==============================================================
MU00.@BFN2699.INNDM160
========================================================================

NOTE TO: Shared System Coordinators, MEDICARE Coordinators

SUBJECT: Inpatient Prospective Payment System (IPPS) Pricer System
         Release, Version 20160
(Aug 17, 2015)  --ACTION--refer to CMS change requests: CR #9253

This IPPS Pricer release is the PRODUCTION version for the October
2015 release. The 16.0 IPPS Pricer release revises the latest IPPS
Pricer release which was the PRODUCTION (15.4) release for FY 2015.

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, "PPHOLDAR", which contains the entirety of the
    01 level Hold-Area. Updated with the FY16 Final Rule/Correction
    Notice.

      Inserted:
        05  H-BUDG-NUTR160               PIC 9(01)V9(06).

        05  H-UPDATE-160                 PIC 9(01)V9(06).

        05  H-NEW-TECH-ADDON-BLINATU-STOP PIC S9(07)V99.
        05  H-NEW-TECH-ADDON-BLINATU     PIC S9(07)V99.
        05  H-NEW-TECH-ADDON-LUTONIX-STOP PIC S9(07)V99.
        05  H-NEW-TECH-ADDON-LUTONIX     PIC S9(07)V99.

        05  H-LESSER-BLINATU-STOP-1      PIC S9(07)V99.
        05  H-LESSER-BLINATU-STOP-2      PIC S9(07)V99.

        05  H-LESSER-LUTONIX-STOP-1      PIC S9(07)V99.
        05  H-LESSER-LUTONIX-STOP-2      PIC S9(07)V99.

        05  H-CSTMED-BLINATU-STOP       PIC S9(07)V99.
        05  H-CSTMED-LUTONIX-STOP       PIC S9(07)V99.

  - Added new copybook, "DRGSX160", which contains the entirety of the
    01 level PPS-DRG-TABLE. The hardcoded table originally resided in
    the PPCAL*** module. Updated with the FY16 Final Rule/Correction
    Notice.

  - Added new copybook, "LVOLX160", which contains the entirety of the
    01 level LOWVOL-PROV-TABLE. The hardcoded table originally resided
    in the PPCAL*** module. Updated with the FY16 Final Rule/Correction
    Notice.

  - Added new copybook, "RATEX160", which contains the entirety of the
    01 level TB1-RATE-TABLE through TB8-RATE-TABLE. The hardcoded
    tables originally resided in the PPCAL*** module. Updated with the
    FY16 Final Rule/Correction Notice.

  - PPDRV160 R  2016.0 REVISED FOR RELEASE
                ** Replaces PPDRV154 **
                   --------------- 2016.0 ---------------
                   Added new Call PPCAL160 Using statement.

                   Added new rural CBSA state codes.

                   Added an EHR indicator check for 2015 forward.
                    + CHECK-EHR-IND.
                      - IF B-N-DISCHARGE-DATE > 20140930
                      - IF P-NEW-EHR-REDUC-INDN = 'Y' OR ' '

                   Amended Puerto Rico rural floor logic.
                    + Revised paragraphs:
                      - '0260-N-GET-RURAL-CBSA-PR'
                      - '2300-2015-FWD-FLOOR-CBSA'
                      - '2350-2015-FWD-FLOOR-CBSA-PR'

  - PPCAL160 R  2016.0 REVISED FOR RELEASE
                ** Replaces PPCAL154 **
                   --------------- 2016.0 ---------------
                   Created a copybook in the PDS, entitled RATEX160,
                   and copied the entire 01 level TB1-RATE-TABLE through
                   TB8-RATE-TABLE. Removed the COBOL associated with the
                   tables from the module. Added copy statement for
                   copybook RATEX160 to the Working-Storage Section.

                   Created a copybook in the PDS, entitled DRGSX160,
                   and copied the entire 01 level PPS-DRG-TABLE.
                   Removed the COBOL associated with the 01 level
                   table from the module. Added copy statement for
                   copybook DRGSX160 to the Working-Storage Section.

                   Created a copybook in the PDS, entitled LVOLX160,
                   and copied the entire 01 level LOWVOL-PROV-TABLE.
                   Removed the COBOL associated with the 01 level
                   table from the module. Added copy statement for
                   copybook LVOLX160 to the Working-Storage Section.

                   Removed the COBOL associated with the 01 level
                   Hold-Area.

                   Adjusted new technology add-on payment code to
                   account for ICD-10 diagnosis and procedure codes.

                   Updated new technology add-on payment code to
                   account for FY 2016 specifications.
                    + New tech codes to turn off for FY 2016
                      - Voraxaze
                      - Zenith F. Graft
                      - Zilver
                    + New tech codes to continue for FY 2016
                      - Kcentra
                        * Revised procedure code logic
                      - Cardiomems
                        * Revised procedure code logic
                    + New tech codes to add for FY 2016
                      - Blinatumomab
                        * Added procedure code logic
                      - LUTONIX and IN.PACT Drug-Coated Balloon
                        * Added procedure code logic

                   Updated capital rate factors.
                    + COMPUTE H-FEDERAL-RATE ROUNDED =
                      (0438.75 * H-CAPI-GAF).
                    + COMPUTE H-PUERTO-RICO-RATE ROUNDED =
                      (0212.55 * H-PR-CAPI-GAF).

                   Updated outlier threshold amount.
                    + MOVE 22539.00 TO H-CST-THRESH.

                   Updated HSP RBN factor.
                    + MOVE 0.998405 TO H-BUDG-NUTR160.

                   Updated readmissions range of allowable factors.
                    + RANGE OF ALLOWABLE FACTORS (< 0.97 OR > 1.0)

                   Updated VBP range of allowable factors.
                    + RANGE OF ALLOWABLE FACTORS (< 0.9825 OR > 2.0)

                   Updated market basket ratios for EHR savings.
                    + MOVE 1.011940299 TO H-MB-RATIO-EHR-FULL.
                    + MOVE 1.012012012 TO H-MB-RATIO-EHR-QUAL-FULL.

                   Updated factors, adjusted by market basket, applied
                   to the standardized amount and HSP.
                    + MOVE 1.01700 TO H-UPDATE-160.

                   Updated standardized operating and capital threshold.
                    + MOVE 5467.39 TO H-OPER-BASE.
                    + MOVE 438.75 TO H-CAPI-BASE.

                   Resolved Pricer compile warnings.
                    + Commented out unused paragraphs:
                      - '2300-GET-PR-LAB-TB2-RATES'
                      - '2300-GET-PR-LAB-TB4-RATES'
                      - '4100-ISLET-ISOLATION-ADD-ON'
                      - '4500-AUTOLIT-TECH-ADD-ON'
                      - '4600-DIFICID-TECH-ADD-ON'

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

A partitioned data set (PDS) of the Version 20160 code
(MU00.@BFN2699.INNDM160) 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.INNDM154.

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 (2016.0) in the
description column below.

NAME        DESCRIPTION
-------     ------------------------------------------------------------
CBSA160     2016.0 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    2016.0 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
PPCAL148    2014.8 2014 CLAIMS 10/01 TO 09/30/2014
PPCAL154    2015.4 2015 CLAIMS 10/01 TO 09/30/2015
PPCAL160    2016.0 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
         ------------------------------------------
PPDRV160    2016.0 INPAT PRICING PROGRAM - SEE CHANGES ABOVE
PPHOLDAR    2016.0 PPHOLDAR-HOLD-AREA
RATEX160    2016.0 FY 2016 RATES TABLE FOR PRICER
README      2016.0 DESCRIPTION OF RELEASE UPDATES
