(CMS-1739-P)  Model of Alternative Considered Medicare DSH - Supplemental Data File			
Col	Column Name	Description	
A	CCN	Medicare Provider Number	
B	Name	Hospital Name	
C	Cost Reporting Period[1] (CRP) Fiscal Year End Date (FYE)	CRP's FYE 	
D	Cost Reporting Period[1] (CRP) Numerator (Num) of the Medicaid Fraction[2] (Annualized)	"Medicaid patient days (Worksheet S-2, Part I, columns 1 through 6, line 24)"	
E	CRP Denominator (Den) of the Medicaid Fraction (Annualized)	"Total days reported on Worksheet S-3, Part I, column 8, line 14, plus line 32, minus the sum of lines 5 and 6, plus employee discount days reported on line 30."	
F	CRP Medicaid Fraction	"The amount on Worksheet E, Part A, Line 31 on the cost report: Column (C) divided by Column (D)."	
G	CRP DSH Adjustment	"The amount on Worksheet E, Part A, Line 33 on the cost report"	
H	CRP DSH Payments (Annualized)	"The amount on Worksheet E, Part A, Line 34 on the cost report."	
I	Medicare Fraction Num. [3]	"Numerator of the applicable Federal Fiscal Year SSI Ratios or if SSI realignment, then days are from the CRP.

- FY 2012 SSI ratios were based on the MedPAR with claims run out through 12/31/2013 (including Medicare Advantage (MA) Claims Submissions) and the December 2013 SSI Eligibility File. For providers with past SSI realignment, then the CRP was used. 

- FY 2013 SSI ratios were based on the MedPAR with claims run out through 12/31/2014 (including Medicare Advantage (MA) Claims Submissions) and the December 2014 SSI Eligibility File. For providers with past SSI realignment, then the CRP was used.

"	
 J	Medicare Fraction Den.	"Denominator of the applicable Federal Fiscal Year SSI Ratios or if SSI realignment, then days are from the CRP."	
K	Medicare Fraction 	Column (I) divided by Column (J)	
L	Medicare Fraction Num. w/o MA Days	Column (I) minus MA Days.   (An example of alternative Medicare ratio calculation is provided in below footnote. [4])	
M	Medicare Fraction Den. w/o MA Days	Column (J) minus MA Days 	
N	Medicare Fraction w/o MA Days	Column (L) divided by Column (M)	
O	Medicaid Fraction w/ MA Days from the CRP (Estimated) 	"Column (G) plus the proxy of MA days from the CRP.  (An example of alternative Medicaid ratio calculation is provided in below footnote [5]) 
"	
P	Sum of the Alternative Medicare and Alternative Medicaid ratios (Estimated)	Column (N) plus Column (O)	
Q	Alternative Considered CRP DSH Adjustment [4] (Estimated)	Alternative Considered DSH Adjustment calculated based on Column (P)	
R	Percent Change in CRP DSH Adjustment	( Column (Q) divided by Column (G) ) minus 1 	
S	Change in DSH Payments (Estimated) 	Column (R) multiplied by Column (H)	
			
"[1] All references to the Cost Reporting Period (CRP) are to the cost report period for the provider ending in FY 2013.  If more than one cost report ended in FY 2013, the longest one was used.  If the cost reporting period was not 365 days long, values were annualized where indicated.

[2] Medicaid Fraction = Medicaid, Non-Medicare Days divided by Total Patient Days

[3] Medicare Fraction = Medicare/Supplemental Security Income Days divided by Total Medicare Days

[4] For an example of alternative Medicare fraction w/o MA days, consider a hospital that does not have a SSI realignment (e.g. a report from October 1, 2012 through September 30, 2013) has 2000 days in the numerator of the Medicare faction with 250 Medicare Part C (MA) days and a denominator of 10,000 days (that is, 0.2 for Medicare fraction). Under the alternative considered model, the 250 Medicare Part C days would no longer be part of the Medicare fraction’s numerator and denominator, that is, the alternative Medicare fraction would be roughly 0.18 from 1750 days divided by 9750 days.  An example of a provider with a SSI realignment would have the same calculation, except the numerator and denominator would be from the cost reporting period, rather than the FFY period.

[5] For an example of the alternative Medicaid ratio calculation (that is, with the proxy Medicaid days), consider a hospital that has 250 Medicare Part C days from SSI eligible patients in their report's cost reporting period. Those 250 days would be proxied as Medicaid days. Therefore, to compute the alternative Medicaid fraction in this example, the 250 days are added to the Medicaid fraction’s numerator, with no calculation change for the alternative Medicaid fraction’s denominator, as we believe the 250 days are already included in the denominator.

[6] If Col (F) = 0.12 then Col (G) = the amount on Worksheet E, Part A, Line 31 on the cost report. Else if ( ( (Col (F) - 0.025) + ( (0.65)*(0.15) ) ) / 0.65 ) < 0.202 then Col (G) =  ( ( (Col (F) - 0.025) + ( (0.65)*(0.15) ) ) / 0.65 ).  Else Col (G) = ( ( (Col (F) - 0.0588) + ( (0.825)*(0.202) ) ) / 0.825 ).  The purpose of this calculation is to ensure that the sum of the Medicare and Medicaid fractions is consistent with the Medicare DSH adjustment on the cost report.
"			
			
			
			
			
			
			
			
			
			
			
			
			
			
			
			
			
			
