FY 2024 IPPS Final Rule: Implementation of Section 3133 of the Affordable Care Act- Medicare DSH- Supplemental Data	
	
Variable	Description
Medicare CCN	CMS Certification Number (CCN)
Projected to Receive DSH in FY 2024	"'YES' indicates that hospital is projected to receive DSH for FY 2024, thus eligible to receive interim uncompensated care payments.  

'NO' indicates that hospital is not projected to receive DSH for FY 2024, thus ineligible to receive the interim uncompensated care payments.

 'SCH' indicates that the hospital is a Sole Community Hospital that is projected to be paid under its hospital specific rate, not the Federal rate, thus projected to not be paid DSH and ineligible to receive the uncompensated care payment. However, for  hospitals identified as 'SCH', these hospitals are paid the higher of the Federal rate or hospital specific rate on an interim claim-by-claim basis and an estimated per discharge uncompensated care payment amount is listed for this calculation.  

DSH hospitals are projected to receive DSH for FY 2024, based on FY 2020 SSI ratios and the Medicaid ratios from the March 2023 update of the Provider Specific File. Hospitals that are currently projected ineligible will receive an uncompensated care payment if determined DSH eligible at cost report settlement."
IHS or PR	'YES' indicates that the hospital is either Indian Health Service/Tribal or is located in Puerto Rico (PR). 
Rural Community Hospital Demonstration	"'YES' indicates that the hospital is participating in the Rural Community Hospital Demonstration, thus not eligible for DSH in FY 2024."
New Hospital	"'YES' indicates whether a hospital is defined as new for purposes of uncompensated care payment methodology for FY 2024. New hospitals do not receive interim uncompensated care payments. However, if the hospital is later determined to be eligible to receive empirically justified Medicare DSH payments based on its FY 2024 cost report, the hospital will also receive an uncompensated care payment calculated using a Factor 3, where the numerator is the uncompensated care costs reported on Worksheet S–10 of the hospital’s FY 2024 cost report, and the denominator is the sum of uncompensated care costs reported on Worksheet S–10 of all DSH eligible hospitals’ FY 2018, FY 2019 and FY 2020 cost reports.  For FY 2024, CCNs established on or after October 1, 2020 will be considered new and subject to this policy. However, Indian Health Service (IHS) hospitals or hospitals located in Puerto Rico (PR) with a CCN established on or after October 1, 2013 will be considered new and subject to this policy."
2018 UCC	"Sum of charity care costs and bad debt reported on Worksheet S-10 of a hospital's FY 2018 Medicare Hospital Cost Report based on the March 2023 update of the Medicare Hospital Cost Report data. 'N/A' indicates a hospital in Puerto Rico or an IHS/Tribal hospital, if  a hospital in Puerto Rico or an IHS/Tribal hospital is also a new hospital then this field is blank. For hospitals in Puerto Rico and IHS/Tribal hospitals, uncompensated care costs are not used in the calculation of Factor 3 for FY 2018. As finalized in the FY 2018 IPPS Final Rule, uncompensated care costs for hospitals that underwent a merger are based on the uncompensated care costs reported for both hospitals. Also as finalized in the FY 2018 IPPS Final rule, uncompensated care costs have been annualized based upon the length of the hospital's cost reporting period. Uncompensated care costs for acquired hospitals have been adjusted based upon the cost reporting start dates of the acquired and surviving hospitals and the merger effective date."
Length of 2018 Reporting Period	"The length of the cost reporting period of the hospital, in days, based on the March 2023 update of the Medicare Hospital Cost Report data. This value was used in annualizing uncompensated care costs for FY 2018."
2019 UCC	Sum of charity care costs and bad debt reported on Worksheet S-10 of a hospital's FY 2019 Medicare Hospital Cost Report based on an March 2023 update of the Medicare Hospital Cost Report data. (See '2018 UCC' variable description for additional information).
Length of 2019 Reporting Period	"The length of the cost reporting period of the hospital, in days, based on the March 2023 update of the Medicare Hospital Cost Report data. This value was used in annualizing uncompensated care costs for FY 2019."
2020 UCC	Sum of charity care costs and bad debt reported on Worksheet S-10 of a hospital's FY 2020 Medicare Hospital Cost Report based on an April 2023 update of the Medicare Hospital Cost Report data. (See '2018 UCC' variable description for additional information).
Length of 2020 Reporting Period	"The length of the cost reporting period of the hospital, in days, based on an March 2023 update of the Medicare Hospital Cost Report data. This value was used in annualizing uncompensated care costs for FY 2020."
Factor 3	"Factor 3 is the factor representing the proportion of the uncompensated care amount that a DSH hospital will receive under Section 3133 of the Affordable Care Act.  Factor 3 is the hospital's burden of  uncompensated care relative to the uncompensated care burden of all DSH hospitals. For FY 2024, the Factor 3 is based on a blend of FY 2018, FY 2019 and FY 2020 hospital uncompensated care costs. 

For the final rule, the Factor 3 denominator for DSH eligible hospitals for FY 2018 was $33,635,294,402, for FY 2019 was $34,685,336,338, and for FY 2020 was $33,542,394,117. 
For this correction notice, the Factor 3 denominator for DSH eligible hospitals for FY 2018 is $33,635,294,402, for FY 2019 is $34,685,336,338, and for FY 2020 is $33,556,984,227. 
After calculating the blended FY 2018, FY 2019 and FY 2020 Factor 3 for DSH eligible hospitals, the blended factor 3 result is scaled so that the total of factor 3s across all DSH eligible hospitals is equal to 1.0. For the final rule, the scaling factor was approximately 0.99934403. For the correction notice, the scaling factor was approximately 0.99934426.  The final factor 3 amounts for hospitals ineligible for DSH is also adjusted by the same scaling factor as the DSH eligible hospitals.

If a hospital currently projected as ineligible for DSH is determined to be DSH eligible at cost report settlement, then the hospital will receive the uncompensated care payment based on the Factor 3 listed here. 

'N/A' is listed for new hospitals; and for hospitals that do not have audited FY 2018, FY 2019 or FY 2020 Worksheet S-10 data and that are not projected to receive DSH for FY 2024 if their ratio of insured charity care costs to total uncompensated care costs is greater than 60%, and their charity care costs are more than $7 million in either FY 2018, FY 2019 or FY 2020. "
Total Uncompensated Care Payment	"The total uncompensated care payment amount made for hospitals projected to receive DSH for FY 2024 based on each hospitals Factor 3 amount. The uncompensated care payment will be paid on an interim per discharge basis and reconciled to the amount listed in this column at cost report settlement. 'N/A' is listed for hospitals that are not projected to receive DSH and are thus ineligible for the uncompensated care payment for FY 2024.  If a hospital listed as ineligible for DSH and the uncompensated care payment receives DSH at cost report settlement for 2024, then the hospital will receive the uncompensated care payment based on the Factor 3 listed here. "
Total Supplemental Payment	"Supplemental UCP payments to eligible hospitals in Puerto Rico and IHS/Tribal hospitals are calculated as the difference between their FY 2022 UCP amount reduced by 4.4% for FY 2023 and 2.3% for FY 2024 and their calculated UCP amount for FY 2024. Supplemental payments to hospitals in Puerto Rico and IHS/Tribal hospitals are set to zero if this calculation results in a negative amount. 'N/A' is listed for all other hospitals.

If a Puerto Rico and IHS/Tribal hospitals is projected not eligible to receive DSH in FY 2024 , we indicated the amount with an '*', since the hospital may ultimately be determined DSH eligible in FY 2024. The hospital's supplemental payments are calculated as the hospital's FY 2022 Factor 3 multiplied by the total UCP amount for FY 2022, then multiplied by the percent change in the total UCP amount between FY 2022 and FY 2024 (-6.6%).  "
Estimated Per Claim Amount	"Estimated per claim uncompensated care payment amount that will be paid on each claim for FY 2024. The total uncompensated care payment amount in the FY 2024 IPPS Final Rule will be reconciled at cost report settlement with the interim estimated uncompensated care payments that are paid on a per discharge basis. Estimated per claim amount is determined by dividing the total uncompensated care payment, including supplemental payments to hospitals in Puerto Rico and IHS/Tribal hospitals, by the average number of claims from FYs 2021 and 2022. 

'N/A' is listed for hospitals that are not projected to receive DSH, thus ineligible for the uncompensated care payment for FY 2024."
BILLS 2021	"Total number of Medicare cases for the provider for FY 2021 from the FY 2023 Final Rule's Case Mix Index File. If the hospital was the surviving hospital in a merger, this column combines the data of the surviving and acquired hospital(s) involved in the merger."
BILLS 2022	"Total number of Medicare cases for the provider for FY 2022 from the FY 2024 Final Rule's Case Mix Index File. If the hospital was the surviving hospital in a merger, this column combines the data of the surviving and acquired hospital(s) involved in the merger."
Claims Average	"The average number of claims from FYs 2021 and 2022 using 'BILLS 2021' and 'BILLS 2022'. 

If the hospital was the surviving hospital in a merger, this average column accounts for the data of the surviving and acquired hospital(s) involved in the merger."
