==============================================================
MU00.@BFN2699.INNDM190
========================================================================

NOTE TO: Shared System Coordinators, MEDICARE Coordinators

SUBJECT: Inpatient Prospective Payment System (IPPS) Pricer System
         Release, Version 20190 (CMS Change Request: CR 10869)
         ---------------------------------------------------------
         Release Date:          September 12, 2018
         Effective Date:        October 1, 2018
         Implementation Date:   October 1, 2018

This IPPS Pricer release is the PRODUCTION version for the October
2018 release. The 19.0 IPPS Pricer release revises the latest IPPS
Pricer release which was the PRODUCTION (18.2) release for FY 2018.

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 only sending members
    that changed since the previous release.

  - Revised copybook, "PPHOLDAR", which contains the 01 level Hold-Area
    Updated with the FY19 Final Rule/Correction Notice.
      NOTE: All PPCAL*** programs which call the previous version of
      this copybook need to be recompiled.

      Inserted:
        05  H-BUDG-NUTR190               PIC 9(01)V9(06).

        05  H-UPDATE-190                 PIC 9(01)V9(06).

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

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

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

  - Added new copybook, "CBSA190", which contains all wage indices by
    CBSA from FY 2005 to FY 2019. Replaces the "CBSA180" copybook.

  - Added new copybook, "DRGSX190", which contains the entirety of the
    01 level PPS-DRG-TABLE. Replaces the "DRGSX180" copybook.

  - Added new copybook, "NTECH190", which contains the entirety of the
    01  WK-NEW-TECH-VARIABLES. These variables were moved from
    PPCAL190 into this copybook.

  - Added new copybook, "RATEX190", which contains the 01 level
    TB1-RATE-TABLE through TB8-RATE-TABLE. Replaces the "RATEX180"
    copybook.

  - Added new copybook, "OUTM190", 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.
    Replaces the "OUTMIGRA" copybook.

  - PPDRV190 R  2019.0 REVISED FOR RELEASE
         ** Replaces PPDRV182 **
         --------------- 2019.0 ---------------
         Added new Call PPCAL190 Using statement.

         ARIZONA CBSA LOGIC:
         Removed the CBSA logic which would convert the newer AZ CBSA of
         '   00' to the original AZ CBSA of '   03' for pricer purposes.

             + IF HOLD-PROV-CBSA = '   00'
                  MOVE '   03' TO HOLD-PROV-CBSA.

  - PPCAL190 R  2019.0 REVISED FOR RELEASE
         ** Replaces PPCAL182 **
         --------------- 2019.0 ---------------
         NEW TECHNOLOGY ADD-ON PAYMENTS:
         Revised and updated new technology add-on payment code to
         account for FY 2019 specifications.

             + Revised, comprehensive new technology add-on payment
               logic under paragraph 4020-NEW-TECH-ADD-ON

             + Additions / Revisions / Removals for FY 2019
               - New tech codes to remove for FY 2019
                 * Argus
                 * Blinatumomab
                 * Cardiomems
                 * Edwards/Perceval Sutureless Valves
                 * GORE EXCLUDER Iliac Branch Endoprosthesis
                 * Idarucizumab Praxbind
                 * Kcentra
                 * Lutonix/Inpact Drug Coated Balloon
                 * MAGEC Spinal Bracing and Distraction System
                 * Mitraclp
                 * RNS Sys
                 * Vistogard
                 * Voraxaze
                 * Zenith
                 * Zilver
               - New tech codes revised/continued for FY 2019
                 * Defitelio
                 * Stelara
                 * Zinplava
               - New tech codes to add for FY 2019
                 * AndexXa
                 * Aquabeam
                 * Giapreza
                 * Kymriah/Yescarta
                 * Plazomicin
                 * Remede System
                 * Sentinel Cerebral Protection System
                 * Vabomere
                 * Vyxeos

         MDH TRANSITIONAL PAYMENT:
         Extension of MDH payment provision through 09/30/2022.

              IF PPS-RTC = 00 AND
                 B-DISCHARGE-DATE > 20220930 AND
                 P-N-INVALID-PROV-TYPES
                          MOVE 52 TO PPS-RTC.

         RATE AND FACTOR ADJUSTMENTS:

             + Updated standardized operating and capital threshold.
               - MOVE 5646.08 TO H-OPER-BASE.
               - MOVE 459.41 TO H-CAPI-BASE.

             + Updated capital rate factors:

               - COMPUTE H-FEDERAL-RATE ROUNDED =
                      (0459.41 * H-CAPI-GAF).

             + Updated outlier threshold amount:
               - MOVE 25743.00 TO H-CST-THRESH.

             + Updated RBN and market basket factors utilized to
               calculate the overall update factor used in updating
               the HSP amount to 2019 dollars. Removed 2013 - 2018
               factors in order to begin new five year phase.
               - MOVE 0.997190 TO H-BUDG-NUTR190.

                 IF P-NEW-CBSA-HOSP-QUAL-IND = '1' AND
                    P-EHR-REDUC-IND = ' '
                    MOVE 1.01350 TO H-UPDATE-190.

                 IF P-NEW-CBSA-HOSP-QUAL-IND = '1' AND
                    P-EHR-REDUC-IND = 'Y'
                    MOVE 0.99175 TO H-UPDATE-190.

                 IF P-NEW-CBSA-HOSP-QUAL-IND = '0' AND
                    P-EHR-REDUC-IND = ' '
                    MOVE 1.00625 TO H-UPDATE-190.

                 IF P-NEW-CBSA-HOSP-QUAL-IND = '0' AND
                    P-EHR-REDUC-IND = 'Y'
                    MOVE 0.98450 TO H-UPDATE-190.

             + Updated market basket ratios for EHR savings.
               - MOVE 1.021930930 TO H-MB-RATIO-EHR-FULL.
               - MOVE 1.022092433 TO H-MB-RATIO-EHR-QUAL-FULL.

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

A partitioned data set (PDS) of the Version 20190 code
(MU00.@BFN2699.INNDM190) is at the CMS Data Center for users
to obtain by Connect:Direct (Network DataMover).
    **
The 44 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.INNDM182.

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
--- 2019.0 --- in the description column below.

NAME        DESCRIPTION
-------     ------------------------------------------------------------
CBSA190    *2019.0 FY 2019 CBSA & WAGE INDEX TABLE
DRGSX190   *2019.0 FY 2019 DRG WEIGHTS TABLE
MANIFEST   *2019.0 LIST OF RELEASE MEMBERS
MIDNIGHT    2017.0 TWO MIDNIGHT POLICY ADJUSTMENT FACTOR TABLE
MSAX045     2004.5 INPAT PRICING METROPOLITAN STATISTICAL AREA
NTECH190   *2019.0 FY 2019 NEW TECHNOLOGY ADD-ON VARIABLE TABLE
OUTM190    *2019.0 FY 2019 OUTMIGRATION ADJUSTMENT TABLE
--------    -----------------------------------------------------------
PPCAL006    2000.6 2000 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2000
PPCAL017    2001.7 2001 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2001
PPCAL026    2002.6 2002 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2002
PPCAL038    2003.8 2003 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2003
PPCAL04D    2004.D 2004 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2004
PPCAL059    2005.9 2005 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2005
PPCAL069    2006.9 2006 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2006
PPCAL07B    2007.B 2007 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2007
PPCAL08D    2008.D 2008 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2008
PPCAL09D    2009.D 2009 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2009
PPCAL10O    2010.O 2010 INPAT CALC MODULE - CLAIMS 10/01 TO 03/31/2010
PPCAL10P    2010.P 2010 INPAT CALC MODULE - CLAIMS 04/01 TO 09/30/2010
PPCAL119    2011.9 2011 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2011
PPCAL125    2012.5 2012 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2012
PPCAL135    2013.5 2013 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2013
PPCAL14B    2014.B 2014 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2014
PPCAL156    2015.6 2015 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2015
PPCAL163    2016.3 2016 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2016
PPCAL171    2017.1 2017 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2017
PPCAL182    2018.2 2018 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2018
PPCAL190   *2019.0 2019 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2019
PPCAL884    1988.4 1988 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1988
PPCAL894    1989.4 1989 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1989
PPCAL905    1990.5 1990 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1990
PPCAL915    1991.5 1991 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1991
PPCAL926    1992.6 1992 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1992
PPCAL935    1993.5 1993 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1993
PPCAL944    1994.4 1994 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1994
PPCAL954    1995.4 1995 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1995
PPCAL964    1996.4 1996 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1996
PPCAL974    1997.4 1997 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1997
PPCAL987    1998.7 1998 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1998
PPCAL998    1999.8 1999 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1999
--------    -----------------------------------------------------------
PPDRV190   *2019.0 2019 INPAT DRIVER MODULE
PPHOLDAR    2019.0 PPHOLDAR-HOLD-AREA
RATEX190    2019.0 FY 2018 RATES TABLE
README     *2019.0 DESCRIPTION OF RELEASE UPDATES
