==============================================================
MU00.@BFN2699.INNDM162
========================================================================

NOTE TO: Shared System Coordinators, MEDICARE Coordinators

SUBJECT: Inpatient Prospective Payment System (IPPS) Pricer System
         Release, Version 20162
(Jan 15, 2016)  --ACTION--refer to CMS change requests: CR 9253

This IPPS Pricer release is the PRODUCTION version for the April
2016 release. The 16.2 IPPS Pricer release revises the latest IPPS
Pricer release which was the PRODUCTION (16.1) 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.

  - Revised copybook, "RATEX160", which contains the labor and
    non-labor rates for dates of discharge between October 1, 2015 and
    December 31, 2015.

  - Added new copybook, "RATEX162", which contains the labor and
    non-labor rates for dates of discharge between January 1, 2016 and
    September 30, 2016.

  - PPCAL162 R  2016.2 REVISED FOR RELEASE
                ** Replaces PPCAL161 **
                   --------------- 2016.2 ---------------
                   LABOR & NON-LABOR RATES
                   Revised the RATEX160 copybook. All rate table names
                   revised from TB# to OTB# to apply rates for claims
                   between October 1, 2015 and December 31, 2015.

                   Created a copybook in the PDS, entitled RATEX162,
                   and copied the entire RATEX160 copybook. All rate
                   table names revised from OTB# to NTB# to apply rates
                   for claims between January 1, 2016 and September 30,
                   2016. Added copy statement for copybook RATEX162 to
                   the Working-Storage Section.

                   Duplicated the pricer logic which performs labor &
                   non-labor rate calculations and revised the logic to
                   account for the discharge date associated with the
                   claims:

                     IF B-DISCHARGE-DATE < 20160101
                        PERFORM 2050-RATES-OTB
                     ELSE
                        PERFORM 2051-RATES-NTB.

                   STATE CODES
                   Revised pricer logic for Puerto Rico:
                    + 88  P-VBP-INVALID-STATE
                                  VALUE 21 80 40 84.
                    + 88  P-READ-INVALID-STATE
                                  VALUE 40 84.
                    + 88  P-HAC-INVALID-STATE
                                  VALUE 40 84.
                    + 88  P-PR-NEW-STATE
                                  VALUE 40 84.

                   OPERATING & CAPITAL PERCENTAGES
                   Added new capital percentage variables, represented
                   by H-C-NAT-PCT and H-C-REG-PCT, in order to account
                   for the following changes in operating and capital
                   percentages:
                    + 10/01/2015 - 12/31/2015
                      - National
                        * Operating:  National 100% / Regional 0%
                        * Capital:    National 100% / Regional 0%
                      - Puerto Rico
                        * Operating:  National 75%  / Regional 25%
                        * Capital:    National 75%  / Regional 25%
                    + 01/01/2016 - 09/30/2016
                      - National
                        * Operating:  National 100% / Regional 0%
                        * Capital:    National 100% / Regional 0%
                      - Puerto Rico
                        * Operating:  National 100% / Regional 0%
                        * Capital:    National 75%  / Regional 25%

                   Revised pricer logic to account for the new capital
                   percentage variable:

                    IF P-PR-NEW-STATE
                       COMPUTE  H-CAPI-FED-RATE ROUNDED =
                                (H-C-NAT-PCT * H-FEDERAL-RATE) +
                                (H-C-REG-PCT * H-PUERTO-RICO-RATE).

                    IF P-PR-NEW-STATE
                       COMPUTE H-CAPI-PR-DOLLAR-THRESHOLD ROUNDED =
                         H-CST-THRESH * H-PR-CAPI-GAF *
                         H-CAPI-LARG-URBAN *
                         H-CAPI-SHARE-DOLL-THRESHOLD * H-CAPI-COLA
                       COMPUTE H-CAPI-DOLLAR-THRESHOLD ROUNDED =
                         (H-CAPI-DOLLAR-THRESHOLD * H-C-NAT-PCT) +
                         (H-CAPI-PR-DOLLAR-THRESHOLD * H-C-REG-PCT).

                   CAPITAL RATES
                   Duplicated and split capital rate calculations for
                   dates of discharge between 10/01/2015 and 12/31/2015
                   and 01/01/2016 and 09/30/2016. Updated capital rate
                   factor for Puerto Rico claims with date of discharge
                   on or after January 1, 2016:

                    IF B-DISCHARGE-DATE > 20151231
                      COMPUTE H-FEDERAL-RATE ROUNDED =
                            (0438.75 * H-CAPI-GAF)
                      COMPUTE H-PUERTO-RICO-RATE ROUND
                            (0212.29 * H-PR-CAPI-GAF).

                   OUTLIER THRESHOLD
                   Revised the pricer logic to account for the change
                   in outlier threshold based on the dates of discharge
                   between 10/01/2015 and 12/31/2015 vs. 01/01/2016 and
                   09/30/2016:

                    IF B-DISCHARGE-DATE < 20160101
                      MOVE 22539.00 TO H-CST-THRESH
                    ELSE
                      MOVE 22538.00 TO H-CST-THRESH.

                   HSP RBN FACTOR
                   Revised the pricer logic to account for the change
                   in HSP RBN factor based on the dates of discharge
                   between 10/01/2015 and 12/31/2015 vs. 01/01/2016 and
                   09/30/2016:

                    IF B-DISCHARGE-DATE < 20160101
                       MOVE 0.998405 TO H-BUDG-NUTR160
                    ELSE
                       MOVE 0.998404 TO H-BUDG-NUTR160

                   STANDARDIZING OPERATING THRESHOLD
                   Revised the pricer logic to account for the change
                   in standardizing operating threshold based on the
                   dates of discharge between 10/01/2015 and 12/31/2015
                   vs. 01/01/2016 and 09/30/2016:

                     STANDARDIZED OPERATING TRESHOLD
                     IF B-DISCHARGE-DATE < 20160101
                        MOVE 5467.39 TO H-OPER-BASE
                     ELSE
                        MOVE 5467.53 TO H-OPER-BASE.

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

A partitioned data set (PDS) of the Version 20162 code
(MU00.@BFN2699.INNDM162) is at the CMS Data Center for users
to obtain by Connect:Direct (Network DataMover).

The 40 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.INNDM161.

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 (2016.2) 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    2016.2 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
PPCAL155    2015.5 2015 CLAIMS 10/01 TO 09/30/2015
PPCAL162    2016.2 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
         ------------------------------------------
PPDRV162    2016.2 INPAT PRICING PROGRAM
PPHOLDAR    2016.0 PPHOLDAR-HOLD-AREA
RATEX160    2016.0 FY 2016 RATES TABLE FOR PRICER - SEE CHANGES ABOVE
RATEX162    2016.2 FY 2016 RATES TABLE FOR PRICER - SEE CHANGES ABOVE
README      2016.2 DESCRIPTION OF RELEASE UPDATES
