FY 2027 Proposed Rule IPPS Impact File	
"DATA SOURCES FOR THIS FY 2027 RULE IMPACT FILE ARE THE FOLLOWING: DECEMBER 2025 UPDATE OF FY 2025 MEDPAR, DECEMBER 2025 UPDATE OF PROVIDER SPECIFIC FILE (PSF), FY2023/FY2024 COST REPORT DATA"	
"DISCLAIMER: The variables in the impact file are based on information at the time of the Proposed Rule (or correction notice as applicable) which are used to model payments for the upcoming Fiscal Year (2027) and may not reflect what is used for actual payment (e.g: Wage Index, DSH, IME) for FY 2027. Refer to the Provider Specific File (PSF) online at https://pds.mps.cms.gov/#/Download for variables used for actual payment."	
Provider Number	6-digit Medicare provider number; the first 2 digits are the state code.
Name	"Name of Medicare provider from OSCAR.  (""blank"" = unknown)"
Geographic Labor Market Area	The Geographic CBSA location based on OMB's Core Based Statistical Area (CBSA) designations.  The CBSA assignment is based on where the provider is physically located. Rural areas are designated by 2-digit SSA state codes.
Pre-Reclass Labor Market Area	Pre-reclassification CBSA
Post-Reclass Labor Market Area	Post-reclassification CBSA for FY 2027
Payment Labor Market Area	Payment CBSA (urban or rural) for purposes of determining operating payments (other than wage index)
FIPS County Code	Federal Information Processing Standard (FIPS) county code. The FIPS system is used to Identify the county in which the provider is geographically located and this field is used in conjunction with the MSA/CBSA crosswalk file.
REGION	"1 = NEW ENGLAND (CT, ME, MA, NH, RI, VT);"
 	"2 = MIDDLE ATLANTIC (NJ, NY, PA);"
 	"3 = EAST NORTH CENTRAL (IL, IN, MI, OH, WI);"
 	"4 = WEST NORTH CENTRAL (IA, KS, MN, MO, NE, ND, SD);"
 	"5 = SOUTH ATLANTIC (DE, DC, FL, GA, MD, NC, SC, VA, WV);"
 	"6 = EAST SOUTH CENTRAL (AL, KY, MS, TN);"
 	"7 = WEST SOUTH CENTRAL (AR, LA, OK, TX);"
 	"8 = MOUNTAIN (AZ, CO, ID, MT, NV, NM, UT, WY);"
 	"9 = PACIFIC (AK, CA, HI, OR, WA);"
 	40 = PUERTO RICO (PR);
URGEO	Urban or Rural designation of the provider’s geographic CBSA
URSPA	Urban or Rural designation of the provider’s payment CBSA
RECLASS	Reclass Status FY 2027:  
 	N = provider did not reclassify;
 	W = provider reclassified for wage index;
 	L = provider reclassified under 1886(d)(8)(B) of the SSA;
 	S = provider redesignated as rural under Sec. 401 of BIPA.
Wage Index	FY 2027 wage index after applying the following:
	"·         MGCRB reclassifications, "
	·         Rural Floor
	·         Imputed Floor 
	·         Frontier Wage Index provision
	·         P.L. 108-173 Sec 505 adjustments (Out-Migration Adjustment)
	"·         The 5-percent cap, as applicable. "
	·         The transitional payment exception for low wage hospitals (as applicable) due to the discontinuation of the low wage index hospital policy. 
	Note: The wage index reflects the application of national rural floor budget neutrality.
LUGAR	Provider is located in a Lugar County as defined in 1886(d)(8)(B) of the Act
Section 401 Hospital	A 'Y' denotes urban providers redesignated as rural under CFR 412.103 (Sec 401 of BIPA).
Section 401 Hospital with a LUGAR or MGCRB Wage Index Reclass	A 'Y' denotes a hospital that is redesignated as rural under CFR 412.103 (Sec 401 of BIPA) and is also either located in a Lugar County as defined in 1886(d)(8)(B) of the Act (and did not waive its LUGAR status) OR is reclassified to another CBSA through the MGCRB.
Section 505 Eligible	A 'Y' denotes providers eligible to receive a wage index adjustment under Sec. 505 of P.L. 108-173 (out-migration adjustment) for FY 2027.  Hospitals cannot receive the out-migration adjustment if they are reclassified under section 1886(d)(10) of the Act or redesignated under section 1886(d)(8)(B) of the Act or redesignated under section 1886(d)(8)(E) of the Act.
Section 505 Adjustment (Out-Migration Adjustment)	Wage adjustment for providers who are eligible to receive a wage index adjustment under Sec. 505 of P.L. 108-173 for FY 2027.  Hospitals cannot receive the out-migration adjustment if they are reclassified under section 1886(d)(10) of the Act or redesignated under section 1886(d)(8)(B) of the Act or redesignated under section 1886(d)(8)(E) of the Act.
Cost of Living Adjustment	FY 2027 Cost of Living Adjustment factor for IPPS providers located in Alaska or Hawaii for IPPS operating payments.
Resident to Bed Ratio	Resident to Bed Ratio. Used to determine IME factor for operating IPPS payments
RDAY	Resident to Average Daily Census (ADC) ratio. Used to calculate the IME adjustment for Capital IPPS.
BEDS	The number of total beds obtained from cost report data.*
Average Daily Census	Calculated as the ratio of Total Acute Inpatient Days to Total Days in the Cost Reporting Period obtained from cost report data.*
TCHOP	IME adjustment factor for Operating IPPS
TCHCP	IME adjustment factor for Capital IPPS
DSHPCT	Disproportionate Share Hospital Patient Percentage (DPP) as determined from the Medicaid ratio from the December 2025 update of the Provider Specific File (PSF) & the most recent SSI data. 
DSHOPP	Estimated FY 2027 Operating Disproportionate Share Hospital (DSH) adjustment. Reflects a 75% reduction to the DSH adjustment required under Section 1886(r) of the Act.
DSHCPP	FY 2027 Capital Disproportionate Share Hospital (DSH) adjustment. 
DSH_LY	Estimated FY 2026 Operating Disproportionate Share Hospital (DSH) adjustment. Reflects a 75% reduction to the DSH adjustment required under Section 1886(r) of the Act.
UCP_ADJ	FY 2027 Uncompensated Care Payment Factor is the proportion of the additional payment amount for uncompensated care costs that a DSH hospital will receive under the implementation of Section 1886(r) of the Act. The Uncompensated Care Payment Factor is the hospital's uncompensated care costs relative to all DSH hospitals’ uncompensated care costs. DSH hospitals are identified as those hospitals that are projected to receive DSH for FY 2027. 
UCP and IHS/PR Supplemental Payment Per Claim Amount	"FY 2027 Uncompensated Care Per Claim Amount and, if applicable, the IHS/PR Supplemental Payment Per Claim Amount, divided by the 3-year claims average based on MedPAR files from FY23, FY24 and FY25.  Per Claim Amount is used in determination of outlier payments and used to estimate if a SCH is paid on a hospital specific rate or federal rate on a per claim basis.  "
UCP_ADJ_LY   	FY 2026 Uncompensated Care Payment Factor is the proportion of the additional payment amount for uncompensated care costs. The Uncompensated Care Payment Factor is the hospital's uncompensated care costs relative to all DSH hospital's uncompensated care costs. DSH hospitals are identified as those hospitals that are projected to receive DSH for FY 2026.
UCP Per Claim Amount LY and IHS/PR Supplemental Payment Per Claim Amount  	"FY 2026 Uncompensated Care Per Claim Amount and IHS/PR Supplemental Payment Per Claim Amount based on a hospital's assigned Uncompensated Care Payment amount and, if applicable, the IHS/PR Supplemental Payment Per Claim Amount, divided by the 3-year claims average based on MedPAR files from FY22, FY23 and FY24.  Per Claim Amount is used in determination of outlier payments and used to determine if the SCH is paid on a hospital specific rate or federal rate on a per claim basis."
Operating CCR	Ratio of Medicare operating costs to Medicare covered charges from the December 2025 update of the Provider Specific File (PSF). CCRs do not have the adjustment factor applied.
Capital CCR	Ratio of Medicare capital costs to Medicare covered charges from the December 2025 update of the Provider Specific File (PSF). CCRs do not have the adjustment factor applied.
Provider Type	Type of provider - key:  
 	0 = IPPS;
 	7 = Rural Referral Center (RRC);
 	8 = Indian Health Service (IHS);
	14 = Medicare Dependent Hospital (MDH);
	15 = MDH/RRC;
 	16 = Sole Community Hospital (SCH);
 	17 = SCH/RRC;
 	21 = Essential Access Community Hospital (EACH);
 	22 = EACH/RRC 
 	Based on the December 2025 update of the Provider Specific File (PSF).  
HSP Rate	Hospital Specific Payment (HSP) Rate updated to FY 2027 for SCH and MDH providers. HSP Rate is based on the December 2025 update of the Provider Specific File (PSF).
BILLS	"Total number of Medicare cases for the provider from the FY 2025 MedPAR, December 2025 update."
CASETA43	Transfer adjusted cases under Grouper V43 and FY 2026 Post-Acute Transfer Policy.
CMIV43	Case Mix Index under Grouper V43 (generally applicable for SCH and MDH providers paid under their Hospital Specific Payment rate).
TACMIV43	Transfer adjusted Case Mix Index under Grouper V43 and FY 2026 Post-Acute Transfer Policy.
IME_CASETA43	Transfer adjusted cases under Grouper V43 for Medicare Advantage cases submitted by teaching hospitals that receive a fee-for-service IME payment. The IME payment associated with these cases are included in the budget neutrality calculations and in payment modelling.
IME_TACMIV43	Transfer adjusted Case Mix under Grouper V43 for Medicare Advantage cases submitted by teaching hospitals that received a fee-for-service IME payment. These CMIs are used to calculate the IME payments for budget neutrality.
CASETA44	Transfer Adjusted Cases under Grouper V44 and FY 2027 Post-Acute Transfer Policy.
CMIV44	Case Mix Index under Grouper V44 (generally applicable for SCH and MDH providers paid under their Hospital Specific Payment rate).
TACMIV44	Transfer adjusted Case Mix Index under Grouper V44 and FY 2027 Post-Acute Transfer Policy.
IME_CASETA44	Transfer adjusted cases under Grouper V44 for Medicare Advantage cases submitted by teaching hospitals that receive a fee-for-service IME payment. The IME payment associated with these cases are included in the budget neutrality calculations and in payment modelling.
IME_TACMIV44	Transfer adjusted Case Mix under Grouper V44 for Medicare Advantage cases submitted by teaching hospitals that received a fee-for-service IME payment. These CMIs are used to calculate the IME payments for budget neutrality.
GAF	Geographic Adjustment Factor (GAF) for Capital IPPS for FY 2027.  This value includes the applicable Capital Cost of Living Adjustment for hospitals located in Alaska and Hawaii.
	"For FY 2027, the values in this column reflect the transitional payment exception for low wage hospitals significantly impacted by the discontinuation of the low wage index hospital policy. "
Capital Cost of Living Adjustment	"FY 2027 Capital COLA factor for hospitals located in Alaska and Hawaii, which is based on the applicable operating IPPS COLA factor"
OUTFACT_F	Estimated operating outlier payments as a percentage of the provider's Federal operating IPPS payments
COUTFACT_F	Estimated capital outlier payments as a percentage of the provider's Federal capital IPPS payments
Medicare Percentage	Medicare days as a percent of total inpatient days (Note: not available for all providers)
Medicaid Percentage	Medicaid days as a percent of total inpatient days (Note: not available for all providers)
Proxy Value Based Purchasing Adjustment Factor	Proxy payment adjustment for Value Based Purchasing Program (Section 1886(o) of the Act).
Proxy Readmission Adjustment Factor	Proxy payment adjustment for Hospital Readmissions Reduction Program (Section 1886(q) of the Act). Maryland and Puerto Rico hospitals are exempt from the payment adjustment.
Proxy Quality Reduction	"Value of '1' indicates a hospital that was found not to have successfully reported designated quality measures under the Hospital Inpatient Quality Reporting (IQR) Program as shown in the December 2025 update of the Provider Specific File (PSF), and therefore was modeled as receiving a reduction to the percentage increase in the market basket index for FY 2027 under §412.64(d)(2). (Note, this variable will not reflect any subsequent adjustments, if any, to this indicator made in the PSF, and may not reflect the hospital’s final determination under the hospital IQR program.)"
Proxy EHR Reduction	"Value of '1' indicates a hospital that was found not to be a meaningful electronic health record (EHR) user for the applicable EHR reporting period and did not receive an exception as shown in the December 2025 update of the Provider Specific File (PSF), and therefore was modeled as receiving a reduction to the percentage increase in the market basket index for FY 2027 under §§ 412.64(d)(3)-(4). (Note, this variable will not reflect any subsequent adjustments, if any, to this indicator made in the PSF, and may not reflect the hospital’s final determination under the Promoting Interoperability Program.)"
Ownership Control Type	Type of ownership control from cost report data:  
 	G = Government;
 	P = Proprietary;
 	V = Voluntary;
 	X = Unknown.
MDH Flag	"A 'Y' denotes providers classified as Medicare Dependent Hospitals (MDH) for FY 2027 under the MDH program extension through December 31, 2026 provided by section 6202 of the Consolidated Appropriations Act, 2026."
Low-Volume Hospital Payment Adjustment	"Payment adjustment for low-volume hospitals under Section 1886(d)(12) of the Act for FY 2027 under the extension of the temporary changes to the low-volume hospital payment adjustment through December 31, 2026 provided by section 6201 of the Consolidated Appropriations Act, 2026.  (A value of “1” denotes no adjustment.)"
"*The most recent available cost report data were used (FYs 2023 - 2024). A ""zero"" value may indicate unavailable or incomplete data. "	
