==============================================================
MU00.@BFN2699.INNDM161
========================================================================

NOTE TO: Shared System Coordinators, MEDICARE Coordinators

SUBJECT: Inpatient Prospective Payment System (IPPS) Pricer System
         Release, Version 20161
(Nov 16, 2015)  --ACTION--refer to CMS change requests: CR 9408

This IPPS Pricer release is the PRODUCTION version for the January
2016 release. The 16.1 IPPS Pricer release revises the latest IPPS
Pricer release which was the PRODUCTION (16.0) release for FY 2016.

It includes the following changes:

  - Revised member, "README", to describe the release.

  - Revised member, "MANIFEST", which lists members included and
    omitted from the release dataset.  CMS is now only sending members
    that changed since the previous release.

  - PPDRV161 R  2016.1 REVISED FOR RELEASE
                ** Replaces PPDRV160 **
                   --------------- 2016.1 ---------------
                   STATE CODES:
                   Added missing state code for rural floor logic:
                    + California (55)
                   Added new state codes for rural floor logic:
                    + Louisiana (95)
                    + New Mexico (96)
                    + Texas (97)
                   Revised pricer logic for Puerto Rico:
                    + 88  P-PR-NEW-STATE     VALUE 40 84.

                   Revised the EHR indicator check for 2015 forward.
                    + CHECK-EHR-IND.
                      - IF B-N-DISCHARGE-DATE > 20140930 AND
                           (P-NEW-EHR-REDUC-INDN NOT = 'Y' AND
                            P-NEW-EHR-REDUC-INDN NOT = ' ')
                              MOVE 65 TO PPS-RTC
                                GOBACK
                        END-IF.

  - PPCAL149 R  2014.9 REVISED FOR RELEASE
                ** Replaces PPCAL148 **
                   --------------- 2014.9 ---------------
                   PANCREATIC ISLET CELL TRANSPLANTATION:
                   Restored the new technology add-on payment code for
                   pancreatic islet cell transplantation. This code,
                   which had inadvertently been removed from pricer,
                   has been restored to the pricer logic with an
                   effective date of 10/01/2013. Payment excluded from
                   new technology add-on payment for operating cost
                   outlier, low volume, hospital acquired condition
                   (HAC), and operating base DRG payment calculations.

  - PPCAL155 R  2015.5 REVISED FOR RELEASE
                ** Replaces PPCAL154 **
                   --------------- 2015.5 ---------------
                   PANCREATIC ISLET CELL TRANSPLANTATION:
                   Restored the new technology add-on payment code for
                   pancreatic islet cell transplantation. This code,
                   which had inadvertently been removed from pricer,
                   has been restored to the pricer logic with an
                   effective date of 10/01/2013. Payment excluded from
                   new technology add-on payment for operating cost
                   outlier, low volume, hospital acquired condition
                   (HAC), and operating base DRG payment calculations.

  - PPCAL161 R  2016.1 REVISED FOR RELEASE
                ** Replaces PPCAL160 **
                   --------------- 2016.1 ---------------
                   Removed the COBOL/logic associated with the entire
                   01 level PPS-SSRFBN-TABLE. This table held the State-
                   Specific Rural Floor Budget Neutrality (SSRFBN)
                   factors utilized for wage index calculations within
                   the FY 2009 and FY 2010 final rules.

                   WAGE INDEX:
                   Created a copybook in the PDS, entitled CBSA161, to
                   replace and update the CBSA160 copybook. The pricer
                   CBSA table, used for the application of the wage
                   index, has been updated to adjust the wage index
                   for certains CBSAs for FY 2011 through FY 2016.

                    + FY 2011:
                      - 22180 20101001 009407 009254 Fayetteville, NC
                      - 26580 20101001 008877 008672 Huntington-Ashland

                    + FY 2013:
                      -    04 20121001 007460 007460 ARKANSAS
                      -    29 20121001 011337 011337 NEVADA
                      - 11500 20121001 007432 007204 Anniston-Oxford, AL
                      - 16180 20121001 011337 011337 Carson City, NV
                      - 39900 20121001 011337 011337 Reno-Sparks, NV

                    + FY 2016:
                      - 36084L20151001 016893 016893 Oakland-Hayward-Ber

                   PANCREATIC ISLET CELL TRANSPLANTATION:
                   Restored the new technology add-on payment code for
                   pancreatic islet cell transplantation. This code,
                   which had inadvertently been removed from pricer,
                   has been restored to the pricer logic with an
                   effective date of 10/01/2013. Pricer logic updated
                   to account for ICD-10 implementation. Payment
                   excluded from new technology add-on payment for
                   operating cost outlier, low volume, hospital
                   acquired condition (HAC), and operating base DRG
                   payment calculations.

                   MDH TRANSITIONAL PAYMENT:
                   Added transitional payment for certain former
                   Medicare-dependent, small rural hospitals (MDHs).
                   This policy is effective January 1, 2016 through
                   September 30, 2017 (the current expiration date
                   of the MDH program).

                    + Affected former MDHs include:
                      - 080006       - 440031
                      - 140184       - 450451
                      - 390072       - 490019
                      - 420019       - 510062

                    + For discharges occurring 01/01/2016 - 09/30/2016:

                      IF  B-FORMER-MDH-PROVIDERS       AND
                         (B-DISCHARGE-DATE > 20150930  AND
                          B-DISCHARGE-DATE < 20160101)
                          MOVE 0 TO H-OPER-HSP-PART
                          GO TO 3450-EXIT
                      END-IF.

                      IF  B-FORMER-MDH-PROVIDERS       AND
                          B-DISCHARGE-DATE > 20151231  AND
                          B-DISCHARGE-DATE < 20161001
                        MOVE 0 TO H-OPER-HSP-PART
                        IF  H-HSP-RATE > (H-FSP-RATE +
                          (H-FSP-RATE + WK-UNCOMP-CARE-AMOUNT)
                          COMPUTE H-OPER-HSP-PART ROUNDED =
                            ((H-HSP-RATE - (H-FSP-RATE +
                                WK-UNCOMP-CARE-AMOUNT))* 0.75)*(2 / 3)
                              ON SIZE ERROR MOVE 0 TO H-OPER-HSP-PART
                        END-IF
                      END-IF.

========================================================================

A partitioned data set (PDS) of the Version 20161 code
(MU00.@BFN2699.INNDM161) is at the CMS Data Center for users
to obtain by Connect:Direct (Network DataMover).

The 39 members listed below comprise the Pricer, but only the modules
that changed since the previous release are included in the PDS. The
changed members should be used in conjunction w/ MU00.@BFN2699.INNDM160.

CMS now only sends the program modules in the release. The supporting
files and unchanged or unused program modules are no longer included in
the release.

New and/or revised program modules and files will have (2016.1) in the
description column below.

NAME        DESCRIPTION
-------     ------------------------------------------------------------
CBSA161     2016.1 CBSA file FY 2016 Rates and Factors
DRGSX160    2016.0 FY 2016 DRG WEIGHTS TABLE FOR PRICER
LVOLX160    2016.0 FY 2016 LOW VOLUME TABLE FOR PRICER
MANIFEST    2016.1 LIST OF RELEASE MEMBERS
MSAX045     2004.5 INPAT PRICING METROPOLITAN STATISTICAL AREA
         INPAT PRICING PROGRAM CALCULATION PROGRAMS
PPCAL006    2000.6 2000 CLAIMS 10/01 TO 09/30/2000
PPCAL017    2001.7 2001 CLAIMS 10/01 TO 09/30/2001
PPCAL026    2002.6 2002 CLAIMS 10/01 TO 09/30/2002
PPCAL038    2003.8 2003 CLAIMS 10/01 TO 09/30/2003
PPCAL04D    2004.D 2004 CLAIMS 10/01 TO 09/30/2004
PPCAL058    2005.8 2005 CLAIMS 10/01 TO 09/30/2005
PPCAL069    2006.9 2006 CLAIMS 10/01 TO 09/30/2006
PPCAL07B    2007.B 2007 CLAIMS 10/01 TO 09/30/2007
PPCAL08D    2008.D 2008 CLAIMS 10/01 TO 09/30/2008
PPCAL09D    2009.D 2009 CLAIMS 10/01 TO 09/30/2009
PPCAL10O    2010.O 2010 CLAIMS 10/01 TO 03/31/2010
PPCAL10P    2010.P 2010 CLAIMS 04/01 TO 09/30/2010
PPCAL118    2011.8 2011 CLAIMS 10/01 TO 09/30/2011
PPCAL124    2012.4 2012 CLAIMS 10/01 TO 09/30/2012
PPCAL134    2013.4 2013 CLAIMS 10/01 TO 09/30/2013
PPCAL149    2014.9 2014 CLAIMS 10/01 TO 09/30/2014 - SEE CHANGES ABOVE
PPCAL155    2015.5 2015 CLAIMS 10/01 TO 09/30/2015 - SEE CHANGES ABOVE
PPCAL161    2016.1 2016 CLAIMS 10/01 TO 09/30/2016 - SEE CHANGES ABOVE
PPCAL884    1988.4 1988 CLAIMS 10/01 TO 09/30/1988
PPCAL894    1989.4 1989 CLAIMS 10/01 TO 09/30/1989
PPCAL905    1990.5 1990 CLAIMS 10/01 TO 09/30/1990
PPCAL915    1991.5 1991 CLAIMS 10/01 TO 09/30/1991
PPCAL926    1992.6 1992 CLAIMS 10/01 TO 09/30/1992
PPCAL935    1993.5 1993 CLAIMS 10/01 TO 09/30/1993
PPCAL944    1994.4 1994 CLAIMS 10/01 TO 09/30/1994
PPCAL954    1995.4 1995 CLAIMS 10/01 TO 09/30/1995
PPCAL964    1996.4 1996 CLAIMS 10/01 TO 09/30/1996
PPCAL974    1997.4 1997 CLAIMS 10/01 TO 09/30/1997
PPCAL987    1998.7 1998 CLAIMS 10/01 TO 09/30/1998
PPCAL998    1999.8 1999 CLAIMS 10/01 TO 09/30/1999
         ------------------------------------------
PPDRV161    2016.1 INPAT PRICING PROGRAM - SEE CHANGES ABOVE
PPHOLDAR    2016.0 PPHOLDAR-HOLD-AREA
RATEX160    2016.0 FY 2016 RATES TABLE FOR PRICER
README      2016.1 DESCRIPTION OF RELEASE UPDATES
