULT-MULTIPLIERS.                                           04020001
040300*Separately billable payment multiplier (used for outliers)       04030001
040400     05  SEP-BILLABLE-PAYMANT-MULTI.                              04040001
040500         10  SB-AGE-18-44           PIC 9(01)V9(03) VALUE 0.996.  04050001
040600         10  SB-AGE-45-59           PIC 9(01)V9(03) VALUE 0.992.  04060001
040700         10  SB-AGE-60-69           PIC 9(01)V9(03) VALUE 1.000.  04070001
040800         10  SB-AGE-70-79           PIC 9(01)V9(03) VALUE 0.963.  04080001
040900         10  SB-AGE-80-PLUS         PIC 9(01)V9(03) VALUE 0.915.  04090001
041000         10  SB-BSA                 PIC 9(01)V9(03) VALUE 1.014.  04100001
041100         10  SB-BMI-LT-18-5         PIC 9(01)V9(03) VALUE 1.078.  04110001
041200         10  SB-ONSET-LE-120        PIC 9(01)V9(03) VALUE 1.450.  04120001
041300         10  SB-PERICARDITIS        PIC 9(01)V9(03) VALUE 1.354.  04130001
041400         10  SB-PNEUMONIA           PIC 9(01)V9(03) VALUE 1.422.  04140001
041500         10  SB-GI-BLEED            PIC 9(01)V9(03) VALUE 1.571.  04150001
041600         10  SB-SICKEL-CELL         PIC 9(01)V9(03) VALUE 1.225.  04160001
041700         10  SB-MYELODYSPLASTIC     PIC 9(01)V9(03) VALUE 1.309.  04170001
041800         10  SB-MONOCLONAL-GAMM     PIC 9(01)V9(03) VALUE 1.074.  04180001
041900         10  SB-LOW-VOL-ADJ-LT-4000 PIC 9(01)V9(03) VALUE 0.975.  04190001
042000*Case-Mix adjusted payment multiplier (used for normal billing)   04200001
042100     05  CASE-MIX-PAYMENT-MULTI.                                  04210001
042200         10  CM-AGE-18-44           PIC 9(01)V9(03) VALUE 1.171.  04220001
042300         10  CM-AGE-45-59           PIC 9(01)V9(03) VALUE 1.013.  04230001
042400         10  CM-AGE-60-69           PIC 9(01)V9(03) VALUE 1.000.  04240001
042500         10  CM-AGE-70-79           PIC 9(01)V9(03) VALUE 1.011.  04250001
042600         10  CM-AGE-80-PLUS         PIC 9(01)V9(03) VALUE 1.016.  04260001
042700         10  CM-BSA                 PIC 9(01)V9(03) VALUE 1.020.  04270001
042800         10  CM-BMI-LT-18-5         PIC 9(01)V9(03) VALUE 1.025.  04280001
042900         10  CM-ONSET-LE-120        PIC 9(01)V9(03) VALUE 1.510.  04290001
043000         10  CM-PERICARDITIS        PIC 9(01)V9(03) VALUE 1.114.  04300001
043100         10  CM-PNEUMONIA           PIC 9(01)V9(03) VALUE 1.135.  04310001
043200         10  CM-GI-BLEED            PIC 9(01)V9(03) VALUE 1.183.  04320001
043300         10  CM-SICKEL-CELL         PIC 9(01)V9(03) VALUE 1.072.  04330001
043400         10  CM-MYELODYSPLASTIC     PIC 9(01)V9(03) VALUE 1.099.  04340001
043500         10  CM-MONOCLONAL-GAMM     PIC 9(01)V9(03) VALUE 1.024.  04350001
043600         10  CM-LOW-VOL-ADJ-LT-4000 PIC 9(01)V9(03) VALUE 1.189.  04360001
043700                                                                  04370001
043800 01  OUTLIER-SB-CALC-AMOUNTS.                                     04380001
043900     05  ADJ-AVG-MAP-AMT-LT-18      PIC 9(04)V9(02) VALUE 41.39.  04390004
044000     05  ADJ-AVG-MAP-AMT-GT-17      PIC 9(04)V9(02) VALUE 59.42.  04400005
044100     05  FIX-DOLLAR-LOSS-LT-18      PIC 9(04)V9(02) VALUE 47.32.  04410004
044200     05  FIX-DOLLAR-LOSS-GT-17      PIC 9(04)V9(02) VALUE 110.22. 04420004
044300     05  LOSS-SHARING-PCT-LT-18     PIC 9(03)V9(02) VALUE 0.80.   04430001
044400     05  LOSS-SHARING-PCT-GT-17     PIC 9(03)V9(02) VALUE 0.80.   04440001
044500/                                                                 04450001
044600******************************************************************04460001
044700*    This area contains return code variables and their codes.   *04470001
044800******************************************************************04480001
044900 01 PAID-RETURN-CODE-TRACKERS.                                    04490001
045000     05  OUTLIER-TRACK              PIC X(01).                    04500001
045100     05  ACUTE-COMORBID-TRACK       PIC X(01).                    04510001
045200     05  CHRONIC-COMORBID-TRACK     PIC X(01).                    04520001
045300     05  ONSET-TRACK                PIC X(01).                    04530001
045400     05  LOW-VOLUME-TRACK           PIC X(01).                    04540001
045500     05  TRAINING-TRACK             PIC X(01).                    04550001
045600     05  PEDIATRIC-TRACK            PIC X(01).                    04560001
045700     05  LOW-BMI-TRACK              PIC X(01).                    04570001
045800 COPY RTCCPY.                                                     04580001
045900*COPY "RTCCPY.CPY".                                               04590001
046000*                                                                *04600001
046100*  Legal combinations of adjustments for ADULTS are:             *04610001
046200*     if NO ONSET applies, then they can have any combination of:*04620001
046300*       acute OR chronic comorbid, & outlier, low vol., training.*04630001
046400*     if ONSET applies, then they can have:                      *04640001
046500*           outlier and/or low volume.                           *04650001
046600*  Legal combinations of adjustments for PEDIATRIC are:          *04660001
046700*     outlier and/or training.                                   *04670001
046800*                                                                *04680001
046900*  Illegal combinations of adjustments for PEDIATRIC are:        *04690001
047000*     pediatric with comorbid, onset, low volume, BSA, or BMI.   *04700001
047100*     onset     with comorbid or training.                       *04710001
047200*  Illegal combinations of adjustments for ANYONE are:           *04720001
047300*     acute comorbid AND chronic comorbid.                       *04730001
047400/                                                                 04740001
047500 LINKAGE SECTION.                                                 04750001
047600 COPY BILLCPY.                                                    04760001
047700*COPY "BILLCPY.CPY".                                              04770001
047800/                                                                 04780001
047900 COPY WAGECPY.                                                    04790001
048000*COPY "WAGECPY.CPY".                                              04800001
048100/                                                                 04810001
048200 PROCEDURE DIVISION  USING BILL-NEW-DATA                          04820001
048300                           PPS-DATA-ALL                           04830001
048400                           WAGE-NEW-RATE-RECORD                   04840001
048500                           COM-CBSA-WAGE-RECORD                   04850001
048600                           BUN-CBSA-WAGE-RECORD.                  04860001
048700                                                                  04870001
048800******************************************************************04880001
048900* THERE ARE VARIOUS WAYS TO COMPUTE A FINAL DOLLAR AMOUNT.  THE  *04890001
049000* METHOD USED IN THIS PROGRAM IS TO USE ROUNDED INTERMEDIATE     *04900001
049100* VARIABLES.  THIS WAS DONE TO SIMPLIFY THE CALCULATIONS SO THAT *04910001
049200* WHEN SOMETHING GOES AWRY, ONE IS NOT LEFT WONDERING WHERE IN   *04920001
049300* A VAST COMPUTE STATEMENT, THINGS HAVE GONE AWRY.  THE METHOD   *04930001
049400* UTILIZED HERE HAS BEEN APPROVED BY WIL GEHNE AND JOEY BRYSON   *04940001
049500* BOTH OF WHOM WORK IN THE DIVISION OF INSTITUTIONAL CLAIMS      *04950001
049600* PROCESSING (DICP).                                             *04960001
049700*                                                                *04970001
049800*                                                                *04980001
049900*    PROCESSING:                                                 *04990001
050000*        A. WILL PROCESS CLAIMS BASED ON AGE/HEIGHT/WEIGHT       *05000001
050100*        B. INITIALIZE ESCAL HOLD VARIABLES.                     *05010001
050200*        C. EDIT THE DATA PASSED FROM THE CLAIM BEFORE           *05020001
050300*           ATTEMPTING TO CALCULATE PPS. IF THIS CLAIM           *05030001
050400*           CANNOT BE PROCESSED, SET A RETURN CODE AND           *05040001
050500*           GOBACK.                                              *05050001
050600*        D. ASSEMBLE PRICING COMPONENTS.                         *05060001
050700*        E. CALCULATE THE PRICE.                                 *05070001
050800******************************************************************05080001
050900                                                                  05090001
051000 0000-START-TO-FINISH.                                            05100001
051100     INITIALIZE PPS-DATA-ALL.                                     05110001
051200                                                                  05120001
051300     IF BUNDLED-TEST  THEN                                        05130001
051400        INITIALIZE BILL-DATA-TEST                                 05140001
051500        INITIALIZE COND-CD-73                                     05150001
051600     END-IF.                                                      05160001
051700     MOVE CAL-VERSION                  TO PPS-CALC-VERS-CD.       05170001
051800     MOVE ZEROS                        TO PPS-RTC.                05180001
051900                                                                  05190001
052000     PERFORM 1000-VALIDATE-BILL-ELEMENTS.                         05200001
052100                                                                  05210001
052200     IF PPS-RTC = 00  THEN                                        05220001
052300        PERFORM 1200-INITIALIZATION                               05230001
052400**Calculate patient age                                           05240001
052500        COMPUTE H-PATIENT-AGE = B-THRU-CCYY - B-DOB-CCYY          05250001
052600        IF B-DOB-MM > B-THRU-MM  THEN                             05260001
052700           COMPUTE H-PATIENT-AGE = H-PATIENT-AGE - 1              05270001
052800        END-IF                                                    05280001
052900        IF H-PATIENT-AGE < 18  THEN                               05290001
053000           MOVE "Y"                    TO PEDIATRIC-TRACK         05300001
053100        END-IF                                                    05310001
053200        PERFORM 2000-CALCULATE-BUNDLED-FACTORS                    05320001
053300        IF P-PROV-WAIVE-BLEND-PAY-INDIC = 'N'  THEN               05330001
053400           PERFORM 5000-CALC-COMP-RATE-FACTORS                    05340001
053500        END-IF                                                    05350001
053600        PERFORM 9000-SET-RETURN-CODE                              05360001
053700        PERFORM 9100-MOVE-RESULTS                                 05370001
053800     END-IF.                                                      05380001
053900                                                                  05390001
054000     GOBACK.                                                      05400001
054100/                                                                 05410001
054200 1000-VALIDATE-BILL-ELEMENTS.                                     05420001
054300     IF P-PROV-TYPE = '40'  OR  '41' OR '05'  THEN                05430001
054400        NEXT SENTENCE                                             05440001
054500     ELSE                                                         05450001
054600        MOVE 52                        TO PPS-RTC                 05460001
054700     END-IF.                                                      05470001
054800                                                                  05480001
054900     IF PPS-RTC = 00  THEN                                        05490001
055000        IF P-SPEC-PYMT-IND NOT = '1' AND ' '  THEN                05500001
055100           MOVE 53                     TO PPS-RTC                 05510001
055200        END-IF                                                    05520001
055300     END-IF.                                                      05530001
055400                                                                  05540001
055500     IF PPS-RTC = 00  THEN                                        05550001
055600        IF (B-DOB-DATE = ZERO)  OR  (B-DOB-DATE NOT NUMERIC)  THEN05560001
055700           MOVE 54                     TO PPS-RTC                 05570001
055800        END-IF                                                    05580001
055900     END-IF.                                                      05590001
056000                                                                  05600001
056100     IF PPS-RTC = 00  THEN                                        05610001
056200        IF (B-PATIENT-WGT = 0)  OR  (B-PATIENT-WGT NOT NUMERIC)   05620001
056300           MOVE 55                     TO PPS-RTC                 05630001
056400        END-IF                                                    05640001
056500     END-IF.                                                      05650001
056600                                                                  05660001
056700     IF PPS-RTC = 00  THEN                                        05670001
056800        IF (B-PATIENT-HGT = 0)  OR  (B-PATIENT-HGT NOT NUMERIC)   05680001
056900           MOVE 56                     TO PPS-RTC                 05690001
057000        END-IF                                                    05700001
057100     END-IF.                                                      05710001
057200                                                                  05720001
057300     IF PPS-RTC = 00  THEN                                        05730001
057400        IF B-REV-CODE  = '0821' OR '0831' OR '0841' OR '0851'     05740001
057500                                OR '0881'                         05750001
057600           NEXT SENTENCE                                          05760001
057700        ELSE                                                      05770001
057800           MOVE 57                     TO PPS-RTC                 05780001
057900        END-IF                                                    05790001
058000     END-IF.                                                      05800001
058100                                                                  05810001
058200     IF PPS-RTC = 00  THEN                                        05820001
058300        IF B-COND-CODE NOT = '73' AND '74' AND '  '               05830001
058400           MOVE 58                     TO PPS-RTC                 05840001
058500        END-IF                                                    05850001
058600     END-IF.                                                      05860001
058700                                                                  05870001
058800     IF PPS-RTC = 00  THEN                                        05880001
058900        IF P-QIP-REDUCTION NOT = '1' AND '2' AND '3' AND '4' AND  05890001
059000                                 ' '  THEN                        05900001
059100           MOVE 53                     TO PPS-RTC                 05910001
059200*  This RTC is for the Special Payment Indicator not = '1' or     05920001
059300*  blank, which closely approximates the intent of the edit check.05930001
059400*  I propose to make this a PPS-RTC = 59 in 2013 version of Pricer05940001
059500        END-IF                                                    05950001
059600     END-IF.                                                      05960001
059700                                                                  05970001
059800     IF PPS-RTC = 00  THEN                                        05980001
059900        IF B-PATIENT-HGT > 300.00                                 05990001
060000           MOVE 71                     TO PPS-RTC                 06000001
060100        END-IF                                                    06010001
060200     END-IF.                                                      06020001
060300                                                                  06030001
060400     IF PPS-RTC = 00  THEN                                        06040001
060500        IF B-PATIENT-WGT > 500.00  THEN                           06050001
060600           MOVE 72                     TO PPS-RTC                 06060001
060700        END-IF                                                    06070001
060800     END-IF.                                                      06080001
060900                                                                  06090001
061000* Before 2012 pricer, put in edit check to make sure that the     06100001
061100* # of sesions does not exceed the # of days in a month.  Maybe   06110001
061200* the # of cays in a month minus one when patient goes into a     06120001
061300* dialysis center for dialysis (i.e. CC = 74 and rev-cd = (0841   06130001
061400* or 0851)).  If done, then will need extra RTC.                  06140001
061500     IF PPS-RTC = 00  THEN                                        06150001
061600        IF (B-CLAIM-NUM-DIALYSIS-SESSIONS = ZERO) OR              06160001
061700           (B-CLAIM-NUM-DIALYSIS-SESSIONS NOT NUMERIC)  THEN      06170001
061800           MOVE 73                     TO PPS-RTC                 06180001
061900        END-IF                                                    06190001
062000     END-IF.                                                      06200001
062100                                                                  06210001
062200     IF PPS-RTC = 00  THEN                                        06220001
062300        IF (B-LINE-ITEM-DATE-SERVICE = ZERO) OR                   06230001
062400           (B-LINE-ITEM-DATE-SERVICE NOT NUMERIC)  THEN           06240001
062500           MOVE 74                     TO PPS-RTC                 06250001
062600        END-IF                                                    06260001
062700     END-IF.                                                      06270001
062800                                                                  06280001
062900     IF PPS-RTC = 00  THEN                                        06290001
063000        IF (B-DIALYSIS-START-DATE NOT NUMERIC)  THEN              06300001
063100           MOVE 75                     TO PPS-RTC                 06310001
063200        END-IF                                                    06320001
063300     END-IF.                                                      06330001
063400                                                                  06340001
063500     IF PPS-RTC = 00  THEN                                        06350001
063600        IF (B-TOT-PRICE-SB-OUTLIER NOT NUMERIC) THEN              06360001
063700           MOVE 76                     TO PPS-RTC                 06370001
063800        END-IF                                                    06380001
063900     END-IF.                                                      06390001
064000                                                                  06400001
064100     IF PPS-RTC = 00  THEN                                        06410001
064200        IF (COMORBID-CWF-RETURN-CODE = SPACES) OR                 06420001
064300            VALID-COMORBID-CWF-RETURN-CD       THEN               06430001
064400           NEXT SENTENCE                                          06440001
064500        ELSE                                                      06450001
064600           MOVE 81                     TO PPS-RTC                 06460001
064700        END-IF                                                    06470001
064800     END-IF.                                                      06480001
064900/                                                                 06490001
065000 1200-INITIALIZATION.                                             06500001
065100     INITIALIZE HOLD-COMP-RATE-PPS-COMPONENTS.                    06510001
065200     INITIALIZE HOLD-BUNDLED-PPS-COMPONENTS.                      06520001
065300     INITIALIZE HOLD-OUTLIER-PPS-COMPONENTS.                      06530001
065400     INITIALIZE PAID-RETURN-CODE-TRACKERS.                        06540001
065500                                                                  06550001
065600     MOVE SPACES                       TO MOVED-CORMORBIDS.       06560001
065700                                                                  06570001
065800     IF P-QIP-REDUCTION = ' '  THEN                               06580001
065900* no reduction                                                    06590001
066000        MOVE 1.000 TO QIP-REDUCTION                               06600001
066100     ELSE                                                         06610001
066200        IF P-QIP-REDUCTION = '1'  THEN                            06620001
066300* one-half percent reduction                                      06630001
066400           MOVE 0.995 TO QIP-REDUCTION                            06640001
066500        ELSE                                                      06650001
066600           IF P-QIP-REDUCTION = '2'  THEN                         06660001
066700* one percent reduction                                           06670001
066800              MOVE 0.990 TO QIP-REDUCTION                         06680001
066900           ELSE                                                   06690001
067000              IF P-QIP-REDUCTION = '3'  THEN                      06700001
067100* one and one-half percent reduction                              06710001
067200                 MOVE 0.985 TO QIP-REDUCTION                      06720001
067300              ELSE                                                06730001
067400* two percent reduction                                           06740001
067500                 MOVE 0.980 TO QIP-REDUCTION                      06750001
067600              END-IF                                              06760001
067700           END-IF                                                 06770001
067800        END-IF                                                    06780001
067900     END-IF.                                                      06790001
068000                                                                  06800001
068100*    Since pricer has to pay a comorbid condition according to the06810001
068200* return code that CWF passes back, it is cleaner if the pricer   06820001
068300* sets aside whatever comorbid data exists on the line-item when  06830001
068400* it comes into the pricer and then transferrs the CWF code to    06840001
068500* the appropriate place in the comorbid data.  This avoids        06850001
068600* making convoluted changes in the other parts of the program     06860001
068700* which has to look at both original comorbid data AND CWF return 06870001
068800* codes to handle comorbids.  Near the end of the program where   06880001
068900* variables are transferred to the output, the original comorbid  06890001
069000* data is put back into its original place as though nothing      06900001
069100* occurred.                                                       06910001
069200     IF COMORBID-CWF-RETURN-CODE = SPACES  THEN                   06920001
069300        NEXT SENTENCE                                             06930001
069400     ELSE                                                         06940001
069500        MOVE 'Y'                       TO MOVED-CORMORBIDS        06950001
069600        MOVE COMORBID-DATA (1)         TO H-COMORBID-DATA (1)     06960001
069700        MOVE COMORBID-DATA (2)         TO H-COMORBID-DATA (2)     06970001
069800        MOVE COMORBID-DATA (3)         TO H-COMORBID-DATA (3)     06980001
069900        MOVE COMORBID-DATA (4)         TO H-COMORBID-DATA (4)     06990001
070000        MOVE COMORBID-DATA (5)         TO H-COMORBID-DATA (5)     07000001
070100        MOVE COMORBID-DATA (6)         TO H-COMORBID-DATA (6)     07010001
070200        MOVE COMORBID-CWF-RETURN-CODE  TO H-COMORBID-CWF-CODE     07020001
070300        IF COMORBID-CWF-RETURN-CODE = '10'  THEN                  07030001
070400           MOVE SPACES                 TO COMORBID-DATA (1)       07040001
070500                                          COMORBID-DATA (2)       07050001
070600                                          COMORBID-DATA (3)       07060001
070700                                          COMORBID-DATA (4)       07070001
070800                                          COMORBID-DATA (5)       07080001
070900                                          COMORBID-DATA (6)       07090001
071000                                          COMORBID-CWF-RETURN-CODE07100001
071100        ELSE                                                      07110001
071200           IF COMORBID-CWF-RETURN-CODE = '20'  THEN               07120001
071300              MOVE 'MA'                TO COMORBID-DATA (1)       07130001
071400              MOVE SPACES              TO COMORBID-DATA (2)       07140001
071500                                          COMORBID-DATA (3)       07150001
071600                                          COMORBID-DATA (4)       07160001
071700                                          COMORBID-DATA (5)       07170001
071800                                          COMORBID-DATA (6)       07180001
071900                                          COMORBID-CWF-RETURN-CODE07190001
072000           ELSE                                                   07200001
072100              IF COMORBID-CWF-RETURN-CODE = '30'  THEN            07210001
072200                 MOVE SPACES           TO COMORBID-DATA (1)       07220001
072300                 MOVE 'MB'             TO COMORBID-DATA (2)       07230001
072400                 MOVE SPACES           TO COMORBID-DATA (3)       07240001
072500                 MOVE SPACES           TO COMORBID-DATA (4)       07250001
072600                 MOVE SPACES           TO COMORBID-DATA (5)       07260001
072700                 MOVE SPACES           TO COMORBID-DATA (6)       07270001
072800                                          COMORBID-CWF-RETURN-CODE07280001
072900              ELSE                                                07290001
073000                 IF COMORBID-CWF-RETURN-CODE = '40'  THEN         07300001
073100                    MOVE SPACES        TO COMORBID-DATA (1)       07310001
073200                    MOVE SPACES        TO COMORBID-DATA (2)       07320001
073300                    MOVE 'MC'          TO COMORBID-DATA (3)       07330001
073400                    MOVE SPACES        TO COMORBID-DATA (4)       07340001
073500                    MOVE SPACES        TO COMORBID-DATA (5)       07350001
073600                    MOVE SPACES        TO COMORBID-DATA (6)       07360001
073700                                          COMORBID-CWF-RETURN-CODE07370001
073800                 ELSE                                             07380001
073900                    IF COMORBID-CWF-RETURN-CODE = '50'  THEN      07390001
074000                       MOVE SPACES     TO COMORBID-DATA (1)       07400001
074100                       MOVE SPACES     TO COMORBID-DATA (2)       07410001
074200                       MOVE SPACES     TO COMORBID-DATA (3)       07420001
074300                       MOVE 'MD'       TO COMORBID-DATA (4)       07430001
074400                       MOVE SPACES     TO COMORBID-DATA (5)       07440001
074500                       MOVE SPACES     TO COMORBID-DATA (6)       07450001
074600                                          COMORBID-CWF-RETURN-CODE07460001
074700                    ELSE                                          07470001
074800                       IF COMORBID-CWF-RETURN-CODE = '60'  THEN   07480001
074900                          MOVE SPACES  TO COMORBID-DATA (1)       07490001
075000                          MOVE SPACES  TO COMORBID-DATA (2)       07500001
075100                          MOVE SPACES  TO COMORBID-DATA (3)       07510001
075200                          MOVE SPACES  TO COMORBID-DATA (4)       07520001
075300                          MOVE 'ME'    TO COMORBID-DATA (5)       07530001
075400                          MOVE SPACES  TO COMORBID-DATA (6)       07540001
075500                                          COMORBID-CWF-RETURN-CODE07550001
075600                       ELSE                                       07560001
075700                          MOVE SPACES  TO COMORBID-DATA (1)       07570001
075800                                          COMORBID-DATA (2)       07580001
075900                                          COMORBID-DATA (3)       07590001
076000                                          COMORBID-DATA (4)       07600001
076100                                          COMORBID-DATA (5)       07610001
076200                                          COMORBID-CWF-RETURN-CODE07620001
076300                          MOVE 'MF'    TO COMORBID-DATA (6)       07630001
076400                       END-IF                                     07640001
076500                    END-IF                                        07650001
076600                 END-IF                                           07660001
076700              END-IF                                              07670001
076800           END-IF                                                 07680001
076900        END-IF                                                    07690001
077000     END-IF.                                                      07700001
077100                                                                  07710001
077200******************************************************************07720001
077300***Calculate BUNDLED Wage Adjusted Rate (note different method)***07730001
077400******************************************************************07740001
077500     COMPUTE H-BUN-NAT-LABOR-AMT ROUNDED =                        07750001
077600        (BUNDLED-BASE-PMT-RATE * BUN-NAT-LABOR-PCT) *             07760001
077700         BUN-CBSA-W-INDEX.                                        07770001
077800                                                                  07780001
077900     COMPUTE H-BUN-NAT-NONLABOR-AMT ROUNDED =                     07790001
078000        BUNDLED-BASE-PMT-RATE * BUN-NAT-NONLABOR-PCT              07800001
078100                                                                  07810001
078200     COMPUTE H-BUN-BASE-WAGE-AMT ROUNDED =                        07820001
078300        H-BUN-NAT-LABOR-AMT + H-BUN-NAT-NONLABOR-AMT.             07830001
078400/                                                                 07840001
078500 2000-CALCULATE-BUNDLED-FACTORS.                                  07850001
078600******************************************************************07860001
078700***  Set BUNDLED age adjustment factor                         ***07870001
078800******************************************************************07880001
078900     IF H-PATIENT-AGE < 13  THEN                                  07890001
079000        IF B-REV-CODE = '0821' OR '0881' THEN                     07900002
079100           MOVE EB-AGE-LT-13-HEMO-MODE TO H-BUN-AGE-FACTOR        07910001
079200        ELSE                                                      07920001
079300           MOVE EB-AGE-LT-13-PD-MODE   TO H-BUN-AGE-FACTOR        07930001
079400        END-IF                                                    07940001
079500     ELSE                                                         07950001
079600        IF H-PATIENT-AGE < 18 THEN                                07960001
079700           IF B-REV-CODE = '0821' OR '0881' THEN                  07970002
079800              MOVE EB-AGE-13-17-HEMO-MODE                         07980001
079900                                       TO H-BUN-AGE-FACTOR        07990001
080000           ELSE                                                   08000001
080100              MOVE EB-AGE-13-17-PD-MODE                           08010001
080200                                       TO H-BUN-AGE-FACTOR        08020001
080300           END-IF                                                 08030001
080400        ELSE                                                      08040001
080500           IF H-PATIENT-AGE < 45  THEN                            08050001
080600              MOVE CM-AGE-18-44        TO H-BUN-AGE-FACTOR        08060001
080700           ELSE                                                   08070001
080800              IF H-PATIENT-AGE < 60  THEN                         08080001
080900                 MOVE CM-AGE-45-59     TO H-BUN-AGE-FACTOR        08090001
081000              ELSE                                                08100001
081100                 IF H-PATIENT-AGE < 70  THEN                      08110001
081200                    MOVE CM-AGE-60-69  TO H-BUN-AGE-FACTOR        08120001
081300                 ELSE                                             08130001
081400                    IF H-PATIENT-AGE < 80  THEN                   08140001
081500                       MOVE CM-AGE-70-79                          08150001
081600                                       TO H-BUN-AGE-FACTOR        08160001
081700                    ELSE                                          08170001
081800                       MOVE CM-AGE-80-PLUS                        08180001
081900                                       TO H-BUN-AGE-FACTOR        08190001
082000                    END-IF                                        08200001
082100                 END-IF                                           08210001
082200              END-IF                                              08220001
082300           END-IF                                                 08230001
082400        END-IF                                                    08240001
082500     END-IF.                                                      08250001
082600                                                                  08260001
082700******************************************************************08270001
082800***  Calculate BUNDLED BSA factor (note NEW formula)           ***08280001
082900******************************************************************08290001
083000     COMPUTE H-BUN-BSA  ROUNDED = (.007184 *                      08300001
083100         (B-PATIENT-HGT ** .725) * (B-PATIENT-WGT ** .425))       08310001
083200                                                                  08320001
083300     IF H-PATIENT-AGE > 17  THEN                                  08330001
083400        COMPUTE H-BUN-BSA-FACTOR  ROUNDED =                       08340001
083500             CM-BSA ** ((H-BUN-BSA - 1.87) / .1)                  08350001
083600     ELSE                                                         08360001
083700        MOVE 1.000                     TO H-BUN-BSA-FACTOR        08370001
083800     END-IF.                                                      08380001
083900                                                                  08390001
084000******************************************************************08400001
084100***  Calculate BUNDLED BMI factor                              ***08410001
084200******************************************************************08420001
084300     COMPUTE H-BUN-BMI  ROUNDED = (B-PATIENT-WGT /                08430001
084400         (B-PATIENT-HGT ** 2)) * 10000.                           08440001
084500                                                                  08450001
084600     IF (H-PATIENT-AGE > 17) AND (H-BUN-BMI < 18.5)  THEN         08460001
084700        MOVE CM-BMI-LT-18-5            TO H-BUN-BMI-FACTOR        08470001
084800        MOVE "Y"                       TO LOW-BMI-TRACK           08480001
084900     ELSE                                                         08490001
085000        MOVE 1.000                     TO H-BUN-BMI-FACTOR        08500001
085100     END-IF.                                                      08510001
085200                                                                  08520001
085300******************************************************************08530001
085400***  Calculate BUNDLED ONSET factor                            ***08540001
085500******************************************************************08550001
085600     IF B-DIALYSIS-START-DATE > ZERO  THEN                        08560001
085700        MOVE B-LINE-ITEM-DATE-SERVICE  TO THE-DATE                08570001
085800        COMPUTE INTEGER-LINE-ITEM-DATE =                          08580001
085900            FUNCTION INTEGER-OF-DATE(THE-DATE)                    08590001
086000        MOVE B-DIALYSIS-START-DATE     TO THE-DATE                08600001
086100        COMPUTE INTEGER-DIALYSIS-DATE  =                          08610001
086200            FUNCTION INTEGER-OF-DATE(THE-DATE)                    08620001
086300* Need to add one to onset-date because the start date should     08630001
086400* be included in the count of days.  fix made 9/6/2011            08640001
086500        COMPUTE ONSET-DATE = (INTEGER-LINE-ITEM-DATE -            08650001
086600                              INTEGER-DIALYSIS-DATE) + 1          08660001
086700        IF H-PATIENT-AGE > 17  THEN                               08670001
086800           IF ONSET-DATE > 120  THEN                              08680001
086900              MOVE 1                   TO H-BUN-ONSET-FACTOR      08690001
087000           ELSE                                                   08700001
087100              MOVE CM-ONSET-LE-120     TO H-BUN-ONSET-FACTOR      08710001
087200              MOVE "Y"                 TO ONSET-TRACK             08720001
087300           END-IF                                                 08730001
087400        ELSE                                                      08740001
087500           MOVE 1                      TO H-BUN-ONSET-FACTOR      08750001
087600        END-IF                                                    08760001
087700     ELSE                                                         08770001
087800        MOVE 1.000                     TO H-BUN-ONSET-FACTOR      08780001
087900     END-IF.                                                      08790001
088000                                                                  08800001
088100******************************************************************08810001
088200***  Set BUNDLED Co-morbidities adjustment                     ***08820001
088300******************************************************************08830001
088400     IF COMORBID-CWF-RETURN-CODE = SPACES  THEN                   08840001
088500        IF H-PATIENT-AGE  <  18  THEN                             08850001
088600           MOVE 1.000                  TO                         08860001
088700                                       H-BUN-COMORBID-MULTIPLIER  08870001
088800           MOVE '10'                   TO PPS-2011-COMORBID-PAY   08880001
088900        ELSE                                                      08890001
089000           IF H-BUN-ONSET-FACTOR  =  CM-ONSET-LE-120  THEN        08900001
089100              MOVE 1.000               TO                         08910001
089200                                       H-BUN-COMORBID-MULTIPLIER  08920001
089300              MOVE '10'                TO PPS-2011-COMORBID-PAY   08930001
089400           ELSE                                                   08940001
089500              PERFORM 2100-CALC-COMORBID-ADJUST                   08950001
089600              MOVE H-COMORBID-MULTIPLIER TO                       08960001
089700                                       H-BUN-COMORBID-MULTIPLIER  08970001
089800           END-IF                                                 08980001
089900        END-IF                                                    08990001
090000     ELSE                                                         09000001
090100        IF COMORBID-CWF-RETURN-CODE  =  '10'  THEN                09010001
090200           MOVE 1.000                  TO                         09020001
090300                                       H-BUN-COMORBID-MULTIPLIER  09030001
090400           MOVE '10'                   TO PPS-2011-COMORBID-PAY   09040001
090500        ELSE                                                      09050001
090600           IF COMORBID-CWF-RETURN-CODE  =  '20'  THEN             09060001
090700              MOVE CM-GI-BLEED         TO                         09070001
090800                                       H-BUN-COMORBID-MULTIPLIER  09080001
090900              MOVE '20'                TO PPS-2011-COMORBID-PAY   09090001
091000           ELSE                                                   09100001
091100              IF COMORBID-CWF-RETURN-CODE  =  '30'  THEN          09110001
091200                 MOVE CM-PNEUMONIA     TO                         09120001
091300                                       H-BUN-COMORBID-MULTIPLIER  09130001
091400                 MOVE '30'             TO PPS-2011-COMORBID-PAY   09140001
091500              ELSE                                                09150001
091600                 IF COMORBID-CWF-RETURN-CODE  =  '40'  THEN       09160001
091700                    MOVE CM-PERICARDITIS TO                       09170001
091800                                       H-BUN-COMORBID-MULTIPLIER  09180001
091900                    MOVE '40'          TO PPS-2011-COMORBID-PAY   09190001
092000                 END-IF                                           09200001
092100              END-IF                                              09210001
092200           END-IF                                                 09220001
092300        END-IF                                                    09230001
092400     END-IF.                                                      09240001
092500                                                                  09250001
092600******************************************************************09260001
092700***  Calculate BUNDLED Low Volume adjustment                   ***09270001
092800******************************************************************09280001
092900     IF P-PROV-LOW-VOLUME-INDIC = 'Y'  THEN                       09290001
093000        IF H-PATIENT-AGE > 17  THEN                               09300001
093100           MOVE CM-LOW-VOL-ADJ-LT-4000 TO                         09310001
093200                                       H-BUN-LOW-VOL-MULTIPLIER   09320001
093300           MOVE "Y"                    TO  LOW-VOLUME-TRACK       09330001
093400        ELSE                                                      09340001
093500           MOVE 1.000                  TO                         09350001
093600                                       H-BUN-LOW-VOL-MULTIPLIER   09360001
093700        END-IF                                                    09370001
093800     ELSE                                                         09380001
093900        MOVE 1.000                     TO                         09390001
094000                                       H-BUN-LOW-VOL-MULTIPLIER   09400001
094100     END-IF.                                                      09410001
094200                                                                  09420001
094300******************************************************************09430001
094400***  Calculate BUNDLED Adjusted PPS Base Rate                  ***09440001
094500******************************************************************09450001
094600     COMPUTE H-BUN-ADJUSTED-BASE-WAGE-AMT  ROUNDED  =             09460001
094700        (H-BUN-BASE-WAGE-AMT * H-BUN-AGE-FACTOR)    *             09470001
094800        (H-BUN-BSA-FACTOR    * H-BUN-BMI-FACTOR)    *             09480001
094900        (H-BUN-ONSET-FACTOR  * H-BUN-COMORBID-MULTIPLIER) *       09490001
095000        (H-BUN-LOW-VOL-MULTIPLIER).                               09500001
095100                                                                  09510001
095200******************************************************************09520001
095300***  Calculate BUNDLED Condition Code payment                  ***09530001
095400******************************************************************09540001
095500* Self-care in Training add-on                                    09550001
095600     IF B-COND-CODE = '73'  THEN                                  09560001
095700* no add-on when onset is present                                 09570001
095800        IF H-BUN-ONSET-FACTOR  =  CM-ONSET-LE-120  THEN           09580001
095900           MOVE ZERO                   TO                         09590001
096000                                    H-BUN-WAGE-ADJ-TRAINING-AMT   09600001
096100        ELSE                                                      09610001
096200* use new PPS training add-on amount times wage-index             09620001
096300           COMPUTE H-BUN-WAGE-ADJ-TRAINING-AMT  ROUNDED  =        09630001
096400             TRAINING-ADD-ON-PMT-AMT * BUN-CBSA-W-INDEX           09640001
096500           MOVE "Y"                    TO TRAINING-TRACK          09650001
096600        END-IF                                                    09660001
096700     ELSE                                                         09670001
096800* Dialysis in Home and (CAPD or CCPD) Per-Diem calculation        09680001
096900        IF (B-COND-CODE = '74')  AND                              09690001
097000           (B-REV-CODE = '0841' OR '0851')  THEN                  09700001
097100              COMPUTE H-CC-74-PER-DIEM-AMT  ROUNDED =             09710001
097200                 (H-BUN-ADJUSTED-BASE-WAGE-AMT * 3) / 7           09720001
097300        ELSE                                                      09730001
097400           MOVE ZERO                   TO                         09740001
097500                                    H-BUN-WAGE-ADJ-TRAINING-AMT   09750001
097600                                    H-CC-74-PER-DIEM-AMT          09760001
097700        END-IF                                                    09770001
097800     END-IF.                                                      09780001
097900                                                                  09790001
098000******************************************************************09800001
098100***  Calculate BUNDLED ESRD PPS Final Payment Rate             ***09810001
098200******************************************************************09820001
098300     IF (B-COND-CODE = '74')  AND                                 09830001
098400        (B-REV-CODE = '0841' OR '0851')  THEN                     09840001
098500           COMPUTE H-PPS-FINAL-PAY-AMT  ROUNDED  =                09850001
098600                           H-CC-74-PER-DIEM-AMT                   09860001
098700           COMPUTE H-FULL-CLAIM-AMT  ROUNDED  =                   09870001
098800              (H-BUN-ADJUSTED-BASE-WAGE-AMT *                     09880001
098900              ((B-CLAIM-NUM-DIALYSIS-SESSIONS) * 3) / 7)          09890001
099000     ELSE                                                         09900001
099100        COMPUTE H-PPS-FINAL-PAY-AMT  ROUNDED  =                   09910001
099200                H-BUN-ADJUSTED-BASE-WAGE-AMT  +                   09920001
099300                H-BUN-WAGE-ADJ-TRAINING-AMT                       09930001
099400     END-IF.                                                      09940001
099500                                                                  09950001
099600******************************************************************09960001
099700***  Calculate BUNDLED Outlier                                 ***09970001
099800******************************************************************09980001
099900     PERFORM 2500-CALC-OUTLIER-FACTORS.                           09990001
100000                                                                  10000001
100100******************************************************************10010001
100200***  Calculate Low Volume payment for recovery purposes        ***10020001
100300******************************************************************10030001
100400     IF LOW-VOLUME-TRACK = "Y"  THEN                              10040001
100500        PERFORM 3000-LOW-VOL-FULL-PPS-PAYMENT                     10050001
100600        PERFORM 3100-LOW-VOL-OUT-PPS-PAYMENT                      10060001
100700                                                                  10070001
100800        COMPUTE H-LV-PPS-FINAL-PAY-AMT = H-LV-PPS-FINAL-PAY-AMT - 10080001
100900           H-PPS-FINAL-PAY-AMT                                    10090001
101000                                                                  10100001
101100        COMPUTE H-LV-OUT-PAYMENT       = H-LV-OUT-PAYMENT       - 10110001
101200           H-OUT-PAYMENT                                          10120001
101300                                                                  10130001
101400        COMPUTE H-LV-PPS-FINAL-PAY-AMT = H-LV-PPS-FINAL-PAY-AMT + 10140001
101500           H-LV-OUT-PAYMENT                                       10150001
101600                                                                  10160001
101700        IF P-PROV-WAIVE-BLEND-PAY-INDIC = 'N'  THEN               10170001
101800           COMPUTE PPS-LOW-VOL-AMT  ROUNDED =                     10180001
101900              H-LV-PPS-FINAL-PAY-AMT  *  BUN-CBSA-BLEND-PCT       10190001
102000        ELSE                                                      10200001
102100           MOVE H-LV-PPS-FINAL-PAY-AMT TO PPS-LOW-VOL-AMT         10210001
102200        END-IF                                                    10220001
102300     END-IF.                                                      10230001
102400                                                                  10240001
102500                                                                  10250001
102600/                                                                 10260001
102700 2100-CALC-COMORBID-ADJUST.                                       10270001
102800******************************************************************10280001
102900***  Calculate Co-morbidities adjustment                       ***10290001
103000******************************************************************10300001
103100*  This logic assumes that the comorbids are randomly assigned   *10310001
103200*to the comorbid table.  It will select the highest comorbid for *10320001
103300*payment if one is found.                                        *10330001
103400******************************************************************10340001
103500     MOVE 'N'                          TO IS-HIGH-COMORBID-FOUND. 10350001
103600     MOVE 1.000                        TO H-COMORBID-MULTIPLIER.  10360001
103700     MOVE '10'                         TO PPS-2011-COMORBID-PAY.  10370001
103800                                                                  10380001
103900     PERFORM VARYING  SUB  FROM  1 BY 1                           10390001
104000       UNTIL SUB   >  6   OR   HIGH-COMORBID-FOUND                10400001
104100         IF COMORBID-DATA (SUB) = 'MA'  THEN                      10410001
104200           MOVE CM-GI-BLEED            TO H-COMORBID-MULTIPLIER   10420001
104300           MOVE "Y"                    TO IS-HIGH-COMORBID-FOUND  10430001
104400           MOVE "Y"                    TO ACUTE-COMORBID-TRACK    10440001
104500           MOVE '20'                   TO PPS-2011-COMORBID-PAY   10450001
104600         ELSE                                                     10460001
104700           IF COMORBID-DATA (SUB) = 'MB'  THEN                    10470001
104800             IF CM-PNEUMONIA  >  H-COMORBID-MULTIPLIER  THEN      10480001
104900               MOVE CM-PNEUMONIA       TO H-COMORBID-MULTIPLIER   10490001
105000               MOVE "Y"                TO ACUTE-COMORBID-TRACK    10500001
105100               MOVE '30'               TO PPS-2011-COMORBID-PAY   10510001
105200             END-IF                                               10520001
105300           ELSE                                                   10530001
105400             IF COMORBID-DATA (SUB) = 'MC'  THEN                  10540001
105500                IF CM-PERICARDITIS  >                             10550001
105600                                      H-COMORBID-MULTIPLIER  THEN 10560001
105700                  MOVE CM-PERICARDITIS TO H-COMORBID-MULTIPLIER   10570001
105800                  MOVE "Y"             TO ACUTE-COMORBID-TRACK    10580001
105900                  MOVE '40'            TO PPS-2011-COMORBID-PAY   10590001
106000                END-IF                                            10600001
106100             ELSE                                                 10610001
106200               IF COMORBID-DATA (SUB) = 'MD'  THEN                10620001
106300                 IF CM-MYELODYSPLASTIC  >                         10630001
106400                                      H-COMORBID-MULTIPLIER  THEN 10640001
106500                   MOVE CM-MYELODYSPLASTIC  TO                    10650001
106600                                      H-COMORBID-MULTIPLIER       10660001
106700                   MOVE "Y"            TO CHRONIC-COMORBID-TRACK  10670001
106800                   MOVE '50'           TO PPS-2011-COMORBID-PAY   10680001
106900                 END-IF                                           10690001
107000               ELSE                                               10700001
107100                 IF COMORBID-DATA (SUB) = 'ME'  THEN              10710001
107200                   IF CM-SICKEL-CELL  >                           10720001
107300                                      H-COMORBID-MULTIPLIER  THEN 10730001
107400                     MOVE CM-SICKEL-CELL  TO                      10740001
107500                                      H-COMORBID-MULTIPLIER       10750001
107600                     MOVE "Y"          TO CHRONIC-COMORBID-TRACK  10760001
107700                     MOVE '60'         TO PPS-2011-COMORBID-PAY   10770001
107800                   END-IF                                         10780001
107900                 ELSE                                             10790001
108000                   IF COMORBID-DATA (SUB) = 'MF'  THEN            10800001
108100                     IF CM-MONOCLONAL-GAMM  >                     10810001
108200                                      H-COMORBID-MULTIPLIER  THEN 10820001
108300                       MOVE CM-MONOCLONAL-GAMM TO                 10830001
108400                                      H-COMORBID-MULTIPLIER       10840001
108500                       MOVE "Y"        TO CHRONIC-COMORBID-TRACK  10850001
108600                       MOVE '70'       TO PPS-2011-COMORBID-PAY   10860001
108700                     END-IF                                       10870001
108800                   END-IF                                         10880001
108900                 END-IF                                           10890001
109000               END-IF                                             10900001
109100             END-IF                                               10910001
109200           END-IF                                                 10920001
109300         END-IF                                                   10930001
109400     END-PERFORM.                                                 10940001
109500/                                                                 10950001
109600 2500-CALC-OUTLIER-FACTORS.                                       10960001
109700******************************************************************10970001
109800***  Set separately billable OUTLIER age adjustment factor     ***10980001
109900******************************************************************10990001
110000     IF H-PATIENT-AGE < 13  THEN                                  11000001
110100        IF B-REV-CODE = '0821' OR '0881' THEN                     11010007
110200           MOVE SB-AGE-LT-13-HEMO-MODE TO H-OUT-AGE-FACTOR        11020001
110300        ELSE                                                      11030001
110400           MOVE SB-AGE-LT-13-PD-MODE   TO H-OUT-AGE-FACTOR        11040001
110500        END-IF                                                    11050001
110600     ELSE                                                         11060001
110700        IF H-PATIENT-AGE < 18 THEN                                11070001
110800           IF B-REV-CODE = '0821' OR '0881'  THEN                 11080007
110900              MOVE SB-AGE-13-17-HEMO-MODE                         11090001
111000                                       TO H-OUT-AGE-FACTOR        11100001
111100           ELSE                                                   11110001
111200              MOVE SB-AGE-13-17-PD-MODE                           11120001
111300                                       TO H-OUT-AGE-FACTOR        11130001
111400           END-IF                                                 11140001
111500        ELSE                                                      11150001
111600           IF H-PATIENT-AGE < 45  THEN                            11160001
111700              MOVE SB-AGE-18-44        TO H-OUT-AGE-FACTOR        11170001
111800           ELSE                                                   11180001
111900              IF H-PATIENT-AGE < 60  THEN                         11190001
112000                 MOVE SB-AGE-45-59     TO H-OUT-AGE-FACTOR        11200001
112100              ELSE                                                11210001
112200                 IF H-PATIENT-AGE < 70  THEN                      11220001
112300                    MOVE SB-AGE-60-69  TO H-OUT-AGE-FACTOR        11230001
112400                 ELSE                                             11240001
112500                    IF H-PATIENT-AGE < 80  THEN                   11250001
112600                       MOVE SB-AGE-70-79                          11260001
112700                                       TO H-OUT-AGE-FACTOR        11270001
112800                    ELSE                                          11280001
112900                       MOVE SB-AGE-80-PLUS                        11290001
113000                                       TO H-OUT-AGE-FACTOR        11300001
113100                    END-IF                                        11310001
113200                 END-IF                                           11320001
113300              END-IF                                              11330001
113400           END-IF                                                 11340001
113500        END-IF                                                    11350001
113600     END-IF.                                                      11360001
113700                                                                  11370001
113800******************************************************************11380001
113900**Calculate separately billable OUTLIER BSA factor (superscript)**11390001
114000******************************************************************11400001
114100     COMPUTE H-OUT-BSA  ROUNDED = (.007184 *                      11410001
114200         (B-PATIENT-HGT ** .725) * (B-PATIENT-WGT ** .425))       11420001
114300                                                                  11430001
114400     IF H-PATIENT-AGE > 17  THEN                                  11440001
114500        COMPUTE H-OUT-BSA-FACTOR  ROUNDED =                       11450001
114600             SB-BSA ** ((H-OUT-BSA - 1.87) / .1)                  11460001
114700     ELSE                                                         11470001
114800        MOVE 1.000                     TO H-OUT-BSA-FACTOR        11480001
114900     END-IF.                                                      11490001
115000                                                                  11500001
115100******************************************************************11510001
115200***  Calculate separately billable OUTLIER BMI factor          ***11520001
115300******************************************************************11530001
115400     COMPUTE H-OUT-BMI  ROUNDED = (B-PATIENT-WGT /                11540001
115500         (B-PATIENT-HGT ** 2)) * 10000.                           11550001
115600                                                                  11560001
115700     IF (H-PATIENT-AGE > 17) AND (H-OUT-BMI < 18.5)  THEN         11570001
115800        MOVE SB-BMI-LT-18-5            TO H-OUT-BMI-FACTOR        11580001
115900     ELSE                                                         11590001
116000        MOVE 1.000                     TO H-OUT-BMI-FACTOR        11600001
116100     END-IF.                                                      11610001
116200                                                                  11620001
116300******************************************************************11630001
116400***  Calculate separately billable OUTLIER ONSET factor        ***11640001
116500******************************************************************11650001
116600     IF B-DIALYSIS-START-DATE > ZERO  THEN                        11660001
116700        IF H-PATIENT-AGE > 17  THEN                               11670001
116800           IF ONSET-DATE > 120  THEN                              11680001
116900              MOVE 1                   TO H-OUT-ONSET-FACTOR      11690001
117000           ELSE                                                   11700001
117100              MOVE SB-ONSET-LE-120     TO H-OUT-ONSET-FACTOR      11710001
117200           END-IF                                                 11720001
117300        ELSE                                                      11730001
117400           MOVE 1                      TO H-OUT-ONSET-FACTOR      11740001
117500        END-IF                                                    11750001
117600     ELSE                                                         11760001
117700        MOVE 1.000                     TO H-OUT-ONSET-FACTOR      11770001
117800     END-IF.                                                      11780001
117900                                                                  11790001
118000******************************************************************11800001
118100***  Set separately billable OUTLIER Co-morbidities adjustment ***11810001
118200******************************************************************11820001
118300     IF COMORBID-CWF-RETURN-CODE = SPACES  THEN                   11830001
118400        IF H-PATIENT-AGE  <  18  THEN                             11840001
118500           MOVE 1.000                  TO                         11850001
118600                                       H-OUT-COMORBID-MULTIPLIER  11860001
118700           MOVE '10'                   TO PPS-2011-COMORBID-PAY   11870001
118800        ELSE                                                      11880001
118900           IF H-BUN-ONSET-FACTOR  =  CM-ONSET-LE-120  THEN        11890001
119000              MOVE 1.000               TO                         11900001
119100                                       H-OUT-COMORBID-MULTIPLIER  11910001
119200              MOVE '10'                TO PPS-2011-COMORBID-PAY   11920001
119300           ELSE                                                   11930001
119400              PERFORM 2600-CALC-COMORBID-OUT-ADJUST               11940001
119500           END-IF                                                 11950001
119600        END-IF                                                    11960001
119700     ELSE                                                         11970001
119800        IF COMORBID-CWF-RETURN-CODE  =  '10'  THEN                11980001
119900           MOVE 1.000                  TO                         11990001
120000                                       H-OUT-COMORBID-MULTIPLIER  12000001
120100        ELSE                                                      12010001
120200           IF COMORBID-CWF-RETURN-CODE  =  '20'  THEN             12020001
120300              MOVE SB-GI-BLEED         TO                         12030001
120400                                       H-OUT-COMORBID-MULTIPLIER  12040001
120500           ELSE                                                   12050001
120600              IF COMORBID-CWF-RETURN-CODE  =  '30'  THEN          12060001
120700                 MOVE SB-PNEUMONIA     TO                         12070001
120800                                       H-OUT-COMORBID-MULTIPLIER  12080001
120900              ELSE                                                12090001
121000                 IF COMORBID-CWF-RETURN-CODE  =  '40'  THEN       12100001
121100                    MOVE SB-PERICARDITIS TO                       12110001
121200                                       H-OUT-COMORBID-MULTIPLIER  12120001
121300                 END-IF                                           12130001
121400              END-IF                                              12140001
121500           END-IF                                                 12150001
121600        END-IF                                                    12160001
121700     END-IF.                                                      12170001
121800                                                                  12180001
121900******************************************************************12190001
122000***  Set OUTLIER low-volume-multiplier                         ***12200001
122100******************************************************************12210001
122200     IF P-PROV-LOW-VOLUME-INDIC = "N"  THEN                       12220001
122300        MOVE 1                         TO H-OUT-LOW-VOL-MULTIPLIER12230001
122400     ELSE                                                         12240001
122500        IF H-PATIENT-AGE < 18  THEN                               12250001
122600           MOVE 1                      TO H-OUT-LOW-VOL-MULTIPLIER12260001
122700        ELSE                                                      12270001
122800           MOVE SB-LOW-VOL-ADJ-LT-4000 TO H-OUT-LOW-VOL-MULTIPLIER12280001
122900           MOVE "Y"                    TO LOW-VOLUME-TRACK        12290001
123000        END-IF                                                    12300001
123100     END-IF.                                                      12310001
123200                                                                  12320001
123300******************************************************************12330001
123400***  Calculate predicted OUTLIER services MAP per treatment    ***12340001
123500******************************************************************12350001
123600     COMPUTE H-OUT-PREDICTED-SERVICES-MAP  ROUNDED =              12360001
123700        (H-OUT-AGE-FACTOR             *                           12370001
123800         H-OUT-BSA-FACTOR             *                           12380001
123900         H-OUT-BMI-FACTOR             *                           12390001
124000         H-OUT-ONSET-FACTOR           *                           12400001
124100         H-OUT-COMORBID-MULTIPLIER    *                           12410001
124200         H-OUT-LOW-VOL-MULTIPLIER).                               12420001
124300                                                                  12430001
124400******************************************************************12440001
124500***  Calculate case mix adjusted predicted OUTLIER serv MAP/trt***12450001
124600******************************************************************12460001
124700     IF H-PATIENT-AGE < 18  THEN                                  12470001
124800        COMPUTE H-OUT-CM-ADJ-PREDICT-MAP-TRT  ROUNDED  =          12480001
124900           (H-OUT-PREDICTED-SERVICES-MAP * ADJ-AVG-MAP-AMT-LT-18) 12490001
125000        MOVE ADJ-AVG-MAP-AMT-LT-18     TO  H-OUT-ADJ-AVG-MAP-AMT  12500001
125100     ELSE                                                         12510001
125200                                                                  12520001
125300        COMPUTE H-OUT-CM-ADJ-PREDICT-MAP-TRT  ROUNDED  =          12530001
125400           (H-OUT-PREDICTED-SERVICES-MAP * ADJ-AVG-MAP-AMT-GT-17) 12540001
125500        MOVE ADJ-AVG-MAP-AMT-GT-17     TO  H-OUT-ADJ-AVG-MAP-AMT  12550001
125600     END-IF.                                                      12560001
125700                                                                  12570001
125800******************************************************************12580001
125900*** Calculate imputed OUTLIER services MAP amount per treatment***12590001
126000******************************************************************12600001
126100     IF (B-COND-CODE = '74')  AND                                 12610001
126200        (B-REV-CODE = '0841' OR '0851')  THEN                     12620001
126300         COMPUTE H-HEMO-EQUIV-DIAL-SESSIONS  ROUNDED  =           12630001
126400            ((B-CLAIM-NUM-DIALYSIS-SESSIONS * 3) / 7)             12640001
126500         COMPUTE H-OUT-IMPUTED-MAP  ROUNDED =                     12650001
126600         (B-TOT-PRICE-SB-OUTLIER / H-HEMO-EQUIV-DIAL-SESSIONS)    12660001
126700     ELSE                                                         12670001
126800        COMPUTE H-OUT-IMPUTED-MAP  ROUNDED =                      12680001
126900        (B-TOT-PRICE-SB-OUTLIER / B-CLAIM-NUM-DIALYSIS-SESSIONS)  12690001
127000     END-IF.                                                      12700001
127100                                                                  12710001
127200******************************************************************12720001
127300*** Comparison of predicted to the imputed OUTLIER svc MAP/trt ***12730001
127400******************************************************************12740001
127500     IF H-PATIENT-AGE < 18   THEN                                 12750001
127600        COMPUTE H-OUT-PREDICTED-MAP  ROUNDED  =                   12760001
127700           H-OUT-CM-ADJ-PREDICT-MAP-TRT + FIX-DOLLAR-LOSS-LT-18   12770001
127800        MOVE FIX-DOLLAR-LOSS-LT-18     TO H-OUT-FIX-DOLLAR-LOSS   12780001
127900        IF H-OUT-IMPUTED-MAP  >  H-OUT-PREDICTED-MAP  THEN        12790001
128000           COMPUTE H-OUT-PAYMENT  ROUNDED  =                      12800001
128100            (H-OUT-IMPUTED-MAP  -  H-OUT-PREDICTED-MAP)  *        12810001
128200                                         LOSS-SHARING-PCT-LT-18   12820001
128300           MOVE LOSS-SHARING-PCT-LT-18 TO H-OUT-LOSS-SHARING-PCT  12830001
128400           MOVE "Y"                    TO OUTLIER-TRACK           12840001
128500        ELSE                                                      12850001
128600           MOVE ZERO                   TO H-OUT-PAYMENT           12860001
128700           MOVE ZERO                   TO H-OUT-LOSS-SHARING-PCT  12870001
128800        END-IF                                                    12880001
128900     ELSE                                                         12890001
129000        COMPUTE H-OUT-PREDICTED-MAP  ROUNDED =                    12900001
129100           H-OUT-CM-ADJ-PREDICT-MAP-TRT + FIX-DOLLAR-LOSS-GT-17   12910001
129200           MOVE FIX-DOLLAR-LOSS-GT-17  TO H-OUT-FIX-DOLLAR-LOSS   12920001
129300        IF H-OUT-IMPUTED-MAP  >  H-OUT-PREDICTED-MAP  THEN        12930001
129400           COMPUTE H-OUT-PAYMENT  ROUNDED  =                      12940001
129500            (H-OUT-IMPUTED-MAP  -  H-OUT-PREDICTED-MAP)  *        12950001
129600                                         LOSS-SHARING-PCT-GT-17   12960001
129700           MOVE LOSS-SHARING-PCT-GT-17 TO H-OUT-LOSS-SHARING-PCT  12970001
129800           MOVE "Y"                    TO OUTLIER-TRACK           12980001
129900        ELSE                                                      12990001
130000           MOVE ZERO                   TO H-OUT-PAYMENT           13000001
130100        END-IF                                                    13010001
130200     END-IF.                                                      13020001
130300                                                                  13030001
130400     MOVE H-OUT-PAYMENT                TO OUT-NON-PER-DIEM-PAYMENT13040001
130500                                                                  13050001
130600* Dialysis in Home and (CAPD or CCPD) Per-Diem calculation        13060001
130700     IF (B-COND-CODE = '74')  AND                                 13070001
130800        (B-REV-CODE = '0841' OR '0851')  THEN                     13080001
130900           COMPUTE H-OUT-PAYMENT ROUNDED = H-OUT-PAYMENT *        13090001
131000             (((B-CLAIM-NUM-DIALYSIS-SESSIONS) * 3) / 7)          13100001
131100     END-IF.                                                      13110001
131200/                                                                 13120001
131300 2600-CALC-COMORBID-OUT-ADJUST.                                   13130001
131400******************************************************************13140001
131500***  Calculate OUTLIER Co-morbidities adjustment               ***13150001
131600******************************************************************13160001
131700*  This logic assumes that the comorbids are randomly assigned   *13170001
131800*to the comorbid table.  It will select the highest comorbid for *13180001
131900*payment if one is found.                                        *13190001
132000******************************************************************13200001
132100                                                                  13210001
132200     MOVE 'N'                          TO IS-HIGH-COMORBID-FOUND. 13220001
132300     MOVE 1.000                        TO                         13230001
132400                                  H-OUT-COMORBID-MULTIPLIER.      13240001
132500                                                                  13250001
132600     PERFORM VARYING  SUB  FROM  1 BY 1                           13260001
132700       UNTIL SUB   >  6   OR   HIGH-COMORBID-FOUND                13270001
132800         IF COMORBID-DATA (SUB) = 'MA'  THEN                      13280001
132900           MOVE SB-GI-BLEED            TO                         13290001
133000                                  H-OUT-COMORBID-MULTIPLIER       13300001
133100           MOVE "Y"                    TO IS-HIGH-COMORBID-FOUND  13310001
133200           MOVE "Y"                    TO ACUTE-COMORBID-TRACK    13320001
133300         ELSE                                                     13330001
133400           IF COMORBID-DATA (SUB) = 'MB'  THEN                    13340001
133500             IF SB-PNEUMONIA  >  H-OUT-COMORBID-MULTIPLIER  THEN  13350001
133600               MOVE SB-PNEUMONIA       TO                         13360001
133700                                  H-OUT-COMORBID-MULTIPLIER       13370001
133800               MOVE "Y"                TO ACUTE-COMORBID-TRACK    13380001
133900             END-IF                                               13390001
134000           ELSE                                                   13400001
134100             IF COMORBID-DATA (SUB) = 'MC'  THEN                  13410001
134200                IF SB-PERICARDITIS  >                             13420001
134300                                  H-OUT-COMORBID-MULTIPLIER  THEN 13430001
134400                  MOVE SB-PERICARDITIS TO                         13440001
134500                                  H-OUT-COMORBID-MULTIPLIER       13450001
134600                  MOVE "Y"             TO ACUTE-COMORBID-TRACK    13460001
134700                END-IF                                            13470001
134800             ELSE                                                 13480001
134900               IF COMORBID-DATA (SUB) = 'MD'  THEN                13490001
135000                 IF SB-MYELODYSPLASTIC  >                         13500001
135100                                  H-OUT-COMORBID-MULTIPLIER  THEN 13510001
135200                   MOVE SB-MYELODYSPLASTIC  TO                    13520001
135300                                  H-OUT-COMORBID-MULTIPLIER       13530001
135400                   MOVE "Y"            TO CHRONIC-COMORBID-TRACK  13540001
135500                 END-IF                                           13550001
135600               ELSE                                               13560001
135700                 IF COMORBID-DATA (SUB) = 'ME'  THEN              13570001
135800                   IF SB-SICKEL-CELL  >                           13580001
135900                                  H-OUT-COMORBID-MULTIPLIER  THEN 13590001
136000                     MOVE SB-SICKEL-CELL  TO                      13600001
136100                                  H-OUT-COMORBID-MULTIPLIER       13610001
136200                      MOVE "Y"          TO CHRONIC-COMORBID-TRACK 13620001
136300                   END-IF                                         13630001
136400                 ELSE                                             13640001
136500                   IF COMORBID-DATA (SUB) = 'MF'  THEN            13650001
136600                     IF SB-MONOCLONAL-GAMM  >                     13660001
136700                                  H-OUT-COMORBID-MULTIPLIER  THEN 13670001
136800                       MOVE SB-MONOCLONAL-GAMM  TO                13680001
136900                                  H-OUT-COMORBID-MULTIPLIER       13690001
137000                       MOVE "Y"        TO CHRONIC-COMORBID-TRACK  13700001
137100                     END-IF                                       13710001
137200                   END-IF                                         13720001
137300                 END-IF                                           13730001
137400               END-IF                                             13740001
137500             END-IF                                               13750001
137600           END-IF                                                 13760001
137700         END-IF                                                   13770001
137800     END-PERFORM.                                                 13780001
137900/                                                                 13790001
138000******************************************************************13800001
138100*** Calculate Low Volume Full PPS payment for recovery purposes***13810001
138200******************************************************************13820001
138300 3000-LOW-VOL-FULL-PPS-PAYMENT.                                   13830001
138400******************************************************************13840001
138500** Modified code from 'Calc BUNDLED Adjust PPS Base Rate' para. **13850001
138600     COMPUTE H-LV-BUN-ADJUST-BASE-WAGE-AMT  ROUNDED  =            13860001
138700        (H-BUN-BASE-WAGE-AMT * H-BUN-AGE-FACTOR)     *            13870001
138800        (H-BUN-BSA-FACTOR    * H-BUN-BMI-FACTOR)     *            13880001
138900        (H-BUN-ONSET-FACTOR  * H-BUN-COMORBID-MULTIPLIER).        13890001
139000                                                                  13900001
139100******************************************************************13910001
139200**Modified code from 'Calc BUNDLED Condition Code pay' paragraph**13920001
139300* Self-care in Training add-on                                    13930001
139400     IF B-COND-CODE = '73'  THEN                                  13940001
139500* no add-on when onset is present                                 13950001
139600        IF H-BUN-ONSET-FACTOR  =  CM-ONSET-LE-120  THEN           13960001
139700           MOVE ZERO                   TO                         13970001
139800                                    H-BUN-WAGE-ADJ-TRAINING-AMT   13980001
139900        ELSE                                                      13990001
140000* use new PPS training add-on amount times wage-index             14000001
140100           COMPUTE H-BUN-WAGE-ADJ-TRAINING-AMT  ROUNDED  =        14010001
140200             TRAINING-ADD-ON-PMT-AMT * BUN-CBSA-W-INDEX           14020001
140300           MOVE "Y"                    TO TRAINING-TRACK          14030001
140400        END-IF                                                    14040001
140500     ELSE                                                         14050001
140600* Dialysis in Home and (CAPD or CCPD) Per-Diem calculation        14060001
140700        IF (B-COND-CODE = '74')  AND                              14070001
140800           (B-REV-CODE = '0841' OR '0851')  THEN                  14080001
140900              COMPUTE H-CC-74-PER-DIEM-AMT  ROUNDED =             14090001
141000                 (H-LV-BUN-ADJUST-BASE-WAGE-AMT * 3) / 7          14100001
141100        ELSE                                                      14110001
141200           MOVE ZERO                   TO                         14120001
141300                                    H-BUN-WAGE-ADJ-TRAINING-AMT   14130001
141400                                    H-CC-74-PER-DIEM-AMT          14140001
141500        END-IF                                                    14150001
141600     END-IF.                                                      14160001
141700                                                                  14170001
141800******************************************************************14180001
141900**Modified code from 'Calc BUNDLED ESRD PPS Final Pay Rate para.**14190001
142000     IF (B-COND-CODE = '74')  AND                                 14200001
142100        (B-REV-CODE = '0841' OR '0851')  THEN                     14210001
142200           COMPUTE H-LV-PPS-FINAL-PAY-AMT  ROUNDED  =             14220001
142300                           H-CC-74-PER-DIEM-AMT                   14230001
142400     ELSE                                                         14240001
142500        COMPUTE H-LV-PPS-FINAL-PAY-AMT  ROUNDED  =                14250001
142600                H-LV-BUN-ADJUST-BASE-WAGE-AMT +                   14260001
142700                H-BUN-WAGE-ADJ-TRAINING-AMT                       14270001
142800     END-IF.                                                      14280001
142900                                                                  14290001
143000/                                                                 14300001
143100******************************************************************14310001
143200*** Calculate Low Volume OUT PPS payment for recovery purposes ***14320001
143300******************************************************************14330001
143400 3100-LOW-VOL-OUT-PPS-PAYMENT.                                    14340001
143500******************************************************************14350001
143600**Modified code from 'Calc predict OUT serv MAP per treat' para.**14360001
143700     COMPUTE H-LV-OUT-PREDICT-SERVICES-MAP  ROUNDED =             14370001
143800        (H-OUT-AGE-FACTOR             *                           14380001
143900         H-OUT-BSA-FACTOR             *                           14390001
144000         H-OUT-BMI-FACTOR             *                           14400001
144100         H-OUT-ONSET-FACTOR           *                           14410001
144200         H-OUT-COMORBID-MULTIPLIER).                              14420001
144300                                                                  14430001
144400******************************************************************14440001
144500**modifi code 'Calc case mix adj predict OUT serv MAP/trt' para.**14450001
144600     IF H-PATIENT-AGE < 18  THEN                                  14460001
144700        COMPUTE H-LV-OUT-CM-ADJ-PREDICT-M-TRT  ROUNDED  =         14470001
144800           (H-LV-OUT-PREDICT-SERVICES-MAP * ADJ-AVG-MAP-AMT-LT-18)14480001
144900        MOVE ADJ-AVG-MAP-AMT-LT-18     TO  H-OUT-ADJ-AVG-MAP-AMT  14490001
145000     ELSE                                                         14500001
145100        COMPUTE H-LV-OUT-CM-ADJ-PREDICT-M-TRT  ROUNDED  =         14510001
145200           (H-LV-OUT-PREDICT-SERVICES-MAP * ADJ-AVG-MAP-AMT-GT-17)14520001
145300        MOVE ADJ-AVG-MAP-AMT-GT-17     TO  H-OUT-ADJ-AVG-MAP-AMT  14530001
145400     END-IF.                                                      14540001
145500                                                                  14550001
145600******************************************************************14560001
145700** 'Calculate imput OUT services MAP amount per treatment' para **14570001
145800** It is not necessary to modify or insert this paragraph here. **14580001
145900                                                                  14590001
146000******************************************************************14600001
146100**Modified 'Compare of predict to imputed OUT svc MAP/trt' para.**14610001
146200     IF H-PATIENT-AGE < 18   THEN                                 14620001
146300        COMPUTE H-LV-OUT-PREDICTED-MAP  ROUNDED  =                14630001
146400           H-LV-OUT-CM-ADJ-PREDICT-M-TRT + FIX-DOLLAR-LOSS-LT-18  14640001
146500        MOVE FIX-DOLLAR-LOSS-LT-18     TO H-OUT-FIX-DOLLAR-LOSS   14650001
146600        IF H-OUT-IMPUTED-MAP  >  H-LV-OUT-PREDICTED-MAP  THEN     14660001
146700           COMPUTE H-LV-OUT-PAYMENT  ROUNDED  =                   14670001
146800            (H-OUT-IMPUTED-MAP  -  H-LV-OUT-PREDICTED-MAP)  *     14680001
146900                                         LOSS-SHARING-PCT-LT-18   14690001
147000           MOVE LOSS-SHARING-PCT-LT-18 TO H-OUT-LOSS-SHARING-PCT  14700001
147100        ELSE                                                      14710001
147200           MOVE ZERO                   TO H-LV-OUT-PAYMENT        14720001
147300           MOVE ZERO                   TO H-OUT-LOSS-SHARING-PCT  14730001
147400        END-IF                                                    14740001
147500     ELSE                                                         14750001
147600        COMPUTE H-LV-OUT-PREDICTED-MAP  ROUNDED =                 14760001
147700           H-LV-OUT-CM-ADJ-PREDICT-M-TRT + FIX-DOLLAR-LOSS-GT-17  14770001
147800           MOVE FIX-DOLLAR-LOSS-GT-17  TO H-OUT-FIX-DOLLAR-LOSS   14780001
147900        IF H-OUT-IMPUTED-MAP  >  H-LV-OUT-PREDICTED-MAP  THEN     14790001
148000           COMPUTE H-LV-OUT-PAYMENT  ROUNDED  =                   14800001
148100            (H-OUT-IMPUTED-MAP  -  H-LV-OUT-PREDICTED-MAP)  *     14810001
148200                                         LOSS-SHARING-PCT-GT-17   14820001
148300           MOVE LOSS-SHARING-PCT-GT-17 TO H-OUT-LOSS-SHARING-PCT  14830001
148400        ELSE                                                      14840001
148500           MOVE ZERO                   TO H-LV-OUT-PAYMENT        14850001
148600        END-IF                                                    14860001
148700     END-IF.                                                      14870001
148800                                                                  14880001
148900     MOVE H-LV-OUT-PAYMENT             TO OUT-NON-PER-DIEM-PAYMENT14890001
149000                                                                  14900001
149100* Dialysis in Home and (CAPD or CCPD) Per-Diem calculation        14910001
149200     IF (B-COND-CODE = '74')  AND                                 14920001
149300        (B-REV-CODE = '0841' OR '0851')  THEN                     14930001
149400           COMPUTE H-LV-OUT-PAYMENT ROUNDED = H-LV-OUT-PAYMENT *  14940001
149500             (((B-CLAIM-NUM-DIALYSIS-SESSIONS) * 3) / 7)          14950001
149600     END-IF.                                                      14960001
149700/                                                                 14970001
149800 5000-CALC-COMP-RATE-FACTORS.                                     14980001
149900******************************************************************14990001
150000***  Set Composite Rate age adjustment factor                  ***15000001
150100******************************************************************15010001
150200     IF H-PATIENT-AGE < 18  THEN                                  15020001
150300        MOVE CR-AGE-LT-18              TO H-AGE-FACTOR            15030001
150400     ELSE                                                         15040001
150500        IF H-PATIENT-AGE < 45  THEN                               15050001
150600           MOVE CR-AGE-18-44           TO H-AGE-FACTOR            15060001
150700        ELSE                                                      15070001
150800           IF H-PATIENT-AGE < 60  THEN                            15080001
150900              MOVE CR-AGE-45-59        TO H-AGE-FACTOR            15090001
151000           ELSE                                                   15100001
151100              IF H-PATIENT-AGE < 70  THEN                         15110001
151200                 MOVE CR-AGE-60-69     TO H-AGE-FACTOR            15120001
151300              ELSE                                                15130001
151400                 IF H-PATIENT-AGE < 80  THEN                      15140001
151500                    MOVE CR-AGE-70-79  TO H-AGE-FACTOR            15150001
151600                 ELSE                                             15160001
151700                    MOVE CR-AGE-80-PLUS                           15170001
151800                                       TO H-AGE-FACTOR            15180001
151900                 END-IF                                           15190001
152000              END-IF                                              15200001
152100           END-IF                                                 15210001
152200        END-IF                                                    15220001
152300     END-IF.                                                      15230001
152400                                                                  15240001
152500******************************************************************15250001
152600**Calculate Composite Rate BSA factor (2012 superscript now same)*15260001
152700******************************************************************15270001
152800     COMPUTE H-BSA  ROUNDED = (.007184 *                          15280001
152900         (B-PATIENT-HGT ** .725) * (B-PATIENT-WGT ** .425))       15290001
153000                                                                  15300001
153100     IF H-PATIENT-AGE > 17  THEN                                  15310001
153200        COMPUTE H-BSA-FACTOR  ROUNDED =                           15320001
153300             CR-BSA ** ((H-BSA - 1.87) / .1)                      15330001
153400     ELSE                                                         15340001
153500        MOVE 1.000                     TO H-BSA-FACTOR            15350001
153600     END-IF.                                                      15360001
153700                                                                  15370001
153800******************************************************************15380001
153900*** Calculate Composite Rate BMI factor (different BMI < 18.5) ***15390001
154000******************************************************************15400001
154100     COMPUTE H-BMI  ROUNDED = (B-PATIENT-WGT /                    15410001
154200         (B-PATIENT-HGT ** 2)) * 10000.                           15420001
154300                                                                  15430001
154400     IF (H-PATIENT-AGE > 17) AND (H-BMI < 18.5)  THEN             15440001
154500        MOVE CR-BMI-LT-18-5            TO H-BMI-FACTOR            15450001
154600     ELSE                                                         15460001
154700        MOVE 1.000                     TO H-BMI-FACTOR            15470001
154800     END-IF.                                                      15480001
154900                                                                  15490001
155000******************************************************************15500001
155100***  Calculate Composite Rate Payment Amount                   ***15510001
155200******************************************************************15520001
155300*P-ESRD-RATE, also called the Exception Rate, will not be granted*15530001
155400*in full beginning in 2011 (the beginning of the Bundled method) *15540001
155500*and will be eliminated entirely beginning in 2014 which is the  *15550001
155600*end of the blending period.  For 2011, those providers who elect*15560001
155700*to be in the blend, will get only 75% of the exception rate.    *15570001
155800*This apparently is for the pediatric providers who originally   *15580001
155900*had the exception rate.                                         *15590001
156000                                                                  15600001
156100     IF P-ESRD-RATE  =  ZERO  THEN                                15610001
156200        MOVE BASE-PAYMENT-RATE         TO  H-PAYMENT-RATE         15620001
156300     ELSE                                                         15630001
156400        MOVE P-ESRD-RATE               TO  H-PAYMENT-RATE         15640001
156500     END-IF.                                                      15650001
156600                                                                  15660001
156700     COMPUTE H-WAGE-ADJ-PYMT-AMT ROUNDED =                        15670001
156800     (((H-PAYMENT-RATE * NAT-LABOR-PCT) * COM-CBSA-W-INDEX) +     15680001
156900       (H-PAYMENT-RATE * NAT-NONLABOR-PCT)) *                     15690001
157000            CBSA-BLEND-PCT.                                       15700001
157100                                                                  15710001
157200     COMPUTE H-PYMT-AMT ROUNDED = (H-WAGE-ADJ-PYMT-AMT *          15720001
157300        H-BMI-FACTOR * H-BSA-FACTOR * CASE-MIX-BDGT-NEUT-FACTOR * 15730001
157400        H-AGE-FACTOR * DRUG-ADDON).                               15740001
157500                                                                  15750001
157600     MOVE H-PYMT-AMT                   TO CASE-MIX-FCTR-ADJ-RATE. 15760001
157700                                                                  15770001
157800******************************************************************15780001
157900***  Calculate condition code payment                          ***15790001
158000******************************************************************15800001
158100     MOVE SPACES                       TO COND-CD-73.             15810001
158200                                                                  15820001
158300* Hemo, peritoneal, or CCPD training add-on                       15830001
158400     IF (B-COND-CODE = '73') AND (B-REV-CODE = '0821' OR '0831'   15840001
158500                                                      OR '0851')  15850001
158600        COMPUTE H-PYMT-AMT = H-PYMT-AMT + HEMO-PERI-CCPD-AMT      15860001
158700        MOVE 'A'                       TO AMT-INDIC               15870001
158800        MOVE HEMO-PERI-CCPD-AMT        TO BLOOD-DOLLAR            15880001
158900     ELSE                                                         15890001
159000* CAPD training add-on                                            15900001
159100        IF (B-COND-CODE = '73')  AND  (B-REV-CODE = '0841')  THEN 15910001
159200           COMPUTE H-PYMT-AMT = H-PYMT-AMT + CAPD-AMT             15920001
159300           MOVE 'A'                    TO AMT-INDIC               15930001
159400           MOVE CAPD-AMT               TO BLOOD-DOLLAR            15940001
159500        ELSE                                                      15950001
159600* Dialysis in Home and (CAPD or CCPD) Per-Diem calculation        15960001
159700           IF (B-COND-CODE = '74')  AND                           15970001
159800              (B-REV-CODE = '0841' OR '0851')  THEN               15980001
159900              COMPUTE H-PYMT-AMT ROUNDED = H-PYMT-AMT *           15990001
160000                                           CAPD-OR-CCPD-FACTOR    16000001
160100              MOVE CAPD-OR-CCPD-FACTOR TO HEMO-CCPD-CAPD          16010001
160200           ELSE                                                   16020001
160300              MOVE 'A'                 TO AMT-INDIC               16030001
160400              MOVE ZERO                TO BLOOD-DOLLAR            16040001
160500           END-IF                                                 16050001
160600        END-IF                                                    16060001
160700     END-IF.                                                      16070001
160800                                                                  16080001
160900/                                                                 16090001
161000 9000-SET-RETURN-CODE.                                            16100001
161100******************************************************************16110001
161200***  Set the return code                                       ***16120001
161300******************************************************************16130001
161400*   The following 'table' helps in understanding and in making   *16140001
161500*changes to the rather large and complex "IF" statement that     *16150001
161600*follows.  This 'table' just reorders and rewords the comments   *16160001
161700*contained in the working storage area concerning the paid       *16170001
161800*return-codes.                                                   *16180001
161900*                                                                *16190001
162000*  17 = pediatric, outlier, training                             *16200001
162100*  16 = pediatric, outlier                                       *16210001
162200*  15 = pediatric, training                                      *16220001
162300*  14 = pediatric                                                *16230001
162400*                                                                *16240001
162500*  24 = outlier, low volume, training, chronic comorbid          *16250001
162600*  19 = outlier, low volume, training, acute comorbid            *16260001
162700*  29 = outlier, low volume, training                            *16270001
162800*  23 = outlier, low volume, chronic comorbid                    *16280001
162900*  18 = outlier, low volume, acute comorbid                      *16290001
163000*  30 = outlier, low volume, onset                               *16300001
163100*  28 = outlier, low volume                                      *16310001
163200*  34 = outlier, training, chronic comorbid                      *16320001
163300*  35 = outlier, training, acute comorbid                        *16330001
163400*  33 = outlier, training                                        *16340001
163500*  07 = outlier, chronic comorbid                                *16350001
163600*  06 = outlier, acute comorbid                                  *16360001
163700*  09 = outlier, onset                                           *16370001
163800*  03 = outlier                                                  *16380001
163900*                                                                *16390001
164000*  26 = low volume, training, chronic comorbid                   *16400001
164100*  21 = low volume, training, acute comorbid                     *16410001
164200*  12 = low volume, training                                     *16420001
164300*  25 = low volume, chronic comorbid                             *16430001
164400*  20 = low volume, acute comorbid                               *16440001
164500*  32 = low volume, onset                                        *16450001
164600*  10 = low volume                                               *16460001
164700*                                                                *16470001
164800*  27 = training, chronic comorbid                               *16480001
164900*  22 = training, acute comorbid                                 *16490001
165000*  11 = training                                                 *16500001
165100*                                                                *16510001
165200*  08 = onset                                                    *16520001
165300*  04 = acute comorbid                                           *16530001
165400*  05 = chronic comorbid                                         *16540001
165500*  31 = low BMI                                                  *16550001
165600*  02 = no adjustments                                           *16560001
165700*                                                                *16570001
165800*  13 = w/multiple adjustments....reserved for future use        *16580001
165900******************************************************************16590001
166000/                                                                 16600001
166100     IF PEDIATRIC-TRACK                       = "Y"  THEN         16610001
166200        IF OUTLIER-TRACK                      = "Y"  THEN         16620001
166300           IF TRAINING-TRACK                  = "Y"  THEN         16630001
166400              MOVE 17                  TO PPS-RTC                 16640001
166500           ELSE                                                   16650001
166600              MOVE 16                  TO PPS-RTC                 16660001
166700           END-IF                                                 16670001
166800        ELSE                                                      16680001
166900           IF TRAINING-TRACK                  = "Y"  THEN         16690001
167000              MOVE 15                  TO PPS-RTC                 16700001
167100           ELSE                                                   16710001
167200              MOVE 14                  TO PPS-RTC                 16720001
167300           END-IF                                                 16730001
167400        END-IF                                                    16740001
167500     ELSE                                                         16750001
167600        IF OUTLIER-TRACK                      = "Y"  THEN         16760001
167700           IF LOW-VOLUME-TRACK                = "Y"  THEN         16770001
167800              IF TRAINING-TRACK               = "Y"  THEN         16780001
167900                 IF CHRONIC-COMORBID-TRACK    = "Y"  THEN         16790001
168000                    MOVE 24            TO PPS-RTC                 16800001
168100                 ELSE                                             16810001
168200                    IF ACUTE-COMORBID-TRACK   = "Y"  THEN         16820001
168300                       MOVE 19         TO PPS-RTC                 16830001
168400                    ELSE                                          16840001
168500                       MOVE 29         TO PPS-RTC                 16850001
168600                    END-IF                                        16860001
168700                 END-IF                                           16870001
168800              ELSE                                                16880001
168900                 IF CHRONIC-COMORBID-TRACK    = "Y"  THEN         16890001
169000                    MOVE 23            TO PPS-RTC                 16900001
169100                 ELSE                                             16910001
169200                    IF ACUTE-COMORBID-TRACK   = "Y"  THEN         16920001
169300                       MOVE 18         TO PPS-RTC                 16930001
169400                    ELSE                                          16940001
169500                       IF ONSET-TRACK         = "Y"  THEN         16950001
169600                          MOVE 30      TO PPS-RTC                 16960001
169700                       ELSE                                       16970001
169800                          MOVE 28      TO PPS-RTC                 16980001
169900                       END-IF                                     16990001
170000                    END-IF                                        17000001
170100                 END-IF                                           17010001
170200              END-IF                                              17020001
170300           ELSE                                                   17030001
170400              IF TRAINING-TRACK               = "Y"  THEN         17040001
170500                 IF CHRONIC-COMORBID-TRACK    = "Y"  THEN         17050001
170600                    MOVE 34            TO PPS-RTC                 17060001
170700                 ELSE                                             17070001
170800                    IF ACUTE-COMORBID-TRACK   = "Y"  THEN         17080001
170900                       MOVE 35         TO PPS-RTC                 17090001
171000                    ELSE                                          17100001
171100                       MOVE 33         TO PPS-RTC                 17110001
171200                    END-IF                                        17120001
171300                 END-IF                                           17130001
171400              ELSE                                                17140001
171500                 IF CHRONIC-COMORBID-TRACK    = "Y"  THEN         17150001
171600                    MOVE 07            TO PPS-RTC                 17160001
171700                 ELSE                                             17170001
171800                    IF ACUTE-COMORBID-TRACK   = "Y"  THEN         17180001
171900                       MOVE 06         TO PPS-RTC                 17190001
172000                    ELSE                                          17200001
172100                       IF ONSET-TRACK         = "Y"  THEN         17210001
172200                          MOVE 09      TO PPS-RTC                 17220001
172300                       ELSE                                       17230001
172400                          MOVE 03      TO PPS-RTC                 17240001
172500                       END-IF                                     17250001
172600                    END-IF                                        17260001
172700                 END-IF                                           17270001
172800              END-IF                                              17280001
172900           END-IF                                                 17290001
173000        ELSE                                                      17300001
173100           IF LOW-VOLUME-TRACK                = "Y"               17310001
173200              IF TRAINING-TRACK               = "Y"  THEN         17320001
173300                 IF CHRONIC-COMORBID-TRACK    = "Y"  THEN         17330001
173400                    MOVE 26            TO PPS-RTC                 17340001
173500                 ELSE                                             17350001
173600                    IF ACUTE-COMORBID-TRACK   = "Y"  THEN         17360001
173700                       MOVE 21         TO PPS-RTC                 17370001
173800                    ELSE                                          17380001
173900                       MOVE 12         TO PPS-RTC                 17390001
174000                    END-IF                                        17400001
174100                 END-IF                                           17410001
174200              ELSE                                                17420001
174300                 IF CHRONIC-COMORBID-TRACK    = "Y"  THEN         17430001
174400                    MOVE 25            TO PPS-RTC                 17440001
174500                 ELSE                                             17450001
174600                    IF ACUTE-COMORBID-TRACK   = "Y"  THEN         17460001
174700                       MOVE 20         TO PPS-RTC                 17470001
174800                    ELSE                                          17480001
174900                       IF ONSET-TRACK         = "Y"  THEN         17490001
175000                          MOVE 32      TO PPS-RTC                 17500001
175100                       ELSE                                       17510001
175200                          MOVE 10      TO PPS-RTC                 17520001
175300                       END-IF                                     17530001
175400                    END-IF                                        17540001
175500                 END-IF                                           17550001
175600              END-IF                                              17560001
175700           ELSE                                                   17570001
175800              IF TRAINING-TRACK               = "Y"  THEN         17580001
175900                 IF CHRONIC-COMORBID-TRACK    = "Y"  THEN         17590001
176000                    MOVE 27            TO PPS-RTC                 17600001
176100                 ELSE                                             17610001
176200                    IF ACUTE-COMORBID-TRACK   = "Y"  THEN         17620001
176300                       MOVE 22         TO PPS-RTC                 17630001
176400                    ELSE                                          17640001
176500                       MOVE 11         TO PPS-RTC                 17650001
176600                    END-IF                                        17660001
176700                 END-IF                                           17670001
176800              ELSE                                                17680001
176900                 IF ONSET-TRACK               = "Y"  THEN         17690001
177000                    MOVE 08            TO PPS-RTC                 17700001
177100                 ELSE                                             17710001
177200                    IF ACUTE-COMORBID-TRACK   = "Y"  THEN         17720001
177300                       MOVE 04         TO PPS-RTC                 17730001
177400                    ELSE                                          17740001
177500                       IF CHRONIC-COMORBID-TRACK = "Y"  THEN      17750001
177600                          MOVE 05      TO PPS-RTC                 17760001
177700                       ELSE                                       17770001
177800                          IF LOW-BMI-TRACK = "Y"  THEN            17780001
177900                             MOVE 31 TO PPS-RTC                   17790001
178000                          ELSE                                    17800001
178100                             MOVE 02 TO PPS-RTC                   17810001
178200                          END-IF                                  17820001
178300                       END-IF                                     17830001
178400                    END-IF                                        17840001
178500                 END-IF                                           17850001
178600              END-IF                                              17860001
178700           END-IF                                                 17870001
178800        END-IF                                                    17880001
178900     END-IF.                                                      17890001
179000/                                                                 17900001
179100 9100-MOVE-RESULTS.                                               17910001
179200     IF MOVED-CORMORBIDS = SPACES  THEN                           17920001
179300        NEXT SENTENCE                                             17930001
179400     ELSE                                                         17940001
179500        MOVE H-COMORBID-DATA (1)       TO COMORBID-DATA (1)       17950001
179600        MOVE H-COMORBID-DATA (2)       TO COMORBID-DATA (2)       17960001
179700        MOVE H-COMORBID-DATA (3)       TO COMORBID-DATA (3)       17970001
179800        MOVE H-COMORBID-DATA (4)       TO COMORBID-DATA (4)       17980001
179900        MOVE H-COMORBID-DATA (5)       TO COMORBID-DATA (5)       17990001
180000        MOVE H-COMORBID-DATA (6)       TO COMORBID-DATA (6)       18000001
180100        MOVE H-COMORBID-CWF-CODE       TO                         18010001
180200                                    COMORBID-CWF-RETURN-CODE      18020001
180300     END-IF.                                                      18030001
180400                                                                  18040001
180500     MOVE P-GEO-MSA                    TO PPS-MSA.                18050001
180600     MOVE P-GEO-CBSA                   TO PPS-CBSA.               18060001
180700     MOVE H-WAGE-ADJ-PYMT-AMT          TO PPS-WAGE-ADJ-RATE.      18070001
180800     MOVE B-COND-CODE                  TO PPS-COND-CODE.          18080001
180900     MOVE B-REV-CODE                   TO PPS-REV-CODE.           18090001
181000     MOVE H-BUN-BASE-WAGE-AMT          TO PPS-2011-WAGE-ADJ-RATE. 18100001
181100     MOVE BUN-NAT-LABOR-PCT            TO PPS-2011-NAT-LABOR-PCT. 18110001
181200     MOVE BUN-NAT-NONLABOR-PCT         TO                         18120001
181300                                    PPS-2011-NAT-NONLABOR-PCT.    18130001
181400     MOVE NAT-LABOR-PCT                TO PPS-NAT-LABOR-PCT.      18140001
181500     MOVE NAT-NONLABOR-PCT             TO PPS-NAT-NONLABOR-PCT.   18150001
181600     MOVE H-AGE-FACTOR                 TO PPS-AGE-FACTOR.         18160001
181700     MOVE H-BSA-FACTOR                 TO PPS-BSA-FACTOR.         18170001
181800     MOVE H-BMI-FACTOR                 TO PPS-BMI-FACTOR.         18180001
181900     MOVE CASE-MIX-BDGT-NEUT-FACTOR    TO PPS-BDGT-NEUT-RATE.     18190001
182000     MOVE H-BUN-AGE-FACTOR             TO PPS-2011-AGE-FACTOR.    18200001
182100     MOVE H-BUN-BSA-FACTOR             TO PPS-2011-BSA-FACTOR.    18210001
182200     MOVE H-BUN-BMI-FACTOR             TO PPS-2011-BMI-FACTOR.    18220001
182300     MOVE TRANSITION-BDGT-NEUT-FACTOR  TO                         18230001
182400                                    PPS-2011-BDGT-NEUT-RATE.      18240001
182500     MOVE SPACES                       TO PPS-2011-COMORBID-MA.   18250001
182600     MOVE SPACES                       TO                         18260001
182700                                    PPS-2011-COMORBID-MA-CC.      18270001
182800                                                                  18280001
182900     IF (B-COND-CODE = '74')  AND                                 18290001
183000        (B-REV-CODE = '0841' OR '0851')  THEN                     18300001
183100         COMPUTE H-OUT-PAYMENT ROUNDED = H-OUT-PAYMENT /          18310001
183200                                     B-CLAIM-NUM-DIALYSIS-SESSIONS18320001
183300     END-IF.                                                      18330001
183400                                                                  18340001
183500     IF P-PROV-WAIVE-BLEND-PAY-INDIC        = 'N'  THEN           18350001
183600           COMPUTE PPS-2011-BLEND-COMP-RATE    ROUNDED =          18360001
183700              H-PYMT-AMT              *  COM-CBSA-BLEND-PCT       18370001
183800           COMPUTE PPS-2011-BLEND-PPS-RATE     ROUNDED =          18380001
183900              H-PPS-FINAL-PAY-AMT     *  BUN-CBSA-BLEND-PCT       18390001
184000           COMPUTE PPS-2011-BLEND-OUTLIER-RATE ROUNDED =          18400001
184100              H-OUT-PAYMENT           *  BUN-CBSA-BLEND-PCT       18410001
184200     ELSE                                                         18420001
184300        MOVE ZERO                      TO                         18430001
184400                                    PPS-2011-BLEND-COMP-RATE      18440001
184500        MOVE ZERO                      TO                         18450001
184600                                    PPS-2011-BLEND-PPS-RATE       18460001
184700        MOVE ZERO                      TO                         18470001
184800                                    PPS-2011-BLEND-OUTLIER-RATE   18480001
184900     END-IF.                                                      18490001
185000                                                                  18500001
185100     MOVE H-PYMT-AMT                   TO                         18510001
185200                                    PPS-2011-FULL-COMP-RATE.      18520001
185300     MOVE H-PPS-FINAL-PAY-AMT          TO PPS-2011-FULL-PPS-RATE  18530001
185400                                          PPS-FINAL-PAY-AMT.      18540001
185500     MOVE H-OUT-PAYMENT                TO                         18550001
185600                                    PPS-2011-FULL-OUTLIER-RATE.   18560001
185700                                                                  18570001
185800                                                                  18580001
185900     IF P-QIP-REDUCTION = ' ' THEN                                18590001
186000        NEXT SENTENCE                                             18600001
186100     ELSE                                                         18610001
186200        COMPUTE PPS-2011-BLEND-COMP-RATE    ROUNDED =             18620001
186300                PPS-2011-BLEND-COMP-RATE    *  QIP-REDUCTION      18630001
186400        COMPUTE PPS-2011-FULL-COMP-RATE     ROUNDED =             18640001
186500                PPS-2011-FULL-COMP-RATE     *  QIP-REDUCTION      18650001
186600        COMPUTE PPS-2011-BLEND-PPS-RATE     ROUNDED =             18660001
186700                PPS-2011-BLEND-PPS-RATE     *  QIP-REDUCTION      18670001
186800        COMPUTE PPS-2011-FULL-PPS-RATE      ROUNDED =             18680001
186900                PPS-2011-FULL-PPS-RATE      *  QIP-REDUCTION      18690001
187000        COMPUTE PPS-2011-BLEND-OUTLIER-RATE ROUNDED =             18700001
187100                PPS-2011-BLEND-OUTLIER-RATE *  QIP-REDUCTION      18710001
187200        COMPUTE PPS-2011-FULL-OUTLIER-RATE  ROUNDED =             18720001
187300                PPS-2011-FULL-OUTLIER-RATE  *  QIP-REDUCTION      18730001
187400     END-IF.                                                      18740001
187500                                                                  18750001
187600     IF BUNDLED-TEST   THEN                                       18760001
187700        MOVE DRUG-ADDON                TO DRUG-ADD-ON-RETURN      18770001
187800        MOVE 0.0                       TO MSA-WAGE-ADJ            18780001
187900        MOVE H-WAGE-ADJ-PYMT-AMT       TO CBSA-WAGE-ADJ           18790001
188000        MOVE BASE-PAYMENT-RATE         TO CBSA-WAGE-PMT-RATE      18800001
188100        MOVE H-PATIENT-AGE             TO AGE-RETURN              18810001
188200        MOVE 0.0                       TO MSA-WAGE-AMT            18820001
188300        MOVE COM-CBSA-W-INDEX          TO CBSA-WAGE-INDEX         18830001
188400        MOVE H-BMI                     TO PPS-BMI                 18840001
188500        MOVE H-BSA                     TO PPS-BSA                 18850001
188600        MOVE MSA-BLEND-PCT             TO MSA-PCT                 18860001
188700        MOVE CBSA-BLEND-PCT            TO CBSA-PCT                18870001
188800                                                                  18880001
188900        IF P-PROV-WAIVE-BLEND-PAY-INDIC        = 'N'  THEN        18890001
189000           MOVE COM-CBSA-BLEND-PCT     TO COM-CBSA-PCT-BLEND      18900001
189100           MOVE BUN-CBSA-BLEND-PCT     TO BUN-CBSA-PCT-BLEND      18910001
189200        ELSE                                                      18920001
189300           MOVE ZERO                   TO COM-CBSA-PCT-BLEND      18930001
189400           MOVE WAIVE-CBSA-BLEND-PCT   TO BUN-CBSA-PCT-BLEND      18940001
189500        END-IF                                                    18950001
189600                                                                  18960001
189700        MOVE H-BUN-BSA                 TO BUN-BSA                 18970001
189800        MOVE H-BUN-BMI                 TO BUN-BMI                 18980001
189900        MOVE H-BUN-ONSET-FACTOR        TO BUN-ONSET-FACTOR        18990001
190000        MOVE H-BUN-COMORBID-MULTIPLIER TO BUN-COMORBID-MULTIPLIER 19000001
190100        MOVE H-BUN-LOW-VOL-MULTIPLIER  TO BUN-LOW-VOL-MULTIPLIER  19010001
190200        MOVE H-OUT-AGE-FACTOR          TO OUT-AGE-FACTOR          19020001
190300        MOVE H-OUT-BSA                 TO OUT-BSA                 19030001
190400        MOVE SB-BSA                    TO OUT-SB-BSA              19040001
190500        MOVE H-OUT-BSA-FACTOR          TO OUT-BSA-FACTOR          19050001
190600        MOVE H-OUT-BMI                 TO OUT-BMI                 19060001
190700        MOVE H-OUT-BMI-FACTOR          TO OUT-BMI-FACTOR          19070001
190800        MOVE H-OUT-ONSET-FACTOR        TO OUT-ONSET-FACTOR        19080001
190900        MOVE H-OUT-COMORBID-MULTIPLIER TO                         19090001
191000                                    OUT-COMORBID-MULTIPLIER       19100001
191100        MOVE H-OUT-PREDICTED-SERVICES-MAP  TO                     19110001
191200                                    OUT-PREDICTED-SERVICES-MAP    19120001
191300        MOVE H-OUT-CM-ADJ-PREDICT-MAP-TRT  TO                     19130001
191400                                    OUT-CASE-MIX-PREDICTED-MAP    19140001
191500        MOVE H-HEMO-EQUIV-DIAL-SESSIONS    TO                     19150001
191600                                    OUT-HEMO-EQUIV-DIAL-SESSIONS  19160001
191700        MOVE H-OUT-LOW-VOL-MULTIPLIER  TO OUT-LOW-VOL-MULTIPLIER  19170001
191800        MOVE H-OUT-ADJ-AVG-MAP-AMT     TO OUT-ADJ-AVG-MAP-AMT     19180001
191900        MOVE H-OUT-IMPUTED-MAP         TO OUT-IMPUTED-MAP         19190001
192000        MOVE H-OUT-FIX-DOLLAR-LOSS     TO OUT-FIX-DOLLAR-LOSS     19200001
192100        MOVE H-OUT-LOSS-SHARING-PCT    TO OUT-LOSS-SHARING-PCT    19210001
192200        MOVE H-OUT-PREDICTED-MAP       TO OUT-PREDICTED-MAP       19220001
192300        MOVE CR-BSA                    TO CR-BSA-MULTIPLIER       19230001
192400        MOVE CR-BMI-LT-18-5            TO CR-BMI-MULTIPLIER       19240001
192500        MOVE A-49-CENT-PART-D-DRUG-ADJ TO A-49-CENT-DRUG-ADJ      19250001
192600        MOVE CM-BSA                    TO PPS-CM-BSA              19260001
192700        MOVE CM-BMI-LT-18-5            TO PPS-CM-BMI-LT-18-5      19270001
192800        MOVE BUNDLED-BASE-PMT-RATE     TO PPS-BUN-BASE-PMT-RATE   19280001
192900        MOVE BUN-CBSA-W-INDEX          TO PPS-BUN-CBSA-W-INDEX    19290001
193000        MOVE H-BUN-ADJUSTED-BASE-WAGE-AMT  TO                     19300001
193100                                    BUN-ADJUSTED-BASE-WAGE-AMT    19310001
193200        MOVE H-BUN-WAGE-ADJ-TRAINING-AMT   TO                     19320001
193300                                    PPS-BUN-WAGE-ADJ-TRAIN-AMT    19330001
193400        MOVE TRAINING-ADD-ON-PMT-AMT   TO                         19340001
193500                                    PPS-TRAINING-ADD-ON-PMT-AMT   19350001
193600        MOVE H-PAYMENT-RATE            TO COM-PAYMENT-RATE        19360001
193700     END-IF.                                                      19370001
193800******        L A S T   S O U R C E   S T A T E M E N T      *****19380001
