==============================================================
MU00.@BFN2699.LTNDM170
========================================================================

NOTE TO: Shared System Coordinators, MEDICARE Coordinators

SUBJECT: Long-term Care Hospital (LTCH) Prospective Payment System (PPS)
         Pricer Release, Version 20170
(August 25, 2016)  --ACTION-- refer to the following change requests:
        -  CR9579,
        -  CR9599, and
        -  CR9723.

This LTCH Pricer release is the production version for the October 2016
FY 2017 release.

It includes the following changes/additions:

- LTCAL170    ** New **

 CONTAINS THE FOLLOWING UPDATES:
 - ADDED DATA ELEMENT FOR STATE CODE FROM THE PROVIDER SPECIFIC FILE
   - Enter the 2-digit state where the provider is located. Enter only
     the first (lowest) code for a given state. For example, effective
     October 1, 2005, Florida has the following State Codes: 10, 68 and
     69. MACs shall enter a "10" for Florida's state code.
     List of valid state codes is located in 100-07, Chapter 2, Section
     2779A1.
 - APPLIED THE BUDGET NEUTRALITY ADJUSTMENT TO SITE-
   NEUTRAL PAYMENTS
 - APPLIED THE BUDGET NEUTRALITY ADJUSTMENT ONLY TO THE
   "BASE" SITE-NEUTRAL PAYMENT (SUCH AS THE IPPS-
   COMPARABLE AMOUNT) AFTER THE HIGH-COST OUTLIER IS MADE
   AND DID NOT APPLY THE BUDGET NEUTRALITY ADJUSTMENT TO
   ANY APPLICABLE HIGH-COST OUTLIER PAYMENT

 APPLIED THE FOLLOWING CHANGES FROM THE
 FY 2017 LTCH PPS PRICER SPEC SHEET (DATED 8-24-2016):
 - STANDARD FEDERAL RATES (BASED ON QUALITY DATA REPORT
   STATUS FOR FY17):
    - FULL UPDATE (QUALITY INDICATOR ON PSF = 1):
      $42476.41
    - REDUCED UPDATE (QUALITY INDICATOR ON PSF = 0 OR
       BLANK): $41641.49
 - LABOR SHARE: 66.5% (0.665)
 - NONLABOR SHARE: 33.5% (0.335)
 - WAGE INDEX - TABLES ATTACHED.
 - MS-LTC-DRG WEIGHTS/LENGTH OF STAY/IPPS COMPARABLE
   THRESHOLD - TABLE ATTACHED.
 - HIGH COST OUTLIER FIXED-LOSS AMOUNTS (NO
   POLICY/CALCULATION LOGIC CHANGES)
    - STANDARD RATE CASES: $21943
    - SITE NEUTRAL RATE CASES: $23573
 - SITE NEUTRAL RATE HCO BUDGET NEUTRALITY FACTOR: 0.949
    - APPLIED TO TOTAL SITE NEUTRAL PAYMENT RATE AMOUNT
      PRIOR TO APPLYING 50% TRANSITION BLEND FACTOR
    - ONLY APPLY TO NON-HCO PORTION OF THE SITE NEUTRAL
      PAYMENT RATE AMOUNT AND DO NOT APPLY TO THE ANY
      APPLICABLE SITE NEUTRAL PAYMENT RATE HCO PAYMENT
      (LOGIC CHANGE FOR FY 2017)
 - SHORT-STAY OUTLIERS (SSOS) - NO POLICY CHANGES
   (UPDATED RATES/FACTORS BELOW)
 - SSO AND SITE NEUTRAL RATE PAYMENTS IPPS RATES/FACTORS:
   (NOTE, SEPARATE PUERTO RICO RATES NO LONGER NEEDED
    BEGINNING FY 2017)
       - IPPS LABOR SHARE WAGE INDEX > 1: $3839.23
       - IPPS NONLABOR SHARE WAGE INDEX > 1: $1676.91
       - IPPS LABOR SHARE WAGE INDEX < /= 1: $3420.01
       - IPPS NONLABOR SHARE WAGE INDEX < /= 1: $2096.13
       - CAPITAL NATIONAL RATE: $446.79
       (IPPS RATES BASED ON FORTHCOMING CORRECTION NOTICE
       VALUES.)
    - REDUCTION FACTOR FOR IPPS COMPARABLE OPERATING DSH
      PAYMENT AMOUNT: 66.52% OR A FACTOR OF 0.6652. (THIS
      REDUCTION IS NOT APPLIED TO THE CAPITAL DSH PAYMENT
      CALCULATION.)
    - USE FY 2017 IPPS AREA WAGE INDEXES & MS-DRG WEIGHTS/
      LENGTH OF STAY
 - SPECIAL TREATMENT - PROVIDER 362006 (CALVARY
   HOSPITAL) - THIS PROVIDER IS SUBJECT TO
   THE NEW SITE NEUTRAL PRICING LOGIC AND WILL
   CONTINUE TO BE PAID THE PER DIEM LOGIC.
    - PER DIEM CALCULATION BASED ON COST
      REPORT DAYS (NOT IPPS INLIER DAYS).


- LTDRV170    ** Replaces LTDRV162 **

    - CALL to LTCAL170 module
    - Updated the logic in LTDRV17B to use the state code field to find
      the rural state floor IPPS comparable wage index.
    - Revised state code logic to address inconsistency
      with new Arizona state code '00'. Code amended to
      revise the state code to '03', which is the actual
      rural state code for Arizona, when FISS passes
      lowest state code of '00'.
      In revising the state code logic to address the new
      Arizona state code of '00', the CBSA logic was also
      revised to correct the rural Arizona CBSA in case of
      erroneous entry of '00'.


- LTWIX170    ** Replaces LTWIX160 **

    - FY 2017 CBSA Wage Index rates


- IPWIX170    ** Replaces IPWIX170 **

    - FY 2017 CBSA Wage Index rates


- LTDRG170    ** New **

    - FY 2017 LTCH DRG table


- IPDRG170    ** New **

    - FY 2017 IPPS DRG table


************************************************

A partitioned data set (PDS) of the Version 2017B code
(MU00.@BFN2699.LTNDM170) is at the CMS Data Center for users
to obtain by Connect:Direct (Network DataMover).

The 63 members listed below comprise the Pricer, but only the modules
that changed or are new since the previous release are included in the
PDS.  The changed and new members should be used in conjunction with
the current production Pricer files.

      NAME
      --------
      BLEND152
      IPDRG063
      IPDRG071
      IPDRG080
      IPDRG090
      IPDRG104
      IPDRG110
      IPDRG123
      IPDRG130
      IPDRG141
      IPDRG152
      IPDRG160
      IPDRG170
      IPWIX170
      IRFBN091
      IRFBN102
      IRFBN105
      LTCAL032
      LTCAL042
      LTCAL043
      LTCAL058
      LTCAL059
      LTCAL063
      LTCAL064
      LTCAL072
      LTCAL075
      LTCAL080
      LTCAL087
      LTCAL091
      LTCAL094
      LTCAL095
      LTCAL103
      LTCAL105
      LTCAL111
      LTCAL123
      LTCAL130
      LTCAL141
      LTCAL152
      LTCAL154
      LTCAL162
      LTCAL170
      LTDRG031
      LTDRG041
      LTDRG057
      LTDRG062
      LTDRG075
      LTDRG080
      LTDRG086
      LTDRG093
      LTDRG095
      LTDRG100
      LTDRG110
      LTDRG123
      LTDRG130
      LTDRG141
      LTDRG152
      LTDRG160
      LTDRG170
      LTDRV170
      LTMSA152
      LTWIX170
      MANIFEST
      README

