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MU00.@BFN2699.INNDM181
========================================================================

NOTE TO: Shared System Coordinators, MEDICARE Coordinators

SUBJECT: Inpatient Prospective Payment System (IPPS) Pricer System
         Release, Version 20181 (CMS Change Request: CR 10273)
         ---------------------------------------------------------
         Release Date:          August 15, 2017
         Effective Date:        October 1, 2017
         Implementation Date:   October 2, 2017

This IPPS Pricer release is the PRODUCTION version for the October
2018 release. The 18.1 IPPS Pricer release revises the latest IPPS
Pricer release which was the PRODUCTION (17.1) release for FY 2017.

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 only sends members that
    changed since the previous release.

  - Revised copybook, "PPHOLDAR", which contains the 01 level Hold-Area
    Updated with the FY18 Final Rule/Correction Notice.
      NOTE: All PPCAL*** programs which call the previous version of
      this copybook need to be recompiled.

      Inserted:
        05  H-BUDG-NUTR180               PIC 9(01)V9(06).

        05  H-UPDATE-180                 PIC 9(01)V9(06).

        05  H-NEW-TECH-ADDON-STELARA     PIC S9(07)V99.
        05  H-NEW-TECH-ADDON-ZINPLAVA    PIC S9(07)V99.
        05  H-NEW-TECH-ADDON-EDWARDS     PIC S9(07)V99.

        05  H-LESSER-STELARA-STOP-1      PIC S9(07)V99.
        05  H-LESSER-STELARA-STOP-2      PIC S9(07)V99.
        05  H-LESSER-ZINPLAVA-STOP-1     PIC S9(07)V99.
        05  H-LESSER-ZINPLAVA-STOP-2     PIC S9(07)V99.
        05  H-LESSER-EDWARDS-STOP-1      PIC S9(07)V99.
        05  H-LESSER-EDWARDS-STOP-2      PIC S9(07)V99.

        05  H-CSTMED-STELARA-STOP        PIC S9(07)V99.
        05  H-CSTMED-ZINPLAVA-STOP       PIC S9(07)V99.
        05  H-CSTMED-EDWARDS-STOP        PIC S9(07)V99.

  - Added new copybook, "CBSA181", which contains all wage indices by
    CBSA from FY 2005 to FY 2018. Replaces the "CBSA170" copybook.

  - Added new copybook, "DRGSX180", which contains the entirety of the
    01 level PPS-DRG-TABLE. Replaces the "DRGSX170" copybook.

  - Added new copybook, "RATEX181", which contains the 01 level
    TB1-RATE-TABLE through TB8-RATE-TABLE. Replaces the "RATEX170"
    copybook.

  - Added new copybook, "OUTMIGRA", which lists the outmigration factors
    by FIPS county code and fiscal year, for use in applying the
    outmigration adjustment to the wage index of eligible providers.

  - PPDRV181 R  2018.1 REVISED FOR RELEASE
         ** Replaces PPDRV171 **
         --------------- 2018.1 ---------------
         Updated PPCAL058 to PPCAL059.

         Added new Call PPCAL181 Using statement.

         COUNTY CODES:
         Revised the input record by adding a redefines clause
         for the 5 position county code field to ensure the
         inclusion of leading zeros.

             + 05  P-NEW-COUNTY-CODE              PIC 9(05).
               05  P-NEW-COUNTY-CODE-X REDEFINES
                   P-NEW-COUNTY-CODE              PIC X(05).

         SPECIAL WAGE INDEX:
         Added an 88 level conditional variable for providers
         without a special wage index indicator.

             + 88  P-NEW-CBSA-WI-BLANK      VALUE ' ' '0'.

         Added an 88 level conditional variable for providers
         with a dual reclass wage index indicator.


             + 88  P-NEW-CBSA-WI-DUAL       VALUE 'D'.

         Updated wage index logic to account for dual reclass providers.

             + IF P-NEW-CBSA-WI-RECLASS OR P-NEW-CBSA-WI-DUAL
                  MOVE P-NEW-CBSA-RECLASS-LOC TO HOLD-PROV-CBSA.

         OUTMIGRATION ADJUSTMENT:
         Created and initialized the fields essential to
         applying the outmigration adjustment.

             + 01  HOLD-OUTM-DATA.
                   05  OUTM-IND             PIC 9(01) VALUE 0.
                   05  OUTM-IDX2            PIC 9(01) VALUE 0.
                   05  HLD-OUTM-ADJ         PIC S9(01)V9(04).

         Added logic to apply outmigration adjustment to the
         wage index of eligible providers.

             + IF (P-NEW-CBSA-RECLASS-LOC = '     ' OR
                   P-NEW-CBSA-RECLASS-LOC = '00000') AND
                  (P-NEW-CBSA-STAND-AMT-LOC = '     ' OR
                   P-NEW-CBSA-STAND-AMT-LOC = '00000') AND
                   P-NEW-CBSA-WI-BLANK
                 PERFORM 0900-GET-COUNTY-CODE THRU 0900-EXIT
               END-IF.

             + 0900-GET-COUNTY-CODE.

                   INITIALIZE OUTM-IND.

                   SET OUTM-IDX TO 1.

                   SEARCH OUTM-TAB VARYING OUTM-IDX
                   AT END
                        GO TO 0900-EXIT
                   WHEN OUTM-CNTY(OUTM-IDX) = P-NEW-COUNTY-CODE-X
                      SET OUTM-IDX2 TO OUTM-IDX
                      MOVE 1 TO OUTM-IND.

               0900-EXIT.  EXIT.

             + IF OUTM-IND = 1
                     PERFORM 0950-GET-OUTM-ADJ THRU 0950-EXIT
                       VARYING OUTM-IDX2 FROM OUTM-IDX BY 1 UNTIL
                       OUTM-CNTY(OUTM-IDX2) NOT = P-NEW-COUNTY-CODE-X
               END-IF.

             + 0950-GET-OUTM-ADJ.

                   INITIALIZE HLD-OUTM-ADJ.

                   IF OUTM-EFF-DATE(OUTM-IDX2) <= B-N-DISCHARGE-DATE AND
                      OUTM-EFF-DATE(OUTM-IDX2) >= W-FY-BEGIN-DATE AND
                      OUTM-EFF-DATE(OUTM-IDX2) <= W-FY-END-DATE
                        MOVE OUTM-ADJ-FACT(OUTM-IDX2) TO HLD-OUTM-ADJ.

               0950-EXIT.  EXIT.

             + IF OUTM-IND = 1
                  COMPUTE W-NEW-CBSA-WI = W-NEW-CBSA-WI + HLD-OUTM-ADJ.

         PPS-ADDITIONAL-VARIABLES:
         Updated the PPS-ADDITIONAL-VARIABLES layout for all PPCAL
         programs FY 2012 and earlier to the Working-Storage section
         with the name PPS-ADDITIONAL-VARIABLES-PRE13.

         Updated the PPS-ADDITIONAL-VARIABLES layout for PPCAL135
         (FY 2013) and PPCAL14B (FY 2014) to the Working-Storage section
         with the name PPS-ADDITIONAL-VARIABLES-1314.

         Updated paragraph 2900-MOVE-PPS-ADDITIONAL-VARS and associated
         performs to move the PPS-ADDITIONAL-VARIABLES-PRE13 and
         PPS-ADDITIONAL-VARIABLES-1314 to the PPS-ADDITIONAL-VARIABLES
         PPS-ADDITIONAL-VARIABLES record to accomodate the absence of
         PPS-ISLET-ISOL-PAY-ADD-ON from the previous year layouts.

  - PPCAL159 R  2015.9 REVISED FOR RELEASE
         ** Replaces PPCAL158 **
         --------------- 2015.9 ---------------
         PPS-ADDITIONAL-VARIABLES:
         Removed the duplicate low volume payment variable:
             + 10  PPS-LOW-VOL-PAYMENT            PIC 9(07)V9(02).

  - PPCAL171 R  2017.1 REVISED FOR RELEASE
         ** Replaces PPCAL171 **
         --------------- 2017.1 ---------------
         CAPITAL RATE CODE ADJUSTMENT:
             + Restored period to end of compute statement:

               - COMPUTE H-FEDERAL-RATE ROUNDED =
                      (0446.79 * H-CAPI-GAF).

  - PPCAL181 R  2018.1 REVISED FOR RELEASE
         ** Replaces PPCAL171 **
         --------------- 2018.1 ---------------
         COUNTY CODES:
         Revised the input record by adding a redefines clause
         for the 5 position county code field to ensure the
         inclusion of leading zeros.

             + 05  P-NEW-COUNTY-CODE              PIC 9(05).
               05  P-NEW-COUNTY-CODE-X REDEFINES
                   P-NEW-COUNTY-CODE              PIC X(05).

         NEW TECHNOLOGY ADD-ON PAYMENTS:
         Updated new technology add-on payment code to account for
         FY 2018 specifications.

             + Additions / Revisions / Removals for FY 2018
               - New tech codes to turn off for FY 2018
                 * Blinatumomab
                 * Cardiomems
                 * MAGEC Spinal Bracing and Distraction System
                 * Lutonix/Inpact Drug Coated Balloon
               - New tech codes to continue for FY 2018
                 * GORE EXCLUDER Iliac Branch Endoprosthesis
                 * Defitelio
                 * Vistogard
                 * Praxbind Idarucizumab
               - New tech codes to add for FY 2018
                 * Stelara
                 * Zinplava
                 * Edwards/Perceval Sutureless Valves

         RATE AND FACTOR ADJUSTMENTS:

             + Updated labor share and non-labor share:
               - MOVE 0.6830 TO H-LABOR-PCT.
               - MOVE 0.3170 TO H-NONLABOR-PCT.

             + Updated standardized operating and capital threshold.
               - MOVE 5572.53 TO H-OPER-BASE.
               - MOVE 453.95 TO H-CAPI-BASE.

             + Updated capital rate factors:

               - COMPUTE H-FEDERAL-RATE ROUNDED =
                      (0453.95 * H-CAPI-GAF).

             + Updated outlier threshold amount:
               - MOVE 26537.00 TO H-CST-THRESH.

             + Updated RBN and market basket factors utilized to
               calculate the overall update factor used in updating
               the HSP amount to 2018 dollars.
               - MOVE 0.997439 TO H-BUDG-NUTR180.

                 IF P-NEW-CBSA-HOSP-QUAL-IND = '1' AND
                    P-EHR-REDUC-IND = ' '
                    MOVE 1.01350 TO H-UPDATE-180.

                 IF P-NEW-CBSA-HOSP-QUAL-IND = '1' AND
                    P-EHR-REDUC-IND = 'Y'
                    MOVE 0.99325 TO H-UPDATE-180.

                 IF P-NEW-CBSA-HOSP-QUAL-IND = '0' AND
                    P-EHR-REDUC-IND = ' '
                    MOVE 1.00675 TO H-UPDATE-180.

                 IF P-NEW-CBSA-HOSP-QUAL-IND = '0' AND
                    P-EHR-REDUC-IND = 'Y'
                    MOVE 0.98650 TO H-UPDATE-180.

             + Short stay adjustment:
               - MOVE 1.0000 TO H-SHORT-STAY-ADJ.

             + Updated market basket ratios for EHR savings.
               - MOVE 1.020387616 TO H-MB-RATIO-EHR-FULL.
               - MOVE 1.020527116 TO H-MB-RATIO-EHR-QUAL-FULL.

         MDH TRANSITIONAL PAYMENT:
         Turned off the transitional payment for certain former
         Medicare-dependent, small rural hospitals (MDHs). This policy
         is effective as of October 1, 2017 (The MDH program expires
         on September 30, 2017.

             + B-FORMER-MDH-PROVIDERS

             + IF H-HSP-RATE > (H-FSP-RATE + WK-UNCOMP-CARE-AMOUNT
                 IF P-NEW-PROVIDER-TYPE = '14' OR '15'
                   COMPUTE H-OPER-HSP-PART ROUNDED =
                     (H-HSP-RATE - (H-FSP-RATE +
                     WK-UNCOMP-CARE-AMOUNT)) * .75
                   ON SIZE ERROR MOVE 0 TO H-OPER-HSP-PART.

             + IF B-FORMER-MDH-PROVIDERS AND
                 (B-DISCHARGE-DATE > 20160930 AND
                  B-DISCHARGE-DATE < 20171001)
                 IF H-HSP-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)*(1 / 3)
                    ON SIZE ERROR MOVE 0 TO H-OPER-HSP-PART
                 END-IF
               END-IF.

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

A partitioned data set (PDS) of the Version 20181 code
(MU00.@BFN2699.INNDM181) is at the CMS Data Center for users
to obtain by Connect:Direct (Network DataMover).

The 42 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.INNDM171.

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 (2018.1) in the
description column below.

NAME        DESCRIPTION
-------     ------------------------------------------------------------
CBSA181     2018.1 FY 2018 CBSA & WAGE INDEX TABLE
DRGSX180    2018.1 FY 2017 DRG WEIGHTS TABLE
MANIFEST    2018.1 LIST OF RELEASE MEMBERS
MIDNIGHT    2017.0 TWO MIDNIGHT POLICY ADJUSTMENT FACTOR TABLE
MSAX045     2004.5 INPAT PRICING METROPOLITAN STATISTICAL AREA
OUTMIGRA    2018.1 FY 2018 OUTMIGRATION ADJUSTMENT TABLE
         ------------------------------------------
         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
PPCAL059    2005.9 2005 CLAIMS 10/01 TO 09/30/2005 - SEE CHANGES ABOVE
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
PPCAL119    2011.9 2011 CLAIMS 10/01 TO 09/30/2011
PPCAL125    2012.5 2012 CLAIMS 10/01 TO 09/30/2012
PPCAL135    2013.5 2013 CLAIMS 10/01 TO 09/30/2013
PPCAL14B    2014.B 2014 CLAIMS 10/01 TO 09/30/2014
PPCAL156    2015.6 2015 CLAIMS 10/01 TO 09/30/2015
PPCAL163    2016.3 2016 CLAIMS 10/01 TO 09/30/2016
PPCAL171    2017.1 2017 CLAIMS 10/01 TO 09/30/2017 - SEE CHANGES ABOVE
PPCAL181    2018.1 2018 CLAIMS 10/01 TO 09/30/2018 - 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
         ------------------------------------------
PPDRV181    2018.1 INPAT PRICING PROGRAM           - SEE CHANGES ABOVE
PPHOLDAR    2018.1 PPHOLDAR-HOLD-AREA
RATEX181    2018.1 FY 2018 RATES TABLE
README      2018.1 DESCRIPTION OF RELEASE UPDATES
